ABSTRACTS - World Psychiatric Association

sequencing of the pathway to care of patients experiencing a first
episode of psychosis and the determinants of these pathways to better
inform the provision of mental health services.
RS12.3.
PATHWAYS TO CARE AND DURATION
OF UNTREATED PSYCHOSIS: THE IMPACT
OF CULTURE AND ETHNICITY
S.P. Singh
Health Sciences Research Institute, University of Warwick,
Coventry, UK
Ethnic minority patients in the UK experience adverse pathways into
care in early psychosis. This has been attributed to “institutional
racism” in psychiatry, despite lack of evidence to substantiate this
charge. Early intervention services aim to deliver effective intervention
as close as possible to the emergence of psychosis, thereby reducing
duration of untreated psychosis (DUP) and promoting early and
enduring recovery. Early intervention services are therefore ideally
placed to explore ethnic and cultural factors that contribute to such
delays and identify service response to reduce or eliminate ethnic differences.
Two literature reviews of structured measurement tools in
early psychosis were conducted: one for measuring pathways to care
and the other for measuring DUP. In 15 studies of pathways to care in
early psychosis, six different measures have been used. While ethnic
minority status is associated with adverse pathways in UK studies,
most pathways measures do not include ethnic and cultural variables
which determine help-seeking behaviours. The DUP literature shows
a reported mean DUP ranging from 25 weeks to 166 weeks. The relationship
between long DUP and poor outcome is confounded by an
interaction between premorbid dysfunction, insidious onset, and poor
clinical course. Cultural variation in explanatory models of illness
may be a major determinant of help seeking and hence DUP, but this
has received very little attention in published reports. While the conceptual
and methodological problems in quantification of pathways
to care and DUP have been well documented, the key role of ethnic
and cultural variations in help seeking is as yet poorly understood.
RS12.4.
INTERVENTIONS TO REDUCE DELAY
IN TREATMENT OF PSYCHOSIS: DO THEY WORK
A. Malla
Department of Psychiatry, McGill University, Montreal, Canada
This paper reviews different strategies, involving intervention at the
systemic as well as community level, used to reduce delay in treatment
of psychosis. Most such interventions have attempted to reach
the entire community through the media, direct mailing, advertising
in multiple modalities, contact with primary health care professionals
(mostly physicians) and educational professionals, and sometimes
case detection teams or screening clinicians for new cases. Studies
evaluating the impact of such interventions have used quasi-experimental
designs, either parallel or historical control, to study the
impact of such interventions. One recent study using a parallel control
design conducted in Norway has shown a significant effect of a
community focused early case detection intervention on reduction of
duration of untreated psychosis (DUP) prior to entry into treatment.
Results of a Canadian study using a historical control design of a
community wide early case identification intervention have been generally
negative. While the latter study failed to produce an overall significant
decrease in DUP, patients entering treatment within the first
year shifted further to earlier entry into treatment and there was no
impact on patients with much longer DUPs. This impact was well sustained
for three additional years following the cessation of the active
intervention, with minimal maintenance, mostly consumer driven.
These differences in results are likely related to differences in composition
of base populations, access to primary health care, study design
and use of specific components of each intervention. An alternative
approach of working directly with potential sources of referral, using
the technique of academic detailing, is presented briefly within the
context of a recently initiated study.
RS13.
MENTAL HEALTH CARE IN EUROPE: PROBLEMS,
PERSPECTIVES AND SOLUTIONS
RS13.1.
THE CURRENT STATE OF MENTAL HEALTH CARE
IN ITALY: PROBLEMS, PERSPECTIVES
AND LESSONS TO LEARN
G. de Girolamo
Health Care Research Agency, Emilia Romagna Region,
Bologna, Italy
After legislative changes in 1978, Italian psychiatry underwent a thorough
overhaul, with the gradual closure of all mental hospitals. A
nation-wide network of departments of mental health now deliver
outpatient and inpatient care, but also run semi-residential and residential
facilities (the latter with 2.9 beds per 10,000 inhabitants).
Hospital care is delivered through small psychiatric units (with no
more than 15 beds). There are also many private inpatient facilities
operating in Italy, and the number of private inpatient beds per
10,000 inhabitants exceeds the number of public beds; overall there
are 1.7 acute beds per 10,000 inhabitants, one of Europe’s currently
lowest numbers. There is marked quantitative and qualitative variation
in the provision of out- and inpatient care throughout the country,
and service utilization patterns are similarly uneven. Studies
examining quality of life report a fairly high degree of patient satisfaction,
whereas patients’ families frequently bear a heavy burden. In
conclusion, the Italian reform law led to the establishment of a broad
network of facilities to meet diverse care needs. Further efforts are
required to improve quality of care and to develop a more effectively
integrated system. Greater attention must be paid to topics such as
quality of care and outcomes, public and private sector balance, quality
of care, and the coordination of various resources and agencies.
RS13.2.
THE CURRENT STATE OF MENTAL HEALTH CARE
IN FRANCE
M. Coldefy
Institute for Research and Information in Health Economics,
Paris, France
Mental health care in France is a large and important sector of activities,
also as compared to other European countries. With 22 psychiatrists
and 98 nurses for 100,000 inhabitants, France ranks seventh in
the world in terms of number of mental health professionals, and is at
the fifteenth place for the number of beds (12 beds per 100,000 inhabitants).
Its innovative policy and organisation of public mental health
care in “sectors”, developed in the 1960s, has made French mental
health care qualitatively innovative. However, nearly 50 years after,
the implementation of this policy is still incomplete. Strong geographical
variations in staffing and logistics have been noted, as well
42 World Psychiatry 8:S1 - February 2009