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PubMed1979

A mental health system in transition: profiles of change.

These profiles of the changing Saskatchewan mental health system reveal that there have been increases in the number of admissions, readmissions, discharges, and outpatients in both the public and private sectors. Divergent patterns in the utilization of services in the public sector occur among the Indian and non-Indian populations. Over the past several decades there have been considerable changes in the types of psychiatric problems treated in the psychiatric care system. The social, demographic and admission characteristics of the people receiving treatment in the system have changed substantially. The data presented here imply that the status of mental illness is not solely a function of a physical or psychiatric condition but has elastic features capable of being expanded or restricted by the prevailing organizational structure which has evolved to handle the "problem" of mental illness. The advent of community psychiatry plus attendant changes in the health system has altered the nature of mental illness treated in the province. Consequently, concerns about ways of evaluating the effectiveness of current programs, of choosing between alternate service delivery systems, of establishing criteria for equitable resource allocation, and of understanding the forces for change need to be raised and explicitly dealt with.

Community Mental Health Services↗
PubMed2004

Marital transitions and mental health.

Most research identifies marital disruption as a precursor for poor mental health but is generally unable to discount the potential selection effect of poor mental health leading to marital disruption. We use data from nine annual waves of the British Household Panel Survey to examine social selection and social causation as competing explanations. Mental health is measured using the general health questionnaire. We examine mental health at multiple time points prior to and after a marital transition through separation or divorce and compare this process to those who experience widowhood. All groups transitioning out of marriage have a higher prevalence of poor mental health afterwards but for those separated or divorced, poor mental health also precedes marital disruption, lending support to both social-causation and social-selection processes. The processes both preceding and after the transition to widowhood differ, with increased prevalence of disorder centering around the time surrounding the death itself

Adult↗
PubMed2004

Transition of care: health care professionals' view.

There is much anxiety regarding the transfer of adolescents with chronic illness to adult services. Transfer of patients can be haphazard if the transition has not been planned. Problems and obstacles to transition have been identified and discussed by various authors. The purpose of this small study was to explore the views and needs of health care professionals from one National Health Service trust regarding the transition of care for adolescents with a chronic condition from children's to adult services and to identify possible ways to improve the current services for this particular group of young adults. The sample comprised 40 health care professionals, nurses from the children's department and adult ward, doctors, psychologists, physiotherapists and pharmacists currently working in the same hospital trust. A postal survey was conducted. The data were analysed using descriptive statistics and content analysis. The main findings suggest that there is a need for a planned transition programme, supported by a clinical protocols and a specialist unit for adolescents. Health care professionals' views of patients and family/carers' needs and how such needs may be met were identified.

Adolescent↗
PubMed2003

Building integrated health systems in central and eastern Europe: an analysis of WHO and World Bank views and their relevance to health systems in transition.

BACKGROUND: Two questions are addressed. i) What are the views on health and health systems as expressed in the World Development Report 2000/2001 of the WB and the World Health Report 2000 and Health 21 of the World Health Organization, and how compatible are those views? ii) To what extent will compliance of CEEC and NIS with the WHO and WB recommendations result in health systems that produce maximum health for all by adequately addressing the needs of their populations? METHOD: The reports prepared by the World Bank and the World Health Organization were assessed against the theoretical framework of a needs-based public health approach. RESULTS: It is observed that the WHO and WB approaches are currently converging, although there remain differences in their respective focuses. The main merit of the WHO approach is its focus on performance and the systems approach towards health (care). The merit of the WB view is the integrated approach to health, education and poverty. It is argued that CEEC and NIS need to anticipate an ageing population and growing numbers of chronically ill. This calls for integrated health care systems and more integrated funding and payment systems. CONCLUSION: The recommendations provided in the WHR and the WDR with regard to integrated care and integrated financing remain rather abstract. Advisors of CEEC and NIS on health care reform and Western assistance projects should focus more on future needs, in order to avoid building health systems that consistently lag behind the needs of their populations.

Delivery of Health Care, Integrated↗
PubMed1998

A longitudinal study of health selection in marital transitions.

We examined whether differences in health were associated with different probabilities of marital transitions in a longitudinal study, using Cox proportional hazard analysis. Data on approximately 10,000 Dutch persons of the GLOBE study, aged 15-74 years, were used for this purpose. The study started in 1991 and study subjects have been followed for 4.5 years. Of the four marital transitions studied (marriage among never married and divorced persons, and divorce and bereavement among married persons), only divorce among married persons was associated with health status: married persons who reported four or more subjective health complaints or two or more chronic conditions were, respectively, 1.5 and two times more likely to become divorced during follow-up than persons without these health problems. Since hardly any other studies have examined the role of health selection in marital transition with longitudinal data, more research is required before firm conclusions can be drawn. It can be concluded, however, that the frequently made assumption that health selection contributes only little to the explanation of health differences between marital status groups, seems, at least for the divorced, not justified.

Adolescent↗