A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services

Aims and method This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. Results Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. Clinical implications New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

Demonstrating the processes and outcomes of a rural Community Mental Health Rehabilitation Service: A realist evaluation

Background As part of significant mental health reform, the Community Mental Health Rehabilitation Service (CMHRS) was implemented in rural South Australia. The CMHRS is a 10-bed mental health residential program offering rehabilitative mental health support to rural residents. Aim To analyse the CMHRS service delivery model and its impact on recovery outcomes for consumers. Methods A mixed method, realist evaluation approach was utilised. A purposive sample of CMHRS staff (n = 6) and consumers (n = 8) were recruited. Consumer recovery was measured using the RAS-DS (on admission and discharge). Participants’ perspectives of the service were gained via one staff focus group (n = 6) and individual semi-structured interviews (consumers n = 6; staff n = 2). Pre-post RAS-DS scores were analysed using paired t-tests/Wilcoxon paired-signed rank test, with qualitative data analysed thematically. Results Significant positive increases in RAS-DS total scores were observed at discharge, supported by the qualitative themes of (re)building relationships and social connections and recovering health and wellbeing. Contextual factors (e.g. staffing) and program mechanisms (e.g. scheduling) impacting on service implementation were identified. Conclusion Maintaining a rehabilitation recovery-focused approach, balanced with an appropriately trained multi-disciplinary team, are vital for maximising positive consumer outcomes. Significance This realist evaluation identifies critical factors impacting rural mental health rehabilitation service delivery.

Letter to the editor - The 23-Year Existence of the “Zdrowie” [Eng. Health] Rehabilitation Centre in Kraków – Memories and Summary of Activities

On June 30, 2021, 23 years after its establishment, the activity of "Zdrowie" [Eng. Health] Rehabilitation Centre in Kraków came to an end. At the “Zdrowie” Rehabilitation Centre, this was done through appropriate personalised treatment, mainly rehabilitation, and since its inception, the centre had promoted not only the treatment of diseases, the consequences of traumatic injuries and the resulting disability, but most of all, their prevention. In 1998, as one of the first centres in Poland, the “Zdrowie” Rehabilitation Centre began routinely carrying out pedobarographic examinations, to an extent not found in other places at that time. Since 2006, photogrammetric testing has also been performed. What definitely distinguished the Centre, not only in Kraków, but also on the Polish medical market, was, among others, its scientific activity. Based on the Centre's professional and scientific achievements, sixteen M.A. one B.A, three doctoral dissertations, articles published in reputable journals with the Impact Factor (IF) index and scores from the Ministry of Science and Higher Education (MNiSW) or the Ministry of Science and Education (MNiE) were prepared.

Mapping the occupational therapy workforce research worldwide: Study protocol for a scoping review

BACKGROUND: Human Resources for Health (HRH) research informs the development of evidence-based, population-centered HRH policies and practices. Occupational therapists are key human resources for meeting the health, rehabilitation, and occupational needs of the population worldwide. Yet, the global status of the occupational therapy workforce research remains unchartered. OBJECTIVES: This study protocol depicts the methods to map out and synthesize the occupational therapy workforce research worldwide. METHODS: Six scientific-literature databases and key international institutional websites will be systematically searched, complemented by snowballing searches and recommendations from key global, regional, or national representatives of the World Federation of Occupational Therapists. Two independent reviewers will screen titles-and-abstracts and then full-texts against the eligibility criteria, e.g., 10 categories of workforce research. Educational research, non-empirical papers, and papers (or their summaries) not available in English, Spanish or Portuguese are excluded. Data extraction (e.g., methods, geographies, aims, key findings) will be conducted by one author and fully verified by another. The extracted data will be computed as well as subject to content analysis to provide quantitative map of the literature and of the contents addressed, e.g., per inclusion category. CONCLUSION: The results of this review can inform wide consultation processes and strategic, concerted local and global developments of the occupational therapy workforce.

Mieleltään haavoittuneet

Mielenterveyssyistä johtuvat sairauspoissaolot ja työkyvyttömyyseläkkeet ovat lisääntyneet Suomessa viime vuosikymmeninä. Sen vuoksi on tarpeen tutkia mielenterveyskuntoutujien yksilöllisiä elämäntilanteita sekä heidän kuntoutumistaan ja kiinnittymistään yhteiskuntaan. Tässä artikkelissa tarkastellaan mielenterveyskuntoutujien kuntoutusprosessia erityisesti koulutus- ja työtoimijuuden näkökulmasta. Tutkimusaineistona käytetään aikuisten mielenterveyskuntoutujien kirjoittamia elämänkerrontoja (n = 42). Elämänkerrontojen teema-analyysin ja tyypittelyn perusteella kirjoittajat jaettiin kolmeen erilaiseen ryhmään, jotka nimettiin toimijoiksi (9), taistelijoiksi (18) ja tipahtaneiksi (15). Toimijat olivat aktiivisia oman kuntoutumisensa, koulutuksensa, työnsä sekä kokonaiselämänsä suhteen. Heillä oli vahva pyrkimys hakeutua koulutukseen, palata takaisin työelämään tai ylläpitää nykyinen koulutus- ja työtilanteensa. Taistelijat olivat puolestaan omassa kuntoutusprosessissaan matkalaisia, jotka halusivat olla yhteiskunnan tarpeellisia jäseniä. Myös heillä oli koulutukseen ja työhön liittyviä haaveita, mutta keinot oman elämän hallitsemiseksi olivat toisten ihmisten tuen varassa. Tipahtaneet olivat luovuttaneet sekä oman kuntoutumisensa että koulutus- ja työtoimijuutensa suhteen. Heillä ei ollut enää koulutukseen tai työhön liittyviä tavoitteita. Abstract Mentally wounded. Research of Education and Work Agency of Mental Health Rehabilitees Mental health related sick leaves and early pensions have increased enormously in our society in the last decades. That is why it is important to study the life narratives of mental health rehabilitees, especially focusing on individual and societal factors connected to rehabilitation, education and work agency. The data of this research consisted of 42 self-written life stories of adult mental health rehabilitees. Based on theme analysis and typification, life stories were divided into three groups: agentic actors (9), warriors (18) and dropouts (15). Agentic actors were described as active agents of their own rehabilitation, education, work and life. They had strong intentions to participate in education and work. Warriors seemed to be more like passengers in their own rehabilitation process, yet they had intentions to be a necessary part of society. They had hopes and dreams towards education and work, but they seemed to be lacking concrete means to lead their independent lives. The dropouts had given up on their agency in rehabilitation, education and work. They had no more goals or intentions concerning education and work. Keywords: mental health rehabilitation, life story, education, work, agency

Digital Technologies for Innovative Mental Health Rehabilitation

Schizophrenia is a chronic mental illness, characterized by the loss of the notion of reality, failing to distinguish it from the imaginary. It affects the patient in life’s major areas, such as work, interpersonal relationships, or self-care, and the usual treatment is performed with the help of anti-psychotic medication, which targets primarily the hallucinations, delirium, etc. Other symptoms, such as the decreased emotional expression or avolition, require a multidisciplinary approach, including psychopharmacology, cognitive training, and many forms of therapy. In this context, this paper addresses the use of digital technologies to design and develop innovative rehabilitation techniques, particularly focusing on mental health rehabilitation, and contributing for the promotion of well-being and health from a holistic perspective. In this context, serious games and virtual reality allows for creation of immersive environments that contribute to a more effective and lasting recovery, with improvements in terms of quality of life. The use of machine learning techniques will allow the real-time analysis of the data collected during the execution of the rehabilitation procedures, as well as enable their dynamic and automatic adaptation according to the profile and performance of the patients, by increasing or reducing the exercises’ difficulty. It relies on the acquisition of biometric and physiological signals, such as voice, heart rate, and game performance, to estimate the stress level, thus adapting the difficulty of the experience to the skills of the patient. The system described in this paper is currently in development, in collaboration with a health unit, and is an engineering effort that combines hardware and software to develop a rehabilitation tool for schizophrenic patients. A clinical trial is also planned for assessing the effectiveness of the system among negative symptoms in schizophrenia patients.