Transcript Mental health promotion in the hospital setting

Mental health promotion in the
hospital setting:
do we have enough evidence?
Dr. Eva Jané-Llopis
Radboud University of Nijmegen
The Netherlands
WHY
MENTAL
HEALTH?
The burden of mental disorders
• 450 million suffer a
mental health
problem every year
Suicide and self-inflicted
injury,
allandages
100000
120102
+SDR, suicide
self-inflictedper
injury, all
ages per 100000
• One in four of us
• 20% of all ill health
and premature
death
<= 50
<= 40
<= 30
<= 20
Last
Available
EUROPE
17.98
<= 10
No data
Min = 0
Sources: Ustun et al., 2004; Chisholm et al, 2004; WHO HFA database
DEPRESSION
Depression in patients with physical illness
Source: WHO (2003) Investing in Mental Health
Mental health problems
in hospital staff
mental health problems
Mental health problems
in hospital staff
High psychological distress
Anxiety
Anxiety
30%
14%
10%
Depression
Stress
Stress
Psychiatric morbidity
29%
27%
Psychiatric morbidity
Burnout
0
30%
5
10
15
20
25
Maunz & Steyer, 2001; Bourbonnais et al, 1999; McGrath & Boore, 2003; Borill et al; Benett et al. 2001
30
35
Mental Health on the Political Agenda!
WHO European Ministerial Conference
on Mental Health
(Helsinki, January 2005)
31 Ministers of Health - 51 European Countries
signed the Declaration and Action Plan
The WHO Declaration for Mental Health
• that European countries have agreed to support,
calls to:
–
–
–
–
–
Promote mental health across the lifespan
Prevent mental disorders
Implement interventions for vulnerable groups
Network with medical care to approach mental health
Develop a competent workforce through education
and training programmes
– Develop and support research and
evaluation of the above actions
So, what can we
do about it?
Picture: from Atonement, Ian McEwan
MENTAL HEALTH PROMOTION
CAN BE EFFECTIVE
REVIEWS from:
http:/www.iuhpe.org
WHO and the IUHPE
present the evidence for
mental health promotion and
mental disorder prevention
http:/www.who.int
Source: Jané-Llopis et al., 2005; WHO, 2004
What can be done in the hospital setting?
Is there enough evidence to support
mental health promotion and
mental disorder prevention?
Overview of some efficacious approaches:
– Nurses
and
- Patients
at risk for mental health problems
Stress management
for hospital staff
• Stress management is used as a general
concept for interventions to improve
coping abilities and reduce stress.
Stress Management (SM) - Prevention - Promotion
• The underlying principles, mechanisms
and outcomes are very similar in both
types of interventions
Stress management
for hospital staff
1. Environmental management: arranges work
environments to reduce stress sources
1. ENVIRIONMENTAL MANAGEMENT
Shastin Hospital (HPH since 2003)
Ulaan Baatar, Mongolia
1. ENVIRIONMENTAL MANAGEMENT
Environmental management
• Computerized – appointment based
outpatient system
1. ENVIRIONMENTAL MANAGEMENT
Environmental management
• Computerized – appointment based
outpatient system
• Change from 10 patients per room (!) to 4
patients per room
• Intranet system for efficient
communication
• Salary increase
Stress management
for hospital staff
1. Environmental management: arranges work
environments to reduce stress sources
 not many studies available
Stress management
for hospital staff
1. Environmental management: arranges work
environments to reduce stress sources
 not many studies available
2. Individual support: supports personnel to deal
with a variety of stressful situations
 a) generic stress management
 b) communication skills
2. INDIVIDUAL SUPPORT
a) Generic stress management
• To counteract the distress response in the
individual
• Methods: education, role playing,
empowerment, relaxation, music, exercise,
humor, cognitive techniques
Source: Mimura & Griffiths, 2003;
2. INDIVIDUAL SUPPORT
a) Generic stress management
• Cognitive techniques
Effective
• Exercise, music and relaxation training
Potentially effective
• Social support education
Questioned but possibly effective
Evidence is weak; further research is
needed before making recommendations
Source: Mimura & Griffiths, 2003;
2. INDIVIDUAL SUPPORT
b) Communication skills
• Communication difficulties are a stress factor
among health professionals. In palliative care
nurses try to avoid psychological discussions,
focusing on the physical complaints
• This adds to the patients’ stress:
“they dislike being regarded as a hospital
number, wish to be treated with respect for
their dignity and needs”
Source: Dep of health, 2002; Wilkinson 1999;
2. INDIVIDUAL SUPPORT
b) Communication skills
• Several RCTs have demonstrated efficacy
• 3 systematic reviews: promising results
Outcomes:
• 30% increase in relevant questions
• 70% increase in empathy
• Nurses used more emotional speech for anxiety
and distress.
• Patients used more emotional terms
Sources: Wilkinson et al., 1999, 2003; Fellowes et al., 2003
Interventions for hospital users
Support during pregnancy
and the first years of life
Support during pregnancy
Programme:
Nurse home-visitation
Adolescent low income pregnant women
During pregnancy up to 24 months
Goals: Maternal and child functioning
Health behaviour
Parenting care giving practices
Maternal life course development
Olds et al., 1998; 2000
Prenatal Early Infancy Project:
OUTCOMES
Mothers’ Outcomes:
38%  emergency visits
75%  in preterm deliveries
25%  smoking
83%  employment
Olds et al., 1998; 2000
Prenatal Early Infancy Project:
OUTCOMES
Mothers’ Outcomes:
38%  emergency visits
75%  in preterm deliveries
25%  smoking
83%  employment
Children’s Outcomes:
 birth weight (>400 grams)
 IQ scores (age 4)
At age 15:
56%  alcohol - drug use
56%  arrests
81%  convictions
Olds et al., 1998; 2000
Interventions for hospital users
• Support to pregnant mothers:
Interventions for hospital users
• Support to pregnant mothers:
70%  caesarean birth
 antenatal anxiety
50%  be worried about their babies
40%  dissatisfied with care
No impact in the likelihood of giving birth
too early or birth weight
Sources: Hodnett and Fredericks, 2003
Interventions for hospital users
• Support to pregnant mothers
• Aerobic exercise for HIV-Aids patients:
Sources: Hodnett and Fredericks, 2003
Interventions for hospital users
• Support to pregnant mothers
• Aerobic exercise for HIV-Aids patients:
 psychological well being
 anxiety and depressive symptoms
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002;
Interventions for hospital users
• Support to pregnant mothers
• Aerobic exercise for HIV-Aids patients
• Massage (aromatherapy) for cancer patients:
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002;
Interventions for hospital users
• Support to pregnant mothers
• Aerobic exercise for HIV-Aids patients
• Massage (aromatherapy) for cancer patients:
19-32%  anxiety symptoms
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002; Fellowes et al., 2004;
Interventions for hospital users
•
•
•
•
Support to pregnant mothers
Aerobic exercise for HIV-Aids patients
Massage (aromatherapy) for cancer patients
Patient education for rheumatoid arthritis:
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002; Fellowes et al., 2004;
Interventions for hospital users
•
•
•
•
Support to pregnant mothers
Aerobic exercise for HIV-Aids patients
Massage (aromatherapy) for cancer patients
Patient education for rheumatoid arthritis:
5%  psychological status
12% improvement in depression
No change for anxiety
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002; Fellowes et al., 2004; Riemsma et al., 2003;
Interventions for hospital users
•
•
•
•
•
Support to pregnant mothers
Aerobic exercise for HIV-Aids patients
Massage (aromatherapy) for cancer patients:
Patient education for rheumatoid arthritis
Psychological and SM for patients with CHD:
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002; Fellowes et al., 2004; Riemsma et al., 2003;
Interventions for hospital users
•
•
•
•
•
Support to pregnant mothers
Aerobic exercise for HIV-Aids patients
Massage (aromatherapy) for cancer patients:
Patient education for rheumatoid arthritis
Psychological and SM for patients with CHD:
 in anxiety and depression (small)
Sources: Hodnett and Fredericks, 2003 Nixon et al., 2002; Fellowes et al., 2004; Riemsma et al., 2003; Rees et al., 2004
We have seen…
For nurses:
• Environmental
management
• Individual support
– Behavioural
– Exercise, relaxation…
– Communication skills
For users:
• Support to pregnant
mothers
• Aerobic exercise for
HIV-Aids patients
• Massage for cancer
patients
• Patient education for
rheumatoid arthritis
• Psychological and SM
for patients with CHD
One consistency:
More RESEARCH
More RESEARCH
More RESEARCH
With high quality
All reviews stress the need for…
•
•
•
•
•
•
well-designed,
adequately powered,
multicentre,
randomised controlled trials
with high quality
assessing the effectiveness on multiple
outcomes
• including mental health
• using appropriate methodology…
Source: across studies and systematic reviews
So bad or good news?
The problem is:
• NOT that it does not work
• That there are not enough studies yet to
make absolute recommendations
To engage high level decision makers
we need strong arguments and,
good evidence will help
What challenges can be
taken on board by HPH?
1. Improve quality of research undertaken and
stimulate new research: cost-effectiveness
 Creation of partnerships between practice and
research centres to evaluate existing initiatives
2. Understand the impact of existing health
promotion interventions on mental health
 Develop strategies that include mental health
in existing health promotion practices
Conclusions
• Mental health problems are very common in
secondary health care
• Interventions are available to promote mental
health
• Good quality research is essential to continue
improving the evidence base
• Partnerships can help this happen
• Mental health is high in the political agenda
In the last 10 minutes,
only in Europe:
• Over 600 people have got a new
depressive disorder
• About 200 have suffered from new mental
harm done by alcohol
• 3 people have died from suicide
Sources: Ustun et al., 2004; Chisholm et al, 2004; WHO HFAdatabase
and
the hospital setting
provides an exceptional
opportunity to reach
a large proportion of
those at risk
Thank you
We would like to hear your views
Workshop: discussion in groups
How can we integrate mental
health promotion in health
promoting hospitals?
Session III.2: Adelaide Room
Facilitated by:
Eva Jané Llopis, Christina Dietscher and Juergen Pelikan