Mitchell Centre Seminar Series
|Dates:||28 October 2015|
|Times:||16:00 - 16:00|
|What is it:||Seminar|
|Organiser:||School of Social Sciences|
|Who is it for:||University staff, Adults, Current University students|
Vincent Lorant, Université catholique de Louvain
Optimal network for the continuity of care of patients with severe mental disorder: a multi-level social network analysis
The challenge of mental health care in the community is to sustain patients’ continuity of care and their social integration. Accordingly, in several western countries, health authorities have promoted mental health care networks as organisation solution to coordinate services addressing patients with severe mental illness. However, the most effective way to design these networks is unclear. Is continuity of care improved by higher centralisation? Should the relationships across services be strong or weak? All in all, it is thus unclear what an optimal network of mental health care services should looks like to improve continuity of care and the social integration of these patients. We worked out whether some network structures were most suitable for the continuity of care and social integration for patients with severe and chronic mental illness.
A multi-level survey was achieved in 2014 across Belgium: 1,200 patients with severe and chronic mental illness were recruited across 19 mental health care networks. Patient filled out a questionnaire including the Alberta Continuity of Service Scale for Mental Health (ACSS-MH) and an index of social Integration (SIX). Also, 542 services from these 19 networks filled out a social network questionnaire tapping referrals across services. For each network, we computed structural indicators describing the composition, density, centralization, distance, and the magnitude of weak ties (referral to different types of services).
On average, continuity of care was quite good with 74.6% of the maximum score (std=9.1%) whereas social integration was low (3.1/6). The items related to treatment responsiveness received low score (71%) whereas items related to relational continuity had the highest score (78%). Patients complained particularly about low GPs involvement, and the lack of information continuity. Overall, the 19 networks were hospital-centred, had a balanced composition of different type of services. They were also dense, with low centralisation, and had many weak referral ties to other types of services.
Total continuity of care was not related with the network structure. However, relational continuity of care was improved in larger networks and in networks with more strong ties. Social integration was lower in dense network, higher in network with shorter distance across services and higher in network with more weak ties.
Continuity of care and social integration require different network structures. The network structure most suitable to improve social integration of patients with severe mental illness have low density.
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