Comprehensive medical and functional assessment of patients with severe mental illnesses receiving care in period of reforming mental health system 2017-2020 in Republic of Moldova

Abstract

Introduction: Prior to initiation of the mental health reform in August 2014, people with mental health problems were provided the bulk of their care in psychiatric hospitals or residential institutions. While care in institutions was central, a number of people with mental health problems quality for care in community-based settings, either in: a) primary care services led by family doctors and nurses; b) community mental health centers staffed by a multidisciplinary community mental health team, or c) short-term inpatient admission to an acute inpatient ward in a regional general hospital. To understand how many and which patients qualify for shifting to services in community settings, this study aims to carry out a psychological and functional assessment of patients that are residents of the MENSANA project’s 4 pilot rayons (Orhei, Soroca, Cahul and Cimislia), and after the assessment, applying a referral/indication algorithm for the more appropriate mental health services that fits their needs. This study carries potential benefits for people with mental health problems, as they can be re-directed, if necessary, to care that may be a better fit for their needs and enable them to lead a more fulfilling life in their communities. Depending on the outcome of the individual assessment, some patients may stay in the service in which they already receive care (i.e. a psychiatric hospital). This study will have an impact on the patient flow in the mental health care system in Moldova, particularly for mental health services in the 4 pilot rayons. Objective: To conduct a comprehensive diagnostic and functional (psychological and social) assessment of the patients receiving mental health care that reside in the districts of Orhei, Soroca, Cimislia or Cahul, in order to determine their further needs for mental health services. A number of countries have documented the shift in care from psychiatric hospital care to community-based settings (e.g. England, Canada, Australia). Within these processes, the most frequently assessed outcomes are social functioning, psychiatric symptoms, and quality of life. Materials and methods: In order to have a comprehensive assessment to build a patient profile, the survey developed is a comprehensive assessment consisting of several validated tools and outcome measures that assess the following dimensions: • Diagnostic assessment (medical psychiatric assessment); • Psychological assessment (symptoms and functioning); • Functional assessment (social functioning, daily life functioning, quality of life). The first part of the assessment obtains patient-level information which can either be completed by a ward staff member or CMHC employee and corroborated by the patient. Demographic and socioeconomic data such as (1) gender, (2) age, (3) partner status, (4) presence or absence of children under age 18, (5) housing status: independent living (yes/no), (6) occupational status (paid job yes/no; if yes, how many hours per week). In addition, we like to have some clinical information: (1) ICD-10 diagnosis, (2) psychiatric and somatic comorbidities, (3) WHO DAS 2 disability level, (5) EQ-5D quality of life. Conclusions: Often during the course of a mental health problem in Moldova, patients will rotate in and out of different kinds of services (e.g., hospital-based or community-based) and receive different kinds of health care interventions (e.g., pharmacological). Given these changes in service utilization patterns, it is important to capture the types of treatments and services received by patients to be able to compute the economic costs of offering these treatments and services.