Research Projects 2003-2004
[go to CIMH Research Projects]
The impact of severe acute respiratory syndrome outbreak to health care workers in a University Hospital in Taiwan
Investigators:
Dr Wu, EC., Department of Psychiatry, National Taiwan University Hospital; A/Professor Minas, I.H., CIMH ; Professor Good, B., Department of Social Medicine, Harvard School of Medicine
The study explores what factors may be important in protecting medical and hospital administrative personnel in cases of epidemic by exploring life experiences of medical personnel during the SARS epidemic in Taiwan; describes the impact of SARS outbreak on health care workers (HCWs); identifys HCWs concerns in caring for SARS patients in Taiwan and detects the strengths and weaknesses of the organization of health care in circumstances of epidemics in order to protect HCWs. In caring for SARS patients, HCWs became a high risk group for the new infectious disease. Such a situation is potentially disabling to the emergency response to infection epidemics placing the wider ppulation at risk. Analysis of the SARS situation will provide insights as to how to increase resilience in health care systems under similar challenge. The results will include recommendation for protective procedures designed to support an effective medical response under epidemic conditions. The work has relevance to any health system even though it is focused on the example of SARS in a Taiwanese hospital. Given the issue of uncertainty during the outbreak of an infectious epidemic (e.g. lack of effective diagnostic processes, misdiagnosis, coordination in reporting systems, unknown incubation periods, asymptomatic carriers, etc.) HCWs and health systems and their responsiveness are potentially vulnerable to failure in securing public safety. SARS was an unknown illness and spread within hospitals through secondarily infected HCWs to patients. In China , after the SARS outbreak, approximately 20% of cases were in health care workers, and early in the outbreak the rate was closer to 90%. Further, despite implementation of infection control procedures, cases of SARS were still occurring in HCWs.
One of the critical lessons from the SARS outbreak in a number of Asian countries is the need to ensure a range of health care strategies are in place, including the need to restructure service delivery and to protect the safety of HCWs.
To this end there have been a number of recommendations by those affected by the SARS experience, particularly focusing on procedural elements of ensuring sufficient medical resources, surveillance, quarantine, co-ordination and leadership, development of adequate information systems, public communication and other strategies.
In contrast to the above focus, the experience and personal account of HCWs in the context of risk to themselves and their families, the issue of professional and moral responsibilities and other subjective qualities have not been explored in current research. This is identified as an important area of research here with implications regarding the nature of participation in high risk situations with the possibility for incongruity between personal and collective goals contributing to reduced effectiveness of intended protective measures. How HCWs in such situations negotiate such dilemmas is an important focus in this study. In addition, this work intends to explore and describe how HCWs experiencing the SARS outbreak have contributed to the collective response and the emergent issues for them within this setting.
The proposed study will be at the National Taiwan University Hospital . This study will provide detailed information that may enable appropriate strategies to be developed to meet the needs of HCWs exposed to a major epidemic.
Introducing change in a complex organisation: a comparative analysis of the Southern Area First Episode (SAFE) early psychosis program
Investigators:
Mr Kanowski, L .; A/Professor Klimidis, S., CIMH
Early intervention programmes (EIPP) for first episode psychosis have been shown to be effective in symptom reduction and functional status of patients over and above routine treatment and there is evidence for improved cost-effectiveness. Despite the demonstrated benefits of EIPPs their dissemination has been slow and often partial considered that contextual factors to have been responsible for poor dissemination. These include factors such as low funding of mental health programs in general, policy that focuses services towards those with chronic schizophrenia, and scepticism on the part of administrators about the ability to replicate 'model' programs in other sites. More broadly, there is an emerging literature in mental health on the need to understand the gap between efficacy and effectiveness, a gap between the research program implementations leading to evidence-based practices and 'real world' implementations in complex organizations where scientific evidence forms only part of the basis for successful programme dissemination.
This study will document the development and compare two implementations of a program aimed at early intervention with people suffering from psychosis in the Southern Area Mental Health Service (NSW). This is a standard mental health service comprising of three sectors (Monaro, Southern Tablelands, South Coast ). Each sector has tried to implement an EIPP with six staff members considered as specialist in EIPP work. The present study will focus on developing descriptive accounts from staff, management of program development personnel to generate hypotheses regarding possible implementation differences that may have contributed to the differential outcomes. In addition, it will explore and describe what factors, as identified by study participants, may have played a role in the varied success of implementation across the two of the three programme disseminations, selecting the succesful one and comparing it with one of the two less successful.
The information will contribute a broader thinking of program dissemination/implementation in mental health services. For the organizations involved the information will support discussions towards improving the programmes involved in the research.
Investigation of factors motivating politicians to engage with issues and political action
Investigators:
Bromhead, R.; A/Professor Minas, I.H., CIMH
The study aims to understand what motivates politicians to focus and promote an issue or follow it through with political action . Procedural objectives are to derive accounts of politicians' own attributions of political interest and actions in relation to public issues.
Public policy, including mental health policy implementation often lags behind the availability of policy and implementation is often driven by the political process and threfore likely affected by personal motivations of political figures. While anectodally some motivating factors may be suggested, and are often suggested by political commentators and journalists, there appears to be little research research focused on what politicians themselves consider to be relevant motivating factors in guiding their political attention and action. In the present work it is contended that knowledge of factors that direct political attention to an issue of concern as generated from political figures themselves could be useful to orient the political focus on programs such as public health. While the work may not develop a view specifically in relation to public health, as politicians interviewed may not necessarily have such interests, it will provide a preliminary account on the issue of personal motivation in relation to political action.
The ACT Legislative Assembly, chosen to be the setting for this work, is small and covers all aspects of state and local government hence the politicians necessarily engage with a broad range of issues, some issues perhaps being beyond the politicians own interests. The interest of this research is not particular issues themselves but rather what the politicians see in issues that attracts their involvement.
Benefits from the work include understanding how personal political motivations may be incorporated into a broader framework of political action and the role of this in the negotiation of public policy implentation, as for example public health policy.
Mental disorder in primary care settings in Cambodia : evaluation of the utility of the K10 and initial estimates of prevalence.
Investigators:
Dr Sophal, C., Department of Health, Battambang, Cambodis; A/ Professor Minas, I.H., CIMH ; Professor Cohen, A., School of Social Medicine, Harvard University; Professor Sunbaunat, K.; Department of Mental Health and Psychiatry, Phnom Penh University
This project aims to evaluate the utility of the Kessler Psychological Distress Scale (K10), a mental health screening tool and to estimate the primary care prevalence of mental disorder in the Cambodian primary care setting.
Cambodia , following the war, has been in the process of reconstruction with the reconstitution of its institutions including health care services. Although there are some facilities for mental health service provision, as yet these are under-developed, under-resourced and likely to not be meeting the needs of the population. Catering for a population of over 12 million there are currently 11 mental health services within Referral Hospitals and 12 others in Health Centres, spread over 10 provinces (of the 23). The 2002 Annual Report on Health Activities in the Battambang province indicated that less than three percent of patients attending primary care services presented with mental disorder or illness compared to expected rates of 20 percent suggested for such settings by the World Health Organization (WHO) from studies conducted outside Cambodia . Effective lack of a specialist mental health system increases the need to address mental health within the primary care sector in Cambodia . As such it is important to know primary care rates of mental disorder which is not known in the Cambodian setting. This will be the first study to provide such information by accessing patients within primary care, measuring indicators for depression and anxiety in this sample. The project (funded by the Cambodian Government) is seen as an important one from a service planning perspective by the Cambodian Ministry responsible for health care where the screening instrument to be used in this study, the K10, will be adopted within the Ministry's health service evaluation process. The work will benefit the community indirectly by making a contribution to the Ministry's mental health care development processes in Cambodia .
The study will screen 1000 primary care patients in services within the Battambang (primarily rural) province and in Phnom Penh City for mental disorder according to the K10. 200 patients will be re-assessed using a standard structured diagnostic instrument for mental disorders. K-10 cut-off criteria for a mental disorder for the Cambodian primary care sample will be investigated and this will allow a reasonable estimation of rates of mental disorder in this setting.
Awareness, understanding and help-seeking for behaviour problems by parents of primary school age children in Central Jakarta : Qualitative study in the community
Investigators:
Dr Wiguna, T., Child and Adolescent Unit, Cipto Mangunkusumo General Hospital , Jakarta , Indonesia ; A/Professor Klimidis, S., CIMH; A/Professor Minas, I.H., CIMH ; A/Professor Wibisono, S., Department of Psychiatry, University of Indonesia
This study will explore parental perceptions of emotional and behavioural problems in their children, differentiating between children with internalising, externalising and mixed internalising-externalising syndromes at predetermined by a schools-based prevalence study conducted in Indonesian schools.
Parental perceptions will be examined according to: whether the behaviours are regarded as a problem, the nature of the problem, importance, course, severity and consequences, what constitutes appropriate responses to the problem, the regard of standard medical and allied health support and the social network in dealing with the problem, what was attempted and why, what was abandoned and why in dealing with the problem.
Parental perceptions are central to pathways and access to appropriate health care services in children with emotional and behavioural problems, which can affect upto 20% of children. There are secondary difficulties associated with emotional and behavioural problems hampering educational development, socialization and reducing long-term chances of economic and social adjustment. For a significant number, early childhood problems persist into adulthood. Despite this, only a small proportion of children with problems reach appropriate healthcare. In Indonesia a school-based prevalence study (SBPS) of primary school children in Central Jakarta revealed as many as 27% had a six-moth prevalence of emotional and behavioural problems. Yet in the overlapping nine-month period no more than 10% of all children seen by the main health service in Central Jakarta, the Cipto Mangunkusumo General Hospital and Department of Psychology, University of Indonesia , sought help for an emotional or behavioural problem. Critical factors suggested to limit their access are parental recognition of the problem, parental perception of the need for care and perception of ability to overcome barriers to seeking care.
The study has local significance to the community of schools, health services and parents of primary-school children in Central Jakarta . Information gathered by the research will support the ongoing work of the Cipto Mangunkusumo General Hospital and Department of Psychology, University of Indonesia towards the development of information for parents and schools in advising them about mental health issues and access to relevant support services. It will contribute a first account in this setting that may then be examined for generalisation to other parents and wider settings by future studies by this group.
The present study takes a broader approach to child problems examining those with internalising problems (anxiety, insomnia, depression), externalising (misconduct, aggression, stealing, etc.) and mixed syndromes in view of literature suggesting different patterns of tolerance, interpretation and attendance to health care for such problems in different cultural/national contexts.
The study aims to explore and describe common views and experiences of parents. Sampling will attempt to examine variations of perceptions associated with child gender and/or nature of the child's problem as there are theoretical grounds for such associations (as main effects and as interactions).
Needs assessment for caregivers of dementia persons in Hong Kong : A Qualitative study
Investigators:
Dr Wai-Chi, C.; Dr Ng, C., CIMH
Carer burden for those carers of people suffering from mental health problems is recognised as an area for service provision focus in Western countries and increasingly so in non-Western countries. The dementias comprise a set of conditions that are often progressive and increasingly debilitating with time for those afflicted, affecting higher cognitive functions such as memory, ability to plan and organise activities and eventually affecting ability for self-regulation, self-care and basic vegetative functions. Family members of sufferers are often confused about the meaning of the disorder, its progressive nature and they need to make increasing adjustments to their own lives and plans in order to attend to the needs of their relative. There are significant human and economic costs to families dealing with the challenges of the onset of dementia in their family member. In countries where there are strong collectivist and family values the main option is to look after the sufferer in the home. Currently in the Hong Kong setting there is inadequate research into carer burden and carer needs for those tending to sufferers of dementia. This research will conduct a qualitative analysis of carer issues to explore their emergent needs since the time of the onset of the disorder. The information will be of benefit to the families directly (those currently being assisted as well as those seeking assistance in future) as the research team is affiliated with the Castle Peak Hospital and the Community Rehabilitation Network who will undertake to develop relevant information and supportive strategies to assist carers of dementia in Hong Kong.
The design of the study will involve interviewing 30 adults who provide the main caring role in the family of a dementia sufferer. Analysis will examine the situation as it evolves historically with the progression of the disorder since the time of its earliest recognition. This information will be subsequently used by the service providers to develop relevant approaches to improve service supports to carers and their suffering relatives.