International Journal of Mental Health Systems最新文献

{"title":"Testing the psychometric properties of the risk-rescue rating scale: a lethality measure for suicide attempts.","authors":"Tormod Stangeland, Ketil Hanssen-Bauer, Johan Siqveland","doi":"10.1186/s13033-025-00662-0","DOIUrl":"10.1186/s13033-025-00662-0","url":null,"abstract":"<p><p>Health personnel lack a common standard for assessing lethality of suicide attempts. This may lead to inconsistent assessments and unclear reports about suicide attempts. We argue that the Risk-Rescue Rating Scale (RRRS) may help in resolving this problem. It is a measure based on observable indications of the medical danger of a suicide attempt and of the patient's efforts to avoid or achieve rescue. The instrument is a clinician-rated supplement to self-reports and can be administered in a few minutes and learned in a single brief teaching session. We adapted the RRRS for contemporary use in a Norwegian acute adolescent mental health service clinic. We developed a training program for clinicians, a user manual, and a series of five video-based role-played interview cases for reliability testing. In this study, we recruited 28 clinicians with professional backgrounds typical of Norwegian mental health personnel. They rated five role-played video interviews using the RRRS and the well-established interview instrument the Suicide Intent Scale (SIS) and obtained 140 sets of scores. We estimated the interrater reliability (intraclass correlation coefficient [ICC]) to be .93 for the RRRS and .94 for the SIS, both excellent levels. Correlation was .80 between the RRRS and SIS items that were similar to the RRRS and .53 for SIS items measuring other topics, indicating good concurrent and discriminant validity. Adopting a common standard for communicating about suicide attempts can improve clinical practice, and the RRRS may prove to be a reliable and practical candidate for this task.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"19 1","pages":"5"},"PeriodicalIF":3.1,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Costs analysis of integrating group interpersonal therapy into HIV care services in Senegal.","authors":"Yao Abounan, Jérôme Wittwer, Judicaël Malick Tine, Ibrahima Ndiaye, Salaheddine Ziadeh, Sophie Desmonde, Hélène Font, Helen Verdeli, Ndeye Fatou Ngom, Nathalie de Rekeneire, Antoine Jaquet, Moussa Seydi, Charlotte Bernard","doi":"10.1186/s13033-024-00654-6","DOIUrl":"10.1186/s13033-024-00654-6","url":null,"abstract":"<p><strong>Introduction: </strong>Group Interpersonal Therapy (IPT), an evidence-based treatment of depression recommended by the WHO mhGAP Intervention Guide, was implemented through a task-shifting approach in Senegal, as a treatment for depressed people living with HIV (PLWH). Since a description of the resources used and the implementation costs incurred is necessary to inform policymakers better, this study aimed to estimate the costs associated with its implementation.</p><p><strong>Methods: </strong>Intervention costs were analyzed using an \"ingredients-based costing approach\" from the provider's perspective. We identified and described the start-up and implementation costs for the initial phase and a projection over 5 years (implementation at capacity). We estimated total annual costs and cost per beneficiary. We conducted a scenario analysis to highlight some cost uncertainties and their impacts.</p><p><strong>Results: </strong>The total annual costs were estimated at $4064 for the initial phase and $8161 for the implementation at capacity. The training was the main cost driver representing approximately 60% of the total annual costs. The cost per beneficiary receiving group IPT was estimated at $65 for the implementation at capacity. The scenario analysis also illustrated the importance of parameters like the screening strategy, training activities, and allocation to cover transport costs mobilized by participants.</p><p><strong>Conclusion: </strong>This cost analysis highlighted the costs and cost allocations required to implement group IPT in Senegal to treat depression in PLWH. This preliminary work should enable policymakers to identify the optimal resources to be mobilized to implement and ensure the sustainability of this therapy in HIV at a country-level program.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"19 1","pages":"4"},"PeriodicalIF":3.1,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic realist synthesis of digital interventions for enhancing mental health at work: contexts, mechanisms, and outcomes.","authors":"Josefina Peláez Zuberbuhler, Luca Pietrantoni, Greta Mazzetti, Marco De Angelis, Davide Giusino, Mabel San Román-Niaves, Dina Guglielmi, Marisa Salanova","doi":"10.1186/s13033-024-00655-5","DOIUrl":"10.1186/s13033-024-00655-5","url":null,"abstract":"<p><strong>Background: </strong>Digital interventions (DIs) have emerged as promising tools for promoting mental health in the workplace. However, evidence on if, how, and under what circumstances they affect positive outcomes requires elucidation. This systematic realist review aimed to synthesize current knowledge on contexts, mechanisms, and outcomes of workplace DIs to enhance mental health at work.</p><p><strong>Methods: </strong>The review integrates elements of both systematic and realist review methodologies. Forty-four workplace mental health DIs studies were gathered through a systematic electronic search using PsycNet, Scopus, Web of Science, and PubPsych.</p><p><strong>Results: </strong>Results showed that demographics, previous mental health, and personal skills were the main individual context factors influencing the success of DIs. Key mechanisms were DIs usage, frequency, adherence, and relevance of content triggering positive perceptual shifts. Results showed improvements in psychological resources, wellbeing, and affect. Reduced ill-health symptoms were also evidenced. Five propositions were developed on the contexts and mechanisms under which digital interventions yield positive outcomes for mental health at work.</p><p><strong>Conclusions: </strong>This study highlights several areas where future research can expand our understanding of DIs in the workplace by examining interactions between mechanisms and cultural aspects influencing implementation.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"19 1","pages":"3"},"PeriodicalIF":3.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a non-specialist worker delivered psychological intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda and Ukraine.","authors":"Abhijit Nadkarni, Alessandro Massazza, Wietse A Tol, Sergiy Bogdanov, Lena S Andersen, Quincy Moore, Bayard Roberts, Helen A Weiss, Soumya Singh, Melissa Neuman, Carl May, Daniela C Fuhr","doi":"10.1186/s13033-024-00656-4","DOIUrl":"10.1186/s13033-024-00656-4","url":null,"abstract":"<p><strong>Background: </strong>Despite the significant burden of alcohol use disorders (AUD), there is a large treatment gap, especially in settings and populations affected by armed conflict. A key barrier to care is the lack of contextually relevant interventions and adequately skilled human resources to deliver them. This paper describes the systematic development of the CHANGE intervention, a potentially scalable psychological intervention for people with co-existing AUD and psychological distress in conflict-affected populations, delivered by non-specialist workers (NSWs).</p><p><strong>Methods: </strong>CHANGE was developed in sequential steps: (1) identifying potential treatment strategies through a meta-review and Delphi survey with international experts; (2) in-depth interviews (IDIs) with key stakeholders from the study settings in Uganda and Ukraine; and (3) three consultative workshops with international experts and experts from Uganda and Ukraine to develop a theoretical framework for the intervention informed by outputs of the Delphi and IDIs.</p><p><strong>Results: </strong>In the Delphi survey, experts reached agreement on the acceptability, feasibility and potential effectiveness of the following components: identify high-risk situations, problem solving skills, assessment, handling drinking urges, communication skills, pros and cons of drinking, and identifying high-risk situations. From the IDIs we identified (a) causal attributions for using alcohol e.g., psychosocial stressors; (b) cultural norms related to alcohol consumption such as patriarchal stereotypes; and (c) coping strategies to deal with drinking problems such as distraction. The CHANGE intervention developed through the consultative workshops can be delivered in three sequential phases focussed on assessment, feedback, and information (Phase 1); providing the client with need-based skills for dealing with high-risk situations related to alcohol use (Phase 2), and relapse prevention and management (Phase 3).</p><p><strong>Conclusions: </strong>CHANGE is a contextually relevant and potentially scalable treatment for co-existing AUD and psychological distress to be delivered by NSWs to conflict-affected populations. Effectiveness and cost-effectiveness of CHANGE will be tested in Uganda and Ukraine.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"19 1","pages":"2"},"PeriodicalIF":3.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Dynamics of hospitalizations and staffing of Ukraine's mental health services during the Russian invasion.","authors":"Irina Pinchuk, Ryunosuke Goto, Oleksiy Kolodezhny, Nataliia Pimenova, Norbert Skokauskas","doi":"10.1186/s13033-024-00660-8","DOIUrl":"https://doi.org/10.1186/s13033-024-00660-8","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"19 1","pages":"1"},"PeriodicalIF":3.1,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Can computer simulation support strategic service planning? Modelling a large integrated mental health system on recovery from COVID-19.","authors":"Livia Pierotti, Jennifer Cooper, Charlotte James, Kenah Cassels, Emma Gara, Rachel Denholm, Richard Wood","doi":"10.1186/s13033-024-00657-3","DOIUrl":"10.1186/s13033-024-00657-3","url":null,"abstract":"","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"18 1","pages":"37"},"PeriodicalIF":3.1,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11689529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare costs associated with receipt of effective mental healthcare coverage in individuals with moderate or severe symptoms of anxiety and depression.","authors":"Helen-Maria Vasiliadis, Pasquale Roberge, Grace Shen-Tu, Jennifer Vena","doi":"10.1186/s13033-024-00653-7","DOIUrl":"10.1186/s13033-024-00653-7","url":null,"abstract":"<p><strong>Background: </strong>Effective mental healthcare coverage (EMHC) is an important health system performance indicator of a population's mental healthcare needs. This study aims to assess the factors and healthcare costs associated with the receipt of EMHC for anxiety and depression.</p><p><strong>Methods: </strong>This study draws on data from participants from Alberta's Tomorrow Project with moderate or severe symptoms of anxiety and depression during the first wave of the COVID-19 pandemic (2020) with available medico-administrative and complete data [n = 720]. EMHC was assessed during the eighteen months as of March 1, 2020, and defined as adequate pharmacotherapy (i.e., antidepressant dispensed, with ≥ 80% proportion of days covered and 4 follow-up medical visits) and/or adequate psychotherapy (≥ 8 physician consultations for psychotherapy) depending on the severity of symptoms. Logistic regression analysis was used to study EMHC as a function of study variables. Regressions with augmented inverse probability weighting were used to estimate the total healthcare costs attributable to receipt of EMHC during the first 18-month period of the pandemic, controlling for confounders. Mean adjusted differences with 95% bias-corrected bootstrap confidence intervals (CIs) are presented.</p><p><strong>Results: </strong>The proportion receiving EMHC was 26.7%. Individuals with worse self-rated mental health after the pandemic than before were less likely to receive EMHC. Those with a lifetime diagnosis of depression and anxiety were more likely to receive EMHC. The overall mean adjusted total healthcare costs attributable to receipt of EMHC during the pandemic was $2601 [ - $247, $5694]. The mean adjusted outpatient costs attributable to EMHC was significantly higher and reached $1613 [$873, $2577].</p><p><strong>Conclusion: </strong>The study's findings highlight the existence of health inequalities and potential unmet mental health needs in individuals with worsening mental health during the pandemic. The receipt of EMHC during the pandemic was not significantly associated with increased total healthcare costs. These findings underscore the need for mental health policies that are aimed at improving timely access to EMHC to address population unmet mental health service needs.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"18 1","pages":"36"},"PeriodicalIF":3.1,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reducing stigma and improving access to care for people with mental health conditions in the community: protocol for a multi-site feasibility intervention study (Indigo-Local).","authors":"Maya Semrau, Petra C Gronholm, Julian Eaton, Pallab K Maulik, Bethel Ayele, Ioannis Bakolis, Gurucharan Bhaskar Mendon, Kalpana Bhattarai, Elaine Brohan, Anish V Cherian, Mercian Daniel, Eshetu Girma, Dristy Gurung, Ariam Hailemariam, Charlotte Hanlon, Andy Healey, Sudha Kallakuri, Jie Li, Santosh Loganathan, Ning Ma, Yurong Ma, Amani Metsahel, Uta Ouali, Nahel Yaziji, Yosra Zgueb, Wufang Zhang, Xiaotong Zhang, Graham Thornicroft, Nicole Votruba","doi":"10.1186/s13033-024-00649-3","DOIUrl":"10.1186/s13033-024-00649-3","url":null,"abstract":"<p><strong>Background: </strong>Stigma and discrimination towards people with mental health conditions by their communities are common worldwide. This can result in a range of negative outcomes for affected persons, including poor access to health care. However, evidence is still patchy from low- and middle-income countries (LMICs) on affordable, community-based interventions to reduce mental health-related stigma and to improve access to mental health care.</p><p><strong>Methods: </strong>This study aims to conduct a feasibility (proof-of-principle) pilot study that involves developing, implementing and evaluating a community-based, multi-component, awareness-raising intervention (titled Indigo-Local), designed to reduce stigma and discrimination and to increase referrals of people with mental health conditions for assessment and treatment. It is being piloted in seven sites in five LMICs-China, Ethiopia, India, Nepal and Tunisia-and includes several key components: a stakeholder group workshop; a stepped training programme (using a 'Training of Trainers' approach) of community health workers (or similar cadres of workers) and service users that includes repeated supervision and booster sessions; community engagement activities; and a media campaign. Social contact and service user involvement are instrumental to all components. The intervention is being evaluated through a mixed-methods pre-post study design that involves quantitative assessment of stigma outcomes measuring knowledge, attitudes and (discriminatory) behaviour; quantitative evaluation of mental health service utilization rates (optional, where feasible in sites); qualitative exploration of the potential effectiveness and impact of the Indigo-Local intervention; a process evaluation; implementation evaluation; and an evaluation of implementation costs.</p><p><strong>Discussion: </strong>The output of this study will be a contextually adapted, evidence-based intervention to reduce mental health-related stigma in local communities in five LMICs to achieve improved access to healthcare. We will have replicable models of how to involve people with lived experience as an integral part of the intervention and will produce knowledge of how intervention content and implementation strategies vary across settings. The intervention and its delivery will be refined to be feasible and ready for larger-scale implementation and evaluation. This study thereby has the potential to make an important contribution to the evidence base on what works to reduce mental health-related stigma and discrimination and improve access to health care.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"18 1","pages":"35"},"PeriodicalIF":3.1,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reach, uptake, and psychological outcomes of two publicly funded internet-based cognitive behavioural therapy programs in Ontario, Canada: an observational study.","authors":"Bilal Noreen Khan, Rebecca H Liu, Cherry Chu, Blanca Bolea-Alamañac, Megan Nguyen, Serena Thapar, Roz Fanaieyan, Marisa Leon-Carlyle, Mina Tadrous, Paul Kurdyak, Anne O'Riordan, Maggie Keresteci, Onil Bhattacharyya","doi":"10.1186/s13033-024-00651-9","DOIUrl":"10.1186/s13033-024-00651-9","url":null,"abstract":"<p><strong>Background: </strong>Access to traditional mental health services in Canada remains limited, prompting exploration into digital alternatives. The Government of Ontario initiated access to two internet-based cognitive behavioral therapy (iCBT) programs, LifeWorks AbilitiCBT and MindBeacon TAiCBT, for adults with mental health issues.</p><p><strong>Methods: </strong>An uncontrolled observational study utilizing secondary retrospective program data was conducted to evaluate the reach, uptake, and psychological symptom changes among participants engaging with either iCBT program.</p><p><strong>Results: </strong>Between May 2020 and September 2021, 56,769 individuals enrolled in LifeWorks AbilitiCBT, and 73,356 in MindBeacon TAiCBT. However, substantial exclusions were made: 56% of LifeWorks participants and 68% of MindBeacon participants were ineligible or failed to initiate treatment. Consequently, 25,154 LifeWorks participants and 23,795 MindBeacon participants were included in the analysis. Of these, 22% of LifeWorks and 26% of MindBeacon participants completed over 75% of iCBT treatment. On average, LifeWorks participants received 13 ± SD 7.1 therapist messages and sent 5 ± SD 10.3 messages, while MindBeacon participants received 25 ± SD 20.7 therapist messages and sent 13 ± SD 16.4 messages. LifeWorks included synchronous therapist contact averaging 1.4 ± SD 1.9 h per participant, while MindBeacon was purely asynchronous. Baseline severity of anxiety (37%) and depression symptoms (22%) was higher for LifeWorks participants compared to MindBeacon participants (24% and 10%, respectively). Clinically significant changes in anxiety and depression scores were observed: 22% of LifeWorks and 31% of MindBeacon participants exhibited reliable recovery in PHQ-9 scores, while 26% of LifeWorks and 25% of MindBeacon participants demonstrated reliable recovery in GAD-7 scores.</p><p><strong>Conclusion: </strong>In conclusion, iCBT programs show promise for engaged participants with varying levels of severity in anxiety and depression symptoms. Future iterations of iCBT should consider adopting a broad entry criterion to iCBT programming to increase accessibility, especially for those with severe symptoms, alongside integrated intake care pathways, and potential payment structure adjustments for iCBT service providers. Taken all together, these factors could temper high dropout rates post-intake assessment. This evaluation underscores the potential and value of digital mental health interventions for individuals with mild to severe anxiety or depression symptoms, emphasizing the importance of addressing participant dropout.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"18 1","pages":"34"},"PeriodicalIF":3.1,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Italian Evaluation and Excellence in REMS (ITAL-EE-REMS): appropriate placement of forensic patients in REMS forensic facilities.","authors":"Lia Parente, Fulvio Carabellese, Alan Felthous, Donatella La Tegola, Mary Davoren, Harry G Kennedy, Felice F Carabellese","doi":"10.1186/s13033-024-00647-5","DOIUrl":"10.1186/s13033-024-00647-5","url":null,"abstract":"<p><strong>Background: </strong>We set out to assess the appropriateness of current placement of mentally disordered offenders allocated by the courts in Italy to REMS or to forensic community residences. We hypothesised that as in other countries, the match between a standardised assessment and the decision of the court would be imperfect.</p><p><strong>Methods: </strong>The DUNDRUM Toolkit was translated into Italian. The translation had good psychometric properties. In order to compare the current level of therapeutic security with a calculated safest current placement, we compared the DUNDRUM-1 triage security assessment of need for therapeutic security prior to treatment, with evidence for progress made in treatment (DUNDRUM-3) and forensic recovery (DUNDRUM-4). The more conservative of these two would be taken as the safe current level of need for therapeutic security.</p><p><strong>Results: </strong>The Italian translation of the DUNDRUM Toolkit had good internal consistency and mean scores had a Reliable Change Index less than one unit. 3.7% of those in REMS (medium security) were assessed as needing high security and 38% were ready to move to a less secure place. In low secure places, 56% were assessed as needing a higher level of therapeutic security and 6% could have moved to open non-secure places.</p><p><strong>Conclusions: </strong>The Italian translation of the DUNDRUM Toolkit allows an assessment of the current working of the model of care for forensic psychiatry following the reforms of 2015. Most patients are safely placed. A small but important proportion needed high secure places that are not currently available. (3.7% of 604 nationally, 95% Confidence Interval 1.2% to 8.4%, 7 to 50). A greater use of such measures would enable better health gains and safer outcomes. Trial registration ClinicalTrials.gov ID: NCT06018298 Unique Protocol ID: ITAL-EE-REMS.</p>","PeriodicalId":47752,"journal":{"name":"International Journal of Mental Health Systems","volume":"18 1","pages":"33"},"PeriodicalIF":3.1,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}