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The Center, in collaboration with WHO Geneva and
Collaborating
Centers in 17 countries, is participating in a follow-up study of
patients whohad been in previous research studies of schizophrenia,
such as the
International Pilot Study of Schizophrenia (IPPS), the study on the
Determinants of Outcome of Severe Mental Disorder (DOSMeD), and the
study on
Reduction and Assessment of Psychiatric Disability (RAPyD). In this
study of
the course and outcome of schizophrenia, patients have been assessed in
their
second decade after onset of psychosis. Key areas of this research have
been
the development of assessment instruments suitable for cross-cultural
research
and the continuing development of statistical methods for analyzing the
data.
Analysis of the data will focus primarily on cross national variation
in
etiology and course that are consistently apparent across nations.
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In an effort to assist mental health authorities within a wide
range of infrastructures, socioeconomic conditions and technological
resources, the Center has developed an approach to obtaining data on the
characteristics of the health, mental health and social service networks in a
defined area and on the patients with mental health problems who use these
services. The methodology includes a survey to be conducted over a short time
period during which data are collected on patients seen in a typical week in
each setting. The purposes of the methodology are to:
- collect a standard
set of data that describes each provider in an area who serves persons
with mental health problems;
- collect a standard set of data that describes
persons with mental health problems;
- provide an annualized estimate of the
number and proportion of persons in the service system that have mental health
problems and assess the costs to the services of dealing with such
patients;
- generate information useful for planning, resource allocation,
research and reporting to governing, regulatory and funding bodies. ]
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The WHO Center at NKI has developed
and disseminates a microcomputer-based mental health information system
designed to be used for planning, managing, evaluating, and delivering mental
health services. The purposes of the system are to:
- collect a standard
minimum data set on each patient that can provide a balanced picture of
the population in treatment,
- generate information for planning, resource
allocation, reporting to governing, regulatory and funding bodies, and
- provide the clinician or treatment team with basic information about a
patient.
The System is designed to be used by personnel with limited familiarity
with data processing technology and to be adaptable to local situations.The
System collects data from individual facilities and allows for the
aggregation of data to regional and national levels. Tracking of patients
is possible in cases where individuals can be identified by a unique number
such as a system-wide case number or a national identification number. The
System has been translated into Chinese, Czech, Japanese and Spanish.
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Consultative visits and information/technology
transfer activities with countries in the Americas are ongoing. Information
management technologies, in general, and the information system developed by
the Center, in particular, have been of interest to the governments and
universities in the region.
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Since 1993, the Center has
been collaborating with the PeopleOs Republic of China in the development of a
national mental health information system. These efforts included adapting the
NKI/WHO Mental Health Information System to the needs of China, training
visiting scientists, and providing continuous support to the project. In
January, 1995, the Center was notified that the System has been approved by
the Ministry of Health for use nationwide.
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Consultation on methods of conducting
cost-effectiveness analysis is ongoing. Costing approaches are being adapted
for application to countries with highly diverse economic profiles. A method
for studying the cost-effectiveness of the treatment of depression in primary
care settings has been proposed and has been circulated for review. Already
developed is a research protocol that would refine the methodology which could
then be applied to intervention studies for the purpose of assessing
alternative treatment programs of depression in primary care settings. This
observation/naturalistic study will help estimate the prevalence of depression
and will assess the rate at which primary care physicians identify depression,
the adequacy of treatment, the prognoses, the consequences of morbidity on
public cost and the burden of depression. Also, the study aims to describe
variations in service organization and pathways to care for depressive
patients across countries.
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World Health Organization Collaborating Center for Training and Research in
Mental Health and in the Prevention of Substance Abuse