Background and objectives: Specific classifications of mental health interventions have encountered many issues in their integration into a general classification of interventions. Nonetheless, there has not been any previous review on the content and structure of current classifications in relation to mental health care. This expert review aimed to compare the mental health interventions provided in a series of reference classification systems for the incorporation of mental health care into the International Classification of Health Interventions (ICHI).

Methods: Twelve classifications are described with regards to the structure of the classification (unit of analysis, sections, multiaxiality, granularity) and context of utilization (purpose, descriptors, neutrality, interoperability and implementation).

Results: Major problems identified include a granularity unbalance (i.e. differences in the number of codes and its specificity with other areas such as rehabilitation), unclear units of analysis (i.e. differences between procedures, interventions, packages of care and care programs), lack of clearly stated evidence-based interventions in a mental health context; and lack of a well-defined taxonomical tree. An ontology approach to the definition of the different entities involved in the throughput of mental care, including their hierarchical relationships and conceptual map, may have contributed to the failure of previous systems together with the development of systems to classify mental health interventions separate from generic health interventions.

Conclusions: The present review provides additional ground for the development of the ICHI knowledge-base and highlights the importance of taxonomical disambiguation and international comparability in the development and implementation of classifications of mental care interventions. 

The overall aim of this thesis was to investigate the patients’ and their relatives’ perceived participation in discharge planning after stroke and the patients’ health-related quality of life, depressive symptoms, performance of personal daily activities and social activities in connection with discharge. Another aim was to evaluate the psychometric assumptions of the SF-36 for Swedish stroke patients.

Prospective, descriptive and cross-sectional designs were used to study all patients with stroke admitted to the stroke unit at a hospital in southern Sweden from October 1, 2003 to November 30, 2005 each with one close relative. The total sample consisted of 188 patients (mean age=74.0 years) and 152 relatives (mean age=60.1 years). Data were collected during interviews, 2-3 weeks after discharge.

The results showed that less depressive symptoms, more outdoor activities and performance of interests are important variables that related to higher HRQoL. SF-36 functions well as a measure of health related quality of life in Swedish stroke patients, but the two summary scales have shortcomings. Compared to a Swedish normal population, scores on all scales/components of the SF-36 were lower among stroke patients especially in the middle-aged group. Most of the patients perceived that they received information, but fewer perceived participation in the planning of medical treatment and needs of care/service/rehabilitation and goal setting. The relatives perceived that they need more information and they perceived low participation in goal setting and needs assessment. The professionals seem to lack effective practices for involving patients and their relatives to perceive participation in discharge planning. It is essential to develop and to implement methods for discharge planning, including sharing information, needs assessment with goal setting that facilitate patients’ and relatives’ perceived participation. The results suggest that ICF can be used in goal setting and needs assessment in discharge planning after acute stroke.