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Open Access
Article
Publication date: 19 September 2020

Matt Fossey, Lauren Godier-McBard, Elspeth A. Guthrie, Jenny Hewison, Peter Trigwell, Chris J. Smith and Allan O. House

The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared…

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Abstract

Purpose

The purpose of this paper is to explore the challenges that are experienced by staff responsible for commissioning liaison psychiatry services and to establish if these are shared by other health professionals.

Design/methodology/approach

Using a mixed-methods design, the findings from a mental health commissioner workshop (n = 12) were used to construct a survey that was distributed to health care professionals using an opportunistic framework (n = 98).

Findings

Four key themes emerged from the workshop, which was tested using the survey. The importance of secure funding; a better understanding of health care systems and pathways; partnership working and co-production and; access to mental health clinical information in general hospitals. There was broad convergence between commissioners, mental health clinicians and managers, except in relation to gathering and sharing of data. This suggests that poor communication between professionals is of concern.

Research limitations/implications

There were a small number of survey respondents (n = 98). The sampling used an opportunistic framework that targeted commissioner and clinician forums. Using an opportunistic framework, the sample may not be representative. Additionally, multiple pairwise comparisons were conducted during the analysis of the survey responses, increasing the risk that significant results were found by chance.

Practical implications

A number of steps were identified that could be applied in practice. These mainly related to the importance of collecting and communicating data and co-production with commissioners in the design, development and monitoring of liaison psychiatry services.

Originality/value

This is the first study that has specifically considered the challenges associated with the commissioning of liaison psychiatry services.

Details

Mental Health Review Journal, vol. 25 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Open Access
Article
Publication date: 19 October 2017

John E. Berg

The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a…

Abstract

The diagnostic process after referral to an acute psychiatric treatment facility consists of more than the clinical investigation and laboratory tests. Psychometric tests in a broad range of languages may be such an augmentation of our diagnostic armamentarium. Whether such tests are in use, and how they are distributed among different patient categories was the aim of the study. All referrals in one calendar year (N=1168), as they are depicted in the hospital computerized medical records, were investigated. Fifty-six (6.1%) out of 926 ethnic Norwegians and six (3.0%) out of 198 non-Western immigrants were tested, whereas none of the 44 Western immigrants. The difference between ethnic Norwegians and the immigrants was significant (Z=-3.05 and P=0.002). Psychometric tests were thus almost not in use, and even lesser so in immigrants. Mean number of resident days was higher among those tested, 11.7 (SD=11.2) versus those not tested, 7.4 (SD=10.4) days, t=2.97 and P=0.004. Length of stay for ethnic Norwegians did not differ from that for non-Western immigrants 11.4 versus 11.7, respectively. The patients tested were older than those not tested. Mean age was 43.0 (SD=14.4) versus 38.8 (SD=12.1), with a t=2.65 and P=0.03. The difference in resident days between all immigrants and ethnic Norwegians was significant with a Z=−2.232 and P=0.026. Level of testing was higher in ethnic Norwegians, and the tested patients stayed longer, maybe indicating more room for testing. Whether this low test-activity influences treatment quality is an unsettled question.

Details

Mental Illness, vol. 9 no. 2
Type: Research Article
ISSN: 2036-7465

Keywords

Article
Publication date: 22 June 2012

Roger Stanbridge

National mental health policies in the UK have a common theme of seeking to develop working partnerships between people who use mental health services, their families and carers…

348

Abstract

Purpose

National mental health policies in the UK have a common theme of seeking to develop working partnerships between people who use mental health services, their families and carers and professionals. In Somerset, following a staff training programme, a Family Liaison Service has been developed whereby systemically trained staff work alongside inpatient staff to hold family meetings as part of the assessment and admission process on all wards for working age adults and older people. This article aims to focus on this initiative.

Design/methodology/approach

The article considers the development of the Family Liaison Service and evaluates its progress based on audit data, feedback from families using the service, and a survey of staff experience. Issues raised in developing family inclusive services are discussed.

Findings

Evaluation of the service suggests that, although there is still progress to be made, considerable success has been achieved in embedding the service on inpatient units with a substantial increase in meetings held between staff and families. Feedback from families is positive and staff report increased confidence in engaging with families and carers.

Originality/value

This article describes a transferable model for the implementation of national policy to develop working partnerships with families and carers in mainstream mental health services.

Article
Publication date: 1 January 2013

Cristian Raggi, Kiriakos Xenitidis, Maria Moisan, Quinton Deeley and Dene Robertson

Reporting to the police incidents of challenging behaviour displayed by inpatients with autism spectrum disorders (ASD) and learning disability (LD) represents an important but…

1465

Abstract

Purpose

Reporting to the police incidents of challenging behaviour displayed by inpatients with autism spectrum disorders (ASD) and learning disability (LD) represents an important but often controversial issue. The purpose of this paper is to contribute to this topic through a brief literature review and the presentation of a clinical case.

Design/methodology/approach

Case study and literature review.

Findings

The action of reporting to the police can be a useful tool within the therapeutic input provided to patients with ASD and LD who present with challenging behaviour. This can enable staff to feel legally supported, and can promote patients’ learning of social rules, in respect of their rights and duties. The clinical case highlighted that reporting to the police can be effective when it is part of a comprehensive, multi‐professional therapeutic process. This should aim at directing patients towards rehabilitation rather than incarceration. This should also entail the identification of clear pathways and ongoing involvement of patients and families.

Originality/value

Despite the relevance for clinical practice of the above debate, little has been published on this topic. This paper contributes to this discussion through the presentation of a clinical case and by describing how this issue was addressed within a secure inpatient setting.

Details

Journal of Intellectual Disabilities and Offending Behaviour, vol. 4 no. 1/2
Type: Research Article
ISSN: 2050-8824

Keywords

Article
Publication date: 28 October 2014

Nick Walsh, Tricia Handley and Ian Hall

The purpose of this paper is to address the serious problems that people with intellectual disability face in getting their healthcare needs met in general hospitals by improving…

Abstract

Purpose

The purpose of this paper is to address the serious problems that people with intellectual disability face in getting their healthcare needs met in general hospitals by improving the training of general hospital staff.

Design/methodology/approach

Review of recent developments in models of service provision including the development of intellectual disability liaison nurses and the RAID model in liaison psychiatry.

Findings

There is much scope for intellectual disability liaison nurses and liaison psychiatry services to work together in staff training in general hospitals. There is a clear strategic role for both services in convincing the management of general hospitals to implement such training using economic and quality arguments.

Originality/value

The authors suggest a new model of working to improve the healthcare outcomes of people with intellectual disabilities through effective training of staff in general hospitals.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 8 no. 6
Type: Research Article
ISSN: 2044-1282

Keywords

Article
Publication date: 5 October 2021

Vafa Pirjamali, Daniela Ivanova and Andrew John Howe

The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to…

Abstract

Purpose

The intensive 18-month treatment in the personality disorder (PD) therapeutic community (TC) is felt to offer improvement in many aspects of patients’ lives. This study aims to understand if the use of acute services was also affected via a service evaluation project.

Design/methodology/approach

The authors collected data from electronic records on the use of local services in the two years before, during and the two years after treatment in the TC. Specifically, the authors counted inpatient bed days, Emergency department (ED) presentations and days under home treatment team and liaison psychiatry; the authors used ANOVA to analyse the data.

Findings

The study included 25 adult service users, 17 female and 8 male, with an average age of 40. Whilst there were reductions in the use of inpatient beds and ED presentations, on analysis, these were not found statistically significant. The small size of the study is a limitation and may limit the generalisability of the findings. The study concludes there may be reductions in acute psychiatric service use during and after treatment in the TC. The findings were not statistically significant; the authors suggest larger multi-centre studies may be able to demonstrate statistical significance.

Originality/value

PD patients have a relatively high use of acute psychiatric services compared to other patient groups. The authors are not aware of any similar studies in the published literature.

Details

Therapeutic Communities: The International Journal of Therapeutic Communities, vol. 42 no. 3
Type: Research Article
ISSN: 0964-1866

Keywords

Article
Publication date: 12 August 2021

Harriet Greenstone and Katie Wooding

High-fidelity simulation has well-established educational value. However, its use in psychiatry remains underexplored. This study explores medical students’ experiences of…

Abstract

Purpose

High-fidelity simulation has well-established educational value. However, its use in psychiatry remains underexplored. This study explores medical students’ experiences of high-fidelity simulation teaching during their psychiatry placements. A session was delivered on “psychiatric emergencies”, set in a simulated emergency department, with equal emphasis on the management of physical and psychiatric aspects of patient care. This paper aims to report on student attitudes to high-fidelity simulation teaching in psychiatry, as well as student attitudes to “integrated” teaching (i.e. covering both physical and psychiatric knowledge).

Design/methodology/approach

Semi-structured focus groups were conducted with medical students at a UK university. This exploratory approach generated rich qualitative data. Thematic analysis was used.

Findings

High-fidelity simulation teaching in psychiatry is well regarded by medical students, and helps students recognise that psychiatric problems can present in any clinical setting. This study has demonstrated that students value this type of “integrated” teaching, and there is potential for this approach to be more widely adopted in undergraduate health-care professional education. High-fidelity simulation could also be considered for incorporation in undergraduate examinations.

Originality/value

To the best of their knowledge, the authors are the first to conduct an in-depth exploration of attitudes to simulation teaching specifically in psychiatry. The authors are also the first to directly explore student attitudes to “integrated” teaching of psychiatry and physical health topics. The results will support the effective planning and delivery of simulation teaching in psychiatry, the planning of undergraduate summative assessments and will likely be of interest to health-care professionals, educational leads, simulation practitioners and students.

Details

The Journal of Mental Health Training, Education and Practice, vol. 16 no. 5
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 6 January 2012

Kamini Vasudev, Anna Mead, Karine Macritchie and Allan H. Young

This audit was conducted on acute psychiatric in‐patient wards with the aim of establishing if valproate prescribing in acute mania followed evidence‐based guidelines with…

Abstract

Purpose

This audit was conducted on acute psychiatric in‐patient wards with the aim of establishing if valproate prescribing in acute mania followed evidence‐based guidelines with particular emphasis on formulations used and whether accelerated valproate dosing was employed.

Design/methodology/approach

Case notes from 43 (42 percent male) patients admitted with mania and subsequently discharged on valproate were reviewed. Valproate formulation, weight measurement (necessary for dose‐calculation in accelerated dosing), initial valproate dose and increments, serum valproate monitoring and other prescribed psychotropic agents were noted.

Findings

Most (95 percent) patients received sodium valproate (epilim chrono/generic), the remaining received valproate semi‐sodium (depakote). All but one patient received antipsychotic medication in combination. Weight was recorded in only four (9 percent) patients. The mean valproate daily dose after the first week was 1,027 mg (sd=408). It took 29 (sd=42) days to reach the maximum daily dose (1,426 mg sd=467) from valproate initiation. Serum levels were monitored in 34 (79 percent) cases, but the mean period between valproate initiation to the first serum level test was 38 (sd=47) days. A significant positive correlation was found between days taken to reach maximum dose and hospital stay (Spearman's rho=0.41, n=43, p=0.006, two‐tailed).

Practical implications

Accelerated valproate dosing was not common practice, which may have resulted in suboptimal efficacy, probably leading to combination treatment.

Originality/value

This study highlights the need for adequate initial dosing and dose increments when treating manic patients and suggests current practice is not evidence‐based. Local prescribing policy and national guidelines' influence on practice are discussed.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 1
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 17 February 2012

Elizabeth Hughes, Yvette Brown and Robert Tummey

The focus of this paper is to consider the findings of a survey, which aims to identify the types of training that acute mental health staff could access, in relation to workforce…

Abstract

Purpose

The focus of this paper is to consider the findings of a survey, which aims to identify the types of training that acute mental health staff could access, in relation to workforce development and substance misuse issues in acute mental health care.

Design/methodology/approach

An electronic survey was developed and distributed using work email lists to all clinicians who worked in acute mental health services across a region in England. Not all NHS organisations agreed to participate.

Findings

A total of 89 clinicians responded to the survey, some failed to indicate their consent, therefore the results of the 77 that did are presented. The main finding was that most acute care staff had only accessed mandatory training such as risk assessment. Many staff had not been trained in the use of psychosocial approaches. Drug and alcohol specific activities were performed on the whole only “sometimes”.

Research limitations/implications

It was not possible to determine the total number of potentially eligible staff who were sent the survey, therefore, response rates cannot be calculated. It is possible that the findings may not be generalisable to other services. There may be bias in those who choose to respond to an electronic email, in terms of those who had access to a computer or who were more IT literate. In addition, the survey did not specifically set out to examine substance misuse issues as its main focus.

Practical implications

Acute care staff work with service users with increasingly complex needs. Creative and cost effective ways of facilitating access to training and support must be found as a priority to ensure that staff have the competencies to identify and manage substance users effectively in acute mental health settings.

Originality/value

The findings reinforce previous studies highlighting the deficit in access to psychosocial interventions training for acute care staff.

Open Access
Article
Publication date: 1 September 2013

John E. Berg and Jorid Grimeland

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a…

Abstract

Hospitals are labor intensive facilities based on highly skilled employees. A merger of hospitals is an effort to increase and rationalize this production. Decisions behind a merger are made at the top leadership level. How this might be done is demonstrated by examples from a 36 bed acute psychiatric facility. The aim of the study was to calculate the hidden costs of fragmented destruction of parts of a total hospital supply to patients after a merger. Fragmented destruction is the deliberate stopping of activities deemed not part of the core activities of the hospital without due consideration of the impact on core activities. The proposed changes to operational expenses at a single acute psychiatric hospital were materials for the study. The changes included activities as a reduction in local laboratory service, cleaning services, closure of physiotherapy unit, closing of cultural activities and reduced productivity. The selected activities are calculated as giving an imputed gain of € 630,000 as indicated by the leadership. The not calculated costs of reducing or removing the selected activities are estimated at € 1,955,640. The cost of staff disappointment after a merger is difficult to assess, but is probably higher than assumed in the present calculations.

Imputed cost containment is not attained. The calculations indicate that implemented changes may increase cost, contrary to the belief of the leadership at both the hospital level and further up in the hospital trust.

Arguments in favor of a merger have to be scrutinized thoroughly for optimistic neglect of uncalculated costs of mergers. Future hospital mergers and selected fragmentation of productive tasks at ward or hospital levels should include calculations of unavoidable costs as shown in the present paper.

Details

Mental Illness, vol. 5 no. 2
Type: Research Article
ISSN: 2036-7465

Keywords

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