Search results

The purpose of this clinical audit was to review the adherence to the 2017 care and treatment review policy across two NHS assessment and treatment units. Care and treatment reviews should be offered to people with an intellectual disability and/or autism who are at risk of admission into a mental health hospital.

Admission and discharge data was collected across two assessment and treatment units between January 2019 and December 2022. Adherence to the care and treatment review policy was also reviewed as was length of inpatient stay. A retrospective evaluation was conducted. Triangulation of data was collected via the trusts’ electronic patient record system and NHS analytics team. Descriptive statistics, Mann–Whitney U test and a one-way ANOVA with post hoc tests were used in the analysis.

An increase in behaviours of challenge and deterioration of mental health were the main reasons for admission. Forty-nine percent (30) of those admitted to the assessment and treatment units accessed a care and treatment review. Care and treatment reviews were more frequently provided for individuals experiencing longer inpatient stays.

There is limited evidence relating to outcomes and impact of care and treatment reviews. Further research is required to explore effectiveness of care and treatment reviews to understand benefits and appropriately prioritise resource.

There are limited risk assessment tools validated for use with the internet child abuse material (I/CAM) offender cohort. Developed through a multi-stage process, the purpose of this paper is to present the “Estimated Risk for Internet Child Sexual Offending” (ERICSO), a new tool for I/CAM offender assessment, including demographic, collection, nature of engagement and social domains, plus a structured professional judgement section. Validation studies remain ongoing.

This paper presents a case series analysis of six Australian men, including two Aboriginal men, convicted of I/CAM offences to pilot proposed ERICSO domains and commence validation against the short self-esteem scale, University of California Los Angles loneliness scale, internet sex screening test and the sexual violence risk-20 V2.

Participants of all ages generally reported histories of mental health diagnosis and/or treatment and substance abuse. Two participants reported prior sexual offending, one for I/CAM offences. Participants expressed sexual preferences for female child victims and were convicted of possessing thousands of I/CAM files. Two participants reported accessing I/CAM for over six and 10 years, respectively, before detection by law enforcement.

Preliminary implications indicate ERICSO higher scores are consistent with I/CAM offenders having more online sexual behaviour diversity and more areas of risk/treatment need. For example, participants with problematic self-esteem and loneliness in our data set have higher ERICSO scores. Social connectedness may be a relevant factor though definitive conclusions cannot be drawn from the small sample size.

The ERICSO presents novel assessment of factors in considering treatment targets in addressing both illegal I/CAM and problematic legal sexual behaviours.

This study aims to investigate outcomes of multisystemic therapy (MST) using the Youth Level of Service/Case Management Inventory (YLS/CMI) – part I.

This study, using a pre-post design, included a sample of 2,123 Norwegian youths (mean age = 14.7, SD = 1.34). The MST team supervisors assessed the YLS/CMI risk factors in addition to five behavioral treatment goals (Lives at home, Attends school/work, No violence/threats, Law-abiding and Drug-free) before and after treatment. In addition, data included responses from parent interviews six months post treatment.

Significant correlations were found between the total and dynamic YLS/CMI change scores and the additive index of behavioral treatment goals. In addition, the YLS/CMI change scores predicted the five treatment goals at the termination of treatment and at six-month follow-up.

The results indicate that the YLS/CMI is a valuable assessment tool for predicting the achievement of MST behavioral goals in adolescents with serious problem behavior.

This study provides an evaluation of the YLS/CMI in a Norwegian context and adds support for continued use of the YLS/CMI in MST.

This paper provides new insights about the YLS/CMI inventory as a tool for examining treatment change in MST. Results show that the YLS/CMI captures relevant risk factors in the youths’ environment.

Autism spectrum conditions (ASC) and borderline personality disorder (BPD) have overlapping symptom profiles. Dialectical behaviour therapy (DBT) is an established treatment for self-harm and BPD, but little research has investigated the outcomes of DBT for ASC populations. This exploratory service evaluation aims to investigate the outcomes of a comprehensive DBT programme for adolescents with a diagnosis of emerging BPD and a co-occurring ASC diagnosis as compared to those without an ASC diagnosis.

Differences from the start to end of treatment in the frequency of self-harming behaviours, BPD symptoms, emotion dysregulation, depression, anxiety, the number of A&E attendances and inpatient bed days, education and work status, and treatment non-completion rates were analysed for those with an ASC diagnosis, and compared between those with an ASC diagnosis and those without.

Significant medium to large reductions in self-harming behaviours, BPD symptoms, emotion dysregulation and inpatient bed days were found for those with an ASC diagnosis by the end of treatment. There were no significant differences between those with an ASC and those without in any outcome or in non-completion rates. These findings indicate that DBT may be a useful treatment model for those with an ASC diagnosis, though all results are preliminary and require replication.

To the best of the authors’ knowledge, this is the first study to report the outcomes of a comprehensive DBT programme for adolescents with an ASC diagnosis, and to compare the changes in outcomes between those with a diagnosis and those without.

This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Lengthy and complex routes to specialist care may negatively affect clinical profiles of trauma survivors accessing mental health services. The purpose of this study was to describe the characteristics and referral pathways of a cohort of clients accepted by a specialist trauma service in England; and investigate the associations between referral pathways and clients’ clinical profiles, namely, pre-treatment levels of post-traumatic stress, depression, anxiety, stress and post-traumatic growth.

Data on 117 consecutive, accepted referrals were extracted from clients’ clinical records. Information on demographics, trauma histories, clinical presentations and referral pathways was synthesised through summary statistics. Correlational analyses were conducted to test associations with pre-treatment scores.

Clients accessing the service were highly complex and mostly experienced prolonged, interpersonal trauma. Pathways to the service varied, but 50% of the sample had at least four “steps” in their referral histories and seven previous clinical contacts. The average time between trauma and specialist referral was 16.34 years. The number of referral steps positively, significatively and moderately correlated with anxiety and stress at pre-treatment.

Limitations include issues around collecting past referral information, the small sample size for clients with available pre-treatment data and the lack of post-treatment scores.

This evaluation provides an informative overview of the characteristics and referral pathways of clients accessing a specialist trauma service. It also offers preliminary insights on the relationship between clients’ routes into the service and their clinical profiles. Practice, commissioning and research implications are discussed.

This paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.

This is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.

Of 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.

This paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

The UK Mental Health Act (MHA) Reform (2021) on race and ethnicity promotes new governmental strategies to tackle inequalities faced by ethnically racialised communities detained under the MHA. However, there is a scarcity in personality disorder and ethnicity research. This study aims to investigate what is available in the UK in relation to prevalence, aetiology and treatment provisions of personality disorder for ethnically diverse patients, and to understand their interconnectedness with mental health and criminal justice service provisions. Three key areas of investigations were reviewed, (1) UK prevalence of personality disorder amongst ethnically diverse individuals; (2) aetiology of personality disorder and ethnicity; (3) treatment provisions for ethnically diverse individuals diagnosed with personality disorder.

A scoping study review involved a comprehensive scanning of literature published between 2003 and 2022. Screening and data extraction tools were co-produced by an ethnically diverse research team, including people with lived experience of mental health and occupational expertise. Collaborative work was complete throughout the review, ensuring the research remained valid and reliable.

Ten papers were included. Results demonstrated an evident gap in the literature. Of these, nine papers discussed their prevalence, three papers informed on treatment provisions and only one made reference to aetiology. This review further supports the notion that personality disorder is under-represented within ethnic minority populations, particularly of African, Caribbean and British heritage, however, the reasons for this are multi-facetted and complex, hence, requiring further investigation. The evidence collected relating to treatment provisions of personality disorder was limited and of low quality to reach a clear conclusion on effective treatments for ethnically diverse patients.

The shortage of findings on prevalence, aetiology and treatment provisions, emphasises the need to prioritise further research in this area. Results provide valuable insights into this limited body of knowledge from a UK perspective.

This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England.

The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed.

Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions.

This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments.