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The purpose of this paper is to analyse rates of inpatient admissions for people with learning disabilities in England and to identify factors associated with higher rates of inpatient admission.

Secondary analysis of data submitted as part of the Transforming Care programme in England.

2,510 people with learning disabilities in England were inpatients on 31st March 2016. Findings indicate that people with learning disabilities are at risk of higher rate of inpatient admission than can be explained by prevalence within the general population; this risk may be associated with areas where there are higher numbers of inpatient settings which provide assessment and treatment for people with learning disabilities.

Variability in the quality of the data submitted by commissioners across the 48 Transforming Care Plan areas mean that greater attention needs to be paid to determining the validity of the common reporting method. This would improve the quality of data and insight from any future analysis.

The study’s findings are consistent with the hypothesis that geographical variations in the risk of people with learning disabilities being admitted to inpatient services are not consistent with variations in prevalence rates for learning disability. The findings support the hypothesis that building alternatives to inpatient units should impact positively on the numbers of learning disabled people who are able to live independent lives.

This is the first study which examines the data which commissioners in England have reported to NHS England on the experience of people with learning disabilities who are admitted as inpatients and to report on the possible factors which result in higher rates of inpatient admission.

The Swedish health care system is commonly characterized as a national health-service (or Beveridge) model (Freeman, 2000; Blank and Burau, 2004). It is certainly both financed by taxes and organized as a government responsibility, but it has developed over time as a decentralized rather than a national system (Lindgren, 1995). In Europe, only Finland seems to have a more decentralized system (Häkkinen, 2005). Most political decisions on health and health care in Sweden are made at the level of its presently 20 county councils and 290 local municipalities, which are empowered to put proportional income taxes on their citizens in order to finance their activities. Central government has a more passive role. Apart from supervising the fulfilment of the overall objectives of the health care legislation, which has a strong emphasis on equity,¹ its influence is primarily manifested through indirect measures such as general and targeted subsidies. It can also impose ceilings on county council and municipality taxes.

Despite contemporary mental health services shifting to a community‐based model of care, acute inpatient care is still necessary for many patients experiencing an acute psychological crisis. As inpatient services cost the National Health Service nearly £600 million a year, initiatives to reduce time spent in hospital, whilst maintaining safety and quality, are being actively promoted on a national level. Mental health patients in Hertfordshire spend on average two weeks in hospital during their acute crisis. The aim of this study is to reduce bed occupancy rates by implementing a novel approach to inpatient management.

A pragmatic controlled clinical trial design was used to address the aim of this study.

The results demonstrate that, compared to a functionalized inpatient ward (one with a designated inpatient consultant psychiatrist conducting a weekly ward round), it is possible to reduce bed occupancy rates without increasing demand on other wards. Furthermore, 28‐day readmission rates and total admissions over seven days were reduced.

Limitations relating to the study design and potential generalisability to similar services are discussed. Further studies to triangulate the data are suggested.

This novel approach to inpatient management provides exciting data that suggest patients can be moved along the acute pathway more efficiently. Recommendations for further studies are made in light of the findings.

This paper will appeal to acute care clinicians, service managers, and commissioners of mental health services. It provides an evidence base for making efficiencies within the acute service whilst maintaining quality of care for patients.

Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.

A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.

After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.

A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.

Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.

This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.

Dual diagnosis poses particular challenges for inpatient mental health services. Workers have low levels of training, clinical experience and support to deliver integrated care that combines mental health and substance use interventions. In addition, inpatient workers have to balance being therapeutic with ensuring that illicit substance use does not occur on the wards. This often leads to confrontation and poor engagement.In order to improve the capabilities of the workers to deliver more effective interventions for this group of service users, dual diagnosis training should be a high priority for acute inpatient services. However, there are a number of challenges in the implementation of this including lack of resources to fund training and specialist roles, lack of time to attend training (and supervision), and lack of time to implement learning in routine care.This paper will describe the policy drivers for the improvement of dual diagnosis care in acute psychiatric inpatient services, and how two initiatives in London are overcoming some of the obstacles and showing some promising initial outcomes. This paper will make recommendations for future research and developments.

The purpose of this paper is to complete a thorough needs assessment that would enable the development of a robust pathway of care for adults with a learning disability requiring secure care, and to assist commissioners to make informed planning decisions.

The paper identified people with a learning disability originating from London who were in secure care, and collected data about them. The paper used reference groups to inform the analysis.

The paper identified 249 people in secure services and was able to include 136 patients in the analysis. In all, 64 were in NHS provision and 72 in independent sector provision; 109 (80.1 per cent) were male and 27 (19.9 per cent) female; on average, patients were cared for 61.5 miles away from their homes; NHS patients were far closer to home; 69.1 per cent had a mild learning disability; 82.3 per cent had a history of violence; approximately one in six patients could not progress due to a lack of an appropriate ward, facility, resource and/or intervention.

Secure care for this population is a major public health issue. Many are placed a long way from home. Local services should be developed, and there should be sufficiently robust “step down” places for patients to be discharged to.

Systematic identification of the needs of a marginalised group to enable better more appropriate care pathways to be developed in the future.

A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

The purpose of this study is to investigate the status of perceived need, seeking behavior and utilization of health services in the elderly population of Sanandaj (west of Iran).

This is a cross-sectional study conducted on 800 elderly people in Sanandaj. Subjects were selected using multistage sampling and data were collected using self-report questionnaires. A multivariate logistic model with odds ratios (ORs) was used to determine the relationship of independent variables with seeking perceived need. Also, the concentration index was used to measure the inequality in using health services.

The perceived need for outpatient (during the last 30 days) and inpatient health-care services (during the past 12 months) was 69.7% and 29.7%, respectively. Among them, the unmet need for outpatient and inpatient health-care services was 46.6% and 17%, respectively. Having health insurance (adjusted OR 12.08; 95% confidence interval [CI] 1.04–140.11), middle economic status (adjusted OR 5.18; 95% CI 1.30–20.51) and being in an age group of 65–70 years (adjusted OR 7.60; CI 1.42–40.61) increased the chance of seeking inpatient care. Also, being in an age group of 60–65 years (adjusted OR 0.41; 95% CI 0.18–0.95) reduced the chance of seeking outpatient care. There was also a pro-rich inequality in using outpatient health services.

The elderly population suffers from unmet health-care needs, especially in outpatient services. The most important reason for not seeking outpatient and inpatient services was financial barriers and self-medication, respectively. So, designing targeted policies and interventions to address barriers in the conversion of need to demand in the elderly population is essential.

Can models be set in place to prevent neglect and abuse in inpatient settings from becoming systemic? This article suggests that they can, and describes how the establishment of multi‐agency forums within care teams can help foster working practices that are open, accountable and respectful.