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This paper highlights the social context of common mental disorders in primary care and the paucity of evidence relating to effective social interventions. It introduces…
This paper highlights the social context of common mental disorders in primary care and the paucity of evidence relating to effective social interventions. It introduces the ABC‐E Model of Emotion, which combines social interventions with psychological therapy, and discusses how the implementation of the new role of graduate primary care mental health worker (GPCMHW) provides an opportunity for holistic practice in helping individuals experiencing mild to moderate mental health difficulties in primary care. It provides a case example of the implementation of the ABC‐E model and makes recommendations for further research including the evaluation of the model and GPCMHW training programmes.
Clinical governance is at the heart of the drive to improve the quality of patient care in the National Health Service. National targets, the National Service Frameworks…
Clinical governance is at the heart of the drive to improve the quality of patient care in the National Health Service. National targets, the National Service Frameworks and NICE Guidance are providing a top‐down mechanism to deliver this improved care. Improved patient care will not happen, however, without the active and enthusiastic participation of clinicians and clinical teams. This article sets out the mechanism that Dorset Healthcare NHS Trust, a specialist mental health and learning disability trust, has established to foster and develop the involvement of clinical teams in clinical governance. The article describes the development of team‐based clinical governance portfolios and sets out how they have been used to focus clinical teams on clinical governance activities.
The purpose of this paper is to introduce problem-solving therapy (PST) training to an Ontario health region. The aim of this pilot project was to increase psychotherapy…
The purpose of this paper is to introduce problem-solving therapy (PST) training to an Ontario health region. The aim of this pilot project was to increase psychotherapy access by training community-based outreach clinicians and to understand their satisfaction with the training program as well as their confidence in applying the principles of PST.
Clinicians from Southwestern Ontario who provide community-based mental health outreach services to older adults were invited to participate in this training opportunity. Selection was based on their existing client base, the geographic area they served, and self-reported foreseeable PST training benefits. Selected individuals received an eight-hour in-person didactic session, eight one-hour case-based learning opportunities, and individual case supervision. Acquired knowledge, perceived confidence in their skills, level of adherence to PST principles in clinical interactions, and satisfaction with the training program itself were measured.
Of the 36 applicants, eight trainees were selected. All trainees completed their training and seven were successfully certified in PST. Trainees indicated a high level of satisfaction with the training experience. According to the evaluation tools, trainee confidence in providing PST significantly increased, though there was no statistically significant change in knowledge.
This study provides the first evidence that PST can be introduced within a regional geriatric mental health service in Canada. The training involved both in-person training, web-based conferencing sessions and a supervisory component. The training lasted 16 hours and resulted in staff skill development in an evidence-based psychotherapy modality.
The purpose of this paper is to describe a framework for the implementation of clinical governance (CG) within a mental health and addictions service at all functional…
The purpose of this paper is to describe a framework for the implementation of clinical governance (CG) within a mental health and addictions service at all functional levels within the system (consumer, clinician, team, service and unit level). It aims to include and enlarge on the functional subdivisions of CG (as practised in the National Health Service (NHS)) by identifying 11 component domains of interest.
The paper briefly reviews the varying interpretations of the concept of CG in the literature and associated difficulties in its implementation.
Several authors have pointed out the difficulties in the implementation of CG at the operational level. In particular, CG is often seen as top‐down, “managerial” in its focus rather than providing clinicians at the coal‐face with a device for quality assurance and improvement.
The framework asserts that the 11 component domains are relevant at all levels within a healthcare delivery system; in fact, conversations already occur around these domains at all levels with variable frequency, with a focus that is relevant to that level, determined by the needs at each level.
The paper describes a practical framework for implementation of CG within a mental health and addictions service that addresses some of the criticism levelled against the concept of CG in the literature. This conceptualisation provides a seamless merging of the so‐called managerial and clinical imperatives around clinical governance.
This paper examines the promises and pitfalls of integrated models of mental health care in primary care settings, and presents the findings of a successful pilot study of…
This paper examines the promises and pitfalls of integrated models of mental health care in primary care settings, and presents the findings of a successful pilot study of integrated care. There are a number of technological breakthroughs which could improve treatment outcomes. However, research indicates improved outcomes are likely only when changes include new practice patterns, patient education, and systematic monitoring of patient process and outcomes. A study in a health maintenance organization is presented based on a staged model of treatment and exemplifying these principles. We conclude that integrated models while technically feasible, are organizationally complex in actual practice.
The purpose of this paper is to argue that recent attention has been focused on inpatient services at the expense of community mental health teams and that it is time to…
The purpose of this paper is to argue that recent attention has been focused on inpatient services at the expense of community mental health teams and that it is time to redress the balance.
This is a personal viewpoint.
In writing this piece it has enabled us to focus on just how widespread the issues are regarding the lack of focus on community services, and that the view and paradigm needs to change on all levels/structures. Services need to recognise the wide scope of community services and the part they inevitably play in someone’s recovery journey. It also throws the spotlight on services working too often in silos deeply affecting people in receipt of the services.
To stimulate debate about the role of community mental health teams.