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This paper is an extended review and expert commentary on a recently published study by the Centre for Housing Policy (CHP) which discusses the complexities of research in “housing related support” in the UK context, and proposes further work. This review aims to explore the strengths and limitations of the study; and the potential wider relevance outside the UK research context.

The review methodology is traditionally that of expert opinion. The reviewer draws upon previous evaluation studies of mental health and housing, commissioned by the UK Dept of Health, the (Dept of) Communities and Local Government, the National Institute for Mental Health in England, and the Care Services Improvement Partnership, including additional material on the Mental Health Minimum Dataset.

The CHP report reviewed raises important questions over the complexities of evidencing innovative services. Despite some omissions, it should be helpful to health local commissioners in assessing the value of services; and the further research the report proposes is to be welcomed. The report also provides a useful introduction to “housing related support” for an international research audience, less familiar with the UK social policy and funding context.

The review introduces and recommends the CHP study – which is itself a valuable contribution to future research on housing‐related support – to a wider audience. The review also includes additional material never before published on the potential research value in the context of the Mental Health Minimum Dataset.

This paper is an account of the discussions and recommendations by the exper t advisory panel on potential metrics and ‘sentinel indicators’ for improved outcomes in housing and mental health, as par t of an inter‐agency seminar called to advise on the development of metrics and measures for community mental health, for Fair Society, Healthy Lives: The Marmot Review (Marmot, 2010). The seminar covered all aspects of mental health in both its broadest and narrower senses.Much of the background material for these discussions, therefore, cuts across familiar knowledge silos between the fields of health and housing. Where it is necessary to elucidate the text, references are included to relevant research and policy frameworks that may be unfamiliar to the general reader. This paper is not, however, intended as a general literature review nor is it an evaluation of the available research. A paper on this subject will feature in a future issue of the Journal.1The conclusions from the panel discussion are presented in four main areas, reflecting the need to specify metrics across the wide‐ranging interface between housing and mental health, while still keeping the task manageable. Five current or potential health service metrics were proposed as having par ticular value as signal indicators. Two of these (relating to primary care prevention and public health) have no precision as yet, par tly as new services and approaches are still evolving. Among existing health datasets, the Mental Health Minimum Dataset (MHMDS) (NHS Information Centre, 2009a), SITuation REPor ts (SITREPS) (Department of Health, 2003), and the Summary Care Record data were singled out, though each is thought to need more work to improve the current data categories as well as data collection.One rather more fundamental point made was that the identifying, assessing and encouraging of effective inter‐sector par tnership work will be the key to tackling health inequalities. The use of other, non‐health services data therefore holds great potential for a better recognition both of needs and of outcomes in successful par tnership work, especially where this can be interpreted at local level. These wider comments are elaborated in the context of housing, but may be applicable to all effor ts to evidence and work with the social determinants and the social outcomes of mental health. For the future, a combination of well‐crafted nationally sanctioned metrics and the ‘soft intelligence’ of locally identified meaning may be most effective.Subsequent developments confirm the potential in cross‐sector development work, and indicate the potential for fur ther collaboration via the local performance framework. As policy frameworks continue to evolve rapidly, the ar ticle ends with a Codex, updating the relevant policy frameworks context since the seminar (in Spring 2009) and especially in the context of a new coalition government with aspirations to ar ticulate and promote public health in the context of the local performance framework and the ‘new localism’ agenda. This final section and comments therein are therefore entirely the responsibility of the author.

Four routes or pathways have now been identified by which individuals may come within the scope of PSA 16 National Indicator 149, which is concerned with monitoring efforts to achieve settled accommodation for individuals with significant mental health problems. This article focuses on their needs and the identification of those with mental health needs as seen through these four principal routes. An understanding of these four possible pathways can help to identify areas for priority action, local delivery chains and partnerships, and also highlight some of the challenges and risks in and for delivery.

The North of England characteristically has higher levels of alcohol‐related harm and higher levels of mental illness compared with the South. The purpose of this paper is to present observations on the use of services by people who have both alcohol and mental health problems to explore the equality and economic impact of services.

Inpatient hospital datasets as well as other NHS service datasets were examined to gather intelligence on alcohol and co‐occurring mental and behavioural disorders.

The study finds that there are high levels of dual diagnosis (DD) of alcohol and mental health in the North West with significantly higher rates in the more socially deprived areas and gap in access to services.

These health inequalities in relation to DD can only be demonstrated robustly for hospital inpatient admissions because other datasets currently provide intelligence only at larger geographies – such as Primary Care Trust – or by service provider.

Population surveys are useful to generate estimates of the prevalence of mental health issues in alcohol users which then reveal that there are greater inequalities in access to services in more deprived populations. Such valuable intelligence should be generated at the local level so that the most appropriate and the most cost effective services can be commissioned for the local population.

This is the first time that the economic cost of DD in the various services has been estimated.

This paper seeks to provide an overview of how the involvement of clinicians in the design and implementation of an electronic clinical information system has contributed towards more effective clinical governance, while improving the care of patients with a diagnosis of psychosis.

A data collection form was designed by a consultant in public health and a group of consultant psychiatrists to facilitate and standardise the data to be collected and stored on the information system. Two research nurses conducted a retrospective case note audit to record specified data on all existing patients from an inclusive diagnosis list in contact with CMHTs.

The establishment of PsyCIS has increased the understanding of the nature and prevalence of psychosis in Greater Glasgow for patients aged 18‐65. As well as giving some insight into how the needs of this patient group are being addressed, it has also provided clinicians with the ability to benefit from their collective experience on the treatment and support of this patient group.

To ensure excellent data quality and information management systems, it is essential to involve clinicians in their design and validation. The primary goal of information should be to aid clinical practice and patient care. Well designed datasets will also provide information that can inform clinical governance as well as the management of services and resources.

This paper supports the view that clinical audit and electronic clinical information systems are imperative for effective clinical governance.

While efforts to mainstream collection of ethnicity in routine health datasets have gathered pace since the Race Relations (Amendment) Act 2000, relatively little attention has focused on the capture of migrants, and data on asylum seekers and refugees are even more sparse. There is negligible coverage in the key datasets for primary and secondary care, and only a few of the new contract datasets to support the National Service Frameworks accord importance to the migrant population. Some of the communicable disease data collections record country of birth, but its incompleteness is a drawback. Given the growing size of the non‐UK‐born population and the accumulating evidence on the health and health care needs of the migrant population, country of birth merits a place alongside other access variables such as age, sex, ethnicity, socioeconomic status and place of residence in routine data collection. While record linkage studies offer some scope, and there is currently a focus on obtaining improved migration statistics in the forthcoming census and other data flows, health and social care sources remain a neglected area.

This paper aims to present an overview of the current state of evidence on the effect of housing circumstances, and housing‐related interventions, on adult mental health and well‐being. It covers the entire range of health from chronic illness to positive thriving, and both individual and community‐level/public health.

The paper is based upon a purposive review, commissioned originally for the UK Department of Health; and therefore is selective in giving priority to research relevant to public policy considerations, and to the UK context. Research with a variety of methodological foundations is considered, where robust enough by its own standards.

The available evidence gives conditional support to policies accentuating empowerment at individual and community levels; early intervention; locality or place‐based interventions; and integrated working practice. The complexity of methodological issues emerges as a key challenge for research in this field, and for the prospect of evidence‐based national policy. Meanwhile local knowledge and interpretation of data in context may be more reliable than context‐blind studies.

Where “hard evidence” is unavailable, reports of the lived experience of individuals and in communities remain a legitimate basis for policy and commissioning.

This appears to be the first attempt in print to cover such a wide canvas in one overview.

In this study we demonstrate how the Health of the Nation Outcomes Scales for secure and forensic service users (HoNOS‐secure) tracks risk and recovery in men with mental illness and men with learning disability in a secure care pathway. Total and individual HoNOS‐secure item ratings made by multi‐disciplinary teams across the course of a period of admission (mean 15 months) for 180 men were examined. There was significant positive change on the clinical and risk‐related scales of HoNOS‐secure for patients in the learning disability care pathway (N = 48) between initial and final ratings. In the mental health care pathway (N = 132 patients) an apparent lack of change masked a more complex picture, where initial decline in HoNOS‐secure ratings was succeeded by significant improvement. Results suggest that it is challenging to measure clinical and risk‐related medium‐term clinical outcomes objectively for these patients, particularly in relation to core issues of treatment of mental disorder, and reduction of both problem behaviour and risk to others. However, it is important that practitioners continue to strive to demonstrate the benefits of care and treatment through appropriate outcomes measures.

The emphasis on outcomes rather than process is an area that is receiving significant attention across the delivery of public sector services, and the question ‘so what?’ is increasingly being asked of service providers. With service user self‐direction being the focus of both provision and commissioning over the coming years, there will be an increasing need to justify the delivery and development of social care in terms of the end result. Strong leadership and vision is required across the public sector if this change, in both organisational culture and service user expectation, is to be achieved.Leadership as both a competency and an organisational function has been well researched within health and social care. The literature largely points towards the need for clarity and strength within the strategic vision, especially when considering the management of change and multifaceted partnerships, both of which are crucial to the delivery of social care outcomes. The actual detail of the outcome framework, and the means by which it can be measured and quantified, is still an area of debate, and as such the aim here is to highlight some of the benefits and barriers that may be faced as the reform of the social care system evolves, with a specific focus on the impact that leadership can have on the delivery of an outcome‐focused mental health social care serviceThe analysis of outcome‐focused organisations is a relatively new concept in health and social care, and as such this paper seeks to debate the evidence in terms of whether leadership contributes to better service user outcomes in mental health social care. Dynamics within organisations, professions and with service users are all key considerations in the achievement of positive outcomes, and the role of the leader is to empower the staff group to power share and move towards co‐production in order to embed choice, control and service user contribution in the overall philosophy and culture of mental health service provision and developments.The overall conclusions of this paper are that leadership is important in terms of shaping services, ensuring governance and promoting innovation, and as a result it is possible to suggest that leadership and positive outcomes do have a direct correlation.

The purpose of this paper is to establish the effectiveness of self-management training as an intervention for people using secondary mental health services.

A self-management and peer support intervention was developed and delivered by secondary mental health service users to 262 people with psychiatric diagnoses living in the community. Data on wellbeing and health-promoting behaviour were collected at three time points (baseline, six, and 12 months).

Participants reported significant improvements in wellbeing and health-promoting lifestyle six and 12 months after self-management training. Peer-led self-management shows potential to improve long-term health outcomes for people with psychiatric diagnoses.

Due to the lack of a control group, the positive changes cannot definitively be attributed to the intervention. Other limitations were reliance on self-report measures, and the varying numbers of completers at three time points. These issues will be addressed in future studies.

The evaluation demonstrated the effectiveness of self-management training for people with psychiatric diagnoses, suggesting self-management training may bring significant wellbeing gains for this group.

This study represents a first step in the implementation of self-management approaches into mental health services. It demonstrates the feasibility of people with psychiatric diagnoses developing and delivering an effective intervention that complements existing services.

This is the first study to investigate the effectiveness of a self-management training programme developed and delivered by mental health service users in the UK.