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Open Access
Article
Publication date: 2 September 2021

Andrew Healey, Alexandra Melaugh, Len Demetriou, Tracey Power, Nick Sevdalis, Megan Pritchard and Lucy Goulding

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A…

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Abstract

Purpose

Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care.

Design/methodology/approach

The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London.

Findings

Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub.

Research limitations/implications

Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub.

Practical implications

Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams.

Social implications

Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems.

Originality/value

The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

Details

Mental Health Review Journal, vol. 26 no. 4
Type: Research Article
ISSN: 1361-9322

Keywords

Open Access
Article
Publication date: 30 March 2020

Chris Dayson, Jo Painter and Ellen Bennett

This paper aims to identify the well-being outcomes of a social prescribing model set within a secondary mental health service recovery pathway and understand the key…

3960

Abstract

Purpose

This paper aims to identify the well-being outcomes of a social prescribing model set within a secondary mental health service recovery pathway and understand the key characteristics of a social prescribing referral for producing these outcomes.

Design/methodology/approach

A qualitative case study of one mental health social prescribing service with three nested case studies of social prescribing providers. Semi-structured interviews were undertaken with commissioners, providers and patients (n = 20) and analysed thematically.

Findings

Social prescribing makes a positive contribution to emotional, psychological and social well-being for patients of secondary mental health services. A key enabling mechanism of the social prescribing model was the supportive discharge pathway which provided opportunities for sustained engagement in community activities, including participation in peer-to-peer support networks and volunteering.

Research limitations/implications

More in-depth research is required to fully understand when, for whom and in what circumstances social prescribing is effective for patients of secondary mental health services.

Practical implications

A supported social prescribing referral, embedded within a recovery focussed secondary mental health service pathway, offers a valuable accompaniment to traditional approaches. Current social prescribing policy is focussed on increasing the number of link workers in primary care, but this study highlights the importance models embedded within secondary care and of funding VCSE organisations to receive referrals and provide pathways for long-term engagement, enabling positive outcomes to be sustained.

Originality/value

Social prescribing is widely advocated in policy and practice but there are few examples of social prescribing models having been developed in secondary mental health services, and no published academic studies that everybody are aware of.

Details

Journal of Public Mental Health, vol. 19 no. 4
Type: Research Article
ISSN: 1746-5729

Keywords

Article
Publication date: 7 March 2018

Saeideh Saeidi and Richard Wall

Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models…

Abstract

Purpose

Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models of care assert that better preventative services, closer integration between professionals, and increased access to cognitive behavioural therapy in primary care will bring substantial benefits and improved outcomes. The purpose of this paper is to explore the benefits of integrating mental health services into primary care, and improving collaboration between secondary services and primary care. There is a transition underway in healthcare whereby a focus on illness is being supplemented with, or refocused towards achieving better patient well-being. New approaches to service provision are being proposed that: focuses on more holistic outcomes; integrates services around the user; and employs innovative system techniques to incentivise professional and organisational collaboration. Such a transition must be inclusive of those with mental health needs managed in primary care and for those people with serious mental illness in secondary care.

Design/methodology/approach

This paper discusses the issues of professional collaboration and the need to provide mental healthcare in a continuous and coordinated manner and; how this may improve timely access to treatment, early diagnosis and intervention. Importantly, it is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit of better integrating mental health into a more collaborative system may lie.

Findings

Identifying and addressing issues of parity is likely to call for a new approach to service provision that: focuses on outcomes; co-designs services integrated around the user; and employs innovative contracting techniques to incentivise provider integration.

Practical implications

There is a transition underway in healthcare whereby a focus on illness is being supplemented with or refocused towards working towards wellness. Such a transition requires primary care mental health services to be provided in a continuous and coordinated manner in order to meet the health needs of people with serious mental illness.

Originality/value

It discusses the issues of professional collaboration and how this may improve timely access to treatment, early diagnosis and intervention. It is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit may lie.

Details

Journal of Integrated Care, vol. 26 no. 2
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 22 June 2009

Robin Johnson

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…

Abstract

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.

Details

Housing, Care and Support, vol. 12 no. 1
Type: Research Article
ISSN: 1460-8790

Keywords

Article
Publication date: 1 October 1997

Beverlea Frowen

This Overview article focuses on mental health services and, specifically, looks at some aspects of government policy that remain a challenge for managers and practitioners. In…

Abstract

This Overview article focuses on mental health services and, specifically, looks at some aspects of government policy that remain a challenge for managers and practitioners. In particular, new ways are considered of undertaking the assessment of need and a description is given of one initiative: benchmarking to help practitioners measure performance. Examples of new service models emerging as part of the primary care agenda are also highlighted.

Details

Journal of Integrated Care, vol. 5 no. 5
Type: Research Article
ISSN: 1476-9018

Article
Publication date: 21 May 2021

Nicholas Weaver

Theoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways.

Abstract

Purpose

Theoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways.

Design/methodology/approach

Recent mental health service transformation in Wales, United Kingdom, has been stimulated by a policy programme underpinned by person-centred recovery values. This paper offers analysis informed by the perspectives of Niklas Luhmann and other noted theorists to examine escalating service system complexity related to this transformation. Analysis builds upon the findings of a qualitative study employing thematic discourse analysis of talk of people with mental illness and associated workers.

Findings

In total, three themes were constructed in participants' talk: “Competing versions of recovery”, “Misaligned service expectations” and “Disrupted care pathways.” Recovery may be understood as a form of moral communication and autopoietic meaning-making activity, according to Luhmann's radical constructionist epistemology. This has the potential to generate competing versions of recovery, a key contributor to escalating complexity.

Research limitations/implications

Findings could be developed further by continued investigation of the relationship between recovery implementation and service fragmentation.

Social implications

A more judicious, balanced policy-implementation may cultivate optimal conditions for recovery pluralism by avoiding polarisation towards either top-down, policy-based recovery implementation or a proliferation of approaches at the grassroots level. Findings have implications for healthcare settings beyond the scope of mental healthcare, given the prevalence of person-centred care internationally.

Originality/value

A simplistic view of recovery implementation should be challenged. Recovery should not be considered a “magic bullet” for mental healthcare delivery. Haphazard recovery-implementation may have detrimental effects of escalating complexity, service fragmentation and disrupted care pathways.

Details

Kybernetes, vol. 51 no. 5
Type: Research Article
ISSN: 0368-492X

Keywords

Article
Publication date: 23 May 2011

Sarah Anderson

This paper reports on a pilot project that helps women offenders and other women with multiple needs to access mental health care. The paper aims to increase understanding of the…

Abstract

Purpose

This paper reports on a pilot project that helps women offenders and other women with multiple needs to access mental health care. The paper aims to increase understanding of the mental health needs of these women and the barriers they face in accessing and sustaining engagement with appropriate care.

Design/methodology/approach

Key principles and early findings are presented from the partnership project based in Anawim Women's Centre, in which a mental health nurse (MHN) is seconded to the centre one day a week. These are presented in light of research relating to the mental health needs of vulnerable women.

Findings

Early findings suggest mental health needs are largely trauma‐based and co‐occurring substance misuse problems are common. The MHN negotiated a pathway into secondary care with community mental health team managers but concerns continue about the ability of primary care services to meet the complex needs of these women. Principles for working with this group include: provision in a women‐only space; a focus on engagement; flexibility; holistic support and empowering women and voluntary sector staff.

Research limitations/implications

Findings are based on eight months of one pilot project in which 22 women were seen.

Practical implications

Practical implications are outlined for commissioners and service managers of mental health care services for vulnerable women.

Originality/value

Research and experience suggest that women with multiple problems can struggle to engage with traditionally structured services and fail to access the holistic support they need. This paper increases understanding of this problem and suggests how these women might be better supported.

Details

Advances in Dual Diagnosis, vol. 4 no. 2
Type: Research Article
ISSN: 1757-0972

Keywords

Article
Publication date: 8 April 2020

Lucy Fiddick, Emily Neale, Falguni Nathwani, Kristina Bennert and James Gregory

Evidence-based psychological therapies are available for severe and enduring mental health problems, but resources and access to these are limited within England. Practitioners in…

Abstract

Purpose

Evidence-based psychological therapies are available for severe and enduring mental health problems, but resources and access to these are limited within England. Practitioners in community mental health teams (CMHTs) can act as gatekeepers for access to psychological therapies for those in secondary care, but little is known about how they make referral decisions. This paper aims to understand how CMHT practitioners make decisions about who to refer or not, to secondary care psychological therapy services (PTS).

Design/methodology/approach

A total of 11 CMHT practitioners were interviewed to understand the decision making processes underpinning their referrals or otherwise, to a PTS within NHS England. The data were analysed qualitatively using thematic analysis.

Findings

Thematic analysis resulted in 11 sub-themes under three main themes of the self, the organisation and wider structure and the service user. Results indicated that some participants were referred automatically for psychological therapy if a service user asked or if there was external pressure to refer, while others’ decisions were informed by contextual information such as the service user’s ability to engage or change, risk status and limited organisational resources.

Originality/value

This study explores the decision making of multi-disciplinary professionals referring to PTS. The findings have important implications for understanding some of the factors that can influence patient access to psychological treatment in secondary care.

Abstract

Details

Mental Health Review Journal, vol. 9 no. 4
Type: Research Article
ISSN: 1361-9322

Article
Publication date: 9 March 2015

Eva Cyhlarova, David Crepaz-Keay, Rachel Reeves, Kirsten Morgan, Valentina Iemmi and Martin Knapp

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

Abstract

Purpose

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

Design/methodology/approach

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).

Findings

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.

Research limitations/implications

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.

Practical implications

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.

Social implications

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.

Originality/value

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.

Details

The Journal of Mental Health Training, Education and Practice, vol. 10 no. 1
Type: Research Article
ISSN: 1755-6228

Keywords

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