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The paper aims to explore the barriers that currently exist to patient‐driven treatment within the field of mental health care and reform.
Abstract
Purpose
The paper aims to explore the barriers that currently exist to patient‐driven treatment within the field of mental health care and reform.
Design/methodology/approach
This study represents action learning research using grounded theory to explore a possible causal basis for recidivism related to non‐compliance with medication. Interviews addressed concerns from the literature around perceived barriers to patient‐driven treatment evidenced by non‐compliance with medically recommended pharmaceutical treatment. Results were correlated to look for emergent themes that were used to form the basis for subsequent interview questions.
Findings
An analysis of the resulting emergent themes illustrated the importance of participatory treatment and coaching rather than medically applied paternalistic care, which is seen as encouraging learned helplessness on the part of patients. Similar helplessness was also revealed in clinicians themselves. Patients' awareness of their own needs and demands for more services place clients and the caregivers at odds over appropriate care in an environment of limited resources.
Research limitations/implications
The research was limited to only a small number of interviewees in one institution, all of whom were closely associated with mental illness in various capacities. The grounded theory nature of the research does, however, provide a framework for more research in other institutions to test and further explore some of the findings.
Practical implications
The study demonstrated a reinforcement of Maslow's theory of needs hierarchy. The study illustrated a step‐wise approach to treatment to decrease the rate of failure and recidivism in mental health care. The provision of a stable living environment was viewed as instrumental in improving patients' compliance with pharmaceutical treatment. An action plan was therefore created to initiate the support of a transitional/emergency house by various community groups in partnership with pharmaceutical manufacturing companies.
Originality/value
Recidivism in mental health‐created by non‐compliance in pharmaceutical treatment, is a major issue in Canada's health care system. This study brings to the forefront issues from a number of perspectives in order to form a course of action in response to its findings.
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Steffen Moritz, Cicek Hocaoglu, Anne Karow, Azra Deljkovic, Peter Tonn and Dieter Naber
Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced…
Abstract
Neuroleptic non-compliance remains a serious challenge for the treatment of psychosis. Non-compliance is predominantly attributed to side effects, lack of illness insight, reduced well-being or poor therapeutic alliance. However, other still neglected factors may also play a role. Further, little is known about whether psychiatric patients without psychosis who are increasingly prescribed neuroleptics differ in terms of medication compliance or about reasons for non-compliance by psychosis patients. As direct questioning is notoriously prone to social desirability biases, we conducted an anonymous survey. After a strict selection process blind to results, 95 psychiatric patients were retained for the final analyses (69 participants with a presumed diagnosis of schizophrenia psychosis, 26 without psychosis). Self-reported neuroleptic non-compliance was more prevalent in psychosis patients than non-psychosis patients. Apart from side effects and illness insight, main reasons for non-compliance in both groups were forgetfulness, distrust in therapist, and no subjective need for treatment. Other notable reasons were stigma and advice of relatives/acquaintances against neuroleptic medication. Gain from illness was a reason for non-compliance in 11-18% of the psychosis patients. Only 9% of all patients reported no side effects and full compliance and at the same time acknowledged that neuroleptics worked well for them. While pills were preferred over depot injections by the majority of patients, depot was judged as an alternative by a substantial subgroup. Although many patients acknowledge the need and benefits of neuroleptic medication, non-compliance was the norm rather than the exception in our samples.
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Ruth Bagshaw, Rhiannon Lewis and Andrew Watt
The aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental…
Abstract
Purpose
The aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental health unit; also, to gauge whether staff can evaluate attachment style reliably.
Design/methodology/approach
Retrospective case note analysis on 55 inpatient treatment episodes were supplemented with staff ratings of service user attachment style. Records of untoward incidents were centrally retrieved. Kappa statistics were used to analyse levels of staff agreement regarding service user attachment style.
Findings
Attachment style was associated with hostile episodes, treatment non‐compliance and service user aggression. Post hoc analysis on a subset of data yielded poor overall agreement in ratings of attachment style (Kappa=0.2). Further analysis revealed a sex‐based asymmetry with high consistency in ratings of female service users (Kappa=0.79) and very low inter‐rater reliability for male service users (Kappa=−0.05). It is important to note that the staff included in the interrater reliability analysis were female.
Research limitations/implications
The sample was small, the observation period was short and staff conducting the ratings had no special training in the rating tool.
Practical implications
Attachment style per se played a significant part in the success and/or failure of service user treatment (when measured by misconduct). However, the validity of staffs' ratings of attachment style may interact systematically with the sex of staff and service users. These findings have important implications for the application of the concept of attachment in clinical settings.
Social implications
Mental health professionals place central importance on the establishment of therapeutic relationships between clinicians and service users. Service user attachment style is assumed to play a role in mediating the success, or failure, of relationships with clinicians.
Originality/value
This study makes a novel contribution to the application of attachment theory to secure mental health care, it also demonstrates that gender is an important factor in staff appraisals of service users' approach to treatment.
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The purpose of this paper is to review issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings.
Abstract
Purpose
The purpose of this paper is to review issues of relevance to practitioners using group cognitive behavioural therapy (CBT) with women in secure settings.
Design/methodology/approach
The extant literature on CBT as applied to women in secure settings is reviewed to highlight best practice. Aspects of best practice are illustrated with examples from a women's medium secure service.
Findings
Obstacles include the characteristics of the patient group, treatment non compliance and an environment that accepts the primacy of security over treatment. Environmental and need factors amenable to intervention are highlighted in addition to CBT specific considerations that include the timing and intensiveness of treatment, content and delivery of therapy, treatment readiness and use of the group process. The use of a manualised CBT group treatment aid attempts to ensure treatment integrity is associated, and which is associated with treatment outcome. A focus on the social and environmental factors that attribute to the therapeutic milieu is vital to treatment generalisation, as is harnessing the therapeutic potential of the built environment. Finally, treatment evaluation imposes a structure that can facilitate progress in treatment.
Originality/value
There is comparatively little work on CBT group treatments for women in secure settings. Attempts to synthesise best practice initiatives in this area are helpful in guiding treatment developments.
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The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight…
Abstract
Purpose
The purpose of this paper is to identify risk factors for interruptions in opioid dependence treatment and barriers to (re) entering effective treatment through real-world insight on current opioid dependence treatment in the UK.
Design/methodology/approach
Project Access UK, a national survey deployed across multiple regions in England, Wales and Scotland, collected data on the perspectives of patients receiving medication-assisted treatment (MAT) for opioid dependence (n=248), out-of-treatment opioid users (n=196), and physicians (n=100).
Findings
Both patients and users reported multiple prior episodes of MAT and detoxification. Among patients, 57 per cent reported continuing illicit drugs use in addition to their treatment, 25 per cent had misused (injected or snorted) and 30 per cent had diverted (sold or given away) prescribed opioid medications. Diverted medications were currently being used by 26 per cent of out-of-treatment users; of these, 21 per cent used methadone. Supervised dosing was rated as the condition of treatment with the biggest impact on daily life. Daily supervision was a requirement for 44, 34 and 23 per cent of patients receiving methadone, mono-buprenorphine and buprenorphine-naloxone, respectively.
Practical implications
Interruptions to opioid dependence treatment in various forms can hamper the recovery of opioid-dependent patients. The benefits of MAT may not be fully realised if treatment is interrupted due to compliance failure, or inflexible treatment programmes leading to premature treatment exit. These findings serve to highlight areas in which treatment disruption can potentially be addressed.
Originality/value
Consideration of these findings may aid in the optimisation of treatment delivery practices to better meet the UK policy of recovery, and ultimately improve patient outcomes.
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Studies have shown that mental health professionals find working with patients with dual diagnosis challenging, and the purpose of this paper is to examine some of these…
Abstract
Purpose
Studies have shown that mental health professionals find working with patients with dual diagnosis challenging, and the purpose of this paper is to examine some of these challenges.
Design/methodology/approach
In total, 85 mental health professionals from 8 different mental health centres in Denmark were interviewed. The data analysis was inspired by a grounded theory approach.
Findings
Different challenges in the dual diagnosis treatment were identified and they suggested that the focus of treatment was mainly on the mental illness rather than the substance use disorder. The single focus of the treatment made it challenging to treat patients with dual diagnosis sufficiently. While several studies explain the single focus by inadequate competencies among professionals, the present study suggests that the single focus is also explained by the way that the treatment is organised. For instance, standardized treatment packages and insufficient guidelines on substance abuse treatment make it challenging to treat patients with dual diagnosis.
Originality/value
This paper suggests that a more flexible, and a longer period of, treatment, together with more sufficient guidelines on dual diagnosis treatment and a more formalized collaboration with the substance abuse treatment centres, will make it a less challenging issue to treat patients with dual diagnosis.
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Therese O' Donoghue, John Shine and Olufunto Orimalade
The purpose of this paper is to present preliminary data on a cohort of patients referred to a specialist forensic medium-secure autism spectrum disorder (ASD) service during its…
Abstract
Purpose
The purpose of this paper is to present preliminary data on a cohort of patients referred to a specialist forensic medium-secure autism spectrum disorder (ASD) service during its first two years of opening and to identify variables associated with admission to the service.
Design/methodology/approach
Data on all referrals to the service (n=40) was obtained from clinical files on demographics, offending history, psychiatric history and levels of therapeutic engagement. The sample was divided into two groups: referred and admitted (n=23) and referred and not admitted (n=17). Statistical analysis compared the two groups on all variables.
Findings
Totally, 94 per cent of all individuals assessed had a diagnosis of autism, however, structured diagnostic tools for ASD were used in a small minority of cases. About half the sample had a learning disability, almost four-fifths had at least one additional mental disorder and almost three-quarters had a history of prior supervision failure or non-compliance with treatment. The sample had a wide range of previous offences. No significant differences were found between the groups on any of the variables included in the study.
Research limitations/implications
The present study presents a starting point to follow up in terms of response to treatment and characteristics associated with treatment outcome.
Practical implications
The sample had a wide range of clinical and risk-related needs. Both groups shared many similarities.
Originality/value
This highlights the need for comprehensive assessment looking at risk-related needs so that individuals are referred to an optimal treatment pathway.
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Geris Serran and William Marshall
This paper reviews the literature on therapeutic process specific to sexual offender treatment. The general clinical literature emphasises the importance of therapist style, the…
Abstract
This paper reviews the literature on therapeutic process specific to sexual offender treatment. The general clinical literature emphasises the importance of therapist style, the client's perceptions, the therapeutic alliance and cohesiveness. We highlight the importance of therapist characteristics, group cohesion and emotion in effective treatment of sexual offenders. Implications for programming and research are emphasised.
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Health promotion and rehabilitation models of care are valuable for persons with chronic health conditions, but when these individuals are dependent on a life-maintaining…
Abstract
Health promotion and rehabilitation models of care are valuable for persons with chronic health conditions, but when these individuals are dependent on a life-maintaining technology, such as kidney dialysis, a cure-oriented model may dominate the system within which they receive care. Providers can preserve their monopoly over expert treatment knowledge by defining the key care issues, by limiting patients’ access to expert knowledge, and by discrediting the patient as a responsible actor. Multiple care paradigms can benefit patients with chronic conditions, however, empowering the patient-actor to collaborate with the clinician to maximize functioning and well-being as well as patient survival.
Elizabeth Barkham, Santhana Gunasekaran and Caroline Lovelock
The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.
Abstract
Purpose
The purpose of this paper is to offer a general review of care for individuals on the autism spectrum, including Asperger's syndrome within a medium secure setting.
Design/methodology/approach
The authors undertook a review of the current literature relating to pathways to care, offending characteristics and treatment interventions. They examined the available evidence and current practice.
Findings
Available evidence suggests offending characteristics of individuals with autism are different to those of mental disorders such as schizophrenia. Limited evidence in treatment interventions and in risk management for those with autism presents a challenge to clinicians. The heterogeneity makes a strong case for an individualised case formulation approach to treatment and risk management.
Originality/value
This paper offers an overview of the current evidence base relating to the treatment of individuals with autism spectrum disorders within medium secure settings.
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