Mental observation wards: an alternative provision for emergency psychiatric care in England in the first half of the twentieth century

In England in the early twentieth century, mental observation wards in workhouses developed as a parallel service to the asylums for emergency mental health admissions under the 1890 Lunacy Act, particularly in urban areas and especially London on account of local policy. The purpose of the wards was initial patient assessment and early discharge or certification, and there was controversy between their medical supporters and the Board of Control about any extension of their remit which might usurp the role of the mental hospitals. Their significance declined with changing policy in the NHS era, as more emergency admissions went to mental hospitals, and local treatment units emerged. This article explores the history of these services in the context of the changing legal and policy frameworks.

An audit of liaison service provision in Aneurin Bevan University Health Board

AimsAneurin Bevan University Health Board (ABUHB) isundertaking a review of the Mental Health Liaison Service provision within it's acute general hospitals. The current liaison service is a small nurse led team which is available between 8am and midnight. ABUHB has recently opened a new Specialist Critical Care Hospital with the liaison service moving into a new base. A new model of care has been developed across the healthboard which has stretched the Liaison Service across several sites. Therefore, the liaison service may need to expanded to be able to provide high quality and timely care across a wide geographical area. The audit aims to idenitfy areas in which the liaison service is performing well in while identiying areas that need improvement. This audit may provide a focus for recommendations to enhance the current liaison provision.MethodThe liaison service was audited against RCPsych Psychiatric Liaison Accreditation Network (PLAN) quality standards. PLAN identified eighteen functions of a liaison team and provided details of quality standards within each function. These standards are either considered essential, expected or desirable. An accredited service is expected to meet 100% of essential standards, 80% of expected standards and 60% of desirable standards. Data were taken from a combination of sources including ABUHB policies, service managers and senior clinicians within both mental health and acute services.ResultWhen comparing the current liaison service provision in ABUHB, 30% of essential standards were not met and 21% were only somewhat met. Particular domains that were identifed as needing improvement included policies and procedures and urgent and emergency mental health care. 36% of expected standards were met with 41% not met. Notable domains that the service was performing poorly in included governance; induction, and providing teaching and support to acute colleagues. 89% of desirable standards were not met.ConclusionThe audit idenitifed that the current liaison service fails to meet core standards set out by RCPsych. This audit provides quantitative data to demonstrate that the liaison service is in need of improvement and investment. As a result, enhaving the current liaison service is now a priortity for the health board. A business case is being developed to consider enhancing the liaison service with a view to developing a Consultant led multidisciplinary team. The business case can use PLAN quality standards to make recommendations for improvements to the service.

Preparedness, Confidence, and Best Practices in Preventing, Recognizing, Managing Mental Health Cases in NCAA Institutions

Context: Currently, the National Collegiate Athletic Association (NCAA) recommends written policies and procedures that outline steps to support student athletes facing a mental health challenge and the referral processes for emergency and non-emergency mental health situations. Objective: To assess the mental health policies and procedures implemented and athletic trainers' perceived confidence in preventing, recognizing and managing routine and crisis mental health cases across all three divisions of NCAA athletics. Design: Cross-sectional survey design and chart review. Setting: Online survey Participants: Athletic trainers with clinical responsibility at NCAA member institutions (n=1091, 21.5% response rate). Main Outcome Measure(s): Confidence in screening, preventative patient education, recognizing and referring routine and emergency mental health conditions (5-point Likert scale: 1= not at all confident, 2= hardly confident, 3= somewhat confident, 4= fairly confident, 5=very confident) using a content-validated survey (Cronbach's α=0.904) and mental health policy and procedure chart review. Results: Respondents indicated they felt “fairly confident” with screening (40.21%, n=76/189) for risk of any mental health condition and “fairly confident” in implementing preventative patient education (42.11%, n=80/190). Respondents were “fairly confident” they could recognize (48.95%, n=93/190) and refer (45.79%, n=87/190) routine mental health conditions. Respondents were “fairly confident” they could recognize (46.84%, n=89/190), but “very confident” (46.32%, n=88/190) they could refer mental health emergencies. Policies lacked separate procedures for specific emergency mental health situations such as suicidal/homicidal ideation (36.1%), sexual assault (33.3%), substance abuse (19.4%), and confusional state (13.9%). Policies lacked prevention measures such as student athlete involvement (16.7%) in annual mental health education (16.7%). Conclusions: While athletic trainers were generally confident in their ability to address emergency and routine mental health conditions, opportunities exist to improve policies for prevention, screening, and referral. Best practice guidelines should be used as a guide to develop policies that foster an environment of mental health wellness.