scholarly journals Accessing Mental Health Services: a Systematic Review and Meta-ethnography of the Experiences of South Asian Service Users in the UK

2021 ◽  
Author(s):  
Riddhi Prajapati ◽  
Helen Liebling
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Cultural Identity ◽  
South Asian ◽  
Service Use ◽  
Cultural Safety ◽  
Service Users ◽  
The Uk ◽  
The Impact

Abstract Background Despite calls to address ethnic inequalities to accessing mental health services in the UK, governmental initiatives have had limited impact. Studies indicate that South Asian communities underutilise mental health services. Previous reviews have identified cultural and institutional factors that may influence service use, but these are mostly narrative and limited in their scope. Method A systematic literature search resulted in fifteen studies exploring the experiences of seeking help and barriers to accessing and using services from the perspective of British South Asian service users. Findings Qualitative data was synthesised through meta-ethnography, and three themes emerged: Distanced from Services, Dilemma of Trust and Threat to Cultural Identity. South Asian service users were positioned at a distance from being able to access services and stuck in a dilemma of mistrusting White and Asian professionals. They constructed their cultural identity through a set of important values which were neglected by mental health services. Service users, therefore, appeared to engage in an ongoing evaluation of the potential benefits of accessing services against the risks of threat to their personal and cultural identities. The findings are discussed in relation to Eurocentric models of care and community engagement approaches. Conclusion The review argues that institutional racism and cultural dissonance marginalise South Asian service users from access to quality and effective mental healthcare. It is recommended that services acknowledge the impact of alienation and powerlessness and advance their practices to establish trust and cultural safety for South Asian service users in the UK.

scholarly journals Primary care clinical management following self-harm during the first wave of COVID-19 in the UK

2021 ◽  
Author(s):  
Sarah Steeg ◽  
Matthew J Carr ◽  
Laszlo Trefan ◽  
Darren M Ashcroft ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Psychotropic Medication ◽  
Clinical Management ◽  
Practice Nurse ◽  
Self Harm ◽  
The Uk ◽  
The Impact

AbstractBackgroundA substantial reduction in GP-recorded self-harm occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown.AimTo examine the impact of COVID-19 on clinical management within three months of an episode of self-harm.Design and settingProspective cohort study using data from the UK Clinical Practice Research Datalink.MethodWe compared cohorts of patients with an index self-harm episode recorded during a pre-pandemic period (10th March-10th June, 2010-2019) versus the COVID-19 first-wave period (10th March-10th June 2020). Patients were followed up for three months to capture psychotropic medication prescribing, GP/practice nurse consultation and referral to mental health services.Results48,739 episodes of self-harm were recorded during the pre-pandemic period and 4,238 during the first-wave COVID-19 period. Similar proportions were prescribed psychotropic medication within 3 months in the pre-pandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs. 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (3.4%) was around half of that in the pre-pandemic cohort (6.5%).ConclusionDespite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to pre-pandemic levels. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.

scholarly journals Carers and co-production: enabling expertise through experience?

2015 ◽  
Vol 20 (4) ◽  
pp. 232-241 ◽  
Author(s):  
Eleanor Bradley
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Family Members ◽  
Mental Healthcare ◽  
Service Users ◽  
Content Type ◽  
The Impact

Purpose – The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design/methodology/approach – The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings – Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research limitations/implications – Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical implications – Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social implications – The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise. Originality/value – This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.

scholarly journals Alternatives to standard acute in-patient care in England: readmissions, service use and cost after discharge

2010 ◽  
Vol 197 (S53) ◽  
pp. s20-s25 ◽  
Author(s):  
Sarah Byford ◽  
Jessica Sharac ◽  
Brynmor Lloyd-Evans ◽  
Helen Gilburt ◽  
David P. J. Osborn ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Service Use ◽  
Community Mental Health Services ◽  
Index Admission ◽  
Lengths Of Stay ◽  
Clinical Records ◽  
The Impact

BackgroundResidential alternatives to standard psychiatric admissions are associated with shorter lengths of stay, but little is known about the impact on readmissions.AimsTo explore readmissions, use of community mental health services and costs after discharge from alternative and standard services.MethodData on use of hospital and community mental health services were collected from clinical records for participants in six alternative and six standard services for 12 months from the date of index admission.ResultsAfter discharge, the mean number and length of readmissions, use of community mental health services and costs did not differ significantly between standard and alternative services. Cost of index admission and total 12-month cost per participant were significantly higher for standard services.ConclusionsShorter lengths of stay in residential alternatives are not associated with greater frequency or length of readmissions or greater use of community mental health services after discharge.

FIVE YEARS ON: A COHORT STUDY OF YOUNG PEOPLE TREATED WITH ANTIPSYCHOTIC DRUGS WHO WERE TRANSITIONING FROM CHILD TO ADULT MENTAL HEALTH SERVICES IN THE LOMBARDY REGION, ITALY

2015 ◽  
Vol 101 (1) ◽  
pp. e1.2-e1
Author(s):  
Laura Reale ◽  
Antonio Clavenna ◽  
Rita Campi ◽  
Massimo Cartabia ◽  
Maurizio Bonati
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Psychiatric Disorders ◽  
Service Use ◽  
Transition Period ◽  
Early Adulthood ◽  
Antipsychotic Treatment ◽  
Lombardy Region ◽  
The Impact

The aim of this study was to monitor the pattern of service attendance and antipsychotic use in youth with psychiatric disorders crossing age boundaries for paediatric mental health services. Regional administrative health databases were used to identify subjects born in the 1989–1992 period, who were hospitalised for psychiatric disorders and had both outpatient visits and antipsychotic prescriptions between the age of 16 and 17 years. Information about service use, antipsychotic medication, and hospitalizations during the transition period covering the age of 18–20 years was collected. A total of 144 patients were identified. Risperidone was the most commonly prescribed drug (28% of youths), followed by haloperidol (22%) and olanzapine (19%). In early adulthood, 117 of 144 (81%) subjects were still attending a mental health service: 43% of whom were receiving parallel care, and 47 (40%) of whom were being seen by adult, and 20 (17%) by child, psychiatrists. In all, 99 of 144 (69%) continued antipsychotic treatment into adulthood, 65 of whom (66%) switched to another drug, with an increase in aripiprazole, and a reduction of haloperidol and chlorpromazine, prescriptions. Less than half (45%) were re-admitted for psychiatric disorders, mainly for schizophrenia. In conclusion, only 4 out of 10 adolescents completed the transition to adult services by the age of 20 years, while 30% discontinued drug therapy and only a third maintained the treatment received during adolescence. Monitoring therapeutic pathways in this challenging life period is essential, and further analyses on the impact of service transition on pharmacological treatment are ongoing.

Peer workers in mental health services: literature overview

2014 ◽  
Vol 20 (4) ◽  
pp. 286-292 ◽  
Author(s):  
Steve Gillard ◽  
Jessica Holley
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Lived Experience ◽  
Service Use ◽  
Health Service Delivery ◽  
Careful Consideration ◽  
List Type ◽  
Mental Health Service Delivery ◽  
The Uk

SummaryPeer worker roles are being introduced in mental health services in the UK and internationally, to support individuals in their recovery. There is substantial qualitative evidence that demonstrates benefits at an individual level and some evidence of impact on service use and costs, although there are currently few high-quality randomised controlled trials supporting these findings, especially from the UK. A growing body of research indicates that careful consideration of organisational issues regarding the introduction of peer worker roles – the distinctiveness and shared expectations of the role, strategic alignment, organisational support – might maximise their impact. Properly supported and valued peer workers are an important resource to the multidisciplinary team, offering experiential knowledge and the ability to engage patients in their treatment through building relationships of trust based on shared lived experience.LEARNING OBJECTIVESAppreciate the origins of the peer worker role and how the role has been introduced into mental health services to date.Understand the evidence for the benefits of peer worker roles, for patients, peer workers and mental health service delivery.Demonstrate awareness of the organisational and team-level barriers to and facilitators of introducing peer workers into, or alongside, existing multidisciplinary mental health teams.

The “constant tug-of-war” in mental health care in Greece

2018 ◽  
Vol 23 (3) ◽  
pp. 121-130 ◽  
Author(s):  
Niki Kyriakidou ◽  
Sofia Triliva
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Public Mental Health ◽  
Service Users ◽  
Content Type ◽  
Therapeutic Services ◽  
The Impact

Purpose The purpose of this paper is to focus on how mental health professionals involved in the therapeutic treatment of children in public mental health facilities in Greece experience and talk about the impact of the socioeconomic crises on the psychotherapeutic process. Design/methodology/approach In all, 21 semi-structured interviews were conducted and phenomenologically informed thematic analysis was used in analysing the data. Findings The results coalesced into two all-encompassing thematic structures articulating the following: first, the socioeconomic crises have permeated society and therapeutic praxis like a torrential and chronic rain storm. This has resulted in a deluge in demand for therapeutic services within the public mental health sector; second, mental health professionals describe their positioning and work as “a constant tug-of-war” where they are inundated and often overwhelmed with work, find themselves identifying with service users and taking on several roles simultaneously, and being challenged to find solutions often in dire and complex situations. They describe how creativity and flexibility are in demand in their day-to-day interactions and if they are to intervene in place of a health and welfare system that is faltering. Doing therapeutic work under such circumstances appears to be both emotionally onerous and stimulating with regard to conceptualising new ways of intervening in such complex psychosocial situations. Research limitations/implications The study is limited in that only mental health professionals presented their experiences and service users were not included. The findings do highlight how severe austerity policies impact mental health services and peoples’ lives. Practical implications The study has implications for policy regarding the provision and organisation of mental health services in contexts where crises and economic turmoil prevail. Social implications The results associate severe austerity with major changes in family and community life. Originality/value The paper provides insights and implications on how mental health services are impacted by socioeconomic conditions.

scholarly journals How has Covid-19 affected mental health nurses and the delivery of mental health nursing care in the UK? Results of a mixed methods study

2020 ◽  
Author(s):  
Una Foye ◽  
Christian Dalton-Locke ◽  
Jasmine Harju-Seppanen ◽  
Rebecca Lane ◽  
Lewys Beams ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Services ◽  
Nursing Care ◽  
Service Users ◽  
Mental Health Nursing ◽  
Mental Health Nurses ◽  
Inpatient Settings ◽  
Health Nursing ◽  
The Uk ◽  
The Impact

AbstractIntroductionWhile evidence has emerged concerning the impact of Covid-19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care.AimThis paper aims to explore how Covid-19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK.MethodWe investigated staff reports regarding the impact of the Covid-19 pandemic on mental healthcare and mental health service users in the UK, using a mixed methods online survey. A total of 897 nurses across a range of inpatient and community settings participated.DiscussionKey themes within the data explore: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments.Implications for PracticeService developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic.Accessible SummaryWhat is known on the subject?During the Covid-19 pandemic there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. Whilst nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored.What the paper adds to existing knowledge?This paper provides a unique insight into the experiences and impact that the Covid-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses, and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided.What are the implications for practice?By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced, and the impact the crisis has had on care for mental health service users. By doing so we can plan for the ongoing nature of this pandemic as well as the aftermath that the crisis may leave for our service users and workforce alike.Relevance StatementThis paper provides insight into the impact that the Covid-19 pandemic has had on the service and care that mental health nurses are expected to and can provide. As a workforce that often requires ongoing face to face contact with service users, many in serious distress, in inpatient and community settings, it is important that we understand their experiences and the challenges and risks that face this workforce. This will enable us to ensure that future planning, guidance, support and safeguarding can take place during the ongoing and future crises.

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