Head banging as a form of self-harm among inpatients within forensic mental health and intellectual disability services

2017 ◽  
Vol 41 (S1) ◽  
pp. S584-S585
Author(s):  
V. Chester ◽  
R. Alexander
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Care Pathway ◽  
Management Strategies ◽  
Security Incident ◽  
Search Terms ◽  
Self Harm ◽  
Short And Long Term ◽  
Competing Interest ◽  
One Year

Introduction“Head banging” is a common form of self-harm, linked to numerous negative outcomes including significant brain damage. However, little research has investigated the prevalence and correlates of head banging behaviour in clinical populations.MethodHead banging episodes were identified from the incident records (n = 5417) of two inpatient forensic services (one intellectual disability and one mental health), using relevant search terms. Rates were compared between individual patients, by gender, diagnosis and level of security. Incident accounts were analysed qualitatively using thematic analysis.ResultsTwo hundred and twenty nine incidents of head banging were recorded, occurring approximately every three days in each service. The prevalence of the behaviour between individual patients varied widely, ranging from one to 38 incidents within one year. Women and patients with intellectual disability appeared more likely to engage in head banging. Qualitative incident reports indicated that head banging was associated with mental distress, anger, and psychotic experiences.DiscussionHead banging occurs frequently in forensic services, and has documented associations with traumatic brain injury in affected individuals, thus negatively impacting progress through the care pathway and treatment outcomes. Further research should investigate short and long term management strategies and treatment approaches, in order to minimise harm.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Novel research on transition from child to adult mental health services in Europe: The MILESTONE project

2016 ◽  
Vol 33 (S1) ◽  
pp. S58-S59 ◽  
Author(s):  
H. Tuomainen ◽  
S.P. Singh ◽  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Service Providers ◽  
Care Pathway ◽  
Controlled Trial ◽  
Ethical Challenges ◽  
Adult Mental Health ◽  
Related Service ◽  
Competing Interest

IntroductionCurrent service configuration of distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS) is considered the weakest link where the care pathway should be most robust. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge for the EU.ObjectivesThe overall objective of the MILESTONE project is to improve transition from CAMHS to AMHS in diverse healthcare settings in Europe.AimsTo improve the understanding of current transition-related service characteristics, and processes, outcomes and experiences of transition from CAMHS to AMHS using a bespoke suite of measures; to explore the ethical challenges of providing appropriate care to young people as they move to adulthood; to test a model of managed transition in a cluster randomized controlled trial (cRCT) for improving health, social outcomes and transition to adult roles; and to develop training modules for clinicians and policy guidelines.MethodsData will be collected via systematic literature reviews; bespoke surveys to CAMHS professionals, experts and other stakeholders; focus groups with service providers and users and members of youth and mental health advocacy groups; and a longitudinal cohort study with a nested cRCT in eight EU countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS service users, their parents/carers, and clinicians, with assessments at baseline, 9, 18 and 27 months.ResultsFirst results are expected in 2016 with further major findings following in 2019.ConclusionsThe MILESTONE project will provide unprecedented information on the nature and magnitude of problems at the CAMHS-AMHS interface, and potential solutions to overcome these.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Visual and Hearing Impairments and their Impact on the Mental Health of Adults with Intellectual Disability

2020 ◽  
pp. 247-264
Author(s):  
Reza Kiani ◽  
Sugato Bhaumik
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Hearing Impairment ◽  
Mental Health Problems ◽  
Management Strategies ◽  
Signs And Symptoms ◽  
Autism Spectrum ◽  
Hearing Impairments ◽  
Care Givers ◽  
Raising Awareness

Visual and hearing impairments, congenital or acquired, are much more common in people with intellectual disability (ID) than the general population. These can be missed or diagnosed with delay if professionals rely just on the subjective reports by the families/care givers rather than objective screening and assessment. People with ID might be unable to complain about a visual or hearing impairment due to their communication difficulties. Therefore, diagnostic overshadowing might occur whereby these conditions might present with atypical signs and symptoms (e.g. loss of skills, isolation, and challenging behaviours) which could be attributed to dementia, depression, or other mental health problems. There has also been an overrepresentation of autistic-like features and autism spectrum disorder reported in people with visual and hearing impairment. Raising awareness of these comorbidities in people with ID will therefore facilitate early diagnosis and implementation of appropriate management strategies that can improve service provision for this vulnerable population.

Reflections on the use of a specialist acute assessment and treatment unit for adults with intellectual disability

2015 ◽  
Vol 9 (3) ◽  
pp. 132-138 ◽  
Author(s):  
Kiran Purandare ◽  
Anusha Wijeratne
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Care Pathway ◽  
Average Distance ◽  
Community Services ◽  
Discharge Process ◽  
Treatment Unit ◽  
Content Type ◽  
Catchment Areas ◽  
The Impact

Purpose – The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach – The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings – There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications – This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications – There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications – An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value – This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review.

scholarly journals Emergency Department Re-Presentations Following Intentional Self-Harm

2021 ◽  
Author(s):  
◽  
Silke Kuehl
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Suicide Attempts ◽  
Assessment Tool ◽  
Consumer Involvement ◽  
Mental Health Consultation ◽  
Care Needs ◽  
Admission Rates ◽  
Self Harm ◽  
One Year

<p>Repeat intentional self-harm (ISH) episodes are strongly correlated to suicide. Intentional self-harm for this thesis includes suicide attempts, deliberate self-harm and suicidal ideation. The aim was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Descriptive and inferential analyses were undertaken using the Statistical Programme for Social Science (SPSS). Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present ED with intentional self-harm. Such care needs to be provided in a safe way with the intent on reducing the distress experienced by people who intentionally self-harm.</p>

scholarly journals Emergency Department Re-Presentations Following Intentional Self-Harm

2021 ◽  
Author(s):  
◽  
Silke Kuehl
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Suicide Attempts ◽  
Assessment Tool ◽  
Consumer Involvement ◽  
Mental Health Consultation ◽  
Care Needs ◽  
Admission Rates ◽  
Self Harm ◽  
One Year

<p>Repeat intentional self-harm (ISH) episodes are strongly correlated to suicide. Intentional self-harm for this thesis includes suicide attempts, deliberate self-harm and suicidal ideation. The aim was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Descriptive and inferential analyses were undertaken using the Statistical Programme for Social Science (SPSS). Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present ED with intentional self-harm. Such care needs to be provided in a safe way with the intent on reducing the distress experienced by people who intentionally self-harm.</p>

Combination of clozapine and aripiprazole once-monthly in resistant schizophrenia. A review of a clinical case

2017 ◽  
Vol 41 (S1) ◽  
pp. s826-s826
Author(s):  
M. Palomo Monge ◽  
M.F. Tascon Guerra ◽  
J.F. Calvo Mauri ◽  
P. Padilla Romero ◽  
A. Duque Domínguez ◽  
...  
Keyword(s):  
Mental Health ◽  
Treatment Adherence ◽  
Successful Management ◽  
Good Tolerability ◽  
Outpatient Visits ◽  
Combined Use ◽  
Competing Interest ◽  
One Year ◽  
First Contact ◽  
Mental Health Unit

IntroductionWe report the successful management of a 49-year-old woman with an initial diagnosis of schizoaffective disorder transitioned to resistant schizophrenia. First contact with our psychiatrist service in 2000; referring problems with treatment adherence and occasional toxic abuse, she underwent 15 admissions in acute adult psychiatric hospitalisation units since then (last discharge March, 2015), and a one-year stay (2012–2013) in an adult mid-term mental health unit. She is currently followed-up throughout the major mental-health outpatient visits program.AimsThe patient was prescribed paliperidone 6 mg 2-0-0, oxcarbazepine 600 mg 1-0-1 and clonazepam 0.5 mg 1-0-1 during the last 2 months.MethodsDue to lack of treatment adherence and toxic abuse she suffered a psychotic decompensation in May 2015. She was then prescribed clozapine 200 mg 1-0-2, boosted with aripiprazole 400 mg once monthly. The adjunction of aripiprazole once monthly (AOM) was intended to improve treatment adherence, and to supplement the psychotic control of clozapine without entailing a worsening of therapy tolerability. The patient was monitored during 5 months in our unit.ResultsWe observed a positive psychopathological evolution of the patient, which allowed us to re-evaluate the initial diagnostic, ascribing the previous mood fluctuations to toxic consumption.ConclusionPrevious works have been published about the combination of clozapine and oral aripiprazole for the treatment of resistant schizophrenia, but, as far as we know, this is the first repost of the combined use of clozapine and AOM. Based on our results, this antipsychotic combination resulted in a psychopathological improvement of the patient, with good tolerability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The feasibility of using smartphone apps to manage self-harm and suicidal acts in adolescents admitted to an inpatient mental health ward

2020 ◽  
Vol 6 ◽  
pp. 205520762097531
Author(s):  
Frank Muscara ◽  
Olivia Ng ◽  
Louise Crossley ◽  
Sinh Lu ◽  
Lauren Kalisch ◽  
...  
Keyword(s):  
Mental Health ◽  
Management Strategies ◽  
Effect Sizes ◽  
Psychiatric Ward ◽  
Smartphone Apps ◽  
Inpatient Ward ◽  
Safety Plan ◽  
Self Harm ◽  
Almost All

Objective The aim of this study is to assess the feasibility (uptake, retention and adherence) and acceptability of a combination of smartphone apps to deliver a digitized safety plan, BeyondNow, and personalized management strategies, BlueIce, with adolescents discharged from a mental health inpatient ward following self-harm, suicidal ideation and/or behavior. Methods Participants in this pre-post pilot study included 20 adolescents between 13–18 years, presenting with self-harming or suicidal behaviors in an inpatient psychiatric ward at a tertiary pediatric hospital. Participants were familiarized with the apps and completed baseline measures prior to discharge. They used the apps for six weeks before completing the follow-up survey, which measured feasibility and acceptability of the apps, as well as suicide resilience. Results Seventeen participants completed the pilot. Most of the sample accessed both apps at least once, three accessed the BeyondNow safety plan five times or more, and six used the BlueIce toolbox five times or more. A total of 73.5% of the sample that experienced a crisis used at least one of the apps at least once. Forty seven percent felt that the apps would not keep them safe when in crisis, although almost all of the sample rated both apps as easy to use (94% for BeyondNow, and 82% for BlueIce). Medium to large effect sizes were also found with regard to improvements in suicide resilience. Conclusion Both apps were found to be feasible and acceptable in this population, and easy to use, although no conclusions can be drawn regarding the clinical efficacy of the apps.

A pharmacologic option to reduce hospital admissions and relapses of patients with severe mental illness

2017 ◽  
Vol 41 (S1) ◽  
pp. S753-S753
Author(s):  
N. Gomez-Coronado ◽  
P. Blanco ◽  
I. Martinez
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Descriptive Analysis ◽  
Psychotic Episode ◽  
Anti Psychotic ◽  
Before And After ◽  
Previously Treated ◽  
Competing Interest ◽  
One Year ◽  
Long Acting

IntroductionSome diseases relapses involve functional impairment that sometimes takes years to recover. We present our experience using long-acting aripiprazole as maintenance therapy in patients diagnosed with psychotic episode, acute mania (bipolar disorder) or personality disorder, who were previously treated with another anti-psychotic.AimsAnalyze what treatment were they taking before aripiprazole depot. Determine the number of hospital admissions and relapses before and after long-acting aripiprazole treatment.MethodsDescriptive analysis based on a sample of 37 patients, aged 18–65 years, treated during one year with anti-psychotics at two community mental health units.ResultsReduction of hospitalization average: 0.59/year with non-long-acting-aripiprazol anti-psychotic, 0.18/year with long-acting aripiprazol (66.6%).ConclusionLong-acting aripiprazole appears to reduce the number of hospitalizations and relapses compared to other anti-psychotics. However, the sample size is small and more studies are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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