A survey of the role of allied mental health services in learning disabilities at Lanchester Road Hospital, Durham

IntroductionAllied mental health services play important role in patients’ care in Learning Disabilities as they are more in contact with the patients. Their knowledge about common side effects of medication and relevance of routine blood investigations help Clinicians to provide appropriate care and support.ObjectiveTo ascertain the knowledge of Allied mental health services about common side effects of medication and relevance of routine blood investigations.MethodologySurvey questionnaire was distributed to staff between November 09 and January 10.The questions included about the common side effects of Lithium, Insulin, High dose Antidepressants, High dose Antipsychotics and Anticoagulant Medication. Relevance of Routine Blood Tests and Blood Pressure Monitoring were also asked. Number of questionnaire distributed - 60. Number of Respondents -30. Responses were collected anonymously.ResultsRespondent Classification -Registered Nurses- 4, Nursing Assistants- 12, Care Assistants- 10, Associate Practioner- 1, Deputy Charge Nurses- 2, Occupational Therapist -1.Of the Registered Nurses, Associate Practioners, Deputy Charge Nurses the results were 100%. With the Nursing Assistant- 25% (3), Care Assistant- 10% (1) and OT was aware of Routine blood tests and BP.The Nursing Assistants and Care Assistants were aware of one side effect for Lithium, Clozapine, Anticoagulants and Insulin. They were not aware of side effects of High dose Antidepressants & High dose Antipsychotics. The awareness of relevance of Routine Blood Tests and Blood Pressure Monitoring was 80% and 90% respectively.Conclusions•Arrange educational meetings to the Support workers•Conduct the survey in a year's time

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Mental health services use by melanoma patients receiving adjuvant interferon: association of pre-treatment mental health care with early discontinuation

Current Oncology ◽

10.3747/co.24.3685 ◽

2017 ◽

Vol 24 (6) ◽

pp. 503

Author(s):

T.P. Hanna ◽

T. Baetz ◽

J. Xu ◽

Q. Miao ◽

C.C. Earle ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

High Dose ◽

Health Services Use ◽

Mental Health Services Use ◽

Melanoma Patients ◽

Pre Treatment ◽

High Dose Interferon ◽

Services Use

Background Although high-dose interferon (hd-ifn) is the sole approved adjuvant systemic treatment for melanoma in many jurisdictions, it is toxic. We sought to assess the population-level effects of hd-ifn toxicity, particularly neuropsychiatric toxicity, hypothesizing that such toxicity would have the greatest effect on mental health services use in advanced resected melanoma.Methods This retrospective population-based registry study considered all melanoma patients receiving adjuvant hd-ifn in Ontario during 2008–2012. Toxicity was investigated through health services use compatible with hd-ifn toxicity (for example, mental health physician billings). Using stage data reported from cancer centres about a subset of patients (stages iib–iiic), a propensity-matched analysis compared such service use in patients who did and did not receive hd-ifn. Associations between early hd-ifn discontinuation and health services use were examined.Results Of 718 melanoma patients who received hd-ifn, 12% were 65 years of age and older, and 83% had few or no comorbidities. One third of the patients experienced 1 or more toxicity-associated health care utilization events within 1 year of starting hd-ifn. Of 420 utilization events, 364 (87%) were mental health–related, with 54% being family practitioner visits, and 39% being psychiatrist visits. In the propensity-matched analysis, patients receiving hd-ifn were more likely than untreated matched controls to use a mental health service (p = 0.01), with 42% of the control group and 51% of the hd-ifn group using a mental health service in the period spanning the 12 months before to the 24 months after diagnosis. In the multivariable analysis, early drug discontinuation was more likely in the presence of pre-existing mental health issues (odds ratio: 2.0; 95% confidence limits: 1.1, 3.4).Conclusions Stage iib–iiic melanoma patients carry a substantial burden of mental health services use whether or not receiving hd-ifn, highlighting an important survivorship issue for these patients. High-dose interferon is associated with more use of mental health services, and pre-treatment use of mental health services is associated with treatment discontinuation. That association should be kept in mind when hd-ifn is being considered.

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Audit on antipsychotic prescribing in children and young people with a learning disability under the care of mental health services in Surrey

BJPsych Open ◽

10.1192/bjo.2021.229 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S71-S71

Author(s):

Timothy Cherian James ◽

Asifa Zainab ◽

Salvatore Mura ◽

Aaron Vallance ◽

Dola Okusi

Keyword(s):

Mental Health ◽

Primary Care ◽

Side Effects ◽

Mental Health Services ◽

Health Services ◽

Learning Disability ◽

Antipsychotic Medication ◽

The Other ◽

Nice Guidelines ◽

Medication Reviews

AimsTo check the extent to which National Institute of Clinical Excellence (NICE) guidelines were being followed in clinical practice with regards to prescribing antipsychotic medication to Child and Adolescent Mental Health Services (CAMHS) patients with a diagnosed learning disability (LD).MethodA data collection tool (based on a similar Royal College of Psychiatrists [RCPsych] audit) was filled out with retrospective data from patients’ clinical records, then analysed using Microsoft Excel and Microsoft Powerpoint.The agreed standards were the NICE guidelines.There were no ethical issues as the data were retrospective and anonymised.Sample size was 13, comprising 7 males and 6 females.All service users were less than 18 years of age.Result7 out of the 13 patients who were prescribed antipsychotics had a Severe/Profound LD.Among the 5 patients who had been prescribed antipsychotic medication, 4 were on Risperidone and 2 were on Aripiprazole. The reasons for starting antipsychotic medication were clearly documented for all 5, the most common reasons being overt aggressive behaviour and general agitation/anxiety.Only 1 patient had antipsychotic medication initiated in the previous 12 months. NICE guidelines had been generally followed for the management of this case, with good documented evidence.For the other 4 patients, in whom antipsychotic medication was initiated more than 12 months ago, there was a lack of documentation of the subsequent assessment of side effects, extra-pyramidal side effects, body weight, blood pressure, glycaemic control and lipid profile. 1 of these patients did not have a documented review of antipsychotic medication in the previous 6 months. For the other 3 patients, their medication reviews did not consider whether to reduce the dose or stop antipsychotic medication.1 patient had been transferred to primary care, with a clear transfer of prescribing responsibility and documented evidence that written guidance was provided to primary care which addressed all the necessary management details.ConclusionAlthough there was clear documentation of reasons for initiating antipsychotics, there appeared to be a lack of awareness of NICE guidelines for antipsychotic medication reviews, side effect and metabolic markers assessment, and their documentation. This is an area for potential change in practice to conform better to national guidelines and improve patient care.

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Screening of metabolic side effects of antipsychotics in patients with mental disorder

European Psychiatry ◽

10.1016/s0924-9338(11)72979-0 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1274-1274 ◽

Cited By ~ 1

Author(s):

H.T. Reddy ◽

R. Edwards

Keyword(s):

Mental Health ◽

Smoking Cessation ◽

Side Effects ◽

Mental Health Services ◽

Health Services ◽

Physical Health ◽

Lipid Profile ◽

Service Users ◽

Due Dates ◽

Metabolic Side Effects

This audit was undertaken to evaluate what screening is undertaken for metabolic side effects of antipsychotic drugs in patients under the care of Ceredigion Community Mental Health.Raise awareness with Local health Board regarding metabolic screening Raise awareness regarding four aspects of metabolic syndrome.Audit tool based on POMH (Prescribing Observatory for Mental Health) Topic 2B Audit Data was collected from medical notes, abstracted and inputted into Microsoft Excel. The sample consisted of 15 service users; 11(73%) male and 4(27%) female.Most individuals where of white British/Irish ethnicity, (14, 93%).Most (14, 93%) patients primary clinical psychiatric diagnosis based on the ICD10 category was F20–F29.Six (40%) individuals in the sample smoked, of which two (33%) were offered help with smoking cessation. There was evidence of diabetes in three case notes. In one (33%) case note it was Mental Health services that uncovered the diabetes. One service users file had evidence of a known diagnosis of Hypertension. This was not discovered by Mental Health services. Three service users had evidence of a disturbed lipid profile. In two (66%) of these notes it was Mental Health services that discovered the disturbed lipid profile.Lifestyle management pack: guidance and resources for staff and service users around diet, exercise, smoking cessation and other health lifestyle issues. Physical health check reminder cards: A patient-held card to record the results of physical health checks and due dates for new appointments.

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Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125319895839 ◽

2019 ◽

Vol 9 ◽

pp. 204512531989583 ◽

Cited By ~ 1

Author(s):

Carol Paton ◽

Clive E. Adams ◽

Stephen Dye ◽

Oriana Delgado ◽

Chike Okocha ◽

...

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Mental Health Services ◽

Health Services ◽

Physical Health ◽

Health Monitoring ◽

High Dose ◽

Behavioural Disturbance ◽

Falling Asleep ◽

Recommended Level

Background: We aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services. Methods: The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK. Results: Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services. Post-RT physical health monitoring did not reach the minimum recommended level in 1933 (79%) episodes. Patients were more likely to be monitored (OR 1.78, 95% CI 1.39–2.29, p < 0.001) if there was actual or threatened self-harm, and less likely to be monitored if the episode occurred in the evening (OR 0.79, 95% CI 0.62–1.0, p < 0.001) or overnight (OR 0.57, 95% CI 0.44–0.75, p < 0.001). Risk factors such as recent substance use, RT resulting in the patient falling asleep, or receiving high-dose antipsychotic medication on the day of the episode, did not predict whether or not the minimum recommended level of post-RT monitoring was documented. Conclusions: The minimum recommended level of physical health monitoring was reported for only one in five RT episodes. The findings also suggest a lack of targeting of at-risk patients for post-RT monitoring. Possible explanations are that clinicians consider such monitoring too demanding to implement in routine clinical practice or not appropriate in every clinical situation. For example, physical health measures requiring direct contact with a patient may be difficult to undertake, or counter-productive, if RT has failed. These findings prompt speculation that post-RT monitoring practice would be improved by the implementation of guidance that integrated and refined the currently separate systems for undertaking and recording physical health observations post-RT, determining nursing observation schedules and detecting acute deterioration in physical health. The effectiveness and clinical utility of such an approach would be worth testing.

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Toxicity of high-dose interferon for high-risk melanoma in Ontario: A population-based study of health services use.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.31 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 31-31

Author(s):

Timothy P. Hanna ◽

Tara D. Baetz ◽

Jianfeng Xu ◽

Qun Miao ◽

Craig Earle ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Population Based ◽

High Dose ◽

Family Practitioner ◽

Health Services Use ◽

Mental Health Services Use ◽

High Dose Interferon ◽

Services Use

31 Background: While High-Dose Interferon (HDIFN) is the sole approved adjuvant systemic treatment for melanoma in Ontario and many other jurisdictions, it is toxic, of modest benefit, and costly. We sought to assess the population-level impact of toxicity, particularly neuro-psychiatric toxicity. This can inform value assessment for the adjuvant treatment of melanoma. Methods: This was a retrospective population-based registry study of all patients with melanoma receiving adjuvant HDIFN in Ontario 2008-2012. HDIFN receipt was determined from provincial drug-funding data. Toxicity was investigated through health services use compatible with HDIFN toxicity (e.g. mental health physician billings). Associations between early HDIFN discontinuation and health services use were examined. Using stage data reported from cancer centers on a subset of patients, propensity matched analysis compared utilization in stage IIB-IIIC patients that did and did not receive HDIFN. Results: Of 718 patients receiving HDIFN, 12% were ≥65 years, 83% had little or no comorbidity. One third had ≥1 toxicity-associated utilization within one year of starting HDIFN. 364/420 (87%) of utilization was mental health-related: 54% were family practitioner visits, 39% psychiatrist visits. Early drug discontinuation was more likely with pre-existing mental health issues in multivariable analysis (OR 2.0 (1.1,3.4)). In propensity matched analysis, HDIFN patients were more likely than untreated matched controls to have mental health utilization (51% vs. 42%, p=0.01) between 1 year pre-melanoma diagnosis to 2 years post. Conclusions: Mental health services use is common among stage IIB-IIIC patients with melanoma, especially with HDIFN. This emphasizes an important survivorship issue for these patients, and for those receiving HDIFN, and impacts the value of care. Pre-treatment mental health services use is associated with treatment discontinuation. This is important when contemplating the value of HDIFN use for individual patients. For those receiving HDIFN, optimal support must include mental health care.

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Side-effect monitoring of continuing LAI antipsychotic medication in UK adult mental health services

Therapeutic Advances in Psychopharmacology ◽

10.1177/2045125321991278 ◽

2021 ◽

Vol 11 ◽

pp. 204512532199127

Author(s):

Carol Paton ◽

Tom K. J. Craig ◽

Brittany McConnell ◽

Thomas R. E. Barnes

Keyword(s):

Mental Health ◽

Side Effects ◽

Mental Health Services ◽

Health Services ◽

Adverse Effects ◽

Antipsychotic Medication ◽

Side Effect ◽

Antipsychotic Medications ◽

Adult Mental Health ◽

Effect Monitoring

Background: Long-acting injectable (LAI) antipsychotic medications are used to optimise treatment outcomes in schizophrenia. Guaranteed medication delivery increases the responsibility of prescribers to monitor and manage adverse effects. Methods: In the context of a quality improvement programme conducted by the Prescribing Observatory for Mental Health, a clinical audit addressed documented side-effect monitoring in patients prescribed continuing LAI antipsychotic medication under the care of United Kingdom adult mental health services. Results: A total of 62 mental health services submitted data on 5169 patients prescribed LAI antipsychotic medication for more than a year. An assessment of side effects had been documented in the past year in 2304 (45%) cases. Post hoc analysis showed that extrapyramidal side effects were more likely to have been assessed and found to be present in those patients prescribed LAI haloperidol, flupentixol or zuclopenthixol. There was little other targeting of assessments to the known side effects profiles of individual LAI antipsychotic medications, but when dysphoria had been assessed it was most commonly found with LAI haloperidol treatment and when weight gain, sexual and prolactin-related side effects had been assessed, they were more often identified with LAI paliperidone. Conclusion: The data suggest a relatively low frequency of side-effect assessments, largely untargeted. This is likely to result in many adverse effects going unrecognised and unmanaged, thus failing to tackle their potential to confound mental state assessment and adversely affect physical health and adherence. Patients receiving LAI antipsychotic medication have regular contact with a healthcare professional who administers the medication, which provides an opportunity to potentially remedy this situation.

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