Assessing the Current Practice of Physical Health Monitoring for Children and Young Adults On Antipsychotic Medications in St Helens and Knowsley Mental Health Services

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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Effect of point of care blood testing on physical health check completion in mental health services: mixed-methods evaluation

BJPsych Open ◽

10.1192/bjo.2020.110 ◽

2020 ◽

Vol 6 (6) ◽

Author(s):

Joseph Butler ◽

Simone de Cassan ◽

Margaret Glogowska ◽

Thomas R. Fanshawe ◽

Phil Turner ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Community Mental Health ◽

Health Services ◽

Physical Health ◽

Blood Test ◽

Point Of Care ◽

Health Check ◽

Blood Testing ◽

The Impact

Background Physical health outcomes in severe mental illness are worse than in the general population. Routine physical health check completion in this group is poor. Aims To quantitatively and qualitatively evaluate the impact of point of care (POC) blood testing on physical health check completion in community mental health services. Method In a prospective cohort design, we equipped an early intervention service (EIS) and a community mental health team (CMHT) with a POC blood testing device for 6 months. We compared rates of blood test and full physical health check completion in the intervention teams with a matched EIS and CMHT, historically and during the intervention. We explored attitudes to POC testing using thematic analysis of semi-structured interviews with patients and clinicians. Results Although the CMHT scarcely used the POC device and saw no change in outcomes, direct comparison of testing rates in the intervention period showed increased physical health check completion in the EIS with the device (rate ratio RR = 5.18; 95% CI 2.54–12.44; P < 0.001) compared with usual care. The rate was consistent with the EIS's increasing rate of testing over time (RR = 0.45; 95% 0.09–2.08; P = 0.32). Similar trends were seen in blood test completion. POC testing was acceptable to patients but clinicians reported usability, provision and impact on the therapeutic relationship as barriers to uptake. Conclusions POC testing was beneficial and acceptable to patients and may increase physical health check uptake. Further research, accounting for clinician barriers, is needed to evaluate its clinical and cost-effectiveness.

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A Qualitative Investigation of Engagement in Mental Health Services Among Black and Hispanic LGB Young Adults

Psychiatric Services ◽

10.1176/appi.ps.201900399 ◽

2020 ◽

Vol 71 (6) ◽

pp. 555-561

Author(s):

Kiara L. Moore ◽

Lucy Lopez ◽

David Camacho ◽

Michelle R. Munson

Keyword(s):

Mental Health ◽

Young Adults ◽

Mental Health Services ◽

Health Services ◽

Qualitative Investigation

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Young adults receive combination of mental health services

Mental Health Weekly ◽

10.1002/mhw.30461 ◽

2016 ◽

Vol 26 (2) ◽

pp. 5-5

Author(s):

Valerie A. Canady

Keyword(s):

Mental Health ◽

Young Adults ◽

Mental Health Services ◽

Health Services

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Providing physical health care for people accessing mental health services: Clinicians’ perceptions of their role

International Journal of Mental Health Nursing ◽

10.1111/inm.12529 ◽

2018 ◽

Vol 28 (1) ◽

pp. 256-267 ◽

Cited By ~ 4

Author(s):

Richard Clancy ◽

Terry J. Lewin ◽

Jenny A. Bowman ◽

Brian J. Kelly ◽

Antony D. Mullen ◽

...

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Services ◽

Health Services ◽

Physical Health ◽

Physical Health Care

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Youth Mental Health Tracker: protocol to establish a longitudinal cohort and research database for young people attending Australian mental health services

BMJ Open ◽

10.1136/bmjopen-2019-035379 ◽

2020 ◽

Vol 10 (6) ◽

pp. e035379

Author(s):

Cathrin Rohleder ◽

Yun Ju Christine Song ◽

Jacob J Crouse ◽

Tracey A Davenport ◽

Frank Iorfino ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Mental Disorders ◽

Health Services ◽

Physical Health ◽

Youth Mental Health ◽

Severe Illness ◽

Trajectory Data

IntroductionMental disorders are a leading cause of long-term disability worldwide. Much of the burden of mental ill-health is mediated by early onset, comorbidities with physical health conditions and chronicity of the illnesses. This study aims to track the early period of mental disorders among young people presenting to Australian mental health services to facilitate more streamlined transdiagnostic processes, highly personalised and measurement-based care, secondary prevention and enhanced long-term outcomes.Methods and analysisRecruitment to this large-scale, multisite, prospective, transdiagnostic, longitudinal clinical cohort study (‘Youth Mental Health Tracker’) will be offered to all young people between the ages of 12 and 30 years presenting to participating services with proficiency in English and no history of intellectual disability. Young people will be tracked over 3 years with standardised assessments at baseline and 3, 6, 12, 24 and 36 months. Assessments will include self-report and clinician-administered measures, covering five key domains including: (1) social and occupational function; (2) self-harm, suicidal thoughts and behaviour; (3) alcohol or other substance misuse; (4) physical health; and (5) illness type, clinical stage and trajectory. Data collection will be facilitated by the use of health information technology. The data will be used to: (1) determine prospectively the course of multidimensional functional outcomes, based on the differential impact of demographics, medication, psychological interventions and other key potentially modifiable moderator variables and (2) map pathophysiological mechanisms and clinical illness trajectories to determine transition rates of young people to more severe illness forms.Ethics and disseminationThe study has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (2019/ETH00469). All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals and scientific conference presentations.

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