Clinical risk assessment rating and all-cause mortality in secondary mental healthcare: the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) Case Register

2011 ◽  
Vol 42 (8) ◽  
pp. 1581-1590 ◽  
Author(s):  
C.-Y. Wu ◽  
C.-K. Chang ◽  
R. D. Hayes ◽  
M. Broadbent ◽  
M. Hotopf ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Service ◽  
Health Service ◽  
Mental Healthcare ◽  
Research Centre ◽  
Case Register ◽  
All Cause Mortality ◽  
Unit Increase ◽  
Clinical Risk Assessment

BackgroundMental disorders are widely recognized to be associated with increased risk of all-cause mortality. However, the extent to which highest-risk groups for mortality overlap with those viewed with highest concern by mental health services is less clear. The aim of the study was to investigate clinical risk assessment ratings for suicide, violence and self-neglect in relation to all-cause mortality among people receiving secondary mental healthcare.MethodA total of 9234 subjects over the age of 15 years were identified from the South London and Maudsley Biomedical Research Centre Case Register who had received a second tier structured risk assessment in the course of their clinical care. A cohort analysis was carried out. Total scores for three risk assessment clusters (suicide, violence and self-neglect) were calculated and Cox regression models used to assess survival from first assessment.ResultsA total of 234 deaths had occurred over an average 9.4-month follow-up period. Mortality was relatively high for the cohort overall in relation to national norms [standardized mortality ratio 3.23, 95% confidence interval (CI) 2.83–3.67] but not in relation to other mental health service users with similar diagnoses. Only the score for the self-neglect cluster predicted mortality [hazard ratio (HR) per unit increase 1.14, 95% CI 1.04–1.24] with null findings for assessed risk of suicide or violence (HRs per unit increase 1.00 and 1.06 respectively).ConclusionsLevel of clinician-appraised risk of self-neglect, but not of suicide or violence, predicted all-cause mortality among people receiving specific assessment of risk in a secondary mental health service.

Barriers and Solutions to Implementing Metabolic Risk Assessment in a Secondary Mental Health Service

2010 ◽  
Vol 18 (4) ◽  
pp. 322-325 ◽  
Author(s):  
Lucy Dunbar ◽  
Theo Brandt ◽  
Amanda Wheeler ◽  
Jeff Harrison
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Service ◽  
Health Service ◽  
Metabolic Risk

The impact of an expanding community mental health service on patterns of bed usage: evaluation of a four-year period of implementation

1982 ◽  
Vol 12 (1) ◽  
pp. 177-190 ◽  
Author(s):  
H. Häfner ◽  
J. Klug
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
International Standards ◽  
Community Mental Health Service ◽  
Case Register ◽  
National Differences ◽  
The Impact

SynopsisIn the city of Mannheim the introduction of an extensive community mental health service has been shown, by means of case-register data over 4½ years, to have led to a considerable increase in utilization, mainly at the out-patient level of care. The rates of admission to hospital increased very little. Due to the simultaneous decline in long-term bed occupancy, the overall need for psychiatric beds remained stable at a rate of about 1·2/1000, a rate which is very low by international standards.The sharp decline in the ‘old’ long-stay population was followed by a smaller increase in ‘new’ long-stay patients which it has not been possible to prevent. These patients are, however, admitted for a long-term stay significantly later than formerly, and their diagnostic composition has changed significantly.The increase in the bed requirements for short- and medium-term stay patients resulted from different sources: an increasing morbidity in some groups of disorders, the rising utilization in case of emergencies and severe crises, and the transfer of long-stay patients to alternative care services. The level of these needs was very similar in Mannheim, Salford, Samsø and Camberwell, whereas the rates for long-term beds still show clear national differences.

Assessing the Risks Presented by Parents

2001 ◽  
Vol 6 (3) ◽  
pp. 110-112
Author(s):  
Ian Partridge ◽  
Geraldine Casswell ◽  
Greg Richardson
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Service ◽  
Health Service ◽  
Social Services ◽  
Theoretical Basis ◽  
Developmental Context ◽  
Adolescent Mental Health Service ◽  
Tier 3 ◽  
Multi Disciplinary Team

The establishment, operation and theoretical basis of a multi-disciplinary, Tier 3, risk assessment team based in a Child and Adolescent Mental Health Service (CAMHS) is described. The work is based on the premise that a multi-disciplinary team, with a degree of statutory independence, assessing forensic issues within a systemic and developmental context, offers a useful contribution to the comprehensive assessment of risk and provides a valuable and valued service to statutory agencies and the courts. The team is used by Social Services Departments and the courts as an independent assessor of the risk parents and potential carers pose to children. An evaluation of 39 referrals, carried out over the last 3 years of operation of the parenting risk assessment team, is given.

scholarly journals Mental health service activity during COVID-19 lockdown among individuals with potential neurodevelopmental disorders: South London and Maudsley data on services and mortality from January to July 2020

2020 ◽  
Author(s):  
Evangelia Martin ◽  
Eleanor Nuzum ◽  
Matthew Broadbent ◽  
Robert Stewart
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Neurodevelopmental Disorders ◽  
Mental Healthcare ◽  
Home Treatment ◽  
Treatment Team ◽  
Health Service Provider ◽  
Data Resource ◽  
Face To Face

AbstractThe lockdown and social distancing policy imposed due to the COVID-19 pandemic is likely to have had a widespread impact on mental healthcare service provision and use. Previous reports from the South London and Maudsley NHS Trust (SLaM; a large mental health service provider for 1.2m residents in South London) highlighted a shift to virtual contacts among those accessing community mental health and home treatment teams and an increase in deaths over the pandemic’s first wave. However, there is a need to quantify this for individuals with particular vulnerabilities, including those with learning disabilities and other neurodevelopmental disorders. Taking advantage of the Clinical Record Interactive Search (CRIS) data resource with 24-hourly updates of electronic mental health records data, this paper describes daily caseloads and contact numbers (face-to-face and virtual) for individuals with potential neurodevelopmental disorders across community, specialist, crisis and inpatient services. The report focussed on the period 1st January to 31st July 2020. We also report on daily accepted and discharged trust referrals, total trust caseloads and daily inpatient admissions and discharges for individuals with potential neurodevelopmental disorders. In addition, daily deaths are described for all current and previous SLaM service users with potential neurodevelopmental disorders over this period. In summary, comparing periods before and after 16th March 2020 there was a shift from face-to-face contacts to virtual contacts across all teams. The largest declines in caseloads and total contacts were seen in Home Treatment Team, Liaison/A&E and Older Adult teams. Reduced accepted referrals and inpatient admissions were observed and there was an 103% increase in average daily deaths in the period after 16th March, compared to the period 1st January to 15th March (or a 282% increase if the 2-month period from 16th March to 15th May was considered alone).

Occupational health in mental health services: a qualitative study

2019 ◽  
Vol 13 (1) ◽  
pp. 32-44
Author(s):  
Jennifer Oates ◽  
Rasiha Hassan
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Occupational Health ◽  
Lived Experience ◽  
Mental Healthcare ◽  
Working Environment ◽  
Small Scale ◽  
Structured Interviews ◽  
Content Type

Purpose The purpose of this paper is to explore occupational health (OH) clinicians’ perspectives on employee mental health in the mental health workplace in the English National Health Service. Design/methodology/approach Thematic analysis of data from seven semi-structured interviews is performed in this paper. Findings Three themes emerged under the core theme of “Situating OH services”: “the Uniqueness of the mental health service setting”, “the Limitations of OH services” and “the Meaning of mental health at work”. An important finding came from the first theme that management referrals in mental health may be due to disputes about workers’ fitness to face violence and aggression, a common feature of their working environment. Research limitations/implications This was a small scale study of a previously unresearched population. Practical implications These findings should be used to refine and standardise OH provision for mental healthcare workers, with a particular focus on exposure to violence and workers’ potential “lived experience” of mental illness as features of the mental health care workplace. Originality/value This is the first study to explore OH clinicians’ perspectives on the mental health service working environment.

scholarly journals The crucible of co-production: Case study interviews with Recovery College practitioner trainers

2019 ◽  
Vol 78 (8) ◽  
pp. 977-987
Author(s):  
Mark Dalgarno ◽  
Jennifer Oates
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Healthcare Professionals ◽  
Mental Healthcare ◽  
Single Site ◽  
Future Research ◽  
Service Users ◽  
Structured Interviews

Objectives: This study explored healthcare professionals’ accounts of being practitioner trainers in a mental health Recovery College, where they worked with peer trainers, who were people with lived experience of mental illness, to co-produce workshops for mental health service users and staff. The aim of this study was to understand the process of co-production in the Recovery College from the perspective of practitioner trainers. Design: Single-site case study. Setting: A Recovery College in the South of England, open to staff and service users from one mental health care provider organisation. Methods: Semi-structured interviews with eight mental healthcare professionals. Transcripts were thematically analysed. Results: A central image of ‘the workshop as crucible’ emerged from the three themes derived from the analysis. Co-facilitating the workshop was a ‘structured’ encounter, within which health professionals experienced ‘dynamism’ and change. For them, this involved experiences of ‘challenge and discomfort’. Conclusion: Findings from this study contribute to the evidence base for the evaluation of Recovery Colleges by focusing on the training impact on staff. Findings suggest that taking on a trainer role in Recovery College co-production is beneficial for healthcare professionals as well as mental health service users, especially if healthcare professionals are open to the dynamism and possible discomfort of these workshop encounters. Future research, however, should expand beyond single-site case studies to test the extent to which this metaphor and themes are appropriate to describing the ‘transformative’ element of co-production.

Promoting the freedom of thought of mental health service users: Nussbaum’s capabilities approach meets values-based practice

2017 ◽  
Vol 44 (3) ◽  
pp. 180-184
Author(s):  
Mari Stenlund
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Mental Healthcare ◽  
Capabilities Approach ◽  
Service Users ◽  
Human Right ◽  
Process And Outcome ◽  
Liberal Societies ◽  
Freedom Of Thought

This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum’s capabilities approach and Fulford’s and Fulford et al’s values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out that both Nussbaum’s approach and values-based practice recognise that people’s values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum’s approach and values-based practice. However, there are also differences in that values-based practice relies on a ‘good process’ in decision-making, whereas the capabilities approach is oriented towards a ‘right outcome’. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies.

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