The assessment of need in patients presenting to psychiatrists in the general hospital

2006 ◽  
Vol 23 (3) ◽  
pp. 92-95
Author(s):  
Larkin Feeney ◽  
Annette Kavanagh ◽  
Mary Mooney ◽  
Stephen Browne
Keyword(s):  
Mental Illness ◽  
General Hospital ◽  
Alcohol Problems ◽  
Psychosocial Assessment ◽  
Assessment Process ◽  
Psychotic Symptoms ◽  
Semi Group ◽  
Camberwell Assessment Of Need ◽  
Self Harm ◽  
Assessment Of Need

AbstractObjective: The evaluation of psychosocial need is an important part of the assessment of any patient who presents to a psychiatrist. The Camberwell Assessment of Need (CAN) instrument was developed for the systematic assessment of need in people with severe and enduring mental illness. Variations of the CAN have been developed for forensic, elderly and learning disability populations. Patients presenting to psychiatrists in the general hospital may also have different needs to those presenting to psychiatrists in other settings. We set out to examine whether the CAN would be useful in identifying needs in patients referred to psychiatrists in the general hospital with self-harm or alcohol problems.Method: Over a four-month period from September 2004 we prospectively assessed all patients with self-harm or alcohol problems referred to a liaison psychiatry service. We used the short version of the Camberwell Assessment of Need instrument (CANSAS) to assess psychosocial needs. Urgent referrals to a local psychiatric service of patients with severe enduring mental illness (SEMI) were assessed using identical methodology over the same time period and used as a comparison group.Results: Over the study period 53 patients with self-harm, 42 with alcohol problems and 45 with SEMI were assessed. Patients presenting with self-harm and alcohol problems had significantly fewer needs than those with SEMI (4.40 vs 3.98 vs 7.96, p < 0.001). Looking after the home, self-care, daytime activity, psychotic symptoms, safety to others and sexual expression needs were significantly greater in the SEMI group than in either the DSH or alcohol groups. Only safety to self-needs in the DSH group and alcohol needs in the alcohol group were significantly higher than in the SEMI group. The proportion of needs that were unmet was similar in each group.Conclusions: The CANSAS instrument identified some needs in deliberate self-harm and alcohol problem patients that might not have been identified during the course of a standard psychosocial assessment. It was easy to administer and as such was a useful addition to the assessment process. However the development of a more specific instrument for the assessment of need in these populations would be useful.

scholarly journals Discriminating levels of alcohol use associated with self-harm in individuals presenting to a district general hospital

2010 ◽  
Vol 34 (6) ◽  
pp. 226-230 ◽  
Author(s):  
Nicholas Holdsworth ◽  
Hugh Griffiths ◽  
David Crawford
Keyword(s):  
Alcohol Use ◽  
General Hospital ◽  
Screening Tool ◽  
District General Hospital ◽  
Alcohol Screening ◽  
Screening Tools ◽  
Psychosocial Assessment ◽  
Different Types ◽  
Self Harm ◽  
Problematic Alcohol Use

Aims and methodAlthough alcohol is reported as commonly associated with self-harm, there is nothing in the literature that bases the association on validated screening tools. We sought to discern the different types of alcohol use as discriminated by the Alcohol Use Disorders Identification Test (AUDIT). Completed AUDITs from a 2-year period were analysed, all relating to people who had presented to a district general hospital in Northumberland following self-harm.ResultsThe proportion of dependent, harmful and hazardous drinkers identified using AUDIT was many times higher than previously estimated in similar studies that had not used a validated alcohol screening tool.Clinical implicationsThe routine use of an alcohol screening tool should be part of any standard psychosocial assessment of self-harm, to guide appropriate interventions for problematic alcohol use that might otherwise be overlooked.

Deliberate Self-Harm Patients Who Discharge Themselves from the General Hospital Without Adequate Psychosocial Assessment

Crisis ◽  
2004 ◽  
Vol 25 (4) ◽  
pp. 183-186 ◽  
Author(s):  
Rachel Crowder ◽  
Rohan Van Der Putt ◽  
Ceri-Anne Ashby ◽  
Andrew Blewett
Keyword(s):  
General Hospital ◽  
Care Pathway ◽  
Alcohol Intoxication ◽  
Psychosocial Assessment ◽  
Hospital Environment ◽  
Control Group ◽  
Deliberate Self Harm ◽  
Increased Risk ◽  
Self Harm ◽  
Integrated Care Pathway

Abstract: Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.

scholarly journals Factor structure in the Camberwell Assessment of Need

2004 ◽  
Vol 185 (6) ◽  
pp. 505-510 ◽  
Author(s):  
Erik Wennström ◽  
Dag Sörbom ◽  
Frits-Axel Wiesel
Keyword(s):  
Mental Illness ◽  
Factor Analysis ◽  
Severe Mental Illness ◽  
Factor Structure ◽  
Functional Disability ◽  
Factor Model ◽  
Maximum Likelihood Factor Analysis ◽  
Emotional Loneliness ◽  
Camberwell Assessment Of Need ◽  
Assessment Of Need

BackgroundIn order to define needs for care of people with severe mental illness, the Camberwell Assessment of Need (CAN) is focused on measuring personal and social functioning. However, previous studies of the CAN have given inconsistent results in terms of what variables are actually being measured.AimsTo investigate the factor structure of the CAN.MethodAssessments of 741 out-patients (mean age 45.5 years, 50% females) with severe mental illness (68% schizophrenia or other psychotic disorder) were used in an exploratory maximum likelihood factor analysis.ResultsSupport was found for a three-factor model, comprising 13 of the 22 variables in the CAN, with the factors corresponding to functional disability (7 variables), social loneliness (3 variables) and emotional loneliness (3 variables). The remaining variables did not load on any factor.ConclusionsExploratory factor analysis revealed three homogeneous dimensions in the CAN that may represent functional disability and two aspects of social health.

Emergency Department Psychiatry

2014 ◽  
Author(s):  
Amber Fossey
Keyword(s):  
Mental Illness ◽  
Emergency Services ◽  
Mental Health Problems ◽  
Acute Stress ◽  
Medically Unexplained Symptoms ◽  
Psychosocial Assessment ◽  
Acute Psychosis ◽  
Stress Reactions ◽  
Mind And Body ◽  
Self Harm

All doctors working in the ED will regularly meet patients with acute mental health problems. Five percent of total ED attendees are attrib­utable to mental disorder. With nationwide ED attendances averaging 400 000 per week during November to April 2013, the trend shows a growing pressure on emergency services. However, these figures repre­sent just the tip of the true burden of acute mental illness in our com­munities. Stigma, the healthcare funnel, and marginalization often mean that it is the sickest who finally present to the ED. It is also important to recognize the co-morbidity of mental illness and addictions in those seeking help for what initially appear to be physical complaints, as so often the mind and body are closely intertwined. Most common psychiatric presentations to the ED include DSH, alco­hol and substance misuse, delirium, acute psychosis, factitious disorders, medically unexplained symptoms (MUS), and acute stress reactions (such as to trauma). DSH is common but under-recognized. A quarter of people who die by suicide attended the ED in the preceding year. All patients in the ED presenting with self-harm should have a detailed psychosocial assessment. Alcohol is responsible for 0% of all ED attendances. It is also an independent variable, raising the risk of DSH. Substance users are also frequent attendees, with high levels of medical morbidity and mortality. Patients with a dual diagnosis of substance use plus mental illness fre­quently present with multiple psychosocial problems. Acute psychosis may be caused by a functional disorder, such as schizophrenia, but organic conditions must also be considered. Where a patient is extremely disturbed in the ED, restraint and sedation may be necessary to enable safe and adequate assessment. Security presence may also be required to minimize the risk of violence, where this has been identified. Implications for working in the ED are that all doctors should famil­iarize themselves with the management of common acute psychiatric presentations. Know how to access local Trust rapid tranquillization guidelines. Read NICE guidelines for management of self-harm. Seize opportunities to screen for mental illness and social problems.

The Camberwell Assessment of Need: The Validity and Reliability of an Instrument to Assess the Needs of People with Severe Mental Illness

1995 ◽  
Vol 167 (5) ◽  
pp. 589-595 ◽  
Author(s):  
Michael Phelan ◽  
Mike Slade ◽  
Graham Thornicroft ◽  
Graham Dunn ◽  
Frank Holloway ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Health Service ◽  
Severe Mental Illness ◽  
Complete Agreement ◽  
Retest Reliability ◽  
New Instrument ◽  
Camberwell Assessment Of Need ◽  
Test Retest Reliability ◽  
Assessment Of Need

BackgroundPeople with severe mental illness often have a complex mixture of clinical and social needs. The Camberwell Assessment of Need (CAN) is a new instrument which has been designed to provide a comprehensive assessment of these needs. There are two versions of the instrument: the clinical version has been designed to be used by staff to plan patients' care; whereas the research version is primarily a mental health service evaluation tool. The CAN has been designed to assist local authorities to fulfil their statutory obligations under the National Health Service and Community Care Act 1990 to assess needs for community services.MethodA draft version of the instrument was designed by the authors. Modifications were made following comments from mental health experts and a patient survey. Patients (n = 49) and staff (n = 60) were then interviewed, using the amended version, to assess the inter-rater and test-retest reliability of the instrument.ResultsThe mean number of needs identified per patient ranged from 7.55 to 8.64. Correlations of the inter-rater and test-retest reliability of the total number of needs identified by staff were 0.99 and 0.78 respectively. The percentage of complete agreement on individual items ranged from 100–81.6% (inter-rater) and 100–58.1% (test-retest).ConclusionsThe study suggests that the CAN is a valid and reliable instrument for assessing the needs of people with severe mental illness. It is easily learnt by staff from a range of professional backgrounds, and a complete assessment took, on average, around 25 minutes.

Police Referrals to a Psychiatric Hospital: Indicators for Referral and Psychiatric Outcome

1994 ◽  
Vol 28 (2) ◽  
pp. 259-268 ◽  
Author(s):  
Graham Meadows ◽  
Greg Calder ◽  
Hans van Den Bos
Keyword(s):  
Mental Illness ◽  
Psychotic Symptoms ◽  
Relative Odds ◽  
Self Injury ◽  
Language Difficulties ◽  
The Usa ◽  
Self Harm ◽  
Clinical Description ◽  
The Uk ◽  
Psychiatric Outcome

Studies of police psychiatric referrals in the USA and the UK generally show these patients to be ill and in need of care. There are, however, no published Australian studies and such findings may not be validly generalised. This prospective study of consecutive police psychiatric referrals in Adelaide reports psychiatric assessment in 92 cases and observations by police in 69 of these, with no evidence of selection bias. The most common reason for referral was threat of self harm (28%). Mental illness was deemed to be present in 49% and the most common clinical description was “situational crisis” (29%). Schizophrenia was diagnosed in 18%. Clinicians viewed 19% of referrals as inappropriate. Increased relative odds for mental illness were associated with police accounts of psychotic symptoms, and decreased odds with threat of self harm and violence. Increased odds for admission were associated with language difficulties and damage to own property, decreased odds with threat to others, threat of suicide, and threat to self injury. There were 14 cases where possible charges were not being pursued: of these 7 were regarded as ill and 4 were regarded as inappropriate referrals. The rates of major disorders are lower than in other published work. It is proposed that this can be explained by relative ease of referral by police to psychiatry and flexible acceptance criteria.

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