Improving outcomes for homeless inpatients in mental health

2018 ◽  
Vol 22 (1) ◽  
pp. 77-90 ◽  
Author(s):  
Zana Khan ◽  
Sophie Koehne ◽  
Philip Haine ◽  
Samantha Dorney-Smith
Keyword(s):  
Mental Health ◽  
Service Development ◽  
Post Discharge ◽  
College Hospital ◽  
Content Type ◽  
Housing Status ◽  
Unscheduled Care ◽  
Mental Health Settings ◽  
Housing Outcomes ◽  
Health Trust

Purpose The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King’s Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy’s and St Thomas’ (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding. Design/methodology/approach This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust’s management structures. Findings Innovations including the transitional arrangements for patients’ post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care. Originality/value The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts.

Inequalities in women’s medium or low secure mental health settings: a scoping review

2021 ◽  
Vol 23 (3) ◽  
pp. 254-271
Author(s):  
Aile Trumm ◽  
Kristina Brenisin ◽  
Kieran Breen
Keyword(s):  
Mental Health ◽  
Sexual Orientation ◽  
Gender Identity ◽  
High Quality Research ◽  
Dysfunctional Family ◽  
Health Service Provision ◽  
Content Type ◽  
Mental Health Settings ◽  
Health Need ◽  
The Impact

Purpose The more disadvantaged members of society generally experience poorer outcomes following the development of mental ill-health. The purpose of this paper is to scope the literature and synthesise findings on the inequalities and mental health within secure mental health settings. Design/methodology/approach Six electronic databases were searched to identify relevant studies. These were included if they examined the association between inequalities and mental health in women’s secure mental health settings. Findings Of the 608 studies reviewed, 14 met the inclusion criteria. In these papers, violence and/or abuse were described as the most prevalent inequalities. The second most frequent group of inequalities identified were socio-economic. Only three published studies researched the impact of ethnicities. Physical health, alcohol abuse and a dysfunctional family upbringing were only mentioned in one of the studies. Gender identity, transitioning and sexual orientation was not considered in any papers. These are areas, which require further investigation to determine their specific impact in this setting. Research limitations/implications This review highlights the dearth of high-quality research-based evidence underpinning an understanding of the impact of inequalities on women in secure mental health settings. The existing studies suggest that inequalities have a very particular impact and that intersectionality plays a key role. Further research is required to further understand how inequalities impact the lives of women in secure mental health settings. Practical implications The inequalities that women experience in relation to mental health need to be further researched in the context of intersectionality. There are also research gaps in terms of gender identity, sexual orientation and socio-economic background. Further primary research using a more complex methodological paradigm is required to explore these factors and their impact on mental health service provision. Social implications The role of inequalities should be considered as part of an overall care package, including the experiences of adverse childhood experiences and this should contribute towards the development of a trauma-based care approach. Originality/value To the best of the authors’ knowledge, this is the first study to scope literature about inequalities experienced in women’s secure psychiatric settings considering intersectionality.

scholarly journals Demystifying the pathway of assessment and treatment for bipolar disorder – utilising co-production and algorithms to personalise the approach

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S150-S150
Author(s):  
Jessica Nicholls-Mindlin ◽  
Digby Quested ◽  
Matthew Taylor ◽  
Lauren Fuzi ◽  
David Gee
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Public Involvement ◽  
Psychological Intervention ◽  
Patient And Public Involvement ◽  
Service Development ◽  
Post Discharge ◽  
Nice Guideline

AimsTo develop an evidence based, patient centred treatment pathway for people experiencing symptoms of bipolar disorder (BD), modifiable to include local resources.MethodThis project was developed in line with current approaches to service development such as coproduction, with patient and public involvement (PPI) and enhancing personalisation of treatment in medicine. As part of a local initiative, a multi-disciplinary team was brought together to understand and analyse the current local pathway for those affected by BD. It was found that the approach to assessment and management was not consistent between locality teams. Two experts by experience who have a diagnosis of BD were invited to become involved with the development of the pathway. Meetings were set up to enable coproduction and elicit information from those with the diagnosis. The responses provided insight into the effectiveness of different approaches used nationally to inform the methods and resources that are most helpful and appropriate to comprehensively support those with the illness.NICE guideline evidence was used to create two algorithms to streamline the care of those with BD in both primary and secondary care. These algorithms include pharmacological, psychological and social approaches. It also considers the junctions at which referrals should be made and the criteria on which decisions are based.ResultOne algorithm was designed for use in primary care and will be distributed to local GPs to clarify the initial steps for assessment and management of BD and the criteria for referral. A second decision tree will be made available to all doctors working in mental health services with detailed medication options, when they are appropriate and whether additional psychological intervention should be considered e.g. post-discharge groups. Other specialist options such as Early Intervention for Psychosis and Perinatal Mental Health Services were also included. An information pack was created to be offered to all those with a diagnosis or possible diagnosis of BD. This contains useful resources such as skills and exercises that patients may find of benefit, external resources and websites regarding additional support and further information on BD, its nature and management.ConclusionThe approach and resources collated here will help to streamline the management of those with bipolar disorder whilst also ensuring a more consistent approach. The involvement of experts by experience and the incorporation of NICE guidelines ensures a well-rounded and comprehensive set of documents that will be helpful to both clinicians and patients.

Creating a culture of employability in mental health

2014 ◽  
Vol 18 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Naomi Boycott ◽  
Justine Schneider ◽  
Michael Osborne
Keyword(s):  
Mental Health ◽  
Supported Employment ◽  
Implementation Process ◽  
Lessons Learned ◽  
Service Development ◽  
Content Type ◽  
The Individual ◽  
The Uk ◽  
Early Intervention In Psychosis ◽  
The Impact

Purpose – The purpose of this paper is to draw out the lessons learned from the implementation of the Individual Placement and Support (IPS) approach to supported employment in two contrasting adult mental health teams; one “standard” CMHT, and one early intervention in psychosis (EIP) team. Design/methodology/approach – These inferences are based on the evidence from a four-year study of IPS in one mental health care provider in the UK, which began by setting up a new service, and went on to run a RCT looking at the impact of psychological input as an adjunct to IPS alone. Findings – In attempting to introduce IPS to mental health teams in Nottingham the authors came across numerous barriers, including service reorganisation, funding cuts and the wider context of recession. Differences were observed between mental health teams in the willingness to embrace IPS. The authors argue that this variability is due to differences in caseload size, recovery priorities and client profiles. The authors have learnt that perseverance, strenuous efforts to engage clinical staff and the use of IPS fidelity reviews can make a positive difference to the implementation process. Practical implications – The experience suggests that setting up an IPS service is possible even in the most challenging of times, and that EIP services may be a particularly fertile ground for this approach. The authors also discuss potential barriers to implementing new services in mental health teams. Originality/value – This paper will be of value to service development and the science of implementation in mental health.

Professionals harnessing experiential knowledge in Dutch mental health settings

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Simona Karbouniaris ◽  
Alie Weerman ◽  
Bea Dunnewind ◽  
Jean Pierre Wilken ◽  
Tineke A. Abma
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Experiential Knowledge ◽  
Research Approach ◽  
Content Type ◽  
Action Research Approach ◽  
Mental Health Settings ◽  
Four Levels

Purpose This study aims to explore the perspectives of mental health professionals who are in a process of integrating their own experiential knowledge in their professional role. This study considers implications for identity, dilemmas and challenges within the broader organization, when bringing experiential knowledge to practice. Design/methodology/approach As part of a participatory action research approach, qualitative methods have been used, such as in-depth interviews, discussions and observations during training and project team. Findings The actual use of experiential knowledge by mental health care professionals in their work affected four levels: their personal–professional development; the relation with service users; the relation with colleagues; and their position in the organization. Research limitations/implications Because of its limited context, this study may lack generalisability and further research with regard to psychologists and psychiatrists, as well as perceptions from users, is desirable. Social implications According to this study, social change starts from a bottom-up movement and synchronously should be facilitated by top-down policy. A dialogue with academic mental health professionals seems crucial to integrate this source of knowledge. Active collaboration with peer workers and supervisors is desired as well. Originality/value Professionals with lived experiences play an important role in working recovery-oriented, demonstrating bravery and resilience. Having dealt with mental health distress, they risked stigma and rejections when introducing this as a type of knowledge in current mental health service culture. Next to trainings to facilitate the personal–professional process, investments in the entire organization are needed to transform governance, policy and ethics.

Mental health, social inclusion and the development of vocational services in the NHS – what can be learnt?

2019 ◽  
Vol 24 (2) ◽  
pp. 133-143 ◽  
Author(s):  
Mark Bertram
Keyword(s):  
Mental Health ◽  
Social Inclusion ◽  
Health Impact ◽  
Service Development ◽  
Service Users ◽  
Policy Makers ◽  
Content Type ◽  
Descriptive Case Study ◽  
Personal Bias ◽  
Vocational Goals

Purpose The purpose of this paper is to describe the learning from a historical NHS vocational service development that focused on: mental health, employment and social inclusion – in an inner city area – involving service users, staff and commissioners. Design/methodology/approach It is a descriptive case study. A range of historical documents was content analysed and described through a first-person narrative: service user consultations, service specifications, audit records, outcome frameworks, internal service evaluations and published literature. Findings When vocational NHS service developments are grounded in what service users say helps them (person-centred, networked and co-ordinated approaches) the evidence indicates people can achieve their vocational goals. Research limitations/implications The range of documents described is factual, although the learning insights from some of the service developments are based on personal judgements. The author was the responsible manager – personal bias is high. There is not enough robust evidence to warrant generalisation. Practical implications When employment and social inclusion are prioritised, as core business in NHS, outcomes and health impact can increase. Greater detail is needed from healthcare policy makers – focusing on who exactly should undertake this work and what the key commissioning social inclusion performance indicators are. Originality/value The bulk of literature on employment support focuses on promoting evidence from one model: individual placement and support. Evidence here indicates a broader range of activity (education, training and volunteering) can have value and health impact.

Multi-professional approved clinicians’ contribution to clinical leadership

2018 ◽  
Vol 13 (2) ◽  
pp. 65-76 ◽  
Author(s):  
Selma Ebrahim
Keyword(s):  
Mental Health ◽  
Workforce Development ◽  
Distributed Leadership ◽  
Patient Choice ◽  
Clinical Psychologist ◽  
Mental Health Nursing ◽  
Clinical Leadership ◽  
Content Type ◽  
Mental Health Settings ◽  
The Uk

Purpose The purpose of this paper is to explore how multi-professional approved clinicians (MPACs), responsible for the care of patients detained under the Mental Health Act (2007), can enable clinical leadership in mental health settings. Design/methodology/approach A questionnaire was completed by clinical psychology and mental health nursing practitioners in a mental health trust in the UK working towards or having gained approved clinician (AC) status, identifying barriers to implementation of the roles and enablers. Qualitative interview data were also gathered with psychiatrists, clinical psychologist and Mental Health Nurse ACs (three in each group). Findings There are a number of barriers and enablers of distributed leadership promoted by the MPAC role. Themes identified focused on enabling person-centred care, clinical leadership and culture change more broadly within mental health care. The AC role is supporting clinical leadership by a range of professionals, promoting patient choice by enabling access to clinicians with the appropriate skills to meet needs. Clinical leadership roles are promoting links between organisational priorities, teams and patient care, fostering distributed leadership in practice. Research limitations/implications This project reflects the views of a limited number of practitioners within one organisation which limits generalisabilty. Practical implications Organisations need clear strategies linked to workforce development and implementation of the roles to capitalise on their potential to support clinical leadership and person-centred care. Originality/value This study provides initial qualitative data on potential benefits and challenges of implementing the role.

Nurses’ views about unlicensed and off-license medicines in forensic mental health

2014 ◽  
Vol 16 (3) ◽  
pp. 194-202
Author(s):  
Camilla M. Haw ◽  
Jean H. Stubbs ◽  
Geoffrey L. Dickens
Keyword(s):  
Mental Health ◽  
Design Methodology ◽  
Forensic Mental Health ◽  
Pragmatic Approach ◽  
Structured Interviews ◽  
Mental Health Nurses ◽  
Content Type ◽  
Unlicensed Medicines ◽  
Mental Health Settings ◽  
Practical Implications

Purpose – Use of off-license medicines in forensic mental health settings is common and unlicensed drugs are sometimes prescribed. Despite their responsibility for administering medicines little is known about how mental health nurses view these practices. The paper aims to discuss these issues. Design/methodology/approach – In total, 50 mental health nurses working in low and medium secure adolescent and adult mental health wards were presented with a clinical vignette about administration of unlicensed and off-license medicines. Semi-structured interviews about their likely clinical response to, and feelings about, this practice were conducted. Interview data were subject to a thematic analysis. Findings – Analysis revealed six themes: status of unlicensed/off-label medicines; legality of administering unlicensed medicines; professional standards around administering unlicensed medicines; finding out more about unlicensed medicines; trusting medical colleagues; and decision making in uncertain cases. Practical implications – Forensic mental health nurses take a pragmatic approach to the practice of administering unlicensed medicines and most are aware of their professional responsibilities. Originality/value – This study provides the first evidence to inform the development of training for forensic mental health nurses about an issue that is common in forensic mental health practice.

scholarly journals Foregrounding the perspectives of mental health services users during the COVID-19 pandemic

2020 ◽  
Vol 24 (3) ◽  
pp. 131-133
Author(s):  
Hannah Zeilig ◽  
Brioney Gee ◽  
Bonnie Teague ◽  
Jonathan Wilson ◽  
Corinna Hackmann
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Design Methodology ◽  
Lead Author ◽  
Service Development ◽  
Service Users ◽  
Service Strategy ◽  
Content Type ◽  
Strategy Design

Purpose This paper aims to highlight the critical importance of the perspectives of mental health service-users during the COVID-19 pandemic. Design/methodology/approach This viewpoint is based on a review of recent research and literature and draws on consultations with experts by experience, including the lead author. Findings The authors argue that expertise-by-experience is critical to policy, service development and research; but there is a risk it will be neglected at a time of rapid and reactive clinical development. Research limitations/implications Understanding and responding to the nuances of individual need can only be achieved through coproducing service strategy design, delivery and research with mental health service users. The consultation outlined in this viewpoint gives some indication of the type of valuable insights that can be gained through seeking and listening to the perspectives of experts by experience. Originality/value The discussions revealed that experience of managing severe and complex mental health conditions can actually be advantageous when facing a crisis such as COVID-19.

Measuring parent satisfaction in youth mental health services

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Aileen O’Reilly ◽  
Alanna Donnelly ◽  
Jennifer Rogers ◽  
Olive Maloney ◽  
Gillian O’Brien ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Parent Satisfaction ◽  
Youth Mental Health ◽  
Service Development ◽  
Content Type ◽  
Growth And Change

Purpose Measuring parent satisfaction is regarded as essential but there is a paucity of research reporting on parental satisfaction with community youth mental health services. This study aims to examine parent satisfaction with Jigsaw – a primary care youth mental health service. Design/methodology/approach A measure of parent satisfaction was developed and administered to parents in 12 Jigsaw services over a two-year period (n = 510, age range: 28 to 70 years) when young people and parents were ending their engagement with these services. Findings Overall, parents had high levels of satisfaction with Jigsaw and their level of satisfaction did not vary depending on the parent or young person’s age and/or gender. Examination of qualitative feedback revealed three overarching themes relating to growth and change in young people, parents and their families; strengths of the service and; suggestions for future service development. Analysis of the psychometric properties of the measure provided evidence for a two-factor structure examining satisfaction with the intervention and outcomes and service accessibility and facilities. Originality/value This study represents one of the first efforts to measure parent satisfaction with primary care youth mental health services. It has resulted in the development of a brief measure that can be more widely administered to parents engaging with primary care youth mental health services.

Maximising resilience resources for mental healthcare staff

2018 ◽  
Vol 23 (1) ◽  
pp. 37-53
Author(s):  
Nicole S. Gevaux ◽  
Stephanie Petty
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
Working Environment ◽  
Card Sorting ◽  
Content Type ◽  
Mental Health Settings ◽  
Practical Implications ◽  
Insight Into

Purpose The purpose of this paper is to investigate optimal resources to promote resilience in staff working in inpatient mental health services. The study also provides an example of card sorting methodology used as an efficient way to identify the most helpful resources for resilience. Design/methodology/approach In total, 25 clinical staff participated in the study. A preliminary focus group and brief literature search identified resources used in two tasks. Two card sorting tasks identified resources participants found helpful vs unhelpful and abundant vs scarce, and resources they would find valuable to use more often. Findings The results indicate that most resources helpful to resilience and available to staff were personal resources (relating to positive outlooks or ways of working), whereas resources valuable to resilience but scarce in the working environment were organisational resources (relating to management or social workplace culture). Resources found to not be valuable to resilience were largely personal tangible resources (e.g. smoking, massages). Practical implications The findings and method may be generalisable to other mental health services, giving insight into promoting resilience within individuals and organisations. This information could serve as guidelines to streamline the allocation of organisational resources to best promote resilience across various mental health settings. Originality/value Staff resilience to working in mental health services contributes to high-quality, sustainable patient care. This study provides further insight into how personal and organisational resources are both vital to resilience in staff working in highly challenging environments.

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