scholarly journals WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

2019 ◽  
Vol 14 (6) ◽  
pp. 399-410
Author(s):  
Robert J. Snowden ◽  
Jordan Holt ◽  
Nicola Simkiss ◽  
Aimee Smith ◽  
Daniel Webb ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Services ◽  
Health Services ◽  
Assessment Process ◽  
Research Network ◽  
Safety Planning ◽  
Content Type ◽  
Risk Assessment Process ◽  
Health Boards

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives.

An inductive content analysis of formative feedback given by lived experience assessors in pre-registration mental health nurse education

2019 ◽  
Vol 15 (1) ◽  
pp. 33-42
Author(s):  
Gemma Stacey ◽  
Mark Pearson
Keyword(s):  
Mental Health ◽  
Content Analysis ◽  
Mental Health Services ◽  
Health Services ◽  
Lived Experience ◽  
Student Nurses ◽  
Assessment Process ◽  
Written Feedback ◽  
Mental Health Nurses ◽  
Content Type

Purpose In the assessment of student nurses, there is limited research exploring why the contributions of people with lived experience (LE) have an impact on learning. The purpose of this paper is to compare the nature of feedback provided to students by people who have both worked in and used mental health services. Design/methodology/approach To explore the nature of qualitative student feedback generated from an assessment involving people who have experience of using and working in mental health services. Therefore, an inductive content analysis conducted on the formative written feedback provided to students following a simulated assessment. Findings The results demonstrate significant similarities in the feedback provided by those with LE of using and working within mental health services, suggesting a shared conceptualisation of professionalism. Research limitations/implications The research indicates the potential socialisation of professionals and service users to not only the assessment process but also the professional expectations of mental health nurses. These findings resonate with Barker et al.’s (1999) description of the “pseudo ordinary me” and emphasise the principles and importance of person-centred care. Originality/value The paper highlights that assessment approaches which incorporate feedback from people with LE offer a vehicle to demonstrate and explore how attributes, subjectively associated with professionalism, can be recognised and developed by student mental health nurses.

Evaluation of a diagnostic ADHD pathway in a community child mental health service in South London

2020 ◽  
Vol 25 (1) ◽  
pp. 1-19
Author(s):  
Georgina L. Barnes ◽  
Alexandra Eleanor Wretham ◽  
Rosemary Sedgwick ◽  
Georgina Boon ◽  
Katie Cheesman ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Child Mental Health ◽  
Assessment Process ◽  
Children And Young People ◽  
Content Type ◽  
Nice Guideline ◽  
Child Mental Health Services

Purpose Clinicians working in UK child mental health services are faced with several challenges in providing accurate assessment and diagnosis of attention deficit hyperactivity disorder (ADHD). Within the South London & Maudsley (SLaM) NHS Trust, community Child & Adolescent Mental Health Services (CAMHS) are developing structured pathways for assessing and diagnosing ADHD in young people. To date, these pathways have not been formally evaluated. The main aims of this evaluation are to evaluate all ADHD referrals made to the service in an 18-month period, including the number of completed assessments and proportion of children diagnosed with ADHD; and investigate adherence to the National Institute for Clinical Excellence (NICE) guideline for diagnosing ADHD in children and young people. Design/methodology/approach Retrospective data analysis was performed using service databases and electronic patient records. Adherence to the clinical guideline was measured using the NICE data collection tool for diagnosing ADHD in children and young people. All completed ADHD assessments were compared to four key recommendation points in the guideline. Findings Within the time frame, 146 children aged 4-17 years were referred and accepted for an ADHD assessment. Of these, 92 families opted in and were seen for an initial appointment. In total, 36 ADHD assessments were completed, of which 19 children received a diagnosis of ADHD and 17 did not. Aside from structured recording of ADHD symptoms based on ICD-10 criteria (69%) and reporting of functional impairment (75%), adherence to all guidance points was above 90%. The study also found that although a greater proportion of children referred to the service were male and identified as White, these differences narrowed upon receipt of ADHD diagnosis. Research limitations/implications Relationship to the existing literature is discussed in relation to the assessment process, demographic characteristics and rates of co-occurrence. Practical implications The findings demonstrate that in child mental health services, gold standard practice for diagnosing ADHD should be the adoption of clear, protocol-driven pathways to support appropriate access and treatment for young people and their families. Originality/value This article is unique in that it is, to the best of the authors’ knowledge, the first to describe and report clinician-adherence to a structured pathway for diagnosing ADHD in young people within a community CAMHS service in South London.

scholarly journals WARRN – a formulation-based risk assessment procedure for Child and Adolescent Mental Health Services (CAMHS): the view of clinicians

2019 ◽  
Vol 21 (4) ◽  
pp. 228-239 ◽  
Author(s):  
Nicola S. Gray ◽  
Jacqui Tiller ◽  
Robert J. Snowden
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Well Being ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Research Network ◽  
Assessment Procedure ◽  
Evaluation Instrument ◽  
Content Type

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services which has been adopted across most Child and Adolescent Mental Health Services (CAMHS) across Wales. The paper aims to discuss this issue. Design/methodology/approach An online survey was disseminated to National Health Service clinicians in CAMHS to evaluate their perceptions of the use and effectiveness of WARRN. Data from 88 clinicians were analysed with both quantitative and qualitative methods. Findings Clinicians reported increased clinical skills, increased confidence in their assessment and management of risk and in safety planning, the increased safety of service users and the general public, and a belief that WARRN had saved lives. The qualitative data showed that clinicians thought a common risk evaluation instrument across Wales and different agencies had created a common language and understanding that improved communication. Practical implications WARRN appears well accepted in CAMHS services with the view that it is having a very positive effect on service user well-being and safety and could be implemented in other services. Originality/value This is the first report of a formulation-based approach to the management of serious problem behaviours in CAMHS services.

scholarly journals Experiences of men with psychosis participating in a community-based football programme

2017 ◽  
Vol 45 (2) ◽  
pp. 100-111 ◽  
Author(s):  
Laura Moloney ◽  
Daniela Rohde
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Mental Health Services ◽  
Health Services ◽  
Occupational Therapy ◽  
Positive Impact ◽  
Physical And Mental Health ◽  
Community Based ◽  
Health Service Provision ◽  
Content Type

Purpose Physical activity is associated with both physical and mental health benefits for people with psychosis. However, mental health services have been criticised for failing to adequately promote physical activities. Occupational Therapy, with its focus on meaningful everyday occupations, is well placed to incorporate physical activity interventions. The purpose of this study was to explore the experiences of men with psychosis participating in an Irish community-based football programme. Design/methodology/approach Six men with psychosis participated in qualitative interviews. The interviews were audio-recorded and transcribed verbatim. Interview data were analysed thematically. Findings Participants identified many benefits of engaging in the programme. Football became a valued part of weekly routines and fostered re-engagement with previously valued roles. Participants identified improvements in social confidence and motor and process skills, as well as a positive impact on their mental and physical health. Originality/value This study highlights the value and meaning of participation in football for men with psychosis, as well as demonstrating the longer-term feasibility of football as a therapeutic medium in Occupational Therapy mental health service provision. Findings could help to promote the routine use of sports interventions to mental health services.

A day in the life of a peer support worker: re-entry

2016 ◽  
Vol 20 (3) ◽  
pp. 149-152
Author(s):  
Emma Watson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Design Methodology ◽  
Narrative Approach ◽  
Personal Recovery ◽  
Support Worker ◽  
Content Type ◽  
Returning To Work

Purpose – The purpose of this paper is to share the experiences and reflections of a peer support worker over the course of a day working in mental health services. Design/methodology/approach – A narrative approach has been taken to structure reflections based on the experience of returning to work after taking sick leave. Findings – Reflections are offered based on the process of returning to work and the way that this experience sheds light on personal recovery. Originality/value – This paper adds to the small number of accounts of the experiences of peer support working in mental health services and as such is highly original.

The transition between mental health services in Scotland

2018 ◽  
Vol 23 (1) ◽  
pp. 12-24 ◽  
Author(s):  
Juliette van der Kamp
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Transition Period ◽  
Organisational Development ◽  
Structured Interviews ◽  
Content Type ◽  
Experience Difficulty

Purpose The purpose of this paper is to describe the barriers and facilitators to an effective transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). It also presents a new entry into considering how the transition can be improved. Design/methodology/approach Insights into the transition from CAMHS to AMHS were gathered through eight semi-structured interviews with mental health professionals. Two methods of data analysis were employed to explore the emerging themes in the data and the observed deficit approach to organisational development. Findings The findings identified a vast volume of barriers in comparison to facilitators to the transition. Adolescents who transition from CAMHS to AMHS initially experience difficulty adapting to the differences in the services due to the short duration of the transition period. However, despite the established barriers to the transition, adolescents tend to adapt to the differences between the services. Findings also showed a negative framing towards the transition amongst the mental health professionals which resembles a deficit approach to organisational development. Originality/value This paper explores mental health professionals’ perspectives regarding the transition in Dumfries and Galloway, Scotland. The transition is increasingly recognised as an area in health care that requires improvement. This research provides a new way to consider the transition by exploring the perceived deficit approach to organisational development in the services.

“Walking wounded or wounded healer?” Does personal experience of mental health problems help or hinder mental health practice? A review of the literature

2014 ◽  
Vol 18 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Catherine Conchar ◽  
Julie Repper
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Peer Support ◽  
Personal Experience ◽  
Mental Health Problems ◽  
Health Problems ◽  
Review Of The Literature ◽  
Wounded Healer ◽  
Content Type

Purpose – A systematic review of the literature on “wounded healers” was undertaken to identify, define and interpret the term and its application within the mental health environment. The paper aims to discuss these issues. Design/methodology/approach – Eight key medical/social sciences databases were interrogated. In total, 835 papers were identified in the systematic database search and abstracts were obtained for each to determine whether they met the inclusion criteria. In total, 237 sources were retrieved for critical reading, to assess relevance and value to the review, and 125 documents were subsequently included. Through thematic analysis a number of themes and sub themes were identified Findings – The archetypal image of the wounded healer originates in ancient mythology and crosses many cultures. There are many interpretations and applications of the belief that having healed their own wounds a person is in a better position to heal others, however, the evidence to support this is not so robust. Of more direct relevance to contemporary practice are reports of supporting staff with mental health problems to make a contribution to mental health services, most recently through the employment of peer support workers. Originality/value – As peer support workers are increasingly being employed in mental health services, it is helpful to consider the many existing staff who bring personal experience of mental health problems. This paper explores the evidence that their lived experience makes a difference to the way that they work and considers their employment support needs.

scholarly journals Designing servicescapes for transformative service conversations: lessons from mental health services

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahir Gopaldas ◽  
Anton Siebert ◽  
Burçak Ertimur
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Risk Taking ◽  
Design Theory ◽  
Well Being ◽  
Service Encounters ◽  
Design Strategies ◽  
Content Type ◽  
Emotional Risk

Purpose Dyadic services research has increasingly focused on helping providers facilitate transformative service conversations with consumers. Extant research has thoroughly documented the conversational skills that providers can use to facilitate consumer microtransformations (i.e. small changes in consumers’ thoughts, feelings and action plans toward their well-being goals). At the same time, extant research has largely neglected the role of servicescape design in transformative service conversations despite some evidence of its potential significance. To redress this oversight, this article aims to examine how servicescape design can be used to better facilitate consumer microtransformations in dyadic service conversations. Design/methodology/approach This article is based on an interpretive study of mental health services (i.e. counseling, psychotherapy and coaching). Both providers and consumers were interviewed about their lived experiences of service encounters. Informants frequently described the spatial and temporal dimensions of their service encounters as crucial to their experiences of service encounters. These data are interpreted through the lens of servicescape design theory, which disentangles servicescape design effects into dimensions, strategies, tactics, experiences and outcomes. Findings The data reveal two servicescape design strategies that help facilitate consumer microtransformations. “Service sequestration” is a suite of spatial design tactics (e.g., private offices) that creates strong consumer protections for emotional risk-taking. “Service serialization” is a suite of temporal design tactics (e.g., recurring appointments) that creates predictable rhythms for emotional risk-taking. The effects of service sequestration and service serialization on consumer microtransformations are mediated by psychological safety and psychological readiness, respectively. Practical implications The article details concrete servicescape design tactics that providers can use to improve consumer experiences and outcomes in dyadic service contexts. These tactics can help promote consumer microtransformations in the short run and consumer well-being in the long run. Originality/value This article develops a conceptual model of servicescape design strategies for transformative service conversations. This model explains how and why servicescape design can influence consumer microtransformations. The article also begins to transfer servicescape design tactics from mental health services to other dyadic services that seek to facilitate consumer microtransformations. Examples of such services include career counseling, divorce law, financial advising, geriatric social work, nutrition counseling, personal styling and professional organizing.

scholarly journals Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP)

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola S. Gray ◽  
Ann John ◽  
Aimee McKinnon ◽  
Stephanie Raybould ◽  
James Knowles ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Evaluation ◽  
Suicide Risk ◽  
Professional Judgment ◽  
Health Board ◽  
Safety Planning ◽  
Nice Guidelines ◽  
Structured Professional Judgment

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk.Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder.Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission.Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93–0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample.Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

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