scholarly journals Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nicholas Weaver
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Meaning Making ◽  
Healthcare Delivery ◽  
Mental Healthcare ◽  
Magic Bullet ◽  
Care Pathways ◽  
Content Type ◽  
Moral Communication

PurposeTheoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways.Design/methodology/approachRecent mental health service transformation in Wales, United Kingdom, has been stimulated by a policy programme underpinned by person-centred recovery values. This paper offers analysis informed by the perspectives of Niklas Luhmann and other noted theorists to examine escalating service system complexity related to this transformation. Analysis builds upon the findings of a qualitative study employing thematic discourse analysis of talk of people with mental illness and associated workers.FindingsIn total, three themes were constructed in participants' talk: “Competing versions of recovery”, “Misaligned service expectations” and “Disrupted care pathways.” Recovery may be understood as a form of moral communication and autopoietic meaning-making activity, according to Luhmann's radical constructionist epistemology. This has the potential to generate competing versions of recovery, a key contributor to escalating complexity.Research limitations/implicationsFindings could be developed further by continued investigation of the relationship between recovery implementation and service fragmentation.Social implicationsA more judicious, balanced policy-implementation may cultivate optimal conditions for recovery pluralism by avoiding polarisation towards either top-down, policy-based recovery implementation or a proliferation of approaches at the grassroots level. Findings have implications for healthcare settings beyond the scope of mental healthcare, given the prevalence of person-centred care internationally.Originality/valueA simplistic view of recovery implementation should be challenged. Recovery should not be considered a “magic bullet” for mental healthcare delivery. Haphazard recovery-implementation may have detrimental effects of escalating complexity, service fragmentation and disrupted care pathways.

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 impact of a night confinement policy on patients in a UK high secure inpatient mental health service

2015 ◽  
Vol 17 (1) ◽  
pp. 21-30 ◽  
Author(s):  
Simon Chu ◽  
Kimberley McNeill ◽  
Karen M. Wright ◽  
Anthony Hague ◽  
Tracy Wilkins
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Negative Impact ◽  
Sleep Hygiene ◽  
Content Type ◽  
Inpatient Mental Health ◽  
The Impact

Purpose – From 2012, all high-secure forensic mental health services in England began operating a policy of confining patients to their locked bedrooms overnight to increase service efficiency and reduce costs. The purpose of this paper is to assess the views of staff and patients concerning the policy and examine the specific impact of the policy on patients. Design/methodology/approach – Measures of patients’ sleep hygiene, patients’ behaviour, ward atmosphere, engagement with therapy and adverse incidents were taken both before and after the night confinement (NC) policy was implemented. Both patients and staff also expressed their views of the impact of the NC policy. Findings – Results provide converging evidence that the impact of the NC policy on patients is negligible. There were no consistent negative effects of confining patients overnight. Rather, patients and staff were broadly positive about the impact that the practice had on patients. Practical implications – Confining patients to locked bedrooms overnight does not exert any consistent influence, positive or negative, on patients’ sleep hygiene, behaviour or engagement with therapy, and patients expressed a broadly positive view of the practice of NC. Thus, a NC policy may have a contribution to make to the provision an effective high-secure mental health service. Originality/value – The study provides convincing evidence that secure inpatient mental health services that are considering the adoption of a NC policy may do so without fear of a negative impact on patients.

Linking the past and the present: service users’ perspectives of how adverse experiences relate to their admission to forensic mental health services

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jessica Cartwright ◽  
Daniel Lawrence ◽  
Christopher Hartwright
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Service Users ◽  
Forensic Mental Health ◽  
Discussion Section ◽  
Content Type ◽  
The Past ◽  
Secure Care ◽  
Adverse Experiences

Purpose This study aimed to explore how forensic mental health service users make sense of their past adverse experiences. Secondly, it aimed to explore whether service users considered their adverse experiences to be related to their current stay in a forensic mental health setting. Design/methodology/approach Interpretative phenomenological analysis was used to analyse interviews with eight service users in low and medium secure care. Six of the participants were male and two were female. Findings Four super-ordinate themes emerged from the data: “Living amongst adversity”; “Managing adverse experiences”; “Making sense of going into secure care”; and “Coping with the past in the present”. All participants referred to multiple adverse experiences throughout their lives and used harmful coping strategies to manage these. Individual differences in how they related their past experiences to their detention in secure care were evident. Practical implications Author guidelines state that this section is optional. Implications for clinical practice are discussed at length in the discussion section. Originality/value This study offers an insight into the way in which forensic mental health service users make sense of their past traumas in relation to their current admission to secure services. To the best of the authors’ knowledge, no research has previously addressed this from the perspective of service users.

The experience of learning from mental health service users and carers

2019 ◽  
Vol 14 (2) ◽  
pp. 119-130
Author(s):  
Charlotte Wilson
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Online Survey ◽  
User Involvement ◽  
Emotional Arousal ◽  
Student Experiences ◽  
Service Users ◽  
Content Type ◽  
Cognitive Experience

Purpose The purpose of this paper is to explore student experiences of learning from mental health service users and carers. Design/methodology/approach In total, 30 clinical psychology trainees and ex-trainees took part in an online survey (n=21) or focus group (n=9). Responses were analysed using interpretative thematic analysis. Findings A number of themes were identified. There were two pre-conditions of learning: valuing the teaching and emotional arousal. Participants’ learning experiences were characterised by cognitive and meta-cognitive processes: active learning, reflection, increased attention and vivid memories. Furthermore, participants might have a meta-cognitive experience of having learned something, but being unsure what that something was. Participants reported learning about the lives of service users, about themselves and about the wider societal context for people with mental health difficulties. Practical implications In order to facilitate learning students should value the input of service users. This allows them to contain and use the emotional arousal the teaching produces. Furthermore, leaving students with a feeling that something has been learned but not being exactly sure what that has been may facilitate students seeking out further opportunities for service user involvement. Originality/value Few studies have explored the process of learning from mental health service users and carers. In the current study, the emotion aroused in participants was primary. Furthermore, a new meta-cognitive experience, namely, the experience of having learned something, but not being sure what has been learned, has been identified.

An evaluation of peer-led self-management training for people with severe psychiatric diagnoses

2015 ◽  
Vol 10 (1) ◽  
pp. 3-13 ◽  
Author(s):  
Eva Cyhlarova ◽  
David Crepaz-Keay ◽  
Rachel Reeves ◽  
Kirsten Morgan ◽  
Valentina Iemmi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Management Training ◽  
Self Management ◽  
Psychiatric Diagnoses ◽  
Service Users ◽  
Content Type ◽  
Time Points ◽  
Health Promoting

Purpose – The purpose of this paper is to establish the effectiveness of self-management training as an intervention for people using secondary mental health services. Design/methodology/approach – A self-management and peer support intervention was developed and delivered by secondary mental health service users to 262 people with psychiatric diagnoses living in the community. Data on wellbeing and health-promoting behaviour were collected at three time points (baseline, six, and 12 months). Findings – Participants reported significant improvements in wellbeing and health-promoting lifestyle six and 12 months after self-management training. Peer-led self-management shows potential to improve long-term health outcomes for people with psychiatric diagnoses. Research limitations/implications – Due to the lack of a control group, the positive changes cannot definitively be attributed to the intervention. Other limitations were reliance on self-report measures, and the varying numbers of completers at three time points. These issues will be addressed in future studies. Practical implications – The evaluation demonstrated the effectiveness of self-management training for people with psychiatric diagnoses, suggesting self-management training may bring significant wellbeing gains for this group. Social implications – This study represents a first step in the implementation of self-management approaches into mental health services. It demonstrates the feasibility of people with psychiatric diagnoses developing and delivering an effective intervention that complements existing services. Originality/value – This is the first study to investigate the effectiveness of a self-management training programme developed and delivered by mental health service users in the UK.

Incarcerated youth mental and physical health: parity of esteem

2017 ◽  
Vol 10 (3) ◽  
pp. 203-212 ◽  
Author(s):  
Yolisha Singh ◽  
John Kasinathan ◽  
Andrew Kennedy
Keyword(s):  
Mental Health ◽  
Health Service ◽  
Service Provision ◽  
Relevant Literature ◽  
Mental Healthcare ◽  
Incarcerated Youth ◽  
Physical And Mental Health ◽  
Global Improvement ◽  
Health Service Provision ◽  
Content Type

Purpose The purpose of this paper is to describe physical and mental health characteristics of incarcerated youth both internationally and in New South Wales (NSW) Australia. To outline current practices in the provision of mental and physical healthcare for incarcerated youth internationally and in NSW. Design/methodology/approach Population relevant literature will be outlined as applicable. Health service delivery will be discussed, with an emphasis on the experiences of NSW physical and mental health service provision for incarcerated youth. Findings This paper illustrates that in NSW there was a parity of provision between physical and mental healthcare, though there were deficits in what should ideally be provided. Internationally there was clear evidence that current minimum standards of healthcare in both physical and mental healthcare domains remain unmet. Practical implications Provision of physical and mental healthcare for incarcerated youth warrants global improvement. Further research into current provisions, across jurisdictions and subsequent standardisation of practice, will improve health outcomes for this vulnerable group. Originality/value This is the first paper to describe mental and physical healthcare provision in NSW for incarcerated youth framed within the broader context of international health service provision for similar populations.

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.

Towards disabled futures: Non-realist embodiment in puppetry1

2020 ◽  
Vol 11 (1) ◽  
pp. 59-72
Author(s):  
Petra Kuppers
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Object Relations ◽  
Service Providers ◽  
Meaning Making ◽  
Health Service Providers ◽  
Experimental Poetics ◽  
Hospital Practices

This article engages disability puppetry as plays of transactional object relations, opening into speculative realms, articulating new alignments of embodied and enminded difference. The examples here range from hospital practices via art/life pain-related somatic explorations to experimental poetics of classroom and gallery installations, and from there to small local theatres working in collaboration with mental health service providers. In all of these sites, disability and puppetry have much to say to one another, offering connection and new forms of meaning-making, using non-realist conventions to make new worlds in which disability stays present.

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).

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