The risk of risk management: adopting critical theories to explore clinical risk concerns in mental health care

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kris Deering ◽  
Jo Williams ◽  
Rob Williams
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Risk Management ◽  
Mental Health Care ◽  
Social Inclusion ◽  
Management Practices ◽  
Content Type ◽  
Clinical Risk ◽  
Critical Theories ◽  
The Impact

Purpose The purpose of this paper is to outline several critical risk theories and explore their application to risk concerns in mental health care. This will contribute to the on-going debate about risk management practices and the impact these might have on recovery and social inclusion. Notably, while risks like suicide can be therapeutically addressed, risk management may involve paternalistic practices that exclude the participation needed for recovery. Design/methodology/approach A viewpoint of key risk theories will be presented to provide a critical eye about some clinical risk concerns in mental health care. Implications for recovery and social inclusion will then be discussed alongside direction for practice and research. Findings Clinical concerns seemed to involve difficulties with uncertainty, holding onto expertise, and the othering of patients through risk. These concerns suggest the patient voice might become lost, particularly within the backdrop of clinical fears about blame. Alternatively, a relational approach to risk management could have merit, while patient expertise may develop understanding in how to improve risk management practices. Originality/value Clinical concerns appear more than managing potential harms; it can involve appraising behaviours around societal norms, explaining to an extent why mental illness might be addressed in terms of risks. While the points raised in the paper support existing findings about risk management, the underlying reasons drawing on the critical risk theories are less explored.

Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vivienne de Vogel ◽  
Nienke Verstegen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Forensic Mental Health ◽  
Content Type ◽  
Self Injury ◽  
Forensic Psychiatric ◽  
The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

scholarly journals The familiar stranger of mental health

2020 ◽  
Vol 15 (4) ◽  
pp. 237-247
Author(s):  
Matthew Sydney Long
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Facility ◽  
Health Care Professionals ◽  
Service User ◽  
Health Care Facilities ◽  
Mental Health Facility ◽  
Content Type ◽  
The Impact

Purpose This paper aims to contribute to the debate about the closure of institutional mental health-care facilities, from an experiential perspective of a former mental health inpatient, ongoing service user and campaigner for retention of such facilities. It argues that auto-ethnographic accounts of mental illness by those with multiple social identities can have a greater role in terms of future training of mental health-care professionals. Design/methodology/approach The paper offers an experiential account of the impact of mental health facility bed closures as a patient admitted to institutional mental health facilities; as a mental health campaigner, fighting for the provision of both places of safety and “safe space” within his own local community; and as an ongoing service user. The research is in the interpretivist tradition of social science in taking an auto-ethnographical methodological stance. Findings This paper is underpinned by two key theoretical notions. Firstly, Stuart Hall’s concept of the Familiar Stranger (2017) is used to explore the tensions of self-identity as the author SHIFTS uncomfortably between his three-fold statuses. Secondly, the notion of “ontological insecurity” offered by Giddens (1991) is used with the paper exploring the paradox that admission to a mental health facility so-called “place of safety” is in fact itself a disorientating experience for both patient and carer(s). Research limitations/implications No positivistic claims to reliability, representativeness or generalisability can be made. It is the authenticity of the account which the reader feels should be afforded primacy in terms of its original contribution to knowledge. Practical implications This paper should have practical use for those tasked with developing educational and training curriculums for professionals across the mental health-care sector. Social implications This paper implicitly assesses the political wisdom of the policy of mental health bed closures within the wider context of the deinstitutionalisation movement. Originality/value This paper is underpinned by original experiential accounts from the author as patient, campaigner for places of safety and onging service-user of mental health care provision.

Cultivating compassion through compassion circles: learning from experience in mental health care in the NHS

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Clark ◽  
Andy Bradley ◽  
Laura Simms ◽  
Benna Waites ◽  
Alister Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
National Policy ◽  
Well Being ◽  
Content Type ◽  
Team Members ◽  
Health And Social Care ◽  
Current Concerns ◽  
The Impact

Purpose This paper aims to discuss the importance of compassion in health care and experiences of Compassion Circles (CCs) in supporting it, placing this into the national policy context of the National Health Service (NHS), whilst focusing on lessons from using the practice in mental health care. Design/methodology/approach This conceptual paper is a discussion of the context of compassion in health care and a description of model and related concepts of CCs. This paper also discusses lessons from implementation of CCs in mental health care. Findings CCs were developed from an initial broad concern with the place of compassion and well-being in communities and organisations, particularly in health and social care after a number of scandals about failures of care. Through experience CCs have been refined into a flexible model of supporting staff in mental health care settings. Experience to date suggests they are a valuable method of increasing compassion for self and others, improving relationships between team members and raising issues of organisational support to enable compassionate practice. Research limitations/implications This paper is a discussion of CCs and their conceptual underpinnings and of insights and lessons from their adoption to date, and more robust evaluation is required. Practical implications As an emergent area of practice CCs have been seen to present a powerful and practical approach to supporting individual members of staff and teams. Organisations and individuals might wish to join the community of practice that exists around CCs to consider the potential of this intervention in their workplaces and add to the growing body of learning about it. It is worth further investigation to examine the impact of CCs on current concerns with maintaining staff well-being and engagement, and, hence, on stress, absence and the sustainability of work environments over time. Social implications CCs present a promising means of developing a culture and practice of more compassion in mental health care and other care contexts. Originality/value CCs have become supported in national NHS guidance and more support to adopt, evaluate and learn from this model is warranted. This paper is a contribution to developing a better understanding of the CCs model, implementation lessons and early insights into impact.

The 10th EAMHID International Congress: integrating different approaches in the neurodevelopmental perspective – the mental health care evolution timeline

2016 ◽  
Vol 10 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Marco O. Bertelli
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Full Range ◽  
Autism Spectrum ◽  
International Congress ◽  
Content Type ◽  
Interdisciplinary Approaches ◽  
The Impact

Purpose – The purpose of this paper is to provide a summary of main outcomes of the 10th EAMHID International Congress and a critical overview of some key contributions. Design/methodology/approach – A discussion on the impact of the neurodevelopmental perspective on mental health care achievements and failures in the field of intellectual disability (ID) and autism spectrum disorders (ASD). Findings – The considerable progress in the field of mental health care for people with ID that has been made in the last 30 years and that is reflected through the 350 papers presented in this Congress represents the continuation of the work of great pioneers, such as Frank Menolascino, Felix Platter or William I. Gardner, who have been honoured by the EAMHID in the naming of the congress rooms, and the dedication of the poster award. The neurodevelopmental perspective was confirmed to be the current most valued conceptual framework to explain relations across systems and to support multi-level, transnosographic, life-long, interdisciplinary approaches in the production of aetiological insight and good-quality intervention for mental health problems; on the other hand it might determine a premature abandonment of the traditional nosology and the appearance of very broad spectrum conditions covering the full range of psychopathology. Also psychopharmacology was extensively considered, with the explicit aim to raise the attention of researchers and clinicians on this neglected topic. Unfortunately, adults with ID/ASD are still deprived of the right to receive treatments that are based on strong evidence, as it is for the general population. Originality/value – This editorial outlines the second part of a special issue that offers a comprehensive and varied collection of papers from the contributions to the 10th International Congress of the EAMHID.

scholarly journals Commissioning for better outcomes in mental health care: testing Alliance Contracting as an enabling framework

2015 ◽  
Vol 19 (4) ◽  
pp. 191-201
Author(s):  
Michael Clark ◽  
Tony Ryan ◽  
Nick Dixon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Inclusion ◽  
Mental Health Problems ◽  
Content Type ◽  
Contractual Arrangements ◽  
Health And Social Care ◽  
Pathways Of Care

Purpose – Commissioning has been a central plank of health and social care policy in England for many years now, yet there are still debates about how effective it is in delivering improvements in care and outcomes. Social inclusion of people with experience of mental health is one of the goals that commissioners would like to help services to improve but such a complex outcome for people can often be undermined by contractual arrangements that fragment service responses rather than deliver holistic support. The purpose of this paper is to discuss a form of commissioning, Alliance Contracting, and how it has been allied with a Social Inclusion Outcomes Framework (SIOF) in Stockport to begin to improve services and outcomes. Design/methodology/approach – The paper is a conceptual discussion and case description of the use of Alliance Contracts to improve recovery services and social inclusion in mental health care in one locality. Findings – The paper finds that the Alliance Contracting approach fits well with the SIOF and is beginning to deliver some promising results in terms of improving services. Research limitations/implications – This is a case study of one area and, as such, it is hard to generalise beyond that. Practical implications – The paper discusses a promising approach for commissioners to develop locally to guide service improvements and better social inclusion outcomes for people. Social implications – Rather than developing good services but fractured pathways of care across providers and teams, the Alliance Contracting approach potentially delivers more holistic and flexible pathways that ought to better help individuals in their recovery journeys. Originality/value – This is the first paper to set out the use of Alliance Contracting and social inclusion measures to help improve services and outcomes for people experiencing mental health problems.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

scholarly journals Incorporating digital self-services into integrated mental health care: a physician’s perspective

2018 ◽  
Vol 52 (11) ◽  
pp. 2234-2250 ◽  
Author(s):  
Heini Sisko Maarit Taiminen ◽  
Saila Saraniemi ◽  
Joy Parkinson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Delivery ◽  
Value Creation ◽  
Care Delivery ◽  
Service Marketing ◽  
Content Type ◽  
Integrated Mental Health ◽  
Physician’S Perspective

Purpose This paper aims to enhance the current understanding of digital self-services (computerized cognitive behavioral therapy [cCBT]) and how they could be better incorporated into integrated mental health care from the physician’s perspective. Service marketing and information systems literature are combined in the context of mental health-care delivery. Design/methodology/approach An online survey of 412 Finnish physicians was undertaken to understand physicians’ acceptance of cCBT. The study applies thematic analysis and structural equation modeling to answer its research questions. Findings Adopting a service marketing perspective helps understand how digital self-services can be incorporated in health-care delivery. The findings suggest that value creation within this context should be seen as an intertwined process where value co-creation and self-creation should occur seamlessly at different stages. Furthermore, the usefulness of having a value self-creation supervisor was identified. These value creation logic changes should be understood and enabled to incorporate digital self-services into integrated mental health-care delivery. Research limitations/implications Because health-care systems vary across countries, strengthening understanding through exploring different contexts is crucial. Practical implications Assistance should be provided to physicians to enable better understanding of the application and suitability of digital self-service as a treatment option (such as cCBT) within their profession. Additionally, supportive facilitating conditions should be created to incorporate them as part of integrated care chain. Social implications Digital self-services have the potential to serve goals beyond routine activities in a health-care setting. Originality/value This study demonstrates the relevance of service theories within the health-care context and improves understanding of value creation in digital self-services. It also offers a profound depiction of the barriers to acceptance.

Organisational impact of the National Disability Insurance Scheme transition on mental health care providers: the experience in the Australian Capital Territory

2018 ◽  
Vol 26 (6) ◽  
pp. 590-594 ◽  
Author(s):  
Mary Anne Furst ◽  
Jose A Salinas-Perez ◽  
Luis Salvador-Carulla
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Care Providers ◽  
Service Provision ◽  
Care Providers ◽  
Australian Capital Territory ◽  
Insurance Scheme ◽  
Mental Health Care Providers ◽  
The Impact

Objectives: Concerns raised about the appropriateness of the National Disability Insurance Scheme (NDIS) in Australia for people with mental illness have not been given full weight due to a perceived lack of available evidence. In the Australian Capital Territory (ACT), one of the pilot sites of the Scheme, mental health care providers across all relevant sectors who were interviewed for a local Atlas of Mental Health Care described the impact of the scheme on their service provision. Methods: All mental health care providers from every sector in the ACT were contacted. The participation rate was 92%. We used the Description and Evaluation of Services and Directories for Long Term Care to assess all service provision at the local level. Results: Around one-third of services interviewed lacked funding stability for longer than 12 months. Nine of the 12 services who commented on the impact of the NDIS expressed deep concern over problems in planning and other issues. Conclusions: The transition to NDIS has had a major impact on ACT service providers. The ACT was a best-case scenario as it was one of the NDIS pilot sites.

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