Occupational Therapy in Community Mental Health, Part 1: Intervention Choice

1998 ◽  
Vol 61 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Beverley Meeson
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Work Practice ◽  
Occupational Therapists ◽  
Daily Lives ◽  
Anxiety Management ◽  
Daily Work ◽  
Supportive Counselling ◽  
Patterns Of Practice

Arguments about the blurring of roles between the members of multidisciplinary community mental health teams and the generic style of intervention within them are well rehearsed. However, an empirical description of the daily work practice of occupational therapists in this field has not yet been attempted. This article presents a study examining the choices made by 12 therapists in the south east of England when working with their clients. Part 1 reports quantifiable findings on intervention media chosen over a 4-week period, drawn from diary data. The results revealed diverse patterns of intervention choices. However, an emphasis on anxiety management chosen 295 times (16% of intervention selections), supportive counselling chosen 348 times (18% of selections) and problem-solving discussion with clients about aspects of their daily lives chosen 255 times (13% of selections) emerged. Follow-up interviews explored each participant's rationale for the patterns of practice highlighted by the diaries, which will be illustrated and discussed in part 2.

Occupational Therapy in Community Mental Health, Part 2: Factors Influencing Intervention Choice

1998 ◽  
Vol 61 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Beverley Meeson
Keyword(s):  
Mental Health ◽  
Problem Solving ◽  
Community Mental Health ◽  
Good Practice ◽  
Occupational Therapists ◽  
Division Of Labour ◽  
Personal Perspective ◽  
Management Problem ◽  
Anxiety Management ◽  
Supportive Counselling

Part 1 of this article examined how frequently various intervention media were chosen by 12 occupational therapists working in community mental health. An emphasis on anxiety management, problem solving and supportive counselling techniques was evident. In part 2, these therapists' rationale for therapy choices is explored. The influence of personal perspective and context, that is, policy, organisation of services, division of labour within the team and resources at their disposal, set the boundaries for the therapists' intervention repertoire. Individual interventions were chosen on the basis of utility and client-centred values. The therapists expressed a preference for instigating activity participation by their clients in their locality and homes rather than doing activities with them in a contrived simulation of daily life. These influences are discussed and the extent to which activity-centred analysis or client-centred problem solving is dominant in this setting is questioned. It is clear that some therapists would see certain elements to be important to enable good practice in this working context. These and further implications for educators and practitioners are explored.

scholarly journals Survey of roles of community psychiatric nurses and occupational therapists

1997 ◽  
Vol 21 (2) ◽  
pp. 70-73 ◽  
Author(s):  
Pam Filson ◽  
Tony Kendrick
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mental Health Professionals ◽  
Health Workers ◽  
Occupational Therapists ◽  
Mental Health Workers ◽  
Psychiatric Nurses ◽  
Work Skills ◽  
Anxiety Management ◽  
Community Psychiatric

The roles of community mental health professionals may overlap and need clarifying. A survey is described of 95 occupational therapists (OT) and 200 community psychiatric nurses (CPN), of their views on their respective roles, and information on current practices. Administering medication and crisis intervention were regarded as specifically CPN roles, yet 26% of CPNs did not regularly administer medication. Half of the CPNs' clients were not chronically mentally ill, and over two-thirds of the nurses regularly carried out counselling and anxiety management. Assessing activities of daily living and work skills were seen specifically as OT tasks, yet 60% of the OTs did not usually assess work skills in practice. Roles overlapped considerably, suggesting that a more efficient approach might be to develop a generic core training for community mental health workers.

Patient-controlled benzodiazepine dose reduction in a community mental health service

2005 ◽  
Vol 22 (2) ◽  
pp. 42-45 ◽  
Author(s):  
Bangaru Raju ◽  
David Meagher
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Community Mental Health ◽  
Health Service ◽  
Dose Reduction ◽  
Community Mental Health Service ◽  
Anxiety Management ◽  
Valuable Adjunct ◽  
Benzodiazepine Use

AbstactObjectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.

Anxiety Management Groups in a Community Mental Health Team

1998 ◽  
Vol 61 (5) ◽  
pp. 203-206 ◽  
Author(s):  
Candida Rosier ◽  
Hilary Williams ◽  
Iain Ryrie
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mental Health Problems ◽  
Occupational Therapists ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Anxiety Management ◽  
Delivery Of Care ◽  
Health Team ◽  
Set Up

Just as the delivery of care to people with mental health problems has evolved, so too has the role an occupational therapist plays in the multidisciplinary mental health team. This paper highlights the valuable role of occupational therapists within a particular community mental health team by, first, acknowledging their specialist skills and then describing one component of their work: a 7-week closed group for anxiety management. Finally, it provides recommendations for others who may wish to set up a similar group, which have been drawn from the authors' own experiences.

scholarly journals Community mental health care after self-harm: A retrospective cohort study

2016 ◽  
Vol 51 (7) ◽  
pp. 727-735 ◽  
Author(s):  
Matthew J Spittal ◽  
Fiona Shand ◽  
Helen Christensen ◽  
Lisa Brophy ◽  
Jane Pirkis
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Community Mental Health ◽  
Health Services ◽  
Mental Health Care ◽  
Psychiatric Inpatient ◽  
Community Mental Health Services ◽  
Community Mental Health Care ◽  
Self Harm

Objective: Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). Methods: We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. Results: A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. Conclusion: Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community.

Six-month follow up of patients with dual pathology in a community mental health setting

2017 ◽  
Vol 27 ◽  
pp. S1076-S1077
Author(s):  
A. Novo Ponte ◽  
A. Fernandez Quintana ◽  
C. Quiroga Fernandez ◽  
M.C. Garcia Mahia
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mental Health Setting ◽  
Dual Pathology

Psychiatric out-patient services: origins and future

2006 ◽  
Vol 12 (5) ◽  
pp. 309-319 ◽  
Author(s):  
Helen Killaspy
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Alternative Model ◽  
Community Mental Health Services ◽  
Psychiatric Services ◽  
Early 20Th Century ◽  
Clinical Implications ◽  
Missed Appointments ◽  
Cost Implications

Psychiatric out-patient services originated in the early-20th century to enable triage of new referrals to the asylum in order to differentiate between treatable and untreatable cases. They evolved to provide community follow-up of patients discharged from hospital and assessment of those newly referred to psychiatric services. Non-attendance at out-patient appointments represents an enormous waste of clinical and administrative resources and has potentially serious clinical implications for those who are most psychiatrically unwell. The place of out-patient clinics in modern community mental health services is explored with reference to the reasons for, and clinical and cost implications of, missed appointments. An alternative model is described that incorporates recent UK government guidance on the roles and implementation of community mental health teams, liaison with primary care and new roles for consultant psychiatrists.

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