scholarly journals Getting a balance between generalisation and specialisation in mental health services: a defence of general services

2018 ◽  
Vol 42 (6) ◽  
pp. 229-232
Author(s):  
Richard Laugharne ◽  
Matthew Thompson ◽  
Alind Srivastava ◽  
Simon Marlow ◽  
Rohit Shankar
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Secondary Care ◽  
Diagnostic Uncertainty ◽  
Care Specialist ◽  
Specialist Services ◽  
Uk National Health Service ◽  
The Uk

Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff. There is a risk of a polo-mint service, where the specialist services on the edge are well resourced, but the secondary-care generalist services taking the greatest burden struggle to recruit and retain clinicians. We need to establish equity in resources and expectations between generalist and specialist mental health services.Declaration of interestNone.

scholarly journals Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Siobhan Reilly ◽  
Catherine McCabe ◽  
Natalie Marchevsky ◽  
Maria Green ◽  
Linda Davies ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Medical Records ◽  
Secondary Care ◽  
Mental Healthcare ◽  
The Uk

Background There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. Aims This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. Method We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. Results The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. Conclusions The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.

scholarly journals Primary care clinical management following self-harm during the first wave of COVID-19 in the UK

2021 ◽  
Author(s):  
Sarah Steeg ◽  
Matthew J Carr ◽  
Laszlo Trefan ◽  
Darren M Ashcroft ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Psychotropic Medication ◽  
Clinical Management ◽  
Practice Nurse ◽  
Self Harm ◽  
The Uk ◽  
The Impact

AbstractBackgroundA substantial reduction in GP-recorded self-harm occurred during the first wave of COVID-19 but effects on primary care management of self-harm are unknown.AimTo examine the impact of COVID-19 on clinical management within three months of an episode of self-harm.Design and settingProspective cohort study using data from the UK Clinical Practice Research Datalink.MethodWe compared cohorts of patients with an index self-harm episode recorded during a pre-pandemic period (10th March-10th June, 2010-2019) versus the COVID-19 first-wave period (10th March-10th June 2020). Patients were followed up for three months to capture psychotropic medication prescribing, GP/practice nurse consultation and referral to mental health services.Results48,739 episodes of self-harm were recorded during the pre-pandemic period and 4,238 during the first-wave COVID-19 period. Similar proportions were prescribed psychotropic medication within 3 months in the pre-pandemic (54.0%) and COVID-19 first-wave (54.9%) cohorts. Likelihood of having at least one GP/practice nurse consultation was broadly similar (83.2% vs. 80.3% in the COVID-19 cohort). The proportion of patients referred to mental health services in the COVID-19 cohort (3.4%) was around half of that in the pre-pandemic cohort (6.5%).ConclusionDespite the challenges experienced by primary healthcare teams during the initial COVID-19 wave, prescribing and consultation patterns following self-harm were broadly similar to pre-pandemic levels. However, the reduced likelihood of referral to mental health services warrants attention. Accessible outpatient and community services for people who have self-harmed are required as the COVID-19 crisis recedes and the population faces new challenges to mental health.

Managing challenging behavior in people with intellectual disabilities in communities and reducing hospital stays: Current and future challenges from an European perspective

2017 ◽  
Vol 41 (S1) ◽  
pp. S598-S599
Author(s):  
B. Perera ◽  
K. Courtenay ◽  
S. Elstner ◽  
K. Krysta
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Disorder ◽  
Challenging Behavior ◽  
Psychiatric Inpatient ◽  
Psychotropic Medications ◽  
Behavior Difficulties ◽  
Specialist Services ◽  
The Uk

Prevalence of intellectual disability (ID) ranges from 0.05 to 1.55%. A total of10–15% of the people with ID present with challenging behavior (CB). This causes a significant strain on mental health services. People with ID; end up staying in psychiatric inpatient units for longer periods. Most people with ID move out of their family home to various care settings due to severity of their behavior difficulties. Few European countries have specialist services for people with ID whereas most countries manage people with ID and CB using adult mental health services. There is ongoing debate whether patients with ID and CB need to be managed by specialist services. There are significant financial implications looking after people with ID and CB. This has often led to over prescribing of psychotropic medications to people with ID without a mental disorder to manage their behaviors. There are significant strains on mental health services to manage people with ID and CB. This presentation discusses. Describe people with CB and ID and their characteristics including mental disorder, use of psychotropic medications, socio demographic factors and financial costs to look after them. Social and health care approach to look after people with CB in the UK, Challenges to develop services for people with CB in ID in Germany and Poland. Do we need specialist services for people with ID and CB? Pros and cons.Disclosure of interestCOI: Bhathika Perera, I have received travel grants from pharmaceutical companies to attend ADHD conferences and I have been a speaker at pharmaceutical company sponsored events on ADHD.

scholarly journals Regional analysis of UK primary care prescribing and adult service referrals for young people with attention-deficit hyperactivity disorder: from little to very little

BJPsych Open ◽  
2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Samuele Cortese
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Attention Deficit Hyperactivity Disorder ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Mental Health Professionals ◽  
Attention Deficit ◽  
Hyperactivity Disorder ◽  
The Uk

Summary Drawing on data from the Clinical Practice Research Datalink, Price et al reported UK regional variations in primary care prescribing and referral rates to adult mental health services for young people with attention-deficit hyperactivity disorder (ADHD) in transition from child and adolescent mental health services. Overall, considering that around 65% of young adults with childhood ADHD present with impairing ADHD symptoms and up to 90% of individuals with ADHD may benefit from ADHD medications, the study by Price et al shows that the rate of appropriate treatment for youngsters in the transition period varies from low to very low across the UK. As such, there is a continuous need for education and training for patients, their families, mental health professionals and commissioners, to eradicate the misconception that, in the majority of the cases, ADHD remits during adolescence and to support the devolvement of appropriate services for the evidence-based management of adult ADHD across the UK.

scholarly journals Mental health services in primary care

2010 ◽  
Vol 7 (1) ◽  
pp. 3-3 ◽  
Author(s):  
David Skuse
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Royal College ◽  
Mental Health Problems ◽  
The Uk ◽  
Models Of Service Delivery ◽  
Enormous Number

In the UK, only 13% of people with long-term mental health problems are in employment, compared with 35% generally of people with a disability (Royal College of General Practitioners, 2005). Nearly 2.6 million individuals receive incapacity benefit and/or severe disability allowance and, of these, close to 1 million are claiming incapacity benefit due to mental ill health. The management of this enormous number of people – providing support to them and helping them get back into employment – is an issue that cannot be addressed adequately by our specialist mental health services. Accordingly, other models of service delivery need to be considered. The three thematic papers in this issue look at this issue from the perspective of three highly contrasting societies.

scholarly journals Developing integrated mental health services for adults with ADHD

2011 ◽  
Vol 17 (6) ◽  
pp. 461-469 ◽  
Author(s):  
Helen Crimlisk
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Training Needs ◽  
Service Model ◽  
Local Service ◽  
Hyperactivity Disorder ◽  
Specialist Services ◽  
Integrated Mental Health

SummaryThe article discusses the issues and challenges for mental health services in providing care for adults with attention-deficit hyperactivity disorder (ADHD). Based on work developed in Sheffield (UK), it describes the contribution that services integrated into community mental health teams may be able to provide. Given the likely increase in numbers of referrals of adults with ADHD (both ‘graduates’ from children's services and adults seeking diagnosis) and the pressures on resources, it is unlikely that current specialist services will be able to address the growing demand. A local service that can link with other mental health services and that has close links to primary care is most likely to provide a sustainable service model, but there are still considerable training needs for this model to be put into practice.

scholarly journals Consultation liaison to support efficient delivery of mental health care

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S317-S317
Author(s):  
Emma Davies ◽  
Mihaela Bucur
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Secondary Care ◽  
Waiting Times ◽  
Individual Treatment ◽  
Efficient Treatment ◽  
Number Of Patients ◽  
The Impact

AimsTo study the impact of collaborative working, via consultation liaison, between Mental Health Liaison Practitioners (MHLPs) and Doctors within a secondary care mental health service. We hypothesise that this model of working may avoid unnecessary clinic appointments and waiting times, whilst providing patients with more efficient treatment.BackgroundMental health services are stretched, understaffed and under-resourced. It is estimated that 75% of people with mental health problems in England may not get access to the treatment they need. We therefore need efficient and innovative ways for people who seek help to receive support. Good practice consultation liaison involves face to face contact between clinicians; treatment can be delivered by supporting primary care whilst reducing the burden of secondary care mental health services.MethodRegular 30-minute sessions within an Assessment and Treatment Service, between MHLPs and Doctors, at both Consultant and Trainee level, were coordinated. Patients assessed by MHLPs were discussed by opening a dialogue whereby further management was discussed across a multi-professional team. A record was created of all patients discussed and the outcome.ResultNumber of MHLP/Doctor sessions: 10 across a six-month period.Number of patients discussed: 17.Medication advice provided for 16 patients. One patient required a referral for a clinic appointment.For several patients, integrated working procured alternative care pathways and resources to be considered, to incorporate into individual treatment plans.ConclusionRegular consultation liaison with MHLPs and Doctors is a model of working across the interface between primary care and specialist mental health services. It may provide patients with more efficient care, whilst avoiding unnecessary waiting times for clinic appointments. The consultation liaison working supported the development of an educative relationship between clinicians, with interprofessional learning. This is an example of an integrated and collaborative care model, whereby multi-professional working can provide efficient and effective treatment, whilst the support for the patient can remain in the primary care setting.

scholarly journals Assessment and Management of Suicide Risk in Primary Care

Crisis ◽  
2014 ◽  
Vol 35 (6) ◽  
pp. 415-425 ◽  
Author(s):  
Pooja Saini ◽  
David While ◽  
Khatidja Chantler ◽  
Kirsten Windfuhr ◽  
Navneet Kapur
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Secondary Care ◽  
Suicide Risk ◽  
Clinical Sample ◽  
Primary Care Practices ◽  
Risk Assessment And Management

Background: Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. Aims: To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Method: Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Results: Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Conclusion: Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

scholarly journals Preventing unnecessary referrals into specialist mental health services: an interrupted time-series evaluation of a new primary care-linked mental health service

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Andrew Healey ◽  
Alexandra Melaugh ◽  
Len Demetriou ◽  
Tracey Power ◽  
Nick Sevdalis ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Secondary Care ◽  
Interrupted Time Series ◽  
Content Type ◽  
Care Assessment

Purpose Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care. Design/methodology/approach The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London. Findings Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub. Research limitations/implications Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub. Practical implications Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams. Social implications Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems. Originality/value The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

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