scholarly journals The unheard voice: a qualitative exploration of companions' experiences of liaison psychiatry and mental health crises in the emergency department

2019 ◽  
Vol 43 (5) ◽  
pp. 204-209
Author(s):  
Jennifer Collom ◽  
Emma Patterson ◽  
Geoff Lawrence-Smith ◽  
Derek K. Tracy
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Clinical Practice ◽  
Current Understanding ◽  
Clinical Implications ◽  
Structured Interviews ◽  
Liaison Psychiatry ◽  
Purposive Sampling ◽  
London Hospital ◽  
Qualitative Exploration

Aims and methodTo understand the experience of companions of patients seen in the emergency department by liaison psychiatry teams. Participants were recruited via purposive sampling following a recent visit to the emergency department of an inner- or outer-London hospital. Semi-structured interviews were administered to all participants.ResultsTwo major themes were generated. The first concerned the appropriateness of the clinical space, in which ‘noise’, ‘privacy’ and the ‘waiting area’ were subthemes. The second was communication with staff, including subthemes of ‘wanting more information’ and a ‘desire to be more involved’.Clinical implicationsLiaison psychiatry services should consider appropriateness of the clinical space, promoting improved communication between staff and patients' companions, and a review of the information provided to companions in the emergency department. This research offers a novel perspective on liaison psychiatry and will enhance current understanding and clinical practice.

scholarly journals A qualitative exploration of the barriers to and facilitators of clozapine monitoring in a secure psychiatric setting

2020 ◽  
pp. 1-7
Author(s):  
Sarah Blagden ◽  
Jane Beenstock ◽  
Natalie Auld ◽  
Steve Noblett ◽  
Mark Limmer
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Clinical Implications ◽  
Health Unit ◽  
Structured Interviews ◽  
Staff Members ◽  
Psychiatric Setting ◽  
Important Barrier ◽  
Qualitative Exploration ◽  
Mental Health Unit

Aims and method To explore the beliefs and understanding of staff and patients at a secure mental health unit regarding clozapine monitoring, and to identify barriers to and facilitators of monitoring. Qualitative semi-structured interviews and focus groups were conducted with 17 staff members and six patients. Results Six key themes were identified. The key facilitator of effective monitoring was the motivation of staff to help patients to become independent and facilitate recovery. An important barrier was a lack of clarity around the roles of different staff groups in monitoring. Staff and patients widely supported the establishment of an in-patient clozapine clinic and perceived that it would prepare patients for discharge. Clinical implications An in-patient clozapine clinic is a robust mechanism for clozapine monitoring in secure settings. The barriers and facilitators identified here could be applied to other secure units to guide their systems of clozapine monitoring.

scholarly journals Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 418-420 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Antipsychotic Drugs ◽  
Service Level ◽  
Case Mix ◽  
Clinical Implications ◽  
High Dose ◽  
Prescribing Practice ◽  
Acute Psychiatric Wards ◽  
High Doses

Aims and MethodA 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.ResultsThe proportion of patients prescribed a high dose ranged 0–50% and simultaneous use of more than one antipsychotic drug ranged 12–71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.Clinical ImplicationsServices with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

scholarly journals Psychoeducation for the Frontline: Ealing Liaison Psychiatry Service (ELPS) pilot training day for London Ambulance Service (LAS)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S148-S148
Author(s):  
Emma McLean ◽  
Mariam Alexander
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Training Programme ◽  
Training Needs ◽  
Health Issues ◽  
Liaison Psychiatry ◽  
Mental Health Issues ◽  
Legal Frameworks ◽  
Almost All

AimsTo host the first ELPS training day specifically for LAS staff to improve their knowledge and understanding about mental health issues and the role of ELPS.On average 13,000 calls are received by LAS relating to mental health issues every month. Many patients seen by ELPS will have multiple interactions with LAS. ELPS has previously held training for the Emergency Department team but this innovative day was designed to extend this training commitment to pre-hospital cliniciansMethodLAS training needs were initially assessed by a bespoke questionnaire and ELPS attending another LAS training event held by the new mental health joint response car team.We then developed a training programme to match the identified training needs and which utilised the specific expertise of individual ELPS staff.14 members of the local LAS stations attended including both Paramedics and Emergency Ambulance Clinicians. The presentations covered mental state examination, suicide, risk assessment, substance misuse, legal frameworks and then a ‘challenging cases’ session to bring it all together.Pre and post course questionnaires were completed by participants, exploring attitudes and knowledge.ResultThere was a statistically significant improvement in the average self-ratings for all of the categories assessed including attitudes to mental health, confidence in assessment and knowledge relating to the process the patient will experience in the emergency department.The knowledge about the pathway and role of liaison psychiatry showed the greatest improvement with an average 4.25 increase in pre and post course rating.Almost all participants (9.2/10) would recommend this training day to a colleagueConclusionWe met our objective of improving LAS staff knowledge and understanding about mental health issues and the role of ELPS. We plan to build on this successful pilot and expand our training programme for LAS with the ultimate aim of improving patient care.

Psychiatric Ethics

2021 ◽  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Child And Adolescent Psychiatry ◽  
Social Contexts ◽  
Psychiatric Research ◽  
Liaison Psychiatry

Ethical issues inherent in psychiatric research and clinical practice are invariably complex and multifaceted. Well-reasoned ethical decision-making is essential to deal effectively with patients and enhance their care. Drawing on the positive reception of Psychiatric Ethics since its first publication in 1981, this highly anticipated fifth edition offers psychiatrists and other mental health professionals a coherent guide to dealing with the diverse ethical issues that challenge them. This edition has been substantially updated to reflect the many changes that have occurred in the field during the past decade. Its 25 chapters are grouped in three sections, as follows: 1) clinical practice in child and adolescent psychiatry, consultation-liaison psychiatry, psychogeriatrics, community psychiatry, and forensic psychiatry; 2) relevant basic sciences such as neuroethics and genetics; and 3) philosophical and social contexts including the history of ethics in psychiatry and the nature of professionalism. Principal aspects of clinical practice in general, such as confidentiality, boundary violations, and involuntary treatment, are covered comprehensively, as is a new chapter on diagnosis. Given the contributors’ expertise in their respective fields, Psychiatric Ethics will undoubtedly continue to serve as a significant resource for all mental health professionals, whatever the role they play in psychiatry. It will also benefit students of moral philosophy in their professional pursuits.

scholarly journals Experiences of ward rounds among in-patients on an acute mental health ward: a qualitative exploration

2015 ◽  
Vol 39 (5) ◽  
pp. 233-236 ◽  
Author(s):  
Reed Cappleman ◽  
Zandra Bamford ◽  
Clare Dixon ◽  
Hayley Thomas
Keyword(s):  
Mental Health ◽  
Thematic Analysis ◽  
Clinical Implications ◽  
First Order ◽  
Power And Control ◽  
Systemic Factors ◽  
Ward Rounds ◽  
Qualitative Exploration ◽  
And Control ◽  
Depth Interviews

Aims and methodTo address the gap in qualitative research examining patients' experiences of ward rounds. In-depth interviews were conducted with five in-patients on an acute mental health ward. Data were analysed using thematic analysis.ResultsData were organised into three first-order themes, positioned within an overarching theme relating to patients' perceptions of the use of power and control within ward rounds.Clinical implicationsSystemic factors may make it difficult to facilitate ward rounds in a manner which leaves patients feeling fully empowered or in control, but there are practical measures to address these issues, drawn from participants' accounts.

scholarly journals Psychiatrists' understanding and use of psychological formulation: a qualitative exploration

2016 ◽  
Vol 40 (4) ◽  
pp. 212-216 ◽  
Author(s):  
Roxanna Mohtashemi ◽  
John Stevens ◽  
Paul G. Jackson ◽  
Stephen Weatherhead
Keyword(s):  
Grounded Theory ◽  
Contextual Factors ◽  
Constructivist Grounded Theory ◽  
Clinical Implications ◽  
Psychiatry Training ◽  
Structured Interviews ◽  
Grounded Theory Methodology ◽  
Adult Psychiatry ◽  
Psychological Formulation ◽  
Qualitative Exploration

Aims and methodTo establish an initial conceptualisation of how psychiatrists understand and use formulation within adult psychiatry practice. Twelve psychiatrists took part in semi-structured interviews. Transcripts were analysed using a constructivist grounded theory methodology.ResultsFormulation was conceptualised as an addition to diagnosis, triggered by risk, complexity and a need for an enhanced understanding. Participants valued collaborative formulation with psychologists. Multiple contextual factors were perceived to either facilitate or inhibit the process. Barriers to formulation led to a disjointed way of working.Clinical implicationsFindings contribute to an understanding of formulation within psychiatry training and practice.

scholarly journals Capacity, compliance and electroconvulsive therapy (ECT): the practice of ECT among consultant psychiatrists

2006 ◽  
Vol 30 (1) ◽  
pp. 13-15 ◽  
Author(s):  
Richard Law-Min ◽  
John Patrick Stephens
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Electroconvulsive Therapy ◽  
Best Practice ◽  
Response Rate ◽  
Common Law ◽  
Good Practice ◽  
Legal Framework ◽  
Clinical Implications ◽  
Clinical Vignettes

Aims and MethodThe aim of this study was to seek the views of consultant psychiatrists on the legal framework they would use when considering treatment with electroconvulsive therapy (ECT). A questionnaire, consisting of three clinical vignettes, was sent to 70 consultants in the Wessex rotation (East Dorset/Hampshire region).ResultsA total of 56 questionnaires were returned; a response rate of 80%. Most consultant psychiatrists agree when giving ECT to capacitated and non-consenting patients. However, there was a lack of consensus when dealing with seemingly incapacitated but compliant patients.Clinical ImplicationsMore clarification in this area is needed. Trusts can assist clinicians by devising their own policies based on nationally agreed standards of best practice. The treatment of mentally incapacitated but compliant patients is an area of practice where uncertainty exists. If proceeding under common law in such cases, it is good practice to discuss with relatives/carers and obtain a second opinion from a consultant colleague. The most recent Bournewood judgement and the new Mental Health Bill will have further implications for clinical practice.

Older adult recovery: “What are we working towards?”

2016 ◽  
Vol 21 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Samantha Rankin ◽  
Stephanie Petty
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Clinical Practice ◽  
Older Adult ◽  
Later Life ◽  
Mental Health Setting ◽  
Personal Recovery ◽  
Structured Interviews ◽  
Content Type ◽  
Inpatient Mental Health

Purpose – The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice. Design/methodology/approach – Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts. Findings – Three main themes were identified: participants identified their normative task as the promotion of “moving on” (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults. Originality/value – Staff working in a inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood.

scholarly journals ‘We've got another one for you!’ Liaison psychiatry's experience of stigma towards patients with mental illness and mental health professionals

2012 ◽  
Vol 36 (12) ◽  
pp. 450-454 ◽  
Author(s):  
Jim Bolton
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Patient Care ◽  
General Hospital ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Clinical Communication ◽  
The Impact

Aims and methodTo assess stigmatising attitudes towards mental illness and psychiatric professionals experienced by UK liaison psychiatry staff. A questionnaire asked about the impact of these events on patient care and for suggestions for tackling stigma in the general hospital.ResultsOut of 72 multidisciplinary respondents, over three-quarters had experienced stigmatising attitudes towards mental illness by general hospital colleagues at least monthly. Two-thirds reported instances where stigmatisation had an adverse impact on patient care, and over a quarter reported stigmatising attitudes towards mental health professionals. Suggestions for combating stigma included educational initiatives, clear clinical communication, and the provision of high-quality liaison services.Clinical implicationsLiaison psychiatry is well placed to both recognise and combat stigma in the general hospital. This can help to ensure that patient care is comprehensive, safe and respectful.

scholarly journals The Mental Health Act 1983

1999 ◽  
Vol 23 (9) ◽  
pp. 534-536 ◽  
Author(s):  
Vijay Bhatti ◽  
Jeremy Kenney-Herbert ◽  
Rosemarie Cope ◽  
Martin Humphreys
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Clinical Practice ◽  
Random Sample ◽  
Clinical Implications ◽  
The West ◽  
Mental Health Act ◽  
West Midlands

Aims and methodA one-in-five random sample (n=104) of practitioners approved under Section 12(2) of the Mental Health Act 1983 in the West Midlands was selected. Opinions were sought on issues relating to current law and potential reform.ResultsEighty-three (80%) doctors were interviewed. Over half (52%) stated that the term ‘mental illness' in the Act was unsatisfactory. Two-thirds (68%) specified the need for a review of legislation relating to treatment in the community.Clinical implicationsThere was a diversity of views. This is likely to be reflected in the clinical practice of those interviewed. Many respondents believed that there was a need for reform in specific areas of the Act.

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