scholarly journals Compliance with nice guidelines for management of depression in a community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S333-S334
Author(s):  
Sophie Mellor ◽  
Shay-Anne Pantall ◽  
Lisa Brownell
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Community Mental Health ◽  
Psychiatric Comorbidity ◽  
Stepped Care ◽  
List Type ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Nice Guidelines ◽  
Health Team

AimsTo evaluate compliance within a Community Mental Health Team (CMHT) to the NICE guidelines for the management of depression.BackgroundReducing the prevalence of depression continues to be a major public health challenge.Given the complexity and recurrent nature of the condition, the NICE guideline CG90 is an invaluable resource to aid the effective management of depression. Here we present an audit of adherence to this guideline within a CMHT.MethodA retrospective electronic casenote review of all patients diagnosed with depression between January 2016 and October 2019 under the care of a Birmingham CMHT (n = 35), assessing key performance areas including: quality of assessment and coordinated care, risk assessment, choice of pharmacological and psychological treatment using the stepped care model and appropriate crisis resolution planning.ResultKey results include: The majority of patients were Caucasian (63%). Ages ranged from 27 to 69 (mean age 48 years old).Severity of disorder was typically moderate (46%) or severe (48%). Of those with a diagnosis of severe depression, 41% had associated psychotic symptoms.Psychiatric comorbidity was high (49%), of which generalised anxiety disorder was the most common (59%).Referrals were typically from primary care (77%). Approximately half (51%) had reported suicidal thoughts according to the referral.A quarter of patients (26%) were seen by CMHT within 8 weeks of referral; 20% of referrals however waited over 12 months before being assessed.Risk assessments were out of date for 71% of patients.100% of patients had a crisis plan noted within their most recent clinic letter; however, none of these met the required standards.Polypharmacy was common (60%), with 34% prescribed two antidepressants. Use of lithium augmentation was uncommon, with only one patient prescribed this. 43% were prescribed an antipsychotic; of which, 29% had appropriate physical health monitoring completed.Over half of patients (60%) had been referred to psychology services; of these, 38% had either completed or were in ongoing treatment at the time of review.ConclusionCMHTs manage the care of individuals with depression who have high levels of active symptoms and disability, psychiatric comorbidity, care requirements, and complex treatment plans. Pharmacological management was broadly in line with guidelines, and rates of referral to psychology were satisfactory. Risk assessment and crisis planning are clear areas in need of urgent attention in order to comply with guidelines and ensure patient safety.

scholarly journals The clinical complexity of cases of schizophrenia in a community mental health team: a 3 year comparison

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S340-S340
Author(s):  
Shay-Anne Pantall ◽  
Laxsan Karunanithy ◽  
Hayley Boden ◽  
Lisa Brownell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
List Type ◽  
Community Mental Health Team ◽  
Service Usage ◽  
Care Programme ◽  
Mental Health Team ◽  
Health Team ◽  
Long Acting

AimsTo describe the changes in complexity and management of individuals with schizophrenia in a community mental health team (CMHT) over a three year period.BackgroundIt is often believed that individuals receiving care from CMHTs are those with low levels of complexity and risk, and are relatively stable, with more complex individuals being managed by assertive outreach or other specialist teams. Here, we describe changes in the complexity, comorbidity, service-usage and management, of patients with a diagnosis of schizophrenia in a CMHT between 2016 and 2019.MethodData were collected from an electronic patient record system (RiO) for all individuals with schizophrenia in a CMHT in Birmingham (n = 84 in 2016, n = 71 in 2019), examining demographic variables, comorbidity, use of mental health services and current management.ResultKey findings included: - •63% were managed through care programme approach (CPA) in 2016, compared to only 31% in 2019.•21% had required home treatment or inpatient care in the preceding 12 months in 2016; this had improved to 8.5% in 2019.•Significant levels of psychiatric comorbidity, including addictions with almost half of patients (46.5%) having a known history of substance use in 2019, compared to only 15.5% noted in 2016.•Pharmacological management has remained broadly similar; in 2016 21% patients were taking a combination of 2 antipsychotics compared to only 10% in 2019 and 25% were taking clozapine in 2016 (21% in 2019). 39% were prescribed a long acting antipsychotic injection in 2016, compared to 32% in 2019.•In 2016, medication was being prescribed in the majority of cases within secondary care (55%) patients and in primary care in only 21%. GPs have now taken on greater prescribing responsibility in 2019, prescribing in 44% of cases, with 47% being prescribed by the CMHT.ConclusionThe acuity and management of individuals with a diagnosis of schizophrenia under the care of a CMHT has changed over a 3 year period. It is positive to note the reduced use of crisis services and lower rates of polypharmacy. There is a reduction in the proportion of patients receiving management through CPA, and a move towards more medication being prescribed in primary care. The reasons for this change are however unclear and may reflect change in available resources, given that more than half of this group receive clozapine or long acting injections, and have high levels of comorbidity.

scholarly journals To improve the communication between a community mental health team and its service users, their families and carers

2020 ◽  
Vol 9 (4) ◽  
pp. e000914
Author(s):  
Priyalakshmi Chowdhury ◽  
Amir Tari ◽  
Ola Hill ◽  
Amar Shah
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
User Satisfaction ◽  
Service User ◽  
Service Users ◽  
Not Given ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Specialist Registrar ◽  
Health Team

This article describes the application of quality improvement (QI) to solve a long-standing, ongoing problem where service users or their carers felt they were not given enough information regarding diagnosis and medication during clinic assessments in a community mental health setting. Service users and carers had shared feedback that some of the information documented on clinic letters was not accurate and the service users were not given the opportunity to discuss these letters with the clinician. The aim of this QI project was to improve the communication between the community mental health team (CMHT) and service users and their carers. Wardown CMHT volunteered to take on this project. The stakeholders involved were the team manager and deputy manager, the team consultant, the team specialist registrar, team administrative manager, two carers and one service user. The project had access to QI learning and support through East London NHS Foundation Trust’s QI programme. The team organised weekly meetings to brainstorm ideas, plan tests of change to review progress and to agree on the next course of action. The outcome was an increase in service user satisfaction from 59.9% to 78% over a period of 6 months, and a reduction in complaints to zero.

scholarly journals Birmingham community mental health team for the homeless

1997 ◽  
Vol 21 (2) ◽  
pp. 74-76 ◽  
Author(s):  
Martin Commander ◽  
Sue Odell ◽  
Sashi Sashidharan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mentally Ill ◽  
First Year ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Health Team ◽  
Severely Mentally Ill ◽  
Homeless Mentally Ill ◽  
History Of

Mental health services have been criticised for failing to respond to the needs of the rising number of homeless mentally ill. We report on the first year of referrals to a community mental health team established to meet the needs of the severely mentally ill homeless in Birmingham. Most users had a psychotic disorder and a lengthy history of unstable housing, and experienced a range of other disadvantages. Although the team is successfully reaching its priority group, examination of other characteristics of users has highlighted a number of issues which should inform the future planning and development of the service.

scholarly journals Patient factors associated with the use of psychotropic polypharmacy in patients under the care of a community mental health team in the West of Ireland

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S106-S106
Author(s):  
Karthika Srikumar ◽  
Richard Walsh ◽  
Donnchadh Walsh ◽  
Sonn Patel ◽  
Sheila O'Sullivan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Psychotic Disorders ◽  
Drug Regimen ◽  
Psychotropic Medications ◽  
Community Mental Health Team ◽  
Patient Factors ◽  
Mental Health Team ◽  
Health Team ◽  
Factors Associated

AimsPsychiatric polypharmacy refers to the prescription of two or more psychotropic medications to any one patient. This definition is purely quantitative and does not take into account whether such a prescription is detrimental, or unnecessary. In many cases, polypharmacy has been implemented in challenging illnesses, and some studies have shown that it can improve overall outcomes for certain patients. Evidence suggests that the prevalence of psychotropic polypharmacy is increasing, despite advances in psychosocial interventions. The aim of this study was to assess the current prevalence of polypharmacy among patients being treated by a community mental health team (CMHT), and the patient factors associated with its use.MethodWe performed a cross-sectional study of all patients registered with a CMHT in a mixed urban/rural area on a single date. Case records were examined to determine the most recently prescribed drug regimen for each patient. Clinical chart diagnoses were recorded and each one independently verified by the team consultant using ICD-10. A number other sociodemographic variables were recorded. Using Microsoft Excel, we analysed the medications prescribed as well as rates and levels of polypharmacy based on multiple different patient characteristics.ResultOf the 245 patients, the mean age was 56.3 and 51.2% (n = 126) were female. Psychotropic polypharmacy was seen in 62% (n = 152) of patients. 33% (n = 82) of patients were on two psychotropic medications, and of this subset, a combination of one antipsychotic and one antidepressant was the most common drug regimen, seen in 16.7% (n = 41) of all patients. Polypharmacy was more prevalent in females, with 68% (n = 85) being on two or more psychotropics, in comparison to 58% of male patients. In relation to age, patients aged between 51 to 65 years had the highest prevalence of polypharmacy, at a rate of 71% (n = 49). Among all primary diagnoses, polypharmacy was most common in patients with affective disorders, with 80% (n = 40) of this patient cohort on two or more medications. Second to this was psychotic disorders, with polypharmacy seen in 65% (n = 62) of this group.ConclusionWe found that psychotropic polypharmacy is highly prevalent in psychiatric patients being treated in a community setting. Certain demographics and patient factors, such as age, gender and psychiatric diagnosis influenced the rate of polypharmacy and certain drug combinations were more commonly prescribed than others.

scholarly journals Increasing staff confidence about domestic abuse identification, disclosure and safeguarding in a community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S146-S147
Author(s):  
Beth McCausland ◽  
Nicola Minicozzi ◽  
Siobhan O'Halloran ◽  
Avril Ward ◽  
Kerry Elliott
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Trust Management ◽  
Domestic Abuse ◽  
Pilot Project ◽  
Baseline Survey ◽  
Service Users ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Health Team

AimsTo increase staff confidence about identifying Domestic Abuse (DA), particularly regarding ‘how to ask’ to encourage disclosure and the pathways available for appropriately safeguarding survivors; in a Community Mental Health Team (CMHT) setting.BackgroundDA is bi-directionally associated with mental health (MH) disorders; 1:4 women in contact with MH services are currently experiencing DA. MH professionals (MHPs) are in a privileged position to identify DA and support survivors. However, this is dependent on MHPs receiving adequate training about DA. For this, we collaborated with Pathfinder, a national pilot project run by a consortium of five expert partners that aims to establish comprehensive health practice in relation to DA and Violence Against Women & Girls in Acute Hospital Trusts, MH Trusts and Primary Care. In Southampton, Pathfinder has funded two domestic and sexual abuse (DSA) advocates to both train MH staff and take a small caseload of MH service users who are experiencing abuse.MethodWe conducted a baseline survey of staff confidence across the following domains:Knowing the legal definition of DA,The process used to escalate a DA concern,How to make a referral,How to complete DASH forms,How and when to refer to Pathfinder,What the following acronyms mean: PIPPA, MAPPA, MARAC, IDVA, DASH,What HRDA and MASH mean,How to ask about DA,Who to signpost service users to if they make a disclosure, and when to involve the police.We presented the survey results at the regional Pathfinder strategic group, with Trust management representatives present. This project fits within the strategic group's sustainability aims to increase DA awareness and safeguarding processes across the Trust.The Pathfinder funded DSA Advisors delivered a four-hour training package targeting the surveyed questions and wider information on DA. We then re-surveyed to see if staff confidence had increased. We are currently analyzing the number of referrals to the Pathfinder service pre- and post-training.ResultStaff confidence increased across all domains following the training (% mean increase): Qs1 (35%), Qs2 (9%), Qs3 (45%), Qs4 (81%), Qs5 (25%), Qs6 (49%), Qs7 (89%), Qs8 (62%) and Qs9 (48%).We have now arranged a bi-monthly drop-in at the CMHT by the DSA advisor who provided the training, to embed the link between the services and maintain staff confidence. We will circulate these results to advocate that this training is provided across the Trust.

scholarly journals Psychiatric admission for homeless people: the impact of a specialist community mental health team

1997 ◽  
Vol 21 (5) ◽  
pp. 260-263 ◽  
Author(s):  
Martin Commander ◽  
Sue Odell ◽  
Sashi Sashidharan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Homeless People ◽  
Discharge Process ◽  
Community Mental Health Team ◽  
Psychiatric Admission ◽  
Mental Health Team ◽  
Health Team ◽  
Before And After ◽  
The Impact

The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.

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