Acute wards: problems and solutions: Alternatives to acute wards: users' perspectives

The move from institutional to community care in the second half of the twentieth century arose in a climate in which civil rights became increasingly prominent, and out of which the modern survivor movement grew (Campbell, 1996). Government policy for mental health services, as set out in Standard Five of the National Service Framework (NSF; Department of Health, 1999), requires that care should be provided in hospital, or an alternative in the least restrictive environment, and as close to home as possible. At the same time, Government policy also attaches increasing importance to the involvement of service users and carers in the planning, delivery and evaluation of services. This paper examines alternatives to hospital care from a user perspective. The problem is that the evidence base for the NSF largely consists of quantitative studies designed to answer questions of concern to mental health professionals. This tells us little about the perspectives of the service user, which is the strength and value of user-led research (Faulkner & Thomas, 2002). Much of what follows is taken from this area, but in addition we describe briefly our own experience of home treatment, which the NSF sets out as one of the main alternatives to in-patient care.

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Reviews in Medical Ethics

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2006.00078.x ◽

2006 ◽

Vol 34 (3) ◽

pp. 629-631

Author(s):

Susan Herrick

Keyword(s):

Mental Health ◽

New York ◽

Civil Rights ◽

Mental Health Professionals ◽

Health Law ◽

Mental Health Law ◽

Mentally Disabled ◽

Circuit Court ◽

Court Of Appeals ◽

Alternative Setting

The Bazelon Center for Mental Health Law (the Center), founded as the Mental Health Law Project by a group of attorneys and mental health professionals, has been a major advocacy force promoting the civil rights of persons with mental disabilities since the 1972 New York Willowbrook litigation.Named for D. C. Circuit Court of Appeals Judge David L. Bazelon, whose opinions first articulated the principles that the mentally disabled have a right to treatment in the least restrictive alternative setting, the Center has actively pursued greater rights for the mentally disabled in housing, education, and federal entitlements such as Medicaid, as well as in treatment-related issues.

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Least restrictive alternative – advance statements and the new mental health legislation

Psychiatric Bulletin ◽

10.1192/pb.26.7.246 ◽

2002 ◽

Vol 26 (7) ◽

pp. 246-247 ◽

Cited By ~ 9

Author(s):

J. M. Atkinson ◽

H. C. Garner

Keyword(s):

Mental Health ◽

Home Office ◽

Policy Makers ◽

Department Of Health ◽

Mental Health Legislation ◽

Advance Statements ◽

Restrictive Environment ◽

The Patient’S View ◽

Health Legislation ◽

Least Restrictive Alternative

Proposals for new mental health legislation make the case for using the ‘least restrictive alternative’ (Scottish Executive, 2001) and the ‘least restrictive environment’ (Department of Health & Home Office, 2000) as guiding principles in deciding the management and treatment of the patient. This appears to be the case made for introducing compulsory treatment in the community. The patient living in the community, while maintained on medication, rather than the hospital would appear to be defined as on the ‘least restrictive alternative’. This, however, takes only a limited approach to what is ‘restrictive’, which should be interpreted more widely, including the patient's view as well as that of clinicians and policy makers. Thus, a patient may see it as less restrictive during an acute phase to be in hospital and not on medication, than in the community but on medication. It is likely, given our knowledge of patients' attitudes to medication (Eastwood & Pugh, 1997), that many patients will prefer to be on oral medication rather than depot, which they see as less restrictive.

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National Service Framework for Mental Health

Psychiatric Bulletin ◽

10.1192/pb.24.6.203 ◽

2000 ◽

Vol 24 (6) ◽

pp. 203-206 ◽

Cited By ~ 13

Author(s):

Graham Thornicroft

Keyword(s):

Mental Health ◽

National Service ◽

Department Of Health ◽

National Service Framework ◽

Local Flexibility ◽

Working Age ◽

And Performance ◽

The Given ◽

Clear Statement ◽

Service Framework

The National Service Framework for Mental Health (NSF–MH) is a strategic blueprint for services for adults of working age for the next 10 years. It is both mandatory, in being a clear statement of what services must seek to achieve in relation to the given standards and performance indicators, and permissive, in that it allows considerable local flexibility to customise the services which need to be provided to fit the framework. This paper summarises the process by which the NSF was created, and its content, which became clear when it was published on 30 September 1999 (Department of Health, 1999).

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Creating the infrastructure for mental health research

Psychiatric Bulletin ◽

10.1192/pb.26.11.403 ◽

2002 ◽

Vol 26 (11) ◽

pp. 403-406 ◽

Cited By ~ 9

Author(s):

Graham Thornicroft ◽

Jonathan Bindman ◽

David Goldberg ◽

Kevin Gournay ◽

Peter Huxley

Keyword(s):

Mental Health ◽

Health Research ◽

Research Agenda ◽

Mental Health Research ◽

National Service ◽

Department Of Health ◽

National Service Framework ◽

Service Framework

The purpose of this paper is to identify the important gaps in research coverage, particularly in areas key to the National Service Framework for Mental Health (NSF-MH) (Department of Health, 1999) and the NHS Plan (Department of Health, 2000), and to translate these gaps into researchable questions, with a view to developing a potential research agenda for consideration by research funders.

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Developing mental health services in response to research evidence

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00002682 ◽

2008 ◽

Vol 17 (1) ◽

pp. 47-56 ◽

Cited By ~ 13

Author(s):

Helen Killaspy ◽

Sonia Johnson ◽

Michael King ◽

Paul Bebbington

Keyword(s):

Mental Health ◽

Community Treatment ◽

Local Context ◽

Department Of Health ◽

Home Based ◽

Crisis Resolution Teams ◽

National Service Framework ◽

The Us ◽

Satisfaction With Services ◽

Service Framework

AbstractOver the last thirty to forty years, psychiatric care in England has relocated from hospital-based settings to community mental health teams (CMHTs) and supported accommodation. Since the 1980s, two forms of intensive home based treatment have evolved in addition to CMHTS, assertive community treatment (ACT) and crisis resolution teams (CRTs). On the basis of evidence for their efficacy in the US and other countries, they have been implemented across England through the Government's National Service Framework for Mental Health. This paper describes this evidence and the first UK studies that were carried out to evaluate these newly implemented services.Methods– Descriptions of the evaluations of ACT and CRTs in the inner London boroughs of Camden and Islington.Results– The implementation of CRTs in North London were associated with reduced use of inpatient services, but the ACT teams were not. Both types of team were associated with greater patient satisfaction with services and the ACTs were better able to engage patients than CMHTs.Conclusions– The authors comment on the implications of the findings for service planners in terms of the difficulties in implementing innovative approaches based on the best available evidence when it originates outside the local context.Declaration of Interest:These studies were funded by Camden and Islington Health Authority, the King's Fund and the Department of Health.

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Researchable questions to support evidence-based mental health policy concerning adult mental illness

Psychiatric Bulletin ◽

10.1192/pb.26.10.364 ◽

2002 ◽

Vol 26 (10) ◽

pp. 364-367 ◽

Cited By ~ 3

Author(s):

Graham Thornicroft ◽

Jonathan Bindman ◽

David Goldberg ◽

Kevin Gournay ◽

Peter Huxley

Keyword(s):

Mental Health ◽

Mental Health Policy ◽

Health Department ◽

Mental Health Research ◽

Future Research ◽

Policy Makers ◽

Future Research Agenda ◽

Department Of Health ◽

National Service Framework ◽

Mental Health Department

Policy makers find much mental health research irrelevant to their concerns. What types of research would directly assist those who formulate policy? The two purposes of this paper are (i) to identify important gaps in completed research, particularly in relation to the National Service Framework (NSF) for Mental Health (Department of Health, 1999a) and the NHS Plan (NHS Confederation, 2001); and (ii) to translate these gaps into researchable questions that can contribute to a debate about the future research agenda for general adult mental health in England.

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Differences between specialist community adolescent mental health teams and generic child and adolescent mental health services: training issues for specialist registrars

Psychiatric Bulletin ◽

10.1192/pb.30.6.232 ◽

2006 ◽

Vol 30 (6) ◽

pp. 232-233 ◽

Cited By ~ 1

Author(s):

Carmen Pinto

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Mental Health Problems ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Department Of Health ◽

National Service Framework ◽

First Onset ◽

Age Range

Following the National Service Framework (Department of Health, 2004) recommendation of extending the age range of child and adolescent mental health services to 18 years there is an increasing expectation that these generic services will provide the comprehensive care for severe mental health problems in areas where specialist teams do not exist. Services have responded to this with a variety of teams from generic adolescent teams to smaller first-onset psychosis or assertive outreach teams.

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Full metal jacket or the emperor's new clothes?

Psychiatric Bulletin ◽

10.1192/pb.24.6.207 ◽

2000 ◽

Vol 24 (6) ◽

pp. 207-210 ◽

Cited By ~ 4

Author(s):

Martin Deahl ◽

Brian Douglas ◽

Trevor Turner

Keyword(s):

Mental Health ◽

Reference Group ◽

Good Practice ◽

Self Regulation ◽

Developmental Factors ◽

General Psychiatry ◽

Department Of Health ◽

Severely Mentally Ill ◽

National Service Framework ◽

Professional Self

Launched with little more than a whimper during the Labour Party Conference the much vaunted National Service Framework for Mental Health (NSF–MH) outlines the Government's ‘ambitious agenda’ for mental health services (Department of Health, 1999a). The official driving force has been the desire to deliver a quality service throughout the whole NHS via clinical governance and underpinned by professional self-regulation. Developed following widespread consultation and with the advice of the External Reference Group (although some of this advice was clearly disregarded), the NSF–MH provides a series of seven core standards with examples of good practice. Although developed with general psychiatry and severe mental illness in mind, the NSF is not quite the ‘National Schizophrenia Framework’ that some envisaged, since it also acknowledges the needs of young people and the influence of developmental factors on adult mental health. The NSF–MH sets standards in five areas: mental health promotion, primary care and access to services, services for the severely mentally ill, caring about carers and preventing suicide. It is only the second to be published (the other being for coronary care) which is hopefully a reflection of the ‘priority’ once more being given to mental health. However, the near-simultaneous appointment of a cancer ‘tsar’ suggests that ‘priority’ is a readily used and easily diluted term.

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