scholarly journals Triage in mental health – a new model for acute in-patient psychiatry

2005 ◽  
Vol 29 (7) ◽  
pp. 255-258 ◽  
Author(s):  
Gary Inglis ◽  
Martin Baggaley
Keyword(s):  
Psychiatric Care ◽  
Systems Approach ◽  
Psychiatric Service ◽  
Clinical Implications ◽  
Bed Occupancy ◽  
Care Needs ◽  
London Borough ◽  
New Model ◽  
The Impact ◽  
Whole Systems

Aims and MethodIn-patient psychiatric care needs urgent improvement and development. A new model of psychiatric care (triage) has been used for 6 months across an adult psychiatric service covering a London borough.ResultsPreliminary results show that the new model has reduced bed occupancy, leading to more-efficient throughput, with positive feedback from patients and staff. Important factors contributing to these positive changes include a whole-systems approach, senior medical input 6 days a week, creative use of information technology and a highly skilled multidisciplinary team.Clinical ImplicationsThe introduction of the new model has resulted in a more-efficient use of beds. Further evaluation will enable us to assess the impact on other parts of the service. As with all innovations, the improvements must be sustained once the initial enthusiasm has passed.

scholarly journals Monitoring inner London mental illness services

1995 ◽  
Vol 19 (5) ◽  
pp. 276-280 ◽  
Author(s):  
◽  
Bernard Audini ◽  
Michael Crowe ◽  
Joan Feldman ◽  
Anna Higgitt ◽  
...  
Keyword(s):  
Mental Illness ◽  
Psychiatric Care ◽  
Bed Occupancy ◽  
Local Data ◽  
Catchment Population ◽  
The Poor ◽  
Number Of Patients ◽  
The Mean ◽  
Acute Psychiatric Care ◽  
The Impact

Our objective was to establish a mechanism for monitoring indicators of the state of health of inner London's mental illness services. Data were collected for a census week around 15 June 1994. Local data collection was coordinated by consultant pyschiatrists working in inner London services. Twelve services participated with a combined catchment population of 2.6 m. They included ten London services which were among the 17 most socially deprived areas of England. Main indicators were admission bed occupancy levels (including an estimate of the total requirement), proportion of patients detained under the Mental Health Act, number of assaults committed by inpatients, number of emergency assessments and CPN caseloads. The mean true bed occupancy (which reflects the number of patients who were receiving, or required, in-patient care on census day) was 130%. To meet all need for acute psychiatric care, including for patients who should have been admitted and those discharged prematurely because beds were full, a further 426 beds would have been required. Fifty per cent of patients were legally detained. Physical assaults were virtually a daily occurrence on the admission units. Average community pyschiatric nurse caseloads were 37, suggesting that the majority were not working intensively with limited caseloads of patients with severe mental illness. These indicators, although imperfect, will allow for some measurement of the impact of local and central initiatives on the poor state of London's mental illness services.

scholarly journals Better care: reducing length of stay and bed occupancy on an older adult psychiatric ward

2018 ◽  
Vol 7 (4) ◽  
pp. e000149 ◽  
Author(s):  
Katherine Adlington ◽  
Juliette Brown ◽  
Laura Ralph ◽  
Alan Clarke ◽  
Tim Bhoyroo ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Length Of Stay ◽  
Older Adult ◽  
Average Length ◽  
Psychiatric Ward ◽  
Bed Occupancy ◽  
Care Needs ◽  
Bed Days ◽  
Community Team ◽  
The Impact

BackgroundLength of stay and bed occupancy are important indicators of quality of care. Admissions are longer on older adult psychiatric wards as a result of physical comorbidity and complex care needs. The recommended bed occupancy is 85%; levels of 95% or higher are associated with violent incidents on inpatient wards.MethodsWe aimed to reduce length of stay and bed occupancy on Leadenhall ward, a functional older adult psychiatric ward serving a population of just under 40 000 older adults in two of the most deprived areas of the UK.At baseline in October 2015, the average length of stay was 47 days, and bed occupancy was at 77%. We approached the problem using quality improvement methods, established a project team and proceeded to test a number of changes over time in line with the driver diagram we produced.ResultsIn 12 months, length of stay was reduced from an average 47 to an average 30 days and bed occupancy from 77% to 54%.At the end of 2016, the closure of some beds effected this calculation and we added an additional outcome measure of occupied bed days (OBD) better to assess the impact of the work. OBD data show a decrease over the course of the project from 251 to 194 bed days (a reduction of 23%).ConclusionThe most effective interventions to address length of stay and bed occupancy on an older adult functional mental health ward were the daily management round and the high-level management focus on longer-stay patients. The work depended on an effective community team and on the support of the quality improvement programme in the trust, which have led to sustained improvements.

Integrative Nursing and Mental Health

2018 ◽  
pp. 461-473
Author(s):  
Gisli K. Kristofersson ◽  
Merrie J. Kaas
Keyword(s):  
Mental Health ◽  
Systems Approach ◽  
Mental Health Nursing ◽  
Whole Person ◽  
Health Nursing ◽  
The Individual ◽  
The Impact ◽  
Psychiatric Mental Health Nursing ◽  
Whole Systems ◽  
Integrated Health Services

Integrative nursing offers exciting opportunities to create new models of integrative mental health care to meet growing demands by patients and providers, especially when it comes to access to the broad range of interventions needed to promote mental health and reduce the impact of mental illness. This becomes ever more important as less inclusive treatment paradigms become more prominent in the treatment of mental health disorders. Integrative nursing and psychiatric mental health nursing share many of the same historical emphasis points, including the focus on the therapeutic alliance and the individual needs of the client. This shared heritage lends the fusion of the two, strong face value as well as a strong, mutually beneficial philosophical foundation. Integrative mental health nursing builds on the six principles of integrative nursing to develop a plan for integrated health services based on a whole-person, whole-systems approach using a careful risk benefit analysis.

scholarly journals Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care

2018 ◽  
Vol 42 (3) ◽  
pp. 127-129 ◽  
Author(s):  
Simon Dein
Keyword(s):  
Mental Health ◽  
Drug Abuse ◽  
Religious Coping ◽  
Religious Experience ◽  
Psychiatric Care ◽  
Clinical Implications ◽  
Religion And Spirituality ◽  
Positive Effects ◽  
The Impact ◽  
Critical Overview

This paper argues for the inclusion of religion and spirituality in psychiatric care. After discussing the antagonism of psychiatrists and psychologists to religion, I present a critical overview of studies examining the relationships between spirituality, religion and diverse aspects of mental health: depression, suicide, anxiety, delinquency, drug abuse and schizophrenia. The need to assesses the impact of religion in different faith groups is discussed. Measures of religious coping, both positive and negative, may provide a more accurate portrayal as to how individuals deploy religion in their lives than global measures such as belief and attendance. I highlight the fact that there is a dearth of research on ritual, prayer and other aspects of religious experience. While many studies demonstrate positive effects of religion on mental health, others find detrimental effects. Finally I examine the clinical implications of these findings.Declaration of interestNone.

An evaluation of the impact of attachment and trauma training for pupil referral unit staff

2020 ◽  
Vol 2 (2) ◽  
pp. 75-91
Author(s):  
Rebecca Greenhalgh ◽  
Siana Fflur ◽  
Katherine Donnelly ◽  
Helen Kirkaldie ◽  
Lynn McDonnell
Keyword(s):  
Systems Approach ◽  
Added Value ◽  
Monthly Basis ◽  
Staff Members ◽  
Starting Point ◽  
Training Post ◽  
Trauma Informed ◽  
Work Education ◽  
The Impact ◽  
Whole Systems

Background: The Gwent Attachment Service trained four pupil referral units (PRUs) staff in attachment- and trauma-informed work. Education staff received 2 days of training and then attended six skills development sessions (SDSs) on a monthly basis to embed the training concepts into their work. This model takes a “whole systems approach” to intervention, drawing on evidence suggesting that having a supportive and consistent system around a child that takes into account their attachment needs leads to better outcomes. Methods: Self-reported knowledge of attachment- and trauma-informed work, confidence in carrying out this work, and worries about implementing this work were collected from 64 education staff members across the four PRUs. Measures were repeated at three time points: pre-training, post-training, and post-SDS. Results: Knowledge and confidence increased from pre- to post-training. Knowledge did not significantly differ between post-training and post-SDS. Confidence was lower at post-SDS than post-training but remained above pre-training ratings. Worries decreased from pre- to post-training and decreased again post-SDS. Conclusion: Training and SDSs can improve teaching staffs’ perception of their knowledge and confidence, while reducing worries about working in an attachment- and trauma-informed way. SDSs decreased worries about working in an attachment- and trauma-informed way over and above training alone, indicating that the SDSs contribute added value. This study presents a promising starting point for improving the lives of children and young people who have experienced trauma and have attachment difficulties.

scholarly journals Changes to mental healthcare for working age adults: impact of a crisis team and an assertive outreach team

2007 ◽  
Vol 31 (8) ◽  
pp. 288-292 ◽  
Author(s):  
Patrick Keown ◽  
Mary Jane Tacchi ◽  
Stephen Niemiec ◽  
John Hughes
Keyword(s):  
Length Of Stay ◽  
Mental Healthcare ◽  
Clinical Implications ◽  
Bed Occupancy ◽  
Crisis Resolution ◽  
Median Length ◽  
Assertive Outreach ◽  
Working Age ◽  
Psychiatric Beds ◽  
The Impact

Aims and MethodTo investigate changes to admissions, compulsory detentions, diagnosis, length of stay and suicides following introduction of crisis resolution home treatment and assertive outreach teams.ResultsThere was a 45% reduction in admissions with an increase in the median length of stay from 15.5 to 25 days. Bed occupancy fell by 22%. The number of suicides remained constant. Detentions under sections 2 and 3 of the Mental Health Act 1983 increased whereas those under sections 5(2) and 5(4) declined.Clinical ImplicationsThe introduction of crisis and assertive outreach teams was followed by a reduction in admissions, particularly short admissions. The impact differed according to gender (reduction in female bed occupancy). This and the increased length of stay need to be considered when determining the number of acute psychiatric beds needed.

scholarly journals The impact on carers of individuals with social care needs: the Whole Systems Demonstrator study

2012 ◽  
Vol 12 (4) ◽  
Author(s):  
Michelle Beynon ◽  
Shashi Hirani ◽  
Martin Cartwright ◽  
Lorna Rixon ◽  
Helen Doll ◽  
...  
Keyword(s):  
Social Care ◽  
Care Needs ◽  
The Impact ◽  
Whole Systems

scholarly journals Deliberate self-harm

2001 ◽  
Vol 25 (3) ◽  
pp. 98-101 ◽  
Author(s):  
Sean Whyte ◽  
Andrew Blewett
Keyword(s):  
Mental State ◽  
Psychiatric Care ◽  
Case Note ◽  
Clinical Implications ◽  
Deliberate Self Harm ◽  
Accident And Emergency ◽  
Self Harm ◽  
Medical Wards ◽  
The Impact

Aims and MethodA repetition after 5 years of a prospective case note audit, looking at the impact of a recently established deliberate self-harm (DSH) assessment team on the quality of DSH assessments at Kettering general hospital.ResultsAspecialist DSH team achieved improvement in the quality of psychiatric assessments for the majority of patients who harmed themselves. Assessments of mental state by accident and emergency (A & E) and medical staff before referral to the psychiatric team remain problematic.Clinical ImplicationsSetting up aspecialist team to assess patients who harm themselves can improve the quality of the psychiatric care they receive, but emphasis must still be placed on an adequate assessment of mental state by medical and nursing staff in A&E and on medical wards.

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