Managing outcome performance in mental health using HoNOS: experience at St Andrew's Healthcare

Aims and MethodModern mental healthcare providers must demonstrate service-level clinical effectiveness to key stakeholders. We introduced two performance indicators of clinical effectiveness based on outcome data from routinely collected Health of the Nation Outcome Scales (HoNOS) and HoNOS–secure assessments across St Andrew's Healthcare, a charity providing in-patient services in Northampton and Essex. We present outcome data from the period 2004–2007.ResultsThe indicators showed consistent 90-day improvement rates and increasing stability over time. the validity of results is supported by levels of change along predicted lines among different patient cohorts.Clinical ImplicationsIt is possible and beneficial to use routine outcome measures to demonstrate clinical effectiveness at service level. the future of managing mental health outcomes will be in electronic health records systems.

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Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 ‘lockdown’ policy in 10 UK sites: a regression discontinuity in time design

BMJ Open ◽

10.1136/bmjopen-2021-049721 ◽

2021 ◽

Vol 11 (5) ◽

pp. e049721

Author(s):

Ioannis Bakolis ◽

Robert Stewart ◽

David Baldwin ◽

Jane Beenstock ◽

Paul Bibby ◽

...

Keyword(s):

Mental Health ◽

Inpatient Care ◽

Service Use ◽

Regression Discontinuity ◽

Mental Healthcare ◽

Service Level ◽

Community Services ◽

Mental Health Service Use ◽

Healthcare Data ◽

Early Intervention In Psychosis

ObjectivesTo investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 ‘lockdown’ policy in Spring 2020.DesignA regression discontinuity in time (RDiT) analysis of daily service-level activity.Setting and participantsMental healthcare data were extracted from 10 UK providers.Outcome measuresDaily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (A&E). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 ‘lockdown’ policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites.ResultsPooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect.ConclusionsMH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences.

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An outcomes study of eTherapy for dual diagnosis using Breaking Free Online

Advances in Dual Diagnosis ◽

10.1108/add-11-2013-0025 ◽

2014 ◽

Vol 7 (2) ◽

pp. 52-62 ◽

Cited By ~ 17

Author(s):

Sarah Elison ◽

Jonathan Ward ◽

Glyn Davies ◽

Nicky Lidbetter ◽

Daniel Hulme ◽

...

Keyword(s):

Mental Health ◽

Dual Diagnosis ◽

Substance Dependence ◽

Clinical Effectiveness ◽

Outcome Data ◽

Post Treatment ◽

Service Users ◽

Original Cohort ◽

Content Type ◽

Self Help

Purpose – In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service. Design/methodology/approach – A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74. Findings – Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant. Research limitations/implications – These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach. Originality/value – This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.

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A human right to be detained? Mental healthcare after ‘Savage’ and ‘Rabone'

The Psychiatrist ◽

10.1192/pb.bp.112.040980 ◽

2013 ◽

Vol 37 (9) ◽

pp. 294-296 ◽

Cited By ~ 1

Author(s):

Mohammad Shaiyan Rahman ◽

Nadya Wolferstan

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Service Providers ◽

Healthcare Providers ◽

Mental Healthcare ◽

Case Law ◽

Human Right ◽

Health Service Providers ◽

The Uk ◽

Suicidal Patients

SummaryThe UK courts have recently considered the management of suicidal patients in the cases of Savage and Rabone. As a result of these judgments, the case law has extended significantly the responsibilities of mental healthcare providers. In this article we discuss the repercussions of these landmark decisions which are likely to have significant consequences for mental health service providers in the UK.

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Geographical identification of the vulnerable groups during COVID-19 crisis: the typhoon eye effect and its boundary conditions

10.1101/2020.04.28.20083667 ◽

2020 ◽

Author(s):

Pok Man Tang ◽

Stephen X. Zhang ◽

Chi Hon Li ◽

Feng Wei

Keyword(s):

Mental Health ◽

Life Satisfaction ◽

Boundary Conditions ◽

Healthcare Providers ◽

Negative Relationship ◽

Mental Healthcare ◽

Well Being ◽

Vulnerable Groups ◽

Negative Consequences ◽

Working Adults

AimAlthough some studies suggest the coronavirus disease (COVID-19) is associated with negative consequences on physical health, our knowledge about the detrimental effects of COVID-19 on people’s mental health is still nascent. This study uses typhoon eye theory to offer insights in helping clinical psychiatrists to screen people with well-being issues during COVID-19 outbreak.MethodsWe collected survey data from working adults across different geographical areas in China on 20 and 21 February 2020 during the outbreak of COVID-19. The sample contains 308 working adults, who were in various parts of China, with varying distance to the epicenter of Wuhan.ResultsIndividual adults’ distance to the epicenter was negatively associated with life satisfaction (β = −0.235, 95% CI −0.450 to −0.020, p = 0.032). This association between distance and life satisfaction was significant only for adults who were young or had smaller family sizes. For example, the negative relationship was strongest when the individuals were in the age bracket of 20 years old (15.7%; β = −0.703, 95% CI −1.098 to −0.307; p = 0.001) and single (32.3%; β = −0.767, 95% CI −1.125 to −0.408; p < 0.001).ConclusionOur results that people’s well-being deteriorates by the distance from the epicenter for specific groups of people help guide mental healthcare providers towards the regions that are further away from the epicenter in the ongoing COVID-19 outbreak. Meanwhile, our results indicate the practitioners should be cautious of using typhoon eye effect for individuals who were older or had a larger family size.

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Perinatal mental health around the world: priorities for research and service development in China

BJPsych International ◽

10.1192/bji.2020.5 ◽

2020 ◽

Vol 17 (3) ◽

pp. 50-53 ◽

Cited By ~ 1

Author(s):

Simone Eliane Schwank ◽

Qiongjie Zhou ◽

Yanling He ◽

Ganesh Acharya

Keyword(s):

Mental Health ◽

Mental Disorders ◽

Perceived Risk ◽

Help Seeking ◽

Healthcare Providers ◽

Mental Healthcare ◽

Healthcare Services ◽

Service Development ◽

Community Healthcare ◽

Help Seeking Behaviour

China's healthcare is improving together with rapid economic growth. Yet, mental healthcare is lagging behind. Prevalence of perinatal depression is high among women of the one-child generation, but access to qualified care is limited. Chinese healthcare professionals, policy makers and patients alike express concerns about insufficient knowledge among the public as well as healthcare providers regarding mental disorders. There appears to be a general lack of help-seeking behaviour for mental disorders owing to perceived risk of social stigmatisation. Social support through family and friends, use of online resources and community healthcare services are preferred, rather than seeking help from mental health specialists.

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Agreement between patients and mental healthcare providers on unmet care needs in child and adolescent psychiatry

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-020-01969-8 ◽

2020 ◽

Author(s):

Richard Vijverberg ◽

Robert Ferdinand ◽

Aartjan Beekman ◽

Berno van Meijel

Keyword(s):

Mental Health ◽

Unmet Needs ◽

Mental Health Problems ◽

Healthcare Providers ◽

Unmet Need ◽

Young Patients ◽

Mental Healthcare ◽

Child And Adolescent Psychiatry ◽

Care Providers ◽

Care Needs

Abstract Purpose In mental health care, patients and their care providers may conceptualize the nature of the disorder and appropriate action in profoundly different ways. This may lead to dropout and lack of compliance with the treatments being provided, in particular in young patients with more severe disorders. This study provides detailed information about patient–provider (dis)agreement regarding the care needs of children and adolescents. Methods We used the Camberwell Assessment of Need (CANSAS) to assess the met and unmet needs of 244 patients aged between 6 and 18 years. These needs were assessed from the perspectives of both patients and their care providers. Our primary outcome measure was agreement between the patient and care provider on unmet need. By comparing a general outpatient sample (n = 123) with a youth-ACT sample (n = 121), we were able to assess the influence of severity of psychiatric and psychosocial problems on the extent of agreement on patient’s unmet care needs. Results In general, patients reported unmet care needs less often than care providers did. Patients and care providers had the lowest extents of agreement on unmet needs with regard to “mental health problems” (k = 0.113) and “information regarding diagnosis/treatment” (k = 0.171). Comparison of the two mental healthcare settings highlighted differences for three-quarters of the unmet care needs that were examined. Agreement was lower in the youth-ACT setting. Conclusions Clarification of different views on patients’ unmet needs may help reduce nonattendance of appointments, noncompliance, or dropout. Routine assessment of patients’ and care providers’ perceptions of patients’ unmet care needs may also help provide information on areas of disagreement.

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Electronic Patient Monitoring in Mental Health Services

Health Information Systems ◽

10.4018/978-1-60566-988-5.ch054 ◽

2011 ◽

pp. 871-888

Author(s):

Werner G. Stritzke ◽

Andrew Page

Keyword(s):

Mental Health ◽

Patient Monitoring ◽

Interactive Voice Response ◽

Mental Healthcare ◽

Well Being ◽

Touch Screen ◽

Health Service Delivery ◽

Outcome Data ◽

Clinical Tool ◽

Mental Health Service Delivery

This chapter reviews advances in electronic patient monitoring in mental health service delivery. The first part focuses on interactive-voice-response (IVR) technology and its dual role of enhancing the efficient and reliable access to vital patient information and reducing the need for human resources in using that information to guide patient care. Future directions for IVR-mediated mental healthcare are outlined and challenges to dissemination and routine implementation are discussed. The second part of the chapter focuses on touch screen technology as a clinical tool for continuing, flexible treatment planning in mental health inpatient clinics. It reports on a successful trial of linking an innovative mental health ‘well-being thermometer’ to a touch screen interface for keeping electronic patient reported outcome data at the clinician’s finger tips. The authors argue that the field needs to move beyond feasibility studies and identify the drivers of and barriers to routine implementation.

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Parenting and personality disorder: clinical and child protection implications

BJPsych Advances ◽

10.1192/apt.bp.113.011627 ◽

2015 ◽

Vol 21 (1) ◽

pp. 15-22 ◽

Cited By ~ 7

Author(s):

Gwen Adshead

Keyword(s):

Mental Health ◽

Personality Disorder ◽

Child Development ◽

Personality Disorders ◽

Child Protection ◽

Psychiatric Morbidity ◽

Healthcare Providers ◽

Mental Healthcare ◽

Parental Mental Health ◽

Psychological Burden

SummaryI review some of the evidence that parental personality disorder represents a risk to child development, in terms of both transmission of genetic vulnerability and the environmental stress of living with a parent who has a personality disorder that negatively affects their parenting capacities. I argue that there are two compelling reasons to impose a duty on mental healthcare providers to offer services for adults with personality disorders that specifically focus on their parenting identity: first, because effective therapies for personality disorder are now available; and second, because there is a strong utilitarian and economic argument for improving parental mental health so as to reduce the economic and psychological burden of their offsprings' future psychiatric morbidity.

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From ‘reckless’ to ‘mindful’ in the use of outcome data to inform service-level performance management: perspectives from child mental health

BMJ Quality & Safety ◽

10.1136/bmjqs-2013-002557 ◽

2014 ◽

Vol 23 (4) ◽

pp. 272-276 ◽

Cited By ~ 22

Author(s):

Miranda Wolpert ◽

Jessica Deighton ◽

Davide De Francesco ◽

Peter Martin ◽

Peter Fonagy ◽

...

Keyword(s):

Mental Health ◽

Performance Management ◽

Child Mental Health ◽

Service Level ◽

Outcome Data ◽

Level Performance

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Families of victims of homicide: qualitative study of their experiences with mental health inquiries

BJPsych Open ◽

10.1192/bjo.2020.84 ◽

2020 ◽

Vol 6 (5) ◽

Author(s):

Lillian Ng ◽

Alan F. Merry ◽

Ron Paterson ◽

Sally N. Merry

Keyword(s):

Mental Health ◽

New Zealand ◽

Qualitative Study ◽

Healthcare Providers ◽

Mental Healthcare ◽

Interpretive Description ◽

Structured Interviews ◽

Mental Health Patient ◽

Loved One ◽

Inquiry Process

Background Investigations may be undertaken into mental healthcare related homicides to ascertain if lessons can be learned to prevent the chance of recurrence. Families of victims are variably involved in serious incident reviews. Their perspectives on the inquiry process have rarely been studied. Aims To explore the experiences of investigative processes from the perspectives of family members of homicide victims killed by a mental health patient to better inform the process of conducting inquiries. Method The study design was informed by interpretive description methodology. Semi-structured interviews were conducted with five families whose loved one had been killed by a mental health patient and where there had been a subsequent inquiry process in New Zealand. Data were analysed using an inductive approach. Results Families in this study felt excluded, marginalised and disempowered by mental health inquires. The data highlight these families’ perspectives, particularly on the importance of a clear process of inquiry, and of actions by healthcare providers that indicate restorative intent. Conclusions Families in this study were united in reporting that they felt excluded from mental health inquiries. We suggest that the inclusion of families’ perspectives should be a key consideration in the conduct of mental health inquiries. There may be benefit from inquiries that communicate a clear process of investigation that reflects restorative intent, acknowledges victims, provides appropriate apologies and gives families opportunities to contribute.

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