Community learning disability teams: the need for objective methods of prioritization and discharge planning

2002 ◽  
Vol 15 (4) ◽  
pp. 223-233 ◽  
Author(s):  
Anna Caffrey ◽  
Margaret Todd
Keyword(s):  
Mental Health ◽  
Learning Disability ◽  
Discharge Planning ◽  
Evidence Base ◽  
Planning System ◽  
Community Learning ◽  
Referral Criteria ◽  
Formal Mechanism ◽  
Health Domains ◽  
Do So

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

Unmet Needs of Remand Prisoners

1998 ◽  
Vol 38 (3) ◽  
pp. 233-236 ◽  
Author(s):  
Tim Hardie ◽  
Kamaldeep Bhui ◽  
Phillip M Brown ◽  
James P Watson ◽  
Janet M Parrott
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Needs Assessment ◽  
Unmet Needs ◽  
Discharge Planning ◽  
Unmet Need ◽  
Assessment Protocol ◽  
Mental Health Act ◽  
Discharge Plan ◽  
Do So

A needs assessment protocol which examines 11 problem areas was devised. This was administered to 277 prisoners on remand at Brixton Prison. We found high levels of unmet need for housing, treatment of substance abuse and neurotic symptoms. Twenty-nine per cent were transferred to hospital under the provisions of the Mental Health Act and about a third of those at liberty to do so complied with a discharge plan. Diversion and discharge planning can potentially meet the unmet needs of remand prisoners.

scholarly journals Audit of the use of psychotropic medication for challenging behaviour in a community learning disability service

2004 ◽  
Vol 28 (12) ◽  
pp. 447-450 ◽  
Author(s):  
Tom Marshall
Keyword(s):  
Side Effects ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Evidence Base ◽  
Challenging Behaviour ◽  
Duration Of Treatment ◽  
Community Learning ◽  
Disability Service ◽  
People With Dementia ◽  
Multiple Drugs

Aims and MethodThe aims of the study were to identify patients in a community learning disability service receiving psychotropic medication for challenging behaviour, to examine prescribing practice and to compare this against local consensus standards. Local consensus standards were agreed by the consultants and the notes were reviewed by the author.ResultsA total of 102 patients were identified as receiving psychotropic medication for challenging behaviour (26.7% of notes examined). The most common additional diagnoses were autism (29%) and epilepsy (28%). The average duration of treatment was 5.3 years, and multiple drugs were used in 34% of these patients. Antipsychotics were the most commonly used drugs (96% of patients). There was rarely a detailed description of the challenging behaviour. There was little regular monitoring of side-effects or warning about potential side-effects when the medication was started.Clinical ImplicationsChallenging behaviour is a common cause of multiple prescribing in learning disability patients, and is often long-term in the absence of a strong evidence base. Other specialties use medication to control disturbed behaviour, particularly in people with dementia or personality disorder, so this audit may also be of interest to old age, adult and forensic psychiatrists.

The equifinality and multifinality of violent radicalization and mental health

2021 ◽  
pp. 125-136
Author(s):  
Paul Gill ◽  
Frank Farnham ◽  
Caitlin Clemmow
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Evidence Base ◽  
Health Problems ◽  
Poor Mental Health ◽  
Base Rate ◽  
Meta Analyses ◽  
The Relationship ◽  
Do So

The relationship between violent radicalization and poor mental health is complex and multilayered. We use the principles of equifinality and multifinality to demonstrate this complexity. In terms of equifinality, we draw upon the existing evidence base to demonstrate that the end outcome of violent radicalization has many paths into it. Some individuals will be touched by different aspects related to poor mental health along this path. In terms of multifinality, we demonstrate trajectories to multiple outcomes originating from poor mental health problems, where violent radicalization is a low base rate outcome, of many. To do so, we draw on the evidence base from various systematic reviews and meta-analyses of other public/personal harms. We also draw upon illustrations of different individuals displaying similar symptoms/diagnoses and map the mechanisms through which their end outcome differed (e.g. because of exposure to different influences, opportunity, and so on).

scholarly journals Recommendations for Implementing Gamification for Mental Health and Wellbeing

2020 ◽  
Vol 11 ◽  
Author(s):  
Vanessa Wan Sze Cheng
Keyword(s):  
Mental Health ◽  
Evidence Base ◽  
Game Studies ◽  
Game Form ◽  
Health Technologies ◽  
Health And Wellbeing ◽  
Academic Fields ◽  
Behavior Change Theory ◽  
Production Cycles ◽  
Do So

Gamification is increasingly being proposed as a strategy to increase engagement for mental health and wellbeing technologies. However, its implementation has been criticized as atheoretical, particularly in relation to behavior change theory and game studies theories. Definitions of the term “gamification” vary, sometimes widely, between and within academic fields and the effectiveness of gamification is yet to be empirically established. Despite this, enthusiasm for developing gamified mental health technologies, such as interventions, continues to grow. There is a need to examine how best to implement gamification in mental health and wellbeing technologies in a way that takes quick production cycles into account while still emphasizing empirical investigation and building a rigorous evidence base. With reference to game studies and the medical (eHealth/mHealth) literature, this article interrogates gamification for mental health and wellbeing by examining core properties of the game form. It then explores how gamification can best be conceptualized and implemented for mental health and wellbeing goals from conceptualization through to iterative co-development and evaluation that accommodates software development schedules. Finally, it summarizes its conceptual analysis into recommendations for researchers and designers looking to do so. These recommendations are: (1) assess suitability, (2) implement to support, (3) assess acceptability, (4) evaluate impact, and (5) document comprehensively. These recommendations aim to encourage clear language, unified terminology, the application and evaluation of theory, comprehensive and constant documentation, and transparent evaluation of outcomes.

Using clinical audit to improve the quality of mental health-care services for people with learning disabilities

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Edward da Costa ◽  
Danielle Adams ◽  
Munzer Salmeh ◽  
Omar Mahmoud ◽  
Ekim Yetkili
Keyword(s):  
Mental Health ◽  
Learning Disabilities ◽  
Learning Disability ◽  
Psychotropic Medication ◽  
Clinical Audit ◽  
Action Plan ◽  
Significant Proportion ◽  
Clinical Psychologist ◽  
Community Learning ◽  
Content Type

Purpose The over-reliance on psychotropic medication for the management of patients with learning disabilities with behaviour that challenges is well documented.This paper aims to discuss the application of the methodology of clinical audit within community learning disability mental health services to adapt interventions including optimising prescribing practice and behavioural interventions aiming to reduce behaviour that challenges in people with learning disabilities. Design/methodology/approach Questionnaire-based review of documentation in electronic patient records, covering relevant audit standards in line with NICE and Royal College of Psychiatrists, was carried out in the North Essex Community Learning Disability Service, Hertfordshire Partnership NHS Foundation Trust. The audit included patients on the caseload of consultant psychiatrists. Findings The audit demonstrated that the prescribing of psychotropic medication was within BNF maximum limits for all patients, evidence of “consent” procedures was being followed in the majority, and there was some evidence of deprescribing attempts.Improvement was required in several areas e.g. undocumented off label prescribing in a significant proportion of patients. Objective measures to record the severity of behaviours and the effects of the medication were being used by clinicians in only a small proportion of patients. A significant proportion of patients have prescribed medication in the absence of appropriate psychological or environmental interventions. Originality/value As a result of the audit findings, the action plan made recommendations such as the development of a database for tracking the prescribing of psychotropic medicines and routine use of standardised measures. This action has been supported by the pharmacy team. Positive developments include a clinical psychologist taking on the role of leading the development of behavioural intervention strategies.

Introduction

2019 ◽  
pp. xvi-6
Author(s):  
Kate L. Harkness ◽  
Elizabeth P. Hayden
Keyword(s):  
Mental Health ◽  
Evidence Base ◽  
Integrative Review ◽  
Stress Exposure ◽  
Stress Resilience ◽  
Psychological Models ◽  
Area Of Study

In this introductory chapter, we provide an overview of The Handbook of Stress and Mental Health. We begin by introducing the scope of the issue and critically operationally defining the construct of stress. We then provide a description of the chapters included in the volume, as well as an outline of the purpose of each of the five major sections: Assessment and Definitional Issues, Stress Exposure and Mental Health, Psychological Models, Neurobiological Models, and Stress Resilience and Treatment. The contributors represent international leaders in the field of stress and provide authoritative and integrative review and analysis of the evidence base in this crucial area of study.

Strategies to boost the mental health and learning disability nursing workforce

2021 ◽  
Vol 30 (3) ◽  
pp. 194-195
Author(s):  
Alan Glasper
Keyword(s):  
Mental Health ◽  
Learning Disability ◽  
Nursing Workforce ◽  
Emeritus Professor ◽  
The University ◽  
Recent Policy

Emeritus Professor Alan Glasper, from the University of Southampton, discusses two recent policy reports which indicate a potential crisis in mental health and learning disability nursing

The Evidence Base for the Benefits of Functional Septorhinoplasty and its Future Post COVID-19

2021 ◽  
Author(s):  
Samit N. Unadkat ◽  
Alfonso Luca Pendolino ◽  
Deborah Auer ◽  
Sadie Khwaja ◽  
Premjit S. Randhawa ◽  
...  
Keyword(s):  
Mental Health ◽  
National Health Service ◽  
Congenital Malformations ◽  
Well Being ◽  
Evidence Base ◽  
Health Conditions ◽  
Clinical Value ◽  
The United Kingdom ◽  
Additional Funding ◽  
Aesthetic Rhinoplasty

AbstractEver since the introduction of the concept of Procedures of Limited Clinical Value (PoLCV), procedures such as functional septorhinoplasty have been subject to additional funding restrictions within the British National Health Service. Recent publications have suggested that 10% of Clinical Commissioning Groups in the United Kingdom no longer fund septorhinoplasty surgery irrespective of the indications, including congenital malformations or post-trauma, and despite the strong evidence available in the literature in treating a range of health conditions. Thus, inequity exists across the country. At present functional septorhinoplasty surgery is frequently but incorrectly grouped together with aesthetic rhinoplasty, both of which are deemed to be cosmetic interventions. Moreover, as we exit the peak of the current coronavirus disease 2019 (COVID-19) pandemic, procedures deemed to be of lower clinical priority will potentially be at risk throughout Europe. The purpose of this review is twofold; the first is to put forward the evidence to commissioners in favor of functional septorhinoplasty surgery on patient well-being and mental health; the second is to demonstrate why functional septorhinoplasty surgery is a distinct procedure from aesthetic rhinoplasty and why it ought not to be classified as a procedure of limited clinical value.

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