scholarly journals Community-Based Mental Health Care in Britain

2020 ◽  
Vol 1 (2) ◽  
pp. 14-20
Author(s):  
T. Burns
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Services ◽  
Multidisciplinary Teams ◽  
Outpatient Psychotherapy ◽  
Family Doctors ◽  
Assertive Outreach ◽  
Admission Rates ◽  
The Uk

Community mental health care in the UK was established by two influential mental health acts (MHAs). The 1930 MHA legislated for voluntary admissions and outpatient clinics. The 1959 MHA required hospitals to provide local follow- up after discharge, required them to work closely with local social services and obliged social services to help with accommodation and support. An effect of this was to establish highly sectorized services for populations of about 50,000. These were served by multidisciplinary teams (generic CMHTs), which accepted all local referrals from family doctors. Sector CMHTs evolved a pragmatic approach with an emphasis on skill-sharing and outreach, depending heavily on community psychiatric nurses. The NHS is funded by central taxation, with no distortion of clinical practice by per-item service fees. It is highly centrally regulated, with a strong emphasis on evidence-based treatments.Since 2000, generic sector teams have gradually been replaced or enhanced by Crisis Resolution Home Treatment teams, Assertive Outreach Teams and Early Intervention Teams. Assertive Outreach Teams were resorbed into CMHTs, based on outcome evidence. The last decade has seen a major expansion in outpatient psychotherapy (Improving Access to Psychological Treatments (IAPT) services) and in specialist teams for personality disorders and perinatal psychiatry. The traditional continuity of care across the inpatient-outpatient divide has recently been broken. During the last decade of austerity, day care services have been decimated, and (along with the reduction in availability of beds) compulsory admission rates have risen sharply. Mental health care is still disadvantaged, receiving 11% of the NHS spend while accounting for 23% of the burden of disease.

scholarly journals Reform of psychiatric services in Germany: hospital staffing directive and commissioning of community care

2004 ◽  
Vol 28 (6) ◽  
pp. 218-221 ◽  
Author(s):  
Heinrich Kunze ◽  
Thomas Becker ◽  
Stefan Priebe
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Social Services ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Legal Framework ◽  
Free Access ◽  
The Government ◽  
The Uk

The German mental health care system differs significantly from the system in the UK. There is no central organisation with overall responsibility as in the National Health Service (NHS), and the government is not entitled to prescribe details of policy or set specific targets. It can only determine the legal framework, define general goals and, with difficulties, influence the spending level. Responsibilities for mental health care, as for other fields of health care, are shared between federal authorities, the 16 states (Lander), local authorities, and semi-statutory organisations, which govern out-patient health care provided by psychiatrists in office-based practices. Virtually every citizen is health-insured and there is free access to health care for those who have no insurance coverage, in which case social services usually cover the costs. Social services also directly fund various services in the community. The fragmented system can be difficult to comprehend. However, many of the challenges are similar to those in other countries, and policy makers and practitioners elsewhere might be interested to know some of the lessons learnt in the German system.

Handling Ethical Dilemmas in Multidisciplinary Teams

2014 ◽  
Author(s):  
Jill Thistlethwaite ◽  
Wendy Hawksworth
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Ethical Issues ◽  
Interprofessional Collaboration ◽  
Ethical Dilemmas ◽  
Multidisciplinary Teams ◽  
Team Members ◽  
Secondary Health Care

This chapter explores the concept and practice of teamwork and interprofessional collaboration in the support and treatment of clients with mental health problems. Mental health care provision is complex, ethically challenging, and frequently delivered via mental health care teams (MHCT) in both primary and secondary health care settings. We consider how such teams may work together optimally using values-based and client-centered approaches. We discuss the nature of and reasons for conflict arising in multidisciplinary MHCTs, focusing on ethical dilemmas that occur where there is diversity amongst team members in respect of personal, professional, and/or organizational values. The specific ethical issues discussed are: boundary issues; receiving gifts; confidentiality, and involuntary treatment and restraint. Three case studies are used to provide examples of values in action.

The next step: a strategic focus on physical activity and sedentary behaviour in Irish mental health care

2018 ◽  
pp. 1-3 ◽  
Author(s):  
E. Matthews ◽  
M. Cowman ◽  
S. Denieffe
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Health Care ◽  
Mental Health Care ◽  
Sedentary Behaviour ◽  
Mental Health Professionals ◽  
Mental Illnesses ◽  
Multidisciplinary Teams ◽  
Mental Health Nurses ◽  
Health Strategy

People with severe mental illnesses have dramatically reduced life expectancy compared with the general population, which is largely attributed to physical comorbidity. Physical activity and sedentary behaviour interventions offer a safe and viable therapeutic resource for multi-disciplinary mental health care teams. The accumulating evidence supporting the role of these interventions has changed the focus of mental health strategy in some countries, with new developing roles for certain mental health professionals in this field. However, in Ireland the absence of specialised exercise practitioners places a leadership role for mental health nurses in this regard. National mental health strategy in Ireland should prioritise physical activity and sedentary behaviour interventions, make recommendations for the integration of specialised exercise practitioners in all mental health multidisciplinary teams, and recommend the provision of training and awareness for mental health nurses and other multidisciplinary professionals who are already well placed to address this issue.

Expanding the Role of Primary Health Care in the Provision of Mental Health Services to the Population of the Kyrgyz Republic

2017 ◽  
Vol 41 (S1) ◽  
pp. S606-S606
Author(s):  
T. Galako
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Health Care ◽  
Kyrgyz Republic ◽  
Family Doctors ◽  
Primary Health

Providing comprehensive, integrated services in the field of mental health in primary health care (PHC) is a component of the state mental health program for the population of the Kyrgyz republic (KR) in the 2017–2030 biennium. In order to develop an action plan in this area a situational analysis of resources of psychiatric care at PHC level was carried out. There was revealed a significant deficit of specialists, such as family doctors, mental health care professionals. In spite of the need for 3,300 family doctors, only 1706 work, and 80% of them are of retirement age.The results of a research showed a low level of knowledge and skills of family physicians for the early detection of mental disorders and provision of appropriate medical care. There are also a limited number of psychiatrists, especially in rural regions (77% of the required quantity).During recent years, there have been implemented significant changes in the system of mental health services, aimed at improving its quality, the approach to the place of residence of the patient and the prevalence of psychosocial services.Since 2016 in 8 southern regions in the Kyrgyz Republic has been introduced a new model for the provision of comprehensive health care services. Piloting this model involves psychosocial rehabilitation of patients with mental disorders, the help of mobile teams at the place of patient residence, as well as psychoeducation, training, and support to family doctors. These and other measures will help to optimise mental health care at PHC level.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Mental health care in London

2005 ◽  
Vol 20 (S2) ◽  
pp. s274-s278 ◽  
Author(s):  
P. De Ponte ◽  
G. Hughes
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
National Policy ◽  
Health Staff ◽  
Mental Health Staff ◽  
The Uk ◽  
Occupancy Rates

AbstractAimTo describe principles and characteristics of mental health care in London.MethodBased on existing data, service provision, number of professionals working in services, funding arrangements, pathways intocare, user/carer involvement and specific issues are reported.ResultsLondon experiences high levels of need and use of mental health services compared to England as a whole. Inpatient andcompulsory admissions are considerably higher than the national average. Despite having more psychiatric beds and mental health staff, London has higher bed occupancy rates and staffing shortages. At the same time there is a trend away from institutionalised care to care in the community.ConclusionMental health services in the UK are undergoing considerable reform. These changes will not remove the greater need formental health services in the capital, but national policy and funding lends support to cross-agency and pan-London work to tackle some of the problems characteristic of mental health in London. Whilst various issues of mental health care in London overlap with those in other European capitals, there also are some specific problems and features.

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