scholarly journals A Cultural Consultation Service in East London: Experiences and Outcomes from Implementation of an Innovative Service

2021 ◽  
Author(s):  
Andrea Palinski ◽  
John Owiti ◽  
Micol Ascoli ◽  
Bertine de Jongh ◽  
Jane Archer ◽  
...  
Keyword(s):  
Mental Health ◽  
Cultural Competency ◽  
Mental Health Professionals ◽  
Service Use ◽  
Health Care Systems ◽  
Treatment Plan ◽  
Average Score ◽  
Service Users ◽  
Consultation Service

Executive Summary1. In the context of the increasing challenges facing mental health services and in line with existing equalities guidance (including the NHS Tower Hamlets Mental Health Promotion Strategy 2008-2011), the Cultural Consultation Service (CCS) was commissioned by Tower Hamlets NHS with support from the National Mental Health Development Unit to provide cultural consultation in East London. The CCS was designed to work at multiple levels of service delivery and commissioning with an additional focus to promote recovery and facilitate high quality clinical learning.2. The broad aims of the service were to: improve clinical outcomes, service user outcomes, and the experience of mentalhealthcare for patients from black and ethnic minorities. improve the cultural capability of mental health professionals. work at a strategic level with commissioners to inform the process of development and improvement of services.3. The CCS was launched in 2010. During the course of the first year to 18 months, the CCS aimed to develop and pilot the service specification whilst embedding itself within the local commissioning and health care systems. 4. Over 900 clinically related contacts were provided. The CCS received a total of 99 referrals for in-depth consultation over a period of 18 months. Qualitative findings were collected from 46 cases which had in-depth consultations. Quantitative outcome measures were available for 36 of these in-depth consultations both at baseline and follow-up at least 3 months following a clinical cultural consultation.5. Overall, service users referred to CCS had high levels of clinical needs. The Health of the Nation Outcomes Scale (HoNOS) was particularly high with an average score of 15.9.6. After the cultural consultation contact, clinicians rated service users as having significantly higher overall functioning. Although no significant changes were found in service users’ perception of their overall health, levels of depression and anxiety, objective scores did indicate some improvement.7. The level of service receipt (and by implication associated costs) significantly reduced after CCS intervention, with a significant reduction in use of A&E services, psychiatrists and CPNs/case managers. Overall, GAF scores improved, indicating better functioning levels. Cost analysis indicates that savings amounted to £497 per patient, taking account of service use costs (which go down after intervention) and costs of CCS provision to this group. Therefore, CCS intervention costs NO MORE than usual care, and was shown to actually reduce spend per patient over a three month follow-up.8. Clinicians found CCS helpful as it provided a richer clinical perspective and allowed service users to share issues about life and illness experiences that were not previously known tostaff. More specifically, clinicians had felt the cultural consultation service had helped to provide: changes to treatment plan (71%); improved engagement (50%); increasedmedication compliance (21%); and earlier discharge (7%). Forty-five per cent of those clinicians who responded wanted to have a cultural consultant permanently based withintheir team and cited lack of resources as the main obstacle to implementing the recommendations of the CCS.9. Training sessions were delivered to five community mental health teams within Tower Hamlets, the Voluntary Sector Network, and there was a one day training on the BartsExplanatory Model Interview. In addition, there were monthly Cultural Consultation Club meetings where case presentations took place to a wider audience. Overall there was positive feedback, as clinicians reported that they had gained new knowledge with regards to ways of working with culture and in engaging with patients’ often complex narratives. This was objectively supported by significant improvements in cultural competency as reported from a validated self-evaluation quantitative questionnaire completed by clinicians which indicates that workforce cultural competence as an aggregate measure improved over time.10. The CCS provided six organisational consultations through a series of workshops on culturally competent commissioning focusing on increased awareness of the context of local services and identifying priorities for future direction.11. Having a tertiary service of cultural consultation may offer a privileged point of observation of teams’ cultures, functions and dysfunctions. It may clarify where the problemslie, rather than to offer simple solutions. Cultural consultation can therefore be conceptualised as both an effective and direct clinical intervention which improves functioning, met need, cultural competency, and it reduces costs per patient. It can also be used as a tool to analyse the scale of a clinical or organisational dilemma and what the solutions might be.

Follow-up and Sticking with Treatment

2010 ◽  
Author(s):  
Michael T Compton ◽  
Beth Broussard
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Treatment Plan ◽  
Case Managers ◽  
First Episode ◽  
Psychosocial Treatments ◽  
Knowing That ◽  
Patient Will

When someone is diagnosed with a first episode of psychosis, it can be easy to want to forget about the diagnosis after leaving the hospital or clinic. Symptoms may even appear to go away. However, the likely reason the person’s symptoms have improved is that he or she has been taking medicine and getting treatment. It is important for the patient to stick to this treatment plan to continue to feel better, have decreasing symptoms, and eventually return to normal functioning. At the hospital or clinic, patients work with mental health professionals on a plan for their treatment. Adherence or compliance is when patients stick with their treatment plan and include this plan into their daily life. Mental health professionals use the words adherence and compliance to mean the same thing. In this book, we use the word adherence. Adherence includes: attending follow-up appointments with mental health professionals, taking medicine regularly, and completing therapy exercises given at appointments. We discuss each of these in the following pages. Before the patient leaves the hospital or clinic, the mental health professional and patient will discuss or plan future follow-up appointments. Patients may need to go to these appointments every other week, or even more frequently, when just leaving the hospital. Those who have stayed well for a longer period may be able to go to appointments less often. They may go every month and eventually, only every three months. If available in the community, other choices may include appointments in the home or in the community with case managers or treating professionals (See Chapter 7 on Psychosocial Treatments for Early Psychosis). Appointments may be at a clinic or hospital and usually last 30 to 45 minutes. They may be with a doctor for a checkup. The patient also may have to go to appointments for counseling, therapy, or other types of psychosocial treatments. The number of appointments the patient has to go to will depend on his or her specific needs. Knowing that they have to go to many sessions may be disappointing for patients. Most people do not like going to the doctor! This is true for many people with psychosis as well.

Now they’re listening: involvement in clinical psychology training

2019 ◽  
Vol 23 (1) ◽  
pp. 23-29
Author(s):  
Laura Lea ◽  
Sue Holttum ◽  
Victoria Butters ◽  
Diana Byrne ◽  
Helen Cable ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Psychology ◽  
Health Professionals ◽  
Service User ◽  
Health Workers ◽  
Psychology Training ◽  
Service Users ◽  
Clinical Psychology Training ◽  
Content Type

PurposeThe 2014/2015 UK requirement for involvement of service users and carers in training mental health professionals has prompted the authors to review the work of involvement in clinical psychology training in the university programme. Have the voices of service users and carers been heard? The paper aims to discuss this issue.Design/methodology/approachThe authors update the paper of 2011 in which the authors described the challenges of inclusion and the specific approaches the authors take to involvement. The authors do this in the context of the recent change to UK standards for service user and carer involvement, and recent developments in relation to partnership working and co-production in mental healthcare. The authors describe the work carried out by the authors – members of a service user involvement group at a UK university – to ensure the voices of people affected by mental health difficulties are included in all aspects of training.FindingsCareful work and the need for dedicated time is required to enable inclusive, effective and comprehensive participation in a mental health training programme. It is apparent that there is a group of service users whose voice is less heard: those who are training to be mental health workers.Social implicationsFor some people, involvement has increased. Trainee mental health professionals’ own experience of distress may need more recognition and valuing.Originality/valueThe authors are in a unique position to review a service-user-led project, which has run for 12 years, whose aim has been to embed involvement in training. The authors can identify both achievements and challenges.

Cultural competency training for psychiatry residents and mental health professionals: A systematic review

2020 ◽  
pp. 002076402098161
Author(s):  
Vyjayanthi N Venkataramu ◽  
Bhavika Vajawat ◽  
Bharathram Sathur Raghuraman ◽  
SK Chaturvedi
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Cultural Competence ◽  
Cultural Competency ◽  
Mental Health Professionals ◽  
Case Vignette ◽  
Training Methods ◽  
Psychiatry Residents ◽  
Competency Training ◽  
Cultural Competency Training

Introduction: Cultural competence is a prerequisite skill for a psychiatrist. There is a dearth of information on the methods used for training of cultural competence and their outcomes. This study aims to explore and determine the existing methods used for cultural competency training (CCT) for psychiatry residents and how useful these training methods are. Method: A systematic review methodology based on PRISMA guidelines was adopted for this study. The literature search reviewed databases of PubMed and MesH, using keywords ‘psychiatry resident’, ‘psychiatry’, ‘psychiatrist’, ‘mental health’, and ‘mental health professional’. In the end,14 articles qualified for the detailed review. The level of evidence and quality of the studies were evaluated and recorded. Results: The methods of cultural competence training identified were grouped as, active/passive/mixed; group training/individual training. These included documentaries or non-feature films based teaching, secondary consultation and cross consultation models, case vignette discussions, Objective Structured Clinical Examination (OSCE), behavioral simulation, video demonstration, cultural discussion in rounds, and traditional clinical teaching. The studies covered participants from different cultural backgrounds, mainly urban and predominantly university/institution based. Conclusion: There is limited literature in the area to conclude one method to be better than the other with respect to CCT in psychiatry residents. However, this review identified a variety of training methods, which can be used and pave way for research on their effectiveness. Training and evaluation of psychiatry residents in the area of cultural competence should be done routinely during their training to enable them to practice in the multi ethic societies.

Treatment alliance and needs of care concerning religiousness and spirituality: A follow-up study among psychiatric inpatients

2021 ◽  
pp. 002076402110230
Author(s):  
Joke C van Nieuw Amerongen-Meeuse ◽  
Arjan W Braam ◽  
Christa Anbeek ◽  
Jos WR Twisk ◽  
Hanneke Schaap-Jonker
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Structural Equation ◽  
Treatment Compliance ◽  
Health Clinic ◽  
Care Needs ◽  
Service Engagement ◽  
Treatment Alliance ◽  
Over Time

Background: Patient satisfaction with religious/spiritual (R/S) care during mental health treatment has been associated with a better treatment alliance. Aims: To investigate the longitudinal relations between (un)met R/S care needs and treatment alliance/compliance over a 6-month period. Method: 201 patients in a Christian (CC) and a secular mental health clinic completed a questionnaire (T0) containing an R/S care needs questionnaire, the Working Alliance Inventory (WAI) and the Service Engagement Scale (SES). After 6 months 136 of them took part in a follow-up (T1). Associations were analysed using hybrid linear mixed models and structural equation modelling. Results: R/S care needs decreased over time, but a similar percentage remained unanswered (e.g. 67% of the needs on R/S conversations in a secular setting). Over a 6-month period, met R/S care needs were associated with a higher WAI score (β = .25; p < .001), and unmet R/S care needs with lower WAI score (β = −.36; p < .001), which were mainly between subjects effects. Patients reporting a high score of unmet R/S care at baseline, reported a decrease in SES over time (β = −.13; p < .05). Conclusions: Satisfaction with R/S care among mental health patients is related to a better treatment alliance. When unmet R/S care needs persist, they precede a decrease in treatment compliance. Mental health professionals are recommended to assess the presence of R/S care needs and consider possibilities of R/S care especially in the first weeks of treatment.

Working with cultural diverse persons involved in law and mental health - cultural competency training manual

2011 ◽  
Vol 26 (S2) ◽  
pp. 450-450
Author(s):  
W. Chow ◽  
J. Sadavoy ◽  
J. Wong
Keyword(s):  
Mental Health ◽  
Cultural Competency ◽  
Mental Health Professionals ◽  
Culturally Diverse ◽  
Mount Sinai Hospital ◽  
Training Manual ◽  
Competency Training ◽  
Cultural Competency Training ◽  
Language And Communication ◽  
Mount Sinai

The goal of this presentation is to introduce a new “Cultural Competency Training/Manual (CCTP) for Law and Mental Health professionals Working with persons involved with law and mental health” sponsored by a grant from the Law Foundation of Ontario and department of psychiatry of Mount Sinai Hospital.The manual is qualitative which includes conducting a literature review, facilitation of multi-stakeholder focus groups, and interviewed key stakeholders, consultation with clinical staff from the Mount Sinai Hospital and other Court Support programs, to address the key challenges in working with culturally diverse persons involved with law and mental health. In the oral presentation, we will present key themes on the challenges in dealing with culturally-diverse persons involved in law and mental health. The themes were consistent with the literature, evidence-based research, and validated by actual provider experience. They include language and communication, mistrust of mainstream services, racism and discrimination, resistance from persons involved with law and mental health and their families, and the need for cultural competency practices, such as interpretation, cultural understanding, community and systemic support. With these themes in mind, we will demonstrate the application of practical skills and cultural competencies using vignettes. A cultural competency model of working with culturally diverse persons involved in law and mental health and the five key responsibilities will be introduced. They include the following domains: language and communication, system support and navigation, education and advocacy, and collaboration.

Working with interpreters

2021 ◽  
pp. 335-342
Author(s):  
Rachel Tribe
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Meaning Making ◽  
Clinical Work ◽  
Cultural Factors ◽  
Service Users ◽  
Cultural Brokers ◽  
New Knowledge ◽  
Ways Of Thinking

Psychiatrists will come into contact with service users who do not use English or the language of the country to which they have migrated. The professional responsibilities of all mental health professionals carry an obligation to serve all members of our communities equitably and impartially; this will include people who have migrated and are not fluent in the language of their chosen country of migration. Working with interpreters and cultural brokers can be an enriching and informative experience for psychiatrists, which can lead to the development of new knowledge. This is in addition to the challenging of what may be taken-for-granted knowledge, as well as the development of additional skills and ways of thinking about mental health. Interpreters and cultural brokers can, in addition to translating the language, explain relevant cultural factors, which are important to the clinical work and the meaning-making of service users and gain additional perspectives.

scholarly journals M223. EXPLORING YOUR PERSONAL IDENTITY: USING USER-CENTRED-DESIGN FOR THE DEVELOPMENT OF A NEW INTERVENTION FOR SERVICE USERS WITH COMPLEX MENTAL HEALTH NEEDS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S220-S221
Author(s):  
Lisette Van der Meer ◽  
Tessa Jonker ◽  
Charlotte Wunderink ◽  
Jaap van Weeghel ◽  
Marieke (Gerdina) Pijnenborg ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Process ◽  
Mental Health Professionals ◽  
Psychosocial Intervention ◽  
Health Needs ◽  
Service Users ◽  
Personal Recovery ◽  
Mental Health Needs ◽  
User Centred Design ◽  
Starting Point

Abstract Background Introduction: As a human being we give meaning to our stories, in relation to the social and physical context. For people with severe and complex mental health needs, who have been dependent on (intensive) residential psychiatric support for a long time, it is possible that talents and qualities disappear because this part of their identity has been buried under a long psychiatric history. This can result in people’s identity becoming limited to ‘patient’, and the experience of life as meaningless. Objectives For these service-users, few interventions aimed at personal recovery are available that match their cognitive and communicative skills. In this project, we developed a new psychosocial intervention to stimulate self-reflection and personal recovery. Methods The development of the intervention took place through a “user-centred-design process” (UCD). UCD is an iterative design process in which the needs and wishes of the user are the starting point, and they remain central in the product design circle. Throughout the whole design process, service users, significant others, mental health professionals, peer support workers, artists, and researchers collaborate in order to design a first testable prototype. For each step of design process, we organized focus group meetings and brainstorm sessions with all stakeholders as well as individual interviews with service users. Based on the input in these meetings and interviews, the design was adapted. This was done for each consecutive step, which made the whole design process iterative by nature. Results A new psychosocial intervention entitled “This Is Me” was developed as a “journey of discovery” through the lives of service users at both verbal and non-verbal levels. From the UCD process four basic principles underlying the intervention were disentangled that have been incorporated in the intervention: 1) “gaining new experiences”, 2) “attention for (self)stigma”, 3) “equal treatment as a person”, 4) “uniqueness of the individual”. This resulted in an intervention in which service-users, together with a teammate, engage in new experiences. Moreover, they are prompted to reflect on these experiences upon their return. With this process, we aim to support people in (re)discovering roles, talents and characteristics to broaden the identity from ‘patienthood’ to ‘personhood’. Discussion Conclusions: UCD was a useful method for the development of a new psychosocial intervention targeting identity for people with complex mental health needs. The process resulted into new knowledge about factors that are important in the (re)development of identity. In addition, we will present the first results of a pilot study in which we assessed the feasibility and effectiveness of the intervention.

Sign in / Sign up

Export Citation Format

Share Document