scholarly journals A mixed-methods study exploring the characteristics and needs of long-stay patients in high and medium secure settings in England: implications for service organisation

2017 ◽  
Vol 5 (11) ◽  
pp. 1-234 ◽  
Author(s):  
Birgit Völlm ◽  
Rachel Edworthy ◽  
Jessica Holley ◽  
Emily Talbot ◽  
Shazmin Majid ◽  
...  
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Focus Groups ◽  
Research Network ◽  
Cross Sectional Survey ◽  
Prolonged Stay ◽  
Mental Health Act ◽  
High Resource ◽  
Secure Care ◽  
Common Diagnosis

BackgroundForensic psychiatric services provide care for those with mental disorders and offending behaviour. Concerns have been expressed that patients may stay for too long in too high levels of security. The economic burden of these services is high, and they are highly restrictive for patients. There is no agreed standard for ‘long stay’; we defined a length of stay exceeding 5 years in medium secure care, 10 years in high secure care or 15 years in a combination of both settings as long stay.ObjectivesTo (1) estimate the number of long-stay patients in secure settings; (2) describe patients’ characteristics, needs and care pathways and the reasons for their prolonged stay; (3) identify patients’ perceptions of their treatment and quality of life; and (4) explore stakeholders’ views on long stay.DesignA mixed-methods approach, including a cross-sectional survey (on 1 April 2013) of all patients in participating units to identify long-stay patients [work package (WP) 1], file reviews and consultant questionnaires for long-stay patients (WP2), interviews with patients (WP3) and focus groups with other stakeholders (WP4).SettingAll three high secure hospitals and 23 medium secure units (16 NHS and 9 independent providers) in England.ParticipantsInformation was gathered on all patients in participating units (WP1), from which 401 long-stay patients were identified (WP2), 40 patients (WP3), 17 international and 31 UK experts were interviewed and three focus groups were held (WP4).ResultsApproximately 23.5% of high secure patients and 18% of medium secure patients were long-stay patients. We estimated that there are currently about 730 forensic long-stay patients in England. The source of a patient’s admission and the current section of the Mental Health Act [Great Britain.Mental Health Act 1983 (as Amended by the Mental Health Act 2007). London: The Stationery Office; 2007] under which they were admitted predicted long-stay status. Long-stay patients had complex pathways, moving ‘around’ between settings rather than moving forward. They were most likely to be detained under a hospital order with restrictions (section 37/41) and to have disturbed backgrounds with previous psychiatric admissions, self-harm and significant offending histories. The most common diagnosis was schizophrenia, but 47% had been diagnosed with personality disorder. Only 50% had current formal psychological therapies. The rates of violent incidents within institutions and seclusion were high, and a large proportion had unsuccessful referrals to less secure settings. Most patients had some contact with their families. We identified five classes of patients within the long-stay sample with different characteristics. Patients differed in their attribution of reasons for long stay (internal/external), outlook (positive/negative), approach (active/passive) and readiness for change. Other countries have successfully developed specific long-stay services; however, UK experts were reluctant to accept the reality of long stay and that the medical model of ‘cure’ does not work with this group.LimitationsWe did not conduct file reviews on non-long-stay patients; therefore, we cannot say which factors differentiate between long-stay patients and non-long-stay patients.ConclusionsThe number of long-stay patients in England is high, resulting in high resource use. Significant barriers were identified in developing designated long-stay services. Without a national strategy, these issues are likely to remain.Future workTo compare long-stay patients and non-long-stay patients. To evaluate new service models specifically designed for long-stay patients.Study registrationThe National Institute for Health Research (NIHR) Clinical Research Network Portfolio 129376.FundingThe NIHR Health Services and Delivery Research programme.

scholarly journals “I Go up to the Edge of the Valley, and I Talk to God”: Using Mixed Methods to Understand the Relationship between Gender-Based Violence and Mental Health among Lebanese and Syrian Refugee Women Engaged in Psychosocial Programming

2021 ◽  
Vol 18 (9) ◽  
pp. 4500
Author(s):  
Rassil Barada ◽  
Alina Potts ◽  
Angela Bourassa ◽  
Manuel Contreras-Urbina ◽  
Krystel Nasr
Keyword(s):  
Mental Health ◽  
Mixed Methods ◽  
Focus Groups ◽  
Service Providers ◽  
Gender Based Violence ◽  
Community Members ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
International Research Institute ◽  
Gender Based

Lebanon’s intersecting economic and political crises exacerbate complex public health issues among both host and refugee populations. This mixed-methods study by a Lebanese service provider, in partnership with an international research institute, seeks to better understand how experiences of gender-based violence (GBV) and mental health intersect in the lives of Syrian and Lebanese women, and how to better meet these needs. It employs a randomized cross-sectional survey of 969 Abaad service users and focus groups with community members and service providers. There were significant associations between GBV and ill mental health; notably, respondents reporting transactional sex had 4 times the likelihood of severe distress (aOR 4.2; 95% CI 1.2–14.8; p ≤ 0.05). Focus groups emphasized less-visible forms of violence, such as emotional violence, and the importance of environmental factors in one’s ability to cope, noting “it always came back to the economy”. Recommendations include providing a more holistic and coordinated approach between GBV, mental health, livelihood, and basic assistance sectors; and sensitive, accessible, and higher-quality mental health services informed by GBV response actors’ experience putting in place survivor-centered programming and made available to both host and refugee community members.

scholarly journals The PACT advance decision-making template: preparing for Mental Health Act reforms with co-production, focus groups and consultation

2020 ◽  
Vol 71 ◽  
pp. 101563 ◽  
Author(s):  
Lucy A. Stephenson ◽  
Tania Gergel ◽  
Alex Ruck Keene ◽  
Larry Rifkin ◽  
Gareth Owen
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Focus Groups ◽  
Mental Health Act

Attitudes and experiences of nursing staff to the Mental Health Act 2001: lessons for future mental health legislation

2014 ◽  
Vol 31 (2) ◽  
pp. 83-87 ◽  
Author(s):  
A. M. Doherty ◽  
F. Jabbar ◽  
B. D. Kelly
Keyword(s):  
Mental Health ◽  
Nursing Staff ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Mental Health Act ◽  
Clinical Nursing ◽  
Mental Health Legislation ◽  
Paper Work ◽  
Health Legislation ◽  
The Impact

ObjectivesThe Mental Health Act 2001 was implemented in 2006 to bring Ireland into line with international practice and United Nations Conventions on Human Rights. Previous studies have reported some practical difficulties for the professionals involved. We wished to examine the experiences of nursing staff and the impact of the Act on clinical nursing practice since its implementation.MethodThis cross-sectional survey was conducted by questionnaire. It contained questions examining training in and attitudes to the Act, and any resultant changes in nursing practise.ResultsA total of 317 questionnaires were returned. Of the nurses, 92% reported having received training in the Act, and 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative, with increased paper work, lack of clarity and an excessive focus on legalities being the most common difficulties reported.ConclusionsNursing staff have shown mixed attitudes to the Mental Health Act 2001, but many of the difficulties encountered are similar to those experienced by other professionals.

scholarly journals Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees’ Experiences, Views, and Understanding

10.2196/19008 ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. e19008 ◽  
Author(s):  
Golnar Aref-Adib ◽  
Gabriella Landy ◽  
Michelle Eskinazi ◽  
Andrew Sommerlad ◽  
Nicola Morant ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Internet Use ◽  
Child And Adolescent ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Data Set ◽  
Related Risk

Background The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective This study aimed to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;P=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; P=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; P=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; P=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment.

Mental capacity assessments in secure care: an unnecessary complication?

2009 ◽  
Vol 33 (12) ◽  
pp. 461-464
Author(s):  
Ashimesh Roychowdhury
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Mental Capacity ◽  
Code Of Practice ◽  
Mental Health Act ◽  
Secure Care ◽  
Clinical Scenarios ◽  
Clinical Thinking ◽  
Mental Capacity Act ◽  
The Impact

SummaryThis is a review of the key criteria and implications of the Mental Capacity Act 2005 for patients in forensic care detained under the Mental Health Act 1983. Both Acts were amended by the Mental Health Act 2007 and its subsequent Code of Practice; the impact of these changes will be explored here. Through review of the Code of Practice and hypothetical clinical scenarios, I argue that capacity judgements in mental disorder are inherently complex, unreliable and inextricably linked to risk assessment, and that an overemphasis on capacity when making decisions about patient management in secure care can paradoxically obscure the more central issue of risk and proportionality. the key clinical implication is a call for secure services to be balanced in how they adopt best practice principles from the new Mental Capacity Act so that the spirit of the Act, such as valuing patient autonomy, is preserved and that the debate about what practices in secure care are truly proportionate and justified remains at the forefront of clinical thinking.

Cross-Sectional Survey of the Use of Section 5(2), Mental Health Act 1983, Within a Psychiatric Hospital

2005 ◽  
Vol 45 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Caroline Jacob ◽  
Tegwedd Freer
Keyword(s):  
Mental Health ◽  
Psychiatric Hospital ◽  
Psychiatric Inpatient ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Code Of Practice ◽  
Mental Health Act ◽  
Conversion Rates ◽  
Chi Square Test

A survey of the use of section 5(2), Mental Health Act 1983 within a psychiatric hospital was carried out between January and December 2001. Using computer-based patient records, it was found that 89 patients were placed on a section 5(2) between January and December 2001. Data on patient demographics, hospital admission date, date of implementation of section 5(2), date of reassessment after section 5(2) and outcome of the assessment was obtained from these records. In addition, the medical case notes of those patients identified (total of 81 case notes obtained) were studied with regard to the reasons for use of section 5(2), the process of implementing the section, the documentation of reassessments and the notification to the patient of his/her rights whilst under section. It was found that the conversion rates to a further section after implementation of section 5(2) were significantly higher amongst patients who are over 65 years than amongst patients under the age of 65 years (Yates corrected chi-square test 3.87, p=0.04.df=1. Risk ratio 0.68 (0.51-0.92, 95% CI). 53% of patients detained under section 5(2) were male, 47% were female. Sixty-four per cent of section 5(2)s were converted to a further section, 37% to a section 2 and 27% to a section 3. A longer period of time until reassessment of the patients led to a lower conversion rate to a further section. Fifty-four per cent of section 5(2)s were implemented within 24 hours of the patient's admission. Many current areas of practice do not meet with standards recommended by the Code of Practice. Higher conversion rates of section 5(2) to a further section may imply increasing psychiatric inpatient morbidity, hence higher numbers of patients being eligible for detention under the Mental Health Act 1983.

Attitudes and experiences to the implementation of the Mental Health Act 2001

2011 ◽  
Vol 26 (S2) ◽  
pp. 755-755 ◽  
Author(s):  
A.M. Doherty ◽  
F. Jabbar ◽  
B.D. Kelly
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Nursing Staff ◽  
Nursing Management ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Mental Health Act ◽  
Chain Of Command ◽  
Paper Work ◽  
The Impact

IntroductionThe Mental Health Act 2001 was implemented in November 2006 and its introduction has heralded many important changes in the provision of mental health care in Ireland.ObjectivesTo examine the impact of the Act on the time and patterns of attention given to patients since its implementation, and to look at some of the difficulties encountered.AimsTo propose amendments to the legislation, based on the experiences elicited.MethodsThis cross-sectional survey was conducted by questionnaire which we distributed along the chain of command in nursing management. They contained questions looking at attitudes to the Act and the resultant changes in nursing practise. The questionnaire also examined the levels of training with regard to the Act received by members of nursing staff. There was a space given for comments not encompassed by the questions.Results317 questionnaires were returned. 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative in relation to the new legislation, with increased paper work, lack of clarity and an excessive focus on legal technicalities being the most common difficulties reported.ConclusionNursing staff have shown mixed attitudes to the Mental Health Act 2001. However, as a majority have reported a need for increased training, this is an important need which needs to be met.

The Mental Health Act Assessment Process and Risk Factors for Compulsory Admission to Psychiatric Hospital: A Mixed Methods Study

2019 ◽  
Vol 50 (3) ◽  
pp. 642-663 ◽  
Author(s):  
Alice Wickersham ◽  
Shilpa Nairi ◽  
Rebecca Jones ◽  
Brynmor Lloyd-Evans
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Mixed Methods ◽  
Service Evaluation ◽  
Model Potential ◽  
Assessment Process ◽  
Compulsory Admission ◽  
Admission Rates ◽  
Mental Health Act ◽  
Community Team

Abstract Background Compulsory admission rates under the Mental Health Act (MHA) have been on the rise for many years despite representing a costly and coercive approach to psychiatric care. There is therefore an urgent need to minimise compulsory admission rates using interventions based on known risk factors for detention. However, risk factors in the MHA assessment process have been under-researched. Methods A mixed methods service evaluation was conducted in one inner London NHS Trust. A retrospective cohort study used routinely collected assessment records to model potential risk factors for detention. Local assessors were interviewed to explore factors that might help or hinder detention minimisation. Main findings Assessments were less likely to result in detention when professionals other than the assessing team were in attendance, although this association weakened after adjusting for potential confounders. Interviewed assessors identified factors that could contribute to detention minimisation in the assessment process, in general service provision, and in wider society. Conclusion Some local assessment processes could contribute to minimising detention rates, such as community team participation in assessments. Challenges posed by limited resources and community and inpatient care were particularly evident. Consideration of these might also help reduce detentions.

scholarly journals Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees’ Experiences, Views, and Understanding (Preprint)

2020 ◽  
Author(s):  
Golnar Aref-Adib ◽  
Gabriella Landy ◽  
Michelle Eskinazi ◽  
Andrew Sommerlad ◽  
Nicola Morant ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Focus Groups ◽  
Thematic Analysis ◽  
Internet Use ◽  
Child And Adolescent ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Data Set ◽  
Related Risk

BACKGROUND The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. OBJECTIVE This study aimed to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. METHODS We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. RESULTS The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;<i>P</i>=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; <i>P</i>=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; <i>P</i>=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; <i>P</i>=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. CONCLUSIONS Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment.

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