scholarly journals Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP)

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola S. Gray ◽  
Ann John ◽  
Aimee McKinnon ◽  
Stephanie Raybould ◽  
James Knowles ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Evaluation ◽  
Suicide Risk ◽  
Professional Judgment ◽  
Health Board ◽  
Safety Planning ◽  
Nice Guidelines ◽  
Structured Professional Judgment

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk.Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder.Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission.Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93–0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample.Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

The SIEP-DIRECT's Project on the discrepancy between routine practice and evidence. An outline of main findings and practical implications for the future of community based mental health services

2008 ◽  
Vol 17 (4) ◽  
pp. 358-368 ◽  
Author(s):  
Mirella Ruggeri ◽  
Antonio Lora ◽  
Domenico Semisa
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Guideline Implementation ◽  
Specific Treatment ◽  
Care Process ◽  
First Episode ◽  
Routine Practice ◽  
Nice Guidelines ◽  
Illness Onset

SUMMARYAims– To highlight the major discrepancies that emerged between evidence and routine practice in the framework of the SIEP-DIRECT's Project (DIscrepancy betweenRoutine practice andEvidence in psychiatricCommunityTreatments onSchizophrenia). The Project was conducted in 19 Italian mental health services (MHS), with the aims of: a) evaluating the appropriateness of the NICE Guidelines for Schizophrenia in the Italian context, b) developing and testing a set of 103 indicators that operationalised preferred clinical practice requirements according to the NICE Guidelines, and c) evaluating their actual application in Italian MHSs.Methods– The indicators investigated five different areas: common elements in all phases of schizophrenia; first episode treatment; crisis treatment; promoting recovery; the aggressive behaviour management.Results– The NICE recommendations examined were judged in most instances to be appropriate to the Italian MHS context, and the indicators fairly easy to use. The more severe and frequently encountered evidence-practice discrepancies were: lack of written material, guidelines, and information to be systematically provided to users; lack of intervention monitoring and evaluation; difficulty in implementingspecific and structured forms of intervention; difficulty in considering patients' family members as figures requiring targeted support themselves and who should also be regularly involved in the patient care process.Conclusions– The key actions to be undertaken to favour implementation of evidence-based routine practices are: focussing on mental illness onset and family support/involvement in care; planning training activities aimed at achieving specific treatment goals; encouraging MHS participation in evaluation activities; identifying thresholds for guideline application and promoting specific guideline implementation actions; and activating decision making and resource allocationprocesses that rely more strictly on evidence and epidemiological assessment. These considerations are of value for rethinking the model of community psychiatry in Italy as well as in other countries.Declaration of Interest: None.

scholarly journals WARRN – a formulation-based risk assessment process: its implementation and impact across a whole country

2019 ◽  
Vol 14 (6) ◽  
pp. 399-410
Author(s):  
Robert J. Snowden ◽  
Jordan Holt ◽  
Nicola Simkiss ◽  
Aimee Smith ◽  
Daniel Webb ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Services ◽  
Health Services ◽  
Assessment Process ◽  
Research Network ◽  
Safety Planning ◽  
Content Type ◽  
Risk Assessment Process ◽  
Health Boards

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the “common-language” created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives.

scholarly journals Clinicians’ ratings of the Health of the Nation Outcome Scales (HoNOS) show sensitivity/bias that may affect patients’ progress: analyses of routine administrative data

2020 ◽  
Author(s):  
Jonathan Williams
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Rational Design ◽  
Inpatient Admission ◽  
Bipartite Network ◽  
Health Board ◽  
List Type ◽  
Chronic Patients

ABSTRACTObjectives(1) To estimate clinician sensitivity/bias in rating the HoNOS. (2) To test if high or low clinician sensitivity determines slower resolution of patients’ problems or earlier inpatient admission.DesignThe primary analysis used many-facet Item Response Theory to construct a multi-level Graded Response Model that teased apart clinician sensitivity/bias from the severity of patients’ problems in routine HoNOS records. Secondary analyses then tested if patients’ outcomes depend on their clinicians’ sensitivity/bias.Outcome measuresThe outcome measures were (1) overall differences in sensitivity/bias between (a) individual clinicians and (b) different Community Mental Health Teams (CMHTs); (2) clinical outcomes, comprising (a) the rate of resolution of patients’ problems and (b) the dependence of the time to inpatient admission on clinician sensitivity/bias.SettingAll archival electronic HoNOS records for all new referrals to all CMHTs providing mental health services in secondary care in a New Zealand District Health Board during 2007-2015.ParticipantsThe initial sample comprised 2170 adults of working age who received 5459 HoNOS assessments from 186 clinicians. From these initial data, I derived an opportunistic, connected, bipartite, longitudinal network, in which (i) every patient received HoNOS ratings from 2 or more clinicians and (ii) every clinician assessed more than 5 patients. The bipartite network comprised 88 clinicians and 778 patients; 112 patients underwent later inpatient admission.ResultsSensitivity/bias differed importantly between individual clinicians and CMHTs. Patients whose clinicians had more extreme sensitivity/bias showed slower resolution of their problems and earlier inpatient admission.ConclusionsRaw HoNOS ratings reflect the sensitivity/bias of clinicians almost as much as the severity of patients’ problems. Additionally, low or high clinician sensitivity can adversely affect patients’ outcomes. Hence, the HoNOS’s main value may be to measure clinician sensitivity. Accounting for clinician sensitivity could enable the HoNOS to fulfil its goal of improving mental health services.Strengths and limitations of the studyThe study derived a connected network of clinicians and patients that approximates a rational design for estimating clinicians’ sensitivity/bias.The opportunistic network sample was atypical, with chronic patients and experienced clinicians – so the study may under-estimate clinician bias.The study’s statistical methods were appropriate to the ordinal nature of HoNOS ratings.The study used earlier estimates of clinician sensitivity/bias to predict later outcomes – so that effects of clinician sensitivity/bias on outcomes may be causalThe study assumed that all HoNOS items tap a single dimension of the severity of patients’ problems.

611 Screening Adults for Depression and Suicidality in an Outpatient Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Amanda Rose ◽  
Alan D Gilbertson ◽  
Heather Belacic ◽  
John Crow
Keyword(s):  
Mental Health ◽  
Suicidal Ideation ◽  
Mental Health Services ◽  
Health Services ◽  
Suicide Risk ◽  
Compliance Rate ◽  
Quality Improvement Initiative ◽  
Burn Patients ◽  
Initial Visit ◽  
Burn Center

Abstract Introduction In response to NIH recommendations and ABA verification standards, a protocol was initiated to screen adult burn patients in an outpatient verified burn center for depression and suicidality. It utilized the Patient Health Questionnaire (PHQ-9), a widely recognized depression screening tool. The protocol dictated patients scoring 10 or greater, or endorsing the suicide risk question would require further assessment. This project was part of a quality improvement initiative to assess initiating the protocol, identifying at-risk patients, and making appropriate referrals. Methods The initial visit of adults (ages 19 and over) seen over a one year period were retrospectively reviewed. For adults screening positive in the EMR, a Data Collection Form was completed gathering information on PHQ-9 scores, mental health treatment and diagnosis, and burn injuries. Results There were 748 adults seen for an initial visit at the burn center, ages 19–85, 61% men and 39% women. Of those patients, 572 had a PHQ-9 score documented in the EMR, demonstrating a 76% compliance rate with administration. Of those screened, 52 met criteria for inclusion by scoring 10 or greater or endorsing the suicide risk question on the PHQ-9. Scoring ranges on the PHQ-9 were as follows (N=52): 15.4% mild; 50% moderate; 19.2% moderate-severe; and 15.4% severe. Sixty percent of patients endorsed some suicidal ideation. Fifty two percent of patients were documented clearly as being on psychotropic medication or in specialized mental health services. Results were reviewed or discussed with patients in 81% of the initial visit notes. Nineteen of the 52 patients were offered a referral for mental health services. Conclusions Initiating this protocol creates an opportunity to begin conversations about mental health and offer additional support to patients. Approximately 9% of the outpatients screened at the burn center endorsed significant symptoms of depression and or suicidal ideation. Nearly half of these patients were not actively receiving treatment for these symptoms and could potentially benefit from mental health services. This project highlighted that compliance with administering and documenting the PHQ-9 and referral for follow-up services could be improved at this institution. Applicability of Research to Practice This protocol supports the need for continued evaluation and screening for depression and suicide risk in adult burn patients. Consideration should be given for monitoring other mental health conditions that could create barriers to care or compliance with treatment, such as anxiety, PTSD, psychosis, etc.

scholarly journals Audit on antipsychotic prescribing in children and young people with a learning disability under the care of mental health services in Surrey

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S71-S71
Author(s):  
Timothy Cherian James ◽  
Asifa Zainab ◽  
Salvatore Mura ◽  
Aaron Vallance ◽  
Dola Okusi
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Side Effects ◽  
Mental Health Services ◽  
Health Services ◽  
Learning Disability ◽  
Antipsychotic Medication ◽  
The Other ◽  
Nice Guidelines ◽  
Medication Reviews

AimsTo check the extent to which National Institute of Clinical Excellence (NICE) guidelines were being followed in clinical practice with regards to prescribing antipsychotic medication to Child and Adolescent Mental Health Services (CAMHS) patients with a diagnosed learning disability (LD).MethodA data collection tool (based on a similar Royal College of Psychiatrists [RCPsych] audit) was filled out with retrospective data from patients’ clinical records, then analysed using Microsoft Excel and Microsoft Powerpoint.The agreed standards were the NICE guidelines.There were no ethical issues as the data were retrospective and anonymised.Sample size was 13, comprising 7 males and 6 females.All service users were less than 18 years of age.Result7 out of the 13 patients who were prescribed antipsychotics had a Severe/Profound LD.Among the 5 patients who had been prescribed antipsychotic medication, 4 were on Risperidone and 2 were on Aripiprazole. The reasons for starting antipsychotic medication were clearly documented for all 5, the most common reasons being overt aggressive behaviour and general agitation/anxiety.Only 1 patient had antipsychotic medication initiated in the previous 12 months. NICE guidelines had been generally followed for the management of this case, with good documented evidence.For the other 4 patients, in whom antipsychotic medication was initiated more than 12 months ago, there was a lack of documentation of the subsequent assessment of side effects, extra-pyramidal side effects, body weight, blood pressure, glycaemic control and lipid profile. 1 of these patients did not have a documented review of antipsychotic medication in the previous 6 months. For the other 3 patients, their medication reviews did not consider whether to reduce the dose or stop antipsychotic medication.1 patient had been transferred to primary care, with a clear transfer of prescribing responsibility and documented evidence that written guidance was provided to primary care which addressed all the necessary management details.ConclusionAlthough there was clear documentation of reasons for initiating antipsychotics, there appeared to be a lack of awareness of NICE guidelines for antipsychotic medication reviews, side effect and metabolic markers assessment, and their documentation. This is an area for potential change in practice to conform better to national guidelines and improve patient care.

The evolution of a successful telemedicine mental health service

2002 ◽  
Vol 8 (3_suppl) ◽  
pp. 24-26 ◽  
Author(s):  
David Hailey ◽  
Tim Bulger ◽  
Sharlene Stayberg ◽  
Douglas Urness
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Effectiveness ◽  
Pilot Project ◽  
Provincial Government ◽  
Decision Makers ◽  
Health Board ◽  
Local Stakeholders ◽  
Care Decision

summary Development of telemedicine mental health services in Alberta evolved via a pilot project, the delivery of routine services to a small group of centres and subsequent expansion to a province-wide programme. Success of the service was linked to support for telehealth by the provincial government and consultation between the Alberta Mental Health Board (AMHB) and local stakeholders. Assessments by the AMHB have shown that telepsychiatry is acceptable and sustainable at a realistic cost. However, there are few measures of clinical effectiveness available and none of cost-effectiveness. A detailed economic evaluation of the telemedicine mental health network would now be a major task. The expansion of telemedicine mental health services has increased the expectations of health-care decision makers. In addition, the complexity of the network has increased and new initiatives, such as the use of telepsychology, have been introduced. Management of this successful telehealth programme continues to be time consuming and challenging.

scholarly journals Building a network to support people in suicide risk in Rio de Janeiro, from Primary Care to Mental Health Services

2019 ◽  
Author(s):  
Helio Rocha ◽  
Fabiane Minozzo ◽  
Debora Silva Teixeira ◽  
Laura de Carvalho Moraes Sarmento ◽  
Sandra Fortes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Rio De Janeiro ◽  
Suicide Risk

scholarly journals A Multi-Site Study of Mental Disorders in the Mozambican Health Care System

2020 ◽  
Author(s):  
Lidia Gouveia ◽  
Kathryn Lovero ◽  
Wilza Fumo ◽  
Afonso Mazine Tiago Fumo ◽  
Palmira Dos Santos ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Mental Disorder ◽  
Suicide Risk ◽  
Common Mental Disorders ◽  
Tertiary Care ◽  
Public Mental Health

Abstract BackgroundIn Mozambique, human and financial resources for public mental health services are extremely limited. Understanding the mental health needs of those seeking healthcare can inform efficient targeting of mental health services. We examined if the frequency of mental disorders in a health facility varied based on the level of specialization of such facility, from primary care without mental health specialists (PrCMH-), to those with mental health specialists (PrCMH+) and tertiary care (TerC), where both inpatient and outpatient mental health services are available.MethodsParticipants were adults seeking health or mental health services at six facilities (2 PrCMH+, 3 PrCMH-, and 1 TerC) in the cities of Maputo and Nampula in Mozambique. Mental disorders were assessed by the MINI International Neuropsychiatric Interview (MINI) 4.0.0. We compared the sociodemographic characteristics and MINI diagnoses across the three types of health facilities. Multiple logistic regression models determined the likelihood that a person seeking services at each type of facility would have any mental disorder, common mental disorders (CMD), severe mental disorders (SMD), substance use disorders (SUD), and moderate-to-high suicide risk, adjusting for sociodemographic factors. ResultsOf the 612 total participants, 52.6% (n=322) were positive for at least one mental disorder: 37.1% were positive for CMD, 28.9% for SMD, 13.2% for SUD, and 10.5% had suicide risk. Presence of any mental disorder was highest in TerC (62.5%) and lowest in PrCMH- (48.4%). Adjusting for sociodemographic covariates, participants in PrCMH+ were significantly more likely to have SMD (OR: 1.85, 95%CI: 1.10-3.11) and SUD (OR: 2.79, 95%CI: 1.31-5.94) than participants in PrCMH-; participants in TerC were more likely to have CMD (OR: 1.70, 95%CI: 1.01-2.87) and SUD (OR: 2.57, 95%CI: 1.14-5.79) than in PrCMH-. Suicide risk was the only condition that did not differ across facility types.ConclusionsAs anticipated, people with mental disorders were more likely to be cared for at facilities with mental health specialists. However, our study suggests there is a remarkably high frequency of mental disorders across different types of facilities within the Mozambican healthcare system. These results suggest a need to increase mental health services at the primary care level.

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