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PubMed2003

From research and development to practice-based evidence: clinical governance initiatives in a service for adults with mild intellectual disability and mental health needs.

BACKGROUND: Practice-based evidence represents the contribution of practitioners who utilize research methodologies to examine the quality of their clinical practice and service provision. METHODS: The present paper describes the evolution of a routine practice-based evidence system (PBES) via four phases of research and development. The four phases are described, as is their relevance to assessment and intervention with regard to the mental health problems of people with mild intellectual disability. Phase four describes the development of a routine PBES. RESULTS: The PBES is capable of profiling the individual mental health needs of service users and examining service effectiveness and quality at an organizational level. CONCLUSIONS: The PBES is discussed according to its current utility and possible directions for future development. The system is presented as an example of clinical governance that could be utilized by multidisciplinary teams to develop and maintain an organizational culture of quality.

Evidence-Based Medicine↗
PubMed2002

Access to nursing education by disabled students: rights and duties of nursing programs.

This paper outlines the rights and duties of nursing programs regarding access to nursing education for disabled students and the subsequent provision of services for them in the UK. Discussed briefly are the implications of these duties for nursing programs when disabled students are treated less favourably than their peers such as through a failure to make reasonable adjustments within the curriculum. Part IV of the Disability Discrimination Act (1995), as amended by the Special Educational Needs and Disability Act (2001), identifies such statutory duties and rights for nursing programs. For the purpose of this article, access to nursing education by disabled students and the subsequent service provision for these students in nursing programs is described as a game, using a conceptual framework by North. Different roles identified within the formal and informal legal rules, such as attitudes toward disabled students in nursing programs throughout the UK, are discussed briefly using this framework. It is noted that the rules of the game very much mirror the rules under Part II and Part III of the Disability Discrimination Act (1995) relating to disabled employees and disabled service users of public services, in force since December 1996. It is argued that lecturers and senior management teams in both nursing education and the health services occupy historical roles in the efficient design and playing of this game. The next step is to gradually align informal rules with formal rules, which can only be done through proper and correct education of key players.

Civil Rights↗
PubMed1993

The effect of providing ipecac to families seeking poison-related services.

Although home availability of ipecac is recommended for families with young children in case of unintentional toxic ingestion, fewer than half actually have it. We designed a study to evaluate the efficacy of providing ipecac to families requiring poison-related services. Families (n = 100) contacting the Children's Memorial Hospital (CMH) emergency department (ED)/poison center were enrolled. Baseline general poison knowledge and self-report of ipecac availability were obtained. Ipecac was discussed, and families were mailed general safety and poison information, the ED telephone number, and a coded package of ipecac, with instructions. Approximately three months later a follow-up call was made to determine change in knowledge, access to our ED (or any poison center) phone number, and availability of ipecac. Initially 71% had heard of ipecac, 51% knew what it did, and 47% said they had it. Ninety families were contacted in follow-up, 82 by phone and eight by mail. Eighty-three of 90 (92%) knew what ipecac did (vs 51/100 initially; P < 0.0001). Sixty-eight of 90 (76%) knew the ED or a poison control phone number (vs 39/100 initially; P < 0.0001). Seventy-seven of 82 (94%) reached by phone read the ipecac code number (vs 47/100 initial self-reports of possession; P < 0.0001). The data indicate that providing ipecac to poison service users increases availability in the home for at least three months. Poison service users may be particularly amenable to anticipatory guidance and interventions related to poisoning prevention and preparedness.

Adult↗
PubMed1992

Patterns of service utilisation following the 1989 Newcastle earthquake: findings from phase 1 of the Quake Impact Study.

A screening questionnaire was distributed to 5,000 adult members of the community six months after the 1989 Newcastle earthquake, with a response rate of 63 per cent (n = 3,007). The mean age of respondents was 46.7 years and 58 per cent were female. Subjects' earthquake experiences were rated in terms of weighted indices of exposure to threat and disruption. Psychological morbidity was measured using the General Health Questionnaire and the Impact of Event Scale. Subjects were asked to indicate which of a range of general and disaster-related support services they had used in dealing with the stressful effects of the earthquake. It was estimated that 21.3 per cent of the adult population used general and/or disaster-related support services. Users of these services reported greater exposure to threat and/or disruption and had higher levels of psychological distress than nonusers. However, a high level of use of general services and reliance on medical services were related more to psychological morbidity than degree of exposure to earthquake-related events. Overall, the Newcastle community's needs for assistance in the aftermath of the earthquake were effectively absorbed by the existing support services and the resources marshalled to supplement those services. Individuals and organisations mobilised following natural disasters need to be strengthened by enhancing the capacity of support service workers to identify and manage psychological distress in their clients.

Adult↗
PubMed2007

"There is such a thing as asking for trouble": taking rapid HIV testing to gay venues is fraught with challenges.

OBJECTIVES: To explore the feasibility and acceptability of offering rapid HIV testing to men who have sex with men in gay social venues. METHODS: Qualitative study with in-depth interviews and focus group discussions. Interview transcripts were analysed for recurrent themes. 24 respondents participated in the study. Six gay venue owners, four gay service users and one service provider took part in in-depth interviews. Focus groups were conducted with eight members of a rapid HIV testing clinic staff and five positive gay men. RESULTS: Respondents had strong concerns about confidentiality and privacy, and many felt that HIV testing was "too serious" an event to be undertaken in social venues. Many also voiced concerns about issues relating to post-test support and behaviour, and clinical standards. Venue owners also discussed the potential negative impact of HIV testing on social venues. CONCLUSION: There are currently substantial barriers to offering rapid HIV tests to men who have sex with men in social venues. Further work to enhance acceptability must consider ways of increasing the confidentiality and professionalism of testing services, designing appropriate pre-discussion and post-discussion protocols, evaluating different models of service delivery, and considering their cost-effectiveness in relation to existing services.

Antibodies, Viral↗
PubMed2005

From rhetoric to routine: assessing perceptions of recovery-oriented practices in a state mental health and addiction system.

The Recovery Self Assessment (RSA) was developed to gauge perceptions of the degree to which programs implement recovery-oriented practices. Nine hundred and sixty-seven directors, providers, persons in recovery, and significant others from 78 mental health and addiction programs completed the instrument. Factor analysis revealed five factors: Life Goals, Involvement, Diversity of Treatment Options, Choice, and Individually-Tailored Services. Agencies were rated highest on items related to helping people explore their interests and lowest on items regarding service user involvement in services. The RSA is a useful, self-reflective tool to identify strengths and areas for improvement as agencies strive to offer recovery-oriented care.

Choice Behavior↗
PubMedDate not supplied

Views of young people using augmentative and alternative communication systems.

Children with physical impairments who cannot use intelligible speech are often recommended augmentative and alternative communication (AAC) systems. In England and Wales, it is usually the job of speech and language therapists to support development in AAC skills. This paper reports findings from discussion with children and young people who use AAC systems concerning their attitudes and opinions towards the organization of speech and language therapy, the role of the speech and language therapist in school and issues concerned with AAC systems themselves. Six young adults and 17 children from London education authorities were interviewed on a one-to-one basis and in focus groups. Children were interviewed who had a communication aid incorporating at least 20 symbols and/or pictures and/or written words, language understanding at the two-word level and above, i.e. they demonstrated understanding of adult requests with at least two information carrying words. For children using communication aids, it is conceivable that their communication systems do not contain appropriate symbol vocabulary to express complex ideas, opinions and feelings. Consequently, a symbol-based interview tool was designed to allow children to express complex issues through visual means. Most children interviewed reported that their AAC system was useful to them. Further analysis of opinions revealed that negative attitudes towards AAC systems were primarily associated with operational issues (technical skills required to operate an AAC system) and issues of self-image/identity, and to some degree, with a lack of perceived benefit in interaction. In apparent contrast to therapists' preferred models of working, children and young people identified a preference for therapy organized on a one-to-one basis targeting linguistic and operational skills. It is suggested that more acceptable and individualized design of AAC systems could have implications for their use in school and other contexts. The value of service users' views in service planning and evaluation are discussed.

Adult↗
PubMedDate not supplied

Supplementary prescribing in mental health nursing.

Nurse prescribing is now possible in mental health care settings since the introduction of supplementary prescribing. The impact that supplementary prescribing will have on mental health service users, mental health services, mental health nurses and their educational preparation needs to be addressed by service providers, higher education institutions and workforce development confederations.

Drug Prescriptions↗
PubMed1998

Impact of community mental health services on users' social networks. PRiSM Psychosis Study. 7.

BACKGROUND: Social networks are important for people with severe mental illness, and services need to assess whether they succeed in improving social contacts. METHODS: In a prospective controlled study, social network data were obtained in an epidemiologically representative sample of people with psychotic disorders both before (Time 1) and two years after (Time 2) the introduction of two sectorised community mental health services in south London (one intensive service with two specialist teams, one standard service with a generic team). RESULTS: There were significant baseline differences between sectors with social networks being smaller in the sector later served by the intensive service. Social network size increased within the intensive service sector, but not in the standard service sector. There was a significant sector effect for the network component of relatives (intensive > standard) and in the other ('non friends') component (standard > intensive) after adjusting for baseline differences. CONCLUSIONS: The findings suggest that the intensive sector community mental health service enhanced people's social networks with their relatives, relative to the standard service. The reverse is the case for other contacts.

Community Mental Health Services↗
PubMed1996

Impact of visit copayments on outpatient mental health utilization by members of a health maintenance organization.

OBJECTIVE: The authors examined the impact of increasing cost sharing on use of outpatient mental health services. METHOD: A quasi-experimental design was used to study outpatient utilization by members of a health maintenance organization (HMO) who were subject to increasing copayments for mental health visits (state government employees and dependents). Their outpatient mental health utilization was compared with that of similar HMO members who were not subject to cost sharing (federal government employees and dependents). Analyses compared both likelihood of any service use and number of visits per year among service users. RESULTS: Institution of $20/visit copayments was associated with a 16% decrease in likelihood of service use but no change in visit rate among service users. A subsequent copayment increase to $30/visit resulted in no significant change in likelihood of use but was associated with a 9% decrease in visits per year among those using services. The impact of the first copayment change on likelihood of using services did not vary according to level of clinical need (as measured by prior service use and psychotropic drug use). CONCLUSIONS: In this staff-model HMO, modest visit copayments significantly reduced initial access to mental health treatment and had a smaller effect on treatment intensity. Copayments restricted access regardless of clinical need. Designers of mental health benefits must consider the impact of copayments on those with the greatest need for treatment.

Ambulatory Care↗
PubMed1998

The role of quality standards--accreditation in redressing asymmetry of information in health care markets.

Asymmetry of information presents major difficulties for the efficient operation of markets in health care. The use of accreditation schemes may reduce these difficulties by enhancing the availability of reliable, accessible information on aspects of service quality considered important by service users and their agents. The UK's Patients' Charter with its associated Charter Marks has the potential to perform such a function in respect of inpatient services. In as much as it refers to aspects of service valued by service users which are specified in contracts by service procurers and appear not to be negatively correlated with other aspects of service quality, it can be seen to provide unambiguous signals of service quality. Given the Charter is currently under review, it seems appropriate that such attributes are borne in mind by policy makers in their deliberations as to its future.

Accreditation↗
PubMed1998

Empowerment and care management: swimming against the tide.

This paper is concerned with the policy and practice of care management, that is, the system for assessing care needs and arranging services to meet them, developed under the legislative framework of National Health Service (NHS) and Community Care Act 1990. The paper takes as its starting point the contrast between the rhetoric of service user empowerment in professional training, particularly of social workers, with the disempowering realities that arise in practice. It examines some of the sources of this conflict, looking in particular at contradictions inherent within the development of care management as a policy, conflicts contained within the legislation and associated guidance and contradictions evident at the level of practice. It argues that organizational processes and procedures consequent upon care management as it is evolving in practice are decreasing the possibilities for empowering practice and reinforcing the power of care managers at the expense of service users. It suggests that the power of the care manager is based on increased administrative and managerial responsibility, counterbalanced by diminishing professional autonomy and discretion. Some possibilities for future development if empowerment is to survive as a meaningful concept within care management are outlined. The paper concludes that there are serious limitations on the scope for empowerment within care management and that the real hope for empowerment lies in the encouragement and support of user-led initiatives in service planning, evaluation and provision.

Journal Article↗
PubMed2004

Social exclusion in clients with comorbid mental health and substance misuse problems.

BACKGROUND: The concept of comorbid mental health problems and substance misuse has gained prominence in the last two decades, due in part to the closure of large psychiatric hospitals and to the increasing prevalence of drug use in the community. This client group has a dual requirement for both medical and social care needs and is at risk for social exclusion. METHODS: A retrospective matched case-control study to examine aspects of social exclusion between service users who have comorbid diagnoses and those with a single diagnosis. Samples were drawn from the service users of a mental health Trust in the South-East of England, from both Adult Mental Health (n = 400) and Drug and Alcohol services (n = 190). Data were collected from Care Programme Approach assessment forms and medical records. McNemar's chi(2) and odds ratios via a conditional logit regression model are used to test for differences in the social exclusion indicators. RESULTS: There were significant differences in social exclusion between the comorbid and singly diagnosed clients of the Adult Mental Health service, but differences were less pronounced between the comorbid and singly diagnosed clients of the specialist Drug and Alcohol service. CONCLUSIONS: Recent Government policy advocates treating comorbid clients within mainstream mental health services. Health care workers need to recognise the likelihood of high levels of social exclusion among clients with comorbid problems.

Adolescent↗
PubMed2006

Nursing and public participation in health: an ethnographic study of a patient council.

BACKGROUND: Conceptualisations of the nurse-patient relationship tend to view nursing as embodying an empowering approach to patients, one that places the service user perspective at the centre of decision-making. However, the relationship of nursing to public participation in health service planning and development has been under examined. AIMS: The aim is to explore the relationship of the nursing profession to public participation as enacted through a UK-based patient and public council, located in an acute hospital. The council was developed by nursing staff and aimed to achieve service user participation in strategic level health care decision-making. The views and experiences of participants and the applicability of the 'nurse-patient partnership' construct to public participation are considered. METHODS: The study employed integrative ethnography, involving multiple field methods: non-participant observation of council meetings, i.e. fourteen 3 h meetings (n=42 h); in-depth interviews with councillors (n=17) and with key hospital staff (n=18). A documentary review and mapping of the actions of the council was undertaken. RESULTS: A nurse-patient partnership was not initially intrinsic to the operation of the council or embedded in the perspectives of the nurse or patient participants. Professional vulnerability and the organisational context constrained the nursing response. Councillors and nursing staff moved to create a shared set of understandings in order to progress change in service organisation and delivery. Nurses' repositioning vis-à-vis the credibility of user experiences and status was central to the effective progression of the council. CONCLUSIONS: Partnership in public participation requires a shift by nurses' towards acceptance of members of the public functioning as informed, critical and powerful agents in health care decision-making. Equipping nurses with the skills to communicate with patient representatives in a position of interactional equality is likely to be a pre-requisite for successful engagement by nursing with public participation.

Anthropology, Cultural↗
PubMed2000

'Building up safe havens... around the world': users' experiences of living in the community with mental health problems.

Deinstitutionalization moved the focus of psychiatric care away from hospital institutions to community settings. Mental health services are no longer driven by a policy of illness containment, although detention and coercion retain legislative and cultural legitimacy, because the conceptual and practical focus of caring for people in the 1990s is built around journeys to(wards) ordinary 'independent' living. This paper draws upon the experiences of people with enduring mental health problems to explore the positions, roles and therapeutic benefits established by socio-spatial networking in the community. Social isolation and community integration are polar extremes, two very different 'locations' on a 'theoretical' rehabilitation pathway shaping mental health policy and community care practices. The paper assesses these two locations and searches for the middle-ground in practice. It draws on the concept of normality to compare service user and professional perspectives on the rehabilitation process. The paper argues, with optimism, that spaces of rehabilitation are being found 'in the community' but notes that until mental illness is de-stigmatised and society celebrates difference, creating space for 'Mad Pride', the post-asylum landscape must continue to evolve in search of models of good community care practice and potential landscapes of caring. The research presented in the paper was carried out with Rehabilitation and Community Care Services (RCCS) in Nottingham (1994-1997), and is based upon fieldwork observations and in-depth interviews with RCCS staff and 25 service users.

Activities of Daily Living↗
PubMedDate not supplied

Detecting hyperprolactinaemia in mental health patients.

Hyperprolactinaemia is associated with drugs used in mental health to treat psychosis (antipsychotics) and affects a significant number of service users. The condition causes endocrine disturbances, including sexual dysfunction, amenorrhoea and infertility. In the longer term, service users are also at risk of disabling conditions such as osteoporosis. Early detection of hyperprolactinaemia enables safer use of antipsychotic drugs. This article focuses on neuroendocrine adverse effects and how this problem can be addressed.

Adult↗