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PubMed1995

The application of the ideas of Frantz Fanon to the practice of mental health nursing.

This paper is based on an extensive review of the published literature which refers to the clinical and social psychology of Frantz Fanon, and seeks to establish the relevance of Fanon's psychological thought to the practice of mental health nursing in the 1990s. The writer sets out the key principles of Fanon's clinical and social psychology, and engages with the theoretical problems which arise from the close relationship between Fanon's psychological theories and his involvement with violent revolutionary politics. After discussing the links between Fanon's unique psychology and the work of the anti-psychiatrists of the 1960s and later critiques of mental health care, the writer argues that the development and adoption of a neo-Fanonist approach to the practice of mental health nursing would address many of the problems of current mental health care practice. In particular, the principles of Fanon's psychology address many of the concerns about disempowerment of service users which have been highlighted in work by feminist and anti-racist writers, and by members of the Mental Health Service Users' Movement.

History, 20th Century↗

PubMed2005

Community psychiatric nurses and the care co-ordinator role: squeezed to provide 'limited nursing'.

AIM: This paper reports a study illuminating the factors that either facilitate or constrain the ability of community psychiatric nurses, in their role as care co-ordinators, to meet service users' and carers' needs. BACKGROUND: The Care Programme Approach is the key policy underpinning community-focused mental health services in England, but has been unevenly implemented and is associated with increased inpatient bed use. The care co-ordinator role is central to the Care Programme Approach and is most often held by community psychiatric nurses, but there has been little research into how this role is performed or how it affects the work of community psychiatric nurses and their ability to meet the needs of service users. METHODS: A multiple case study of seven sectorised community mental health teams was employed over 2 years using predominantly qualitative methods including participant observation, semi-structured interviews and document review. The data were collected in one National Health Service trust in south England between 1999 and 2001. FINDINGS: Additional duties and responsibilities specifically associated with the care co-ordinator role and multidisciplinary working, combined with heavy workloads, produced 'limited nursing', whereby community psychiatric nurses were unable to provide evidence-based psychosocial interventions that are recognized to reduce relapse amongst people with severe mental illness. CONCLUSIONS: The role of the Care Programme Approach care co-ordinator was not designed to support the provision of psychosocial interventions. Consequently, community psychiatric nurses in the co-ordinator role are faced with competing demands and are unable to provide the range of structured, evidence-based interventions required. This may partially account for the increased inpatient bed use associated with the Care Programme Approach.

Adult↗

PubMedDate not supplied

The "in-between' times: video analysis of peer interactions.

Research into day services for adults with severe learning disabilities continues to place great emphasis on the importance of structured activities (Seed, 1988). As a result, the policy for a service user's day tends to consist of timetabled activity with formal periods of learning and communication with staff (Social Services Inspectorate, 1992). In reality, however, there can be quite long gaps between activities, which are equally deserving of research interest. These are the 'in-between' times; times of the day when service users are waiting for an activity to be initiated by staff, or simply waiting for something to happen. It is suggested that the 'in-between' times offer similar potential for promoting learning and communication, through more informal and natural interaction.

Adult↗

PubMed1974

Evaluation of MEDLINE service by user survey.

The use of MEDLINE at the Calder Memorial Library of the University of Miami School of Medicine has grown so substantially over the past one and one-half years that we felt an evaluation of the service was appropriate. A one-page questionnaire was sent to 350 patrons who had requested MEDLINE searches in 1973. The response validated many of our assumptions about the user group and their reasons for using MEDLINE. Most surprising were the degree of enthusiasm, the willingness to pay out of personal funds, the apparent lack of knowledge about SDILINE, and the small number of critical comments. We expect that the experience gained from this assessment will enable us to make improvements in some aspects of our service, as well as to undertake more subject-specific evaluations at shorter intervals in the future.

Evaluation Studies as Topic↗

PubMed2003

Respite for dementia caregivers: the effects of adult day service use on caregiving hours and care demands.

The objective of this study was to determine whether adult day service use was related to decreases in primary caregiving hours (i.e., the time caregivers spent on activities of daily living/instrumental activities of daily living and behavior problems for care recipients) and care recipient function for these domains. Three-month longitudinal data from the Adult Day Care Collaborative Study (N = 400) were used. Adult day service users reported greater decreases in hours spent on behavior problems when compared to nonusers, even after controlling for baseline differences between the two groups. In addition, adult day service users reported decreased frequency of behavior problems in their relatives who attended adult day programs. The findings suggest that adult day services, if used over time, are effective in restructuring caregiving time and may offer potential benefits not only to family caregivers but to community-residing older adults who have dementia as well.

Aged↗

PubMed2003

Doing it by yourself.

The DoH (1999) describes how it 'needs leaders who are motivated, self aware, socially skilled and able to work together with others across professional and organisational boundaries'. Self-medication incorporates all professional groups and divisions within Calderdale and Huddersfield NHS Trust; we work in partnership with the pharmacy departments. The main purpose of any organisation in the health and social sector is to ensure that a high quality service is delivered to service users (Martin 2001), so self-medication is now being given the attention it deserves. Assessment will be integral to every service user's stay and will continue throughout their stay, including transfer from secondary to primary care. It is expected that following its introduction, quality will improve; patients will receive their medication on time and it is anticipated that discharge delays will reduce. We acknowledge however that this will be difficult to demonstrate, as often medical conditions are cited as reasons for admission, not non-compliance with medication regimes. We see ourselves as being competent in the roles of change agents and our styles have changed throughout the process. We have worked together as equals and focused on one outcome. It will call on all our professional and educational skills to mould staff so that they are ready to embrace the change. Perhaps the lesson that has been learned so far is that, despite meticulous planning, the actions of others for whom we are not responsible can seriously disrupt the plan. The opportunity to manage change through experiential learning, reflection and the transfer of knowledge has been challenging while enhancing our personal growth and self-awareness. The project has been extended until March 2004 because of the merger and the associated increased workload. Becoming a project manager, leader and change agent has proved to be an exciting, interesting and challenging experience, although at times we felt isolated. The project has now entered a phase that involves intense staff training and phase one of introduction.

England↗

PubMed2006

Can malaria be controlled where basic health services are not used?

OBJECTIVE: To assess the potential of integrating malaria control interventions in underused health services. METHODS: Using the Piot predictive model, we estimated malaria cure rates by deriving parameters influencing treatment at home and in health facilities from the best-performing African malaria programmes and applying them to Yanfolila district, Mali. RESULTS: Without any malaria control intervention, the population cure rate is 8.4% with home treatment, but would be 13% if access to timely treatment were improved (as in Kenya). A further 3.2% of malaria patients could be cured in institutional settings with more sensitive diagnosis, timely start of treatment, better compliance (as in Uganda, Tanzania, Ghana) and 80% chloroquine efficacy. Applied in a setting where 7.6% of malaria patients seek institutional care, these assumptions would result in a total population cure rate of 14.5%. Increasing the health service user rate from 0.17 in Yanfolila to 0.95 new cases/inhabitant/year (as in Namibia) would result in half of all malaria patients attending professional services, raising the cure rate to 26.1%. CONCLUSION: If malaria patients are to be treated and followed-up early and appropriately, basic health services need to deliver integrated care and be attended by an adequate pool of users. Improved service user rates and case management can increase malaria cure rates far more than isolated control interventions can. This has implications for international policies endorsing a narrow disease-based approach.

Africa↗

PubMed2005

Involving NHS users and carers in healthcare education.

This paper is based on a presentation delivered by the Special Interest Group for Education and Training (SIGET) at the annual Community Practitioners' and Health Visitors' Association (CPHVA) conference. Service user and carer involvement in all aspects of health care delivery, including the educational process, is a key element of the government's modernisation programme. This paper considers the policy context that requires nurse educationalists to seek the views of service users and carers in planning quality healthcare education programmes. It identifies issues and challenges for those working in higher education establishments based on evidence from the literature and the experiences of the authors. Principles of good practice are suggested which value and respect the views of those who are recipients of healthcare delivery.

Benchmarking↗

PubMed1997

Understanding professional behavior: experiences of occupational therapy students in mental health settings.

A phenomenological study explored occupational therapy students' experiences in psychiatric fieldwork. Of particular interest was students' understanding of professional behavior toward persons who use mental health services. Data were gathered from 16 informants via in-depth interviews and participant observation on multiple occasions during fieldwork affiliations. Emerging from informants' views of professional behavior were difficulties in their reconciling conflicting expectations with regard to emotional and social distance from persons who use mental health services. Additionally, the informants experienced a need to assume authority and maintain control in their dealings with service users. Students' encounters with such issues during fieldwork are indicative of challenges they may face as health professionals in a changing climate of mental health services. These data are stimuli for reflection on features of professional relationships with service users, particularly in response to expectations of persons with disabilities regarding control over their lives.

Adult↗

PubMed1993

[Format of images and connections of sources].

One of the major problems in the many applications of transfer, and storage of medical images is the availability of quality data (image). This article discusses various ways of overcoming this difficulty of processing all medical imaging sources (analogue and digital). This technique of connection is analysed in terms of quality, availability and cost. A large section is devoted to introduction of the ACR-NEMA DICOM V3.0 standard, which is the tool for exchange of images between image suppliers, processing stations, storage centre and printing peripherals. In conclusion, this article presents a standard plan of connection between image sources and user services by introducing the concept of an "intelligent" universal interface allowing connection of digital and analogue sources which "standardizes" image formats for user services.

Angiography↗

PubMed1999

Dimensions of choice in the assessment and care management process: the views of older people, carers and care managers.

The aim of promoting the maximum possible choice for service users and carers is - together with the goal of greater independence - central to recent community care policies. This paper sets out a typology of those key choices which users and carers are expected to be able to make within each stage of the assessment and care management process: choices about what services, when to receive them (i.e. at what times and for what duration) and from whom (i.e. which provider organization and which individual care worker). Drawing on interviews with 28 older service users, 20 informal carers and 22 care managers across four local authority areas in England, the paper goes on to describe the extent to which such choices - both at the strategic/macro and operation/micro level - have increased or decreased in practice. The evidence confirms that of other recent studies that the gap between the 'ideal' of user and carer involvement and the 'reality' of everyday practice is still considerable.

Journal Article↗

PubMed2006

Nursing and midwifery research in Scotland: from partnership to collaboration.

Nurses and midwives form the workforce that provides the greatest proportion of direct care to service users. They have the ability to make a significant impact not only on the quality and outcomes of patient care, but also on service users' and carers' perceptions of the care experience. It is therefore vital that nursing and midwifery practice has a robust knowledge and evidence base. The Scottish Executive Health Department, in partnership with other key stakeholders, launched in 2004 an 8 million pounds funding package for research and development capacity and capability initiatives for nursing, midwifery and the allied health professions. This article seeks to describe the process of engagement and partnership building that enabled this scheme to be developed. It will attempt to illustrate how the convergence of political, policy and professional agendas has provided the opportunity for nurses and midwives to set a direction of travel for research and development that will enable them to become key players within multidisciplinary research at United Kingdom and international levels.

Cooperative Behavior↗

PubMed2006

The implementation of managed behavioral healthcare in Colorado and the effects on older Medicaid beneficiaries.

BACKGROUND: One of five persons over the age of 65 experiences a diagnosable form of mental illness. Yet their access to and use of specialty services are the lowest among all age groups. It is unclear how managed behavioral healthcare has affected this problematic situation. The Colorado Medicaid Mental Health Capitation Pilot Program, implemented in 1995, provided an opportunity to investigate the impact of managed behavioral healthcare on older Medicaid beneficiaries. STUDY AIMS: This study compared two capitated administrative models of Medicaid mental health service delivery to a traditional fee-for-service model, and specifically focused on how these models shaped service use and expenditure patterns for Medicaid beneficiaries over the age of 65. METHODS: This study employed a quasi-experimental, pre-post design with a non-equivalent comparison group that reflects the implementation of capitation financing in some parts of Colorado and not others. A difference in difference specification was used to identify the effects of capitation under two administrative models relative to areas remaining under fee-for-service reimbursement. Logistic and Ordinary Least Squares regression were used to estimate service use and (logged) expenditures per repeat and total number of service users. Generalized corrections for heteroskedasticity and repeated observations were applied. Probabilities and average user expenditures were derived from regression results with a fixed case-mix and compared to actuals. RESULTS: The analyses indicated that one of the capitated administrative models increased the total number of older beneficiaries who used services while the total number of service users decreased in the other capitated models. Both capitated models reduced repeat use and expenditures for specialty mental health services relative to the traditional FFS model. DISCUSSION: Capitation had the expected effect of reducing the duration and intensity of treatment. Clear differences between the two capitated administrative models emerged that appeared consistent with their management philosophies. Measured effects were limited to services covered by capitation and may have been influenced by the observational design. Overall results were somewhat different from those pertaining to younger populations studied in Colorado. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: While capitation clearly reduced total expenditures for older beneficiaries, its influence on specific treatment process measures such as user expenditures, repeat users and total users may vary considerably across treatment systems. Notably, capitation may result in increases or decreases in total users within a specific sub-population such as elders. IMPLICATIONS FOR HEALTH POLICIES: This analysis provides critical information for those state mental health and Medicaid agencies that are expanding the application of managed behavioral healthcare within a demographic environment where the population of older adults with mental illnesses is increasing. Financing, organization and their impact on specific treatment populations need to be considered in developing and applying managed behavioral health care. IMPLICATIONS FOR FURTHER RESEARCH: The differential effects on elders by administrative models needs further explication and should be measured against clinical and social outcomes as well as the effect of other sources of financing and service substitution.

Aged↗

PubMed2002

Service organisation, service use and costs of community mental health care.

BACKGROUND: Different forms of service organisation may be expected to affect costs. I is important to understand the distribution of costs amongst providers of mental health care, so that the effect of service developments on budgets can be better anticipated and planned. AIMS: This study explored the association between different forms of mental health service organisation and costs. It tested the impact on costs of services with high degrees of integration between health and social care providers, and of services targeting at people with more severe mental health problems. METHODS: 260 service users in 4 districts in the north of England were interviewed and costs identified for each person. The districts comprised examples of four types of service configuration. Use and non-use was compared by type of service, and after suitable transformations, costs were also compared between districts and between types of service. The sample was large enough to discern a difference of 50 ( 80) per week with 80% power and 5% significance. RESULTS: Costs were closely related to severity. People in targeted services had higher mean costs ( 136, SD 191 versus 92, SD 106; p=0.001). The costs of targeted services in this study were very similar to those of psychosis-only services in a London study. Integrated services were predicted to have lower inpatient costs (p=0.003), lower PCG costs (p=0.003) and lower total health and social care costs (p=0.024). Differences between use and costs of specific services were largely attributable to imprecise definitions and supply-side factors. DISCUSSION: While the sample is not representative, the a priori distinctions made in selecting the districts were reflected in service use and costs. This study suggests strongly that targeting services at people with more severe mental health problems seems likely to increase mean health and social care costs per service user. It also suggests that integration maybe associated with lower costs. Since both targeting and integration are increasingly common mental health policies, it is important to recognise that they may have opposing effects on costs.

Adult↗

PubMed2006

Joint inspection of services for people with learning disabilities in Scotland: compliance or commitment?

PURPOSE: The article describes the development of a practical model of joint, integrated inspection of managed care services for people with learning disabilities in Scotland. The model will give a reliable measure of the impact services are making to people's lives and the quality of service that individuals are actually receiving. CONTEXT OF CASE: At present health, social services and education services for people with learning disabilities in Scotland are inspected separately, by up to nine different agencies. The first joint, integrated inspections of all services for people with learning disabilities in Scotland will take place in 2006. This is the first inspection of its kind in the UK, and the first to involve carers and people with learning disabilities on the inspection team. DATA SOURCES: Quality Outcome Indicators were developed in 21 different areas, or domains. Evidence based best practice, and evaluative data from previous inspections were the primary sources of data. CASE DESCRIPTION: This paper reviews the background and rationale for the integrated, joint inspection process. Strengths and constraints of this approach to inspection are discussed, including the crucial importance of commitment from services and from inspectors, rather than mere compliance with demands. Some guidance on how to fully involve staff, carers and services users in the inspection process is given. CONCLUSIONS AND DISCUSSION: The model will produce data to inform decision-making for managers in integrated services and give services users clear information about how well local needs are being met, what areas need development, and what capacity the organisations have to improve. The model of inspection may be of interest to practitioners in a national and international context. The model will be evaluated, following the first joint inspection.

Journal Article↗

PubMed2003

Assessment of community mental health centres in Bosnia and Herzegovina as part of the ongoing mental health reform.

In summary it seems reasonable to state that around 5000 individual service users are visiting the CMHCs in Bosnia and Herzegovina during one week. Approximately 60% of them have mental health problems, around 25% come for non mental medical disorders and around 15% are healthy and come for check ups or certificates. The average CMHC cater for about 65,000 inhabitants with a staff of one psychiatrist, three nurses and 0.7 psychologist and social worker respectively. Most of them have training for tasks within mental health services. The progress of the mental health reform is positive with more CMHCs opened, and basically staffed with trained personnel. They offer a variety of services practiced with a modern strategy. Most personnel has changed their attitudes to mental health itself and the relevant service provision and hence devoted to implement the mental health reform. They would like to have more influence on decision making and present constructive suggestions for future service and policy improvements. The service users are almost all of them very satisfied with the service provided.

Bosnia and Herzegovina↗

PubMed2003

Promoting mental health through employment and developing healthy workplaces: the potential of natural supports at work.

In England, policy developments in the field of mental health are stimulating interest in employment for mental health service users as a means of mental health promotion. To date, research that might assist in increasing employment rates amongst this group has focused largely on the question of which service users are most likely to benefit from vocational interventions and, more recently, on models of vocational support. Less is known about how employers can assist people in their transition or return to work. In this article we draw on the accounts of 17 employment project clients to identify workplace factors that were associated with job retention. Specific adjustments such as flexibility about working hours, work schedules and job tasks emerged as crucial in enabling clients to deal with the effects of medication, and to regain stamina and confidence. Over and above these, however, 'natural supports' of a kind from which any employee would arguably benefit were equally important. In this respect the main themes revolved around training and support to learn the job, supportive interpersonal relationships at work, workplace culture, and approaches to staff management. These themes might equally provide a productive focus for workplace health promotion more generally, using organization development approaches.

Employment↗

PubMed1996

Focus groups in mental health research: enhancing the validity of user and provider questionnaires.

Most mental health researchers rely upon quantitative methods of data collection. Whilst such methods are commonly seen as reliable, qualitative methods are often seen as more valid. Despite the value of qualitative methods of data collection, however, many researchers denigrate their use. Qualitative research is often viewed as lacking in scientific rigour. This paper explores the use of the focus group as a qualitative instrument to enhance the validity of existing questionnaires for mental health service users and providers. Between July and August 1995 four focus groups were conducted in Exeter and Taunton among service users (with severe or long-term mental health problems) and providers (community psychiatric nurses, social workers and occupational therapists). It is demonstrated that focus groups enhance the validity of existing questionnaires by highlighting those concerns held by users and providers that would otherwise have been neglected.

Attitude of Health Personnel↗