Adult Mental Health Settings Research Articles

Exploring the impact of peer support in early intervention in psychosis

PurposePeer support (PS) has, over recent years, been implemented across a variety of NHS adult mental health settings. In November 2015, peer support workers (PSW) were introduced to an Early Intervention in Psychosis Service (EIS) in the Midlands. The purpose of this paper is to focus on organisational factors, asking how do PS impact on an early intervention in psychosis multi-disciplinary team (MDT).Design/methodology/approachSix EIS MDT members participated in an hour-long focus group. The data were analysed using thematic analysis, in line with a qualitative methodology (Braun and Clarke, 2006).FindingsTwo themes were generated, including “The values of PS” (consisting of three sub-themes: improving service engagement; personal qualities; and the peer relationship); and “The peer support role” (consisting of three sub-themes: living experience; boundaries; and alternative perspectives). Findings imply that PS in the current EIS related to: improved service engagement and greater understanding between service providers and users; which could be linked to better outcomes for service users (such as reduced duration of untreated psychosis (DUP)).Originality/valueIt has been suggested that PSWs facilitate an improved understanding between service providers and service users (Repper and Watson, 2012). However, research into organisational and team benefits of PS is lacking, with a need for more exploration (Repper, 2013). The current study begins to address the lack of literature regarding the organisational impact of PS, and even further regarding early intervention.

Development of a code of good practice for ward rounds in an adult mental health rehabilitation service

A service evaluation of ward round processes was conducted in an adult mental health setting as a result of interest from both service user and staff groups, and results were used to generate a ‘Code of Good Practice’.

Efficacy of Group CBT Vs Group Information and Support in Relapse and Recurrence of Depression in Adults

This study aimed to analyse the rates and length of time to relapse and/or recurrence of depression in individuals who attended either Group CBT or Group Information and Support in an adult secondary mental health setting in Ireland. The present study centred on the analysis of previously collected data from groups running between 2005 and 2010 and on the retrospective file review. It formed part of a larger scale research study conducted by the Principal Clinical Psychologist evaluating the effectiveness of CBT for depression and bipolar disorder. The study was quantitative in nature and incorporated qualitative elements (i.e. Clients’ and Practitioners’ description of the severity of the depressive episodes) which were converted into quantifiable categories. Participants comprised of two groups: Treatment I (Group CBT) including participants who attended 8 or 12 sessions of manualised Group CBT and a comparison sample: Treatment II (Group Information and Support) comprised of participants who attended 12 sessions of group information and support. Based on survival analysis, no significant difference was found in effectiveness for Group CBT and Group Information and Support in preventing and/or decreasing the number and the length of time to relapse and/or recurrence of depression in this client group. Findings, clinical implications, methodological limitations and future research directions were also discussed.

Improving Mental Health through Social Support: Building Positive and Empowering Relationships

Jonathan Leach's book offers a well-organised and engaging exploration into social support. Its readership is likely to be social workers and other professionals based in adult mental health settings, although it should draw the interest of health and social care workers in a range of settings, where the need to grasp how to genuinely provide social support to people experiencing mental health problems is a necessary part of practice. The written expression is clear and, very early in the book, Leach states that the book is sociologically informed. He then outlines what he wants the book to do, which is for it to contribute to a more sophisticated understanding of how social support operates and can be used by mental health practitioners. This aim is achieved by locating and exploring where social support fits in a range of mental health settings. The book advocates how social support can be used as an approach to addressing a variety of mental health problems, ranging from mild anxiety difficulties to severe and enduring mental health conditions, which impact on multiple aspects of a person's life. This is ambitious considering the broad range of mental health problems that this encompasses and different individual life experiences. However, Leach does provide examples that help to contextualise these complexities in practice.

Coping with work‐related stressors and building resilience in mental health workers: A comparative focus group study using interpretative phenomenological analysis

Experiencing excessive stress in the workplace can lead to mental ill health, which has costs both personally for individuals and for the wider economy in terms of lost working days. This study used two in‐depth focus groups, one with NHS mental health workers (n = 9) and one with Samaritans’ volunteers (n = 8), to investigate how they cope with work‐based stressors, and build and maintain resilience. The qualitative data derived from the focus groups were compared and analysed using interpretative phenomenological analysis to gain an in‐depth understanding of the lived experiences of those working in both statutory and voluntary adult mental health settings. Four superordinate themes emerged: (1) Perceived lack of control as a stressor; (2) Ways of building resilience; (3) The dual impact of values; and (4) The effect of environment. The implications of these findings are discussed in the context of recommendations for training to help foster resilience within mental health care systems, along with possible areas of future investigation.Practitioner points Resilience has been shown to be an important element in allowing those working and volunteering in mental health settings to cope with the stressors inherent in their chosen field. Allowing staff reasonable control over their work, and providing an adequate environment in which to carry out their work, is conducive to building and maintaining resilience. Consideration should be given to the dual nature of some elements of working in a mental health context, in terms of both the positive and negative impact they can have (e.g., values and environment). Training programmes using aspects of developments such as mindfulness and acceptance and commitment training may also be able to contribute to building and maintaining resilience in mental health workers.

Has evidence-based psychosocial treatment for anxiety disorders permeated usual care in community mental health settings?

Cognitive behavioral therapy (CBT), particularly when it includes an exposure component, is an empirically supported psychosocial treatment for anxiety disorders that has been shown to be highly efficacious, desirable to patients, and cost-effective. However, access to and receipt of exposure-based treatment CBT anxiety remains lacking despite these benefits. The current study reviewed electronic medical records at a large public outpatient psychiatry clinic in order to clarify what usual care for anxiety disorders entails, and to determine the extent to which effective psychosocial treatment is accessible to, and implemented with anxiety disorder patients. Database queries generated from the billing and medical record system at the Los Angeles County Adult Outpatient Psychiatry Clinic identified 582 patients presenting with an anxiety disorder diagnosis in a 6-month time frame. These patients' electronic medical records were reviewed using a standardized data collection form. Findings indicated that the majority of patients received pharmacological treatment for their anxiety. The majority of the psychosocial treatment delivered was supportive therapy. Among the minority of patients who did initiate CBT, an even smaller minority received treatment that included an exposure component, and those who did receive exposure likely received a sub-optimal dose. Understanding usual care delivery patterns is an important preliminary step to identifying and addressing barriers to optimal anxiety disorder treatment in adult community mental health settings.

The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment.

This study investigated changes in the 'atmosphere' of an acute adult mental health setting following relocation to a new purpose-built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital-based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose-built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less 'staff control' in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer 'involvement' in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the 'atmosphere' of a health facility, for both staff and consumers.

Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review.

BackgroundCrisis Resolution Teams (CRTs) aim to offer an alternative to hospital admission during mental health crises, providing rapid assessment, home treatment, and facilitation of early discharge from hospital. CRTs were implemented nationally in England following the NHS Plan of 2000. Single centre studies suggest CRTs can reduce hospital admissions and increase service users’ satisfaction: however, there is also evidence that model implementation and outcomes vary considerably. Evidence on crucial characteristics of effective CRTs is needed to allow team functioning to be optimised. This review aims to establish what evidence, if any, is available regarding the characteristics of effective and acceptable CRTs.MethodsA systematic review was conducted. MEDLINE, Embase, PsycINFO, CINAHL and Web of Science were searched to November 2013. A further web-based search was conducted for government and expert guidelines on CRTs. We analysed studies separately as: comparing CRTs to Treatment as Usual; comparing two or more CRT models; national or regional surveys of CRT services; qualitative studies of stakeholders’ views regarding best practice in CRTs; and guidelines from government and expert organisations regarding CRT service delivery. Quality assessment and narrative synthesis were conducted. Statistical meta-analysis was not feasible due to the variety of design of retrieved studies.ResultsSixty-nine studies were included. Studies varied in quality and in the composition and activities of the clinical services studied. Quantitative studies suggested that longer opening hours and the presence of a psychiatrist in the team may increase CRTs’ ability to prevent hospital admissions. Stakeholders emphasised communication and integration with other local mental health services; provision of treatment at home; and limiting the number of different staff members visiting a service user. Existing guidelines prioritised 24-hour, seven-day-a-week CRT service provision (including psychiatrist and medical prescriber); and high quality of staff training.ConclusionsWe cannot draw confident conclusions about the critical components of CRTs from available quantitative evidence. Clearer definition of the CRT model is required, informed by stakeholders’ views and guidelines. Future studies examining the relationship of overall CRT model fidelity to outcomes, or evaluating the impact of key aspects of the CRT model, are desirable.Trial registrationProspero CRD42013006415.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0441-x) contains supplementary material, which is available to authorized users.

Using Writing as Therapy: Finding Identity

This practice analysis describes a case study from qualitative research (Cooper 2008) using questionnaires and interviews. It explores the use of a writing intervention in occupational therapy practice that follows the journey of one female inpatient in an acute adult mental health setting, suffering with significant symptoms of depression as part of a diagnosis of schizophrenia. The new intervention, Using Writing as Therapy, is a six-session writing therapy intervention exploring identity and self-esteem. Results showed that Using Writing as Therapy enabled cognitive change and provided a number of ‘containers’ through which to explore life experiences that improved understanding of role and self-identity.

Use and Results of MOHO Global Assessments in Community Mental Health: A Practice Analysis

This practice analysis reports an evaluation of occupational therapists' utilization of assessments derived from the Model of Human Occupation (MOHO) within adult community mental health settings. An audit of all documented assessments recorded details of (1) the number of assessments completed by each of the occupational therapists, and (2) the specific occupational difficulties identified across all assessments. Thirty-eight assessments had been completed, with a total of 35 service users. Results show variation in practice among occupational therapists in their application of MOHO assessments and, further, that the range of occupational difficulties identified for the client cohort is diverse.

A 12-week healthy living programme piloted in community mental health – is it feasible and what is achievable?

The physical health outcomes of people with mental illness are significantly poorer compared to the normal population. The aims of this study were to (i) assess the feasibility and outcomes of a 12-week healthy living programme piloted in a community adult mental health setting and (ii) assess the lead author’s research and evaluation competency as part of the conditions of the Psychology Supervised Practice Programme. Participants were referred to the programme to learn and develop healthy living skills, assist in weight management, and enhance emotional wellbeing. The programme included weekly educational sessions followed by an activity related to the education for 3-4 hours, between June-September 2010. The programme facilitators completed assessments with participants at Week 1 (baseline) and Week 12 (graduation) including; demographic and physical health indicators (e.g. weight, BMI, blood pressure), psychological wellbeing and overall satisfaction with programme. Seventeen participants commenced the healthy living programme pilot. There was an average weekly attendance of eleven people and nine graduated at Week 12. No meaningful change in physical health or psychological wellbeing could be determined from the measurements at 12 weeks however the graduates rated the programme highly, particularly the social perspective and healthy eating skills. This feasibility assessment of the HLP pilot illustrates the difficulties inherent in real-world service-based research but also highlights the potential benefits for future replication of the HLP for enhancing both physical health and quality of life for people with a serious mental illness. Key words: physical health, community mental health, healthy living, evaluation, group programme

Are We Achieving Occupation-Focused Practice?

In 2012, the National Institute for Health and Clinical Excellence (NICE) accredited the College of Occupational Therapists (COT) practice guideline, Occupational therapists’ use of occupation-focused practice in secure hospitals (COT 2012). This practice guideline evaluated the evidence base available to therapists working within secure (that is, locked) adult mental health settings. However, the guideline affirms that occupation-focused practice is pertinent to all of our work, whether based within secure settings or not. The themes identified have much to offer occupational therapists in all areas of practice and research, with realistic recommendations such as understanding and considering the impact of the environment and time, working with service users, and the need to increase our evidence base.

Ward features and stigma experiences of mental health service users in Belgium and England: A replication study

Stigmatizing attitudes can impair the quality of life of people with mental health problems. Psychiatric hospitalization can generate stigma. Are some approaches to care less stigmatizing than others? This study was designed to replicate findings from Flanders, Belgium in an English context, investigating how ward size and treatment approach affected service users' expectations and experiences of stigma. The translated Belgian questionnaire was administered to 70 service users in 15 inpatient adult mental health settings in central England. Adjustments were made to the multivariate analysis in light of the smaller sample size, in order to replicate the original equation as closely as possible. Neither ward size nor individualized care proved significant in the smaller English sample, which was subject to the risk of type II error. Across two models, self-rejection correlated with age (negatively), social rejection and stigma expectations. This analysis shows that attempts to translate evidence about psychiatric inpatient services must take into account differences between the settings, populations and models of care. Expectations as well as outcomes of stigma may be relevant when assessing the impact of psychiatric hospital treatment on individual patients.

A Child‐inclusive Family Intervention in a Community Adult Mental Health Service

In this paper we describe an intervention that focuses on the needs of children in families where a parent has a mental illness and attends a community adult mental health setting. After a brief outline of the literature, we present a family approach that includes children and young people, their parents and grandparents. Case studies then illustrate the work as a ‘best practice’ for parents who are clients in community adult mental health services.

Meta‐analysis of self‐reported substance use compared with laboratory substance assay in general adult mental health settings

An accurate assessment of substance use is necessary to make a correct psychiatric diagnosis and to provide appropriate treatment. This study uses meta-analysis to establish the strength of the association between self-reported substance use and the results of laboratory substance assay including the testing for specific substances and screening for any substance use in psychiatric hospitals and in community mental health settings. A systematic search for published studies was supplemented by additional data required for meta-analysis provided by several researchers in this field. Using random-effects meta-analysis, we calculated the pooled estimate of the odds ratio of a positive substance assay in patients reporting use or non-use of substances and estimated the sensitivity, specificity, positive predictive value and negative predictive value. Twenty-six studies met the inclusion criteria. Very strong associations were found between self-reported use and positive tests for cannabis [N = 11 studies, odds ratio (OR) = 22.3; 95% confidence interval (CI) = 10.1-49.1], amphetamines (N = 8, OR = 26.6; 95% CI = 7.9-88.9), cocaine (N = 8, OR = 39.7; 95% CI = 16.2-97.2) and opiates (N = 7, OR = 83.5; 95% CI = 26.7-260.7). Strong associations were found between self-reported use of any substance and positive substance screening (N = 15, OR = 7.2, 95% CI = 3.6-14.1) and tests for alcohol use (N = 5, OR = 8.5; 95% CI = 2.5-28.4). Screening for any substance use had a sensitivity of 61% and a specificity of 66%. Testing for individual substances was specific but lacked sensitivity. Screening has the potential to detect clinically relevant substances that would not be reported by the patient, whereas testing for a specific substance has little advantage over self-report. The sensitivity of the substance assay might be improved by obtaining a sample at the earliest opportunity. Consideration should be given to the increased use of substance screening in general adult mental health settings because it could improve the accuracy of psychiatric diagnosis and increase the likelihood of patients receiving treatment for substance use disorders.

Service user experience of adapted dialectical behaviour therapy in a community adult mental health setting

BackgroundDialectical behaviour therapy (DBT), a skill-based cognitive behavioural treatment, is increasingly used in the treatment of borderline personality disorder (BPD).AimsThe study examined service users' perspective on the effectiveness of an adapted DBT programme, delivered within a community adult mental health setting.MethodsSemi-structured interviews and focus groups were conducted with eight participants with a diagnosis of BPD about their experience of the programme.ResultsThematic analysis focused on two key themes: evaluation of therapy and treatment impact. Therapy-specific factors and personal challenges emerged as important themes. Treatment impact raised issues relating to a renewed sense of identity and changes in daily life.ConclusionsThe study describes the positive and negative experiences of service users with BPD attending an adapted DBT programme.

Use of smoking cessation therapies in adult mental health settings

Use of smoking cessation therapies in adult mental health settings

Eyes we didn’t know we had

Two clinical psychology trainees relate their experience of four brief psychodynamic observations in a public and an Older Adult mental health setting. They reflect on their learning and the impact this has had on their practice.

Key Changes Music Therapy: An Extended Pilot Project in an Adult Mental Health Hospital Setting

This article introduces an evolving research project based in an NHS adult in-patient mental health setting. The project was set up to assess the longer term benefits of music therapy for these client populations, and to enable and facilitate patients' personal growth. The background to the project and method of evaluation is described, including pre and post therapy evaluations from both patients and staff. Samples of data collected are presented. Recommendations are made for similar projects in music therapy. This was a collaborative project between the NHS setting and the local charity Key Changes Music Therapy, launched in 2008 to: “…promote the use of music to alleviate behavioural, emotional and physical difficulties, and to protect and promote good health by the use of music. Key Changes also aims to advance the education of the public concerning music as a means of therapy and to carry out and publish research” (Memorandum and articles, registered charity no: 1124102).

Prevalence of Autism Spectrum Conditions in a Youth Mental Health Service

Andrew Thompson,, Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia: Recent estimates regarding prevalence of Autism Spectrum Conditions (ASCs) in community samples range between 1 and 1.5 per 100 [1]. ASCs are associated with increased rates of comorbid psychiatric disorders including depression, anxiety disorders and obsessive compulsive disorder [2]. The main diagnostic and treat-ment issues in those presenting with ASC and psychiatric comorbidity are non-recognition of an existing ASC and misdiagnosis of an ASC occurring with another disorder such as psychosis [3]. Both non-recognition and misdi-agnosis are likely to signifi cantly impair treatment and delay recovery. At Orygen Youth Health, a mental health service for 15 to 25 year olds in Melbourne, Australia, we conducted an audit of all current cases in November 2007 to ascer-tain the prevalence of ASCs within the service. Treating clinicians were interviewed using a specifi c audit tool to determine whether any of the clients on their caseloads had an existing formal diagnosis of ASC or appeared to meet DSM-IV criteria for an ASC. The interview was pre-ceded by three local professional development sessions on diagnosis, treatment and comorbidity of mental illness and ASC provided by the study lead author (R.F.). Infor mation on ASC status was obtained for 476 of the 523 current patients. A total of 3.4% (n 16) had a con- fi rmed diagnosis of ASC and 7.8% (n 37) w ere reported by case managers to have a possible ASC diagnosis. A total of 3.4% (n 10) of those with psychotic disorders and 4.1% (n 5) of those with mood and anxiety disorders had a confi rmed diagnosis of ASC. There was no relationship between ASC status and gender χ (2) 2.91, p 0.233, ho wever there was a signifi cant difference between the three groups with respect to age, F(2, 473) 7.78, p 0.001, with post hoc anal yses (using Games-Howell test) revealing that those with a confi rmed diagnosis of ASC were signifi cantly younger on average than those with either possible ASC (p 0.002) or no ASC (p 0.001). It is interesting that this audit did not fi nd a gender difference in those with ASC as it is generally agreed that there is a 4:1 male female ratio [4]. This may be because there was a female predominance in this clinical sample. Those with a confi rmed ASC diagnosis were younger than those without in this sample, which may represent the additional impact of having an ASC as well as psychiatric illness. These results raise some impor tant issues for clinicians, service developers and commissioners. There are consid-erably higher rates of confi rmed ASCs within this clinical service compared to community settings, with the possi-bility that there are also additional undiagnosed cases. If these ASCs are not recognized it is unlikely that treat-ment will be optimal. Following this audit, and with sup-port from the Victorian Government, a developmental disorders clinic was established in Orygen Youth Health in 2009. It is hoped that through raising awareness of ASCs within youth and adult mental health settings that services might develop to provide expert treatment for a complex group of individuals who appear to be more prevalent than appreciated in such settings.