Community Adult Mental Health Service Research Articles

Recovery colleges in mental health-care services: an Australian feasibility and acceptability study

PurposeThis study aims to evaluate the feasibility and acceptability of establishing a recovery college in an Australian acute and community adult mental health service. Very little has been published on efforts to incorporate recovery colleges in inpatient settings other than forensic. This study offers an evaluation of feasibility and acceptability of this service model within a health-care setting.Design/methodology/approachParticipant feedback and qualitative implementation data, from an acute mental health-care inpatient ward and adult community care were used. Participants were mental health service consumers and staff. The intervention involved a co-produced, co-designed, co-delivered and co-received educational opportunity for mental health consumers, carers, staff and the community.FindingsFeedback from course participants indicates that learning objectives were met by the majority of participants, while stakeholders identified that establishing a recovery college within both the inpatient and community health-care service was feasible at a service level and broadly acceptable to consumers.Originality/valueEstablishing an adult recovery college in inpatient and community care is likely to be effective re-orientating mental health-care services as well as improving outcomes for consumers.

Staff stress and burnout in a community adult mental health service.

Burnout has been associated with medical errors and low levels should be considered an indicator of service quality. This study examined the level of personal, work and client-related burnout in medical, other clinical and non-clinical staff in an adult community mental health service. An anonymous study-specific questionnaire was designed and circulated to all staff with an explanatory document. The Copenhagen Burnout Inventory was used as a validated measure of burnout, with high levels reflecting high rates of stress and burnout. Further questions were added from Maslach Burnout Inventory and effort-reward imbalance index. Information on demographics, job satisfaction, turnover intention, feeling valued and effort/reward balance was gathered and analysed. The overall response rate was 47.4% (63/133), of whom 43 were clinical staff. Overall levels of burnout were low and similar across staff type, with only 30.1% showing moderate levels of burnout, and none in the 'high-burnout' category. All staff displayed positive disposition towards patients, with lower client burnout, as compared to personal and work-related burnout. All medical staff felt valued in their work, with lower rates in the other groups (48.7% of non-medical clinicians and 58.3% of non-clinical staff). Relatively low levels of overall burnout were reported among clinical and non-clinical staff working in our adult mental health service. These rates are similar to the levels identified in a national study of burnout in Irish hospital doctors but lower than the levels found among consultants in Irish child and adolescent mental health services.

Lockdown logistics in consultation-liaison psychiatry.

We describe the adaptation of services to allow flexible and practical responses to the coronavirus-19 (COVID-19) public health crisis by four Consultation-Liaison Psychiatry (CLP) services; Galway University Hospital (GUH), Beaumont Hospital, University Hospital Waterford and St Vincent's University Hospital (SVUH) CLP services. This article also illustrates close collaboration with community adult mental health services and Emergency Department (ED) colleagues to implement effective community diversion pathways and develop safe, effective patient assessment pathways within the EDs. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post-COVID-19 world, if our psychiatry services receive appropriate resources.

Relationship between dysfunctional beliefs, self-esteem, extreme appraisals, and symptoms of mania and depression over time in bipolar disorder.

Bipolar disorder (BD) is a mental health problem characterized by episodes of mania and depression which can lead to significant difficulties impairing one's daily functioning. Cross-sectional research has highlighted self-esteem and dysfunctional beliefs in those with this diagnosis, but there has been little research into how self-esteem and dysfunctional beliefs relate to symptoms of mania anddepression over time. A secondary data analysis of a prospective cohort study was used. Forty patients with BD attending a community adult mental health service completed the Dysfunctional Attitudes Scale, Rosenberg Self-Esteem Scale, Brief Hypomanic Attitudes and Positive Predictions Inventory, Centre for Epidemiologic Studies Depression Scale, and Altman Self-Rating Mania Scale at two time points 4months apart. Cross-sectional correlations revealed significant associations between elevated goal attainment dysfunctional beliefs and higher symptoms of mania; however, this did not hold over time. Elevated dependency-related dysfunctional beliefs and lower self-esteem were linked to higher symptoms of depression, and this relationship held over time. There was no impact of achievement-related dysfunctional beliefs on mood. Extreme appraisals were correlated with higher depression symptoms at baseline, but this did not hold over time. Findings suggest lower self-esteem and specific dysfunctional beliefs around dependency may precede symptoms of depression. Further research is required to further explore these associations. Elevated dysfunctional beliefs around dependency on others and lower levels of self-esteem may precede symptoms of depression in BD. Therapeutic interventions and relapse prevention targeting these psychological factors may help reduce the risk of depression relapse.

Community adult mental health services to be integrated

Community adult mental health services to be integrated

Service user experiences of clinical psychology within an adult mental health service: an IPA study

Purpose The purpose of this paper, a qualitative study, is to explore service users’ experiences of attending clinical psychology within a public community adult mental health service. Design/methodology/approach Six individuals who had completed at least 16 sessions of psychotherapy participated in semi-structured interviews. Data were transcribed and analysed using interpretative phenomenological analysis. Findings The results showed the following overarching domains: the relationship and its impacts, structure and focus, and participant factors – timing/readiness. The importance of the use of language was also identified. Participants appeared to value a sense of humanity within the relationship. Interestingly, the personal impact of therapy as perceived by the participants was not focussed on symptom reduction, but on broader changes. The results are discussed in relation to the relevant literature. Practical implications Suggested principles for practice include maintaining attentiveness to relational factors, to client factors such as readiness for change and to the use of structure and flexibility. The use of recovery focussed and alliance measures are recommended. Originality/value For clinical psychologists providing psychotherapy within the public system, there are valuable lessons we can learn from asking the service users directly about their experiences, in terms of focussing on the human element of the relationship, and striking a balance between professionalism and humanity.

Running a mentalization-based treatment (MBT) programme within a public community adult mental health service setting: a feasibility study.

This article aimed to address the feasibility of mentalization-based treatment (MBT) for patients with personality disorder in a non-specialist setting. The development and implementation of an MBT Programme is described. A multidisciplinary Consult Group met to plan the implementation of the programme. Participants attended a psychoeducation group (MBT Introductory Group), then weekly individual and group therapy. Fourteen participants started the full programme with eight completing at least 9 months, complete data are available for five participants who completed 27 months (first cohort) and 21 months (second cohort). Data include quantitative measures and qualitative questionnaires/interviews. All had a diagnosis of personality dysfunction with co-morbid disorder including anxiety/depressive disorder, post-traumatic stress disorder and eating disorder. Data on five participants revealed reductions in global level of distress, improvements in psychological well-being, less interpersonal difficulties and better work and social functioning. Qualitative data from feedback questionnaires (n = 18) and in-depth interview (n = 2) are discussed under the themes of mentalizing, treatment feedback/outcomes and group factors. Therapist reflections on the process identify the challenges involved in implementing a specialist psychotherapy programme within a general service and learning points from this are discussed. MBT is an acceptable treatment for patients with personality dysfunction. Prior to the implementation of a programme, factors at the therapist, team and organizational level, as well as the wider context, need to be examined. This is to ensure that conditions are in place for proper adherence to the model to achieve the positive outcomes demonstrated in the RCT studies.

Implementation of a Quit Smoking Programme in Community Adult Mental Health Services-A Qualitative Study.

Little is known about the experiences of people with severe mental health difficulties in smoking cessation interventions. This study aimed to review the implementation of a smoking cessation programme across 16 community mental health day services. The aim was to establish the experience from both service user and facilitator perspectives and refine implementation for future groups. In-depth interviews were conducted with 20 service users and four focus groups held with 17 facilitators. Thematic analysis was used to analyse the data for emergent themes in relation to key enablers and barriers to implementation. Data from service users and facilitators revealed that implementation was enabled by an open and engaged recruitment approach; the resourcefulness of facilitators; programme materials and group-based format; combining the cessation programme with other and broader health initiatives; and participants' motivations, including health and money. Barriers included the structure of the service; the lack of a joined-up approach across the health services; literacy issues and the serial/logical process assumed by the programme. Barriers perceived as more specific to those with mental health difficulties included the use of smoking as a coping mechanism, lack of alternative activities/structure and lack of consistent determination. The tobacco free policy, implemented shortly before the programme, interestingly emerged as both a barrier and an enabler. In conclusion, although this group-based cessation programme in community mental health settings was well-received overall, a number of key barriers persist. A joined-up approach which addresses the culture of smoking in mental health settings, inconsistencies in smoking policies, and provides consistent cessation support, is needed. Care needs to be taken with the timing as overall it may not be helpful to introduce a new smoking cessation programme at the same time as a tobacco free policy.

The effect of SMS (text message) reminders on attendance at a community adult mental health service clinic: do SMS reminders really increase attendance?

Non-attendance at outpatient clinics is common and costly. This study aimed to determine if sending SMS ('short message service' or text message) reminders to patients before appointments reduced non-attendance. We collected outpatient data at Ballyfermot and Lucan Community Adult Mental Health Service, Dublin, Ireland during 6-month periods (a) immediately prior to the introduction of SMS reminders for outpatient appointments; (b) immediately following the introduction of SMS reminders; and (c) two and a half years later. In the 6-month period prior to SMS reminders, 2170 outpatient appointments were offered and there was a 22.2% non-attendance rate. In the 6-months following the introduction of SMS reminders, 2092 appointments were offered and the non-attendance rate fell to 13.9% (p < 0.001), with the lower non-attendance rate among those who did not receive SMS reminders (9.7%) rather than those who did (15.7%) (p = 0.0002). There were 98 appointment cancellations during this period (73% via SMS messaging). In the 6-month period two and a half years after the introduction of SMS reminders, 2474 appointments were offered and the non-attendance rate rose to 19.3%; this did not differ between those who received SMS reminders (19.3%) and those who did not (19.1%) (p = 0.38209) and was still lower than the rate prior to SMS reminders (p = 0.01321). During this period, 197 appointments were cancelled (75% via SMS messaging). The chief value of SMS reminders lies not in reminding patients of appointments but in providing a convenient way to cancel them, thus allowing more appointments to be offered.

Development and Evaluation of Acceptance and Commitment Therapy Delivered by Psychologists and Non-Psychologists in an NHS Community Adult Mental Health Service: a Preliminary Analysis.

Previous studies have demonstrated that acceptance and commitment therapy (ACT) is effective for depression and may be useful for complex transdiagnostic clients. To conduct a preliminary evaluation of whether ACT is feasible and effective when delivered by psychologists and non-psychologists for complex clients in a National Health Service (NHS) community mental health service for adults. Staff were trained in ACT and conducted one-to-one therapy with clients. Measures on general mental health, depression, fusion and values were given pre-therapy, post-therapy and at 3-month follow-up. Standardized measures showed significant improvements post-therapy for global mental health, depression, cognitive fusion and values post-treatment. These were partially maintained at follow-up and remained after an intent-to-treat analysis. There were no differences in outcomes between psychologists and non-psychologists. ACT may be delivered effectively with limited training for complex cases in secondary care, though further research is needed.

Improving access to psychological therapies: the HEAT is on

The evidence base demonstrating the effectiveness of psychological therapies has grown significantly in the last 20 years. These interventions now feature strongly in both NICE and SIGN guidance. Improving access to these evidence-based psychological therapies is a major priority in mental health services. There is recognition that psychologists and accredited psychological therapists cannot and should not be the sole providers of psychological interventions. By introducing skill mix there is scope to increase capacity in the wider staff resource. A number of projects in one NHS board in Scotland aimed at improving access to all levels of psychological expertise. This included a redesign of community adult mental health services, an increase in the delivery of training, the establishment of psychological therapies-focused clinical supervision and other governance systems for the delivery of psychological interventions.

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.

Naturalistic study of crisis referrals to an Irish community adult mental health service

There is no agreed definition of a mental health crisis; however, a useful one is 'a situation where mental health has deteriorated to an extent that the user is likely to be at risk of harm to self or others and is in need of urgent intensive specialist support and treatment' (Minghella et al, 1998). Community-based care is the primary model of specialist mental healthcare in Ireland (Government of Ireland, 2006a). When clinically indicated, a patient with mental health crisis is referred to the community mental health team (CMHT) for an urgent assessment.

Child and Family Inclusive Practice: A Pilot Program in a Community Adult Mental Health Service

The aim of this paper is to describe the Child and Family Inclusive Practice program (CFIP), a pilot program implemented in an adult community mental health centre in Newcastle, New South Wales, which aimed to enhance family relationships through child and family inclusive practice. The CFIP used a family-focused, child-sensitive approach in which two clinicians met together with families where there was parental mental illness. Adults and children were seen together and separately. Work with parents was aimed at validating their concerns for the child, and enhancing their confidence as parents/carers. Children had the opportunity to express their concerns in a safe and protective environment and, where appropriate, were supported in their concerns if these were being put to the adult family members. The project was seen to add value to the service provision of the community mental health team, and demonstrated to clinical staff the benefits of an inclusive and whole of family approach to mental health care.