English Mental Health Services Research Articles

Conceptualizing the peer contribution in Open Dialogue practice.

In English mental health services, people with their own experience of mental distress have trained as Open Dialogue practitioners and have been employed as peer practitioners, co-working as equals alongside workers with professional backgrounds in Network Meetings. The conceptual underpinnings of the peer practitioner role have been drawn from the principles and relational approach of Intentional Peer Support. These have significant similarities with Open Dialogue, in terms of philosophical and theoretical orientations, with a particular focus on what happens in the "between" of a relational encounter. However, there are also significant differences in how practice principles are conceptualized, particularly around areas such as mutuality and self-disclosure. This article offers an analysis of this conceptual territory drawing on the relevant literature. This is then taken forward with the teasing out of specific practice principles that capture the unique contribution that peer practitioners can bring to Open Dialogue practice. These are derived through discussions that took place in an Action Learning Set for peer practitioners who have been involved in delivering Open Dialogue services in mainstream mental health service settings. This was part of a wider research study entitled Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI). The principles address how peer practitioners may be particularly well-placed to offer attunement, validation, connection and mutuality, and self-disclosure - and hence how they may be able to contribute an additional dimension to dialogical practice.

Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression

BackgroundClinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. ProceduresThirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FindingsData from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. ConclusionsThere was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.

Do English mental health services know whether they followed N.I.C.E. guidelines with patients who killed themselves?

Mental health services need, urgently, to develop data systems that can inform clinical team leaders about gaps in their services to suicidal people in their care Clinical psychologists have a particular responsibility to pressure managers to effectively monitor the provision of evidence-based treatments to suicidal people Trusts and commissioners must be aware of, and rectify, any failings of their services in relation to the prevention of suicide.

You can’t buy me love but can you buy me integration? The example of English Mental Health Services

You can’t buy me love but can you buy me integration? The example of English Mental Health Services

Using ethnography to explore causality in mental health policy and practice

This article discusses the early findings of an on-going ethnographic study which is exploring the implementation of Community Treatment Orders (CTOs) in English mental health services, a process in which social work practitioners are closely involved. CTOs are present in a number of countries, and most recently in 2008 were enacted in England and Wales with the policy purposes of reducing ‘revolving door’ admissions, increasing the ability of clinicians to manage risk and encouraging recovery. They work by imposing conditions on how mental health service users live in the community as well as providing a mechanism for them to be recalled for treatment in hospital if they fail to meet those conditions. Perhaps unsurprisingly, their introduction has brought with it debate on the ethical implications of extending compulsory treatment into the community. The majority of research on CTOs has tended to ask the question, ‘Do they work?’ In this article I argue that ethnography may help to address a more ethically engaged and pertinent question for social work practice, namely, ‘Who might CTOs work for, in what circumstances and why?’ Immersion in service settings over an extended period enabled the incorporation of contextual factors and causal mechanisms into the analysis, which in turn has led to a consideration of the nature of CTO outcomes. This approach draws upon ideas about the role of qualitative research in exploring causality, and consideration is given to how the research may fit within some form of a realist framework.

Meeting the Occupational Needs of Mental Health Service Users: Indicative Care Packages and Actual Practice

Payment mechanisms in English mental health services require professionals to describe treatments and demonstrate cost-effectiveness. A national occupational therapy study has prepared the way by profiling the occupational needs of service users and describing indicative care packages. This practice analysis reports on a local survey, which was conducted in parallel with the national study. Treatment aims were found to correspond with key elements of the occupational profiles. This supports the accuracy of the profiles. It also provides evidence towards the effectiveness of the service being provided by demonstrating the ability of occupational therapists to target the proven needs of service users.

The demography of nurses and patients on acute psychiatric wards in England

To describe the ethnic and demographic composition of staff and patients on acute psychiatric wards in England. A significant proportion of the UK population (7.6%) belong to an ethnic minority and there are concerns that ethnic minority patients are not well served by psychiatry, in particular that they are subject to excessive force and coercion. Survey of a random sample of psychiatric wards in three regions. A survey was conducted of staff (n = 1536) and patients (n = 11,128) on 136 acute admission psychiatric wards. Ethnic minority patients were more likely to be admitted with a diagnosis of schizophrenia, younger, more likely to be admitted for a risk of harm to others and more likely to be legally detained. The association between ethnic minority status and detention remains, even when risk, age, gender and diagnosis are taken into account. Ethnic minority patients come from areas of greater social deprivation and fragmentation. Ethnic concordance between staff and patients varies, but the greatest difference is found in London where the proportion of minority staff is greater than the proportion of minority patients. There continues to be evidence that ethnic minority patients are subject to an excessive amount of legal coercion in English mental health services. However, the proportion of staff belonging to an ethnic minority is greater than the proportion of patients. Solutions to the problem of excessive use of legal coercion with ethnic minority patients need to be found. Changes of recruitment strategies are required if concordance is to be achieved.

Incremental change without policy learning: Explaining information rejection in English mental health services

This paper reviews recent policy changes in English mental health services and the nature of the evidence base that has guided these changes. In particular, the paper focuses on different groups within mental health policy and practice, citing examples of information rejection by each of the key stakeholders. Drawing on a neo-Durkheimian institutionalist framework, the paper argues that each group classifies the world, remembers and forgets, and rejects the information that they do, in order to solve or at least to cope with the organizational challenges and pressures they face, which in turn are the product of informal institutions. As a result of this, the ideas and assumptions underpinning English mental health policy have remained remarkably consistent over time, due in part to the fact that different stakeholders have been institutionally disposed to hear only a limited range of messages from the growing evidence base and correspondingly find it very difficult to engage in constructive debate with each other or reach consensus.