General Mental Health Services Research Articles

Australian community and inpatient general public sector mental health services between 2017-18 and 2021-22: Relative stasis in bed capacity, increasing outpatient demand, and stunted expenditure.

To descriptively analyse Australian public sector General Mental Health Services (GMHS) expenditure, ambulatory, and inpatient services, including key performance indicators (KPIs) in comparison with other subspeciality mental health services (MHS). We descriptively analysed data published by the Australian Institute of Health and Welfare (AIHW), including inpatient, ambulatory services, expenditure, and KPIs. From 2017-18 to 2021-22, per capita expenditure for Australian GMHS (18-64) rose by an average annual inflation-adjusted change of 2%. Overall bed numbers remained static, with non-acute beds declining, and commensurate expansion of acute beds. Community GMHS had high outpatient utilisation, with high rates of schizophrenia, schizoaffective disorder, and bipolar affective disorders as primary diagnoses in mid-life. From 2017-18 to 2021-22, GMHS inpatient and ambulatory episodes had decreasing rates of significant improvement and increasing rates of significant deterioration. Although GMHS has the highest overall population and service utilisation, there has been static bed availability and relatively small increases in expenditure which are occurring concurrently with worsening clinical outcomes. Evidence-based modelling of GMHS and outcomes is required to inform future service improvement.

‘It’s like someone is holding your hand, an invisible hand’: A grounded theory study of participation and personal recovery in Flexible Assertive Community Treatment

Background Participation in everyday life and personal recovery is often adversely affected for individuals with complex mental health needs. Flexible Assertive Community Treatment (FACT) is a recovery-oriented service targeting participation in everyday life and personal recovery and is thus important to understand from the perspectives of service users. Aim To explore how service users experience the care and support they receive from FACT as facilitating processes of participation in everyday life and in their personal recovery process. Materials and Methods A constructivist Grounded Theory approach was employed, involving 14 in-depth interviews conducted from January to November 2023 with FACT service users (9 women, 5 men; 23-55 years) within the Swedish adult general Mental Health Services. Results The process of Building genuine relationships between participants and FACT team members enabled Doing as a way of recovering. This was facilitated by how FACT was organised, promoting continuity and flexibility in care and support. Conclusions and significance This study contributes to a greater understanding of how genuine relationships between FACT service users and team members provide opportunities for participation and doing as a means for personal recovery. The results underscore the significance of incorporating an occupational therapy perspective into recovery-oriented services.

Health screening clinic to reduce absenteeism and presenteeism among NHS Staff: eTHOS a pilot RCT.

Staff sickness absenteeism and presenteeism (attending work while unwell) incur high costs to the NHS, are associated with adverse patient outcomes and have been exacerbated by the COVID-19 pandemic. The main causes are mental and musculoskeletal ill health with cardiovascular risk factors common. To undertake a feasibility study to inform the design of a definitive randomised controlled trial of the effectiveness and cost effectiveness of a health screening clinic in reducing absenteeism and presenteeism amongst the National Health Service staff. Individually randomised controlled pilot trial of the staff health screening clinic compared with usual care, including qualitative process evaluation. Four United Kingdom National Health Service hospitals from two urban and one rural Trust. Hospital employees who had not previously attended a pilot health screening clinic at Queen Elizabeth Hospital Birmingham. Nurse-led staff health screening clinic with assessment for musculoskeletal health (STarT musculoskeletal; STarT Back), mental health (patient health questionnaire-9; generalised anxiety disorder questionnaire-7) and cardiovascular health (NHS health check if aged ≥ 40, lifestyle check if < 40 years). Screen positives were given advice and/or referral to services according to UK guidelines. The three coprimary outcomes were recruitment, referrals and attendance at referred services. These formed stop/go criteria when considered together. If any of these values fell into the 'amber' zone, then the trial would require modifications to proceed to full trial. If all were 'red', then the trial would be considered unfeasible. Secondary outcomes collected to inform the design of the definitive randomised controlled trial included: generalisability, screening results, individual referrals required/attended, health behaviours, acceptability/feasibility of processes, indication of contamination and costs. Outcomes related to the definitive trial included self-reported and employee records of absenteeism with reasons. Process evaluation included interviews with participants, intervention delivery staff and service providers. Descriptive statistics were presented and framework analysis conducted for qualitative data. Due to the COVID-19 pandemic, outcomes were captured up to 6 months only. Three hundred and fourteen participants were consented (236 randomised), the majority within 4 months. The recruitment rate of 314/3788 (8.3%) invited was lower than anticipated (meeting red for this criteria), but screening identified that 57/118 (48.3%) randomised were eligible for referral to either general practitioner (81%), mental health (18%) and/or physiotherapy services (30%) (green). Early trial closure precluded determination of attendance at referrals, but 31.6% of those eligible reported intending to attend (amber). Fifty-one of the 80 (63.75%) planned qualitative interviews were conducted. Quantitative and qualitative data from the process evaluation indicated that the electronic database-driven screening intervention and data collection were efficient, promoting good fidelity, although needing more personalisation at times. Recruitment and delivery of the full trial would benefit from a longer development period to better understand local context, develop effective strategies for engaging with underserved groups, provide longer training and better integration with referral services. Delivery of the pilot was limited by the impact of COVID-19 with staff redeployment, COVID-research prioritisation and reduced availability of community and in-house referral services. While recruitment was rapid, it did not fully represent ethnic minority groups and truncated follow-up due to funding limitations prevented full assessment of attendance at recommended services and secondary outcomes. There is both a clinical need (evidenced by 48% screened eligible for a referral) and perceived benefit (data from the qualitative interviews) for this National Health Service staff health screening clinic. The three stop/go criteria were red, green and amber; therefore, the Trial Oversight Committee recommended that a full-scale trial should proceed, but with modifications to adapt to local context and adopt processes to engage better with underserved communities. This trial is registered as ISRCTN10237475. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/42/42) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 23. See the NIHR Funding and Awards website for further award information.

Expanding and developing the workforce to serve autistic people and people with intellectual disability

This paper considers current workforce issues facing psychological professionals working in NHS services, examining the challenges, and identifying opportunities to better meet the needs of autistic people and people with an intellectual disability (PwID) across the lifespan. The aim of this paper is to identify and publicly articulate the need for a coherent approach to guide the practice of psychological professionals when helping autistic people and/or PwID. It should be noted that the scope of the paper is limited to autism and intellectual disability. In addressing these broad groups and their co-occurring conditions and needs, we anticipate that many principles could be applied to other neurodevelopmental conditions. We also note the significant potential challenges in linking intellectual disability and autistic populations, hence have attempted – in drawing together a working group to write this paper – to ensure representation from a range of psychological professionals including those in policy, leadership, and training roles, those working in specialist or generic mental health services and undertaking clinical research across the lifespan.Objectives:■To help define and support clear action so that all sectors welcome and adequately support people with neurodevelopmental differences, including autistic people and/or PwID.■To play a role in the development, planning and evaluation of new psychological professions roles such as the Clinical Associates in Psychology (CAPS) and Education Mental Health Practitioners (EMHPs).■To reflect on the obstacles to recruiting to autism and learning disability services and to propose approaches to developing a sustainable psychological workforce in these areas.■To recognise where good examples of education and training programmes exist to address training, confidence and competence for all psychological professionals working with those who may be autistic and/or have an ID, and consider how to establish a more consistent approach to education, training and CPD across the workforce.■To engage in policy discussions around the current gaps, such as the demand for diagnostic assessments and support which significantly outstrips capacity, whilst highlighting unrealised opportunities, through for example, a systematic approach to training.■To advocate for the need for the voice of autistic people and PwID and their families/carers which is often absent from the design and offer of help.

Alcoholmisuse/dependence carepathway in and outside the general hospital. Detecting, motivating and treating the whole person.

Problematic alcoholuse is a common problem, frequently missed , as somatic medicine and mental health services are seperated/siloed. Patients admitted to a general hospital have an increased probability of a comorbid alcoholproblem (and other mental health problems like depression and anxiety) which is not adressed due to the separation of mind and body, which leads to greater costs for society , poor patient experience and discomfort with the somatic team.&#x0D; Comorbidity within the general hospital is largest for the patient with gastrointestinal (GI) problems, which is why we opted to roll out our approach here, gradually expanding to other patient groups in a later stage.&#x0D; To tackle this problem, the mental health department of the hospital contacted the GI-team (i.e. nurses, doctors, social services), the psychological services, management, general practitioners and service users (AA).&#x0D; After consultation of the existing literature, we chose a collaborative care approach mixed with population based screening and a proactive approach. In the past, a care pathway for alcohol was developed with first line actors (general practitioners, social services, psychologists, AA and mental health services), which was used to determine the level of care in the hospital and after discharge. The team comprises a fulltime psychiatric nurse and 0.3 full time employee (FTE) psychiatrist (trainee) embedded in the somatic GI team.&#x0D; Patients are screened for alcohol and psychiatric issues within 48 hours. If necessary, the appropriate detoxification scheme is started and followed up by the somatic team, aided by the mental health team. The patient is assessed and encouraged to stop drinking, depending on the stage they are in. Motivational interviewing techniques are used, along with psycho-education and other (pharmacological) interventions. A care plan is developed together with the patient and is then communicated with the primary care provider. &#x0D; After discharge, psychiatric follow-up is scheduled with the primary care provider, mobile crisis team or psychiatric nurse when pt comes for follow-up visits to the ambulatory GI service if needed.&#x0D; Teammembers are trained in mental health issues so they become able to recognice and handle mental health issues, making them much more comfortable with comorbid psychiatric problems and optimizing workflows.&#x0D; &#x0D; We have since expanded to the AE department and planned surgery. &#x0D; Since the program started there were fewer cases of delirium tremens. Due to a merger with an other hospital while the pathway started we have no exact data. Over a period of 1 year 235 patients were included in the project and 143 were followed-up after testing positive on intake for planned surgery.&#x0D; We want to further expand to the entire hospital and develop a digital care support plan which follows the patient after discharge, with all the information about the patient for future care-givers, with their care plan , controlled by the patient.&#x0D; Due to COVID, involvement of partners outside the hospital was delayed. This is now top of the agenda.&#x0D; As a proof of concept this integrated pathway was well received and initiated a new pathway , integrating mental health into perinatal care.

Identifying Social Determinants and Measuring Socioeconomic Inequalities in the Use of Four Different Mental Health Services by Australian Adolescents Aged 13-17 Years: Results from a Nationwide Study.

In this study, we aimed to identify the determinants of four different forms of mental health service usage (general health services, school counselling, telephone, and online services), and the number of mental health services accessed (single and multiple) by Australian adolescents aged 13-17 years. We also measured socioeconomic inequality in mental health services' usage following the concentration index approach within the same sample. The data came from the nationwide cross-sectional survey, Young Minds Matter (YMM): the second Australian Child and Adolescent Survey of Mental Health and Wellbeing. Random effect models were used to identify the factors associated with four different mental health services and the number of services accessed. Further, the Erreygers' corrected concentration indices for binary variables were used to quantify the socioeconomic inequality in each mental health service. The four services were the general health service (GP, specialist, psychiatrist, psychologist, hospital including emergency), school services, telephone counselling and online services. Overall, 31.9% of the total analytical sample (n = 2268) aged 13-17 years old visited at least one service, with 21.9% accessing a single service and 10% accessing multiple services. The highest percentage of adolescents used online services (20.1%), followed by general mental health services (18.3%), while school services (2.4%) were the least used service. Age, gender, family type and family cohesion statistically significantly increased the use of general health and multiple mental health service usage (p < 0.05). Area of residence was also found to be a significant factor for online service use. The concentration indices (CIs) were -0.073 (p < 0.001) and -0.032 (p < 0.001) for health and telephone services, respectively, which implies pro-rich socio-economic inequality. Adolescents from low-income families frequently used general mental health services and telephone services compared to those who belonged to high-income families. The study concluded that if we want to increase adolescents' usage of mental health services, we need to tailor our approaches to their socioeconomic backgrounds. In addition, from a policy standpoint, a multi-sectoral strategy is needed to address the factors related to mental health services to reduce inequity in service utilisation.

Barriers and facilitators to the participation and engagement of primary care in shared-care arrangements with community mental health services for preventive care of people with serious mental illness: a scoping review

BackgroundPeople with serious mental illness die about 20 years earlier than the general population from preventable diseases. Shared-care arrangements between general practitioners and mental health services can improve consumers’ access to preventive care, but implementing shared care is challenging. This scoping review sought to describe current evidence on the barriers and facilitators to the participation and engagement of primary care (specifically general practitioners) in shared-care arrangements with community mental health services for preventive health care of this population.MethodsWe searched Medline, Embase, CINAHL, Scopus, APA PsychINFO and EBM Reviews from 2010 to 2022. Data was extracted against a Microsoft Excel template developed for the review. Data was synthesised through tabulation and narrative methods.ResultsWe identified 295 records. After eligibility screening and full-text review, seven studies were included. Facilitators of engagement included a good fit with organisation and practice and opportunities to increase collaboration, specific roles to promote communication and coordination and help patients to navigate appointments, multidisciplinary teams and teamwork, and access to shared medical/health records. Barriers included a lack of willingness and motivation on the part of providers and low levels of confidence with tasks, lack of physical structures to produce capacity, poor alignment of funding/incentives, inability to share patient information and challenges engaging people with severe mental illness in the service and with their care.ConclusionOur results were consistent with other research on shared care and suggests that the broader literature is likely to be applicable to the context of general practitioner/mental health services shared care. Specific challenges relating to this cohort present difficulties for recruitment and retention in shared care programs. Sharing “goals and knowledge, mutual respect” and engaging in “frequent, timely, accurate, problem-solving communication”, supported by structures such as shared information systems are likely to engage primary care in shared care arrangements more than the traditional focus on incentives, education, and guidelines.

Worrying post-pandemic trends in eating disorders and self-harm in adolescents

Increasing global evidence is unveiling the extent to which the COVID-19 pandemic and resulting societal upheaval adversely affected young people's mental health. 1 Feinmann J Eating disorders during the COVID-19 pandemic. BMJ. 2021; 374n1787 Google Scholar In England, the Mental Health of Children and Young People (MHCYP) Survey series and the Children and Young People with an Eating Disorder (CYP ED) Waiting Times data provide clear evidence that referrals to specialist services for the assessment and treatment of eating disorders increased substantially following pandemic onset in 2020. Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based studyAlthough causes are uncertain, increased incidence of eating disorder diagnoses and self-harm among teenage girls in the UK during the first 2 years of the COVID-19 pandemic highlight an urgent need for intervention. Early identification of mental health difficulties by primary care clinicians is necessary. Timely access to treatments and sufficient support from general practitioners and mental health services needs to be available to manage presenting problems and to prevent exacerbations of conditions. Full-Text PDF Open Access

Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study

Self-harm and eating disorders share multiple risk factors, with onset typically during adolescence or early adulthood. We aimed to examine the incidence rates of these psychopathologies among young people in the UK in the 2 years following onset of the COVID-19 pandemic. We conducted a population-based study using the primary care electronic health records of patients aged 10-24 years in the UK Clinical Practice Research Datalink (CPRD). The observation period was from Jan 1, 2010, to March 31, 2022. We calculated the monthly incidence rates of eating disorders and self-harm according to the first record of each outcome. On the basis of antecedent trends between January, 2010, and February, 2020, negative binomial regression models were fitted to predict monthly incidence rates after the pandemic began in March, 2020. Percentage differences between observed and expected incidence were calculated to indicate changes since the onset of the pandemic, with stratification by sex, age, and deprivation quintile. The primary care health records of 9 184 712 patients aged 10-24 years (4 836 226 [52·7%] female patients and 4 348 486 [47·3%] male patients; n=1881 general practices) were included for analysis. The incidence rates of eating disorders and self-harm among girls were higher than expected between March 1, 2020, and March 31, 2022. The observed incidence of eating disorders was 42·4% (95% CI 25·7-61·3) higher than expected for girls aged 13-16 years, and 32·0% (13·3-53·8) higher than expected for girls aged 17-19 years, whereas other age groups showed little difference between observed and expected incidence. Similarly, the increase in self-harm incidence was driven by girls aged 13-16 years, for whom the observed incidence was 38·4% (20·7-58·5) higher than expected. By contrast, among boys in all age groups, the incidence rates of eating disorders and self-harm were lower than, or close to, the expected rates. Among boys, the observed incidence of eating disorders was 22·8% (9·2-34·4) lower than expected, and the observed incidence of self-harm was 11·5% (3·6-18·7) lower than expected. The estimated increases in eating disorder and self-harm incidence among girls aged 13-16 years were largely attributable to increases within less deprived communities. Although causes are uncertain, increased incidence of eating disorder diagnoses and self-harm among teenage girls in the UK during the first 2 years of the COVID-19 pandemic highlight an urgent need for intervention. Early identification of mental health difficulties by primary care clinicians is necessary. Timely access to treatments and sufficient support from general practitioners and mental health services needs to be available to manage presenting problems and to prevent exacerbations of conditions. National Institute for Health and Care Research.

Suicidal ideation and mental health care: Predisposing, enabling and need factors associated with general and specialist mental health service use in France.

Population-based studies have shown that less than one in two individuals reporting suicidal ideation also report past-year mental health service use. Only a few studies have looked at different types of providers consulted. There is a need to better understand the factors associated with different provider combinations of mental health service use in representative samples of individuals with suicidal ideation. The aim of the current study is to assess, using Andersen's model of healthcare seeking behaviors, the predisposing, enabling and need factors associated with type of mental health service use in adults with past-year suicidal ideation. Data were drawn from the 2017 Health Barometer survey, a representative sample of the general population aged 18 to 75 years, among whom 1,128 respondents had reported suicidal ideation in the past year were analyzed. Past-year outpatient mental health service use (MHSU) was categorized into mutually exclusive groups as no use, general practitioner (GP) only; mental health professional (MHP) only; and both GP and MHP. Multinomial regression analyses were used to model mental health service use as a function of predisposing, enabling and need factors. Overall, 44.3% reported past-year MHSU and this was higher in females than males (49.0% vs. 37.6%). Prevalence of GP only use in the overall sample was 8.7%, consulting with GP and MHP was 21.3%, consulting with MHP only was 14.3%. Higher education was associated with increased MHP use. Residing in a rural area was associated with increased GP only use. Presence of a suicide attempt within the year, a major depressive episode and role impairment were associated with consulting a GP and MHP, and MHP only, but not GP only. When controlling for need and predisposing factors, socio-economic factors related to employment and income were associated with higher levels of consulting with mental health professionals.

Exploring Barriers to Mental Health Treatment in the Female Veteran Population: A Qualitative Study

Although female veterans are a growing population, there remains limited research on their unique experiences specifically within the United Kingdom (UK). The limited data available indicates that female veterans are at increased risk of developing mental health disorders following their discharge from the military. However, female veterans make up a small proportion of those seeking mental health treatment. This study is the first qualitative study to explore the barriers faced by UK female veterans in accessing mental health treatment. The sample of the present study took part in a larger cohort study investigating the mental health needs of female veterans. A total of 61 female veterans responded to a qualitative item on the online survey that was investigating barriers they experienced in accessing mental health treatment compared to their male peers. Responses were analysed using thematic analysis to identify key themes in the data. Five key themes were identified: access barriers, lack of understanding from professionals, gender-related discrimination, mental health stigma, and sexual orientation-related discrimination. The current findings suggested that in addition to treatment-seeking barriers experienced more generally in the military, female veterans may face unique barriers to seeking support. With little veteran research focusing solely on the needs of women, further research is needed to better understand the barriers women face in seeking support. Further attention is also required to ensure such findings are practically implemented within veteran-specific and general mental health services.

Development of a model for shared care between general practice and mental healthcare: a protocol for a co-production study

IntroductionMental health illness represents one of the greatest health burdens in the world. It is well documented that treatment of these illnesses could be optimised through strengthened collaboration between general...

An investigation into the factors which influence attendance rates for psychology appointments in an adult intellectual disability service

PurposeThis study aims to investigate whether factors previously shown to influence attendance rates for appointments in general practice and general mental health services also influence attendance rates in services for people with intellectual disabilities (ID).Design/methodology/approachPost hoc data from 452 psychology appointments, ID diagnostic and initial screening (triage) appointments were collected from the health-care files of a community adult ID psychology service. Demographic factors (age, sex) and clinical factors (waiting time, time between appointment invitation being sent and appointment being held, presence of prior telephone call or letter, type of appointment, weekday, month) were recorded along with the attendance outcome (attended/did not attend [DNA]). The impact of the COVID-19 pandemic was also explored by documenting whether the appointment predated March 2020.FindingsNo significant associations were found between any variable investigated and attendance outcome when analysing appointment data as a whole and when splitting the data between appointment type. Weekday was found to significantly be associated with attendance outcome for appointments held during COVID-19, in which more DNA appointments occurred on a Wednesday compared to the other days of the week. No other associations were found for appointments held during the COVID-19 pandemic or for appointments held prior to the COVID-19 pandemic. These results suggest that factors which influence attendance rates in general health-care settings do not necessarily generalise to ID services.Originality/valueTo the best of the authors’ knowledge, this study is the first to examine whether certain demographic and clinical factors influenced attendance rates in an adult intellectual disability service.

The Effect of Regional Factors on the Mental Health Status of Frontline Nurses and Patients With COVID-19 During COVID-19: The Role of Depression and Anxiety.

At the end of 2019, Wuhan, Hubei Province, China, experienced the ravages of Coronavirus disease 2019 (COVID-19). In a few months, infected people rose to tens of thousands. This study aimed to explore the mental health status of military nurse personnel assisting (non-Hubei area) in the fight against COVID-19 and local nurse personnel (in the Wuhan area), as well as the differences in mental health status between nurses and COVID-19 patients that provide a reference basis for psychological crisis intervention. A convenience sampling method was used to select frontline nurses and COVID-19 patients (sample size 1,000+) from two mobile cabin hospitals from January to March 2020. The questionnaire consists of socio-demographic information, Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), General Mental Health Service Questionnaire and Work Intensity and Physical Status Questionnaire. The results showed that depression was present in 117 nurses (19.73%) and 101 patients (23.33%) with PHQ-9 scores >10; anxiety was present in 60 nurses (10.12%) and 54 patients (12.47%) with GAD-7 >10. The anxiety and depression levels of nurses in Wuhan area were higher than those in non-Hubei area. The differences in PHQ-9 and GAD-7 scores were also statistically significant (p < 0.001) when comparing patients from different regions, with anxiety and depression rates of 30.19 and 16.04% in local patients and 16.74 and 9.50% in foreign patients. The comparison between nurses and patients showed that the nurses were more depressed than the patients, while the patients were more anxious. Local nurses in Wuhan had a higher workload intensity than aid nurses (77.72 vs. 57.29%). Over 95% of frontline nurses and patients reported that they had not received any form of psychological counseling before the COVID-19 outbreak. 12.87% (26/194) of frontline nurses in Wuhan had a history of taking hypnotic drugs. However, fewer patients (16/212, 7.55%) took medication than frontline nurses. Anxiety and depression levels were far higher among local nurses and patients in Wuhan than in non-Hubei areas. The nurses had higher levels of depression, while the patients had higher anxiety levels. Providing targeted mental health services to healthcare professionals and patients is necessary when experiencing the impact of a major event.

"The Average Counsellor Wouldn't Know": Exploring How General Health Practitioners Understand and Respond to Domestic Violence.

Individuals experiencing and perpetrating intimate partner violence (IPV) are frequently in contact with general health and mental health services. Health service providers, including nurses, thus have a key role in identifying and responding to initial indicators of IPV risk. The present study provides descriptive information about current assessment and intervention practices of health and mental health service providers when patients are presenting with concerns about IPV. A secondary data analysis of interviews with general health practitioners (n = 17) were coded and dominant themes analyzed through thematic analysis. The present study uncovered ways in which IPV-related risks are, and are not, recognized and responded to. A metaphorical visual display in the form of a "domestic violence supply room" depicts the level of access and degree of competency described by practitioners in respective areas of practice. Within reach for all practitioners is the knowledge of factors that increase risk and vulnerability to IPV. Out of reach is a comprehensive understanding of the needs of children and perpetrators as well as the consistent ability to consider intersectionality and be reflexive when working with culturally and linguistically diverse populations. The step ladder to improved IPV response, including formal supports such as training and procedures, is frequently described as lacking. A consistent and empirically supported approach to IPV assessment and response is rare to find across generalist service provision. Although service providers possess basic knowledge of risk factors, organizational direction is needed to allow providers to address IPV confidently and effectively.

Transitions in health service use among women with poor mental health: a 7-year follow-up

ObjectiveWomen suffering from mental health problems require varied needs of mental health service utilisation. Transition between general practitioner and mental health services use are available through the Better Access Scheme...

Self-reported sleep and exercise patterns in patients admitted with suicidal attempts: a cross-sectional comparative study

BackgroundThere is evidence that sleep disturbances and exercise are risk factors for suicide attempts; however, whether sleep disturbances are independently associated with suicide attempts is debatable. We compared the sleep and exercise patterns of individuals who attempted suicide to those of the general population and investigated whether sleep disturbances were independently associated with suicide attempts.MethodsOver a year, individuals presented to the emergency department at Hamad General Hospital and Mental Health Services in Doha with suicide attempts (n = 127) filled out questionnaires on sleep and exercise, demographics, and clinical measures. A control group (n = 126) from two primary care centers filled out the same questionnaires during the same period.ResultsSubjects in the suicide group were significantly younger, single, had a lower level of education, and showed considerably more early insomnia, daytime tiredness, interrupted sleep, and no regular exercise. The most common diagnoses seen with suicidality were adjustment disorder and major depression, and the most common method used to attempt suicide was an overdose. After multiple regression analysis, being Arab, belonging to the category “other nationalities,” unemployment, and early insomnia were significantly associated with an increased risk of suicide attempts.ConclusionThis is the first comparative study on suicide in the Arabian Gulf. Individuals in Qatar with acute stress, depressive symptoms, sleep disturbances, and lack of exercise are at increased risk of attempting suicide. Thus, clinicians need to routinely screen for sleep and physical activity because of their significant contribution to physical and mental well-being.

Access to healthcare for street sex workers in the UK: perspectives and best practice guidance from\xa0a national cross-sectional survey of frontline workers

BackgroundStreet sex workers (SSWs) are a highly marginalised and stigmatised group who carry an extremely high burden of unmet health need. They experience multiple and interdependent health and social problems and extreme health inequality. Despite high levels of chronic physical and mental ill-health, there is little evidence of effective healthcare provision for this group. They are often considered ‘hard to reach’, but many individuals and organisations have extensive experience of working with this group.MethodsWe conducted a cross-sectional survey of professionals who work with SSWs in the UK on their perspectives on their access to primary care, mental health, sexual health and drug and alcohol services, how well these services met the needs of SSWs and suggestions of best practice.Results50 professionals mostly from England, responded. Mainstream general practice and mental health services were found to be largely inaccessible to SSWs. Sexual health, drug and alcohol services and homeless health services better met their needs; this was mostly attributed to flexible services and collaborations with organisations who work closely with SSWs. The main challenges in providing healthcare to SSWs were services being inflexible, under-resourced services and services not being trauma-informed. Best practice in providing healthcare to SSWs includes- seamless partnership working between agencies with case worker support; peer-involvement in service development and engagement, a range of health provision including outreach, presence in community spaces and fast-track access into mainstream services; trauma-informed, gender-sensitive health services in a welcoming environment with flexible, responsive appointment and drop-in systems and consistent clinicians with specialist knowledge of substance misuse, mental health, domestic violence and homelessness.ConclusionsAccess to healthcare for SSWs in the UK is highly variable but largely inadequate with regards to primary care and mental health provision. The examples of positive healthcare provision and partnership working presented here demonstrate the feasibility of accessible healthcare that meets the needs of SSWs. These need to be systematically implemented and evaluated to understand their impact and implications. As we build back from COVID-19 there is an urgent need to make accessible healthcare provision for marginalised groups the norm, not the exception.

Successful diagnosis of attention deficit hyperactivity disorder in later life of an adult with intellectual disability: A case report

AbstractBackgroundDiagnosing and managing attention deficit hyperactivity disorder in adults with intellectual disabilities is currently largely based on findings from assessment and treatment in children or adults without intellectual disabilities. Current evidence suggests that individuals with intellectual disabilities are more likely to have attention deficit hyperactivity disorder compared to those without intellectual disabilities, but more research is needed. There is increasing knowledge of diagnosing and treating attention deficit hyperactivity disorder in people with intellectual disabilities with published guidance on delivering care based on good evidence. More is needed so that clinicians do not have to depend on the evidence from those who do not have intellectual disabilities.MethodTo write this report, we reviewed a female in her 50s with mild intellectual disability who has been known to general and specialist intellectual disability mental health services for at least 20 years over many episodes of care. We assessed her clinically and using the Diagnostic Interview for attention deficit hyperactivity disorder in Adults with intellectual disabilities to make a diagnosis of attention deficit hyperactivity disorder. We call her Mary, which is not her real name.FindingsMary has had many diagnoses however, we found that her neurodevelopmental disorders of attention deficit hyperactivity disorder and we believe, autism were missed which led to a complex presentation of behavioural and mental symptoms; and diagnostic and management challenges. Mary was receiving combinations of medications known as antipsychotics, antidepressants, hypnotics and mood stabilisers to high doses. She was able to stop them all successfully over 12–18 months before being diagnosed with attention deficit hyperactivity disorder. Once diagnosed with attention deficit hyperactivity disorder, Mary rapidly responded to a long acting stimulant as recommended by the National Institute for Health and Care Excellence and this has significantly improved her quality of life.ConclusionAttention deficit hyperactivity disorder in people with intellectual disabilities is often missed and inadequately managed, despite having highly effective and specific treatment strategies. Making the diagnoses of attention deficit hyperactivity disorder and intellectual disabilities is important as individuals with both together have worse outcomes. Therefore, effective treatment of attention deficit hyperactivity disorder in individuals with intellectual disabilities is critical.

Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

BackgroundIndividuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision for this population is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users encounter. Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views.MethodsWe used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach.FindingsMain themes were: 1) Acknowledging the heterogeneity of needs: the need for a person-centred care approach and flexibility when working with CEN, 2) ‘Still a diagnosis of exclusion’: Exploring the healthcare provider-level barriers to providing care, and 3) Understanding the exclusionary culture: exploring the system-based barriers to providing care for CEN. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. Major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support.DiscussionOverall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that best practice care is provided for people with CEN. Particularly prominent is the need to put in place systemwide training and support for clinicians working with CEN, encompassing generic and specialist services, and to challenge the stigma still experienced throughout the system.ConclusionsStaff working with this service user group report that delivering best practice care requires services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.