Health Problem In England Research Articles

Data-Driven Exploration of National Health Service Talking Therapies Care Pathways Using Process Mining: Retrospective Cohort Study.

The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to "stepped care," in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.

Assessing the potential impact of applying a higher sensitivity test to selected cattle populations for the control of bovine tuberculosis in England.

Bovine tuberculosis (bTB) continues to be the costliest, most complex animal health problem in England. The effectiveness of the test-and-slaughter policy is hampered by the imperfect sensitivity of the surveillance tests. Up to half of recurrent incidents within 24 months of a previous one could have been due to undetected infected cattle not being removed. Improving diagnostic testing with more sensitive tests, like the interferon (IFN)-gamma test, is one of the government's top priorities. However, blanket deployment of such tests could result in more false positive results (due to imperfect specificity), together with logistical and cost-efficiency challenges. A targeted application of such tests in higher prevalence scenarios, such as a subpopulation of high-risk herds, could mitigate against these challenges. We developed classification machine learning algorithms (using 80% of 2012-2019 bTB surveillance data as the training set) to evaluate the deployment of IFN-gamma testing in high-risk herds (i.e. those at risk of an incident in England) in two testing data sets: i) the remaining 20% of 2012-19 data, and ii) 2020 bTB surveillance data. The resulting model, classification tree analysis, with an area under a receiver operating characteristic (ROC) curve (AUC) >95, showed a 73% sensitivity and a 97% specificity in the 2012-2019 test dataset. Used on 2020 data, it predicted eight percent (3 510 of 41 493) of eligible active herds as at-risk of a bTB incident, the majority of them (66% or 2 328 herds) experiencing at least one. Whilst all predicted at-risk herds could have preventive measures applied, the additional application of IFN-gamma test in parallel interpretation to the statutory skin test, if the risk materialises, would have resulted in 8 585 additional IFN-gamma reactors detected (a 217% increase over the 2 710 IFN-gamma reactors already detected by tests carried out). Only 18% (330 of 1 819) of incidents in predicted high-risk herds had the IFN-gamma test applied in 2020. We therefore conclude that this methodology provides a better way of directing the application of the IFN-gamma test towards the high-risk subgroup of herds. Classification tree analysis ensured the systematic identification of high-risk herds to consistently apply additional measures in a targeted way. This could increase the detection of infected cattle more efficiently, preventing recurrence and accelerating efforts to achieve eradication by 2038. This methodology has wider application, like targeting improved biosecurity measures in avian influenza at-risk farms to limit damage to the industry in future outbreaks.

Perceptions of the key components of effective, acceptable and accessible services for children and young people experiencing common mental health problems: a qualitative study

BackgroundChildren and young people’s (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP’s, parents’ and service providers’ perceptions of the effectiveness, acceptability and accessibility of services.MethodsCase studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis.ResultsFour key themes defined participants’ perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner’s personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child’s mental health problems.ConclusionsThis study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services.

Improving Access to Psychological Therapies (IAPT): the impact of service changes due to COVID-19 on people with learning disabilities

PurposePrimary care psychological interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. People with learning disabilities within IAPT have poorer key clinical outcomes than people who do not identify as having a learning disability. During the global COVID-19 pandemic remote consultations have accounted for nearly 90% of all contacts in IAPT services; this paper aims to report the effects of these on outcomes for people with learning disabilities.Design/methodology/approachPublicly available national data from the COVID-affected period are compared to the most recent available comparison periods that are not during the COVID pandemic. Data are presented graphically.FindingsPeople with learning disabilities differ little from those with no disabilities on several key process and outcome variables, although their clinical recovery is very much lower than those without disabilities. People with learning disabilities appear to have been affected by the changes in service delivery in a similar way to those without learning disabilities.Originality/valueDespite the shift to predominantly remote therapy delivery, outcomes for people with learning disabilities have not been differentially affected compared to those who have no recorded disability. The potential to learn what has worked and not worked in the delivery of remote interventions for people with learning disabilities is highlighted.

Improving Access to Psychological Therapies (IAPT) services outcomes for people with learning disabilities: national data 2012–2013 to 2019–2020

AbstractPrimary care interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. One of the priorities for IAPT services is to reduce inequalities in access and outcomes for potentially disadvantaged populations. This paper uses national data from the years 2012–2013 to 2019–2020 to present a comparison of service process and therapy outcomes for people with learning disabilities. Annual data for people with learning disabilities, people with other recorded disabilities and people with no recorded disabilities were extracted from a publicly available, national data source. Data are presented graphically with relative risk calculated for each variable and year, and show a broadly similar pattern of waiting time access for people with learning disabilities and people with no disabilities, and a broadly similar proportion of people with learning disabilities and people with no disabilities who finish treatment. However, people with learning disabilities have poorer clinical outcomes than people with no disabilities. We discuss adaptations to IAPT processes and therapy provision that may further support people with learning disabilities’ access to IAPT services.Key learning aims(1)To describe how IAPT services record disabilities, and in particular record whether a person identifies themselves as having a learning disability.1(2)To explore the differences in processes and therapy outcomes for people with learning disabilities compared with people with no disabilities and people with other disabilities.(3)To understand adaptations to IAPT processes and therapies that may make IAPT services more accessible to people with learning disabilities.

Machine learning classification methods informing the management of inconclusive reactors at bovine tuberculosis surveillance tests in England

Bovine tuberculosis (bTB) remains one of the most complex, challenging, and costly animal health problems in England. Identifying and promptly removing all infected cattle from affected herds is key to its eradication strategy; the imperfect sensitivity of the diagnostic testing regime remaining a serious obstacle.The main diagnostic test for bTB in cattle in England, the Single Intradermal Comparative Cervical Tuberculin Test (SICCT: also known as the skin test), can produce inconclusive results below the reactor threshold. The immediate isolation of inconclusive reactor (IR) animals followed by a 60-day retest may not prevent lateral spread within the herd (if it is substandard, allowing transmission) or transmission to wildlife. Over half of IR-only herds that went on to have a positive skin test result (a bTB herd ‘incident’) in 2020, had it triggered by at least one IR not clearing their 60-day retest, instead of by another test within the previous 15 months.Machine learning classification algorithms (classification tree analysis and random forest), applied to England’s 2012–2020 IR-only surveillance herd tests, identified at-risk tests for an incident at the IRs’ 60-day retest. In this period, 4 739 out of 22 946 (21 %) IR-only surveillance tests disclosing 6 296 out of 42 685 total IRs, had an incident at retest (2 716 IRs became reactors and 3 580 IRs became two-time IRs). Both models showed an AUC above 80 % in the 2012–2019 dataset. Classification tree analysis was preferred due to its easy-to-interpret outputs, 70 % sensitivity, and 93 % specificity in the 20 % of 2019–2020 testing dataset.The paper aimed to identify IR-only surveillance tests at-risk of an incident at the 60-day retest to target them with appropriate measures to mitigate the IRs’ risk. Sixteen percent (341 out of 2 177) of IR-only herd tests were identified as high-risk in the 2020 dataset, with 265 (78 %) of these having at least one reactor or IR at retest. Severe-level reinterpretation of the high-risk IR-only disclosing tests identified in this dataset would turn 68 out of the 590 (12 %) IRs into reactors, generating 23 incidents, the majority (19 or 83 %) part of the 265 incidents that would have been declared at the retest.Classification tree analysis used to identify IR-only high-risk tests in herds eligible for severe interpretation would enhance the sensitivity of the test-and-slaughter regime, cornerstone of the bTB eradication programme in England, further mitigating the risk of disease spread posed by IRs.

Consultation liaison to support efficient delivery of mental health care

AimsTo study the impact of collaborative working, via consultation liaison, between Mental Health Liaison Practitioners (MHLPs) and Doctors within a secondary care mental health service. We hypothesise that this model of working may avoid unnecessary clinic appointments and waiting times, whilst providing patients with more efficient treatment.BackgroundMental health services are stretched, understaffed and under-resourced. It is estimated that 75% of people with mental health problems in England may not get access to the treatment they need. We therefore need efficient and innovative ways for people who seek help to receive support. Good practice consultation liaison involves face to face contact between clinicians; treatment can be delivered by supporting primary care whilst reducing the burden of secondary care mental health services.MethodRegular 30-minute sessions within an Assessment and Treatment Service, between MHLPs and Doctors, at both Consultant and Trainee level, were coordinated. Patients assessed by MHLPs were discussed by opening a dialogue whereby further management was discussed across a multi-professional team. A record was created of all patients discussed and the outcome.ResultNumber of MHLP/Doctor sessions: 10 across a six-month period.Number of patients discussed: 17.Medication advice provided for 16 patients. One patient required a referral for a clinic appointment.For several patients, integrated working procured alternative care pathways and resources to be considered, to incorporate into individual treatment plans.ConclusionRegular consultation liaison with MHLPs and Doctors is a model of working across the interface between primary care and specialist mental health services. It may provide patients with more efficient care, whilst avoiding unnecessary waiting times for clinic appointments. The consultation liaison working supported the development of an educative relationship between clinicians, with interprofessional learning. This is an example of an integrated and collaborative care model, whereby multi-professional working can provide efficient and effective treatment, whilst the support for the patient can remain in the primary care setting.

A comparison of the value of two machine learning predictive models to support bovine tuberculosis disease control in England

Nearly a decade into Defra’s current eradication strategy, bovine tuberculosis (bTB) remains a serious animal health problem in England, with c.30,000 cattle slaughtered annually in the fight against this insidious disease. There is an urgent need to improve our understanding of bTB risk in order to enhance the current disease control policy. Machine learning approaches applied to big datasets offer a potential way to do this. Regularized regression and random forest machine learning methodologies were implemented using 2016 herd-level data to generate the best possible predictive models for a bTB incident in England and its three surveillance risk areas (High-risk area [HRA], Edge area [EA] and Low-risk area [LRA]). Their predictive performance was compared and the best models in each area were used to characterize herds according to risk.While all models provided excellent discrimination, random forest models achieved the highest balanced accuracy (i.e. average of sensitivity and specificity) in England, HRA and LRA, whereas the regularized regression LASSO model did so in the EA. The time since the last confirmed incident was resolved was the only variable in the top-ten ranking in all areas according to both types of models, which highlights the importance of bTB history as a predictor of a new incident.Risk categorisation based on Receiver Operating Characteristic (ROC) analysis was carried out using the best predictive models in each area setting a 99 % threshold value for sensitivity and specificity (97 % in the LRA). Thirteen percent of herds in the whole of England as well as in its HRA, 14 % in its EA and 31 % in its LRA were classified as high-risk. These could be selected for the deployment of additional disease control measures at national or area level. In this way, low-risk herds within the area considered would not be penalised unnecessarily by blanket control measures and limited resources be used more efficiently. The methodology presented in this paper demonstrates a way to accurately identify high-risk farms to inform a targeted disease control and prevention strategy in England that supplements existing population strategies.

Perspectives of drug treatment and mental health professionals towards treatment provision for substance use disorders with coexisting mental health problems in England

Background Opioid-related deaths are at record levels in the UK and contribute to over half of all drug-related deaths. The prevalence of psychiatric disorders within people who uses substances is known to be considerably higher than the general population, yet only 4% of people accessing treatment are thought to receive integrated care for coexisting conditions. This study aimed to explore perspectives on treatment for people with substance use disorders and coexisting psychiatric problems. Methods Face-to-face semi-structured interviews with community drug workers, specialist nurses, prescribing administration worker and one clinical psychologist were conducted. Deductive analysis of three preconceived themes (i.e. reasons for substance use, treatment provision, the role of medication) was conducted. Results There was agreement between drug treatment professionals and mental health professionals for the complexities for being in treatment for people who use substances. An expectancy of prolonged periods of abstinence from drug and alcohol use before psychological treatment would be initiated leading to relapse was reported. Individual judgements of practitioners, stigmatisation and fear of people who use substances and organisational barriers often meant psychological help was unavailable which contributed to a reliance on medication, against national clinical guidance which was known by only one interviewee. Conclusion The UK drug treatment and mental health services should review the pathways to ensure that national guidelines are followed so that people who use substances are not excluded from accessing psychological therapies. Data from the coronavirus pandemic indicates heightened psychiatric problems, where illicit drug use may escalate as a means of self-medication leading to further increases in drug-related deaths.

Assessing optimal use of the standard dose adjuvanted trivalent seasonal influenza vaccine in the elderly

BackgroundDespite a long-standing vaccination programme, seasonal influenza remains a major public health problem in England, in particular for the elderly where a significant disease burden remains despite vaccine coverage approaching the WHO target of 75%. The recently licensed adjuvanted trivalent vaccines (TIV-ADJ) have been shown to offer greater protection for the elderly compared to the standard-dose non-adjuvanted trivalent vaccines (TIV), particularly for those individuals 75 years old and above for whom the TIV has limited effectiveness. We assessed the cost-effectiveness of the TIV-ADJ for use in the elderly. MethodsWe used a dynamic SEIR-type transmission model coupled with an economic evaluation framework, estimating the reduction in GP consultations, hospitalisations and influenza-attributable mortality. We assessed the optimal use of the TIV-ADJ by estimating the cost-effectiveness of programmes that used this vaccine in the 65+ and 75+ age groups. FindingsThe use of TIV-ADJ is highly cost-effective for both target age cohorts with incremental cost-effectiveness ratios well below the £20,000 per quality-adjusted life year (QALY) with over 90% probability that the vaccine is cost-effective at a cost-effectiveness threshold of £30,000 per QALY. InterpretationThe increased protection provided across all three influenza vaccine sub-types makes TIV-ADJ a more attractive option than TIV from the perspective of the healthcare provider, driven by the increased efficacy against A(H3N2). When deciding on the optimal use of the newly available vaccine it is important to consider the fact that TIV has very limited effectiveness for the 75+ age group, who would therefore get the greatest benefit from a more effective vaccine. FundingI-MOVE+ project (Integrated Monitoring of Vaccines in Europe) through the European Union’s Horizon 2020 research and innovation programme under grant agreement #634446 and the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Respiratory Infections at Imperial College London in partnership with Public Health England, as well as the NIHR HPRU in Immunisation at the London School of Hygiene and Tropical Medicine.

Long-term trends in child maltreatment in England and Wales, 1858–2016: an observational, time-series analysis

It is unclear whether child maltreatment is increasing or decreasing in England and Wales. More evidence is needed, from multiple sources and over longer periods of time, to explore trends in child maltreatment. We investigated whether the annual incidence of child maltreatment has changed over time, using official record data and time-series methods to establish long-term trends. In this observational time-series analysis, we used six data sources (Government records for child mortality, police-recorded child homicides, crimes against children, child protection, and children in care; and NSPCC data) to estimate the incidence of child maltreatment in England and Wales and examine long-term trends. We included nationally representative data that could estimate the incidence of child maltreatment for more than 25 years. Our primary outcomes were the number of victims (age <20 years) or perpetrators (age >16 years) of child maltreatment per 12-month period in England, including or excluding Wales. We fitted Poisson regression models with year as the exposure and the number of victims or perpetrators of child maltreatment as the outcome (adjusted for population age-structure and size). When a linear trend was not appropriate, we fitted generalised additive models with penalised splines to visualise trends. The incidence of child mortality by homicide or assault decreased by 90% (2·7 per 100 000 children) between 1858 and 2016 and the incidence of people guilty of child cruelty or neglect decreased by 83% (6·7 per 100 000 adults) between 1893 and 2016, whereas child protection registrations increased by 182% (328·7 per 100 000 children) between 1988 and 2016. Crimes against children and children entering care increased between 2000 and 2016. In 2016, 40 children died by homicide, with twice as many adolescent (15-19 years) deaths than infant (age <1 year) deaths. In 2016, 67 700 children were placed on the child protection register and neglect and emotional abuse were the most common reasons. Although long-term trends have decreased, child maltreatment remains a major public health problem in England and Wales. Further research is needed to establish whether adolescents are a particularly vulnerable age group and whether neglect and emotional abuse are increasing. Future child protection policies and practices should respond to these areas of growing need. Andrew W Mellon Foundation and Clarendon through The Oxford Research Centre in the Humanities, Oxford.

Prevalence of mental health problems in schools: poverty and other risk factors among 28 000 adolescents in England.

None.

Public knowledge, attitudes, social distance and reporting contact with people with mental illness 2009-2017.

Our aim was to investigate patterns of change in public knowledge, attitudes, desire for social distance and reporting having contact with people with mental health problems in England during the Time to Change (TTC) programme to reduce stigma and discrimination 2009-2017. Using data from an annual face-to-face survey of a nationally representative quota sample of adults, we evaluated longitudinal trends of the outcome measures with regression analyses and made assumptions on the basis of a simple random sample. We tested interactions between year and demographic subgroups. There were improvements in all outcomes in 2017 compared with baseline measures (2008 or 2009). Reported in s.d. units [95% confidence interval (CI)], the improvement for knowledge was 0.17 (0.10-0.23); for attitudes 0.25 (0.18-0.31); and for social distance 0.29 (0.23-0.35). A higher likelihood of reporting contact was also associated with most recent survey year (odds ratio 1.47, 95% CI 1.27-1.71). Statistically significant interactions between year and region of England suggest greatest improvements in attitudes and intended behaviour in London, where both outcomes were significantly worse in the early years of the survey. However, for attitudes, this interaction was only significant among women. Other significant interactions suggest that attitudes improved most in the target age group (25-44). The results provide support for the effectiveness of TTC across demographic groups. However, other societal changes may influence the results, such as the increasing prevalence of common mental disorder in young women.

Are long-term trends in child maltreatment decreasing in England and Wales? A time-series analysis of official record data, 1858–2016

BackgroundChild maltreatment can result in serious immediate and long-term consequences for the child, family, and society. With mounting pressure from media scrutiny and public debate, establishing whether rates of child maltreatment are increasing or decreasing in England and Wales is a public health priority. MethodsWe used multiple sources of official record data to investigate long-term trends in child maltreatment from 1858 to 2016 in England and Wales. Data were drawn from a new data source on the incidence of child maltreatment over time (iCoverT), which includes routinely collected data from one UK-wide charity (NSPCC) and five government-collected statistics on child protection, children in care, crime, homicides, and mortality. We excluded data that did not estimate the incidence of child maltreatment, were not available for more than 25 years, or were not nationally representative of England and Wales. We used quasi-Poisson regression and fitted generalised linear models with year as the primary exposure and the number of victims (<19 years) or adult perpetrators (>16 years) of child maltreatment as the outcome, adjusted for population size. We adjusted for changes in definitions and recording practices over time. When a linear association between year and maltreatment was not appropriate, we fitted generalised additive models with penalised natural cubic regression splines to visualise changing trends. FindingsBetween 1858 and 2016, rates of violent child deaths decreased by 90% (2·7 per 100 000 children). This was due to a 96% decrease in rates of infant deaths (aged <1 years) and a 75% decrease in child deaths (aged 1–14 years). Rates of adolescent deaths (aged 15–19 years) did not change. Between 1893 and 2016, rates of adults found guilty of child cruelty or neglect decreased by 83% (6·7 per 100 000 adults). Rates of children entering care decreased by 9% between 1952 and 2016 (23·4 per 100 000 children), and the number of children helped by the NSPCC decreased by 84% between 1910 and 1985 (1074·0 per 100 000 children). However, the number of registrations to the child protection register increased by 182% between 1988 and 2016 (328·7 per 100 000 children). The main reason for registration changed from physical abuse in 1988 to neglect in 2016. InterpretationAlthough long-term trends suggest that rates are decreasing, child maltreatment remains a major public health problem in England and Wales. FundingAndrew W Mellon Foundation, Clarendon through The Oxford Research Centre in the Humanities.

Tuberculosis incidence in England hits 30-year low

Tuberculosis incidence in England hits 30-year low

Supporting general practices to provide sexual and reproductive health services: protocol for the 3Cs & HIV programme

ObjectivesSexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. Study design & methodsThe 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the ‘3Cs’) to 15–24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. ConclusionA key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme.

The clinical profile of employees with mental health problems working in social firms in the UK

Background: UK social firms are under-researched but are a potentially important vocational option for people with mental health problems.Aims: To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems.Method: Clinical, work and service use characteristics were collected from social firms’ employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively.Results: Predominantly, social firms’ employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations.Conclusions: The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams.

Mental health nurses can increase capability and capacity in primary care by educating practice nurses: an evaluation of an education programme in England.

Most people with a mental health problem in England are cared for by clinicians in primary care who may have had little or no training in this area. Our aim was to develop an accessible education programme which was appropriate to the learning needs of this workforce. A survey of the mental health and well-being training needs and preferred learning methods of practice nurses was undertaken, then a programme of education was developed by a primary care mental health expert. Teaching was delivered by mental health nurses who were trained as educators. Both the practice nurses and mental health nurses felt their clinical practice would improve as a result of being involved in this programme. To sustain the learning, mental health nurses were supported by attending and then leading their own action learning sets. This model of education can be adapted and used by health organizations both nationally and internationally. Research is required to find out whether training practice nurses using this programme has an impact on patients.

Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010

ObjectivesTo quantify mortality associated with sepsis in the whole population of England.DesignDescriptive statistics of multiple cause of death data.SettingEngland between 2001 and 2010.ParticipantsAll people whose death was registered in England...

EDITORIAL

In the UK alone, at any one time, around one adult in six experiences symptoms of mental illness. One in four adults experience mental illness during their lifetime. Mental illness is the largest single cause of disability in our society. To place this in context, mental ill health is the largest single cause of disability in the UK, contributing almost twenty-three per cent of the overall burden of disease compared to about sixteen per cent each for cancer and cardiovascular disease.1 The economic (and social) costs of mental health problems in England and Wales have been estimated to be around £105 billion per year.2 Such figures imply that mental health services should be sufficiently robust and well-resourced in order to respond to such need. Yet, this is far from the truth. Much public attention on mental health care has tended to be negative: media interest is fuelled when failures in care provision emerge because of harm caused to unsuspecting ‘victims’ within the wider community. Failures in care standards tend to illicit a less pronounced public response.