Mental Health Disability Research Articles

Care Quality Commission strengthens its inspection of ‘closed cultures’

In November 2019, the Care Quality Commission (CQC) issued new guidance for inspectors and Mental Health Act Reviewers in addressing closed or punitive cultures in mental health and learning disability services. Helena Frankova explains

Improving access to services for psychotic patients: does implementing a waiting time target make a difference

ObjectiveIn April 2015, the English National Health Service started implementing the first waiting time targets in mental health care. This study aims to investigate the effect of the 14-day waiting time target for early intervention in psychosis (EIP) services after the first six months of its implementation.Study designWe analyse a cohort of first-episode psychosis patients from the English administrative Mental Health and Learning Disabilities Dataset 2011 to 2015. We compare patients being treated by EIP services (treatment) with those receiving care from standard community mental health services (control). We combine non-parametric matching with a difference-in-difference approach to account for observed and unobserved group differences. We analyse the probability of waiting below target and look at different percentiles of the waiting time distribution.ResultsEIP patients had an 11.6–18.4 percentage point higher chance of waiting below target post-policy compared to standard care patients. However, post-policy trends at different percentiles of the waiting time distribution were not different between groups.ConclusionsMental health providers seem to respond to waiting time targets in a similar way as physical health providers. The increased proportion waiting below target did not, however, result in an overall improvement across the waiting time distribution.

A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe.

Autism research is heavily skewed toward western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross-cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help-seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture-specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help-seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross-cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029-1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The vast majority of autism research is conducted in western high-income settings. We therefore know relatively little of how culture and context can affect the identification, help-seeking, and diagnosis of autism across the globe. This study synthesizes what is known from the autism research literature and a broader literature and maps out how culture and context may affect (a) the expression, (b) recognition, (c) interpretation, and (d) reporting of autism symptoms.

Adrian James, M.B.B.S., Elected President of Royal College of Psychiatrists

Back to table of contents Previous article Next article ProfessionalFull AccessAdrian James, M.B.B.S., Elected President of Royal College of PsychiatristsSearch for more papers by this authorPublished Online:31 Jan 2020https://doi.org/10.1176/appi.pn.2020.2a17AbstractAdrian James, M.B.B.S., will serve a three-year term as president of the Royal College of Psychiatrists beginning in July.Justin GraingeAdrian James, M.B.B.S. (left), has been elected the next president of the Royal College of Psychiatrists (RCPsych). He will become president on July 1, when the term of the current president, Prof. Wendy Burn, ends.The RCPsych is the professional organization representing psychiatrists throughout the United Kingdom. James will serve a three-year term.“This is a pivotal time for psychiatry,” he said in a statement from the RCPsych. “I will focus my energies on achieving parity of esteem, addressing workforce well-being, and championing diversity and the needs of marginalized groups.”James is a consultant in forensic psychiatry at Devon Partnership NHS Trust, providing mental health and learning disability services in Devon, England, as part of Britain’s National Health Service.The position of president is the most senior post in the college, which has a national and international leadership role in psychiatry. The president also chairs the college’s Council and Board of Trustees. Burn said in a statement, “I know that [James] will bring passion and commitment to the continuation of the work that I have been doing to ensure that care for our patients is improved.”APA CEO and Medical Director Saul Levin, M.D., M.P.A., congratulated James and the RCPsych. “Dr. James will not only be an exceptional leader for psychiatrists in the U.K., but also a valuable colleague on the world stage as we work together for our patients and our profession,” Levin said. “The Royal College of Psychiatrists is such an important partner and friend in all our efforts to promote psychiatry and mental health around the world. I look forward to our continued collaborative efforts to provide equity and esteem to people with mental illness, humane care, and effective treatment.”Levin was awarded an Honorary Fellowship by the RCPsych during the college’s International Congress last July. ■ ISSUES NewArchived

Challenges to community transitions through Money Follows the Person.

To examine the effects of transition challenges on the success and timeliness of transitions from institutions to community living for long-stay participants in the Money Follows the Person (MFP) RebalancingDemonstration and determine whether outcomes vary by age and disability. Secondary data on transition challenges for individuals enrolled in Connecticut's MFP program between December 2008 and December 2017. Challenges were analyzed for older adults, people with mental health disability, and people with physical disability. Bivariate and multivariate analyses investigated which transition challenges and selected demographic variables predict transition versus closure and length of transition period for each group. The sample includes 3506 persons who attempted transition from institutions to community living and whose case concluded with transition or closure from 2015 to 2017. The association between most transition challenges and the ability of long-stay institutional residents to return to the community, and to do so in a timely manner, varies significantly among older adults and younger persons with physical or mental health disabilities. For all groups, however, consumer engagement challenges predicted closure without transition (OR: 1.3-3.9) and housing challenges predicted longer transition periods (84-132days). Length of institutional stay was associated with both outcomes for older adults and persons with physical disability. Other challenges, such as issues with services and supports, differed among the three groups on both outcomes. Knowledge of the effects of transition challenges on success and timeliness of transition for each group allows program managers and health and service providers to focus resources on addressing the most serious challenges. Particular emphasis should be placed on consumer engagement and housing challenges, and on targeting persons for transition early in their institutional stay. Federal and state transition programs can benefit by individualizing supports for residents to yield successful outcomes.

Training needs analysis of nurses caring for individuals an intellectual disability and or autism spectrum disorder in a forensic service

Purpose Examining the education and training needs of forensic nurses is paramount as services move from the older institutions to new care settings. The purpose of this study was to identify Irish Forensic nurses perceived deficits in their knowledge and skills to assist them to provide effective seamless care for individuals with an intellectual disability within their forensic mental health service, so that appropriate training could be provided. Design/methodology/approach Training needs analysis (TNA) procedures are used as a way of establishing the continuing processional development of staff, as they seek to identify the gaps between the knowledge and skills of an individual and the need for further training. A training needs tool developed by Hicks and Hennessy (2011) was used and completed by nurses working in an Irish forensic mental health service. A total of 140 surveys were circulated and 74 were completed (51 per cent response). Findings The top priority training needs identified were for additional training in research and audit and in the use of technology. Other self-identified training needs included additional training in behavioural management for challenging behaviour, understanding mental health and intellectual disability and dual diagnosis, training in enhancing communication skills and how to work with patients who have an intellectual disability patients specific training on autistic spectrum disorders and a guide and template for advance individual care planning and for caring for the physical health needs and promoting the physical health needs of these patients. Originality/value Despite there being a vast range of training issues identified, the majority of nurses appear to have a clear idea of their training needs to ensure the provision of seamless care for individuals with an intellectual disability within a forensic mental health setting. This TNA has identified the specific needs of nursing staff working at different positions across the interface of intellectual disability and forensic mental health care.

Learning disability training and probation officer knowledge

Purpose Knowledge about learning disabilities has found to be limited in both health and social care staff. To improve the treatment of individuals with learning disabilities and mental health problems within the criminal justice system (CJS), Lord Bradley recommends that professionals receive mental health and learning disability awareness training. However, little is known about the impact of training on the knowledge of professionals in the CJS. This study aims to investigate the impact of a 3-h learning disability training session on the knowledge of probation officers. Design/methodology/approach Using a repeated measures design, the impact of a 3-h learning disability training session on the knowledge of 12 probation officers was analysed. Findings In support of this study’s hypothesis, a repeated measures t-test revealed a significant difference between participants pre-training and post-training learning disability knowledge questionnaire (LDKQ) scores. Participants scored significantly higher on the LDKQ post-training compared to pre-training. A linear regression revealed that years worked in probation did not significantly predict participant’s difference scores. Research limitations/implications Limitations of this study and directions for future studies are discussed. Originality/value This paper demonstrates that learning disability training can significantly improve the knowledge of probation officers.

Connecticut city reaches $625K settlement in halfway house lawsuit

A federal prison halfway house will not be built in Connecticut after a Pennsylvania‐based nonprofit reached a $625,000 settlement in an ongoing lawsuit with the city of Norwalk, The News & Observer reported Dec. 24, 2019. The city will pay $275,000 of the settlement, while the city's insurance company will pay the rest. Firetree, the nonprofit, will not be able to build a halfway house as part of the settlement, The Hour reports. In 2017, the nonprofit sued the city because it denied them permits to operate the 2,700‐square‐foot halfway house. In the lawsuit, the company claimed the city discriminated against the intended residents, many of whom were recovering from addiction and had physical and mental health disabilities. Firetree was denied a certificate of occupancy because city officials said it went against approved use. The nonprofit appealed the decision to the Zoning Board of Appeals but was also denied in 2017, eventually leading to the lawsuit. The building was previously operated as a sober house. Firetree bought it in 2015 and invested nearly $630,000 worth of improvements. Josh Morgan, a city spokesman, said the money the city paid out would be significantly less than what it would cost if it went to trial. Firetree's attorney could not be reached.

Bullying among undergraduate medical students at Tanta University, Egypt: a cross-sectional study

ABSTRACT Introduction Bullying is an aggressive behaviour that involves unwanted negative actions, which are repeated over time that can negatively impact a person. Aim To explore bullying behaviours experienced by Tanta University undergraduate students during their study in clinical medical education. Methods A cross-sectional study was conducted at Faculty of Medicine, during the period between first of October 2018 to end of May 2019. A stratified random sample was used to select medical students who rolled fourth-, fifth- and sixth-year classes at the academic year 2018–2019. Data were collected by a self-administered questionnaire included questions regarding demographic characteristics, history of exposure to different types of bullying and the response of bullied students. Results Findings of this study revealed that 71.1% of studied sample faced bullying during their medical study. The most frequently reported types were verbal (51.9%), behavioural (44.8%), being ignored (24.4%), written (17.8%) and physical (15.8%). About half of students (49.4%) were exposed to multiple forms of bullying. Male students were more exposed to physical, written and being ignored, whereas females were more witnessed to verbal and behavioural ones as follows: (30.7% vs 18.9% physical type, 72.5% vs 74.8% verbal, 28.1 vs 24.9% written, 57.9% vs 68.3% behavioural and 38.5% vs 32.4% being ignored), respectively. Fellow students (56.3%) were the most frequent perpetrators of mistreatment actions. The majority of students (91.3%) chose not to report bullying behaviours. Having mental health problems (0.00*) or disability (0.01*) were significantly more potential to experience mistreatment. Discussion Large proportion of medical students faced many forms of bullying. Implications for Practice Applying an effective policy to stop bullying with support for medical students may help to minimize this phenomenon.

Radicalizing advocacy in service settings: Using structural competency to address tensions between social action and psychological practice.

Although recent years have seen an increase in attention paid to social justice concerns by psychologists, challenges remain in fulfilling the promise of psychology as a discipline that can meaningfully undertake social action. These challenges arise largely due to some persistent contradictions between the typical goals of psychological practice and the tenets of social change. These contradictions include (a) the emphasis of psychological practice on individual and small group change versus the need for social justice endeavors to tackle widespread inequality and oppression; (b) the greater likelihood of psychologists to advocate for clients by helping them to navigate existing systems versus advocating by challenging and dismantling these systems; and (c) aligning ourselves as practitioners, educators, and scientists within oppressive structures versus acknowledging the ways that we uphold, perpetuate, and benefit from such structures. In this article, we argue that the structural competency paradigm can provide a guiding framework for training and practice in psychology that aims to reconcile these tensions. We use the illustrative case of a low-income, minority client struggling with mental health problems, disabilities, and housing instability to demonstrate the complexities of the challenges confronting social justice-minded practitioners and to explore how a structurally competent stance can inform efforts to achieve social change while retaining psychology's investment in positive person-level transformation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Employment is a critical mental health intervention.

employment is critically important in mental health care. Unemployment worsens mental health and gaining employment can improve mental health, even for people with the most serious mental illnesses. In this editorial, we argue for a new treatment paradigm in mental health that emphasises employment, because supported employment is an evidence-based intervention that can help the majority of people with mental health disability to succeed in integrated, competitive employment. Unlike most mental health treatments, employment engenders self-reliance and leads to other valued outcomes, including self-confidence, the respect of others, personal income and community integration. It is not only an effective short-term treatment but also one of the only interventions that lessen dependence on the mental health system over time.

Peran Workplace Well-being terhadap Mental Health: Studi pada Karyawan Disabilitas

Disability employees are still relatively few employed in he company. When disability employees have to work in tandem with normal employees, of course there will be a little different treatment from their normal coworkers. It will have a impact on psychological conditions especially on mental health and workplace well-being disability employee, both in internal and external factors. This study examined the effect of workplace well-being on mental health. The study was conducted at one company located in Garut, West Java. Total participants are 70 employee with disability (30 men and 40 women). The researcher used a workplace well-being Questionaire and General Health Questionare (QHG). Data were analyzed using simple regression analysis. The results showed that there was an effect of workplace well-being on mental health. It can be seen from the significance value of 0,000 less than 0.005.

Knowledge of mental capacity assessment in staff working with people with learning disabilities

PurposeThe purpose of this paper is to evaluate staff knowledge of Mental Capacity Act (MCA) capacity assessments within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust. The limited research available suggests staff knowledge tends to be poor, particularly concerning who is the decision maker.Design/methodology/approachA 12-item multiple choice questionnaire, which reflects the five core principles of MCA (2005), was developed. Questionnaires were completed by 262 health and social staff members who support people with LD.FindingsResults show high variability of MCA capacity assessment knowledge within the LD division. However, qualified staff and those from health services scored significantly higher across all categories on the questionnaire compared to non-qualified and social care staff, respectively. On average, all staff scored poorly when asked to identify “who is the decision maker?” in a case scenario question.Research limitations/implicationsThe main limitation is that we did not collect data on how many previous capacity assessments and discussions each person had been involved with. The findings clearly suggest current methods of training lack efficacy in helping staff apply MCA knowledge to their clinical work.Originality/valueCompared to past literature, this study utilised a novel and more comprehensive questionnaire. This focused on case scenario questions to assess staff situational judgement. In addition, the findings add to a sparse evidence base that provides a foundation for future research.

The health of children deprived of liberty: a human rights issue

The UN Global Study on Children Deprived of Liberty launched its final report on Nov 19, 2019, in Geneva, estimating that between 3·5 and 5·5 million children worldwide are living in institutions for reasons related to care, administration of justice, migration, armed conflict, or national security.1 As part of the Global Study, we reviewed literature on the health of children in each of these settings. We found that children deprived of liberty are distinguished by a high prevalence of physical and mental health problems. These conditions are often co-occurring, undiagnosed and un(der)treated, and frequently occur in the context of entrenched disadvantage and trauma. We also found evidence that deprivation of liberty can compound these problems and contribute to the development of new ones, particularly related to mental health and developmental disability. The UN Convention on the Rights of the Child (CRC) recommends that deprivation of liberty should be used only “as a measure of last resort and for the shortest appropriate period of time”.2 The picture painted by the Global Study is one of excessive and often harmful deprivation of liberty in diverse settings. There is much work to be done.

Settlement reached in ADA violation suit against California school district

The Bazelon Center for Mental Health Law and Disability Rights California recently announced a settlement with a California‐based school district that will result in improved services and inclusive programs for special education students with disabilities.

"I wouldn't know where to start": Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults.

Most autistic adults struggle with mental health problems, such as anxiety and depression. However, they often have trouble finding effective mental health treatment in their community. The goal of this study was to identify ways to improve community mental health services for autistic adults. We interviewed 22 autistic adults with mental healthcare experience, 44 community mental health clinicians (outpatient therapists, case managers, and intake coordinators), and 11 community mental health agency leaders in the United States. Our participants identified a variety of barriers to providing quality mental healthcare to autistic adults. Across all three groups, most of the reported barriers involved clinicians' limited knowledge, lack of experience, poor competence, and low confidence working with autistic adults. All three groups also discussed the disconnect between the community mental health and developmental disabilities systems and the need to improve communication between these two systems. Further efforts are needed to train clinicians and provide follow-up consultation to work more effectively with autistic adults. A common suggestion from all three groups was to include autistic adults in creating and delivering the clinician training. The autistic participants provided concrete recommendations for clinicians, such as consider sensory issues, slow the pace, incorporate special interests, use direct language, and set clear expectations. Our findings also highlight a need for community education about co-occurring psychiatric conditions with autism and available treatments, in order to increase awareness about treatment options.

Groups say bill to reduce mass violence sends wrong message

Legislation introduced Oct. 23 to help reduce mass violence and make communities safer following two recent mass shootings and countless others is sending the wrong message, according to a coalition of mental health groups and disability rights organizations. While they appreciate support of mental health reform, the legislation erroneously focuses those efforts on people with mental health disabilities, advocates said.

Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis

PurposeLongitudinal studies have suggested a causal relationship between disability acquisition and mental health, but there is substantial heterogeneity in the magnitude of the effect. Previous studies have provided evidence that socioeconomic characteristics can buffer the effect but have not examined the role of employment characteristics.MethodsWe used data from 17 annual waves of the Household, Income and Labour Dynamics in Australia Survey to compare the mental health of working age individuals before and after disability acquisition, using the Mental Health Inventory, a subscale of the SF-36 health questionnaire. Linear fixed-effects regression models were used to estimate the effect of disability acquisition on mental health. We tested for effect modification by two characteristics of people’s employment prior to disability acquisition: occupational skill level and contract type. Multiple imputation using chained equations was used to handle missing data.ResultsDisability acquisition was associated with a substantial decline in mental health score (estimated mean difference: − 4.3, 95% CI − 5.0, − 3.5). There was evidence of effect modification by occupational skill level, with the largest effects seen for those in low-skilled jobs (− 6.1, 95% CI − 7.6, − 4.5), but not for contract type.ConclusionsThe findings highlight the need for social and health policies that focus on increasing employment rates, improving the sustainability of employment, and providing employment services and education and training opportunities for people who acquire a disability, particularly for people in low-skilled occupations, to reduce the mental health inequalities experienced by people with disabilities.

Quality of Life and Cost Implications of Pseudarthrosis After Anterior Cervical Discectomy and Fusion and its Subsequent Revision Surgery

More than 120,000 anterior cervical discectomy and fusions (ACDFs) are performed annually. Pseudarthrosis is a potential delayed adverse event that affects up to 33% of patients. The degree to which this adverse event affects both patient quality-of-life (QOL) outcomes and health care costs is poorly understood. Patients who underwent revision surgery for pseudarthrosis between 2007 and 2012 were identified and matched to controls not experiencing pseudarthrosis in a 1:2 fashion (case/control). Cases and controls were compared regarding total health care costs incurred in the year after the index ACDF and QOL outcomes on the following metrics: EuroQol Five-Dimensions Questionnaire, Patient Health Questionnaire-9, and Pain Disability Questionnaire. Of 738 patients who underwent ACDF, 11 underwent surgery for pseudarthrosis. No differences were noted between cases and controls regarding any of the matched variables. Patients in the pseudarthrosis cohort had poorer postoperative scores on the EuroQol Five-Dimensions Questionnaire mobility, usual activities, pain/discomfort, and quality-adjusted life-year dimensions. In addition, 64% of patients with pseudarthrosis had worsened quality-adjusted life-year scores compared with only 9% of controls (P < 0.01). Patients with pseudarthrosis also had poorer mental health (P < 0.01) and pain disability outcomes (P < 0.01) than did controls. Pseudarthrosis was associated with significant increases in direct costs, direct postoperative costs, and total costs (all P < 0.01). This is the first study to characterize the effect of surgical revision for pseudarthrosis on both QOL outcomes and care costs after ACDF. Patients requiring revision experienced significantly poorer QOL outcomes and higher care costs relative to controls.

Needing permission: The experience of self-care and self-compassion in nursing: A constructivist grounded theory study

BackgroundHealthcare is delivered in a culture of ongoing change, with many nurses highlighting the impact of this on their own wellbeing. However, there is a dearth of literature focusing on how nurses care for themselves as they try to provide compassionate care in a challenging job. ObjectivesThis study explored nurses’ experience of self-care and self-compassion and how this may relate to compassionate care giving towards patients. DesignA constructivist grounded theory approach was used to develop a theoretical understanding of nurses’ experience. SettingsThis study included participants from two National Health Service (NHS) Trusts within the United Kingdom (UK). ParticipantsPurposive and theoretical sampling were used to recruit general, mental health and learning disability nurses, at different levels of seniority. MethodBetween September 2015 and March 2016 semi-structured interviews were conducted. Analysis was completed in line with the process set out within constructivist grounded theory. Using constant comparison and memo writing, analysis moved from initial coding to focused coding, through to theoretical coding, resulting in the production of core concepts and categories, and theory development. ResultsThirty participants were included in the study. Three concepts were derived from the data: (1) ‘Hardwired to be caregivers’ – vocation versus role, (2) needing a stable base, (3) Managing the emotions of caring. All three concepts linked to a core process: needing permission to self-care and be self-compassionate. Nurses needed permission from others and from themselves to be self-caring and self-compassionate. An inability to do this affected their wellbeing and compassionate care giving to others. Interviewees described how they struggled particularly with self-compassion. Helping nurses to be proactively more self-caring and self-compassionate may increase their ability to manage emotions and prevent some of the negative consequences of nursing such as burnout and compassion fatigue. A conceptual framework is proposed which identifies that formal permission (e.g., within nursing guidance) may be necessary for some nurses to look after themselves. ConclusionFindings identified the need for permission as key in enabling nurses to self-care and be self-compassionate, which may facilitate them to address patients’ needs. The study highlights the importance of self-care and self-compassion within nursing education and nursing guidance.