Mental Health Trusts In England Research Articles

Preparing for Completely Smoke-Free Mental Health Settings: Findings on Patient Smoking, Resources Spent Facilitating Smoking Breaks, and the Role of Smoking in Reported Incidents from a Large Mental Health Trust in England.

Introduction: Despite high smoking prevalence and excessive smoking-related morbidity and mortality among people with mental disorder compared to the general population, smoking treatment is often neglected in mental health settings. The UK National Institute of Health and Clinical Excellence (NICE) recently issued public health guidance stipulating completely smoke-free mental health settings. This project evaluated existing smoking-related practices in preparation for guidance implementation. The objectives were to: audit the recording of smoking-related information and treatment provision; explore current arrangements relating to the facilitation of patient smoking; measure staff time spent and identify costs of facilitating smoking; and explore the role of smoking in smoking-related incidents. Methods: A mixed-methods study was conducted across four acute adult mental health wards, accommodating 16 patients each, over six months. It included a case-note audit, on-site observations, and a qualitative content analysis of incident reports. Results: Smoking status was recorded for less than half of the 290 patients admitted (138, 48%). Of those, 98 (71%) were recorded as current smokers, of whom 72 (74%) had received brief smoking cessation advice. Staff spent 6028 h facilitating smoking, representing an annual cost of £131,040 across four wards. Incident reports demonstrated that smoking facilitation was often central to the cause of incidences, triggered frustration in patients, and strained staff resources. Conclusion: The findings highlight the importance and potential of implementing completely smoke-free policies using comprehensive pathways.

Falls screening and assessment tools used in acute mental health settings: a review of policies in England and Wales

ObjectivesThere is an urgent need to improve the care of older people at risk of falls or who experience falls in mental health settings. The aims of this study were to evaluate the individual falls risk assessment tools adopted by National Health Service (NHS) mental health trusts in England and healthcare boards in Wales, to evaluate the comprehensiveness of these tools and to review their predictive validity. MethodsAll NHS mental health trusts in England (n=56) and healthcare boards in Wales (n=6) were invited to supply their falls policies and other relevant documentation (e.g. local falls audits). In order to check the comprehensiveness of tools listed in policy documents, the risk variables of the tools adopted by the mental health trusts’ policies were compared with the 2004 National Institute for Health and Care Excellence (NICE) falls prevention guidelines. A comprehensive analytical literature review was undertaken to evaluate the predictive validity of the tools used in these settings. ResultsFalls policies were obtained from 46 mental health trusts. Thirty-five policies met the study inclusion criteria and were included in the analysis. The main falls assessment tools used were the St. Thomas’ Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY), Falls Risk Assessment Scale for the Elderly, Morse Falls Scale (MFS) and Falls Risk Assessment Tool (FRAT). On detailed examination, a number of different versions of the FRAT were evident; validated tools had inconsistent predictive validity and none of them had been validated in mental health settings. ConclusionsFalls risk assessment is the most commonly used component of risk prevention strategies, but most policies included unvalidated tools and even well validated tool such as the STRATIFY and the MFS that are reported to have inconsistent predictive accuracy. This raises questions about operational usefulness, as none of these tools have been tested in acute mental health settings. The falls risk assessment tools from only four mental health trusts met all the recommendations of the NICE falls guidelines on multifactorial assessment for prevention of falls. The recent NICE (2013) guidance states that tools predicting risk using numeric scales should no longer be used; however, multifactorial risk assessment and interventions tailored to patient needs is recommended. Trusts will need to update their policies in response to this guidance.

Are new mental nurses prepared for practice?

Purpose – As well as working with people who have serious mental health problems, mental health nurses have to maintain a values-based approach to their interactions with mental health service users. However, some have suggested that students and newly qualified nurses are unprepared for this role. The purpose of this paper is to explore perceptions of practising mental health nurses, third year mental health nurse students and lecturers about how well students are being prepared for practice. Design/methodology/approach – A two-phase phenomenological study within a mental health nurse training institution and with staff from a Mental Health Trust in England. The study collected questionnaire responses from 87 participants (42 third year mental health nurse students, 39 practising mental health nurses and six nurse lecturers). A Likert scale questionnaire with written feedback produced data that formed the schedule for ten subsequent focus groups with 41 participants from the above categories. Focus group data were analysed using a process of interpretive phenomenological analysis. This led to the development of three main study themes. The transition from student to registered nurse is difficult, the importance of learning from experience, violence and aggression is difficult to manage, working effectively with victims of sexual abuse or those who have a diagnosis of personality disorder is difficult. Findings – Whilst the study found some evidence to suggest the development of positive values there is a perception that newly qualified mental health nurses lack confidence in other important areas. Participants also expressed doubt about whether it was possible to prepare someone for practice completely. Another finding was that the relationship between student and the mentor is critical to the quality of practice learning. Research limitations/implications – Study limitations are that this is a small selection of participants from one particular area. The researcher attempted to ensure that this study has internal validity. However, it is possible to question the extent to which findings may apply to other areas. Therefore, this study may be most useful to others as a basis for the discussion and comparison of these issues within mental health nurse educators. Practical implications – The need to encourage proactive learning approaches in students is emphasised. Universities should facilitate the sharing of clinical learning experiences as well as developing realistic training in the management of violence and aggression. It is possible to question how well nurses are prepared to work with the physical health needs of service users. Originality/value – This paper gives information about mental health nurse preparation for practice, which will be of value to training organisations as well as to employers of newly qualified mental health nursing staff.

Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis.

Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers. We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP. Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) perceptions that they were 'already doing SDM'; (iii) concerns regarding the clinical 'appropriateness of service users' choices'; and (iv) limited 'availability of service users' choices'. Service users reported barriers to SDM in routine practice, most of which were addressed by the JCP process. Barriers identified by clinicians led to their lack of constructive engagement in the process, undermining the service users' experience. Future work requires interventions targeted at the engagement of clinicians addressing their concerns about SDM. Particular strategies include organizational investment in implementation of service users' choices and directly training clinicians in SDM communication processes.

Communication – a culture of open dialogue

Purpose – Open dialogue (OD) is an innovative approach to mental health crises based on close collaboration between services and an individual’s family and social network. The approach was originally designed by Jaakko Seikkula and his colleagues in Tornio, Finland and is now being developed in many countries around the world, in particular Denmark, Germany, Norway and the USA. OD describes both a way of being with families and also a way of organising services aimed at maximising communication and connection. The purpose of this paper is to describe the principles of OD, it’s development in Finland and here in the UK. Design/methodology/approach – This paper is a description of the principles and outcomes of OD as practised in Western Finland. It also describes the recent developments in the UK using the approach. Findings – This paper is descriptive of the model and is not of a research project. Originality/value – Whilst care must be taken in assuming that these remarkable results are transferable to the UK, other countries and several Mental Health trusts in England are actively engaged with developing an OD approach.

Type of unit and population served matters when implementing a smoke-free policy in mental health settings: Perceptions of unit managers across England.

Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the National Institute for Health and Care Excellence guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support. The aim of this paper was to determine if unit type and unit manager smoking status influence mental health smoke-free policy implementation. This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study's main aim was to understand unit managers' perceived reasons for success or failure of smoke-free policy. Unit managers (n = 131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers, whereas smoker unit managers were more likely than non-smoker unit managers to think that stopping smoking aggravated patients' mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering nicotine replacement therapy and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation. Applied strategies significantly vary by type of unit, whereas unit managers' knowledge, attitude and practices vary by their smoking status. There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognise the differing contexts of care provision in different types of units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients' smoking and providing staff education and support continue to be key strategies to successful smoke-free policy. Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy and addressing staff smoking.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams: a mixed-methods approach.

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

P.3.d.031 Audit of patients on paliperidone palmitate in a mental health trust in England

P.3.d.031 Audit of patients on paliperidone palmitate in a mental health trust in England

Services for young people with attention deficit/hyperactivity disorder transitioning from child to adult mental health services: a national survey of mental health trusts in England.

Transition from child to adult mental health services is considered to be a difficult process, particularly for individuals with neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD). This article presents results from a national survey of 36 mental health National Health Service (NHS) trusts across England, the findings indicate a lack of accurate data on the number of young people with ADHD transitioning to, and being seen by, adult services. Less than half of the trusts had a specialist adult ADHD service and in only a third of the trusts were there specific commissioning arrangements for adult ADHD. Half of the trusts reported that young people with ADHD were prematurely discharged from child and adolescent mental health services (CAMHS) because there were no suitable adult services. There was also a lack of written transition protocols, care pathways, commissioned services for adults with ADHD and inadequate information sharing between services. The findings advocate the need to provide a better transition service underpinned by clear, structured guidelines and protocols, routine data collection and information sharing across child and adult services. An increase in the commission of specialist adult ADHD clinics is needed to ensure individuals have access to appropriate support and care.

Research productivity of staff in NHS mental health trusts: comparison using the Leiden method.

Aims and method To examine research productivity of staff working across 57 National Health Service (NHS) mental health trusts in England. We examined research productivity between 2010 and 2012, including funded portfolio studies and all research (funded and unfunded).Results Across 57 trusts there were 1297 National Institute for Health Research (NIHR) studies in 2011/2012, involving 46 140 participants and in the same year staff in these trusts published 1334 articles (an average of only 23.4 per trust per annum). After correcting for trust size and budget, the South London and Maudsley NHS Foundation Trust was the most productive. In terms of funded portfolio studies, Manchester Mental Health and Social Care Trust as well as South London and Maudsley NHS Foundation Trust, Oxford Health NHS Foundation Trust and Cambridgeshire and Peterborough NHS Foundation Trust had the strongest performance in 2011/2012.Clinical implications Trusts should aim to capitalise on valuable staff resources and expertise and better support and encourage research in the NHS to help improve clinical services.

A national survey of adult safeguarding in NHS mental health services in England and Wales

BackgroundFollowing the introduction of the No Secrets (Department of Helath, (2000). No Secrets: Guidance on Developing and Implementing Multi-agency Policies and Procedures to Protect Vulnerable Adults from Abuse. London: HMSO) guidance, the implementation and development of adult safeguarding practices and procedures across national services has become an ongoing endeavour. Despite existing research highlighting practice improvements in many services, NHS mental health services are persistently criticised for their lack of engagement with the national adult safeguarding agenda (. Safeguarding Adults: Report on the Consultation on the Review of ‘No Secrets’. London: HMSO).AimTo investigate the organisational structure, implementation and development of adult safeguarding in NHS mental health services.MethodA cross-sectional survey was distributed on-line to 79 (72 NHS Mental Health Trusts in England and seven Health Boards in Wales) NHS mental health services.ResultsThirty-three completed surveys were returned, yielding a response rate of 41%. The results highlight adequate arrangements for adult safeguarding in many services; however, it appears implementation is in its initial stages. Responses suggest that staff attitudes and uptake of training are the greatest barrier to practice; however, barriers are also indicated at a strategic and operational level.ConclusionThe importance of adult safeguarding must be recognised at all levels and there is an immediate need for improvement to staff training and engagement to ensure future effective practice in this area.

The relationship between NHS performance indicators and suicide rates

As mental health services have an important role in prevention of suicides, the relationship between Care Quality Commission performance ratings of mental health trusts and the local suicide rates were examined with the null hypothesis that there will be no relationship between them. Data on suicide rates for men and women aged 16-65 for each district covered by a mental health trust were ascertained from the Office of National Statistics for the year 2009. Data on performance ratings of mental health trusts for the same year were obtained from the Care Quality Commission Report. There was no significant relationship between suicide rates in the districts covered by 60 mental health trusts in England and Wales and their performance ratings. The negative findings suggest that the performance rating of mental health trusts do not influence local suicide rates.

A national survey of the infrastructure and IT policies required to deliver computerised cognitive behavioural therapy in the English NHS

ObjectiveThis study aimed to identify if patients have adequate access to Computerised Cognitive Behavioural Therapy (cCBT) programmes in all mental health trusts across England.DesignThe primary researcher contacted a targeted sample...

Assessment of physical monitoring following rapid tranquillisation: a national survey

BackgroundRapid tranquillisation (RT) is a high risk clinical intervention in terms of potential physical health complications. There has been no published work in the UK to survey nationally whether standards for post RT physical monitoring (as set out in organisation's RT documents) are being adequately audited.AimTo review current auditing of RT practice in England, with particular emphasis on examination of post RT physical monitoring.MethodA scrutiny of evidence provided by English NHS mental health trusts to illustrate auditing of adult RT documents.ResultsFifty-eight mental health trusts in England were contacted. Less than one-third could provide evidence of an audit of post RT physical health monitoring. These audits were variable with respect to what aspect of physical health monitoring they focused on. When results of all audits were combined, it revealed a concerning finding that basic physical observations and investigations were not performed consistently following RT.Conclusions and Implications for Clinical PracticeThe current paucity of trust audits of post RT physical monitoring and the poor practice observed in those audits could reflect a lack of clarity in both trust and national guidelines, as well as poor clinical practice. Given the risks to a patient's physical health associated with RT it is essential to ensure high quality care in this area.

The Social Care Component of Multidisciplinary Mental Health Teams: A Review and National Survey

The study reviewed the disciplinary composition of community mental health teams (CMHTs) and conducted a national survey of mental health providers in England and Wales to explore the determinants of the social care component of CMHTs. A comprehensive literature review and a national survey of NHS mental health Trusts in England and Wales. The literature review showed that team composition was rarely well justified with regard to effectiveness, despite some evidence that greater professional diversity (i.e. inclusion of social workers) was associated with higher effectiveness. Forty-two mental health Trusts responded (53.2%) to the survey. There were no staffing differences between responding and non-responding Trusts. Social workers accounted for 19.3% of the staffing total. Nurses formed a third of the workforce and social support workers made up a further 10%. We found that there continues to be a shortage (compared to policy targets and previous research) of psychiatrists, psychologists and occupational therapists, whereas the numbers of nurses employed far exceeds their target numbers. Total staffing numbers appeared to be slightly higher in Trusts citing 'financial resources' as a determining factor of team composition. Despite being statistically non-significant, the 'financial resource' effect was of medium magnitude. Similarly, there was a non-significant but approaching medium-sized effect of higher numbers of social care support staff when guidance was cited as a rationale for CMHT composition. There was a non-significant (P = 0.076) medium magnitude (η(2)(p) = 0.067) trend towards higher staff numbers in more integrated trusts that did not cite financial resources as a driver of team composition. If service recipients are to gain equal access to appropriately staffed services, further attention needs to be paid to supporting an adequately skilled multidisciplinary workforce. The workforce needs to be organised in a way that best provides for local needs rather than a service based largely on the existing supply of different professionals and disjointed workforce planning.

Practice development efforts impact on mental health rehabilitation: results-based health care implications

Aim: The central aim of this study was to measure the extent of utilization of the Model of Human Occupation (MOHO) according to an existing conceptual framework ( Melton et al, 2010 ) and to examine whether professional development efforts aimed to support the use of this model were associated with a higher degree of incorporation of this model into everyday practice. 4secondary aim was to determine whether certain pre-identified contextual and personal variables influenced the use of MOHO in everyday mental health practice. Methods: The authors solicited participation from 429 occupational therapy practitioners from six NHS mental health trusts in England using an online survey method and 262 (61.1%) responded. Findings: A vast majority (92.1%) of the respondents indicated that they used MOHO as a primary treatment approach. Moreover, therapist participation in professional development efforts aimed to increase MOHO use were associated with higher levels of MOHO use, and the extent of MOHO use was associated with positive client (r=0.33, P<0.01), and professional outcomes (r=0.31, P<0.01 and r=0.33, P<0.01). Characteristics of the immediate team context and personal characteristics were linked to the extent of MOHO use among practitioners (r=0.30, P<0.01). Similarly, causal mechanisms that involve MOHO use in building confidence, finding flow, constructing know-how, accumulating reward, conferring with others, and channeling time were also linked with the extent of MOHO use among practitioners (r=0.55, P<0.01). Conclusion: Findings suggest that there may be a significant payoff for professional development efforts that aim to support client-centered, occupation-focused approaches to mental health rehabilitation practice.

Digest

Digest

Examining the relationship between risk assessment and risk management in mental health

Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others.

Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study

Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.

Physical health care policies in mental health trusts within the North East Midlands (UK)

In recent years there has been an increasing focus on improving the physical health of people with serious mental illness and many policies and guidelines are now tailored to support professionals working in mental health services to meet these requirements. We found, however, that the physical health care policies produced by mental health trusts in England varied enormously. Policies were often cumbersome, vague and lacked clear guidance on what particular action should be taken, when it should be taken, and by whom. Physical health care policy documents of three mental health care trusts in the north sector of the East Midlands Strategic Health Authority (UK) were examined in detail. We found significant disparities between the policies in terms of size, readability, external references and reading cost. None could be read swiftly and all incorporated vague language into their directives. It would be beneficial for there to be more consideration given to forming local policies that are readable, succinct, and unambiguous. There is potential for considerable economy of effort with collaboration in production of these documents.