Mental Health Trusts In England Research Articles

The place and promotion of well‐being in mental health services: a qualitative investigation

The study investigated the place and promotion of well-being from the perspectives of services users and mental health professionals. * Data from focus groups and interviews were analysed and found that well-being promotion was available, for example weight management groups in mental health services. However, they also found that there were some contradictions between the groups of people interviewed about what was available and what to promote in the future. * The study concludes suggesting partnerships with local communities to further develop well-being services, such as opportunities for physical activity, for people with mental health problems. Abstract This study explored service users' and mental health professionals' understandings, experiences and opinions of well-being and its promotion within mental health services. A qualitative case study methodology included nine participants (five adult service users, three mental health professionals, one senior manager) who were purposively sampled from a Mental Health Trust in England. Service users participated in a focus group, while individual semi-structured interviews were held with the mental health professionals and senior manager. Interpretative phenomenological analysis of the data revealed five main themes including well-being as a holistic concept; well-being promotion; the place, promotion and position of well-being; role of mental health services in well-being promotion; and areas for further improvement. Findings revealed evidence of well-being promotion; however, there were contradictions regarding what was known between the groups of participants and what could be provided in the future. Implications for practice include the need to establish more effective partnership working between mental health services and local communities, especially in light of financial constraints within health services at large. This could assist the increased provision of therapeutic services for well-being promotion.

Clinical governance issues arising from the Mental Health and Learning Disabilities Pharmacy Workforce Survey (England) 2006

In the last 10 years changes in the Government's agenda for medicines management and improved patient safety have resulted in unprecedented calls for the provision of mental health pharmacy services. This has not been reflected in pharmacy workforce planning or budgets. We aim to ascertain pharmacy staffing levels in Mental Health Trusts and whether supply of medicines and delivery of clinical pharmacy services are at an appropriate level. All Chief/Lead Pharmacists for Mental Health Trusts in England were sent a questionnaire. Follow-up was done twice by e-mail at 2-week intervals. The response rate was 48% (n = 38 usable questionnaires), and results showed that many Trusts were providing little more than a basic supply service. Pharmacy services equating with risk-management were often provided on an ad hoc basis. Staffing levels were reported as insufficient, with mainly part-time staff. A basic pharmacy ward visit was only offered by 60.8% (n = 14/23; not all participants answered all questions) of respondents, at the 100% level (i.e. a daily service). Six of 31 respondents receiving pharmaceutical services from external organisations reported no formal signed agreements with the external provider. The increasing emphasis on community-based mental health teams, while still retaining on-site provision and Department of Health initiatives to improve patient safety via medicines management, has placed great strain on mental health pharmacy services. The resultant pharmaceutical input from external drivers is not reflected in appropriate pharmacy staffing levels. The results raise some serious governance issues.

Hospital trust engagement with a new vocational learning programme for pharmacists and pharmacy technicians in England

This study aimed to explore hospital trusts' uptake of Learning@Lunch (L@L), a new vocational learning programme for hospital pharmacists and pharmacy technicians in acute and mental health trusts in England, recently introduced by the Centre for Pharmacy Postgraduate Education (CPPE). The CPPE's ordering database for the first eight L@L modules, with addition of hospital trust and pharmacy characteristics, was analysed using SPSS, providing simple frequencies and chi2 cross-tabulations. The CPPE database contained data for 168 acute and 73 mental health trusts, about a third of each being foundation trusts. One-third (33.3%) of acute trusts were teaching, and the majority of them (91.1%) offered pre-registration places for 2009, the mean number being 3.39; only three mental health trusts offered places. L@L uptake by specialist and mental health trusts was lower than by those providing general services. Uptake was highest in the North and South, and lowest in London. Acute trusts with zero to two pre-registration places had a higher uptake than those offering three or more. Despite limitations of the database, analysis provides interesting insights into the uptake of this new learning programme, which are of interest to CPPE, as well as pharmacy academics and educationalists. L@L uptake by specialist and mental health trusts was significantly lower than that by acute trusts providing general services. Reasons for this need to be explored further to ensure that CPPE and other learning providers can meet the needs of hospital pharmacists and pharmacy technicians working in specialist areas, thus ensuring refresher training in core clinical areas.

Risk Assessments for Mental Health Service Users

• Summary: This article considers the nature and basis of risk assessments in mental health services, based on empirical research on the tools used within NHS Mental Health Trusts in England which found a wide variety of such tools in use within them. • Findings: The article examines the problems and potential benefits in the use of such tools, and argues for an inclusive and holistic approach to risk assessments which incorporate our knowledge of the risks of risk assessments. The article pays particular attention to risk assessment procedures as relevant to social workers who have to uphold the requirements of the General Social Care Council Code of Practice, which provides particular emphasis on issues of risk, and service user and carer involvement in assessments. Potential biases and limitations of risk assessment approaches, it is proposed, need to be taken into account in order to have a balanced view of the value of such approaches. • Applications : The article provides a critique of the validity and effectiveness of current risk assessment tools, focusing in upon one key area in mental health work, the assessment and management of potential violence.

Still fighting ageism.

MENTAL HEALTH problems are common in older people. In the UK one quarter of admissions to mental health inpatient services are people aged over 65. The number of people aged over 65 is set to increase by 15 per cent by 2019, and the number of people with dementia to rise to one million by 2025. Yet ageism is widespread in mental health trusts in England, according to new research by the Healthcare Commission ( 2009 ).

Developing Inter‐professional Training for Conflict Resolution ‐ A Scoping Audit and Training Pilot

Managing violence is an important clinical and managerial responsibility within contemporary mental health practice and there have been considerable developments across the country to pave the way for a more ‘standardised’ approach to conflict resolution. Many trusts employ someone to lead on ‘conflict resolution’ but the precise nature of the lead role and the responsibility attached to it vary greatly between organisations. Similarly, some trusts have sophisticated systems for delivering and monitoring conflict training and updates, whereas others do not. The project described here sought to clarify how training for conflict resolution is organised within a sample of mental health trusts in England. Data was generated by questionnaire and telephone interview with trust leads, and the audit findings were then analysed and used to inform an inter‐professional training pilot in one local trust. It is now expected that frontline staff will enter into conflict resolution training as defined by the NHS Security Management Service (2004) and be trained in accordance with a national syllabus of training standards. Audited opinion suggests that the training co‐ordinator role is associated with improved governance in relation to conflict‐resolution training. Arguably, if national benchmarks and standards are to be met in relation to conflict resolution, trusts need to invest in training infrastructure and at least consider the merits of funding a dedicated co‐ordinator role and inter‐professional training.

A National Survey of Psychiatric Mother and Baby Units in England

A National Survey of Psychiatric Mother and Baby Units in England

An evaluation of a medication management training programme for community mental health professionals; service user level outcomes: A cluster randomised controlled trial

Background Antipsychotic treatment is important in reducing symptomatology and relapse in schizophrenia. Community mental health professionals (CMHPs) have a significant role in this treatment; however, evidence suggests that many are ineffective in medication management. Objectives To develop and evaluate a medication management training programme whose aims are to increase the effectiveness of pharmacological treatment and increase services users’ involvement in treatment decisions. Participants Twenty-eight pairs of CMHPs were recruited from mental health Trusts in England. For each practitioner an average of 3.4 service users were randomly selected for their ‘study caseload’. Design A pragmatic cluster randomised trial assessed the service users of CMHPs allocated to medication management training or waiting list controls. Methods All practitioner participants were taught to use a variety of assessment measures and undertook baseline assessments with their service users. The experimental practitioners then attended the training programme. At the 9-month endpoint the service users were re-assessed. Results After the outcome data was adjusted for clustering the trained practitioners made significant improvements in global psychopathology and service user involvement in treatment when compared to controls at 9 months. Conclusions Training CMHPs in medication management has a positive impact on clinical outcomes and service user involvement in treatment.

Smoke-free policy in acute mental health wards: avoiding the pitfalls

Objective The objective of this work was to explore the practical implications of, and the problems arising from, the implementation of a comprehensive smoke-free policy in acute adult inpatient mental health wards. Method This is a qualitative study that uses semistructured interviews with a stratified purposive sample of 16 medical and nonmedical staff of two wards in an acute mental health trust in England that had implemented a smoke-free policy in buildings and grounds in March 2007. Results The smoke-free policy was viewed ambivalently and was substantially compromised by widespread use of exceptions such as permitting patients to smoke in an outdoor patio and covert indoor smoking. Smoking breaks were described to be a fixation for patients and sometimes disruptive to therapeutic activities. Nicotine dependence and withdrawal were not assessed or supported systematically. Awareness of interactions between smoking and certain antipsychotic medications was anecdotal and did not impact on clinical practice. Conclusions The implementation of smoke-free policies in these acute mental health wards suffered from the provision of regular institutionalized smoking breaks, a lack of sustained investment in staff training and a lack of comprehensive cessation or abstinence support for patients. These issues need to be addressed; otherwise, the implementation of smoke-free policies in mental health settings may result in unintended adverse effects.

Digest

Digest

Clozapine: national review of postcode prescribing

Aims and MethodWe review the prescribing rates for clozapine among all mental health trusts in England and explore whether it has changed with the introduction of NICE guidelines, generic clozapine and the Healthcare Commission ratings. Data were collected from mental health trusts in 2005–2006 and compared with a previous study from 2000. Mental health star ratings of 2004–2005 were taken from the Healthcare Commission.ResultsWe found a reduced inter-trust variability from 34-fold variation in 2000 to 5-fold variation in 2005–2006. There was a significant inverse relationship between star rating and clozapine prescribing.Clinical ImplicationsNICE guidelines and generic clozapine seem to have improved access to gold standard therapy for treatment-resistant schizophrenia. Star ratings have little bearing on the implementation of NICE guidelines.

A survey of staff attitudes to smoking-related policy and intervention in psychiatric and general health care settings

Although the move to smoke-free hospital settings is generally a popular initiative, it may be a more challenging and controversial issue in mental health care. A survey was carried out to investigate differences in attitudes between clinical staff in psychiatric and general medical settings to smoke-free policy and intervention. The sample comprised 2574 NHS staff working in two Acute Hospital Trusts and one Mental Health Trust in England. Attitudes were examined on two factors: health care settings as smoke-free environments and the role of staff in stop smoking intervention. The findings indicated that attitudes on the two factors were only moderately correlated. Psychiatric staff expressed significantly less favourable attitudes than general staff to smoke-free health care settings and also to the role of staff in stop smoking intervention. The largest difference between the settings concerned the implementation of smoking bans. While approximately 1 in 10 staff in the general setting disagreed with a smoking ban in their wards or clinics, nearly one in three psychiatric staff was against such a ban in their setting. Staff attitudes need to be carefully considered, particularly in psychiatric settings, in attempts to implement smoke-free policies in health care settings.

The role of the child primary mental health worker.

The purpose of the study was to explore how the child primary mental health worker role, as defined in the Health Advisory Service document, has been interpreted in each of the mental health trusts in England. Studies have indicated there is a deficit in recognition and treatment skills, by primary care workers, of psychological difficulties presented by children and young people, which could be supported by specialist mental health workers. A postal questionnaire was sent to 169 English mental health trusts. There were 98 returns (59%) indicating that 22 child mental health services had established this new role and a further 42 were planning to develop it in the near future. The child primary mental health workers were spending on average 35% of their time in primary care offering consultation and training to health professionals, rather than direct work with children and families. This development was found to be a growing area of advanced practice for nurses. Given the stated intention of the majority of services to develop or retain this role, further evaluation studies will be needed.