Mental Health Services For People Research Articles

Recovery and intellectual disabilities: a review

PurposeGiven the increased prevalence of mental health problems amongst people with intellectual disabilities, it seems pertinent to consider how the recovery approach could potentially benefit practice within mental health services for people with intellectual disabilities. This paper seeks to explore the similarities between recovery principles and existing approaches in services for people with intellectual disabilities; it also aims to reflect on the potential barriers to the explicit uptake of the “recovery” approach in this context.Design/methodology/approachThe presence and implementation of “recovery” approaches within mental health services for people with intellectual disabilities are reviewed. This is achieved through an examination of existing practices that could be described as recovery oriented, along with reflections on how these relate to the recovery approach. Questions are raised regarding whether practices can be regarded as “recovery oriented”, without first consulting service users.FindingsFurther consideration is needed about the extent to which mental health services for people with intellectual disabilities are recovery oriented and how recovery would be defined amongst people with intellectual disabilities.Research limitations/implicationsIt is suggested that further research using qualitative methodology is conducted, to enable the voice of service users to be heard.Originality/valueThe paper is one of the first to explore the relevance of the recovery approach to people with intellectual disabilities. Given the increasing emphasis on recovery approaches within mainstream services, it seems vital to give consideration to the potential for its meaningful application to people with intellectual disabilities and mental health problems.

Adaptation of Intensive Mental Health Intensive Case Management to Rural Communities in the Veterans Health Administration

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

New Mental Health Indicators Provide a Snapshot on Performance of the Mental Health System in Canada

Although the general hospital remains an important place for stabilizing crises, most services for mental illnesses are provided in outpatient/community settings. In the absence of comprehensive data at the community level, data that are routinely collected from general hospitals can provide insights on the performance of mental health services for people living with mental illness or poor mental health. This article describes three new indicators that provide a snapshot on the performance of the mental health system in Canada: self-injury hospitalization rate, 30-day readmission rate for mental illness and percentage of patients with repeat hospitalizations for mental illness. Findings suggest a need for the early detection and treatment of mental illnesses and for optimal transitions between general hospitals and community services.

A nurse-led mental health service for people with multiple sclerosis

BackgroundMental health problems are under recognised and under treated in people with multiple sclerosis (MS). MethodA nurse-led project linking MS and mental health services was evaluated. Data on all referrals and management from 2006 to 2008 were collected prospectively. Results127 referrals were received. 82% had depression, 53% had anxiety (45% both). 42% were offered case management; 52% received Cognitive Behaviour Therapy (CBT), 55% required initiation or alteration of psychiatric medications and 19% were referred to secondary care; 16% had made suicidal plans. Significant improvements in depression at 6months occurred, but not anxiety or fatigue. Clinical implicationsThis service provides a model of mental health provision for patients with long term neurological conditions, in particular MS.

Mental health services for people with intellectual disabilities

This review summarizes recent research into psychiatric services for adults with intellectual disabilities, with a particular focus on inpatient care. People with intellectual disability appear to be admitted with more severe problems and receive more interventions than those without intellectual disability when admitted to general psychiatric units. Qualitative research has shown poor standards of care on some general psychiatric inpatient units. Studies of supported generic inpatient units have reported successful outcomes, supported by qualitative studies of satisfaction. Length of stay for people with intellectual disability is not consistently longer on specialist than general psychiatric units. Delayed discharge and restrictive practices, however, still need addressing. The important components of community mental health services have been evaluated from the points of view of psychiatrists, patients and carers. Emergency provision of psychiatric assessment and care remains a problem in some centres. There have been few randomized controlled trials in this field; however, uncontrolled comparisons and service evaluations suggest positive outcomes in specialist services. Qualitative work has made important contributions to understanding the patients' and carers' experiences. Further work should focus on the measurements of outcome and satisfaction.

Design, Delivery and Evaluation of Teaching by Service Users and Carers

Education influences individual health and social care professionals and the systems in which they work. We describe a postgraduate educational program that did this through involving service users and carers in designing and facilitating teaching programs. A module of teaching was designed and delivered in partnership with users and carers from older people's mental health services to a multidisciplinary student group. Its evaluation employed written feedback and separate focus groups involving students and service user/carer teachers. Both groups highlighted the profound effect of the teaching, and the involvement of users and carers was a powerful experience for all involved.

What are the implications of personal recovery for older people's mental health services?

What are the implications of personal recovery for older people's mental health services?

S21-02 - The structure of the ultra high risk mental state for psychosis. A latent class cluster analysis study

IntroductionIndividuals at Ultra High Risk (UHR) for psychosis typically present with attenuated psychotic symptoms. However it is difficult to predict which individuals will later develop frank psychosis when their mental state is rated in terms of individual symptoms.The objective of the study was to examine the phenomenological structure of the UHR mental state and identify symptom profiles that predict later transition to psychosis.MethodPsychopathological data from a large sample of UHR subjects were analysed using latent class cluster analysis.A total of 318 individuals with a UHR for psychosis. Data were collected from two specialised community mental health services for people at UHR for psychosis: OASIS in London and PACE, in Melbourne.ResultsLatent class cluster analysis produced 4 classes: Class 1 - Mild was characterized by lower scores on all the CAARMS items. Subjects in Class 2 - Moderate scored moderately on all CAARMS items and was more likely to be in employment. Those in Class 3 - Moderate-Severe scored moderately-severe on negative symptoms, social isolation and impaired role functioning. Class 4 - Severe was the smallest group and was associated with the most impairment: subjects in this class scored highest on all items of the CAARMS, had the lowest GAF score and were more likely to be unemployed. This group was also characterized by the highest transition rate (41%).ConclusionsDifferent constellations of symptomatology are associates with varying levels of risk to of transition to psychosis.

How can older people's mental health services in the UK respond to the escalating prevalence of alcohol misuse among older adults?

PurposeThere is growing statistical and research evidence to suggest that the prevalence of alcohol misuse is increasing among older adults in the UK. This has been an under‐recognised problem, but is now a source of increasing concern for health and social care providers. Older adults with mental health problems have increased vulnerability to problematic alcohol use, and this is likely to have a significant impact on older people's mental health services (OPMHS).Design/methodology/approachThis paper discusses some of the problems facing OPMHS in relation to increasing alcohol misuse among services users.FindingsThere is also evidence that alcohol misuse in older adults is often poorly identified and untreated within health and social care services including OPMHS. Use of an alcohol‐screening tool as part of a health care assessment is an effective way to improve detection. This paper also reviews the use of alcohol screening tools in the detection of alcohol related illness among older adults with mental health problems and proposes a care pathway for the management of alcohol misuse in OPMHS.Originality/valueCurrent evidence indicates that the prevalence of alcohol misuse among older adults is increasing and is likely to rise further due to the reasons discussed in this paper.

Improving mental health services for people with intellectual disabilities: service users' views

The aim of this study was to seek the opinions of people with an intellectual disability who have additional mental health needs about the mental health services they receive. A semi‐structured focus group methodology was used to ask participants about all aspects of the mental health services they receive. Overall, it was found that participants valued staff who listened to them and actively tried to help with their difficulties. They also wanted choice and control over their lives, particularly with regard to meaningful day activities. Limitations of the study are highlighted.

This far, yet how much further? Reflections on the allure of the mainstream for people with intellectual disabilities and mental health needs

Services for people with intellectual disabilities would be barely recognisable to clinicians working half a century ago. Two forces in particular stand out as driving the changes that we see today. The first accompanied the closure of the once popular institution‐like hospitals as part of a general reorientation within psychiatry as a whole from the asylum to the community. The second is the push towards incorporating people with intellectual disabilities in ‘mainstream’ services, the principle of ‘normalisation’ that sits at the heart of health and social policy in the UK for this group of people. This article is a reflection on the current status of mental health services for people with intellectual disabilities against this historical and philosophical backdrop and the arguments for their continued existence as a separate specialist entity within the field of psychiatry.

A guide to guidelines for the treatment of PTSD and related conditions

In recent years, several practice guidelines have appeared to inform clinical work in the assessment and treatment of posttraumatic stress disorder. Although there is a high level of consensus across these documents, there are also areas of apparent difference that may lead to confusion among those to whom the guidelines are targeted-providers, consumers, and purchasers of mental health services for people affected by trauma. The authors have been responsible for developing guidelines across three continents (North America, Europe, and Australia). The aim of this article is to examine the various guidelines and to compare and contrast their methodologies and recommendations to aid clinicians in making decisions about their use.

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Mainstream In‐Patient Mental Health Care for People with Intellectual Disabilities: Service User, Carer and Provider Experiences

Background Government guidelines promote the use of mainstream mental health services for people with intellectual disabilities whenever possible. However, little is known about the experiences of people with intellectual disabilities who use such services.Materials and Methods Face‐to‐face interviews with service users, carers and community nurses were completed and analysed on a case by case basis using interpretative phenomenological analysis. The results were followed up in focus groups with service providers.Results Positive aspects included the provision of respite, particularly for carers, and good basic care. These were outweighed by a perception of the admission as disempowering and lacking in flexible treatment provision. Accessing help emerged as a major problem, as well as the prospect of staff neglecting the specific needs of people with intellectual disabilities.Conclusions While there were some indications of improvements in line with recent policies and guidance, mainstream services seem a long way off realizing aims of easy accessibility, person‐centred practices and active partnership with intellectual disability services.

Psychotropic PRN use among older people's inpatient mental health services

Concerns have been expressed about the use of antipsychotics with older people, particularly in those who have dementia. Pro re nata (PRN) psychotropic medications including antipsychotics are commonly used to manage disturbed and distressed behaviour. This audit aimed to understand the use of PRN psychotropic medications in older people's inpatient mental health services and the quality of prescriptions and nursing documentation associated with this. A retrospective audit was undertaken on 154 patients on 11 wards in three Mental Health Trusts in the North West of England. A proforma adapted from previous research was used to collect data. Eighty-seven patients were prescribed combinations of 14 psychotropic drugs in 145 different prescriptions as PRN. Seventy-six doses of PRN were administered to 26 patients (range 1-17 doses). The most commonly administered drug was Lorazepam (n = 28, 36.8%). Drugs were most frequently administered during the night (n = 33, 43.4%). The majority of administrations of PRN were not documented (n = 45, 59.2%). PRN appeared to be used differently (smaller doses and less frequently) in this study compared to previous research of those aged under 65. Further work needs to examine the use of the use of PRN psychotropic medicines and the older person, and focus on developing alternative nonpharmacological interventions.

Medicine use in older people's inpatient mental health services

The aims of this audit were to establish the range and volumes of medicines used in older people's mental health settings and to explore the safety of the prescribing habits through the application of the revised Beers criteria. An audit of all patients on all selected wards (both functional and organic) for current prescriptions of all drugs routinely prescribed on the census day was undertaken on 11 wards in three Mental Health NHS Trusts in the North West of England. Data were collected on 154 patients in 11 different inpatient settings in three Mental Health Trusts. A total of 153 patients had 882 prescriptions of 196 drugs (mean 5.8 drugs). Most frequently prescribed drugs were aspirin (n= 57, 6.5%), paracetamol (n= 36, 4.1%) and quetiapine (n= 35, 4.0%). Nine of the 48 potentially inappropriate medicines in the revised Beers criteria had been prescribed, although at within appropriate limits. The audit highlights the complexity of poly-pharmacotherapy in older adults admitted to mental health services. Further works needs to establish whether nurses have the clinical knowledge and skills to ensure safe practice. There appears to be continued variation in prescribing practice.

The role of ethnicity in clinical psychopathology and care pathways of adults with intellectual disabilities

The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.

Barriers to user involvement in mental health services for people with learning disability

This paper explores some of the issues and barriers to service user involvement for people with learning disability in mental health settings. In particular the paper focuses on barriers to involvement including staff attitudes and the involvement of service users in their own assessment and treatment. The issue of getting people involved in their own care is addressed and is highlighted using examples of good practice.

Assessment of personality disorder

SummaryIn 2003 the Department of Health, in conjunction with the National Institute for Mental Health in England, outlined the government's plan for the provision of mental health services for people with a diagnosis of personality disorder. This emphasised the need for practitioners to have skills in identifying, assessing and treating these disorders. It is important that personality disorders are properly assessed as they are common conditions that have a significant impact on an individual's functioning in all areas of life. Individuals with personality disorder are more vulnerable to other psychiatric disorders, and personality disorders can complicate recovery from severe mental illness. This article reviews the classification of personality disorder and some common assessment instruments. It also offers a structure for the assessment of personality disorder.

Mental health services for people with a learning disability

Many parts of the world are developing specialist mental health services for people with a learning disability. Government policy in England appears to favour a move in the opposite direction. The general aims of mental health services for people with a learning disability are indeed similar to those of the rest of the population, but distinctive clinical skills are required to assess, treat and support effectively people with a learning disability who have mental health and/or behavioural problems. There is therefore a need for specialist services to meet the needs of this population, which should include acute admission facilities, outreach services in the community and long‐term support.