Resource Implications For Services Research Articles

Using attachment theory to inform the design and delivery of mental health services: a systematic review of the literature.

The aim of this review was to propose and describe the design and delivery of an attachment-informed general mental health service. We systematically searched the PsycINFO, MEDLINE, Web of Knowledge, COPAC, CINAHL, and Science Direct databases from 1960 to 2013. We also searched reference lists of relevant papers and directly contacted authors in the field. Literature describing attachment theory and its applicability in designing and delivering general mental health services was synthesized using thematic analysis. Papers published in English, books or chapters in edited books that described applying attachment theory in designing and delivering mental health services for adults and adolescents were included in the review. Of the 1,105 articles identified, 14 met inclusion criteria for the review. Eight key themes, and four subthemes, were extracted and organized to reflect the experience of a service user moving through the mental health system. Key themes extracted were as follows: service policy and evaluation; referrals; assessment and formulation; intervention; support for staff; support for carers; moving on; and potential service benefits. Papers reviewed suggested that service users with severe mental health problems have attachment needs that should be met in general mental health services. Attachment theory provides a useful framework to inform the design and delivery of general mental health services. The resource implications for services are discussed, as are limitations of the review and recommendations for future research. Attachment theory should be used to inform the design and delivery of general mental health services. Mental health services should evaluate the extent to which they meet service users' attachment needs. Attachment-informed mental health services should assess outcomes, including cost-effectiveness over time. Papers included in this review focus on long-stay residential care or secure services and there is a limited experimental evidence base to show that providing an attachment-informed service improves patient outcomes.

Do Novel Psychoactive Substances Displace Established Club Drugs, Supplement Them or Act as Drugs of Initiation? The relationship between Mephedrone, Ecstasy and Cocaine

Background/Aims: To assess whether novel psychoactive substances (NPS) displace established club drugs, supplement them or act as drugs of initiation via a study of the relationship between mephedrone, ecstasy pills, cocaine and MDMA powder amongst club-goers considered to be ‘early adopters' of psychostimulant/club drug trends. Methods: In situ surveys were conducted with 308 customers in two south London gay dance clubs across 3 weekend nights in July 2010 to assess the prevalence and patterns of self-reported use of a range of illegal drugs and NPS. Results: Mephedrone was added to existing drug repertoires amongst those surveyed and acted to supplement more established club drugs including ecstasy pills, cocaine and MDMA powder, rather than replacing or displacing those drugs. Conclusion: This survey suggests that NPS are likely to be added to drug repertoires, particularly amongst experienced users with consequent health risks for individuals and resource implications for services. This study points to a complex relationship between NPS and illegal drug availability, purity and regulatory control, one which is increasingly important to understand given the global emergence of NPS and the challenges they present to existing supply, demand and harm reduction strategies.