Mental Health Service Staff Research Articles

Forgotten suffering

Service user, Amanda Wells knows only too well how an under-resourced mental health service and over-stretched staff can impact on the care provided. But she also knows what is needed to turn the situation around, and that doesn’t include the govenment’s latest proposals

Threshold 2: the reliability, validity and sensitivity to change of the Threshold Assessment Grid (TAG).

This study investigated the psychometric properties of the Threshold Assessment Grid (TAG), a new assessment of the severity of mental health problems. A total of 605 patients were recruited from 10 mental health adult and elderly services in London, UK. TAG ratings and other standardized definitions of severe mental illness were completed by referrers. TAG, Global Assessment of Functioning (GAF), Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and Health of the Nation Outcome Scale (HoNOS) ratings were completed by mental health service staff. Construct validation on extreme groups was investigated. Construct and concurrent validity were good. Referrer TAG scores predicted mental health team view of referral suitability, but not whether assessments were offered. Test-retest reliability was good, interrater reliability ranged from good to poor in different domains (but adequate for total TAG score), internal consistency was appropriate. Sensitivity to change requires further investigation. The TAG can be recommended for use by all agencies when making referrals to mental health services.

A Qualitative Approach to the Mental Health Care Needs of People Living with HIV/AIDS in Victoria

This article reports on the findings of the qualitative stage of a larger project on the mental care needs of people with HIV/AIDS and mental illness (Tender T1176 Department of Human Services, Mental Health Branch, Victoria - Research on the Mental Health Care Needs of People with HIV/AIDS and Mental Illness). The purpose of the larger research was to evaluate the needs and treatment requirements of persons with HIV/AIDS, who also suffer from mental health problems, with a view to developing proposals for improving existing service delivery in Victoria, Australia. The qualitative stage was designed to complement and elucidate data obtained through the quantitative stages of the project. Thirty in-depth open-ended interviews were carried out with service providers including HIV physicians, general practitioners, psychiatrists, clinical and managerial staff of Area Mental Health Services, Contact Tracers and forensic mental health services staff, as well as representatives of community groups such as People Living with HIV/AIDS and Positive Women and carers. The interviews explored the perspective of both service providers and users of such services with respect to needs for psychiatric care and service delivery, ease of access or barriers to mental health services, and the perceived strengths and weaknesses in current service provision. This paper presents the main findings and recommendations submitted to the funding body.

Increasing diagnosis of nicotine dependence in adolescent mental health patients.

The aim of this study was to investigate the routine recording patterns of patients' smoking by clinical staff of an adolescent mental health service over a 3-year period. A systematic examination of the clinical files of all patients who underwent an initial assessment or reassessment at the Youth Specialty Service (Mental Health; YSS) over a 2-month period (1 April-31 May) was carried out in 1996, 1997 and 1998. A range of data were collected including: demographics; diagnoses; amount of total information recorded and history of nicotine dependence. A stable historical record of cigarette smoking in the region of 30-40% across the 3 years sampled was found, but the rate of formal diagnosis of nicotine dependence rose from 3.6% in 1996 to 26.3% in 1998. This rise was in the context of relative stability over this time period of: size of reports and relevant sections (alcohol and drug history, cigarette smoking history); three other key diagnoses, major depression, conduct disorder and alcohol dependence; and demographic data. The rise in rate of diagnosis proceeded specific discussion within the clinical team about nicotine dependence. Adolescent mental health settings are a key venue to address heavy and potentially chronic cigarette smoking, but nicotine dependence has been traditionally a neglected diagnosis in mental health patients. The rate of diagnosis is likely to rise when specific discussion is undertaken within clinical teams.

Staff and patient feedback in mental health services for older people.

OBJECTIVES: To compare the views of patients and staff on the quality of care provided on a psychogeriatric assessment ward over a five year period. To describe the quality improvements...

Building in Dialogue Between Consumers and Staff in Acute Mental Health Services

This paper describes some aspects of the methodology, material, and findings from a lengthy participatory action research engagement by a consumer organization in Australia, which was undertaken in collaboration with staff at a major public psychiatric hospital and then went on to involve “players” throughout the local and national mental health services system. A small first phase established a dialogic methodology for the exchange of experiences and thinking between staff and consumers. The purpose of the second phase of the research was to explore how consumers' voices might be heard, and how staff–consumer communication about that feedback, might be “built in” to ongoing organizational structure and culture. Systems thinking about defensive routines, silences, and voice-as-discourse is reported as offering a possible way of cracking the puzzle of the closed-loop cycle of claim/ blame-defense-and-counter-claim/blame-defense that has been characteristic to date.

Legal rights and responsibilities of adolescents and staff in Victorian Child and Adolescent Mental Health Services.

The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been 'gazetted' and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment. Staff of CAMHS inpatient units have recently posed questions to the Victorian chief psychiatrist. These have included clarification of when the MHA may be appropriately used for adolescents, what is the clinician's duty of care, how to assess young people's capacity to consent to treatment, how to manage some patient groups, and what is the role of the courts in treatment decisions. The author provides a view on each of these matters, based on recent literature and confirmed by legal opinion. Some matters of fact are presented and advice is provided. Services must seek the informed consent of guardians and adolescents and, for those young people with major psychiatric disorders who require treatment and are unable to consent, the amended MHA provides clearer direction for the use of involuntary treatment. Where units offer admission to provide assessment and stabilisation, a clear explanation about the treatment goals, and the role of restraint and medication in managing behaviour is essential at the outset of the admission process.

Therapy Begins at Home: The Psychiatric House Call

The house call is a valuable but underused component of community psychiatric care. A review of home visits conducted by the staff of a community mental health service over a 12 month period identified four situations in which a home visit is useful: getting reluctant patients to enter therapy, conducting a comprehensive assessment, strengthening a support network, and maintaining patients in the community when their condition has deteriorated. Making psychiatric house calls requires some additional skills on the part of therapists and offers residents valuable training experience.