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A successful implementation strategy to support adoption of decision making in mental health services
- Authors:
- MACDONALD-WILSON Kim L., et al
- Journal article citation:
- Community Mental Health Journal, 53(3), 2017, pp.251-256.
- Publisher:
- Springer
Individual involvement in treatment decisions with providers, often through the use of decision support aids, improves quality of care. This study investigates an implementation strategy to bring decision support to community mental health centres (CMHC). Fifty-two CMHCs implemented a decision support toolkit supported by a 12-month learning collaborative using the Breakthrough Series model. Participation in learning collaborative activities was high, indicating feasibility of the implementation model. Progress by staff in meeting process aims around utilisation of components of the toolkit improved significantly over time. Survey responses by individuals in service corroborate successful implementation. Community-based providers were able to successfully implement decision support in mental health services as evidenced by improved process outcomes and sustained practices over 1 year through the structure of the learning collaborative model. (Edited publisher abstract)
The least worst option: user experiences of antipsychotic medication and lack of involvement in medication decisions in a UK community sample
- Authors:
- MORANT Nicola, et al
- Journal article citation:
- Journal of Mental Health, 27(4), 2018, pp.322-328.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Background: Treatment decision-making that fully involves service users is an aim across medicine, including mental health. Aim: To explore service users experiences of taking antipsychotic medication for psychotic disorders and their perceptions of decision-making about this. Method: Semi-structured interviews with 20 users of community mental health services, conducted by service user researchers and analysed using thematic analysis.Results: Antipsychotic medication was perceived to have beneficial effects on symptoms and relapse risk, but adverse effects were prominent, including a global state of lethargy and demotivation. Weighing these up, the majority viewed antipsychotics as the least worst option. Participants were split between positions of “willing acceptance”, “resigned acceptance” and “non-acceptance” of taking antipsychotics. Many felt their choices about medication were limited, due to the nature of their illness or pressure from other people. They commonly experienced their prescribing psychiatrist as not sufficiently acknowledging the negative impacts of medication on life quality and physical health concerns and described feeling powerless to influence decisions about their medication. Conclusion: The study highlights the complexity of agendas surrounding antipsychotic medication, including the pervasive influence of coercive processes and the challenges of implementing collaborative decision-making for people with serious mental health problems.
Mental Health Act assessments: professional narratives on alternatives to hospital admission
- Author:
- HALL Peter
- Journal article citation:
- Journal of Social Work Practice, 31(4), 2017, pp.445-459.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This article draws on themes derived from research conducted as part of a doctoral study, using Framework Analysis, in which fifteen mental health professionals were involved in nine Mental Health Act assessments in the UK. In this work, risk is explored in terms of the social context, using a social constructionist perspective, in which concepts of ‘social crisis/mental illness’, professional negotiations and social capital are explored. The key findings highlighted: the social constructions of service users’ worlds, as presented by the Approved Social Workers (ASWs) and Home Treatment Professionals (HTPs), were notably different; the negotiations between the ASWs and HTPs provided the ASWs with a number of roles including negotiator, deal-maker and decision-maker; and the service user’s social network and the provision of home treatment showed that the ‘treatments’ provided can be seen as a shared role. Finally, the implications for contemporary mental health social work practice are presented. (Publisher abstract)
Training novices to make expert, occupationally focused, community mental health referral decisions
- Authors:
- HARRIES Priscilla, GILHOOLY Kenneth
- Journal article citation:
- British Journal of Occupational Therapy, 74(2), February 2011, pp.58-65.
- Publisher:
- Sage
An essential decision making skill that has to be learnt by occupational therapy students is the ability to prioritise referrals according to an individual's level of need. This is particularly necessary for community mental health services, where referral demand far exceeds service availability. This study used expert occupational therapists' referral prioritisation policies, derived from judgement analysis, to train novices in the skill of referral prioritisation. The policies chosen were those that supported occupationally focused practice. Thirty-seven final-year occupational therapy students at a large UK university were asked to prioritise a set of referrals, before and after being trained with graphical and descriptive representations of these experts' policies. Prior to training, the students overvalued the client's history of violence and undervalued the reason for referral and the diagnosis compared to the experts. Post-training, the policies were better matched. The effect of training was demonstrated by: more accurate prioritisation scores when matched with expert ratings on the same referrals, improved consistency on repeat referrals and higher group agreement. The authors suggest that decision training may be useful in promoting the type of service that aims to target clients' occupational needs in the field of community mental health.
Clinical Decision Support Tool: a rational needs-based approach to making clinical decisions
- Authors:
- ROLAND Self, et al
- Journal article citation:
- Journal of Mental Health, 17(1), February 2008, pp.33-48.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
In a specialist Mental Health Trust in the North of England there appeared to be idiosyncratic referral pathways and care packages, and conflicting views on clinical priorities. A brief review of the literature suggested that this was a national problem. This study aimed to describe the development and initial evaluation of a system of needs-based consistent but flexible care packages. A participatory action research approach was adopted. Through an iterative process staff at all levels explored current clinical practice, and took part in data collection and collation, and consensus building around the assessment of needs and appropriate service responses. A shared vocabulary was developed, covering assessment of needs, aims of interventions and activities of interventions. The project developed a Clinical Decision Support Tool (CDST), with acceptable concurrent validity. It allows for service users to be allocated to clusters on the basis of shared needs and points to care packages linked to needs. The CDST provides an empirically based framework linking care packages to needs. It conveys professional understandings and assessments during care planning in a way that is accessible to people from a range of professional backgrounds, and service users and carers. It underpins the CPA process, and is increasingly the basis for care plans. Detailed information systems are now being developed for the CDST to inform service planning and commissioning decisions.
Secret practices: interdisciplinary work in child welfare
- Author:
- TAYLOR Alexis A
- Publisher:
- Upfront
- Publication year:
- 2003
- Pagination:
- 202p.,bibliog.
- Place of publication:
- Leicester
This ethnographic study presents a different perspective on Child and Adolescent Mental Health Services: that of the child’s. The author argues that the rights of children encountering this service are as seriously compromised as those of adult mental health service users once were. The evidence challenges the quality of assessments, and shows the powerful influence of technical language and power mongering on constructing realities. Professional work can be self-serving rather than ‘in the best interests of the child’. Some of the fundamental tensions in inter-disciplinary work and ‘joined up thinking’ are exposed. Novel ways of exploring critical decision points and working effectively in groups are presented. There are salutary messages for child welfare practitioners and policy makers, and compelling reasons for radically altering the child welfare system in the UK in order to meet the needs of distressed children. A new ‘architecture of care’ must replace the current monolithic institutions and professional tribes.
A will to live
- Author:
- GEORGE Mike
- Journal article citation:
- Community Care, 29.4.99, 1999, pp.32-33.
- Publisher:
- Reed Business Information
A social workers talks to the author about the dilemma she faced when she tried to find an alternative to sectioning a man with a young family who had tried the hang himself, and was intent on further suicide attempts.
Ethics in community mental health care
- Author:
- BACKLAR Patricia
- Journal article citation:
- Community Mental Health Journal, 32(4), August 1996, pp.321-325.
- Publisher:
- Springer
Discusses the difficulty in assessing decision-making capacities of people with mental health problems; to ensure that they are able to give authentic autonomous informed consent to, or refusal of, health care treatment.
The developing role of the forensic community nurse
- Authors:
- FRIEL Colum, CHALONER Chris
- Journal article citation:
- Nursing Times, 17.7.96, 1996, pp.33-35.
- Publisher:
- Nursing Times
Mental health professionals are increasingly concerned with the consequences of clinical judgment errors. Such concern has led to an increase in requests for specialist advice from forensic mental health care teams. Consequently, the demand for forensic community mental health nurses (FCMHNs) to provide specialist advice and reports has increased. Such advice can be significant in planning and delivering care.
'Eccentric' - or a danger to health?
- Author:
- GEORGE Mike
- Journal article citation:
- Community Care, 10.6.99, 1999, pp.30-31.
- Publisher:
- Reed Business Information
Talks to a social worker, Roger Parke, who had to address the problem of twin brothers whose hoarding of rubbish endangered their health.