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Service uptake in a sample of substance misuse and community mental health service clients: a case control study
- Authors:
- TODD J., et al
- Journal article citation:
- Journal of Mental Health, 14(2), April 2005, pp.95-107.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
This study compared service use in clients with single and comorbid diagnoses from Adult Mental Health (AMH) and Drug and Alcohol services (DAS). A retrospective matched case-control study of a sample of service users of a mental health Trust in East Anglia drawn across 400 AMH and 190 DAS. Odds ratios were estimated and used to test for differences in client groups with respect to uptake of community services, formal and informal in-patient services, “out-of-hours” services and engagement with statutory services.Marked differences were observed in terms of service use between clients of AMH who had a single diagnosis of severe, chronic or recurrent psychiatric problems and clients of AMH who had additional substance misuse problems. Differences were less pronounced between clients of DAS who had a single diagnosis of substance misuse and clients of DAS who had substance misuse and psychiatric problems. It is concluded that substance misuse could be a factor influencing service uptake rather than comorbidity per se.
Harm reduction in community mental health settings
- Authors:
- MANCINI Michael A., LINHORST Donald M.
- Journal article citation:
- Journal of Social Work in Disability and Rehabilitation, 9(2-3), April 2010, pp.130-147.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Fifty percent of people with psychiatric disabilities have a co-occurring substance misuse disorder, and are more likely to have a range of chronic disease conditions such as heart disease, diabetes, hypertension and chronic pulmonary disease. Harm reduction is a conceptual framework and set of practices that focus on the minimisation of the physical, social, and legal harms substance users do to themselves and to society as a whole. Its application to community mental health settings is relatively new, and can create controversies and ethical dilemmas if not properly designed, implemented, and evaluated. Building on the harm reduction literature, the community mental health literature, and the authors' experiences with a community mental health programme that uses a harm reduction approach, the authors offer five guidelines for its successful implementation. The authors conclude that when properly integrated with other recovery-based services, and when appropriately applied to the individual client's stage of change, harm reduction can effectively be used, and should be used, in community mental health settings with clients with co-occurring substance use and psychiatric disorders.
Therapeutic communities for psychosis: philosophy, history and clinical practice
- Editors:
- GALE John, REALPE Alba, PEDRIALLI Enrico, (eds.)
- Publisher:
- Routledge
- Publication year:
- 2008
- Pagination:
- 272p.
- Place of publication:
- London
This book offers a global insight into the renewed interest in the use of therapeutic communities for the treatment of psychosis, as complementary to pharmacological treatment. Twenty nine authors from 14 different countries describe their work. The book is divided into three parts which cover the historical and philosophical background of therapeutic communities and the treatment of psychosis in this context; treatment settings and clinical models; and alternative therapies and extended applications. It is intended as a resource for all mental health professionals, targeting readers from a number of disciplines including psychiatry, psychology, social work, psychotherapy, and group analysis.
Making meaning of citizenship: mental illness, forensic involvement, and homelessness
- Authors:
- PONCE Allison N., et al
- Journal article citation:
- Journal of Forensic Psychology Practice, 12(4), July 2012, pp.349-365.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
Those with mental illness, substance use disorders, and criminal justice involvement who experience homelessness are often marginalised and have difficulty achieving community inclusion. A framework of citizenship provides a basis for understanding the components of integration necessary to achieve status as a member of one's community. In this study, a citizenship map was presented to focus groups consisting of 11 people with mental illness and histories of criminal justice charges and of homelessness. Participants discussed the items most salient to them, and several themes emerged: responsibility; giving back and helping others; assaults on dignity; being in the hole and second chances; help isn’t always helpful; time; and employment and housing. The authors concluded that the study provided valuable information on the challenges people face on their way to community and social inclusion.
Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs
- Authors:
- TIMKO Christine, et al
- Journal article citation:
- Journal of Mental Health, 15(2), April 2006, pp.163-177.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
This American study evaluated the effectiveness and cost-effectiveness of community- and hospital-based acute residential treatment for dually disordered patients, and whether moderately-ill patients benefited more from community care, and severely-ill patients from hospital care. Two hundred and thirty patients with dual substance use and psychiatric disorders were randomly assigned to community or hospital acute care programs that had the same level of service-intensity. They were followed for 1 year (80%) using the Addiction Severity Index. Patients' health care utilization was assessed from charts, VA databases, and health care diaries; costs were assigned using methods established by the VA Health Economics Resource Center. Patients had better substance use outcomes when they were initially assigned to community rather than to hospital acute care. Patients assigned to hospital care had shorter index stays, but these index stays were more costly than were the longer index stays of patients assigned to community care. Patients assigned to hospital care also had more mental health follow-up outpatient visits, and more costly mental health follow-up stays, over the study year. The authors concluded that cost savings may be achieved without loss of benefit to all but the most decompensated dually disordered patients by shifting the locus of acute treatment from hospital to community care.
Drug and alcohol work in child and adolescent mental health
- Author:
- ROSS Anthony
- Journal article citation:
- Nursing Times, 22.7.03, 2003, pp.26-27.
- Publisher:
- Nursing Times
Provides an overview of the Barnes Unit in Sunderland, which is an adolescent mental health team providing community-based treatment for 16-19 year olds. It shares a way of working with adolescents who have problems with drugs and alcohol, within Child and Adolescent Mental Health Services. Young people with substance misuse problems who do not have mental health problems can also access the service.
Dual diagnosis screening: preliminary findings on the comparison of 50 clients attending community mental health services and 50 clients attending community substance misuse services
- Authors:
- MANNING V. C., et al
- Journal article citation:
- Journal of Substance Use, 7(4), December 2002, pp.221-228.
- Publisher:
- Taylor and Francis
In the current study clinicians administered a brief screening tool, which detects problematic alcohol, drug use, psychosis and common mental health symptoms, to 50 substance misuse and 50 mental health treatment attenders. Sixty-four per cent of the total sample screened positive for dual diagnosis (positive for any psychiatric disorder and either a drug or alcohol problem). Highest rates were observed in the alcohol sample (92.3%), followed by the drug sample (87.5%), and lowest in the community mental health (CMHT) sample (38%). Current depression and social phobia were most prevalent in alcohol clients compared to psychosis, mania and suicidal ideation in CMHT clients. Around one-third of CMHT clients reported using drugs (mainly cannabis) and around a fifth reported problematic alcohol use. The study demonstrates the feasibility of incorporating a dual diagnosis screen into routine clinical practice. The screen can be used in both mental health and substance misuse treatment settings, which are evidently managing complex client caseloads
Substance misuse among clients with severe and enduring mental health illness
- Authors:
- HIPWELL Alison E., SINGH Krishna, CLARK Ann
- Journal article citation:
- Journal of Mental Health, 9(1), February 2000, pp.37-50.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Substance use, in the context of severe and enduring mental illness, is a growing problem and is likely to have implications for the way mental health services are used. This compares service utilisation, psychiatric symptomatology and social support among 16 clients with psychotic illness who were regular substance users, with 16 clients attending the same service who did not use substances. Their use of the day-service was chaotic and reflected social difficulties, such as housing instability, financial, and legal issues rather than mental health problems. The findings highlighted the need for an integrated and accessible service which could provide long-term, intensive and practical support.
Assertive outreach teams in London: patient characteristics and outcomes: Pan-London Assertive Outreach Study, Part 3
- Authors:
- PRIEBE Stefan, et al
- Journal article citation:
- British Journal of Psychiatry, 183(8), August 2003, pp.148-154.
- Publisher:
- Cambridge University Press
Although the model of assertive outreach has been widely adopted, it is unclear who receives assertive outreach in practice and what outcomes can be expected under routine conditions. Patients (n=580) were sampled from 24 assertive outreach teams in London. Outcomes – days spent in hospital and compulsory hospitalisation – were assessed over a 9-month follow-up. The 6-month prevalence rate of substance misuse was 29%, and 35% of patients had been physically violent in the past 2 years. During follow-up, 39% were hospitalised and 25% compulsorily admitted. Outcome varied significantly between team types. These differences did not hold true when baseline differences in patient characteristics were controlled for. Routine assertive outreach serves a wide range of patients with significant rates of substance misuse and violent behaviour. Over a 9-month period an average of 25% of assertive outreach patients can be expected to be hospitalised compulsorily. Differences in outcome between team types can be explained by differences in patient characteristics.
Clinical governance review: North Cumbria mental health and learning disabilities NHS trust; October 2002
- Author:
- COMMISSION FOR HEALTH IMPROVEMENT
- Publisher:
- Commission for Health Improvement
- Publication year:
- 2002
- Pagination:
- 21p.
- Place of publication:
- London
North Cumbria Mental Health and Learning Disabilities NHS Trust serves a population of 310,000 with middling levels of affluence and less than 0.5% ethnic minorities. This report gives an independent assessment of how well the trust is ensuring high standards of care and what it is doing to continuously improve the quality of services. It takes account of the previous investigation by acknowledging that the trust is not only developing as a new organisation, but that some of its services start from a very low baseline. This review considered mental health services for working age adults in and around Carlisle, and for older adults in and around Whitehaven. CHI is developing methods for assessing clinical governance in learning disability,substance misuse and child and adolescent mental health services.