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London's state of mind: King's Fund mental health inquiry 2003
- Authors:
- LEVENSON Ros, GREATLEY Angela, ROBINSON Janice
- Publisher:
- King's Fund
- Publication year:
- 2003
- Pagination:
- 178p.
- Place of publication:
- London
This report offers a comprehensive overview of substantial changes that have taken place since 1997 in the policy environment and in the organisation and delivery of services. It also identifies the characteristics of the capital’s population that pose particular challenges and opportunities for London’s mental health and mental health services. The report draws on a series of working papers, commissioned to explore areas where information was felt to be lacking, along with consultations with service users, carers and key stakeholders.
Early intervention in psychosis: a pilot study of methods to help existing staff adapt
- Authors:
- PAXTON Roger, et al
- Journal article citation:
- Journal of Mental Health, 12(6), December 2003, pp.627-636.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Improved detection and clear referral systems are prerequisites for effective early intervention. Although specialist early intervention services are being introduced in Britain, changes are still required in the practice of existing primary and secondary care staff. This paper describes an exploratory evaluation of a partnership approach to help existing staff adapt their practice to support early intervention. Policies and procedures of the service described were compared systematically with national policy guidance. Structured interviews with 53 primary care and mental health staff were used to explore changes in their knowledge, attitudes and professional practice. The service model complied with most UK national policy requirements for early intervention. There was increased awareness and knowledge of early psychosis and improved detection, assessment and intervention practice on the part of primary and secondary care staff. It appears possible to influence the practice of existing staff to deliver early intervention using an economical service model.
London's state of mind: King's Fund mental health inquiry 2003; summary
- Authors:
- LEVENSON Ros, GREATLEY Angela, ROBINSON Janice
- Publisher:
- King's Fund
- Publication year:
- 2003
- Pagination:
- 13p.
- Place of publication:
- London
This report offers a comprehensive overview of substantial changes that have taken place since 1997 in the policy environment and in the organisation and delivery of services. It also identifies the characteristics of the capital’s population that pose particular challenges and opportunities for London’s mental health and mental health services. The report draws on a series of working papers, commissioned to explore areas where information was felt to be lacking, along with consultations with service users, carers and key stakeholders.
Identification of psychological morbidity in older people in primary care by practice nurses
- Authors:
- CAPE J., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.446-451.
- Publisher:
- Taylor and Francis
Older people with psychological morbidity generally first present to health services in primary care, where they are increasingly seen by primary care nurses. In order to evaluate primary care nurses' identification of psychological morbidity, 190 older patients attending eight practice nurses completed the General Health Questionnaire (GHQ) and the practice nurses made an assessment as to the presence or absence of psychological problems. The practice nurses identified only 26% of probable cases of psychological morbidity identified by the GHQ. Their threshold for identification was high, rating only 12% of patients as experiencing psychological problems compared to 29% probable cases identified by the GHQ, and their accuracy was low (kappa for agreement between GHQ and nurse ratings = 0.23). Likelihood of identification depended on length and type of visit. The findings suggest that it may be unrealistic to expect practice nurses, without additional training and reorganisation of their work, to identify more than a minority of older patients with psychological morbidity in the course of their routine work.
Associations between migrancy, health and homelessness: a cross-sectional study
- Authors:
- TOMPKINS Charlotte N.E., et al
- Journal article citation:
- Health and Social Care in the Community, 11(5), September 2003, pp.446-452.
- Publisher:
- Wiley
There is limited awareness of the link between differing health problems and migrancy of homeless people. This cross-sectional study sought to quantify the extent of migrancy of homeless people from their birthplace and evaluate whether a history of problematic drug or alcohol misuse or enduring mental health problems were associated with this. The work was conducted at an inner-city health centre for the homeless in the north of England. Birthplace was created as an entry on computerised registration records and collected and recorded for each homeless person registering with the service over the study period. Information was also extracted regarding diagnoses of problematic illicit drug or alcohol use and enduring mental health problems. The study identified statistically significant differences for the migration of homeless people from birthplace for age and problematic drug and alcohol use, the last independently associated with increased likelihood of migration from birthplace. Conversely, a history of illicit drug use is associated with a reduced possibility of migration from birthplace when accessing primary healthcare services. There was no significant difference for migration from birthplace for mental health. Not all homeless people migrate from their birthplace and health problems of drug use, mental health or alcohol use are independently associated with different patterns of migration. Understanding the migrancy of homeless people is important when planning and targeting appropriate health and social services to address their varying health, social and psychological needs.
Mental health services in primary care: a review of recent developments in London
- Authors:
- ROSEN Rebecca, JENKINS Clare
- Publisher:
- King's Fund
- Publication year:
- 2003
- Pagination:
- 58p.
- Place of publication:
- London
This working paper aims to revisit findings from the 1997 King's Fund Inquiry on Mental Health and to examine the extent to which primary care mental health services have developed in line with recommendations made at that time. It takes a narrow view of 'primary care' as relating to general practice. Other community-based mental health services are addressed in other papers being produced as part of the Inquiry. The main focus of this paper is on general practice-based services for people with common mental health problems, and the role of PCTs in developing them. Findings are presented from a postal questionnaire of a 20% sample of London GP practices and a telephone survey of mental health leads in London PCTs.
Drug and alcohol misuse among in-patients with psychotic illnesses in three inner-London psychiatric units
- Authors:
- PHILLIPS Prashant, JOHNSON Sonia
- Journal article citation:
- Psychiatric Bulletin, 27(6), June 2003, pp.217-220.
- Publisher:
- Royal College of Psychiatrists
Ward staff were asked to rate whether in-patients with a diagnosis of functional psychotic illness also met criteria for a diagnosis of alcohol or drug misuse or dependence during the preceding 6 months. Those who demonstrated such evidence were then asked to report the nature and extent of their substance use and whether they continued to use as in-patients. 264 in-patients with psychotic illness were screened for evidence of recent or current alcohol or drug misuse. According to staff reports, 127 (48.9%) met the criteria for substance misuse or dependence. The mean age of those with 'dual diagnosis' was 34.7 years and 72% were male. Eighty-three (83%) of those with a history of current or recent alcohol or drug misuse reported that they had continued to use alcohol and/or illicit drugs in the in-patient wards during their current admission. It appears difficult to prevent in-patients with drug or alcohol misuse problems from continuing to use substances in hospital. Further consideration and investigation of how best to manage this group is therefore required.
Geriatric depression in Nigerian primary care attendees
- Authors:
- SOKOYA Olukunle, BAIYEWU Olusegun
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.506-510.
- Publisher:
- Wiley
202 older people were screened using the Geriatric Depression Scale (GDS). The Geriatric Mental State schedule (GMS) was administered to participants who scored above the cut-off on the GDS in order to assess psychopathology. Diagnosis of depression was based on ICD-10 criteria as well as the GMS-AGECAT programme. The rate of geriatric depression in primary care was found to be 7.4%. Severe depression was only 1.5%. Very low income and subjective report of poor health were significantly associated with depression in the cohort. AGECAT recognition of depression was comparable to that by the ICD-10 (k = 0.7). The study is the first known study of geriatric depression in primary care in Nigeria. The rates are comparable with rates obtained in other countries. Specific correlates of depression in the older Nigerians identified included poor self-assessed health and low income.
Child psychiatric disorders among primary mental health service attenders
- Authors:
- ARCELUS Jon, VOSTANTIS Panos
- Journal article citation:
- British Journal of General Practice, 53(488), March 2003, pp.214-216.
- Publisher:
- Royal College of General Practitioners
The aim of this study was to establish the range of psychiatric disorders and psychiatric comorbidity among children and adolescents attending a primary mental health service (PMHS). The main psychiatric diagnostic categories were: oppositional defiant disorders (ODDs) (75.3%), anxiety disorders (36.1%), mood disorders (35.1%), and attention deficit hyperactivity disorders (ADHDs) (28.9%). The study found high rates (61.8%) of psychiatric comorbidity. It concludes that training in the recognition of likely psychiatric comorbidity in this population is essential for professionals working in the interface between primary and specialist services.
A qualitative evaluation of the 'Trailblazers' teaching the teachers programme in mental health
- Authors:
- BROWN Celia, et al
- Journal article citation:
- Learning in Health and Social Care, 2(2), June 2003, pp.74-82.
- Publisher:
- Blackwell
This article aims to provide an evaluation of the 'Trailblazers' programme, and seeks to identify the factors affecting the impact of the programme. 'Trailblazers' is a learner-centred 'Teaching the Teachers' programme in primary care mental health. In the first programme to be run in the West Midlands, seven pairs of participants attended three residential modules and developed an action plan that was cascaded to local colleagues. A primarily qualitative investigation, exploring the experiences of the first cohort of 14 Trailblazers in the West Midlands, demonstrated that the modules were well received and over 200 other professionals benefited from education sessions delivered by the participants. Most delegates were keen to be involved in future programmes and regional policy-making. The Trailblazers programme demonstrated short-term effectiveness in terms of participant reaction, knowledge and changes in professional practice.