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Employment advice in primary care: a realistic evaluation
- Authors:
- PITTAM Gail, et al
- Journal article citation:
- Health and Social Care in the Community, 18(6), November 2010, pp.598-606.
- Publisher:
- Wiley
In 2007 the Richmond Fellowship, a national mental health charity, received a grant to provide four employment advisers to work with GP surgeries. The goal was to help people with mental health problems gain work or retain their current employment. In this study an evaluation framework was applied to address the question of what works, for whom and in which contexts through interviews with key stakeholders including 22 clients of the project, five primary health care staff and the four employment advisers. The interventions that retain clients found most helpful were careers guidance and developing strategies to negotiate and communicate with employers. These appeared to help individuals to take control, broaden their horizons and move forward. For regaining clients, the most important interventions were help with interview skills, CV writing and assertiveness training. Employment outcomes were considerably higher for the retained clients than for the regained clients. The authors suggest that it could be more effective for retain and regain services to be delivered through different care pathways to avoid diluting the services offered and consequently reducing their effectiveness.
Brief problem-solving treatment in primary care (pst-pc) was not more effective than placebo for elderly patients screened positive of psychological problems
- Authors:
- LAM Cindy L. K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 25(10), October 2010, pp.968-980.
- Publisher:
- Wiley
This study investigated whether screening followed by brief problem-solving treatment by primary care doctors (PST-PC) could improve health-related quality of life (HRQOL) and reduce consultation rates in the elderly. Participants included 299 Chinese patients aged over 60, with positive screening scores for psychological problems by the Hospital Anxiety and Depression Scale (HADS). Of these, 149 received brief PST-PC from primary care doctors, and 150 control group video-viewing of health education videos. All subjects were followed up by telephone at 6, 12, 26 and 52 weeks. Findings indicated a significant improvement in the HRQOL role-emotional and mental component summary scores at week 6 in the PST-PC group but not in the control group. Several HRQOL scores improved significantly in the control group at weeks 6-52. Mixed effects analysis adjusting for baseline values and cofounders did not show any difference in any of the outcomes between the PST-PC and control groups. Screening followed by brief PST-PC was associated with a short-term improvement in HRQOL, but the HRQOL benefit was not greater than those found in the control group.
The Mental Health (Wales) Measure
- Author:
- WALES. Welsh Assembly Government
- Publisher:
- Wales. Welsh Assembly Government
- Publication year:
- 2010
- Pagination:
- 5p.
- Place of publication:
- Cardiff
The Mental Health (Wales) Measure has been laid before the National Assembly for Wales, and if enacted will make a number of important changes to the legislative arrangements in respect of the assessment and treatment of people with mental health problems. The purpose of this briefing sheet is to provide general information about those changes, explain how interested parties can become involved in shaping the legislation, and explain how the Welsh Assembly Government intends that the legislation will be implemented. The Measure has five broad policy intentions. The first is to provide assessment of a person’s mental health and, where appropriate, provide treatment for their mental ill-health within primary care. The second is to create statutory requirements around care and treatment planning and care coordination for all persons receiving care and treatment with secondary mental health services. The third is to require secondary mental health services to have in place arrangements to ensure the provision of timely access to assessment for previous service users. The fourth is to extend the group of qualifying patients under the Mental Health Act 1983 entitled to receive support from an Independent Mental Health Advocate (IMHA), and the final intention is to enable all patients receiving care and treatment for mental health problems in hospital to have access to independent and specialist mental health advocacy.
Is it acceptable to patients to have supported self-help interventions delivered through psycho-educational groups? A qualitative study on the reasons stated for dropout
- Authors:
- RACHAEL Tikka, et al
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 5(2), June 2010, pp.36-42.
- Publisher:
- Emerald
Swindon and Wiltshire Primary Care Psychology Service provides psycho-educational group courses, built around a stress and mood management course which teach basic cognitive behavioural skills. This qualitative study investigated reasons for dropout, in order to indicate acceptability of this intervention and inform future development of the programme. Ninety people who had attended at least one session of a course over a 3 month period were followed up by telephone. The results showed that 75% of people discontinued for reasons related to personal circumstances, such as other commitments, travel problems and ill health (75%), rather than dissatisfaction with the courses, with dissatisfaction with the intervention mostly accounted for by 'course not suited my needs', indicating the importance of managing expectations at the point of referral to the course and at the first session. The authors conclude that providing group-based interventions for common mental health problems is acceptable to patients in primary care, and that service development should focus on making such interventions flexible and accessible to patients.
Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?
- Authors:
- SAXON David, RICKETTS Tom, HEYWOOD Joanna
- Journal article citation:
- Counselling and Psychotherapy Research, 10(1), March 2010, pp.13-21.
- Publisher:
- Wiley
The unplanned ending of therapy is of concern because it raises questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This paper, using a large dataset of CORE data collected routinely from the Sheffield Primary Care Psychological Therapy service between 2000 and 2003, employed logistic regression to consider different measures of risk and other client characteristics recorded during assessment to predict drop-out from the service. The findings suggest that younger age, greater psychological distress during assessment or an addiction problem are associated with an unplanned ending. However, no reliable logistic regression model could be produced, possibly due to data quality issues or important characteristics not being available in the data. The authors conclude that counsellors should actively seek to minimise unplanned endings, as amongst them may be the more distressed and risky clients referred to primary care counselling.
Improving access to mental health services via a clinic-wide mental health intervention in a Southeastern US infectious disease clinic
- Authors:
- BOTTONARI Kathryn A., STEPLEMAN Lara M.
- Journal article citation:
- AIDS Care, 22(2), February 2010, pp.133-136.
- Publisher:
- Taylor and Francis
A brief psychological consultation model, which aims to improve integration of mental health services into HIV primary care is described. This retrospective article seeks to examine which patients in an adult infectious disease clinic were served by this model in a one-year period. Examining whether the patients who subsequently engage in mental health care differ demographically from the consult population, this study, of 963 patients, indicated that 26.1% (252) of the patients at our Infectious Disease clinic received a mental health consultation. The authors observed no statistically significant differences between the study and clinic populations with respect to gender, age, or race. Moreover, 43.3% of those patients served by the consult model received specialised psychiatric care. There were significant racial differences between those patients who engaged specialty psychiatric care and those who did not after receiving a consultation. While the in-clinic consultation service reached a representative population, there was less success recruiting this diverse patient population into traditional psychiatric care. Future efforts will need to examine how mental health consultation and traditional psychiatric services can best reduce barriers to engagement and retention in care.
Adult community statistics: 1st April 2009-31st March 2010
- Author:
- NORTHERN IRELAND. Department of Health, Social Services and Public Safety
- Publisher:
- Northern Ireland. Department of Health, Social Services and Public Safety
- Publication year:
- 2010
- Pagination:
- 77p., tables
- Place of publication:
- Belfast
This statistical report presents information on activity for all Programmes of Care for adults, gathered from HSC Trusts via the annual and quarterly statistical returns. Statistical tables are presented in 6 sections. All Programmes of Care, Elderly Care, Mental Health, Learning Disability, Physical and Sensory Disability, and Primary Health and Adult Community.
Not just talk: what a psychosocial primary care mental health service can do
- Author:
- FIRTH Malcolm T.
- Journal article citation:
- Practice: Social Work in Action, 22(5), December 2010, pp.293-307.
- Publisher:
- Taylor and Francis
This article describes a study which followed the development in 2006 and 2007 of a multi-disciplinary primary care mental health service in central Manchester, England as it moved from a mostly problem-based, social worker led, casework approach to focus on a more holistic, active, community approach to well-being. Seven hundred and sixty two service users were consulted over the 12 months and the allocation, discharge and intervention outcomes and service user feedback on a range of types of direct and indirect work (in partnership with other mainstream or voluntary sector agencies) undertaken are tabulated. Two examples of case illustrations, involving mental health practitioners and graduate mental health workers, are also presented. The author advises that mutual learning across settings and disciplines and a shared appreciation that mental health problems and good mental health outcomes are embedded in community processes were key for this mixed, psychosocial approach to be efficacious. Policies and services which seek remedies via individualised therapies, risk analyses and risk management will, says the author, fail to address the connectedness of service users’ mental health with their material, social and personal environments.
Gender and self-reported mental health problems: predictors of help seeking from a general practitioner
- Authors:
- DOHERTY D. Tedstone, KARTALOVA-O’DOHERTY Y.
- Journal article citation:
- British Journal of Health Psychology, 15(1), February 2010, pp.213-228.
- Publisher:
- Wiley
The main topic of this paper is an examination of the socio-demographic and health status factors that predict help seeking for self-reported mental health problems from a general practitioner (GP), for adults of both genders, because it has been reported previously that many people do not seek help when experiencing psychological distress. Using data from the HRB National Psychological Wellbeing and Distress Survey in Ireland in 2005 and 2006, 382 participants who had reported mental health problems in the previous year, with approximately 60% female and 40% male, were selected. The findings showed gender differences in the models of predictors between males and females with more factors influencing attendance at the GP for males and females. Only access to free health care and social limitations predicted female attendance, a range of seven socio-demographic and psychological factors influenced male attendance – self-reporting embarrassment, limitations in physical activities, martial status, employment status, access to free health care, location/size of household, and level of education. This, say the authors, suggests a ‘gender sensitive approach’ to mental health policies and promotion and to preventative practice programs would be well placed in GP surgeries and at a primary care level generally.
Managing and preventing depression in adolescents
- Authors:
- THAPAR Anita, et al
- Journal article citation:
- British Medical Journal, 30.1.10, 2010, pp.254-258.
- Publisher:
- British Medical Association
Adolescent depression affects 1-6% of adolescents and rates of underdiagnosis and undertreatment are higher than for adults. It has adverse effects on educational attainment and relationships, and longterm negative effects on adult health and functioning. It is also associated with an increased risk of suicide, the leading cause of death in this age group (14-19 years). This article reviews the published evidence on diagnosis, treatment and prevention of adolescent depression. Evidence shows that moderate to severe adolescent depression responds to treatment with the antidepressant fluoxetine, the most widely prescribed of the selective serotonin reuptake inhibitors (SSRIs). However, the value of combining this with cognitive-behavioural therapy CBT) remains unclear. Despite concerns that antidepressants may be associated with an increased suicidal risk in adolescents, a recent meta-analysis found that the benefits of these drugs were greater than the risks in this age group. The most promising preventive strategy is to target three high risk groups: adolescents with raised depressive symptoms, those who have experienced a previous depressive episode and those whose parents have a history of depression. A recent randomised controlled trial in the US found that a group based CBT approach was effective in reducing the incidence of depressive episodes at one year in these at-risk groups.