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Audit as discovery: context and complexity in secondary-to-primary care mental health service users
- Authors:
- FIRTH Malcolm Thomas, POWLING Laura, WITTER Martina
- Journal article citation:
- Journal of Social Work Practice, 26(3), 2012, pp.283-299.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Audit processes are commonly used to ascertain productivity, quality assurance and consumer satisfaction or, more narrowly, to check that practitioners are correctly adhering to service protocols. However, audit can also be a means for practitioners themselves to shed light on their own practices. In this study, data are explored from two very different mental health services, one in primary care (PC) the other in secondary care (SC), with a common clientele. Demographic, risk, health and social need factors were identified from 36 service users who had previously been receiving a service from a crisis resolution or community mental health team, or from a psychology service. Depression and/or anxiety characterised the mental health problems of the majority of primary care service users, although all were experiencing complex, multiple adversities. Risk factors were similar between the services, as were health and social care needs, suggesting that primary care service users' quality of life was little different than when seen earlier in secondary care. Collectively, primary care service users had marked difficulties with psychological health, daily occupation, physical health, money, unemployment and personal and social isolation. At the individual level, however, ‘complexity’ was evident but inadequately captured by the audit methodology, the latter being too remote from user and worker contexts. The authors concluded that recognition of context-based complexity may more usefully inform practitioners' interventions than talking therapies or evidence-based practice alone.
Guidance for commissioners of primary mental health care services: volume two: practical mental health commissioning
- Author:
- JOINT COMMISSIONING PANEL FOR MENTAL HEALTH
- Publisher:
- Royal College of Psychiatrists
- Publication year:
- 2012
- Pagination:
- 20p.
- Place of publication:
- London
This guide is about the commissioning of good quality, integrated primary mental health care. It suggests that mental health problems should be managed mainly in primary care by the primary health care team working collaboratively with other services, with access to specialist expertise and to a range of secondary care services as required. Effective treatment of common mental health disorders in primary care requires integrated services using a stepped care model. This should deliver evidence-based treatments that can be accessed via flexible referral routes, including self-referral, and offer a choice of psychological and non-psychological interventions. Allocation of funds to reflect these principles will result in better integrated patient care pathways that are able to meet a wider range of needs.
Interdisciplinary working in mental health
- Author:
- BAILEY Di
- Publisher:
- Palgrave Macmillan
- Publication year:
- 2012
- Pagination:
- 256p.
- Place of publication:
- Basingstoke
This book presents a model for interdisciplinary working, and offers an overview of practice and policy across a range of mental health settings. It explores how to combine skills, theories and expertise from a range of disciplines in response to the diverse needs of service users, from children to older people, and those with complex needs. Chapters include: the evolution of interdisciplinary working: definitions and policy context; models and values for interdisciplinary working in mental health; interdisciplinary working and the mental health legislation; interdisciplinary care planning in mental health; interdisciplinary risk assessment planning and management; involving people who use services in interdisciplinary working in mental health; interdisciplinary working with people with mental health problems in primary care; interdisciplinary working with children and young people with mental health problems; interdisciplinary working with older adults with mental health needs; interdisciplinary working with individuals with complex needs; interdisciplinary education and training; and managing interdisciplinary working and practice in mental health.
Missed opportunities: mental disorder in children of parents with depression
- Authors:
- POTTER Robert, et al
- Journal article citation:
- British Journal of General Practice, 62(600), July 2012, pp.360-361.
- Publisher:
- Royal College of General Practitioners
Research indicates that a quarter of children with a parent with depression have mental health problems, but about two-thirds of them are not in contact with any services. Evidence suggests that early intervention and prevention programmes are important for this group of patients but they are difficult to implement if the children are not identified and are not accessing services, even if their parents are known to primary care. A total of 333 families were recruited in which at least one parent had received treatment for recurrent depression and had a child aged 9-17 years. Parents and children were assessed using research diagnostic interviews. The service-use interview recorded current (in the past 3 months) and lifetime contact with health, educational, and social services due to concerns about the child's emotions or behaviour. Only 37% of children who met criteria for psychiatric disorder were in contact with any service at the time of interview. A third, who were suicidal or self-harming and had a psychiatric disorder at that time, were not in contact with any service. Lack of parental worry predicted lower service use, with higher rates in children with comorbidity and suicidality. The authors stress the importance of improving ease of access to services, and increasing parental and professional awareness that mental health problems can cluster in families.