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Importance of specialisation in psychiatric services. Commentary on... How did we let it come to this?
- Author:
- KILLASPY Helen
- Journal article citation:
- Psychiatrist (The), 36(10), October 2012, pp.364-365.
- Publisher:
- Royal College of Psychiatrists
In his editorial (ibid, pp.361-363), George Lodge makes a plea for continuity of care, making a case that the increased specialisation of mental healthcare over recent years has led to fragmentation of patient care. This response argues that continuity of care is not a straightforward concept and its relationship to clinical outcome is not established. Three arguments are presented: difficulties with the concept of continuity of care; specialisation as a reason for celebration; and ensuring efficiency in service delivery. It concludes that the increased specialisation of mental healthcare reflects an evolving evidence base that has increased our understanding of mental illness and the treatments and delivery systems that are most effective. In other words, specialisation is the sign of a progressive field.
Turning the tables
- Author:
- SLOCOMBE Will
- Journal article citation:
- Mental Health Today, September 2012, pp.28-29.
- Publisher:
- Pavilion
- Place of publication:
- Hove
A psychiatrist called Isabel Wilson (1895-1982) designed and created a group of table mats for a group of her colleagues. These table mats called, ‘Table Mats of the Famously Insane’, depicted various characters who might be called ‘famous’ and ‘insane’, including George III, an Egyptian god, and King Lear. They were accompanied by coasters designed around the topic of ‘causes and cures’ including drugs, the moon, and psychotherapy. Inspired by this story, CorpoArt, a small service user venture was commissioned to design their own set of table mats on the theme of famous psychiatrists and ‘causes and cures’. The aim was to introduce them to something of the history of psychiatry and how far it has come, and also to allow them to articulate their own experiences of treatment. The resulting mats are varied and interesting. Some focus on the designs of Wilson’s original mats. Another focuses on the ways in which mental health problems are ‘hidden’. Others are inspired by things that help people to cope, including activities such as cycling and the role of the mother. These mats may serve as a useful springboard into a conversation between service users and mental health professionals.
How did we let it come to this? A plea for the principle of continuity of care
- Author:
- LODGE George
- Journal article citation:
- Psychiatrist (The), 36(10), October 2012, pp.361-363.
- Publisher:
- Royal College of Psychiatrists
Caring for patients in the community has resulted in new challenges. To be effective, different professional disciplines need to work together, each providing their unique contribution but also coordinating their work and communicating with each other as part of a community team. National Health Service Trusts providing mental health services have found themselves required to provide a range of services: crisis and home treatment, assertive outreach and early intervention. This editorial argues that the administrative imposition of new specialised models of psychiatric care in the community has led to the fragmentation of services and a deteriorated experience for both service users and professionals. It makes a plea for psychiatrists to reassert the principle of continuity of care, which has been all but lost from the practice of psychiatry during the past decade. It considers how things might be done differently, arguing that it is possible to meet the clinical objectives of necessary support and treatment for service users within the community without the current multiplicity of team structures seen throughout England.
Standards for low secure services
- Author:
- ROYAL COLLEGE OF PSYCHIATRISTS. Quality Network for Forensic Mental Health Services
- Editors:
- TUCKER Sarah, et al
- Publisher:
- Royal College of Psychiatrists' Centre for Quality Improvement
- Publication year:
- 2012
- Pagination:
- 34
- Place of publication:
- London
The Quality Network for Forensic Mental Health Services was launched in 2006 with an initial focus on medium secure services. The Network has developed this third consultation draft of ‘Standards for low secure services’ directly from the ‘Low secure services: good practice commissioning guide: consultation draft’ (Department of Health, February 2012). In addition some standards from the ‘Implementation criteria for recommended specification: adult medium secure units’ (second edition CCQI 105) have been included. These standards have been developed with the purpose of forming the basis of the self- and peer-review questionnaires for the Quality Network for Forensic Mental Health Services’ low secure services self- and peer-reviews. The standards provide an accessible way for services to actively engage in ongoing service development towards implementing the Department of Health recommendations. This report outlines the development of the standards, the model of care, therapeutic and service environments, workforce, governance and equalities issues. (Edited publisher abstract)
‘We’ve got another one for you!’ Liaison psychiatry’s experience of stigma towards patients with mental illness and mental health professionals
- Author:
- BOLTON Jim
- Journal article citation:
- Psychiatrist (The), 36(12), December 2012, pp.450-454.
- Publisher:
- Royal College of Psychiatrists
Within a general hospital there is a risk that prejudicial attitudes towards mental illness held by some members of staff may translate into discriminatory behaviour towards patients with mental illness. Liaison psychiatry workers are well placed to notice this behaviour and any resultant impact on care. This study assessed stigmatising attitudes towards mental illness and psychiatric professionals as experienced by UK liaison psychiatry staff. A questionnaire asked about the impact of these events on patient care and for suggestions for tackling stigma in the general hospital. The total of 72 multidisciplinary respondents was made up of consultants 42%, doctors in training 10%, nursing staff 42%, and others 6%. More than three-quarters of those surveyed had experienced stigmatising attitudes towards mental illness by general hospital colleagues at least once a month. Two-thirds reported instances where stigmatisation had an adverse impact on patient care, and over a quarter reported stigmatising attitudes towards mental health professionals themselves. Suggestions for combating stigma included educational initiatives, clear clinical communication, and the provision of high-quality liaison services. The author believes that liaison psychiatry is well placed to both recognise and combat stigma in the general hospital and so help to ensure that patient care is comprehensive, safe and respectful.
Liaison psychiatry: the way ahead: briefing
- Author:
- NHS CONFEDERATION. Mental Health Network
- Publisher:
- NHS Confederation. Mental Health Network
- Publication year:
- 2012
- Pagination:
- 8p.
- Place of publication:
- London
People with a long-term physical health condition are more than twice as likely to have a mental health problem as the general population. This can have a huge effect on a patient’s chances of recovery; for example, someone with chronic heart failure is eight times more likely to die within 30 months if they also have depression. Liaison psychiatry services provide immediate access to specialist mental health support for people being treated for physical health problems, most often in general hospitals and in some cases, in the community. This reports finds that liaison psychiatry services can save an average hospital £5 million a year by reducing the number and length of admissions to beds. Even bigger savings could be achieved in future if liaison psychiatry services were extended to work in the community to prevent crises from happening at all.
Is adult general psychiatry a pathway to the prison back door?
- Author:
- NEILL Stephen
- Journal article citation:
- Mental Health Today, May 2012, pp.24-29.
- Publisher:
- Pavilion
- Place of publication:
- Hove
There is concern about the high percentage of psychiatrically ill people in prison. Before psychiatric patients have been incarcerated for serious crime in secure units or prison, they have often been assessed for mental illness in general adult acute psychiatric wards. The aim of this study was to investigate whether adult general psychiatry and forensic psychiatry should work together for the better treatment of offenders with mental health problems. The study used anonymised in-depth information derived from electronic records at the South London and Maudsley NHS Foundation Trust. A sample of 542 patients’ files in the adult general psychiatry male ward was examined. The findings showed that 33.8% of these patients were subject to a legal event, from investigation and arrest to imprisonment, during the course of their latest admission. An even larger unspecified number of patients were engaged within the criminal justice system, but their status did not change during the course of admission. Violent conduct in clinical settings, absconding, and the misuse of substances in the course of admission were all linked to criminal conduct. The article concludes that general psychiatry and forensic psychiatry should work together for the better treatment of mentally disordered offenders.
Altering perceptions
- Author:
- SHRUBBS Richard
- Journal article citation:
- Mental Health Today, March 2012, pp.8-9.
- Publisher:
- Pavilion
- Place of publication:
- Hove
In the 1950s and 60s, a raft of research was carried out into psychedelic drugs, such as lysergic acid diethylamide (LSD), psilocybin (a compound found in magic mushrooms), MDMA (ecstasy) and mescaline, which alter cognition and perception, and their potential benefit to people with mental health problems. But at the same time as this research was being carried out, recreational use of psychedelic drugs led to the political view of these drugs being dangerous. As a result, the US banned all uses of psychedelics in 1968, even for research. However, after decades of being seen purely as illegal, the potential for psychedelic drugs to be used as a treatment for mental health problems is being considered once again. A number of studies are taking place that are once again investigating whether psychedelic drugs could have a therapeutic benefit if administered properly. Initial research has shown that MDMA has positive effects on post-traumatic stress disorder and that psilocybins may be able to treat personality disorders. In addition, the fear that psychedelics cause schizophrenia appears to be largely unfounded.