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Utilising Team Recovery Implementation Plan (TRIP): embedding recovery-focused practice in rehabilitation services
- Author:
- ACHER Geraldine
- Journal article citation:
- Mental Health and Social Inclusion, 21(4), 2017, pp.240-247.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide an account of Central and North West London NHS Foundation Trust Mental Health Rehabilitation Services’ experience of utilising Team Recovery Implementation Plan (TRIP) as a framework to embed recovery-focused practice. The paper explores the challenges to creating recovery-focused services in inpatient settings and sets out how using TRIP has enabled frontline staff to work in partnership with people who use services and coproduce changes in practice and service development. Design/methodology/approach: The paper draws on the process of utilising TRIP as a methodology to embed recovery-focused practice. Findings: The account finds that using TRIP as a framework to embed recovery-focused practice supports frontline staff to work in partnership with people who use services and share responsibility for delivering recovery-oriented services, measure progress and drive change. Originality/value: The paper provides an informative account of implementing TRIP as a framework to embed recovery-focused practice in mental health rehabilitation services. It explores the challenges faced by services in creating recovery-focused services and sets out how the TRIP has been used by teams as a methodology for coproducing, co-delivering and co-reviewing action plans. The paper gives practical examples of keeping the TRIP process alive and identifies several changes to practice and service developments achieved since TRIP’s implementation. (Publisher abstract)
Probability and loss: two sides of the risk assessment coin
- Authors:
- LARGE Matthew M., NIELSSEN Olav B.
- Journal article citation:
- Psychiatrist (The), 35(11), November 2011, pp.413-418.
- Publisher:
- Royal College of Psychiatrists
Risk assessment in mental health settings aims to prevent harms such as violence to others and suicide; currently it is mainly concerned with the probability of adverse events. The authors believe this results in the other component of risk, the resulting loss, receiving little attention. This discussion paper examines the concepts involved in risk assessment and the extent to which risk assessment, in particular actuarial risk, can assist clinicians in the everyday task of balancing the risk of various forms of harm and the costs of interventions designed to reduce or prevent them. Although assessments based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The authors believe that the inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. They suggest that for this reason risk assessment can only make a very limited contribution to clinical decision making and decisions should be made as in other areas of medicine, by informed consideration of the potential consequences of treatment and non-treatment.
A survey of older adult patients in special secure psychiatric care in Scotland from 1998 to 2007
- Authors:
- LIGHTBODY Elizabeth, GOW Rona L., GIBB Robert
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 21(6), December 2010, pp.966-974.
- Publisher:
- Taylor and Francis
One area in which the needs of older adults may not be being met is in the field of forensic psychiatry. The aim of this survey was to gather information about the number and the needs of older adult patients in special secure forensic psychiatry care in Scotland. Inpatients of The State Hospital, Carstairs aged 55 or over throughout a 10-year period were included. Thirty-six patients were identified: 22 reached the age of 55 during their admission, and 14 were new admissions after the age of 55. This population has heterogeneous and complex needs. The most common diagnoses are of psychotic illnesses. Most patients are admitted from other secure psychiatric facilities or prison and the duration of admission is long. There are high rates of physical illness, mobility impairment, sensory impairment and polypharmacy. Offences tend to be at the severe end of the spectrum, including homicide, sexual offences and other violent offences. Most patients are single males and socioeconomic classes IV and V are over-represented. The article concludes that, given the complex needs of older mentally disordered offenders, their management would benefit from old age and forensic mental health services jointly working together.
Mental disorder and voting
- Authors:
- SMITH Helen, HUMPHREYS Martin
- Journal article citation:
- Journal of Forensic Psychiatry, 9(2), September 1998, pp.447-451.
- Publisher:
- Routledge
An individual needs only to have his or her name on the electoral register to be eligible to vote in this country. Prior to 1983 individuals with mental disorder were excluded from voting altogether. Discusses how curious anomalies in the law continue to prevent certain groups from exercising this right. Argues that mental health care provision has changed since the introduction of the law, which is now outdated and in need of urgent reform.
Carer support and involvement in secure mental health services: a toolkit
- Publication year:
- 2018
- Pagination:
- 53
- Place of publication:
- London
This toolkit provides information on how carers of people who use secure mental health services should be engaged with, supported, involved and empowered. Based on research findings, it has been in partnership with The University of Central Lancashire (UCLAN) and co-produced with professionals, carers and users of services. It covers involving carers in: assessment before admission; admission to secure care; care in secure services; transition between different levels of security; preparation for discharges; and in service planning and design. The toolkit includes links to additional resources, practice examples and advice that will support staff, commissioners, providers and carers. It highlights what carers should expect from services and can also be used to improve how commissioners and providers can engage and involve carers. (Edited publisher abstract)
Co-producing formulation within a secure setting: a co-authorship with a service user and the clinical team
- Authors:
- LEWIS-MORTON Ruth, et al
- Journal article citation:
- Mental Health and Social Inclusion, 21(4), 2017, pp.230-239.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the process of co-producing a formulation alongside a service user and the clinical team within a secure inpatient service. This paper has been co-authored by the service user and members of the multi-disciplinary team (MDT). Design/methodology/approach: An open-ended focus group discussion was facilitated with the service user and members of her MDT. The process of thematic analysis was applied to the focus group transcript. Findings: The following themes highlighted important outcomes of co-producing a formulation within a secure inpatient setting; “Meaningful Collaboration”, “Co-Produced Understanding” and a “Shift in Power Differential”. This paper demonstrates the importance of meaningful co-production within a secure inpatient service whilst also highlighting the challenges and tensions of working in a co-produced way within this context. Research limitations/implications: This paper explores the process of co-producing and developing a formulation from the perspective of one service user and their MDT within a secure inpatient setting. It would be unhelpful to extrapolate broad assumptions from this case study although this study does raise important considerations for future research and encourages an emphasis on a co-produced design and dissemination. Practical implications: This case study highlights the importance of co-production in clinical endeavours, service delivery and development perspectives and in the dissemination of this information. Originality/value: The importance of co-producing and co-authoring alongside service users have been highlighted in this paper. This approach to co-production and co-authorship is highly recommended in future research endeavours. (Publisher abstract)
Long-stay rehabilitation services: briefing
- Author:
- WRIGHT Emily M.
- Publisher:
- Centre for Mental Health
- Publication year:
- 2017
- Pagination:
- 15
- Place of publication:
- London
Based on a review of Care Quality Commission (CQC) inspection reports and interviews with experts, this briefing summarises the issues facing mental health rehabilitation services in England, which provide intensive or longer-term support for people with severe mental problems. It explores the people involved, the type and costs of services, and the way they have evolved over the last twenty years. The briefing raises concerns about long-stay rehabilitation. These include a lack of appropriate local provision of inpatient rehabilitation services, which result in out of area placements and a risk of isolation and dislocated from their local health and care services. It also found that some people are kept in services of a higher intensity than is necessary due to a lack of community services, which restricts and individuals’ independence and increases costs. A lack of oversight and regulation processes which focuses on services rather than the individual mean that some people face longer stays in inpatient services that are necessary. The paper makes a number of recommendations, including: for the Government and the NHS to provide direction for the development of local community and hospital services for people with complex mental health needs; NHS providers and clinical commissioning groups to offer local services to people requiring rehabilitation support; and for NHS providers and clinical commissioning groups maintain contact with people admitted to hospitals out of their local area. (Edited publisher abstract)
Inpatient groups: working with staff, patients and the whole community: personal reflections of a group analyst
- Author:
- HARRIS Bob
- Journal article citation:
- Groupwork, 17(1), 2007, pp.45-56.
- Publisher:
- Whiting and Birch
In this paper the author shares with the reader his reflections on running inpatient groups. He provides two detailed case studies of his groupwork. The first, took place in a traditional asylum in the early 1980s. The second was a more contemporary group, which took place in a hospital secure unit. Both case studies illustrate the importance of gaining the support of the ward team, including doctors and nurses, in establishing and maintaining a groupwork culture. He illustrates how groupwork can help individuals with serious mental disorders through exploration, reflection and acceptance. He ends by making a plea for using groupwork to cope with wider societal changes.
Religion, spirituality and personal recovery among forensic patients
- Authors:
- GLORNEY Emily, et al
- Journal article citation:
- Journal of Forensic Practice, 21(3), 2019, pp.190-200.
- Publisher:
- Emerald
Purpose: This paper investigates the role of religion/spirituality in high-secure service users’ personal recovery. Design/methodology/approach: Semi-structured interviews were carried out with 13 male patients in a high-secure hospital, with primary diagnoses of mental illness (n=11) or personality disorder (n=2). Participants were from a range of religious/spiritual backgrounds and were asked about how their beliefs impact their recovery and care pathways within the hospital. Data were analysed using interpretative phenomenological analysis. Findings: Three superordinate themes were identified: “religion and spirituality as providing a framework for recovery”; “religion and spirituality as offering key ingredients in the recovery process”; and “barriers to recovery through religion/spirituality”. The first two themes highlight some of the positive aspects that aid participants’ recovery. The third theme reported hindrances in participants’ religious/spiritual practices and beliefs. Each theme is discussed with reference to sub-themes and illustrative excerpts. Practical implications: Religion/spirituality might support therapeutic engagement for some service users and staff could be more active in their enquiry of the value that patients place on the personal meaning of this for their life. Originality/value: For the participants in this study, religion/spirituality supported the principles of recovery, in having an identity separate from illness or offender, promoting hope, agency and personal meaning. (Edited publisher abstract)
Exploring multi-disciplinary team meetings on a personality-disorder ward within a forensic setting
- Authors:
- LEESE Maggie, FRASER Kim
- Journal article citation:
- Mental Health Review Journal, 24(3), 2019, pp.160-170.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to understand how patients on a low security personality disorder ward experienced multi-disciplinary team (MDT) meetings, in order to suggest improvements that would benefit the patients and clinical teams. Design/methodology/approach: The design was a case study where all patients on a low secure ward that specialised in personality disorders were approached to take part in the research. The study utilised non-participant observations of the MDT meeting (n=11), followed by individual interviews with the patients (n=10). Findings: The data were subjected to a thematic analysis and this illuminated five themes relating to the patients’ experience of the MDT meetings namely, the importance of leave applications, the formality of the meetings, the opportunity to check on progress, decision-making and the importance of communication. Practical implications: The findings suggest that small changes could be made to improve the patients’ experience of the MDT meeting. These included the provision of a less formal setting, ensuring a system where leave can be requested confidentially, greater transparency about the content of progress reports, and clearer communication between the MDT and the patient after the meeting. Originality/value: There is limited research that has explored patients’ experiences of MDT meetings within secure forensic settings, and the use of non-participant observations of the MDT meeting followed by semi-structured interviews meant that the researcher and the patient had a shared experience that formed the basis of the later discussion. (Edited publisher abstract)