Search results for ‘Subject term:"severe mental health problems"’ Sort:
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Involuntary out-patient commitment: 2-year follow-up
- Author:
- CASTELLS-AULET Laura
- Journal article citation:
- Psychiatrist (The), 37(2), 2013, pp.60-64.
- Publisher:
- Royal College of Psychiatrists
Involuntary out-patient commitment or is a legal intervention designed to benefit persons with serious mental illness who need ongoing psychiatric care and support to prevent relapse but have difficulty following through with community-based treatment. In the UK it is known as a community treatment order. This retrospective-observational study of 91 patients under involuntary out-patient commitment (OPC) evaluated the impact of (OPC) in patients with severe mental disorder who use hospital services in an area of Spain. The psychiatric diagnosis, sociodemographic variables, who requested the court order and for what motive were studied. The study also looked at the use of the available health services (emergency room visits, admissions, average length of hospital stay) for the period beginning 2 years before and ending 2 years after the initiation of the OPC. The number of emergency room visits, admissions and the length of hospitalisation diminished in the 2 years following the initiation of the OPC. In terms of diagnosis, the OPC has the most impact on individuals with schizophrenia and delusional disorder. (Edited publisher abstract)
We are family
- Author:
- JACKSON Catherine
- Journal article citation:
- Mental Health Today, September 2006, pp.14-15.
- Publisher:
- Pavilion
- Place of publication:
- Hove
This article profiles Staying Out, winner of the NIMHE positive practice award for promoting independence. The service aims to help people with long-term mental health problems stay out of hospital. It comprises of a number of small, user-led support groups which are facilitated (but not led) by a member of staff which meet for two hours per week to talk, go out or to stay in..
Automated telehealth for managing psychiatric instability in people with serious mental illness
- Authors:
- PRATT Sarah I., et al
- Journal article citation:
- Journal of Mental Health, 24(5), 2015, pp.261-265.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Background: Serious mental illness (SMI) with psychiatric instability accounts for disproportionately high use of emergency room visits and hospitalizations. Aim: To evaluate the effectiveness of an automated telehealth intervention supported by nurse health care management for improving psychiatric illness management and reducing acute service use among individuals with SMI and psychiatric instability. Methods: Thirty-eight individuals with SMI received the automated telehealth intervention for 6 months. Psychiatric symptoms, illness self-management, and self-reported service use (emergency room visits and hospital admissions) were collected at baseline, 3- and 6-months. Measures of quality of life, health indicators, and subjective health status were also collected. Results: Participants demonstrated improvements in self-reported psychiatric symptoms and illness self-management skills, an 82% decrease in hospital admissions (from 76 to 14 hospitalizations, p < 0.001) and a 75% decrease in emergency room visits (from 63 to 16 visits, p < 0.001). Improvements were also observed in quality of life, severity of depressive symptoms, and mental health status. Conclusion: These highly promising findings support the use of an automated telehealth device monitored by a nurse care manager for people with SMI, and highlight the potential for cost savings through reductions in acute health care utilisation. (Publisher abstract)
A 10-year service evaluation of an assertive community treatment team: trends in hospital bed use
- Authors:
- SOOD Loopinder, OWEN Andy
- Journal article citation:
- Journal of Mental Health, 23(6), 2014, pp.323-327.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Aims: This study aims to observe the long-term effect of assertive community treatment (ACT) on hospital bed use, incorporating methods of analysis which mitigate against some weaknesses of observational design. Previous studies of assertive community treatment (ACT) have shown various benefits, including reduced hospital bed use. In the UK, this finding was not replicated by randomised controlled trials (RCTs), which lacked fidelity to the model. Conversely, observational studies, while limited by their inherent weakness in implying causality, have shown lower bed use. Against this background many ACT teams are being disestablished in the UK. Methods: Bed use was compared for equal periods of time either side of starting support from an ACT team. Results: Ninety-three people were followed for up to 10.5 years after starting ACT. Hospital bed use was compared for each person, showing a reduction from a mean of 72 d per year prior to ACT to 44 d per year during ACT (p = 0.0018). onclusions: The results demonstrate that ACT is associated with reduced bed use in the UK and that it is possible to use an observational design with enhanced analysis techniques to increase evidence for causality. These techniques may have value in other service evaluations. (Edited publisher abstract)
An audit of admission physical examinations in the settings of medium security
- Authors:
- GALAPPATHIE Nuwan, JETHWA Krishma
- Journal article citation:
- British Journal of Forensic Practice, 9(3), September 2007, pp.15-18.
- Publisher:
- Emerald
This article presents an audit of admission physical examination performed in the setting of medium security. Documentation regarding 16 key items of the admission physical examination was assessed. During the first audit, 51 admission physical examination were assessed, and 50 were assessed on repeat audit. The standard of documentation of the physical examination was poor, and remained poor on re-audit. Of particular concern are ongoing omissions in the neurological examination and poor recording of marks, bruises and injuries.
Use of intensive case management to reduce time in hospital in people with severe mental illness: systematic review and meta-regression
- Authors:
- BURNS Tom, et al
- Journal article citation:
- British Medical Journal, 335(7615), August 2007, pp.336-240.
- Publisher:
- British Medical Association
This review attempts to explain why clinical trials of intensive, multidisciplinary case management for people with severe mental illness produce such inconsistent results on the use of hospital care. Twenty-nine randomised controlled trials provided appropriate data for multivariate meta-regression using mean days in hospital as the dependent variable. The results show that intensive case management works best when trial participants tend to use a lot of hospital care, and less well when their use is already low. Thus the benefits of intensive case management may be marginal in settings where low rates of bed use have already been achieved. The review also indicates that fidelity to the organisational aspects of the assertive community treatment model is associated with greater effectiveness, although the model’s staffing requirements have no measurable impact.
Admission patterns of patients with personality disorder
- Authors:
- DASGUPTA Pritha, BARBER Joan
- Journal article citation:
- Psychiatric Bulletin, 28(9), September 2004, pp.321-323.
- Publisher:
- Royal College of Psychiatrists
The aim was to examine the prevalence and admission patterns of patients with personality disorder admitted to a Scottish general adult psychiatry service. We carried out a retrospective case-note study of patients identified from the computerised patient administration system. A subgroup of patients was identified as having a longer in-patient stay. Their admission pattern over the preceding 4 years was studied further. Sixty-two of 844 patients admitted had personality disorder. Thirty-nine had a primary diagnosis of personality disorder, 19 had an additional diagnosis of psychiatric disorder and 12 of alcohol or substance misuse. Within the subgroup admitted for longer in 2001, patterns of few/brief and numerous/often lengthy admissions were noted in earlier years. Personality disorder occurs in approximately 7% of admissions to general adult psychiatry beds. Many have additional diagnoses of psychiatric disorder, or substance or alcohol misuse further complicating their treatment.
Changes in the use of the Mental Health Act 1983 in England 1984/85 to 2015/16
- Authors:
- KEOWN Patrick, et al
- Journal article citation:
- British Journal of Psychiatry, 213(4), 2018, pp.595-599.
- Publisher:
- Cambridge University Press
Background: Concerns have been raised about the increase in the use of involuntary detentions under the Mental Health Act in England over a number of years, and whether this merits consideration of legislative change. Aims: To investigate changes in the rate of detentions under Part II (civil) and Part III (forensic) sections of the Mental Health Act in England between 1984 and 2016. Method: Retrospective analysis of data on involuntary detentions from the National Archives and NHS Digital. Rates per 100 000 population were calculated with percentage changes. The odds of being formally admitted to a National Health Service hospital compared with a private hospital were calculated for each year. Results: Rates of detention have at least trebled since the 1980s and doubled since the 1990s. This has been because of a rise in Part II (civil) sections. Although the overall rate of detentions under Part III (forensic) sections did not rise, transfers from prison increased and detentions by the courts reduced. The odds of being detained in a private hospital increased fivefold. Conclusions: The move to community-based mental health services in England has paradoxically led to an increase in the number of people being detained in hospital each year, and in particular an inexorable rise in involuntary admissions. This is likely to be partly because of improved case finding with an increased focus on treatment and risk management, and partly because of changes in legislation. An increasing proportion of this government-funded care is being provided by private hospitals. (Publisher abstract)
Mental Health Act: the rise in use of the MHA to detain people in England
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2018
- Pagination:
- 27
- Place of publication:
- Newcastle upon Tyne
This review looks at the rise in use of the Mental Health Act (MHA) to treat people in hospitals and gathers the views of patients, carers and staff on the possible reasons for this increase. The review involved site visits to NHS trusts, independent mental health service providers and local authorities; and engagement with service users. It identifies four areas that that might influence the rates of detention across four broad groups: changes in mental health service provision and bed management, including more frequent re-admissions and loss of specialist community teams; demographic and social change; legal and policy developments influencing practice; and data reporting and data quality. The report also includes examples of what sites have done to monitor the impact of the MHA, counter the rising rates of detention and use information about the MHA to improve services for patients. It concludes there is no single cause for the rise in rates of detention. It argues that action is needed to address underlying problems and that reform of mental health legislation on its own is unlikely to reduce the rate of detention. (Edited publisher abstract)
Outcomes of FLEXIBLE assertive community treatment (FACT) implementation: a prospective real life study
- Authors:
- NUGTER M. Annett, et al
- Journal article citation:
- Community Mental Health Journal, 52(8), 2016, pp.898-907.
- Publisher:
- Springer
This study aimed to investigate social and clinical outcomes and use of care during and after implementation of FLEXIBLE Assertive Community Treatment (ACT). Three teams and 372 patients were involved. Model fidelity, clinical and social assessments were performed at baseline and after 1 and 2 years. Use of care was registered continuously. Model fidelity was good at the end of the study. Data showed much variation between patients in number and duration of ACT periods. Statistically significant improvements were found in compliance, unmet needs and quality of life. Improvement of quality of life and functioning was related to duration of ACT. The percentage of remissions increased with 9 %. The number of admissions, admission days and face to face contacts differed between ACT and non-ACT patients, but generally decreased. Findings suggest that implementation of FACT results in a more flexible adaptation of care to the needs of the patients. (Publisher abstract)