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Bartlett, Annie, and Sheila Hollins. "Challenges and mental health needs of women in prison." British Journal of Psychiatry 212, no. 3 (February 28, 2018): 134–36. http://dx.doi.org/10.1192/bjp.2017.42.
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SummaryThe world population of women and girls in prison is increasing. Evidence points to high rates of mental health problems. Approaches to these problems vary and include both psychiatric epidemiology and gender-sensitive understanding and intervention. Prison environments and women prisoners' needs are complex and demand gender-aware care in view of women's vulnerability and histories of trauma.Declaration of interestA.B. was a clinical director of the offender care services at Central and North West London National Health Service (NHS) Foundation Trust until August 2016, with responsibility for several women’s prison healthcare services in London and the South East, and is currently clinical director of NHS England London Health in Justice Clinical Network, paid as a salary one day a week.
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Perry, Aradhana, Chelsea Gardener, Jonathan Dove, Yocheved Eiger, and Kate Loewenthal. "Improving mental health knowledge of the Charedi Orthodox Jewish Community in North London: A partnership project." International Journal of Social Psychiatry 64, no. 3 (February 20, 2018): 235–47. http://dx.doi.org/10.1177/0020764018756935.
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Introduction: This article describes a successful community-based partnership project between statutory and third-sector services targeting the strictly Orthodox Jewish community (OJC). Methods: The City and Hackney Black and Minority Ethnic (BME) Access Service (East London NHS Foundation Trust (ELFT)) collaborated with Bikur Cholim, a local third-sector organisation based in the heart of a north London Charedi OJC, to develop a brief culturally tailored psychoeducational group intervention focusing on mental health promotion and prevention. In total, 34 carers in the Charedi OJC were provided with general information on mental health, the availability of support services and self-care. Results: Overall improvements in well-being, increased intentions to access services, particularly talking therapies, and qualitative feedback indicated that the group was very well received. Conclusion: The project endorses the value of culturally relevant psychoeducation, enabling suggestions for culturally appropriate service development.
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Jones, Amanda. "Clinical commentary by Dr Amanda Jones, Clinical Lead, North East London NHS Foundation Trust, Perinatal Parent Infant Mental Health Service." Journal of Child Psychotherapy 39, no. 2 (August 2013): 234–36. http://dx.doi.org/10.1080/0075417x.2013.806059.
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d'Ardenne, Patricia, Hanspeter Dorner, James Walugembe, Allen Nakibuuka, James Nsereko, Tom Onen, and Cerdic Hall. "Training in the management of post-traumatic stress disorder in Uganda." International Psychiatry 6, no. 3 (July 2009): 67–68. http://dx.doi.org/10.1192/s174936760000062x.
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The aims of this study were to establish the feasibility and effectiveness of training Ugandan mental health workers in the management of post-traumatic stress disorder (PTSD) based on guidelines from the UK National Institute of Health and Clinical Excellence (NICE). The Butabika Link is a mental health partnership between the East London Foundation NHS Trust (ELFT) and Butabika National Psychiatric Referral Hospital, Kampala, Uganda, supported by the Tropical Health Education Trust (THET), and based on the recommendations of the Crisp report (Crisp, 2007). The Link has worked on the principle that the most effective partnership between high-income and low- or middle-income countries is through organisations already delivering healthcare, that is, through the support of existing services. Butabika Hospital is a centre of excellence, serving an entire nation of 30 million people, many of them recovering from 20 years of armed conflict that took place mainly in the north of Uganda. In addition, Uganda has received refugees from conflicts in neighbouring states, including Congo, Rwanda, Kenya, Sudan and Burundi. The Ugandan Ministry of Health's Strategic Plan (2000) has prioritised post-conflict mental disorders and domestic violence, which is reflected in the vision of the Link's work.
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Schmidt, Martin, and Timothy Leung. "GMC training survey and missing trainees in psychiatry." BJPsych Open 7, S1 (June 2021): S155. http://dx.doi.org/10.1192/bjo.2021.433.
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AimsTo investigate the extent of misattributed responses in the General Medical Council (GMC) National Training Surveys (NTS).BackgroundAs part of its role in quality assurance of medical training, the GMC conducts an annual survey of trainers and trainees. Benchmarking of trusts’ performance is indicated by red flags denoting outlying poor performance. The validity of this depends on the correct attribution of responses to trusts. We have previously found that responses for Foundation Year One (FY1) trainees undertaking psychiatry placements were misattributed to trainees’ affiliated acute trusts (AT), even though the mental health trusts (MHT) were providing the training placements.MethodData from the online reporting tool were used to calculate the numbers of FY1, Foundation Year Two (FY2), and General Practice Speciality trainees (GPST) on psychiatry placements attributed to ATs and MHTs in 2019. A range is provided for the data, as results for trusts with one or two trainees are not reported. The data were analysed by training level and the 13 Health Education England (HEE) regions to give a proportion of trainees missing from the MHT data (% missing), an indication of response misattribution.Result296-302 FY1s were attributed to MHTs and 114-148 to ATs, giving a % missing of 27.4-33.3%. 261-275 FY2s were attributed to MHTs and 89-125 to ATs, giving a % missing of 24.4-30.0%. 507-511 GPSTs were attributed to MHTs and 49-73 to ATs, giving a % missing of 8.8-12.6%.Across the three training levels, all HEE regions were affected by data misattribution. The regions most affected were South London, Kent Surrey Sussex, and North West London, with missing % of 51.6-54.3%, 33.9-40.7% and 29.9-32.5% respectively. The HEE regions least affected were East Midlands, North Central and East London, and East of England, with missing % of 4.3-6.0%, 5.6-8.1% and 5.5-10.4% respectively.ConclusionResponse misattribution for psychiatry placements in the NTS is rife, with the greatest impact on FY1s. While this issue affects all HEE regions, wide variation exists. Response misattribution means that the calculation of outliers is based on incomplete data, threatening the validity of the results. By liaising with our local HEE office to ensure correct attribution of our trainees, Surrey and Borders Partnership NHS Foundation Trust reduced our % missing from 50.0-56.8% in 2018 to 5.4-10.1% in 2019, thus proving that it is possible to remedy the situation on a local level.
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Gez, Mehmet, and Guang Xu. "Improving training and support by improving our out of hours handover, Central and North West London NHS Foundation Trust." BJPsych Open 7, S1 (June 2021): S187—S188. http://dx.doi.org/10.1192/bjo.2021.507.
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AimsDuring out of hour handovers at St Charles Hospital – the two duty SHO (senior house officers) cover on site, whereas the on-call registrar and consultant are available to contact by phone. Some trainees may experience difficulties in contacting their seniors for support, or may not feel comfortable doing so. Trainees may also feel like they would benefit from being more informed of the hospital situation, or added learning and educational opportunities from the shift. The aim of this project was to improve the out of hours support for the on-call SHOs – which we hope to have positive short (such as improving confidence and performance) - and longer-term impacts (improving retention in the deanery and specialty).MethodThe project proposed instating a 15-minute Zoom call at the start of each night shift (9:30pm) which involved the on-call team (SHOs, registrar, consultants and ideally bed managers). Firstly – a survey monkey questionnaire was sent to trainees to gain a baseline on how supported/informed/ease and learning opportunities for that shift. The project then piloted three separate Plan Do Study Act cycles of change and collected feedback from trainees after each cycle. Both qualitative feedback and quantitative feedback from trainees were collected in the Likert scale format after each PDSA cycle.ResultResults showed that a key benefit of this call is that any pressing issues can be brought up and addressed. Furthermore, for the benefit of the trainees, generally trainees felt more supported whilst they are on call, and got to know the fellow on call team. In addition, trainees reported feeling more at ease when calling their senior colleagues.ConclusionIt is particularly important for doctors to feel supported and informed during their on call shift, especially in the current climate, where there are fast changes and adaptations taking place due to the pandemic. By adding a short meeting at the beginning of each night shift, doctors in the hospital demonstrated an increase in feeling supported, informed and having educational opportunities during their on call shifts. In the long term, by addressing on call issues and making trainees feel more confident and supported during their shift, is likely to benefit and improve recruitment and retention.
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Asthana, Sheena, Alex Gibson, Trevor Bailey, Graham Moon, Paul Hewson, and Chris Dibben. "Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation." Health Services and Delivery Research 4, no. 14 (April 2016): 1–712. http://dx.doi.org/10.3310/hsdr04140.
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BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Singh, Kirit, Fatima Ghazi, Rebecca White, Benedicta Sarfo-Adu, and Peter Carter. "Improving access to Early Intervention in Psychosis (EIP): the 2-week wait for cancer comes to psychosis." BMJ Open Quality 7, no. 3 (August 2018): e000190. http://dx.doi.org/10.1136/bmjoq-2017-000190.
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Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a ‘parity of esteem’ between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team’s performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.
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Baillie, Dave, Jed Boardman, Tom Onen, Cerdic Hall, Maia Gedde, and Eldryd Parry. "NHS links: achievements of a scheme between one London mental health trust and Uganda." Psychiatric Bulletin 33, no. 7 (July 2009): 265–69. http://dx.doi.org/10.1192/pb.bp.108.019406.
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SummaryThis paper describes a link between a mental health trust (the East London Foundation Trust (ELFT)) in the UK and mental health services in Uganda which has developed since 2004. the aim of the link was to help support the development of mental health services in Uganda by establishing an educational partnership. During the first 3 years, nine staff from ELFT and nine staff from Butabika, from a variety of disciplines, have made short-term exchange visits. Evaluation of the link has demonstrated that benefits have been experienced in both London and Uganda. Such links can provide one way of strategically supporting and strengthening existing health services in low- and middle-income countries.
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Shah, Amar, Auzewell Chitewe, Emma Binley, Forid Alom, and James Innes. "Improving access to services through a collaborative learning system at East London NHS Foundation Trust." BMJ Open Quality 7, no. 3 (July 2018): e000337. http://dx.doi.org/10.1136/bmjoq-2018-000337.
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Early intervention following initial referral into healthcare services can have a significant impact on the prognosis and outcomes of patients. Long waiting times and non-attendance can have an immediate and enduring negative impact on patients and healthcare service providers. The traditional management options in reducing waiting times have largely revolved around setting performance targets, providing financial incentives or additional resourcing. This large-scale quality improvement project aimed to reduce waiting times from referral to first appointment and non-attendance for a wide range of services providing primary and secondary care mental health and community health services at East London NHS Foundation Trust (ELFT). Fifteen community-based teams across ELFT came together with the shared goal of improving access. These teams were diverse in both nature and geography and included adult community mental health teams, child and adolescent mental health services, secondary care psychological therapy services, memory services, a musculoskeletal physiotherapy service and a sickle cell service. A collaborative learning system was developed to support the teams to come together at regular intervals, share data, test and scale-up ideas through quality improvement and have access to coaching from skilled improvement advisors in the ELFT central quality improvement team. Over the course of the 2-year project, waiting time from referral to first face-to-face appointment reduced from an average of 60.6 days to 46.7 days (a 23% reduction), non-attendance at first face-to-face appointment reduced from an average of 31.7% to an average of 20.5% (a 36% reduction), while referral volume increased from an average of 1021 per month to an average of 1280 per month (a 25% increase).
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Baillie, Dave, Mariam Aligawesa, Harriet Birabwa-Oketcho, Cerdic Hall, David Kyaligonza, Richard Mpango, Moses Mulimira, and Jed Boardman. "Diaspora and peer support working: benefits of and challenges for the Butabika–East London Link." BJPsych. International 12, no. 01 (February 2015): 10–13. http://dx.doi.org/10.1192/s2056474000000064.
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The International Health Partnership (‘the Link’) between the East London NHS Foundation Trust and Butabika Hospital in Uganda was set up in 2005. It has facilitated staff exchanges and set up many workstreams (e.g. in child and adolescent psychiatry, nursing and psychology) and projects (e.g. a peer support worker project and a violence reduction programme). The Link has been collaborative and mutually beneficial. The authors describe benefits and challenges at individual and organisational levels. Notably, the Link has achieved a commitment to service user involvement and an increasingly central involvement of the Ugandan diaspora working in mental health in the UK.
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Basdanis, Georgios, and Cormac Fenton. "Improving patient waiting times and quality of care by arranging access to notes from a neighbouring trust." BJPsych Open 7, S1 (June 2021): S175—S176. http://dx.doi.org/10.1192/bjo.2021.478.
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AimsWe aim to improve waiting times in the Emergency Department and improve the overall quality of care of out-of-area patients by arranging for the liaison team to have access to the electronic notes system of a neighbouring trust.MethodSt Thomas’ Hospital is located in south London, right opposite the City of Westminster. As a result, approximately 20% of patients we see in mental health liaison are from that locality. Given that they belong to a different trust, we do not have access to their notes, which leads to a delay in trying to establish whether they are known to local mental health services. Often, staff are reluctant to divulge information. When information is shared, it is often late and/or incomplete. We approached the Chief Clinical Information Officer and Head of Information Governance from Central and North West London (CNWL) NHS Foundation Trust. We held weekly meetings which included both IT departments. Our IT had to install the electronic notes application (SystmOne) on our computers and open relevant firewall ports. The information is access through an NHS Smartcard, therefore CNWL had to authorise read-only Smartcard profiles for every member of the liaison team. A quick reference guide was created for all staff that would be using the new application. The system went live on 21 January 2021.ResultWe audited patient outcomes in December 2020 and February 2021 for initial comparison. In December 2020, the median time from referral to discharge was 6 hours 35 minutes. 25% of patients were admitted and 17% discharged with HTT. In February 2021, the median time from referral to discharge was 3 hours 19 minutes. 16% of patients were admitted and 5% discharged with HTT.ConclusionIt is likely that by reducing the time required for collateral information, overall waiting times in the emergency department will be reduced. Clinicians are likely to feel more confident in their discharge planning if they have access to all clinical notes and previous risk assessments, which might in turn reduce referrals to HTT or admission. There should be further attempts by neighbouring NHS trusts, especially in London, to ensure access to their electronic notes system in order to reduce waiting times and improve the quality of patient care. We have already been approached for more information by a trust in North London who are interested in establishing access to a neighbouring trust's notes.
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Xia, Grace, and Ahrane Jayakumar. "Prevalence, associated factors and prevention of burnout in psychiatry trainees in Central and North West London NHS Foundation Trust." BJPsych Open 7, S1 (June 2021): S61. http://dx.doi.org/10.1192/bjo.2021.206.
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AimsTo assess burnout, resilience, professional quality of life and coping mechanisms in Central and North West London psychiatry traineesObjectivesTo determine Key factors associated with stress and burnout in workplace Effects of burnout on patient care and doctors Coping mechanisms used by traineesBackgroundBurnout is a well established condition that has been recently reported to affect a third of doctors. Psychiatrists in particular represents a high risk group among doctors for experiencing burnout, alcohol and drug use, posing suicide risk and other forms of work related stress.MethodThe study comprised of a cross sectional questionnaire survey which included measure of stress (General Health Questionnaire), burnout (Maslach Burnout Inventory), and satisfaction with medicine as a career and personality (Big Five). During October to December 2019, core trainee and specialty trainee doctors in CNWL were asked to complete an online survey via emails.ResultWe collected data from 50 CNWL psychiatry trainees. The sample consisted of 20 females (40%) and 30 males (60%). Ages varied from 26–58 years old, with a median age of 28. Core trainees (CT1–3) were recorded as 72% and specialty trainees at 28%.Of those who responded, around half of the trainees (52%) experienced high levels of stress outside of work in their personal life. The most common causes that trainees felt makes psychiatry a stressful profession were violence and fear of violence, limited resources, dealing with confrontational patients, inability to affect systemic change and increasing culture of blame. Around half of respondents (54%) felt that they have experienced burnout but only 26% of respondents knew where to go to find resources to help cope with burnout. Physical exercise and speaking to colleagues were the most common coping mechanisms used by trainees to deal with stress.Free text responses on what can be improved in workplace to enhance a positive experience of work included improving multidisciplinary interactions, easily accessible resources and increasing staffing levels. 74% of respondents felt they continued to care about what happens to patients regardless of working conditions.ConclusionHalf of CNWL trainee doctors who responded have experienced burnout. Some factors associated with stress and burnout in doctors are unique to psychiatry profession. Free text responses were useful in identifying areas for improvement in work places and useful coping mechanisms, which can be used to inform prevention and implement interventions to tackle burnout.
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O'Sullivan, Owen P., Nynn Hui Chang, Day Njovana, Philip Baker, and Amar Shah. "Quality improvement in forensic mental health: the East London forensic violence reduction collaborative." BMJ Open Quality 9, no. 3 (September 2020): e000803. http://dx.doi.org/10.1136/bmjoq-2019-000803.
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Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT). It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways. The contributing factors are varied and complex. Several factors differentiate the forensic setting, which has been identified as a particularly stressful work environment. Staff must constantly balance addressing therapeutic needs with robust risk management in a complex patient cohort. ELFT identified reducing inpatient physical violence on mental health wards as a major quality improvement (QI) priority. The aim was to use a QI methodology to reduce incidents of inpatient violence and aggression across two secure hospital sites by at least 30% between July 2016 and March 2018. Collaborative learning was central to this project. It sought to foster a culture of openness within the organisation around violence and to support service users and staff to work together to understand and address it. A QI methodology was applied in medium and low secure inpatient settings. A change bundle was tested for effectiveness, which included: safety huddles, safety crosses and weekly community safety discussions. Operational definitions for non-physical violence, physical violence and sexual harassment were developed and used. Reductions of 8% and 16.6% in rates of physical and non-physical violent incidents, respectively, were achieved and sustained. Compared with baseline, this equated to one less incident of physical and 17 less of non-physical violence per week averaged across seven wards. Three wards achieved at least a 30% reduction in incidents of physical violence per week. Five wards achieved at least a 30% reduction in incidents of non-physical violence per week. This collaborative brought significant improvements and a cultural shift towards openness around inpatient violence.
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Shepherd, Neil, Caroline Parker, and Nawal Arif. "Pattern of rapid tranquillisation and restraint use in a central London mental health service." Journal of Psychiatric Intensive Care 11, no. 02 (July 31, 2014): 78–83. http://dx.doi.org/10.1017/s1742646414000156.
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AbstractRapid tranquillisation (RT) aims to quickly calm the severely agitated patient, in order to reduce the risk of imminent and serious violence to self or others. While it is widely used within mental health care settings, there is little published information on patterns of practice. Retrospective data collection identified a total of 2267 incidents of RT within the Central and North West London NHS Foundation Trust over a 19 month period equating to a mean frequency of approximately four incidents per day. These incidents mainly occurred in acute inpatient services and two and a half times more frequently in PICUs than on open wards. Of all the PICUS, the female PICU used most RT. Intramuscular RT was reported more often in most services. Restraint was used in 57% (n=1300) of RT incidents and minor injury resulted in only 11% of these incidents overall. There were no reports of major injury or death in the data set. Variations in RT use were seen across the Trust’s geography and ward types.
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Thompson, Susan, and Stuart Marchant. "“Hospital” Treatment Further Refined." International Journal of Mental Health and Capacity Law 1, no. 13 (September 5, 2014): 191. http://dx.doi.org/10.19164/ijmhcl.v1i13.182.
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<p>R (on the application of CS) v Mental Health Review Tribunal; Managers of Homerton Hospital (East London and the City Mental Health NHS Trust) (Interested Party)</p><p>Queen’s Bench Division, (Administrative Court), Pitchford J., 6 December 2004</p><p>EWHC (Admin) 2958</p><p><em>The decision of a Mental Health Review Tribunal under section 72(1) Mental Health Act 1983 not to discharge a patient on section 17 leave from hospital was not unlawful. The link between hospital and treatment may be “gossamer thin” but still a “significant component” to justify renewal of detention</em></p>
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Hewitt, David. "Detention of a recently-discharged psychiatric patient." International Journal of Mental Health and Capacity Law, no. 6 (September 8, 2014): 50. http://dx.doi.org/10.19164/ijmhcl.v0i6.357.
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<p>R v East London & the City Mental Health NHS Trust and David Stuart Snazell, Approved Social Worker, ex parte Count Franz Von Brandenburg<br />Court of Appeal, 21 February 2001, The Master of the Rolls, Buxton LJ and Sedley LJ<br />[2001] 3 WLR 588</p><p>Although it was unnecessary to show a change in circumstances following discharge by a MHRT, it would be difficult for an ASW to be satisfied that a fresh application for detention, made within days of detention, ought to be made</p>
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Chester, L., T. Barry, M. Fernando, and M. Bhat. "Why a multidisciplinary workforce needs a multidisciplinary education team: Our experiences of providing integrated training in a community and mental health service." European Psychiatry 41, S1 (April 2017): s894. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1822.
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IntroductionNorth East London NHS Foundation Trust (NELFT) provides an extensive range of integrated community and mental health services for people living in London serving a population of 1.5 million people. With an annual budget of £325 million NELFT is one of the largest community service providers in the United Kingdom (UK). NELFT is responsible for the education and training of the entire workforce and in August 2016, it employed a nurse fellow to work with the medical education fellows so it could focus on multidisciplinary team (MDT) teaching.Objectives(1) Providing MDT teaching by delivered by a MDT medical education team.(2) Improving the training experience of all trainees, nurses and allied health professionals in NELFT.(3) Improving physical health knowledge for mental health staff.(4) Improving mental health knowledge of physical health staff.MethodsTwo psychiatrists and one nurse manager worked together on joint projects to deliver the MDT teaching. Teaching sessions where at least one psychiatrist and nurse manager delivered teaching on serious incidents affecting patient care, identification and management of sepsis in community settings and empathy training using an old age simulation suit.ResultsMultiple teaching sessions were delivered to MDTs within the Trust. Staffs were receptive to learning in MDTs rather than traditional splits according to professions. Due to the success of this teaching and the reputation of the medical education team, neighboring Trusts have expressed an interest in working in partnership with the team to further enhance teaching and learning in acute and community settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Staite, Emily, Lynne Howey, Clare Anderson, and Paula Maddison. "How well do children in the North East of England function after a crisis: a service evaluation." Mental Health Review Journal 26, no. 2 (February 11, 2021): 161–69. http://dx.doi.org/10.1108/mhrj-09-2020-0065.
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Purpose Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.
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Hewitt, David, and Kristina Stern. "Re-detention after a tribunal discharge – the last word?" International Journal of Mental Health and Capacity Law 1, no. 10 (September 4, 2014): 75. http://dx.doi.org/10.19164/ijmhcl.v1i10.148.
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<p><em> R v East London and the City Mental Health NHS Trust and another, ex parte von Brandenburg (aka Hanley) [2003] UKHL 58</em></p><p><em>House of Lords (13 November 2003). Lord Bingham; Lord Steyn; Lord Hobhouse of Woodborough; Lord Scott of Foscote; Lord Rodger of Earlsferry</em></p><p>A psychiatric patient who has been recently discharged from detention may be lawfully re-detained where the relevant ASW forms the reasonable and bona fide opinion that he or she has information not known to the tribunal that puts a significantly different complexion on the case.</p>
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Ryland, H., T. Exworthy, G. Shaun, A. Khan, and R. Lynne. "Evaluation of a court liaison and diversion service in London over a quarter of a century." European Psychiatry 41, S1 (April 2017): S591. http://dx.doi.org/10.1016/j.eurpsy.2017.01.905.
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IntroductionOxleas NHS Foundation Trust has run a Court Diversion Service in South East London since 1991. It provides services for people within the earlier stages of the Criminal Justice System.ObjectivesThis evaluation aims to combine data from across the 25-year period since the introduction of the diversion scheme. It seeks to provide a longitudinal picture to elucidate the impact of service changes during this time.MethodsThe evaluation uses data obtained from a variety of sources for four points in time: 2015/2016, 2011, 1999 and 1991. Data across domains was collated to allow longitudinal analysis.ResultsAfter the initial introduction of the scheme in 1991, the total mean time on remand was noted to drop from 67.1 days to 49.5 days (P < 0.001). There were 280 referrals over 18 months in 1991, 210 per year in 1999, 190 in 2011 and 174 between April 2015 and March 2016. Violent crimes increased from 29% in 1991 to 47% in 2011. The proportion with schizophrenia decreased from 31% in 1991 to 18% in 1999, before increasing again to 25% in 2011. The use of Section 37 hospital order disposal decreased from 15% in 1991 to just 4% in 2011.ConclusionsThe court diversion scheme has produced significant benefits since it was introduced in 1991, despite a rise in the proportion of violent alleged offences. Changes to the service have seen decreased use of hospital orders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Singh, Dhananjay Kumar, Shakil Khawaja, Ishaq Pala, Jaleel Khaja, Ray Krishnanu, Heather Walker, and Julian Bustin. "Awareness of the cost of psychotropic medication among doctors: a service evaluation." Psychiatrist 34, no. 9 (September 2010): 364–66. http://dx.doi.org/10.1192/pb.bp.109.026914.
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Aims and methodCost-effective prescribing is an increasingly important aspect of our practice. A service evaluation was carried out to assess the level of awareness and knowledge of different aspects of cost-effective prescribing among doctors working in the North East London Foundation Trust. A semi-structured questionnaire was used to benchmark knowledge against six standards.ResultsThe survey was completed by 71% of doctors working in adult or old age psychiatry. A total of 2% of doctors stated that they should always take into consideration the price of the drug when prescribing and only 5% of doctors claimed to know the price of medications they prescribe most frequently.Clinical implicationsStrategies to improve the poor level of knowledge and awareness in this area of clinical practice would be of benefit in making the best use of limited financial resources without any detriment to patient care.
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Vacher, Geraldine. "Utilising Team Recovery Implementation Plan (TRIP): embedding recovery-focused practice in rehabilitation services." Mental Health and Social Inclusion 21, no. 4 (August 14, 2017): 240–47. http://dx.doi.org/10.1108/mhsi-03-2017-0008.
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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.
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Mead, John. "Psychiatric patient who trespassed onto tube line not victim of negligence: G v Central and North West London Mental Health NHS Trust (High Court, 19/10/07 – Swift J)." Clinical Risk 14, no. 4 (July 2008): 163–64. http://dx.doi.org/10.1258/cr.2008.080039.
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Sukhwal, Seema, Claire Gordon-Ellis, and Luneta Tajblova. "Audit of delays in the diversion of mentally disordered defendants under the Mental Health Act 1983/2007 at a liaison and diversion service in North West London." BJPsych Open 7, S1 (June 2021): S352—S353. http://dx.doi.org/10.1192/bjo.2021.932.
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AimsTo ascertain the length of time defendants wait for a Mental Health Act assessment (MHAA) and where necessary, how long they are waiting for a hospital bed.BackgroundThe Liaison and Diversion Service in North West London (the Service) is provided by Central North West London Foundation NHS Trust (CNWL), Barnet Enfield Haringey (BEH) and Together to Willesden Magistrates Court in North West London.One of the core activities of the Service is diverting individuals from the criminal justice system to hospital under the Mental Health Act (MHA).The Code of Practice allows for a period of 14 days between the medical recommendation and conveyance to hospital. Defendants needing admission under MHA are remanded to custody if a bed is not available. This prevents them from receiving the assessment and care they need. We consider that all defendants found to be liable to detention under the MHA should be admitted to a hospital bed on the same day.MethodData were collected between October 2018 and February 2019. All patients referred for a MHAA were included. The time a MHAA was requested, took place as well as how long the defendant waited for a bed was noted.ResultA total of 42 MHAA were requested. 25 individuals were detained under Section 2 of the MHA 1983.The time between referral for a MHAA and the MHAA taking place was obtained in 25 of the 42 referrals. The range of times between a referral being made and the assessment taking placed varied between 1.5 hours and 22 hours. Two defendants were remanded overnight in prison as the MHAA could not take place on the same day as the referral.In the 25 cases where an application for detention under Section 2 of the MHA was made, beds were not available on the same day in 7 cases. In 4 cases defendants required remand in prison custody due to beds not being available.ConclusionThere were some limitations to this audit as data were not available for all 42 individuals referred for a MHAA.Individuals referred for MHAA by the Service had both medical recommendations completed within 5 days and those who required admission to hospital were admitted within 14 days of the recommendations being completed.Whilst these standards are being met, individuals referred for MHAA and those requiring admission to hospital are still facing remand to custody.
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Jewell, Amelia, Matthew Broadbent, Richard D. Hayes, Ruth Gilbert, Robert Stewart, and Johnny Downs. "Impact of matching error on linked mortality outcome in a data linkage of secondary mental health data with Hospital Episode Statistics (HES) and mortality records in South East London: a cross-sectional study." BMJ Open 10, no. 7 (July 2020): e035884. http://dx.doi.org/10.1136/bmjopen-2019-035884.
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ObjectivesLinkage of electronic health records (EHRs) to Hospital Episode Statistics (HES)-Office for National Statistics (ONS) mortality data has provided compelling evidence for lower life expectancy in people with severe mental illness. However, linkage error may underestimate these estimates. Using a clinical sample (n=265 300) of individuals accessing mental health services, we examined potential biases introduced through missed matching and examined the impact on the association between clinical disorders and mortality.SettingThe South London and Maudsley NHS Foundation Trust (SLaM) is a secondary mental healthcare provider in London. A deidentified version of SLaM’s EHR was available via the Clinical Record Interactive Search system linked to HES-ONS mortality records.ParticipantsRecords from SLaM for patients active between January 2006 and December 2016.Outcome measuresTwo sources of death data were available for SLaM participants: accurate and contemporaneous date of death via local batch tracing (gold standard) and date of death via linked HES-ONS mortality data. The effect of linkage error on mortality estimates was evaluated by comparing sociodemographic and clinical risk factor analyses using gold standard death data against HES-ONS mortality records.ResultsOf the total sample, 93.74% were successfully matched to HES-ONS records. We found a number of statistically significant administrative, sociodemographic and clinical differences between matched and unmatched records. Of note, schizophrenia diagnosis showed a significant association with higher mortality using gold standard data (OR 1.08; 95% CI 1.01 to 1.15; p=0.02) but not in HES-ONS data (OR 1.05; 95% CI 0.98 to 1.13; p=0.16). Otherwise, little change was found in the strength of associated risk factors and mortality after accounting for missed matching bias.ConclusionsDespite significant clinical and sociodemographic differences between matched and unmatched records, changes in mortality estimates were minimal. However, researchers and policy analysts using HES-ONS linked resources should be aware that administrative linkage processes can introduce error.
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Wyke, Clementine, Charlotte Wilson Jones, and James Chivers. "‘What is psychiatry?’ – an exploration of the effect of a psychiatry summer school on school students’ attitudes towards psychiatry, through the medium of word clouds." BJPsych Open 7, S1 (June 2021): S163. http://dx.doi.org/10.1192/bjo.2021.451.
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AimsTo explore if attending a psychiatry summer school would change the understanding of school students as to what the word ‘Psychiatry’ represents.BackgroundThe Institute of Psychiatry, Psychology and Neuroscience (IoPPN) and the local mental health trust, South London and Maudsley NHS Foundation Trust (SLaM) ran a free five-day summer school for 16-year-old school students, who had just completed their GCSE exams, from state and private secondary schools within South-East London.MethodWe asked all 26 student attendees to anonymously write down as many single words relating to ‘Psychiatry’ as they could think of. They were given approximately 5 minutes to complete this and they were asked to do this at the beginning of the first day and at the end of the final day of the summer school. These words were then transcribed with the number of times each word was submitted being documented. This information was then formatted into a word cloud, with the size of the word varying according to how many times it had been submitted.ResultAt the start of the summer school, the students submitted a total of 208 words which included a total of 94 distinct words. Of these, the 2 most common were brain (n = 15) and mental (n = 10). At the end of the summer school, the students submitted a total of 199 words which included a total of 100 distinct words. The 2 most common were psychosis (n = 12) and forensic (n = 8). Of the words submitted pre-summer school, there were 8 distinct words that described positive attributes of psychiatry – such as ‘helping’. This increased to 17 distinct positive words post-summer school.ConclusionWe note from our outcomes that the number of words submitted by the students pre and post the summer school were similar but the words submitted most frequently differed. The most common words submitted post the summer school were more consistent with medical terminology than those submitted pre the summer school, which suggests that their knowledge of this had increased. The increase in the number of distinct positive words submitted at the end of the summer school implies that the students had a more positive view of psychiatry following the summer school.
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Reid, Harry, Tennyson Lee, Charlotte James, William Hancox, and Stefanos Stoikos. "A review of serious untoward incidents (SUIS) of patients with personality disorder (PD)." BJPsych Open 7, S1 (June 2021): S284. http://dx.doi.org/10.1192/bjo.2021.756.
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AimsThe aim of this paper is to describe key findings and recommendations of SUI reports regarding patients with a diagnosis of PD in East London NHS Foundation Trust (ELFT). Patients with a diagnosis of PD are often involved in SUIs with regards to risk to themselves or others. Contributing factors might be the nature of their disorder in terms of mood instability and impulsivity, self-harming or antisocial behaviour, and the difficulties posed to assessing clinicians in predicting risk.BackgroundPatients with PD present severe challenges to services. SUI findings thus serve as a lightning rod for issues in their management. With the emergence of NICE guidelines for borderline PD [2009] and antisocial PD [2009] regarding risk assessments, there has been greater optimism for management of PDs.MethodA case series of 50 SUI reports of patients with a diagnosis of PD were identified from the governance and risk management team of ELFT. Themes were categorized as positive practice, contributory factors, and recommendations. Findings are related to guidelines in NICE and RCPsychiatry. Any patient with a diagnosis of PD (of any sub-type) that was involved in a SUI in ELFT met the inclusion criteria. There were no exclusion criteria.ResultThe most frequent themes in positive practice were ‘continuity of care’ and ‘clinical practice’. The most frequent subthemes in clinical practice were ‘assessments’ and ‘follow-up’. ‘Continuity of care’ included examples of collaborative working between various teams, as in joint assessments, good communication, and timely referrals. In contributory factors ‘poor documentation’ was the most frequent theme. 14 reports found no contributory factors. In recommendations the most frequent theme was the need for development and implementation of PD policies and for improved risk management.ConclusionNICE guidelines stress the importance of continuity of care and good clinical care and it is commendable that these were findings in positive practice. The importance of documentation being accurate and timely needs underlining in hard pressed time poor clinicians. Services would do well to review PD policies specifically regarding risk management at a wider Trust and local service level. Our findings point to the ongoing need for workforce development as recommended in the RCPSych position statement on PD published in January 2020.
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Butler, Jonathan. "S.117 MHA 1983 re-visited: the liability of the State and the existence of a duty of care." International Journal of Mental Health and Capacity Law, no. 21 (September 8, 2014): 84. http://dx.doi.org/10.19164/ijmhcl.v0i21.235.
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<p>This article seeks to summarise the movement towards an increased likelihood of branches of the state (in this case, either social services or health trusts) being found to owe a duty of care to specific categories of people. The issue was phrased thus in 2005 by Lord Bingham of Cornhill:<em> ‘The question does arise whether the law of tort should evolve, analogically and incrementally, so as to fashion appropriate remedies to contemporary problems or whether it should remain essentially static, making only such changes as are forced upon it, leaving difficult and. in human terms, very important problems to be swept up by the Convention. I prefer evolution’</em>. In adopting that Darwinian approach to the development of the law, it is necessary to look at the recent history of duties of care that may be owed by the State. The starting point is X v Bedfordshire County Council (1995); the end point (so far) is AK v Central and North West London Mental Health NHS Trust and Royal Borough of Kensington and Chelsea4 (2008).</p>
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Nyein, Chan, and David Oyewole. "Evaluation of an attention deficit hyperactivity disorder (ADHD) assessment & treatment service." BJPsych Open 7, S1 (June 2021): S338. http://dx.doi.org/10.1192/bjo.2021.887.
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AimsThe Central and North West London NHS Foundation Trust ADHD clinic offers diagnosis and medication stabilisation for adults with ADHD, in preparation for discharge back to GP for continued prescribing and monitoring. Referral waiting time is shortened by efficiently managing the service and soon transfer of care to GP whilst referrals have been increasingly accepted years on years. A snap shot service evaluation was made to understand characteristics of service exploring its strength and areas to improve.MethodAll 115 patients offered in March and April 2019 for an ADHD specialist assessment were sampled from the new electronic patient record SystmOne in use since 1st March 2019.Data were collected forMale & Female ratioAge range distributionClinical Commissioning Group referral sourceClinic attendance characteristicsADHD diagnosis, sub-types and psychiatric comorbidityADHD Medication prescribedFP10 Prescription duration by prescribersPatient data were anonymously encoded into Microsoft Excel Sheet for sorting, counting, summating and illustrating into tables and pie charts.ResultThe male & female ratio of the sample was 6:5 and nearly half were in age range 20-29 years. Majority were referred from Westminster and West London Clinical Commissioning Groups.107 patients completed the assessment, of which 106 were diagnosed as having an adult ADHD.22% of follow-up clinics were cancelled or not attended (DNA) by patients. The majority of the patients (62%) required 1-2 follow-ups before transfer to GP, whilst 8% did not require or want follow-ups either already being on ADHD medication, not wanting medication or having lost to reviews. Only 3% require six or more follow-ups.Majority were reviewed after two- to five-week prescription, the peak being four-weekly.91% of completion to GP were discharged on ADHD medication, majority being singly on Elvanse (48%) and Concerta XL (25%). Discharge without ADHD medication was due to concerns for its addiction, preference on non-medication treatment, intolerance of medication adverse effect or mental health priority treatment.ConclusionCollaboration with GPs for their pre-treatment physical health screening facilitated prompt prescribing initiation on assessment with most discharges taken place after 1-2 follow-ups, enabling service turn-over with short waiting time (6-9 months in 2018/2019). Service expansion for increasing referral uptake is probably feasible from this baseline by appointing additional sessional clinicians and further efficiency management on clinic scheduling & DNA with a target majority likely requiring 1-2 follow-ups with average four-weekly prescribing.
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Stevelink, Sharon A. M., Margaret Jones, Lisa Hull, David Pernet, Shirlee MacCrimmon, Laura Goodwin, Deirdre MacManus, et al. "Mental health outcomes at the end of the British involvement in the Iraq and Afghanistan conflicts: a cohort study." British Journal of Psychiatry 213, no. 6 (October 8, 2018): 690–97. http://dx.doi.org/10.1192/bjp.2018.175.
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BackgroundLittle is known about the prevalence of mental health outcomes in UK personnel at the end of the British involvement in the Iraq and Afghanistan conflicts.AimsWe examined the prevalence of mental disorders and alcohol misuse, whether this differed between serving and ex-serving regular personnel and by deployment status.MethodThis is the third phase of a military cohort study (2014–2016; n = 8093). The sample was based on participants from previous phases (2004–2006 and 2007–2009) and a new randomly selected sample of those who had joined the UK armed forces since 2009.ResultsThe prevalence was 6.2% for probable post-traumatic stress disorder, 21.9% for common mental disorders and 10.0% for alcohol misuse. Deployment to Iraq or Afghanistan and a combat role during deployment were associated with significantly worse mental health outcomes and alcohol misuse in ex-serving regular personnel but not in currently serving regular personnel.ConclusionsThe findings highlight an increasing prevalence of post-traumatic stress disorder and a lowering prevalence of alcohol misuse compared with our previous findings and stresses the importance of continued surveillance during service and beyond.Declaration of interest:All authors are based at King's College London which, for the purpose of this study and other military-related studies, receives funding from the UK Ministry of Defence (MoD). S.A.M.S., M.J., L.H., D.P., S.M. and R.J.R. salaries were totally or partially paid by the UK MoD. The UK MoD provides support to the Academic Department of Military Mental Health, and the salaries of N.J., N.G. and N.T.F. are covered totally or partly by this contribution. D.Mu. is employed by Combat Stress, a national UK charity that provides clinical mental health services to veterans. D.MacM. is the lead consultant for an NHS Veteran Mental Health Service. N.G. is the Royal College of Psychiatrists’ Lead for Military and Veterans’ Health, a trustee of Walking with the Wounded, and an independent director at the Forces in Mind Trust; however, he was not directed by these organisations in any way in relation to his contribution to this paper. N.J. is a full-time member of the armed forces seconded to King's College London. N.T.F. reports grants from the US Department of Defense and the UK MoD, is a trustee (unpaid) of The Warrior Programme and an independent advisor to the Independent Group Advising on the Release of Data (IGARD). S.W. is a trustee (unpaid) of Combat Stress and Honorary Civilian Consultant Advisor in Psychiatry for the British Army (unpaid). S.W. is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King's College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, Public Health England or the UK MoD.
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Scott-Gatty, Tom, and Tom Cant. "Improving access to mental health services for homeless people in Torbay." BJPsych Open 7, S1 (June 2021): S218. http://dx.doi.org/10.1192/bjo.2021.582.
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AimsDevon continues to see increasing numbers of rough sleepers despite the “Everyone In” initiative and the South West region is now behind only London and the South East nationally. The interaction of homelessness and Mental Health is complex. Mental health problems and trauma contribute to people becoming homeless as well as homelessness itself causing or exacerbating existing problems, all complicated by high rates of substance use and poor physical health. Despite the desperate need in this population they often struggle to access mental health services which are not designed with their needs in mind. Their pattern of service use is primarily that of acute services when in crisis and disengagement in the community which results in high costs and poor outcomes.MethodIn July 2019 an outreach service was set up consisting of a psychiatry core trainee (Dr Tom Scott-Gatty) for half a day per week supervised by the Torbay North CMHT consultant (Dr Tom Cant) to seek opportunities to engage individuals in assessment and treatment and improve outcomes in this population. The service is primarily based at the homeless hostel in Torquay (Leonard Stocks Centre) for ease of access but is flexible about where patients are seen. Patients have been seen in various locations including medical wards, prison, on the street etc. The role includes close work and liaison with other professionals such as GPs, probation, charity sector, drug and alcohol etc. and this is integral to supporting the level of complexity seen in this population. Engagement, building relationships and trust are central to serving this vulnerable and marginalised population.ResultIn January 2021 feedback forms were completed by 13 patients and 18 professionals who had used the service. Feedback was overwhelmingly positive with average overall score 9/10 from both patients and professionals. All patients reported feeling comfortable using the service and that mental health services are now easier to access. All respondents would like to see the service continue. A significant number of patients and professionals identified increasing the hours offered by the service as an area for improvement.ConclusionThis service has succeeded in improving access to mental health services for homeless people in Torbay. The service is valued by both the people it serves and the professionals supporting them. Further improvement to the service could be achieved by expanding capacity. Funding has been identified from existing local authority budgets to add a CPN to the team to achieve this.
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Malkov, Martynas, Tennyson Lee, Hanspeter Dorner, Alana Ahmet, Alzbeta Karlikova, Kamaldeep Bhui, and Andrew Chanen. "Transition from child and adolescent MHS to adult MHS: what happens to young people with personality disorder?" BJPsych Open 7, S1 (June 2021): S39. http://dx.doi.org/10.1192/bjo.2021.154.
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AimsHypothesis: Personality Disorder (PD) adolescents, compared to non-PD case, have a worse experience at transition.Aims: To describe the outcomes of referrals of adolescents for transition to adult services and compare PD and non-PD populations to identify potential improvements to allow for better transition experience of the PD patients.BackgroundBorderline PD is prevalent in adolescents - although there is a reluctance to make the diagnosis. When patients reach graduation from CAMHS, many fall through the ‘gap’ in services during the transition. Consequently, adding the paucity in research about the transition experience of PD patients, it is important to evaluate what happens to these patients during the transition process to help better understand their experience, and how it can be improved.MethodPatient's clinical records from Tower Hamlet CAMHS, East London NHS Foundation Trust, were reviewed retrospectively from July 2018 to November 2019, assessing whether optimal transition standards were met. A total of 41 cases that transitioned from CAMHS to AMHS were identified. Transition standards compared were: information sharing – case and risk, parallel care, transition planning and continuity. PD diagnosis was identified based on the recording of this diagnosis or meeting DSM5 criteria from the notes. PD and non-PD transition experience was compared.Result36 were given a diagnosis by the CAMHS clinician at transition and 5 had no diagnosis assigned. No cases had a PD diagnosis made by the CAMHS clinician, however 1 case mentioned ‘PD traits’, 1 mentioned ‘EUPD’ as a possible differential and 2 cases were labelled as ‘emotional dysregulation’. The research team found 17 cases that met DSM5 criteria for PD diagnosis.Comparing transition experience of PD vs non-PD patients, the PD patients had a less optimal transition process. Statistical analysis using Chi Square Tests, showed significantly less optimal transition planning (X2 = 5.103, p < 0.05) and continuity (Fisher's exact test p = 0.049). Cohens W indicated a medium effect for transition planning and continuity.ConclusionAdolescents with a diagnosis of PD transition less well to Adult MHS than those without the PD diagnosis. Implications of our findings point to 1) the importance of considering a diagnosis of PD 2) if the diagnosis of PD is made, to anticipate greater difficulties in transition 3) the need to identify specific reasons for transition difficulties related to patient, clinician and system factors and their interrelation.
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Kanter Bax, Orestis, Nadim Hakim, Michael Jeggo, Declan Phelan, Timothy Stevens, and Susham Gupta. "Improving smoking cessation in first episode psychosis: a quality improvement project by the City & Hackney Early and Quick Intervention Psychosis (EQUIP)." BMJ Open Quality 9, no. 4 (December 2020): e001002. http://dx.doi.org/10.1136/bmjoq-2020-001002.
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Smoking tobacco is a major public health issue and a significant cause of increased mortality. People with a first episode of psychosis are more likely to smoke and the subgroup that goes on to have schizophrenia will have a significantly reduced life expectancy to the general population. The City & Hackney Early and Quick Intervention in Psychosis Team is a community mental health team at East London NHS Foundation Trust, providing outpatient care for adults presenting with first episode psychosis. This project aimed to increase the number of smoking cessation referrals from EQUIP to national smoking cessation services to 15% of the total team caseload over 6 months initially. A secondary measure was to complete an assessment of the smoking status for 90% of the caseload at all times. Change ideas were tested using plan-do-study-act cycles. A smoking cessation referral pathway was created and disseminated to the outpatient and inpatient services. The project was discussed at least monthly at the clinical team meeting. An education and skills building session was organised and took place at the team away day and an education drop-in session for patients was organised. The project was slow to take-off and patient participation was essential in driving progress. The aim was achieved at 23 months. A collateral benefit indicated that 25.7% of the total number of smokers had been recorded as having stopped smoking during the course of this project. This project demonstrates the effectiveness of quality improvement methodology facilitated by efficient leadership, collaborative teamwork, patient participation and persistence to address a complex problem that has significant consequences to patient health.
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Newbigging, Karen, James Rees, Rebecca Ince, John Mohan, Doreen Joseph, Michael Ashman, Barbara Norden, Ceri Dare, Suzanne Bourke, and Benjamin Costello. "The contribution of the voluntary sector to mental health crisis care: a mixed-methods study." Health Services and Delivery Research 8, no. 29 (July 2020): 1–200. http://dx.doi.org/10.3310/hsdr08290.
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Background Weaknesses in the provision of mental health crisis support are evident and improvements that include voluntary sector provision are promoted. There is a lack of evidence regarding the contribution of the voluntary sector and how this might be used to the best effect in mental health crisis care. Aim To investigate the contribution of voluntary sector organisations to mental health crisis care in England. Design Multimethod sequential design with a comparative case study. Setting England, with four case studies in North England, East England, the Midlands and London. Method The method included a scoping literature review, a national survey of 1612 voluntary sector organisations, interviews with 27 national stakeholders and detailed mapping of the voluntary sector organisation provision in two regions (the north and south of England) to develop a taxonomy of voluntary sector organisations and to select four case studies. The case studies examined voluntary sector organisation crisis care provision as a system through interviews with local stakeholders (n = 73), eight focus groups with service users and carers and, at an individual level, narrative interviews with service users (n = 47) and carers (n = 12) to understand their crisis experience and service journey. There was extensive patient and public involvement in the study, including service users as co-researchers, to ensure validity. This affected the conduct of the study and the interpretation of the findings. The quality and the impact of the involvement was evaluated and commended. Main findings A mental health crisis is considered a biographical disruption. Voluntary sector organisations can make an important contribution, characterised by a socially oriented and relational approach. Five types of relevant voluntary sector organisations were identified: (1) crisis-specific, (2) general mental health, (3) population-focused, (4) life-event-focused and (5) general social and community voluntary sector organisations. These voluntary sector organisations provide a range of support and have specific expertise. The availability and access to voluntary sector organisations varies and inequalities were evident for rural communities; black, Asian and minority ethnic communities; people who use substances; and people who identified as having a personality disorder. There was little evidence of well-developed crisis systems, with an underdeveloped approach to prevention and a lack of ongoing support. Limitations The survey response was low, reflecting the nature of voluntary sector organisations and demands on their time. This was a descriptive study, so evaluating outcomes from voluntary sector organisation support was beyond the scope of the study. Conclusions The current policy discourse frames a mental health crisis as an urgent event. Viewing a mental health crisis as a biographical disruption would better enable a wide range of contributory factors to be considered and addressed. Voluntary sector organisations have a distinctive and important role to play. The breadth of this contribution needs to be acknowledged and its role as an accessible alternative to inpatient provision prioritised. Future work A whole-system approach to mental health crisis provision is needed. The NHS, local authorities and the voluntary sector should establish how to effectively collaborate to meet the local population’s needs and to ensure the sustainability of the voluntary sector. Service users and carers from all communities need to be central to this. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 29. See the NIHR Journals Library website for further project information.
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Priebe, Stefan, Eoin Golden, David Kingdon, Serif Omer, Sophie Walsh, Kleomenis Katevas, Paul McCrone, Sandra Eldridge, and Rose McCabe. "Effective patient–clinician interaction to improve treatment outcomes for patients with psychosis: a mixed-methods design." Programme Grants for Applied Research 5, no. 6 (February 2017): 1–160. http://dx.doi.org/10.3310/pgfar05060.
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BackgroundAt least 100,000 patients with schizophrenia receive care from community mental health teams (CMHTs) in England. These patients have regular meetings with clinicians, who assess them, engage them in treatment and co-ordinate care. As these routine meetings are not commonly guided by research evidence, a new intervention, DIALOG, was previously designed to structure consultations. Using a hand-held computer, clinicians asked patients to rate their satisfaction with eight life domains and three treatment aspects, and to indicate whether or not additional help was needed in each area, with responses being graphically displayed and compared with previous ratings. In a European multicentre trial, the intervention improved patients’ quality of life over a 1-year period. The current programme builds on this research by further developing DIALOG in the UK.Research questions(1) How can the practical procedure of the intervention be improved, including the software used and the design of the user interface? (2) How can elements of resource-oriented interventions be incorporated into a clinician manual and training programme for a new, more extensive ‘DIALOG+’ intervention? (3) How effective and cost-effective is the new DIALOG+ intervention in improving treatment outcomes for patients with schizophrenia or a related disorder? (4) What are the views of patients and clinicians regarding the new DIALOG+ intervention?MethodsWe produced new software on a tablet computer for CMHTs in the NHS, informed by analysis of videos of DIALOG sessions from the original trial and six focus groups with 18 patients with psychosis. We developed the new ‘DIALOG+’ intervention in consultation with experts, incorporating principles of solution-focused therapy when responding to patients’ ratings and specifying the procedure in a manual and training programme for clinicians. We conducted an exploratory cluster randomised controlled trial with 49 clinicians and 179 patients with psychosis in East London NHS Foundation Trust, comparing DIALOG+ with an active control. Clinicians working as care co-ordinators in CMHTs (along with their patients) were cluster randomised 1 : 1 to either DIALOG+ or treatment as usual plus an active control, to prevent contamination. Intervention and control were to be administered monthly for 6 months, with data collected at baseline and at 3, 6 and 12 months following randomisation. The primary outcome was subjective quality of life as measured on the Manchester Short Assessment of Quality of Life; secondary outcomes were also measured. We also established the cost-effectiveness of the DIALOG intervention using data from the Client Service Receipt Inventory, which records patients’ retrospective reports of using health- and social-care services, including hospital services, outpatient services and medication, in the 3 months prior to each time point. Data were supplemented by the clinical notes in patients’ medical records to improve accuracy. We conducted an exploratory thematic analysis of 16 video-recorded DIALOG+ sessions and measured adherence in these videos using a specially developed adherence scale. We conducted focus groups with patients (n = 19) and clinicians (n = 19) about their experiences of the intervention, and conducted thematic analyses. We disseminated the findings and made the application (app), manual and training freely available, as well as producing a protocol for a definitive trial.ResultsPatients receiving the new intervention showed more favourable quality of life in the DIALOG+ group after 3 months (effect size: Cohen’sd = 0.34), after 6 months (Cohen’sd = 0.29) and after 12 months (Cohen’sd = 0.34). An analysis of video-recorded DIALOG+ sessions showed inconsistent implementation, with adherence to the intervention being a little over half of the possible score. Patients and clinicians from the DIALOG+ arm of the trial reported many positive experiences with the intervention, including better self-expression and improved efficiency of meetings. Difficulties reported with the intervention were addressed by further refining the DIALOG+ manual and training. Cost-effectiveness analyses found a 72% likelihood that the intervention both improved outcomes and saved costs.LimitationsThe research was conducted solely in urban east London, meaning that the results may not be broadly generalisable to other settings.Conclusions(1) Although services might consider adopting DIALOG+ based on the existing evidence, a definitive trial appears warranted; (2) applying DIALOG+ to patient groups with other mental disorders may be considered, and to groups with physical health problems; (3) a more flexible use with variable intervals might help to make the intervention even more acceptable and effective; (4) more process evaluation is required to identify what mechanisms precisely are involved in the improvements seen in the intervention group in the trial; and (5) what appears to make DIALOG+ effective is that it is not a separate treatment and not a technology that is administered by a specialist; rather, it changes and utilises the existing therapeutic relationship between patients and clinicians in CMHTs to initiate positive change, helping the patients to improve their quality of life.Future researchFuture studies should include a definitive trial on DIALOG+ and test the effectiveness of the intervention with other populations, such as people with depression.Trial registrationCurrent Controlled Trials ISRCTN34757603.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Osborn, David, Alexandra Burton, Kate Walters, Lou Atkins, Thomas Barnes, Ruth Blackburn, Thomas Craig, et al. "Primary care management of cardiovascular risk for people with severe mental illnesses: the Primrose research programme including cluster RCT." Programme Grants for Applied Research 7, no. 2 (April 2019): 1–98. http://dx.doi.org/10.3310/pgfar07020.
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Background Effective interventions are needed to prevent cardiovascular disease (CVD) in people with severe mental illnesses (SMI) because their risk of CVD is higher than that of the general population. Objectives (1) Develop and validate risk models for predicting CVD events in people with SMI and evaluate their cost-effectiveness, (2) develop an intervention to reduce levels of cholesterol and CVD risk in SMI and (3) test the clinical effectiveness and cost-effectiveness of this new intervention in primary care. Design Mixed methods with patient and public involvement throughout. The mixed methods were (1) a prospective cohort and risk score validation study and cost-effectiveness modelling, (2) development work (focus groups, updated systematic review of interventions, primary care database studies investigating statin prescribing and effectiveness) and (3) cluster randomised controlled trial (RCT) assessing the clinical effectiveness and cost-effectiveness of a new practitioner-led intervention, and fidelity assessment of audio-recorded appointments. Setting General practices across England. Participants All studies included adults with SMI (schizophrenia, bipolar disorder or other non-organic psychosis). The RCT included adults with SMI and two or more CVD risk factors. Interventions The intervention consisted of 8–12 appointments with a practice nurse/health-care assistant over 6 months, involving collaborative behavioural approaches to CVD risk factors. The intervention was compared with routine practice with a general practitioner (GP). Main outcome measures The primary outcome for the risk score work was CVD events, in the cost-effectiveness modelling it was quality-adjusted life-years (QALYs) and in the RCT it was level of total cholesterol. Data sources Databases studies used The Health Improvement Network (THIN). Intervention development work included focus groups and systematic reviews. The RCT collected patient self-reported and routine NHS GP data. Intervention appointments were audio-recorded. Results Two CVD risk score models were developed and validated in 38,824 people with SMI in THIN: the Primrose lipid model requiring cholesterol levels, and the Primrose body mass index (BMI) model with no blood test. These models performed better than published Cox Framingham models. In health economic modelling, the Primrose BMI model was most cost-effective when used as an algorithm to drive statin prescriptions. Focus groups identified barriers to, and facilitators of, reducing CVD risk in SMI including patient engagement and motivation, staff confidence, involving supportive others, goal-setting and continuity of care. Findings were synthesised with evidence from updated systematic reviews to create the Primrose intervention and training programme. THIN cohort studies in 16,854 people with SMI demonstrated that statins effectively reduced levels of cholesterol, with similar effect sizes to those in general population studies over 12–24 months (mean decrease 1.2 mmol/l). Cluster RCT: 76 GP practices were randomised to the Primrose intervention (n = 38) or treatment as usual (TAU) (n = 38). The primary outcome (level of cholesterol) was analysed for 137 out of 155 participants in Primrose and 152 out of 172 in TAU. There was no difference in levels of cholesterol at 12 months [5.4 mmol/l Primrose vs. 5.5 mmol/l TAU; coefficient 0.03; 95% confidence interval (CI) –0.22 to 0.29], nor in secondary outcomes related to cardiometabolic parameters, well-being or medication adherence. Mean cholesterol levels decreased over 12 months in both arms (–0.22 mmol/l Primrose vs. –0.39 mmol/l TAU). There was a significant reduction in the cost of inpatient mental health attendances (–£799, 95% CI –£1480 to –£117) and total health-care costs (–£895, 95% CI –£1631 to –£160; p = 0.012) in the intervention group, but no significant difference in QALYs (–0.011, 95% CI –0.034 to 0.011). A total of 69% of patients attended two or more Primrose appointments. Audiotapes revealed moderate fidelity to intervention delivery (67.7%). Statin prescribing and adherence was rarely addressed. Limitations RCT participants and practices may not represent all UK practices. CVD care in the TAU arm may have been enhanced by trial procedures involving CVD risk screening and feedback. Conclusions SMI-specific CVD risk scores better predict new CVD if used to guide statin prescribing in SMI. Statins are effective in reducing levels of cholesterol in people with SMI in UK clinical practice. This primary care RCT evaluated an evidence-based practitioner-led intervention that was well attended by patients and intervention components were delivered. No superiority was shown for the new intervention over TAU for level of cholesterol, but cholesterol levels decreased over 12 months in both arms and the intervention showed fewer inpatient admissions. There was no difference in cholesterol levels between the intervention and TAU arms, which might reflect better than standard general practice care in TAU, heterogeneity in intervention delivery or suboptimal emphasis on statins. Future work The new risk score should be updated, deployed and tested in different settings and compared with the latest versions of CVD risk scores in different countries. Future research on CVD risk interventions should emphasise statin prescriptions more. The mechanism behind lower costs with the Primrose intervention needs exploring, including SMI-related training and offering frequent support to people with SMI in primary care. Trial registration Current Controlled Trials ISRCTN13762819. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 2. See the NIHR Journals Library website for further project information. Professor David Osborn is supported by the University College London Hospital NIHR Biomedical Research Centre and he was also in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust.
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O'Sullivan, Owen P., Nynn Hui Chang, Philip Baker, and Amar Shah. "Quality improvement at East London NHS Foundation Trust: the pathway to embedding lasting change." International Journal of Health Governance ahead-of-print, ahead-of-print (December 1, 2020). http://dx.doi.org/10.1108/ijhg-07-2020-0085.
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PurposeEast London NHS Foundation Trust (ELFT) is a major provider of mental healthcare and community health services. Quality improvement (QI) has become central to its organisational policy and goals for which it has received national and international attention.Design/methodology/approachThis piece reflects on the Trust's transformation and its approach. It provides many examples and discusses several of the associated challenges in building and sustaining QI momentum. It is the result of a range of perspectives from staff involved in planning and building large-scale QI capability. It contextualises QI's current status in UK mental healthcare.FindingsSeveral key factors were identified: board-led commitment to organisational transformation; investment in training and resources to support staff motivation; clear and realistic project goals in line with the service's over-arching strategic direction; support for service users and staff at all levels to get involved to address issues that matter to them; and, finally, placement of a high value on service user and staff qualitative feedback.Practical implicationsBuilding QI capability represents a significant challenge faced by all large healthcare providers. Sharing experiences of change can assist other organisations achieve the necessary buy-in and support the planning process.Originality/valueAchieving and sustaining lasting organisational change in healthcare is challenging. This article provides a background on QI at ELFT and reflects on the pathway to its present position at the forefront of the application of QI within healthcare.
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Staite, Emily, Lynne Howey, and Clare Anderson. "How well do children in the North East of England function after a mental health crisis during the COVID-19 pandemic: A service evaluation." Clinical Child Psychology and Psychiatry, August 6, 2021, 135910452110372. http://dx.doi.org/10.1177/13591045211037268.
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The COVID-19 pandemic has affected millions of people, and some researchers postulate that a mental health crisis will follow. The immediate effects of the COVID-19 pandemic on children’s mental health are now starting to be published, and results appear to be mixed. There is no research, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from Child and Adolescent Mental Health Services (CAMHS) Crisis Teams in the UK during the COVID-19 pandemic. This service evaluation aims to do this using data from an NHS trust that supports 1.4 million people in the North East of England. We compared functioning, as measured by the Outcome Rating Scale (ORS), before and after treatment for young people discharged from the CAMHS Crisis Team between December 2019 and December 2020. ORS scores were significantly higher at the end of treatment (t(420) = −57.36, p < 0.001) with a large effect size (d = −1.56). Fifty eight percent of patients exhibited significant and reliable change (i.e. functioning improved to a ‘healthy’ level). No patients significantly deteriorated in functioning after accessing the crisis service.
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Joyce, Christopher, and Rizwan Rajak. "A clinical audit into the adherence of foot health management standards of rheumatoid arthritis compared with the foot health management standards of diabetes mellitus in North-East London." Rheumatology Advances in Practice 5, no. 1 (2021). http://dx.doi.org/10.1093/rap/rkab006.
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Abstract Objectives RA has an affinity for smaller joints, thus its effect on the foot/ankle is widely known. Despite this, there is lack of adherence to foot management standards by podiatrists. This research aimed to audit the adherence to these standards and compare them with well-established adherence to management standards in the diabetic foot. Methods In this clinical audit, data were obtained via six National Health Service (NHS) podiatry departments in North-East London on service provision, management, treatment and professional development on both RA and diabetic foot health via foot management clinical audit tools. Descriptive analyses were conducted and analysed to identify patterns and trends, with set standard compliance conditions calculated on the Net Promotor Score (NPS) metric to allow for multi-comparison. Results All areas of RA foot health management were found to have poor compliance when compared with diabetes foot health management. When using NPS, no trust audited met the majority of foot health standards in RA, with only two having a positive score (meeting the minimum standards), compared with all trusts posting a positive NPS on diabetes foot health standards. Conclusion Our results indicate that poor compliance to RA foot health standards is prevalent across the audited region and might be resulting in worsening foot outcomes despite a paradigm shift in other areas of RA management. Enhanced training and knowledge are required for better adherence to the standards set out and to improve foot health management in RA.
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"Mental Health – Trust has Statutory Defence to Unlawful Detention Claim: TTM V London Borough of Hackney, East London NHS FT and Secretary of State for Health (Court of Appeal, 14/1/2011)." Clinical Risk 17, no. 3 (May 2011): 119–21. http://dx.doi.org/10.1258/cr.2011.011h10.
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Jones, Abbeygail, Helen Todman, and Mujtaba Husain. "Mental health in South East London general hospitals: using electronic patient records to explore associations between psychiatric diagnoses and length of stay in a patient cohort receiving liaison psychiatry input." BJPsych Open 5, no. 6 (October 14, 2019). http://dx.doi.org/10.1192/bjo.2019.79.
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Background Psychiatric illnesses are prevalent in general hospitals and associated with length of stay (LOS). Liaison psychiatry teams provide psychiatric care in acute hospitals and can improve mental health-related outcomes but, to achieve ambitious policy targets, services must understand local need. Aims Using electronic patient records, we investigate associations between psychiatric diagnoses and LOS in South East London hospitals. Method Patient records were extracted using the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register Interactive Search system. There were 6378 admissions seen by liaison psychiatry aged <65 years between 2011 and 2016. Linear mixed-effects models investigated the impact of psychiatric diagnoses on LOS. Potential confounders included medical diagnoses, gender, age, ethnicity, social deprivation, hospital site and investment per admission. Results According to marginal means, longer LOS is associated with primary diagnoses of organic disorders (mean: 23 days, 95% CI 20.39–25.61), depressive disorders (mean: 11.03 days, 95% CI 9.74–25.61) and psychotic disorders (mean: 10.63 days, 95% CI 8.75–12.51). Shorter LOS is associated with personality disorders (mean: 6.28 days, 95% CI 4.12–8.45), bipolar affective disorders (mean 6.81 days, 95% CI 3.49–10.14) and substance-related problems (mean 7.53 days, 95% CI 6.01–9.05). Conclusions Psychiatric diagnoses have differential associations with in-patient LOS. Liaison psychiatry teams aim to mitigate the impact of psychiatric illness on patient and hospital outcomes but understanding local need and the wider context of care provision is needed to maximise potential benefits. Declaration of interest M.H. is a consultant liaison psychiatrist for King's College Hospital adult liaison psychiatry team. At the time of writing, H.T. was senior business manager at SLaM psychological medicine and integrated care clinical academic group. These may be considered financial and/or non-financial interests given the implications of findings for service funding.