scholarly journals Coercion: an understudied issue in mental health

2017 ◽  
Vol 34 (4) ◽  
pp. 221-222
Author(s):  
B. O’Donoghue
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Community Treatment ◽  
Future Research ◽  
Service Users ◽  
Involuntary Admission ◽  
Community Treatment Orders ◽  
Future Directions ◽  
Alternative Models

Coercion in mental health services is a controversial practice, yet it is a relatively understudied area. This special themed edition draws upon research from the international community with the aim of addressing issues related to coercion and involuntary admission. The issue covers topics such as community treatment orders, service users’ perspectives, alternative models of involving service users in their treatment, and future directions for coercion research. It is hoped that this edition will encourage funding and inspire future research on this important topic.

scholarly journals How shortcomings in the mental health system affect the use of involuntary community treatment orders

2017 ◽  
Vol 41 (3) ◽  
pp. 351 ◽  
Author(s):  
Edwina M. Light ◽  
Michael D. Robertson ◽  
Philip Boyce ◽  
Terry Carney ◽  
Alan Rosen ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Health System ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Involuntary Treatment ◽  
Community Settings ◽  
Community Treatment Orders

Objective The aim of the present study was to examine stakeholder perspectives on how the operation of the mental health system affects the use of involuntary community treatment orders (CTOs). Methods A qualitative study was performed, consisting of semi-structured interviews about CTO experiences with 38 purposively selected participants in New South Wales (NSW), Australia. Participants included mental health consumers (n = 5), carers (n = 6), clinicians (n = 15) and members of the Mental Health Review Tribunal of NSW (n = 12). Data were analysed using established qualitative methodologies. Results Analysis of participant accounts about CTOs and their role within the mental health system identified two key themes, namely that: (1) CTOs are used to increase access to services; and (2) CTOs cannot remedy non-existent or inadequate services. Conclusion The findings of the present study indicate that deficiencies in health service structures and resourcing are a significant factor in CTO use. This raises questions about policy accountability for mental health services (both voluntary and involuntary), as well as about the usefulness of CTOs, justifications for CTO use and the legal criteria regulating CTO implementation. What is known about this topic? Following the deinstitutionalisation of psychiatric services over recent decades, community settings are increasingly the focus for the delivery of mental health services to people living with severe and persistent mental illnesses. The rates of use of involuntary treatment in Australian community settings (under CTOs) vary between state and territory jurisdictions and are high by world standards; however, the reasons for variation in rates of CTO use are not well understood. What does this paper add? This paper provides an empirical basis for a link between the politics of mental health and the uptake and usefulness of CTOs. What are the implications for practitioners? This paper makes explicit the real-world demands on the mental health system and how service deficiencies are a significant determinant in the use of CTOs. Practitioners and policy makers need to be candid about system limitations and how they factor in clinical and legal justifications for using involuntary treatment. The results of the present study provide data to support advocacy to improve policy accountability and resourcing of community mental health services.

Sähköiset mielenterveyspalvelut toipumisen näkökulmasta. Integroiva kirjallisuuskatsaus

Kuntoutus ◽  
2020 ◽  
Vol 43 (3) ◽  
pp. 34-50
Author(s):  
Mari Kivistö
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Literature Review ◽  
Future Research ◽  
Service Users ◽  
Personal Recovery ◽  
Recovery Orientation ◽  
Digital Services ◽  
Mental Health Practices

Mielenterveyden häiriöiden merkityksen kasvaminen sekä haasteet mielenterveyspalveluiden järjestämisessä ovat tehneet sähköisten mielenterveyspalveluiden kehittämisestä ja tutkimuksesta ajankohtaista. Nyt COVID-19-pandemia on lisännyt sähköisten mielenterveyspalveluiden tarvetta mutta tuonut samalla näkyviksi organisaatioiden eriytyvät lähtökohdat sähköisten mielenterveyspalveluiden järjestämisessä. Tämän tutkimuksen tavoitteena oli kuvata sähköisten mielenterveyspalveluiden vaikutuksia palvelunkäyttäjien näkökulmasta sekä tunnistaa positiivisesti vaikuttavien sähköisten mielenterveyspalveluiden edellytyksiä. Tutkimus toteutettiin kansainvälisistä tutkimusartikkeleista (n = 27) tietoa kokoavana integroivana kirjallisuuskatsauksena. Analyysimenetelmänä sovellettiin teemoittelua ja tulkintakehyksenä toipumisorientaation (recovery) viitekehystä. Kirjallisuuskatsauksen perusteella sähköiset mielenterveyspalvelut tarjoavat mahdollisuuksia toipumiseen ja sen tukemiseen, mutta toipuminen ehdollistuu sähköisiin mielenterveyspalveluihin liittyvissä toimintakäytännöissä. Tulokset jäsennettiin yksilön laaja-alaista toipumista ja toipumista kokonaisvaltaisesti tukevia sähköisiä mielenterveyspalveluja ilmentävinä yläteemoina, joista edelliseen sisällytettiin alateemat kliininen toipuminen, henkilökohtainen toipuminen ja osallisuuden vahvistuminen ja jälkimmäiseen tietoperusteisuus, tilannekohtaisuus, tuen tarjoaminen, vuorovaikutteisuus, henkilökohtaisuus ja asiakaslähtöisyys. Kirjallisuuskatsaus osoittaa, että tutkimustarpeista huolimatta tiedämme jo paljon tekijöistä, jotka mahdollistavat toipumista edistävien sähköisten mielenterveyspalveluiden toteuttamista. Tätä tietoa on tarpeen hyödyntää myös COVID-19-pandemian muuttamassa toimintaympäristössä. Tulosten sovellettavuutta rajoittaa tutkimustiedon pirstaleisuus sekä se, että tutkimukset kohdistuivat vain henkilöihin, joilla oli pääsy, kyky ja halu sähköisten mielenterveyspalveluiden käyttöön.Abstract Digital mental health services and recovery. An Integrative literature review The increase of mental health disorders and the challenges of delivering mental health services have made the development and research of digital mental health services topical. Currently, the COVID-19 pandemic has increased the need for digital mental health services, but at the same time it has made visible the various potential of organizations for providing digital services. The aim of this study is to describe the effects of digital mental health services from the service users’ perspective and to identify the features of the services that make an impact. The study was conducted as an integrative literature review of international research articles (n = 27). The method used was thematic analysis and a recovery orientation was applied as the interpretation framework. Based on the review, digital mental health services offer opportunities for and support the recovery of service users, but the recovery is conditioned on digital mental health practices. The results were presented as two main-themes: a person’s extensive recovery and digital mental health services that support recovery holistically. The former includes the sub-themes of clinical recovery, personal recovery and participation, and the latter the sub-themes of knowledge orientation, situationality, provision of support, interactivity, personality and client orientation. The integrative literature review shows that despite the need for future research, we already know a great deal about the factors that enable the implementation of digital mental health services that promote recovery. This knowledge needs to be utilized in the operating environment of mental health services, which is currently changing because of the COVID-19 pandemic. The review has some limitations, because research on the subject is fragmentary and the studies involved in the review were only targeted at persons with access to digital mental health services and the ability and motivation to use them. Keywords: mental health, digital services, recovery, integrative literature review

A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

2010 ◽  
Vol 19 (2) ◽  
pp. 168-177 ◽  
Author(s):  
Laura Grigoletti ◽  
Francesco Amaddeo ◽  
Aldrigo Grassi ◽  
Massimo Boldrini ◽  
Marco Chiappelli ◽  
...  
Keyword(s):  
Mental Health ◽  
Logistic Regression ◽  
Mental Health Services ◽  
Health Services ◽  
Predictive Models ◽  
Multinomial Logistic Regression ◽  
Community Treatment ◽  
Service Users ◽  
Community Based ◽  
Predictive Variables

SummaryAim– To develop predictive models to allocate patients into frequent and low service users groups within the Italian Community-based Mental Health Services (CMHSs). To allocate frequent users to different packages of care, identifing the costs of these packages.Methods– Socio-demographic and clinical data and GAF scores at baseline were collected for 1250 users attending five CMHSs. All psychiatric contacts made by these patients during six months were recorded. A logistic regression identified frequent service users predictive variables. Multinomial logistic regression identified variables able to predict the most appropriate package of care. A cost function was utilised to estimate costs.Results– Frequent service users were 49%, using nearly 90% of all contacts. The model classified correctly 80% of users in the frequent and low users groups. Three packages of care were identified: Basic Community Treatment (4,133 Euro per six months); Intensive Community Treatment (6,180 Euro) and Rehabilitative Community Treatment (11,984 Euro) for 83%, 6% and 11% of frequent service users respectively. The model was found to be accurate for 85% of users.Conclusion– It is possible to develop predictive models to identify frequent service users and to assign them to pre-defined packages of care, and to use these models to inform the funding of psychiatric care.

scholarly journals Evaluating the effects of community treatment orders (CTOs) in England using the Mental Health Services Dataset (MHSDS): protocol for a national, population-based study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e024193 ◽  
Author(s):  
Scott Weich ◽  
Craig Duncan ◽  
Kamaldeep Bhui ◽  
Alastair Canaway ◽  
David Crepaz-Keay ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Data Access ◽  
Population Based ◽  
Community Treatment ◽  
Spatial And Temporal Variation ◽  
Control Group ◽  
Advisory Group ◽  
Community Treatment Orders

IntroductionSupervised community treatment (SCT) for people with serious mental disorders has become accepted practice in many countries around the world. In England, SCT was adopted in 2008 in the form of community treatment orders (CTOs). CTOs have been used more than expected, with significant variations between people and places. There is conflicting evidence about the effectiveness of SCT; studies based on randomised controlled trials (RCTs) have suggested few positive impacts, while those employing observational designs have been more favourable. Robust population-based studies are needed, because of the ethical challenges of undertaking further RCTs and because variation across previous studies may reflect the effects of sociospatial context on SCT outcomes. We aim to examine spatial and temporal variation in the use, effectiveness and cost of CTOs in England through the analysis of routine administrative data.Methods and analysisFour years of data from the Mental Health Services Dataset (MHSDS) will be analysed using multilevel models. Models based on all patients eligible for CTOs will be used to explore variation in their use. A subset of CTO-eligible patients comprising a treatment group (CTO patients) and a matched control group (non-CTO patients) will be used to examine variation in the association between CTO use and study outcomes. Primary outcome will be total time in hospital. Secondary outcomes will include time to first readmission and mortality. Outputs from these models will be used to populate predictive models of healthcare resource use.Ethics and disseminationEthical approval has been granted by the National Health Service Data Access and Advisory Group and Warwick University. To ensure patient confidentiality and to meet data governance requirements, analyses will be carried out in a secure microdata laboratory using de-identified data. Study findings will be disseminated through academic channels and shared with mental health policy-makers and other stakeholders.

scholarly journals Use of community treatment orders and their outcomes: an observational study

2020 ◽  
Vol 8 (9) ◽  
pp. 1-76
Author(s):  
Scott Weich ◽  
Craig Duncan ◽  
Liz Twigg ◽  
Orla McBride ◽  
Helen Parsons ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Local Area ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Data Set ◽  
Local Areas ◽  
Treatment Order ◽  
Community Treatment Order

Background Community treatment orders are widely used in England. It is unclear whether their use varies between patients, places and services, or if they are associated with better patient outcomes. Objectives To examine variation in the use of community treatment orders and their associations with patient outcomes and health-care costs. Design Secondary analysis using multilevel statistical modelling. Setting England, including 61 NHS mental health provider trusts. Participants A total of 69,832 patients eligible to be subject to a community treatment order. Main outcome measures Use of community treatment orders and time subject to community treatment order; re-admission and total time in hospital after the start of a community treatment order; and mortality. Data sources The primary data source was the Mental Health Services Data Set. Mental Health Services Data Set data were linked to mortality records and local area deprivation statistics for England. Results There was significant variation in community treatment order use between patients, provider trusts and local areas. Most variation arose from substantially different practice in a small number of providers. Community treatment order patients were more likely to be in the ‘severe psychotic’ care cluster grouping, male or black. There was also significant variation between service providers and local areas in the time patients remained on community treatment orders. Although slightly more community treatment order patients were re-admitted than non-community treatment order patients during the study period (36.9% vs. 35.6%), there was no significant difference in time to first re-admission (around 32 months on average for both). There was some evidence that the rate of re-admission differed between community treatment order and non-community treatment order patients according to care cluster grouping. Community treatment order patients spent 7.5 days longer, on average, in admission than non-community treatment order patients over the study period. This difference remained when other patient and local area characteristics were taken into account. There was no evidence of significant variation between service providers in the effect of community treatment order on total time in admission. Community treatment order patients were less likely to die than non-community treatment order patients, after taking account of other patient and local area characteristics (odds ratio 0.69, 95% credible interval 0.60 to 0.81). Limitations Confounding by indication and potential bias arising from missing data within the Mental Health Services Data Set. Data quality issues precluded inclusion of patients who were subject to community treatment orders more than once. Conclusions Community treatment order use varied between patients, provider trusts and local areas. Community treatment order use was not associated with shorter time to re-admission or reduced time in hospital to a statistically significant degree. We found no evidence that the effectiveness of community treatment orders varied to a significant degree between provider trusts, nor that community treatment orders were associated with reduced mental health treatment costs. Our findings support the view that community treatment orders in England are not effective in reducing future admissions or time spent in hospital. We provide preliminary evidence of an association between community treatment order use and reduced rate of death. Future work These findings need to be replicated among patients who are subject to community treatment order more than once. The association between community treatment order use and reduced mortality requires further investigation. Study registration The study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2015-1623). 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. 9. See the NIHR Journals Library website for further project information.

Rate of community treatment orders and readmission orders following reconfiguration of community mental health services

2016 ◽  
Vol 24 (3) ◽  
pp. 278-281 ◽  
Author(s):  
Brian O’Donoghue ◽  
Lisa Brophy ◽  
Nicholas Owens ◽  
Milana Rasic ◽  
Belinda McCullough ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Community Mental Health Services ◽  
Community Treatment ◽  
Community Treatment Orders

scholarly journals Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e049210
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Jennie Parker ◽  
Janet Willars ◽  
David Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Mental Healthcare ◽  
Well Being ◽  
Comparison Method ◽  
Service Users ◽  
Qualitative Interview Study ◽  
Remote Care

ObjectivesTo explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.DesignQualitative interview study, codesigned with mental health service users and carers.MethodsWe conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.SettingNational Health Service (NHS) secondary mental health services in England between June and August 2020.ParticipantsOf 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.ResultsExperiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.ConclusionsThough remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.

scholarly journals Living with Psychosis without Mental Health Services: A Narrative Interview Study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045661
Author(s):  
Rose McGranahan ◽  
Zivile Jakaite ◽  
Alice Edwards ◽  
Stefan Rennick-Egglestone ◽  
Mike Slade ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Interview Study ◽  
Future Research ◽  
Psychotic Experiences ◽  
Making Sense ◽  
Narrative Interview ◽  
External Sources ◽  
Past Experiences

ObjectivesLittle research has looked at how people who do not use mental health services experience psychosis. Thus, the present study aimed to explore the experiences and views of people with psychosis who have neither sought nor received support from mental health services for at least 5 years.DesignA narrative interview study. Thematic analysis was used to analyse the data.SettingEngland.ParticipantsTwenty-eight participants with self-defined psychotic experiences were asked to provide a free narrative about their experiences.ResultsFive themes were identified: (1) Perceiving psychosis as positive; (2) Making sense of psychotic experiences as a more active psychological process to find explanations and meaning; (3) Finding sources of strength, mainly in relationships and the environment, but outside of services; (4) Negative past experiences of mental health services, leading to disengagement and (5) Positive past experiences with individual clinicians, as an appreciation of individuals despite negative views of services as a whole.ConclusionsPerceiving psychosis as something positive, a process of making sense of psychotic experiences and the ability to find external sources of strength all underpin—in addition to negative experiences with services—a choice to live with psychosis outside of services. Future research may explore to what extent these perceptions, psychological processes and abilities can be facilitated and strengthened, in order to support those people with psychosis who do not seek treatment and possibly also some of those who are in treatment.

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