scholarly journals From taking to using medication: recovery-focused prescribing and medicines management

2013 ◽  
Vol 19 (1) ◽  
pp. 2-10 ◽  
Author(s):  
Elina Baker ◽  
Jason Fee ◽  
Louise Bovingdon ◽  
Tina Campbell ◽  
Elaine Hewis ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Well Being ◽  
Psychiatric Services ◽  
Psychiatric Practice ◽  
Medicines Management ◽  
The Relationship ◽  
Recovery Tools

SummaryMental health services are increasingly supporting recovery-oriented practice as a basis for service delivery. There is considerable overlap between the values and approaches associated with recovery-based practice and those already endorsed as good psychiatric practice. However, these agreed principles may not be consistently applied and further steps may be needed if the reorientation of the relationship between psychiatrists and people using psychiatric services is to fully reflect recovery principles. This article describes ways in which psychiatric practice could develop, including conceptualising medication as one of many possible recovery tools that a person can actively use to support their well-being, and a range of practices available to professionals to support people in taking up an active stance in relation to medication. It also identifies recovery-supportive practices for when someone is unable to fully participate in decision-making, owing to crisis, loss of capacity or concerns about safety.

Consumer search and satisfaction with mental health services

2016 ◽  
Vol 30 (7) ◽  
pp. 736-748 ◽  
Author(s):  
Lindsay R.L. Larson ◽  
Dora Elizabeth Bock
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Patient Satisfaction ◽  
Mental Health Services ◽  
Health Services ◽  
Well Being ◽  
Consumer Search ◽  
Mental Health Provider ◽  
Health Provider ◽  
Content Type

Purpose Recent evidence on consumer decision-making suggests that highly complex choice scenarios lead consumers to use simplistic decision heuristics, often resulting in suboptimal decision-making. This study aims to investigate the relationships among consumers’ primary information source, patient satisfaction and patient well-being, specifically focused on the search for mental health professionals. The selection of a mental health provider is of interest, because practitioners work from a highly diverse set of theoretical bases, may hold a wide range of different credentials and provide drastically different therapeutic approaches, therefore making the selection complex and difficult for consumers to self-navigate. Design/methodology/approach Three studies were undertaken, with data sampling from both patients of mental health services and practitioners. Findings Consumers selecting a provider based on self-performed searches, rather than receiving external input (referrals from physicians, relatives or friends), report lower satisfaction with their mental health provider. In turn, patient satisfaction positively impacts patient well-being. Practitioner data corroborate these findings, revealing that a large percentage of patients stem from a self-performed internet search, though mental health providers recognize that external referrals are likely to lead to better outcomes. Originality/value The results reveal the importance of understanding the consumer search and, particularly, the use of the internet as a search tool. The results present several implications for service providers, including the need to identify patients’ primary source utilized within an information search, as it can adversely impact patient satisfaction.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

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 Designing servicescapes for transformative service conversations: lessons from mental health services

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahir Gopaldas ◽  
Anton Siebert ◽  
Burçak Ertimur
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Risk Taking ◽  
Design Theory ◽  
Well Being ◽  
Service Encounters ◽  
Design Strategies ◽  
Content Type ◽  
Emotional Risk

Purpose Dyadic services research has increasingly focused on helping providers facilitate transformative service conversations with consumers. Extant research has thoroughly documented the conversational skills that providers can use to facilitate consumer microtransformations (i.e. small changes in consumers’ thoughts, feelings and action plans toward their well-being goals). At the same time, extant research has largely neglected the role of servicescape design in transformative service conversations despite some evidence of its potential significance. To redress this oversight, this article aims to examine how servicescape design can be used to better facilitate consumer microtransformations in dyadic service conversations. Design/methodology/approach This article is based on an interpretive study of mental health services (i.e. counseling, psychotherapy and coaching). Both providers and consumers were interviewed about their lived experiences of service encounters. Informants frequently described the spatial and temporal dimensions of their service encounters as crucial to their experiences of service encounters. These data are interpreted through the lens of servicescape design theory, which disentangles servicescape design effects into dimensions, strategies, tactics, experiences and outcomes. Findings The data reveal two servicescape design strategies that help facilitate consumer microtransformations. “Service sequestration” is a suite of spatial design tactics (e.g., private offices) that creates strong consumer protections for emotional risk-taking. “Service serialization” is a suite of temporal design tactics (e.g., recurring appointments) that creates predictable rhythms for emotional risk-taking. The effects of service sequestration and service serialization on consumer microtransformations are mediated by psychological safety and psychological readiness, respectively. Practical implications The article details concrete servicescape design tactics that providers can use to improve consumer experiences and outcomes in dyadic service contexts. These tactics can help promote consumer microtransformations in the short run and consumer well-being in the long run. Originality/value This article develops a conceptual model of servicescape design strategies for transformative service conversations. This model explains how and why servicescape design can influence consumer microtransformations. The article also begins to transfer servicescape design tactics from mental health services to other dyadic services that seek to facilitate consumer microtransformations. Examples of such services include career counseling, divorce law, financial advising, geriatric social work, nutrition counseling, personal styling and professional organizing.

scholarly journals Acute mental health presentations before and during the COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (4) ◽  
Author(s):  
Naaheed Mukadam ◽  
Andrew Sommerlad ◽  
Jessica Wright ◽  
Abigail Smith ◽  
Aleksandra Szczap ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Health Services ◽  
Health Services ◽  
Psychological Symptoms ◽  
Interrupted Time Series ◽  
Psychiatric Services ◽  
Psychotic Symptoms ◽  
Duration Of Symptoms ◽  
Mental Capacity Act

Background A number of community based surveys have identified an increase in psychological symptoms and distress but there has been no examination of symptoms at the more severe end of the mental health spectrum. Aims We aimed to analyse numbers and types of psychiatric presentations to inform planning for future demand on mental health services in light of the COVID-19 pandemic. Method We analysed electronic data between January and April 2020 for 2534 patients referred to acute psychiatric services, and tested for differences in patient demographics, symptom severity and use of the Mental Health Act 1983 (MHA), before and after lockdown. We used interrupted time-series analyses to compare trends in emergency department and psychiatric presentations until December 2020. Results There were 22% fewer psychiatric presentations the first week and 48% fewer emergency department presentations in the first month after lockdown initiated. A higher proportion of patients were detained under the MHA (22.2 v. 16.1%) and Mental Capacity Act 2005 (2.2 v. 1.1%) (χ2(2) = 16.3, P < 0.0001), and they experienced a longer duration of symptoms before seeking help from mental health services (χ2(3) = 18.6, P < 0.0001). A higher proportion of patients presented with psychotic symptoms (23.3 v. 17.0%) or delirium (7.0 v. 3.6%), and fewer had self-harm behaviour (43.8 v. 52.0%, χ2(7) = 28.7, P < 0.0001). A higher proportion were admitted to psychiatric in-patient units (22.2 v. 18.3%) (χ2(6) = 42.8, P < 0.0001) after lockdown. Conclusions UK lockdown resulted in fewer psychiatric presentations, but those who presented were more likely to have severe symptoms, be detained under the MHA and be admitted to hospital. Psychiatric services should ensure provision of care for these patients as well as planning for those affected by future COVID-19 waves.

scholarly journals Evaluating the Prosper peer-led peer support network: a participatory, coproduced evaluation

2016 ◽  
Vol 20 (2) ◽  
pp. 80-91 ◽  
Author(s):  
Steve Gillard ◽  
Rhiannon Foster ◽  
Kati Turner
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Social Movement ◽  
Peer Support ◽  
Online Survey ◽  
Well Being ◽  
Support Network ◽  
Content Type ◽  
One To One

Purpose – A range of one-to-one, group and online approaches to peer support are increasingly complementing formal mental health service delivery. Evidence is emerging of the potential benefits and challenges of peer support for individuals, communities and organisations. There is more limited evidence describing peer-led peer support networks. The paper aims to discuss these issues. Design/methodology/approach – In an evaluation of Prosper, a peer-led, peer support network and social movement, members of the network played a participatory role in the design, conduct and interpretative work of the evaluation. An online survey, one-to-one interviews and group discussions were used. Findings – The evaluation describes an evolving network with planning and development meetings constituting core activity for many members alongside a monthly training programme supporting people to set up their own activities. There were strong shared values, and consensus that Prosper could strengthen social networks, improve individual well-being and impact on the way people used mental health services. Challenges were identified around feelings of uncertainty and vulnerability in relation to involvement in the network. Research limitations/implications – The participatory nature of the evaluation adds value to the learning offered. This was a descriptive evaluation; potential is indicated for the more formal modelling and testing of peer-led network and social movement initiatives. Practical implications – Clarity is needed on the relationship of the network to statutory mental health services – specifically around taking on a “service provider” role – and on the advantages and challenges of a “hybrid” organisational model that combines traditional, hierarchical and new distributed forms of leadership and structure. Social implications – Prosper demonstrated potential to create a sense of common culture based on sharing lived experience and mutual peer support, providing an alternative to the traditional culture of mental health services. Originality/value – This paper offers wider learning derived from evaluation of a highly original initiative in peer leadership, network structure and interface with statutory mental health services.

P-OGC66 Mental Health and Wellbeing Services for Patients with Upper GI Cancer

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Claire Coleman ◽  
Wendy Hickey ◽  
Cathy White
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Well Being ◽  
Verbal Information ◽  
Patient Cohort ◽  
Upper Gi ◽  
Gi Cancer ◽  
Number Of Patients ◽  
Upper Gi Cancer

Abstract Background Cancer related distress has a major impact on quality of life. The psychosocial needs of patients post an oesophagectomy  are significant and exacerbate the physical burden. The Upper GI MDT at our hospital aim to provide holistic patient centred care that equips patients mentally and physically for their treatment pathway. Formal or structured pyschoncology services are not routinely available to our patient cohort. The aim of the audit undertaken was to assess awareness of and subsequent engagement with available mental health services in patients undergoing a curative resection for oesophagogastric cancer. Methods Patients who underwent either a gastrectomy or oesophagectomy in the Upper GI Centre between Nov 2018 and May 2019 were included. They each received a questionnaire to complete anonymously. Responses were via prepaid post. Responses were collated and analysed. Results 36 questionnaires sent out with 21 patients responding (Response rate 58%). Average age:69 (age range 40-84). 18 of the 21 responses were male Time diagnosed with cancer: 57% were between 12 to 18 months post diagnosis and 43% between 6 to 11 months. Source of Information received: 43% reported verbal information provided and 38% reported written information was provided Current engagement with Mental Health Services: National, Community, and Exercise programmes were used by a very small number of  patients - 6 in total out of 21 respondents  Reasons for not engaging with Mental Health Services responses included ‘Not being interested or required' to ‘fearful' ‘No knowledge of service' to ‘Cant remember ' or ‘Plans to engage' 93% of respondents would recommend use of wellbeing or mental health services to someone with a diagnosis of an Upper GI Cancer Suggestions for improvements varied from use of information packs, information on life post op and more guidance needed surrounding availability of current mental health supports  Conclusions Psychosocial issues need to be addressed and there is a huge deficit in current service provision. Current service is not meeting service user needs and not empowering patients how best to manage mental burden and thus contribute to maximising treatment outcomes. National Cancer Strategy acknowledges lack of access for cancer patients to pyschoncology services. The Cancer Centre is awaiting appointment of a Pyschoncology Consultant and Team in the coming months. The Upper GI MDT will seek access to this service once available for their patient cohort. In interim use limited national and community resources available. Provide education to wider team members to standardise approach providing both written and verbal information on available mental health and well being services, embed mental health awareness into daily practice with encouragement for early patient intervention if cancer related distress evident. Re Audit after introduction of these measures.

scholarly journals Causal Modelling for Supporting Planning and Management of Mental Health Services and Systems: A Systematic Review.

2019 ◽  
Vol 16 (3) ◽  
pp. 332 ◽  
Author(s):  
Nerea Almeda ◽  
Carlos R. García-Alonso ◽  
José A. Salinas-Pérez ◽  
Mencía R. Gutiérrez-Colosía ◽  
Luis Salvador-Carulla
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Policy Making ◽  
Structural Equation ◽  
Target Population ◽  
Performance Factors ◽  
Causal Modelling

Mental health services and systems (MHSS) are characterized by their complexity. Causal modelling is a tool for decision-making based on identifying critical variables and their causal relationships. In the last two decades, great efforts have been made to provide integrated and balanced mental health care, but there is no a clear systematization of causal links among MHSS variables. This study aims to review the empirical background of causal modelling applications (Bayesian networks and structural equation modelling) for MHSS management. The study followed the PRISMA guidelines (PROSPERO: CRD42018102518). The quality of the studies was assessed by using a new checklist based on MHSS structure, target population, resources, outcomes, and methodology. Seven out of 1847 studies fulfilled the inclusion criteria. After the review, the selected papers showed very different objectives and subjects of study. This finding seems to indicate that causal modelling has potential to be relevant for decision-making. The main findings provided information about the complexity of the analyzed systems, distinguishing whether they analyzed a single MHSS or a group of MHSSs. The discriminative power of the checklist for quality assessment was evaluated, with positive results. This review identified relevant strategies for policy-making. Causal modelling can be used for better understanding the MHSS behavior, identifying service performance factors, and improving evidence-informed policy-making.

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