scholarly journals Reconfiguring in-patient services for adults with mental health problems: changing the balance of care

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 420-426 ◽  
Author(s):  
Sue Tucker ◽  
Jane Hughes ◽  
David Jolley ◽  
Deborah Buck ◽  
Claire Hargreaves ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Care ◽  
Mental Health Problems ◽  
Cost Savings ◽  
Community Services ◽  
Nominal Group ◽  
Strategic Issues ◽  
Patient Groups ◽  
Balance Of Care ◽  
Alternative Settings

BackgroundResearch suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.AimsTo identify which individuals require what services, at what cost.MethodA ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.ResultsCommunity care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.ConclusionsThe findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.Declaration of interestNone.

Coercion in Community Mental Health Care

2016 ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mentally Ill ◽  
Community Care ◽  
Current Knowledge ◽  
Community Services ◽  
Community Treatment ◽  
Community Treatment Orders ◽  
Improved Outcome

The use of coercion is one of the defining issues of mental health care and has been intensely controversial since the very earliest attempts to contain and treat the mentally ill. The balance between respecting autonomy and ensuring that those who most need treatment and support are provided with it has never been finer, with the ‘move into the community’ in many high-income countries over the last 50 years and the development of community services. The vast majority of patients worldwide now receive mental health care outside hospital, and this trend is increasing. New models of community care, such as assertive community treatment (ACT), have evolved as a result and there are widespread provisions for compulsory treatment in the community in the form of community treatment orders. These legal mechanisms now exist in over 75 jurisdictions worldwide. Many people using community services feel coerced, but at the same time intensive forms of treatment such as ACT, which arguably add pressure to patients to engage in treatment, have been associated with improved outcome. This volume draws together current knowledge about coercive practices worldwide, both those founded in law and those ‘informal’ processes whose coerciveness remains contested. It does so from a variety of perspectives, drawing on diverse disciplines such as history, law, sociology, anthropology, and medicine and for is explored

The development and results of the European Mental Health Integration Index (2014)

2015 ◽  
Vol 14 (4) ◽  
pp. 205-210
Author(s):  
Peter John Huxley
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Best Practice ◽  
Mental Health Problems ◽  
Community Mental Health Services ◽  
Health Problems ◽  
Community Services ◽  
Content Type ◽  
People With Mental Illness ◽  
Mental Health Integration

Purpose – The purpose of this paper is to report on the development and results of the Mental Health Inclusion Index. Design/methodology/approach – Data gathering and interviews with key policy makers in 30 countries in Europe (the EU28 plus Switzerland and Norway). Data gathered enabled the production of an 18 indicator benchmarking index ranking the 30 countries based on their commitment to integrating people with mental illness. Findings – The main findings were: mental illness exacts a substantial human and economic toll on Europe, and there is a substantial treatment gap, especially for people with common mental health problems. Germany’s generous social provision and strong healthcare system put it number one in the Mental Health Integration Index. The UK and Scandinavian states come next. The lowest-scoring countries in the index are from Europe’s south-east, where there is a long history of neglect of mental illness and poorly developed community services. One needs to understand that the leading countries are not the only ones providing examples of best practice in integrating those with mental illness. Employment is the field of greatest concern for people with mental illness, but employment is also the area with the most inconsistent policies across Europe. A distinction can be made between countries whose policies are aspirational and those where implantation is support by substantial and most importantly sustained, resource investment. Europe as a whole is only in the early stages of the journey from institution- to community-based care. Lack of data makes greater understanding of this field difficult, and improvement can only be demonstrated by repeated surveys of this kind, based on more substantial, comprehensive and coherent information. Research limitations/implications – Usual caveats about the use of surveys. Missing data due to non-response and poverty of mental health inclusion data in many European countries. Practical implications – The author reflects on the findings and considers areas for future action. The main implications are: better services result from substantial, but most importantly, sustained investment; and that employment is most important to people with mental health problems, but is one of the most inconsistent policy areas across Europe. Social implications – Supports the need for consistent investment in community mental health services and more consistent employment policies in Europe. Originality/value – This survey is the first of its kind in Europe, and was conducted by the Economist Intelligence Unit in London, and sponsored by Janssen.

Improving mental healthcare in multi-cultural communities

2019 ◽  
Vol 30 (5) ◽  
pp. 238-243
Author(s):  
Ashley Morgan
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cultural Competence ◽  
Health Inequalities ◽  
Mental Health Problems ◽  
Mental Healthcare ◽  
Practice Nurses ◽  
Communication Problems ◽  
Diverse Patient Population ◽  
Patient Groups

Patients from marginalised or minority communities often experience health inequalities. Ashley Morgan explains how practice nurses are best placed to use their cultural competency skills to relieve these failings in primary care Patients from marginalised or minority populations presenting with mental health problems in primary care often struggle to access appropriate and timely support. Communication problems, confusion among primary care professionals and inconsistent definitions of cultural competence contribute to prevailing health inequalities among these patient groups. Training to increase the cultural competence of the nursing workforce goes some way to reducing barriers to effective and appropriate care, although evidence suggests that training alone may be insufficient. This article explores the rationale for cultural competence and encourages practice nurses to develop a sense of cultural curiosity in order to engage with the mental health of their diverse patient population.

The Role of Social Housing in the ‘Care’ and ‘Control’ of Tenants with Mental Health Problems

2009 ◽  
Vol 9 (1) ◽  
pp. 111-122 ◽  
Author(s):  
Sadie Parr
Keyword(s):  
Mental Health ◽  
Social Housing ◽  
Community Care ◽  
Mental Health Problems ◽  
Health It ◽  
Housing Officers ◽  
Housing Professionals ◽  
Policy Agendas ◽  
And Control

Social housing is at the intersection of two policy agendas, namely anti-social behaviour and community care. This means that tenants with mental ill-health might at once be defined as vulnerable and in need of support to enable them to live independently, but simultaneously their behaviour may be viewed as a threat to the safety of others serving to legitimatise disciplinary and punitive forms of intervention on the grounds of ‘difference’. This paper focuses on the role of housing professionals in the management of cases of ASB involving people with mental ill-health. It argues that housing practitioners are not adequately equipped to make judgements on the culpability of ‘perpetrators’ who have mental ill-health and ensure their response is appropriate. This raises questions about the training housing officers recieve, and more broadly, whether the competing policy aims of community care and ASB can be reconciled.

scholarly journals Understanding community care law in England and Wales

2009 ◽  
Vol 15 (6) ◽  
pp. 428-433 ◽  
Author(s):  
Danny Allen
Keyword(s):  
Mental Health ◽  
Community Care ◽  
Mental Health Problems ◽  
Case Law ◽  
Mental Capacity ◽  
Care Provision ◽  
Care Programme ◽  
England And Wales ◽  
Mental Capacity Act 2005 ◽  
Mental Capacity Act

SummaryAlthough psychiatrists in England and Wales are generally familiar with the Mental Health Act 1983 and the Mental Capacity Act 2005, there is a body of law that is available to assist patients in the community with which they are generally less familiar. There are two main reasons for this. The first is that it is a rather confused amalgam of different statutes and case law affecting each other in ways that are less than clear. The other is that the care programme approach (CPA) was meant to cut through all this and make care provision straightforward. In fact, the latter has never been the case and community care law has always sat uneasily alongside the CPA, but in October 2008 the CPA was withdrawn from some patients with mental health problems. This article explains what is meant by community care law and how psychiatrists can use it to help their patients.

scholarly journals Psichikos negalią turinčių asmenų globa Lietuvoje: priklausomybė nuo paveldėtos paslaugų teikimo kultūros

2012 ◽  
Vol 6 ◽  
pp. 87-96 ◽  
Author(s):  
Dainius Pūras ◽  
Eglė Šumskienė
Keyword(s):  
Mental Health ◽  
European Union ◽  
Intellectual Disabilities ◽  
Residential Care ◽  
Community Care ◽  
Mental Health Problems ◽  
Current System ◽  
The European Union ◽  
Soviet System ◽  
Residential Institutions

Vilniaus universiteto Medicinos fakulteto Psichiatrijos klinikaVasaros g. 5, tel. (+370 5) 261 10 43. El. paštas: [email protected] universiteto Filosofijos fakulteto Socialinio darbo katedraUniversiteto g. 9/1, Tel. (+370 5) 266 76 10. El. paštas: [email protected]  Straipsnyje nagrinėjama sutrikusios psichikos ir sutrikusio intelekto asmenų globa didelėse uždarose stacionariose globos įstaigose. Iki Sovietų Sąjungos žlugimo šios įstaigos ne tik globojo, bet ir izoliavo sutrikusios psichikos ir sutrikusio intelekto individus. Tvirtas šių įstaigų pozicijas to meto socialinės apsaugos sistemoje lėmė ideologinės priežastys, dominuojantis defektologijos mokslas, sukurta materialinė ir teisinė bazė, neigiamas visuomenės nusistatymas sutrikusios psichikos ir sutrikusio intelekto asmenų atžvilgiu. Žlugus Sovietų Sąjungai, stacionarios globos sistema pasirodė esanti ypač atspari permainoms – ji ne tik atsilaikė prieš bandymus veiksmingai transformuoti, bet ir sulaukė investicijų iš Europos Sąjungos fondų. Atkūrus Nepriklausomybę įvykusios permainos – darbuotojų mokymai, pastatų rekonstrukcija, paslaugų įvairovės didinimas – neatnešė institucinės kultūros, atskirties tradicijos permainų ir tik sustiprino stacionarios globos institucijų padėtį.Tai sudarė prielaidas Lietuvoje susiformuoti unikaliam sutrikusios psichikos ir sutrikusio intelekto asmenų globos būdui, kurį galima įvardyti kaip visuomenės ir valstybės raidai nepalankią ydingo sovietinio paveldo ir atsirinktų ES paramos bei vertybių kombinaciją.Pagrindiniai žodžiai: stacionari globa, psichikos ir intelekto sutrikimai, Europos Sąjunga, ideologija.Care for persons with memental disability: dependency on inherited culture of srevicesDainius Pūras, Eglė Šumskienė SummaryGoal of this article is to identify main obstacles while transforming Lithuanian system of residential care for persons with mental and intellectual disabilities from repressive and isolating Soviet tradition to individualised community care. During the Soviet times the goal of large residential institutions was to take physical care after individuals with mental and intellectual disabilities as well as to isolate them from the rest of the society. These institutions were deeply anchored in the Soviet system of social assistance, based on the principles of defectology and stigmatizing attitudes towards persons with mental health problems. After collapse of the Soviet Union this system appeared to be eminently resistant to reforms: it withstood attempts of transformation and even managed to receive investments from the European Union structural funds thus strengthening the positions of large residential institutions over modern community care. More than two decades of investments in training of staff, reconstruction of buildings, modernisation of services and other components of mental health services in Lithuania have not resulted in the change of paradigm, as institutional culture and tradition of exclusion remains still very strong.Thus, current system of care for persons with mental and intellectual disabilities in Lithuania can be defined as a combination of strong effects of former Soviet system and selectively chosen components of modern mental health policy and services.Key words: residential care, intellectual and mental disabilities, European Union, ideology.

scholarly journals National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

2014 ◽  
Vol 2 (4) ◽  
pp. 1-480 ◽  
Author(s):  
David Challis ◽  
Sue Tucker ◽  
Mark Wilberforce ◽  
Christian Brand ◽  
Michele Abendstern ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Older People ◽  
Mental Health Problems ◽  
Care Home ◽  
Research Programme ◽  
Community Services ◽  
Care Homes ◽  
Care Home Staff ◽  
Mental Health Outreach

BackgroundThe rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models.AimsThe programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups.MethodsThe programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award.ResultsBoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training.LimitationsLimitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored.ConclusionsBoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental health services and the relative cost-effectiveness of different models of mental health outreach for older care home residents.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Towards a General Explanation for the Survival of the Private Asylum

10.1068/c15r ◽  
2005 ◽  
Vol 23 (2) ◽  
pp. 159-172 ◽  
Author(s):  
Graham Moon ◽  
Alun E Joseph ◽  
Robin Kearns
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Community Care ◽  
Mental Health Problems ◽  
Dominant Role ◽  
Analytical Framework ◽  
The Public ◽  
Role Of The State ◽  
General Explanation

Taken together, the ascendancy of community care and the dominant role of the state as a funder of services have meant that private sector residential care for people with mental health problems is now a rarity in most countries. Yet private asylums have persisted in some places. The authors propose an analytical framework for understanding such ‘institutional survivals’. This framework problematises the public—private and community—asylum boundaries that have hitherto been taken for granted. The framework is applied to case studies in Canada and New Zealand. Survival of these institutions is found to be centrally associated with accommodations with legislative environments, proactive innovation, and the availability of markets.

scholarly journals Lost in a Legal Maze: Community Care Law and People with Mental Health Problems: The Law Commission’s Review of Adult Social Care Law

2014 ◽  
pp. 139
Author(s):  
Tim Spencer-Lane
Keyword(s):  
Mental Health ◽  
Social Care ◽  
Community Care ◽  
Mental Health Problems ◽  
Health Problems ◽  
Law Reform ◽  
Disabled People ◽  
Wide Range ◽  
The Law ◽  
Physically Disabled People

In June 2008, the Law Commission published its Tenth Programme of Law Reform, which includes a project to review adult social care law in England and Wales. Adult social care impacts on a wide range of individuals, including older people, people with learning disabilities, physically disabled people, people with mental health problems and carers. This article considers the particular problems and challenges that community care law presents for people with mental health problems and how the Law Commission’s review proposes to address this.

Optimising emergency department and acute care for people experiencing mental health problems: a nominal group study

2021 ◽  
Author(s):  
Donna Marynowski-Traczyk ◽  
Marianne Wallis ◽  
Marc Broadbent ◽  
Paul Scuffham ◽  
Jesse T. Young ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Acute Care ◽  
Mental Health Problems ◽  
Health Problems ◽  
Nominal Group
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