scholarly journals The psychiatry virtual-on-call experience: Can it improve confidence of foundation and GP trainees with out-of-hours work in psychiatry?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S28-S29
Author(s):  
Charlotte Harrison ◽  
Helen Blamey ◽  
Alistair Roddick ◽  
Kate Saunders ◽  
Tina Malhotra
Keyword(s):  
Mental Health ◽  
Interpersonal Communication ◽  
Multiple Testing ◽  
Learning Experience ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Mental Health Act ◽  
Telephone Advice ◽  
Introductory Lecture ◽  
Perceived Preparedness

AimsOut-of-hours (‘on-call’) work can be perceived by junior doctors to be a daunting experience, associated with feeling unprepared and less supported. Simulated on-call programmes have been used to great effect in medicine and surgery to improve junior doctors’ skills in task prioritisation, interpersonal communication and confidence on-call. However, few psychiatry-specific programmes exist.We aimed to: i) Develop a psychiatry specific virtual-on-call programme, ii) Investigate if the virtual-on-call programme improved confidence amongst junior trainees in key areas of psychiatry practice.MethodThe Psychiatry Virtual-On-Call programme commenced in December 2020. It involves attending an introductory on-call lecture, followed later in the rotation by a 2-hour simulated on-call shift. All trainees are expected to attend during their attachment and the simulated shifts are ongoing. During the shift, trainees are ‘bleeped’ with different psychiatry specific tasks. They work through the tasks, using local intranet policies and telephone advice from the on-call psychiatry registrar. Due to COVID-19 the sessions were delivered virtually. Participants completed a questionnaire evaluating confidence in ten domains, rated on a Likert scale from 0–10. Questionnaires were completed at four time-points during the programme; pre- and post-introductory lecture and pre- and post-simulated shift. Scores were compared using Mann-Whitney U tests. Significance was defined as P < 0.05 with Bonferroni correction applied for multiple testing.ResultTwenty-nine trainees attended the introductory lecture, 25 and 21 trainees completed the pre- and post-lecture questionnaire respectively. A non-significant improvement in confidence was reported in three domains: seclusions reviews, prescribing, detention under the mental health act.At the time of writing, ten trainees had attended the on-call shift. All participants completed a pre- and post-session questionnaire. The on-call shift was a useful learning experience (median score 9), and significantly increased perceived preparedness for on-call work from 3/10 to 7/10 (p < 0.001). Confidence was significantly improved in seven domains, most markedly in seclusion reviews, prescribing and mental health act tasks.ConclusionThe psychiatry virtual-on-call programme fills a niche in the training curriculum and is perceived by trainees to be a useful learning experience. The introductory lecture improved confidence in several domains, but not as effectively as the on-call shift. The on-call shift was well received by participants and significantly improved confidence in 7/10 domains. In summary, the virtual-on-call experience improves preparedness for out-of-hours psychiatry work. Follow-up of participants at the end of their psychiatry rotation will ascertain if they felt the programme to be useful during out-of-hours work.

scholarly journals Joint assessment out of hours: assessing the benefits for patients and junior doctors

2013 ◽  
Vol 37 (8) ◽  
pp. 272-275
Author(s):  
Laura Boyd ◽  
Colin Crawford ◽  
Eugene Wong
Keyword(s):  
Mental Health ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Out Of Hours ◽  
Assessment Protocol ◽  
Admission Rates ◽  
Mental Health Nurse ◽  
Health Nurse ◽  
The Impact ◽  
Joint Assessment

Aims and methodWe examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.ResultsIn the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.Clinical implicationsJoint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.

Mental health review tribunal medical reports

1998 ◽  
Vol 22 (10) ◽  
pp. 615-618 ◽  
Author(s):  
Khalida Ismail ◽  
Shubulade Smith ◽  
Tony Maden
Keyword(s):  
Mental Health ◽  
Forensic Psychiatry ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Mental Health Act ◽  
Acceptable Standard ◽  
Medical Reports ◽  
Health Review

Aims and methodMedical reports submitted to mental health review tribunals should be of a clinically acceptable standard. We examined 100 medical reports to assess whether they stated the four criteria for detention under Section 3 of the Mental Health Act 1983. We compared the standard of reports according to the seniority, qualifications and speciality of the doctor, and with the outcome from the tribunal.ResultsThe majority of the reports were written by junior doctors and did not fulfil the criteria laid down by the Mental Health Act 1983. Consultant and forensic psychiatry status were associated with completed reports.Clinical implicationsThis study was performed in one hospital only but highlights the ongoing need to review and improve the workings of the Mental Health Act before reform is considered.

Detaining patients in the general hospital – current practice and pitfalls

2019 ◽  
Vol 64 (3) ◽  
pp. 91-96
Author(s):  
Murray Smith ◽  
Rian O’Regan ◽  
Rainer Goldbeck
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Current Practice ◽  
Electronic System ◽  
Royal Infirmary ◽  
General Hospitals ◽  
Out Of Hours ◽  
Mental Health Act ◽  
Written Information ◽  
Psychiatric Staff

Aims Much has been written about the use of the Mental Health Act in psychiatric settings. There is, however, little written on its use to detain patients with mental disorder in general hospitals. Method and results We therefore carried out a survey of the use of the Mental Health Act in general hospital settings in Aberdeen, and also posted a questionnaire to Scottish Liaison Psychiatrists, asking about their experience of the use of the Mental Health Act in general hospitals. Over a six-month period in Aberdeen Royal Infirmary, we identified 39 detentions. Out of hours, the use of Emergency Detention Certificates was more common than use of Short Term Detention Certificates – the latter is recommended by the Mental Welfare Commission, as patients are afforded more rights. When psychiatric staff were not directly involved, procedural and administrative errors were more likely to occur. Liaison psychiatrists elsewhere in Scotland reported similar observations. Conclusion General hospital clinicians are unfamiliar with the Mental Health Act and its use. Errors in its application therefore arise, and are more common when psychiatric staff is not involved. Better education, including the provision of written information and consideration of an electronic system, may improve current practice.

scholarly journals Has the COVID-19 pandemic affected out-of-hours presentations in CAMHS?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S321-S321
Author(s):  
Sacha Evans
Keyword(s):  
Mental Health ◽  
Emergency Departments ◽  
Child And Adolescent ◽  
North Central ◽  
Out Of Hours ◽  
Mental Health Act ◽  
The North ◽  
Training Scheme ◽  
Phone Calls ◽  
Mental Health Difficulties

AimsThe aim of this project was to look at whether the COVID-19 pandemic, specifically lockdown, has impacted out-of-hours presentations to Child and Adolescent Mental Health Services (CAMHS) in North Central and East London.MethodSpecialist Registrars (SpRs) on the Royal London/Great Ormond Street CAMHS Higher Training Scheme are contacted for advice regarding all CAMHS presentations in the North Central and East London area. Responsibilities includes provision of advice to 6 hospitals (including 4 emergency departments) and 4 child and adolescent inpatient units. A record of all phone calls and call-outs, including Mental Health Act and Section 136 (S136) assessments are maintained and this study compares pre- and post-COVID-19 data to see if there are any differences in number of presentations, on-site assessments (including Mental Health Act and S136 assessments over 2019 and 2020.ResultNumbers of CAMHS presentations were lower in 2020 (mean 74 patients per month) compared with 2019 (60 patients per month). This was consistent across all months except October and December. The largest difference was seen in March: 109 patients presented in March 2019, compared with 55 in March 2020. This is also reflected in the number of assessments conducted on site. However, there do not appear to be differences in the numbers of Mental Health Act or S136 assessments undertaken over 2020, compared with 2019.ConclusionCAMHS out-of-hours presentations dropped off significantly at the start of the COVID-19 pandemic in the UK, and in particular, with the first lockdown (March to July 2020). Specialist Registrars provided advice via telephone less frequently in 2020 compared with 2019, and were required to do fewer on-site assessments of children and young people presenting with mental health difficulties.There were no significant differences in Mental Health Act or S136 assessments between the two years, however, these numbers are too small to make any meaningful conclusions.It is likely that children and adolescents were less likely to present to emergency departments for assessment of their mental health difficulties during the COVID-19 pandemic, rather than this reflecting a true reduction in mental health difficulties.Recommendations:It is helpful to continue to monitor CAMHS out-of-hour presentations.Trusts may want to consider alternative settings for providing emergency CAMHS assessments, for example, mental health hubs.Limitations:This provision of data is subject to recall bias.

scholarly journals Knowledge of mental health legislation in junior doctors training in psychiatry

2011 ◽  
Vol 35 (12) ◽  
pp. 460-466 ◽  
Author(s):  
Ovais Wadoo ◽  
Aadil Jan Shah ◽  
Nadarajah Jehaanandan ◽  
Michelle Laing ◽  
Manoj Agarwal ◽  
...  
Keyword(s):  
Mental Health ◽  
Quantitative Research ◽  
Early Stage ◽  
Fundamental Rights ◽  
Junior Doctors ◽  
Psychiatry Training ◽  
Inappropriate Use ◽  
Mental Health Act ◽  
Mental Health Legislation ◽  
Health Legislation

Aims and methodTo assess junior doctors' knowledge of the procedures involved in involuntary admission of patients detained under Sections 5(2), 2 and 3 of the Mental Health Act 1983. A semi-quantitative research study of junior trainees affiliated to two psychiatry training schemes was carried out.ResultsTrainees' knowledge of professionally relevant sections of the Mental Health Act was patchy. Knowledge correlated significantly with experience in clinical practice and with experience of using mental health legislation. Surprisingly, in-service training in mental health legislation had no effect on participants' knowledge.Clinical implicationsLack of knowledge and understanding raises the possibility of inappropriate use of the mental health legislation. This threatens patients' fundamental rights and can lead to complaints or litigation. There is a clear need to address this at an early stage in psychiatry training.

Consultant psychiatrists' experiences and attitudes following the introduction of the Mental Health Act 2001: a national survey

2009 ◽  
Vol 26 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Brian O'Donoghue ◽  
Paul Moran
Keyword(s):  
Mental Health ◽  
Substance Misuse ◽  
Response Rate ◽  
Child And Adolescent Psychiatry ◽  
Postal Survey ◽  
Junior Doctors ◽  
Mental Health Act ◽  
The Republic ◽  
Similar Risk

AbstractObjective: This study explored the attitudes and experiences of consultant psychiatrists regarding the Mental Health Act 2001.Method: A postal survey was distributed to all consultant psychiatrists (n=238) in the Republic of Ireland. All specialties were included except Child and Adolescent Psychiatry.Results: A response rate of 70% was achieved. Care of involuntarily admitted patients has improved according to 32%, but 48% found that the care of voluntary patients has deteriorated. Sixty-nine per cent of consultant psychiatrists acknowledge that involuntarily admitted patients are being changed to voluntary early to avoid a tribunal, and 21 % believe it occurs in over 40% of cases. Fourteen per cent of consultant psychiatrists have re-admitted a patient involuntarily immediately after a tribunal revoked the original Involuntary Order. Junior doctors' training by consultant psychiatrists has been reduced in 57% of placements as a result of the increased demands of the MHA 2001. Eighty-seven per cent report an increase in their on call service workload but only 23% report a sufficient increase in the number of consultants within their service. While 78% agree that patients should not be admitted involuntarily solely on the grounds that the person is suffering from a personality disorder, 58% feel that there is a risk in such patients not being involuntarily admitted in situations in which it is clinically necessary. Fifty-six per cent feel that there is a similar risk in patients with a diagnosis of substance misuse.Conclusion: Resources required to implement the Mental Health Act 2001 have not been sufficient leading to poorer quality of service and negatively affecting NCHDs training.

A Systematic Review of Research Relating to the Mental Health Act (1983)

1998 ◽  
Author(s):  
Rachel Churchill ◽  
Sharon Wall ◽  
Matthew Hotopf ◽  
Alec Buchanan ◽  
Simon Wessely
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Act
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