scholarly journals Does a cluster always equal a cluster? Geographical variation of cluster populations

2014 ◽  
Vol 38 (6) ◽  
pp. 294-298 ◽  
Author(s):  
Josephine Morgan
Keyword(s):  
Mental Health ◽  
Resource Use ◽  
Service Provision ◽  
Financial Risk ◽  
Geographical Variation ◽  
Clinical Implications ◽  
Deep Dive ◽  
Complex Patients

Aims and methodTo provide information regarding the extent to which the process of clustering using the mental health clustering tool captures the complexity of patient need across different geographical areas. Investigation was undertaken via a ‘deep dive’ into patient notes, with data collected on patients allocated to cluster 5, 8 or 13 in three different London boroughs.ResultsThere is evidence for within-cluster differences between patients in different London boroughs in terms of various complexity factors. Further findings in relation to accuracy of clustering suggest some area-specific patterns in terms of clustering practice, raising the possibility that clinicians have different scoring thresholds in different areas.Clinical implicationsComplexity factors can affect resource use and therefore cost of service provision. In the case of a national tariff, providers of care to more complex patients may be placed at greater financial risk. It is therefore likely that some form of tariff adjustments will need to be introduced so as not to disadvantage patients and clinicians practising in areas of greater complexity.

scholarly journals The Experiences and Views of Service Providers on the Mental Health and Well-Being Services for Syrian Refugees in Coventry and Warwickshire

2022 ◽  
Author(s):  
Eleni Anastasiou ◽  
Helen Liebling ◽  
Michelle Webster ◽  
Fiona MacCallum
Keyword(s):  
Mental Health ◽  
Support Services ◽  
Service Provision ◽  
Service Providers ◽  
Well Being ◽  
Clinical Implications ◽  
Syrian Refugees ◽  
Semistructured Interviews ◽  
Views And Perceptions ◽  
Health And Well Being

Abstract. Objectives: Previous literature demonstrated that, even when mental health and psychological support services are available for refugees, there may still be obstacles in accessing services. This is the first known study to explore the experiences of mental-health and well-being services for Syrian refugees in Coventry and Warwickshire, United Kingdom. The research investigates the views and perceptions of service providers on the current mental-health and well-being services provided for this population. Methods: Eight service providers participated in semistructured interviews and focus groups, and the data were analyzed using thematic analysis. Results: Three main themes emerged from an analysis of the data: “positive aspects of service delivery,” “service challenges,” and “recommendations for service improvements and quality.” Conclusion: The findings bring to the fore specific gaps in current provision and interpreting services. Recommendations for proposed improvements in service provision and policy as well as clinical implications are included in this article.

scholarly journals Community treatment orders in England: review of usage from national data

2018 ◽  
Vol 42 (3) ◽  
pp. 119-122 ◽  
Author(s):  
Susham Gupta ◽  
Elvan U. Akyuz ◽  
Toby Baldwin ◽  
David Curtis
Keyword(s):  
Mental Health ◽  
Service Provision ◽  
Psychiatric Service ◽  
Community Treatment ◽  
Clinical Implications ◽  
Economic Downturn ◽  
National Data ◽  
Community Treatment Orders ◽  
England And Wales ◽  
Low Rate

Aims and methodCommunity treatment orders (CTOs) have been in used in England and Wales since November 2008; however, their effectiveness has been debated widely, as has the question of which methodology is appropriate to investigate them. This paper uses national data to explore the use of CTOs in England.ResultsAbout 5500 patients are subject to CTOs at any one time. Each year, ~4500 patients are made subject to a CTO each year and ~2500 are fully discharged, usually by the responsible clinician; fewer than half of CTO patients are recalled, and two-thirds of recalls end in revocation. The low rate of CTO discharges by mental health tribunals (below 5%) suggests that they are not used inappropriately.Clinical implicationsThe introduction of CTOs in England has coincided with a reduction in psychiatric service provision due to the economic downturn. Pressures on services might be even more severe if patients currently subject to CTOs instead needed to be detained as in-patients.Declaration of interestNone.

scholarly journals Psychiatry of learning disability – a future with mental health?

2002 ◽  
Vol 26 (8) ◽  
pp. 299-301 ◽  
Author(s):  
R. Alexander ◽  
A. Regan ◽  
S. Gangadharan ◽  
S. Bhaumik
Keyword(s):  
Mental Health ◽  
Learning Disability ◽  
Social Services ◽  
Service Provision ◽  
Postal Survey ◽  
Clinical Implications ◽  
Current Management ◽  
Process Of Change ◽  
Management Changes ◽  
Integrated Mental Health

Aims and MethodA postal survey was sent to all consultants in the psychiatry of learning disability from four English regions. Their views on job satisfaction, their core roles and the management re-structuring of services were elicited.ResultsThe proportion agreeing or strongly agreeing with each management option was 79% for integrated mental health–learning disability trusts, 61% for specialist learning disability trusts, 47% for care trusts, 10% for primary care trusts and 5% for social services. Only 34% felt consulted or able to influence the process of change and only 33% were satisfied with the current management changes within their trust but 67% were satisfied overall with their jobs.Clinical ImplicationsManagement from integrated mental health–learning disability trusts is the most preferred option for psychiatrists in learning disability. A large number of consultants, though otherwise satisfied with their jobs, feel excluded or unable to influence the current changes in management structures. A model of integrated service provision in line with the government's learning disability strategy is presented.

scholarly journals Payment by results: validating care cluster allocation in the real world

2013 ◽  
Vol 37 (11) ◽  
pp. 349-355 ◽  
Author(s):  
Stavros Bekas ◽  
Orlin Michev
Keyword(s):  
Mental Health ◽  
Clinical Judgement ◽  
Clinical Implications ◽  
Exclusion Criteria ◽  
Deep Dive ◽  
Inappropriate Care ◽  
Margin Of Error ◽  
Icd 10 ◽  
Cluster Allocation ◽  
Health Trust

Aims and methodTo validate care cluster allocation for payment by results (PbR) in mental health and to evaluate clustering and auditing methodologies. We applied exclusion criteria to the patient population of a mental health trust. An automated validation compared cluster with expected ICD-10 codes or scores on the Health of the Nation Outcome Scales (HoNOS) and Mental Health Clustering Tool (MHCT). Six hundred ‘mismatched’ cases were reviewed in depth to better understand the reasons why these cases appeared misclustered.ResultsThere was a significant mismatch between ICD-10 codes, HoNOS and MHCT scores and allocated care cluster, with differences between services and localities. Some clusters appeared to be more accurately allocated. The ‘deep dive’ analysis indicated that most mismatches occurred because psychosis was allocated to a non-psychotic cluster and vice versa, but also as a result of inherent weaknesses of the MHCT.Clinical implicationsHigh levels of inappropriate care cluster allocation highlight the need to improve practice. Weaknesses in the MHCT and ICD-10 coding mean that the final arbiter should be clinical judgement. Auditing will, by necessity, have a significant margin of error.

School Settings

2018 ◽  
Author(s):  
Melissa K. Holt ◽  
Jennifer Greif Green ◽  
Javier Guzman
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Service Provision ◽  
Community Mental Health Service ◽  
Health Service Provision ◽  
School Settings ◽  
Mental Health Service Provision

Schools are a primary setting for mental health service provision to youth and are also main sources of referral to community mental health service providers. This chapter examines the school context and its key role in the child and adolescent mental health services system. The chapter first provides information about the association of emotional and behavioral disorders with school experiences, including academic performance. Next, the chapter presents a framework for mental health service provision and assessment in schools, including describing methods for identifying students who might need mental health services and tracking their progress. Further, several evidence-based interventions are highlighted as examples of effective practices in schools. The chapter concludes with recommendations for clinical practice in school settings.

scholarly journals Street triage services in England: service models, national provision and the opinions of police

2018 ◽  
Vol 42 (6) ◽  
pp. 253-257 ◽  
Author(s):  
Abirami Kirubarajan ◽  
Stephen Puntis ◽  
Devon Perfect ◽  
Marc Tarbit ◽  
Mary Buckman ◽  
...  
Keyword(s):  
Mental Health ◽  
National Survey ◽  
Police Officers ◽  
Traditional Approach ◽  
Clinical Implications ◽  
Modes Of Operation ◽  
Specialist Services ◽  
Service Models ◽  
The Law ◽  
Core Part

Aims and methodStreet triage services are increasingly common and part of standard responses to mental health crises in the community, but little is understood about them. We conducted a national survey of mental health trusts to gather detailed information regarding street triage services alongside a survey of Thames Valley police officers to ascertain their views and experiences.ResultsTriage services are available in most areas of the country and are growing in scope. There is wide variation in levels of funding and modes of operation, including hours covered. Police officers from our survey overwhelmingly support such services and would like to see them expanded.Clinical implicationsMental health crises now form a core part of policing and there are compelling reasons for the support of specialist services. Recent changes to the law have heightened this need, with a requirement for specialist input before a Section 136 is enacted. Those who have experienced triage services report it as less stigmatising and traumatic than a traditional approach, but there remains little evidence on which to base decisions.Declaration of interestNone.

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