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Welfare Reform on the Web (November 2008): Mental health services - UK

Barriers and facilitators to partnership working between early intervention services and the voluntary and community sector

H. Lester and others

Health and Social Care in the Community, vol. 16, 2008, p. 493-500

Partnership working between the health and voluntary sectors is a high priority for government. This study explores the extent and patterns of partnership working between health and the voluntary sector in the context of early intervention services for young people with a first episode of psychosis. The paper presents data collected from voluntary sector group leads, early intervention services team members and senior management staff in mental health services provider and commissioning bodies in the West Midlands. These data are framed within a four stage partnership life cycle model.

Broadening horizons

K. Jupp

Learning Disability Today, Sept. 2008, p. 28-29

Individual budgets will enable people with learning difficulties to hire and fire staff they choose and to design the lifestyle that they really want. New service providers are emerging to facilitate this process. One of these is Home Care Direct, which will act as legal employer of staff chosen to assist clients.

(For a case study see Learning Disability Today, Sept. 2008, p. 32-34)

Campaigners blast 'shambles' that has left safe detention places empty


Community Care, Sept. 18th 2008, p. 11

The Independent Police Complaints Commission has found that people suffering mental distress in public places in England were twice as likely to be removed to police cells as hospitals in 2005/06. There is a lack of suitable alternatives to police cells despite the Department of Health providing 130m so that every mental health trust could build appropriate places of safety. Campaigners point out that the government had provided only capital funding, and that some trusts have had to leave facilities empty because they do not have the money to run them.

(See also Mental Health Today, Oct. 2008, p.15-17)

Care vs. security: just who is at risk of harm?

C. Santry

Health Service Journal, Oct. 2nd 2008, p. 12-13

This article discusses the dilemma facing the mental health services in deciding how to strike the right balance between protecting the public from violence by patients who have absconded from secure units and providing the best possible care. Stirred up by excitable media coverage, the public is quick to link violence with mental illness. In a humane society, it should perhaps learn to accept that patients need access to the outside world and that tragedies will happen.

CBT and the challenge of primary care: developing effective, efficient, equitable, acceptable and accessible services for common mental health problems

J. White

Journal of Public Mental Health, vol. 7, Aug. 2008, p. 32-41

This paper suggests that there are significant problems at every level of the mental health care system. Current approaches to the treatment of common mental health problems favour more use of individual therapies. There is a limited supply of therapists and waiting times are long. No healthcare system focused on individual therapy will ever be able to deal with more than a fraction of those who could benefit from intervention, since the average therapist can treat no more than 60-80 patients per year. There is an urgent need to consider alternative approaches such as social prescribing, group work and stepped care. We should also focus on removing the toxic factors within society that give rise to anxiety and depression in the first place.

Child and adolescent mental health services (CAMHS): providing services for children and young people with learning disabilities

B. Nixon, S. Hooton and A. Jones

Journal of Mental Health Training, Education and Practice, vol. 3, Sept. 2008, p. 39-52

Targets set in 2005 by the Department of Health in the form of a public service agreement standard require the development of comprehensive CAMHS which cover children and young people with learning disabilities. This standard presents particular challenges to the existing national CAMHS workforce. This paper reports on a specific project to undertake a northwest regional audit regarding capacity and capability of CAMHS staff to care for young patients with learning disabilities.

A collaborative approach to embedding graduate primary care mental health workers in the UK National Health Service

J. Fletcher and others

Health and Social Care in the Community, vol. 16, 2008, p. 451-459

The UK NHS workforce has recently witnessed the introduction of graduate primary care mental health workers to help GPs manage and treat common mental disorders such as depression in all age groups. There was a lack of clarity in guidance from the Department of Health on exactly how the new workers should be trained and managed and what their specific clinical role should be. Cumbria and Lancashire Strategic Health Authority established a Quality Improvement Collaborative to assist with embedding this new workforce. The intervention used 'collaborative' technology which involved bringing together groups of practitioners from different organisations to work in a structured way to improve service quality.

Coming out of the shadows

J. Cosh

Mental Health Today, July/Aug. 2008, p. 10-12

This article reports on progress with implementation of the Scottish National Strategy for Adult Survivors of Childhood Sexual Abuse. A sum of 2m was allocated to fund local projects and to help with the development of better services. A national reference group was set up to oversee the implementation of the strategy. To raise awareness of the issue, the Survivor Scotland web site was set up to communicate with the public, create a network and receive feedback.

Debt advice: a missing dimension

D. Palmer, S.E. White and G. Holmes

Mental Health Today, July/Aug. 2008, p. 32-33

Mental ill health is strongly associated with experiencing financial adversity and debt. This article reports on a study of how access to a specialist debt service improved the mental health of a group of 30 adults of working age in contact with Mind in Bexley. Mental health professionals lack the knowledge and skills to intervene effectively when clients report problems with debt, and need to work more closely with specialist advisers.

Education as an exit strategy for community mental health nurses: a thematic analysis of narratives

P. Crawford, B. Brown, and P. Majomi

Mental Health Review Journal, vol. 13, Sept. 2008, p. 8-15

Community mental health nurses face difficulties in balancing work and home life, and struggles over professional identity in sometimes inhospitable organisational environments. This study explored the narratives of community mental health nurses in an urban NHS trust in the Midlands, looking at how they described their working lives, with particular emphasis on the role of education and training in their professional development. Education was seen to offer a 'stepping stone' out of the profession. The NHS faces a significant challenge in retaining nurses who have achieved academic success.

An evaluation of an innovative project designed to enhance child and adolescent mental health services

S. Walker

Journal of Mental Health Training, Education and Practice, vol. 3, Sept. 2008, p. 4-13

Evidence suggests that specialist child and adolescent mental health services are overwhelmed by demand resulting in treatment delays and causing exacerbation of symptoms in children and young people. This paper details the development of one of the multidisciplinary initiatives to spring from a policy designed to stimulate innovative ideas in the field of early intervention and relieve demand on specialist CAMH services. The project was one of eight located in the voluntary sector and supported by the Mental Health Foundation.

Family matters: developments concerning the role of the nearest relative and social worker under mental health law in England and Wales

J. Rapaport and J. Manthorpe

British Journal of Social Work, vol. 38, 2008, p. 1115-1131

The 'nearest relative' and approved social worker roles in the mental health services share common ground. Although the approved social worker is a trained professional and the nearest relative is identified from a strict hierarchy of kin, both roles were awarded the authority to make a compulsory order for the hospital admission of persons with a serious mental disorder. Both roles will alter when amendments to the 1983 Mental Health Act come into force. This article presents an analysis of the interlocking powers of the approved social worker and the nearest relative, and an overview of the legal proposals. This covers the now defunct 'nominated person', the revised nearest relative role, and the new role of approved mental health professional.

First aid for the mind

H. Tweedie

Mental Health Today, Oct. 2008, p. 32-33

Mental Health First Aid is the help provided to a person developing a mental health problem or in a mental health crisis. It is given until appropriate professional treatment is received or until the crisis resolves. First aiders complete a 12 hour training course covering dealing with panic attacks, suicidal thoughts, overdoses and psychosis.

Health for all?

J. Blair and others

Learning Disability Today, Sept. 2008, p. 24-26

There is widespread ignorance of, and indifference to, the needs of people with learning difficulties in the health services in the UK. Learning disability nurses have a significant contribution to make to service improvement and to addressing the health inequalities experienced by this population. The learning disability nurse is a key player in multidisciplinary teams. The role involves: sharing specialist knowledge, identifying unmet health needs and future risks, supporting colleagues to identify the learning disabled population, and liaison across acute and primary healthcare services.

Integrating health and social care in community mental health teams in the UK: a study of assessments and eligibility criteria in England

P. Huxley and others

Health and Social Care in the Community, vol. 16, 2008, p. 476-482

In England since 2003 all adults with mental health problems requiring social care as an element of their care package must have an assessment to determine eligibility, set within the four level framework of Fair Access to Care Services (FACS). At the same time assessments under the Care Pathways Approach determine the level of mental health service support provided. There is a separate imperative for the equitable distribution of social or community care resources under the control of councils with social services responsibilities, for which an eligibility assessment is also required. This paper explores the tensions which are emerging around relationships between these assessments.

Marriages of convenience

N. Valios

Community Care, Aug. 28th 2008, p. 24-26

Some South Asian families are forcing children with learning disabilities into marriage. In the case of girls with learning disabilities, this enables the family to maintain face in a community which expects all young women to marry. In the case of boys, the wife becomes the carer. The practice has been going on for years, but professionals have been reluctant to confront it for fear of offending communities.

The Mental Capacity Act 2005: promoting the citizenship of people with dementia?

G. Boyle

Health and Social Care in the Community, vol.16, 2008, p. 529-537

This paper examines the extent to which the Mental Capacity Act 2005 promotes the social citizenship of people with dementia, focusing on its effectiveness in protecting liberty and promoting self-determination and in providing social rights to facilitate autonomy. The author considers the extent to which the law will facilitate decision-making by people with dementia, centring on decisions about where to live (at home or in an institution). It is pointed out that the civil rights accorded by the Act are conditional only and can be over-ridden by the decisions of others. Additionally, the realisation of these rights is constrained by lack of access to social rights, particularly the availability of domiciliary and community services to avoid institutional admission.

Mental health and self-directed support

C. Bamber and P. Flanagan

Mental Health Today, July/Aug. 2008, p. 26-28

Presents a case study of how Rotherham has made self-directed support available to people with mental health problems. Following a self-assessment of needs, clients are allocated a budget which they can use to create their own support package.

Outcomes of the TATE Project for people with learning disabilities and staff

S. Beyer and others

Journal of Assistive Technologies, vol. 2, Sept. 2008, p.57-65

This research looked at the TATE (Through Assistive Technology to Employment) Project and its delivery of information and assistive technologies to people with learning disabilities. A purposive sample of 29 people with learning disabilities was selected, and key workers were surveyed using a postal questionnaire at two time periods. Questionnaires covered information and assistive technologies received and any outcomes in independence, skills, choice and control. Staff were asked about changes in their skills and attitudes. Staff became supportive of assistive technology and developed ICT skills. Service users developed 'life stories' using PowerPoint. A variety of assistive technologies were installed leading to increased independence, confidence and skills.

Safe and sound

J. Cosh

Mental Health Today, Oct. 2008, p. 18-19

Deaf people are four times more likely to develop mental health problems than hearing people. However specialist services for people with hearing loss and mental health problems are only just starting to be developed in Scotland.

Should women be a special case when it comes to services for psychosis?

M. Spurrell

Mental Health Today, Oct. 2008, p. 23-26

This article uses routine baseline Health of the Nation Outcome Scores to illustrate the marked differences in areas of concern to men and women in tertiary specialist units with a diagnosis of psychosis. In a number of areas these distinctions are quite noticeable, especially in relation to mood disorders, physical health issues, impact of childhood abuse, and loss of home and family. Care programmes for women therefore need to manage complex affective disorders as well as the psychosis. The article explores the challenges that this represents for services.

Struggle for survival

J. Ogden

Learning Disability Today, Sept. 2008, p. 16-18

Self-advocacy groups help people with learning difficulties to find information, make choices and take control of their lives. However, the future of many groups is threatened by lack of funding. Most groups rely on finding commissions for project work to survive, but contracts usually last only twelve months. They are also threatened with withdrawal of local authority funding following the introduction of independent mental capacity advocates (IMCAs), since councils believe that they have fulfilled their statutory obligations by funding the latter.

Take it from the top

T. Reid

Mental Health Today, Oct. 2008, p. 10-12

A Healthcare Commission review of acute mental health services found that the quality of provision varied widely across the country. However Dudley Primary Care Trust came top of the ratings. This article explores the secrets of their success, which include:

  1. facilitating user involvement in service planning
  2. getting home care and acute staff to work more closely together
  3. centralisation of data gathering, enabling ward managers to focus on improving patient care.

The way ahead for NIMHE

I. McPherson

Mental Health Today, July/Aug. 2008, p. 18-19

Since 2005, the National Institute for Mental Health in England (NIMHE) has operated within the Care Services Improvement Partnership (CSIP). Following a major review, and in line with the policy of maximum devolution in health and social care, it has been decided that the majority of CSIP's activity should be commissioned at a regional level through Strategic Health Authorities and through the enhanced social care presence the Department of Health is creating in the government offices for the regions. CSIP will become a partnership of four core national improvement programmes (NIMHE, social care, offenders, and children and young people) delivered regionally through eight regional development centres.

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