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Welfare Reform on the Web (June 2007): Mental health services - UK

Being assertive effectively

S. Meddings and others

Mental Health Today, May 2007, p. 34-37

Assertive outreach teams were introduced in East Sussex in 2000. This article reports on an audit of the effectiveness of the two teams. A number of reasons for the effectiveness of the teams in reducing hospital admissions were identified, including: 1) maintenance of clear referral criteria; 2) fidelity to the assertive outreach model as defined by Department of Health implementation guidance; 3) use of recovery-oriented and strengths models; 4) offering a range of multi-disciplinary interventions, medical, vocational and psychological; and 5) use of reflective practice groups.

The best mental health act in the world

J. Wallace

Mental Health Today, May 2007, p. 16-18

This article reviews progress in implementing the new Mental Health (Care and Treatment) Scotland Act passed in 2003. The operation of the Act is informed by a set of guiding principles that explain the spirit in which legislators intended it to be used. It introduced an independent tribunal system to deal with all matters related to compulsory treatment orders, which has proved beneficial. Problems have arisen from the drain on clinicians’ time in dealing with extra paperwork required by the Act and from additional demand for limited advocacy service resources. Weaknesses have also emerged in the operation of the “named person” system and in the use of advance statements.

Community-based compulsory treatment orders in Scotland: the early evidence

S. Lawton-Smith

London: King’s Fund, 2006

In recent years, several countries have introduced powers to compel certain people with mental disorders living in the community to engage with services and undergo treatment. This paper explores what happened in the first six months after community-based compulsory treatment orders were introduced in Scotland in October 2005. It looks at how many people have become subject to the orders, the pathways to being placed on an order, the impacts on mental health staff, and resource issues. It also considers what lessons emerge for England and Wales, which will soon be introducing similar arrangements.

Gateway to mental health services

D. Marsden and M. Wesson

British Journal of Healthcare Management, vol.13, 2007, p. 166-170

Mental health services are not always easy to access, or delivered in the most helpful way. Significant recent investment in mental health services by government has led to the establishment of a range of specialist services, such as assertive outreach teams, crisis and home treatment teams, and early intervention for psychosis teams. This proliferation of specialist teams has left primary care practitioners confused as to how access support and advice when needed. A redesign of local services in Southport and Formby has created an innovative and simple gateway to mental health services and transformed the experience for service users, carers and relatives.

Helping them to help each other

S. Vincent, S. Warden and M. Duffy

Mental Health Today, May 2007, p. 30-33

Many schools in Scotland are introducing peer support programmes to supplement pastoral care and guidance available from staff. This article reports findings from a research study of the role of formal and informal peer support in schools for children with mental health problems. The young people involved in the study said that they valued the informal support of friends and family above the formal peer support arrangements that were available in their school. They also felt they needed more information in order to be able to effectively support their friends. It is concluded that a range of support should be available in schools, including befriending, drop-in facilities, and young people’s web sites. All young people could also benefit from peer support training.

Home truths

M. Gould

Health Service Journal, vol.117, May 24th 2007, p. 24-26

The delayed discharge of patients on mental health wards costs over £110m per year. The problem is worsened by the fact that modernisation of mental health services is being hit by cuts. The Department of Health is considering fines for every day a patient who should have been discharged remains in hospital.

Mental health of children and adolescents with learning disabilities in Britain

E. Emerson

Foundation for People with Learning Disabilities, 2007

This research used data collected in two surveys of the mental health of children and adolescents in Britain undertaken in 1999 and 2004. Analyses show that children with learning disabilities are at much greater risk of having mental health problems than children who do not have learning disabilities. However this increased risk is associated with their greater exposure to poverty and social exclusion than their peers. The greater risk of mental health problems is not something inherent in having learning disabilities. Addressing the mental health needs of children with learning disabilities will thus require us to address their social circumstances.

The net widens

M. Hunter

Community Care, Apr. 26th 2007, p. 38-39

In spite of fierce opposition, the Government is persisting with its plans to introduce compulsory treatment in the community for people with mental health problems who are in danger of re-admission to hospital due to failure to take their medication. This article traces the history of government’s attempts to amend the Mental Health Act 1983 and considers the implications of introducing compulsory community treatment orders.

Predictors, costs and characteristics of out of area placement for people with intellectual disability and challenging behaviour

D.G. Allen and others

Journal of Intellectual Disability Research, vol. 51, 2007, p. 409-416

Out of area placements for people with challenging behaviour represent an expensive and often ineffective strategy for meeting the needs of this service user group. The regression model used in this study showed that predictors of out of area placement included behaviours resulting in physical injury and exclusion from service settings, a history of formal detention under the Mental Health Act, the presence of mental health problems, a diagnosis of autism, and higher total score on the Adaptive Behaviour Scale. Out of area placements were typically high cost, and associated with only limited evidence of improved service quality. Identifying predictors for out of area placement can be used by commissioners to highlight deficiencies in local services.

Setting up new services in the NHS: 'just add water!'

K. Norton

London: J. Kingsley, 2006

This guide to setting up a clinical service in the National Health Service is based on the author’s experience of leading a nationally funded project to develop two new specialist services in different parts of the country and involving three separate NHS Trusts. The project successfully delivered two new services for personality disordered patients based on the template of Henderson Hospital, a democratic therapeutic community (TC). The book takes the reader, step by step, through the entire process of setting up these new services. Unpacking Henderson Hospital’s complex interpersonal environment into its ideological, cultural and structural constituents, the development team used these ingredients to imprint the TC model in the newly recruited staff teams. The two replicated organisations were further supported and evaluated by the development team during their first 18 months of operation.

Too much overlooking

F. Rabiee and P. Smith

Mental Health Today, May 2007, p. 26-29

This article reports findings from a review of current statutory and voluntary mental health service provision for Birmingham’s African and African-Caribbean communities. It focuses on the experiences of service users and carers from Somalia and Congo. Respondents said they struggled with lack of continuity of care, racist attitudes, lack of culturally appropriate services, lack of information about existing provision, and language barriers. It is concluded that there is a need both for mainstreaming of culturally appropriate practice and for targeted provision to supply a bridge between excluded groups and mainstream services.

'We would like more friends and support'

J. Snell

Community Care, May 17th 2007, p. 14-15

In support of a campaign for improved services, Community Care surveyed people with learning disabilities. A total of almost 1,200 questionnaires were returned. Respondents said they wanted more opportunities for paid employment, more formal support, and larger social networks. Sixteen per cent said they had been bullied in the street in the past year, and one third of those who did not have children would like to. Over a fifth of respondents were using direct payments, but 37% had not even heard of them.

(See also Community Care, May 17th 2007, p. 16-17)

Why aren’t we Valuing People

J. Smith

Professional Social Work, May 2007, p. 13

The author explores why the high ideals set out in the Valuing People White Paper of 2001 have failed to prevent a recent series of abuse cases in facilities for people with learning difficulties.

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