Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011312
R. Jacobs
Against the backdrop of a tight financial climate, a new method of funding mental health services is being rolled out in England’s National Health Service. Called payment by results (PbR), it represents a fundamental change to the way providers of psychiatric services are paid for care of patients. The Mental Health Clustering Tool has been developed to capture activity which reflects the relative needs of patients, and cluster costs are being collected by service providers. The ultimate goal is the creation of a national tariff or fixed price for each cluster. This article describes the incentives generated by PbR and gives evidence on PbR in acute physical care services where it has been in operation for a decade, with respect to efficiency, quality, volume of activity, administrative costs, upcoding or gaming, equity of provision, and cross-subsidisation. It explores the challenges for mental health services as PbR is introduced.
{"title":"Payment by results for mental health services: economic considerations of case-mix funding","authors":"R. Jacobs","doi":"10.1192/APT.BP.113.011312","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011312","url":null,"abstract":"Against the backdrop of a tight financial climate, a new method of funding mental health services is being rolled out in England’s National Health Service. Called payment by results (PbR), it represents a fundamental change to the way providers of psychiatric services are paid for care of patients. The Mental Health Clustering Tool has been developed to capture activity which reflects the relative needs of patients, and cluster costs are being collected by service providers. The ultimate goal is the creation of a national tariff or fixed price for each cluster. This article describes the incentives generated by PbR and gives evidence on PbR in acute physical care services where it has been in operation for a decade, with respect to efficiency, quality, volume of activity, administrative costs, upcoding or gaming, equity of provision, and cross-subsidisation. It explores the challenges for mental health services as PbR is introduced.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"155-164"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011312","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011809
G. Lewis, H. Killaspy
It has been argued that the routine use of patient-reported outcome measures (PROMs) should be encouraged in order to improve the quality of services and even to determine payment. Clinician-rated outcome measures (CROMs), patient-reported experience measures (PREMs) and process measures also should be considered in evaluating healthcare quality. We discuss difficulties that the routine use of outcome measures might pose for psychiatric services. When outcome and experience measures are used to evaluate services they are difficult to interpret because of differences in case mix and regression to the mean. We conclude that PROMs and CROMs could be useful for monitoring the progress of individuals and that clinical audit still has an important role to play in improving the quality of services.
{"title":"Getting the measure of outcomes in clinical practice","authors":"G. Lewis, H. Killaspy","doi":"10.1192/APT.BP.113.011809","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011809","url":null,"abstract":"It has been argued that the routine use of patient-reported outcome measures (PROMs) should be encouraged in order to improve the quality of services and even to determine payment. Clinician-rated outcome measures (CROMs), patient-reported experience measures (PREMs) and process measures also should be considered in evaluating healthcare quality. We discuss difficulties that the routine use of outcome measures might pose for psychiatric services. When outcome and experience measures are used to evaluate services they are difficult to interpret because of differences in case mix and regression to the mean. We conclude that PROMs and CROMs could be useful for monitoring the progress of individuals and that clinical audit still has an important role to play in improving the quality of services.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"165-171"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011460
G. Vázquez, L. Tondo, J. Undurraga, R. Zaratiegui, V. Selle, R. Baldessarini
SUMMARY Bipolar depression remains a major challenge for psychiatric therapeutics. It is associated with disability and excess mortality, and accounts for three-quarters of the time spent in morbid states by treated patients with bipolar disorder. Major limitations of research on the treatment of depression in bipolar disorder include a paucity of short-term and lack of long-term trials, probably reflecting concern about inducing mania. In addition, polytherapy with multiple drugs appears to be widespread, but it is virtually untested for efficacy and safety. Here, we summarise the evidence concerning efficacy of treatment of bipolar depression with antidepressants, mood-stabilising anticonvulsants, lithium and second-generation antipsychotics.
{"title":"Pharmacological treatment of bipolar depression","authors":"G. Vázquez, L. Tondo, J. Undurraga, R. Zaratiegui, V. Selle, R. Baldessarini","doi":"10.1192/APT.BP.113.011460","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011460","url":null,"abstract":"SUMMARY Bipolar depression remains a major challenge for psychiatric therapeutics. It is associated with disability and excess mortality, and accounts for three-quarters of the time spent in morbid states by treated patients with bipolar disorder. Major limitations of research on the treatment of depression in bipolar disorder include a paucity of short-term and lack of long-term trials, probably reflecting concern about inducing mania. In addition, polytherapy with multiple drugs appears to be widespread, but it is virtually untested for efficacy and safety. Here, we summarise the evidence concerning efficacy of treatment of bipolar depression with antidepressants, mood-stabilising anticonvulsants, lithium and second-generation antipsychotics.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"193-201"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011460","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011197
Jessica Yakeley, H. Wood
We outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.
{"title":"Paraphilias and paraphilic disorders: diagnosis, assessment and management","authors":"Jessica Yakeley, H. Wood","doi":"10.1192/APT.BP.113.011197","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011197","url":null,"abstract":"We outline the difficulties in classifying paraphilias as mental disorder and summarise the changes to this diagnostic category in DSM-5. We review the research on the epidemiology and aetiology of paraphilias, and provide guidance on assessment and referral options for general psychiatrists when they encounter patients who may meet diagnostic criteria for a paraphilic disorder. Empirical evidence for effective treatments for paraphilias is limited, and specific treatment services are scarce, particularly for individuals presenting with legal paraphilias or those who are committing paraphilic sexual offences but who have not been convicted.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"202-213"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011866
A. Wand
The care of women with anxiety and depressive disorders in the perinatal period is complex. The literature in this field is vast and may be difficult for busy clinicians to keep abreast of. The first part of this article provides an overview of the potential risks and benefits of treatment options, including no treatment, at various stages in the perinatal period. The second part explores the frameworks which may assist clinicians in decision-making with their pregnant patients, including risk–benefit analysis, ethical considerations, evaluating capacity, and mental health legislation. The common pitfalls and limitations of these approaches are examined to guide good practice.
{"title":"Making decisions in the management of perinatal depression and anxiety","authors":"A. Wand","doi":"10.1192/APT.BP.113.011866","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011866","url":null,"abstract":"The care of women with anxiety and depressive disorders in the perinatal period is complex. The literature in this field is vast and may be difficult for busy clinicians to keep abreast of. The first part of this article provides an overview of the potential risks and benefits of treatment options, including no treatment, at various stages in the perinatal period. The second part explores the frameworks which may assist clinicians in decision-making with their pregnant patients, including risk–benefit analysis, ethical considerations, evaluating capacity, and mental health legislation. The common pitfalls and limitations of these approaches are examined to guide good practice.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"175-183"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011866","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011890
C. Fegan, Sarah Cook
There is growing evidence from smaller evaluative studies in the USA and anecdotal papers in the UK that supported volunteering can help recovery and can be a pathway into paid work for people with serious and fluctuating mental health conditions. It allows the person to take risks and test out a working environment. This opportunity can integrate their experience of mental illness into a valued identity and provides opportunities to engage with a world of work. We recommend that mental health professionals consider ways of providing volunteering opportunities as part of a recovery-oriented service within their organisations.
{"title":"The therapeutic power of volunteering","authors":"C. Fegan, Sarah Cook","doi":"10.1192/APT.BP.113.011890","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011890","url":null,"abstract":"There is growing evidence from smaller evaluative studies in the USA and anecdotal papers in the UK that supported volunteering can help recovery and can be a pathway into paid work for people with serious and fluctuating mental health conditions. It allows the person to take risks and test out a working environment. This opportunity can integrate their experience of mental illness into a valued identity and provides opportunities to engage with a world of work. We recommend that mental health professionals consider ways of providing volunteering opportunities as part of a recovery-oriented service within their organisations.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"217-224"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.111.009597
Lisa Conlan
Benjamin Britten’s opera Peter Grimes premiered in 1945 and has since enjoyed lasting popular and critical acclaim. Its central character is a fisherman driven to suicide by circumstances beyond his control. It has a wide political and social resonance and is a testament to the damaging psychological effects of exclusion and stigma.
{"title":"‘What harbour shelters peace?’ On the opera Peter Grimes, exclusion and stigma","authors":"Lisa Conlan","doi":"10.1192/APT.BP.111.009597","DOIUrl":"https://doi.org/10.1192/APT.BP.111.009597","url":null,"abstract":"Benjamin Britten’s opera Peter Grimes premiered in 1945 and has since enjoyed lasting popular and critical acclaim. Its central character is a fisherman driven to suicide by circumstances beyond his control. It has a wide political and social resonance and is a testament to the damaging psychological effects of exclusion and stigma.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"214-216"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.111.009597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65775432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011577
Afia Ali, J. Blickwedel, A. Hassiotis
Challenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.
{"title":"Interventions for challenging behaviour in intellectual disability","authors":"Afia Ali, J. Blickwedel, A. Hassiotis","doi":"10.1192/APT.BP.113.011577","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011577","url":null,"abstract":"Challenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"184-192"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011577","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65779050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-05-01DOI: 10.1192/APT.BP.113.011478
S. Kyaga
Psychiatrists are wanting in Sweden and many other countries. Among Swedish efforts to improve specialist training in psychiatry and to make a future psychiatric career attractive is a national course-based project named METIS. An evaluation of METIS courses run between 2007 and 2012 revealed that, in parallel with the initiative, the number of doctors obtaining proofs of specialist competence in psychiatry increased by more than a third. This article outlines current specialist training in Sweden and describes how the 40-hour METIS programme fits within it.
{"title":"METIS: a Swedish programme to boost recruitment in psychiatry","authors":"S. Kyaga","doi":"10.1192/APT.BP.113.011478","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011478","url":null,"abstract":"Psychiatrists are wanting in Sweden and many other countries. Among Swedish efforts to improve specialist training in psychiatry and to make a future psychiatric career attractive is a national course-based project named METIS. An evaluation of METIS courses run between 2007 and 2012 revealed that, in parallel with the initiative, the number of doctors obtaining proofs of specialist competence in psychiatry increased by more than a third. This article outlines current specialist training in Sweden and describes how the 40-hour METIS programme fits within it.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"172-174"},"PeriodicalIF":0.0,"publicationDate":"2014-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011478","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2014-03-01DOI: 10.1192/APT.BP.113.011452
R. Upthegrove, N. Barnes
It has long been recognised that the pathology of schizophrenia may involve the immune system, yet this has been a relatively neglected area of research. Recent advances in our understanding of the complexities and functioning of the immune system have allowed new investigation into this area from many angles, including cellular and genetic avenues. A number of prominent theories have been developed. This article gives an overview of our understanding of the immune system and highlights recent advances pertaining to schizophrenia.
{"title":"The immune system and schizophrenia: An update for clinicians","authors":"R. Upthegrove, N. Barnes","doi":"10.1192/APT.BP.113.011452","DOIUrl":"https://doi.org/10.1192/APT.BP.113.011452","url":null,"abstract":"It has long been recognised that the pathology of schizophrenia may involve the immune system, yet this has been a relatively neglected area of research. Recent advances in our understanding of the complexities and functioning of the immune system have allowed new investigation into this area from many angles, including cellular and genetic avenues. A number of prominent theories have been developed. This article gives an overview of our understanding of the immune system and highlights recent advances pertaining to schizophrenia.","PeriodicalId":89879,"journal":{"name":"Advances in psychiatric treatment : the Royal College of Psychiatrists' journal of continuing professional development","volume":"20 1","pages":"83-91"},"PeriodicalIF":0.0,"publicationDate":"2014-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1192/APT.BP.113.011452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65778469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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