Psychiatric bulletin (2014)最新文献

Aims and method To assess whether a home treatment team acute relapse prevention (ARP) strategy reduces admissions to hospital with mania. A retrospective design was used to analyse records for manic admissions since 2002. The number and length of admissions and detentions pre- and post-ARP were determined and rates of admissions and detentions calculated from this. Results We found reductions in admission and detention rates following the introduction of the ARP: 0.3 fewer admissions per person per year (95% bootstrap CI 0.09-0.62) and 0.25 fewer detentions per person per year (95% bootstrap CI 0.0-0.48). Wilcoxon signed-rank tests gave P<0.0001. Clinical implications A person-centred care plan such as the ARP which enables quick action in response to relapse-warning signs of mania appears to reduce rates of admission to hospital. The ARP could be used anywhere in the UK and fits with current mental health policy.

Aims and method People with severe mental illness (SMI) die relatively young, with mortality rates four times higher than average, mainly from natural causes, including heart disease. We developed a computer-based physical health screening template for use with primary care information systems and evaluated its introduction across a whole city against standards recommended by the National Institute for Health and Care Excellence for physical health and cardiovascular risk screening. Results A significant proportion of SMI patients were excluded from the SMI register and only a third of people on the register had an annual physical health check recorded. The screening template was taken up by 75% of GP practices and was associated with better quality screening than usual care, doubling the rate of cardiovascular risk recording and the early detection of high cardiovascular risk. Clinical implications A computerised annual physical health screening template can be introduced to clinical information systems to improve quality of care.

Aims and method To build on previous research findings by examining engagement and problematic behaviours of patients in 10 residential rehabilitation units. Two measures were completed on patients in community rehabilitation, longer-term complex care and high-dependency units (109 patients in total). Data were analysed and categorised into higher-engagement ratings across the domains of engagement and behaviour over the past 6 months and lifetime in terms of presence of the behaviour and likelihood of resulting harm. Results Data were available for 73% of patients. All aspects of engagement were consistently low for all units, with highest levels in community rehabilitation units. Levels of problematic behaviours were similar across all units. Socially inappropriate behaviours and failure to complete everyday activities were evident for over half of all patients and higher for lifetime prevalence. Verbal aggression was at significantly lower levels in community units. Lifetime behaviours likely to lead to harm were much more evident in high-dependency units. Clinical implications Despite some benefits of this type of care, patients continue to present challenges in engagement and problematic behaviours that require new approaches and a change in focus.

Demands on our mental health services are growing as financial pressures increase. In addition, there are regular changes to service design and commissioning. The current political mantra is 'more and more, of better quality, for less and less, please'. We suggest that mental health services need to actively respond to these constraints and that clinical transformation is needed to move towards a more sustainable system of healthcare. Emphasis on prevention, patient empowerment and leaner, greener services is required alongside more extensive use of technologies. Focusing on these areas will make mental health services more responsive to the challenges we face and serve to future-proof psychiatry in the UK. Services need to be delivered to provide maximum benefit to the health of our patients, but also to our society and the environment.

Aims and method This study investigates patient satisfaction and levels of hope after receiving treatment from a home treatment team. It studies whether distributing questionnaires during the last visit increases the response rate, and explores whether patient satisfaction and levels of hope are associated with particular elements of the care received. Results Patients who answered the questionnaire tended to be satisfied. When forms were distributed during the last visit, the response rate increased to at least 64%. People with negative views were more likely to return the form by post. Patient satisfaction and levels of hope were associated with most elements of received care, and the resolution of problems was predictive of both satisfaction and increased hope in logistic regression. Clinical implications The distribution of service evaluation questionnaires during the last visit increased the response rate considerably. This study suggests that in order to improve services, it is important to focus on whether patients think their problems have been resolved.

Aims and method An audit cycle assessed compliance of healthcare professionals within Oxleas NHS Foundation Trust with the statutory requirements of the Mental Capacity Act 2005 in patient care. Each stage involved a retrospective review of relevant patient electronic records. The additional purpose of the audit was to make recommendations to improve compliance with the requirement of the Act by healthcare professionals and improve patient understanding of its provisions. Results The audit cycle demonstrated some improvement in clinical practice as well as the need for further efforts at raising the understanding and compliance of clinicians and the public with provisions of the Act. Clinical Implications Healthcare professionals need further understanding of the provisions of the Act and their responsibilities. There is also the need to enhance public awareness to provisions of the Act in relation to their decision-making autonomy. Stakeholders need to put strategies in place for these to be achieved.