The experiences of detained mental health service users: issues of dignity in care.

BACKGROUND: When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. METHODS: This paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not). RESULTS: The service users considered their dignity and respect compromised by 1) not being 'heard' by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom. CONCLUSIONS: Dignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice

Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined. Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data. Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity between researchers and clinicians were considered crucial to successful recruitment. Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration

Public health aspects of mental health care: implications and risks in a state owned southern Nigerian Psychiatric Hospital

Public health issues appear often ignored in hospital settings and lack of public health infrastructure like basic  hygiene facilities, being part of basic human requirement, affects the quality of life and patient’s physical and mental  health states and outcomes. This cross-sectional descriptive study examined the often-neglected public health  aspects of mental health care as exemplified by the risks associated with environmental health neglect in a state- owned psychiatric hospital in South-south Nigeria. Data was collected using the National Health Management  Information System-based Health Facility Daily Attendance Register (Version 2013), while Hospital In-patient  Facilities Checklist (for Psychiatric Units) was used for facility assessment and its compliance to standards. The data analysis was done using SPSS software Version 17. Results showed deficiencies in environmental health  infrastructure like absence of toilet facilities, window panes and mosquito nets and protocol/facilities for handling  sharps, as well as lack of bed-sheets or laundry facilities and inadequate beds; with many patients lying on the  ground. The common infections recorded in the hospital were malaria (13.5%), acute gastroenteritis (9.4%), and  those affecting the skin (8.5%). Thus, new policies that would favour good infrastructure and high standard of environmental hygiene in psychiatric hospitals are suggested to improve patient outcome. Keywords: Public, health risk, neglect, psychiatric hospita

Penal characteristics as predictors of depression in a Southern Nigerian prison

This study examined the penal characteristics acting as predictors of depressive disorders among 400 prison inmates using the stratified random sampling technique and the Depression component of WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analysis was performed with the SPSS software package (Version 17) with the test of significance set at p<0.05. Results revealed a prevalence of 14.8% mild depression; 14.2% moderate depression with somatic features; 6.2% severe depression without psychotic features; 4.5% severe depression with psychotic features and an overall prevalence of 37%. Significant penal factors were nature of crime, reasons for delay in trial, and duration of stay. `The most frequently violated criminal code was Criminal code 401 (Armed Robbery). Logistic regression analysis indicated that the strongest predictor of depression was the duration of time spent in prison (or: 1.43, ci=1.19-1.73, p=0.00). Our findings suggest that duration of stay in prison increases the risk of depression among inmates and that the penal predictors for depression during imprisonment could help identify people for mental health interventions. It is recommended that concerned agencies of government should, as a matter of urgent public health importance, consider reforming the criminal justice system to reduce the duration of  stay in prisons.Keywords: Crime, penal, depression, offender, prison population

Suicides in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm: A retrospective cohort data linkage study from the Northern Territory

Purpose: This study aimed to explore risk factors for suicide in Aboriginal and non-Aboriginal people following hospital admission for suicidal ideation and self-harm in the Northern Territory, Australia to help clarify opportunities for improved care and intervention for these population groups. Methods: Individuals with at least one hospital admission involving suicidal ideation and/or self-harm between 1 July 2001 and 31 December 2013 were retrospectively recruited and followed up using linked mortality records to 31 December 2014. Survival analyses stratified by Indigenous status identified socio-demographic and clinical characteristics from index hospital admissions associated with suicide. Results: Just over half of the 4391 cohort members identified as Aboriginal (n = 2304; 52.4%). By 2014, 281 deaths were observed comprising 68 suicides, representing a 2.6% and 2.0% probability of suicide for Aboriginal and non-Aboriginal people, respectively. After adjusting for other characteristics, a higher risk of suicide was associated with male sex (Aboriginal adjusted hazard ratio: 4.14; 95% confidence interval: [1.76, 9.75]; non-Aboriginal adjusted hazard ratio: 5.96; 95% confidence interval: [1.98, 17.88]) and repeat hospital admissions involving self-harm (Aboriginal adjusted hazard ratio: 1.37; 95% confidence interval: [1.21, 1.55]; non-Aboriginal adjusted hazard ratio: 1.29; 95% confidence interval: [1.10, 1.51]). Severe mental disorders were associated with a four times higher risk of suicide (adjusted hazard ratio: 4.23; 95% confidence interval: [1.93, 9.27]) in Aboriginal people only. Conclusion: The findings highlight non-clinical risk factors for suicide that suggest the need for comprehensive psychosocial assessment tailored to Aboriginal and non-Aboriginal people hospitalised with suicidal ideation or self-harm. Implementing appropriate management and aftercare within a broader public health framework is needed to support recovery and reduce long-term suicide risk in the community, especially for Aboriginal people and males

Polysubstance use, mental health and high-risk behaviours:Results from the 2012 Global Drug Survey

INTRODUCTION AND AIMS: Polysubstance use is associated with adverse health and social outcomes, but few studies have investigated whether these associations differ between individuals engaged in different patterns of illicit drug and non-prescription medication use.DESIGN AND METHODS: Latent class analysis (LCA) was used to identify patterns of drug use in the Global Drug Survey, a purposive sample collected in late 2012 and surveyed using an online questionnaire including past-year drug use, sociodemographics, mental illness, involvement in violence and sexual behaviour. The sample analysed (n = 14 869; median age 27 years; 68.5% male) included those residing in the UK (n = 5869), Australia (n = 6313) and the USA (n = 2687).RESULTS: LCA of cannabis, ecstasy, cocaine, stimulants, nitrous, ketamine, benzodiazepines and opioid painkiller use identified six classes: no polysubstance use (Class 1, 49.1%); cannabis and ecstasy (Class 2, 23.6%); all illicit drugs (Class 3, 9.4%); ecstasy and cocaine (Class 4, 8.3%); cannabis and medication (Class 5, 5.9%); and all drugs (Class 6, 3.8%). Participants diagnosed with anxiety were most likely to belong to Class 5 [odds ratio (OR) 2.66, 95% confidence interval (CI) 2.10-3.38]. Violent behaviour was most strongly associated with Class 6 membership (OR 1.9, 95% CI 1.36-2.64). Sexual risk-taking also predicted membership of this class (OR 5.79, 95% CI 4.66-7.18) and Class 4 (OR 4.41, 95% CI 3.57-5.43).DISCUSSION AND CONCLUSIONS: Five heterogeneous groups of polysubstance users were identified in this international sample covering the UK, Australia and USA. Anxiety disorders were associated with medication and cannabis use, while high-risk behaviours predicted use of cocaine and ecstasy, or wide-ranging polysubstance use including ketamine and medications.</p

The health of children deprived of liberty: a human rights issue

The UN Global Study on Children Deprived of Liberty launched its final report on Nov 19, 2019, in Geneva, estimating that between 3·5 and 5·5 million children worldwide are living in institutions for reasons related to care, administration of justice, migration, armed conflict, or national security.1 As part of the Global Study, we reviewed literature on the health of children in each of these settings. We found that children deprived of liberty are distinguished by a high prevalence of physical and mental health problems. These conditions are often co-occurring, undiagnosed and un(der)treated, and frequently occur in the context of entrenched disadvantage and trauma. We also found evidence that deprivation of liberty can compound these problems and contribute to the development of new ones, particularly related to mental health and developmental disability. The UN Convention on the Rights of the Child (CRC) recommends that deprivation of liberty should be used only “as a measure of last resort and for the shortest appropriate period of time”.2 The picture painted by the Global Study is one of excessive and often harmful deprivation of liberty in diverse settings. There is much work to be done.No Full Tex

Successful recruitment to trials : findings from the SCIMITAR+ Trial

BACKGROUND: Randomised controlled trials (RCT) can struggle to recruit to target on time. This is especially the case with hard to reach populations such as those with severe mental ill health. The SCIMITAR+ trial, a trial of a bespoke smoking cessation intervention for people with severe mental ill health achieved their recruitment ahead of time and target. This article reports strategies that helped us to achieve this with the aim of aiding others recruiting from similar populations. METHODS: SCIMITAR+ is a multi-centre pragmatic two-arm parallel-group RCT, which aimed to recruit 400 participants with severe mental ill health who smoke and would like to cut down or quit. The study recruited primarily in secondary care through community mental health teams and psychiatrists with a smaller number of participants recruited through primary care. Recruitment opened in October 2015 and closed in December 2016, by which point 526 participants had been recruited. We gathered information from recruiting sites on strategies which led to the successful recruitment in SCIMITAR+ and in this article present our approach to trial management along with the strategies employed by the recruiting sites. RESULTS: Alongside having a dedicated trial manager and trial management team, we identified three main themes that led to successful recruitment. These were: clinicians with a positive attitude to research; researchers and clinicians working together; and the use of NHS targets. The overriding theme was the importance of relationships between both the researchers and the recruiting clinicians and the recruiting clinicians and the participants. CONCLUSIONS: This study makes a significant contribution to the limited evidence base of real-world cases of successful recruitment to RCTs and offers practical guidance to those planning and conducting trials. Building positive relationships between clinicians, researchers and participants is crucial to successful recruitment

Violent and non-violent crime against adults with severe mental illness

Background Little is known about the relative extent of crime against people with severe mental illness (SMI). Aims To assess the prevalence and impact of crime among people with SMI compared with the general population. Method A total of 361 psychiatric patients were interviewed using the national crime survey questionnaire, and findings compared with those from 3138 general population controls participating in the contemporaneous national crime survey. Results Past-year crime was experienced by 40% of patients v. 14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0-3.8); and violent assaults by 19% of patients v. 3% of controls (adjusted OR = 5.3, 95% CI 3.1-8.8). Women with SMI had four-, ten- and four-fold increases in the odds of experiencing domestic, community and sexual violence, respectively. Victims with SMI were more likely to report psychosocial morbidity following violence than victims from the general population. Conclusions People with SMI are at greatly increased risk of crime and associated morbidity. Violence prevention policies should be particularly focused on people with SMI

Deaths among adults under supervision of the England and Wales probation services: variation in individual and criminal justice-related factors by cause of death

Background: The mortality rate among people under probation supervision in the community is greater than that among incarcerated people and that among the general population. However, there is limited research on the distinct vulnerabilities and risks underlying the causes of death in this population. In this retrospective cohort study, we examined the individual and criminal justice-related factors associated with different causes of death. Factors were assessed in relation to the type of supervision, distinguishing between those under post-custodial release and those serving a community sentence. Results: The study utilised the official data held by His Majesty’s Prison and Probation Service in England and Wales on the deaths of men and women under probation supervision between 01 April 2019 and 31 March 2021 where the cause of death had been definitively recorded (n = 1770). The high risk of deaths primarily caused by external factors (i.e., suspected suicide (10%), homicide (5%), and drug-related death (26%)) in this population was confirmed. A Gaussian Graphical Model (GGM) demonstrated unique relationships with suspected suicide and drug-related deaths for known suicide risk, history of drug use and recent (< 28 days of death) enforcement action due to a breach of probation conditions. Our findings suggest that that familial violence and abuse may be relevant in suicide and drug-related deaths and that minority groups may experience disproportional risk to certain types of death. Conclusions: This study identified unique risk indicators and modifiable factors for deaths primarily caused by external factors in this population within the health and justice spheres. It emphasised the importance of addressing health inequalities in this population and improved joint-working across health and justice. This involves ensuring that research, policies, training, and services are responsive to the complex needs of those under probation supervision, including those serving community sentences. Only then can we hope to see lower rates of death within this population