Erlang could have told you so—A case study of health policy without maths

Little consideration is given to the operational reality of implementing national policy at local scale. Using a case study from Norway, we examine how simple mathematical models may offer powerful insights to policy makers when planning policies. Our case study refers to a national initiative requiring Norwegian municipalities to establish acute community beds (municipal acute units or MAUs) to avoid hospital admissions. We use Erlang loss queueing models to estimate the total number of MAU beds required nationally to achieve the original policy aim. We demonstrate the effect of unit size and patient demand on anticipated utilisation. The results of our model imply that both the average demand for beds and the current number of MAU beds would have to be increased by 34% to achieve the original policy goal of transferring 240 000 patient days to MAUs. Increasing average demand or bed capacity alone would be insufficient to reach the policy goal. Day-to-day variation and uncertainty in the numbers of patients arriving or leaving the system can profoundly affect health service delivery at the local level. Health policy makers need to account for these effects when estimating capacity implications of policy. We demonstrate how a simple, easily reproducible, mathematical model could assist policy makers in understanding the impact of national policy implemented at the local level

Compulsory treatment in patients' homes in the Netherlands: What do mental health professionals think of this?

Background: Compulsory treatment in patients' homes (CTH) will be introduced in the new Dutch mental health legislation. The aim of this study is to identify the opinions of mental health workers in the Netherlands on compulsory community treatment (CCT), and particularly on compulsory treatment in the patients' home. Methods: This is a mixed methods study, comprising a semi-structured interview and a survey. Forty mental health workers took part in the semi-structured interview about CCT and 20 of them, working in outpatient services, also completed a questionnaire about CTH. Descriptive analyses were performed of indicated (dis) advantages and problems of CCT and of mean scores on the CTH questionnaire. Results: Overall, the mental health workers seemed to have positive opinions on CCT. With respect to CTH, all mean scores were in the middle of the range, possibly indicating tha

Different forms of informal coercion in psychiatry: a qualitative study.

OBJECTIVES: The objective of the study was to investigate how mental health professionals describe and reflect upon different forms of informal coercion. RESULTS: In a deductive qualitative content analysis of focus group interviews, several examples of persuasion, interpersonal leverage, inducements, and threats were found. Persuasion was sometimes described as being more like a negotiation. Some participants worried about that the use of interpersonal leverage and inducements risked to pass into blackmail in some situations. In a following inductive analysis, three more categories of informal coercion was found: cheating, using a disciplinary style and referring to rules and routines. Participants also described situations of coercion from other stakeholders: relatives and other authorities than psychiatry. The results indicate that informal coercion includes forms that are not obviously arranged in a hierarchy, and that its use is complex with a variety of pathways between different forms before treatment is accepted by the patient or compulsion is imposed

Exploring professionals' understanding, interpretation and implementation of the 'appropriate medical treatment test' in the 2007 amendment of the Mental Health Act 1983.

BACKGROUND: The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available. AIMS: As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice. METHOD: Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process. RESULTS: We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice. CONCLUSIONS: Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implement the ATT as its designers intended. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license

Carer involvement in compulsory out-patient psychiatric care in England

Background: There is an expectation in current heath care policy that family carers are involved in service delivery. This is also the case with compulsory outpatient mental health care, Community Treatment Orders (CTOs) that were introduced in England in 2008. No study has systematically investigated family involvement through the CTO process. Method: We conducted qualitative interviews with 24 family carers to ascertain their views and experiences of involvement in CTOs. The transcripts were subjected to thematic analysis that incorporated both deductive and inductive elements. Results: We found significant variation in both the type and extent of family carer involvement throughout the CTO process (initiation, recall to hospital, renewal, tribunal hearings, discharge). Some were satisfied with their level of involvement while others felt (at least partly) excluded or that they wanted to be more involved. Some wanted less involvement than what they had. From the interviews we identified key factors shaping carers' involvement. These included: perceptions of patient preference; concern over the relationship to the patient; carers’ knowledge of the CTO and of the potential for carer involvement; access to and relationships with health professionals; issues of patient confidentiality; opportunities for private discussions, and; health professionals limiting involvement. These factors show that health professionals have many opportunities to facilitate, or hinder, carer involvement. The various roles attributed to carers, such ‘proxy’ for patient decision, ‘gatekeeper’ to services, ‘mother’ or ‘expert carer’, however, conflict with one another and make the overall role unclear. Conclusions: There is a need for clarification of the expectations of carers in individual care situations, for carers to be equipped with the information they need to in order to be involved, and for services to find flexible and innovative ways of ensuring continuous, open communication. The introduction of CTOs in England has not been successful in its ambition for carer involvement

PENGGUNAAN MODEL PEMBELAJARAN AKTIF TEAM QUIZ DALAM MENINGKATKAN KEMAMPUAN MEMBACA PEMAHAMAN BAHASA JEPANG

Penelitian ini mengambil judul “penggunaan model pembelajaran aktif team quiz dalam meningkatkan kemampuan membaca pemahaman bahasa Jepang” . membaca pemahaman adalah memahami suatu informasi dari sebuah tulisan. membaca pemahaman merupakan salah satu pembelajaran yang sulit. Disebabkan karena metode yang digunakan oleh pengajar monoton dan kurang memotivasi siswa dalam pembelajaran membaca pemahaman. Penelitian ini bertujuan untuk mengetahui bagaimana penggunaan model pembelajaran aktif team quiz dalam meningkatkan kemampuan membaca pemahaman bahasa Jepang. Penelitian ini menggunakan metode quasi eksperiment dengan one group before-after (pretest dan posttest) design. Sampel dalam penelitian ini adalah siswa kelas XI Bahasa SMA Negeri 1 Parongpong tahun ajaran 2015/2016. Instrument penelitiannya adalah tes dan angket. Berdasarkan analisis data dengan perhitungan statistic yang menggunakan t hitung diketahui bahwa t hitung > t tabel maka Ho ditolak dan Hk diterima yang dapat disimpulkan bahwa penggunaan model pembelajaran aktif team quiz dalam meningkatkan kemampuan membaca pemahaman bahasa jepang efektif. Sedangkan hasil analisis data angket diketahui bahwa penggunaan model pembelajaran aktif team quiz dalam meningkatkan kemampuan membaca pemahaman bahasa Jepang mendapat respon positif dari siswa. ; Reading comprehension is the act of understanding information from a presented text. It is one of difficulties found in learning. It caused by monotonous method conducted by teacher and in turn, students have less motivation on learning reading comprehension. This research aims for how the Team Quiz active learning method can improve reading comprehension in Japanese. The quasi-experiment method with “one group before-after (pretest and posttest)” design is conducted in this research, by taking XI language students from 2015/2016 academic year of SMA Negeri 1 Parongpong as sample. Test and questionnaire is instrument used in this research. According to data analysis with statistical calculation using t count, noting that t count > t table, therefore Ho is rejected and Hk is accepted. To conclude, Team Quiz active learning method is effective in improving reading comprehension in Japanese. Moreover, according to data analysis conducted in questionnaire, the Team Quiz active learning method gains positive responses from students

A prospective, quantitative study of mental health act assessments in England following the 2007 amendments to the 1983 act: did the changes fulfill their promise?

BACKGROUND: In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007. METHOD: A prospective, quantitative study of MHA assessments undertaken between July-October 2008-11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases. RESULTS: The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher's exact Χ 2 p = 0.735). Only patients with LD and 'any other disorder or disability of the mind' were significantly more likely to be assessed under the MHA post implementation (Χ2 = 5.485, P = 0.018; Χ2 = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients. CONCLUSIONS: In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs

'You give us rangoli, we give you talk': using an art-based activity to elicit data from a seldom heard group

<p>Abstract</p> <p>Background</p> <p>The exclusion from health research of groups most affected by poor health is an issue not only of poor science, but also of ethics and social justice. Even if exclusion is inadvertent and unplanned, policy makers will be uninformed by the data and experiences of these groups. The effect on the allocation of resources is likely to be an exacerbation of health inequalities.</p> <p>Discussion</p> <p>We subject to critical analysis the notion that certain groups, by virtue of sharing a particular identity, are inaccessible to researchers - a phenomenon often problematically referred to as 'hard to reach'. We use the term 'seldom heard' to move the emphasis from a perceived innate characteristic of these groups to a consideration of the methods we choose as researchers. Drawing on a study exploring the intersections of faith, culture, health and food, we describe a process of recruitment, data collection and analysis in which we sought to overcome barriers to participation. As we were interested in the voices of South Asian women, many of whom are largely invisible in public life, we adopted an approach to data collection which was culturally in tune with the women's lives and values. A collaborative activity mirroring food preparation provided a focus for talk and created an environment conducive to data collection. We discuss the importance of what we term 'shoe leather research' which involves visiting the local area, meeting potential gatekeepers, and attending public events in order to develop our profile as researchers in the community. We examine issues of ethics, data quality, management and analysis which were raised by our choice of method.</p> <p>Summary</p> <p>In order to work towards a more theoretical understanding of how material, social and cultural factors are connected and influence each other in ways that have effects on health, researchers must attend to the quality of the data they collect to generate finely grained and contextually relevant findings. This in turn will inform the design of culturally sensitive health care services. To achieve this, researchers need to consider methods of recruitment; the makeup of the research team; issues of gender, faith and culture; and data quality, management and analysis.</p

Community treatment orders: current evidence and the implications.

Community treatment orders (CTOs) have been widely introduced to address the problems faced by 'revolving door' patients. A number of case-control studies have been conducted but show conflicting results concerning the effectiveness of CTOs. The Oxford Community Treatment Order Evaluation Trial (OCTET) is the third randomised controlled trial (RCT) to show that CTOs do not reduce rates of readmission over 12 months, despite restricting patients' autonomy. This evidence gives pause for thought about current CTO practice. Further high-quality RCTs may settle the contentious debate about effectiveness