"When you haven't got much of a voice": An evaluation of the quality of Independent Mental Health Advocate (IMHA) Services in England

Advocacy serves to promote the voice of service users, represent their interests and enable participation in decision-making. Given the context of increasing numbers of people detained under the Mental Health Act and heightened awareness of the potential for neglect and abuse in human services, statutory advocacy is an important safeguard supporting human rights and democratising the social relationships of care. This article reports findings from a national review of Independent Mental Health Advocate (IMHA) provision in England. A qualitative study used a two-stage design to define quality and assess the experience and impact of IMHA provision in eight study sites. A sample of 289 participants – 75 focus group participants and 214 individuals interviewed – including 90 people eligible for IMHA services, as well as advocates, a range of hospital and community-based mental health professionals, and commissioners. The research team included people with experience of compulsion. Findings indicate that the experience of compulsion can be profoundly disempowering, confirming the need for IMHA. However, access was highly variable and more problematic for people with specific needs relating to ethnicity, age and disability. Uptake of IMHA services was influenced by available resources, attitude and understanding of mental health professionals, as well as the organisation of IMHA provision. Access could be improved through a system of opt-out as opposed to opt-in. Service user satisfaction was most frequently reported in terms of positive experiences of the process of advocacy rather than tangible impacts on care and treatment under the Mental Health Act. IMHA has the potential to significantly shift the dynamic so that service users have more of a voice in their care and treatment. However, a shift is needed from a narrow conception of statutory advocacy as safeguarding rights to one emphasising self-determination and participation in decisions about care and treatment

Contribution of the voluntary sector to mental health crisis care in England: protocol for a multimethod study.

Introduction - Timely access to the right kind of support for people experiencing a mental health crisis can be problematic. The voluntary sector (VS) plays a key role in providing support and enabling access, but there is a knowledge gap concerning its contribution and interface with public services in mental health crisis care. Methods and analysis - This study aims to address this. The study has three empirical elements: (1) a national survey of voluntary sector organisations (VSOs) in England and national stakeholder interviews to develop a typology of organisations and interventions provided by VSOs; (2) detailed mapping of VS services in two regions through interviews and extending the national survey; (3) four case studies, identified from the regional mapping, of VS mental health crisis services and their interface with National Health Service (NHS) and local authority services, at both a system and individual level. Data collection will involve interviews with commissioners; VSO and NHS or local authority providers; and focus groups with people who have experience of VSO crisis support, both service users and carers; and mapping the crisis trajectory of 10 service users in each study site through narrative interviews with service users and informal carers to understand the experience of VSO crisis care and its impact. Ethics and dissemination - The University of Birmingham Humanities and Social Sciences Ethical Review Committee granted ethical approval (reference ERN_16-1183) for the national and regional elements of the study. Ethical review by the Health Research Authority will be required for the case study research once the sites have been identified from the first two elements of the study. A range of methods including a policy seminar, publication in academic journals and a tool kit for commissioners and practitioners will be produced to maximise the impact of the findings on policy and practice

The particularity of autonomy

1. The nature and scope of this thesis is the meaning and possibility of personal autonomy for the contemporary self embedded in a complex of changing organizations. 2. Its contribution is in relating philosophy to the study of complex organizations. 3. The research is based upon the relevant literature and empirical studies informed by the writer's organizational experience. 4. The thesis is structured in two parts with the following arguments. Part I (The Situated Self of Sensible Reasoning) sets out a checklist for personal autonomy as positive freedom and rejects a universalist concept of autonomy as moral autonomy for its neglect of the self s particularity - its situation, sentiments and contingency. A midway position combines the principle of detachment with an evaluatory understanding of the nested self of cognitive sensibility. The self's coherence and its perspective are embodied in a unique narrative which governs the portfolio of the individual as agent in its relations, roles and aims. The sells portfolio constitutes the choices of its nestedness and its autonomy: it's not here, not there but where I choose to locate it. Part II (Managing Contingency)explores different types of organizations and their members' behaviour to identify those which enable the individual to confront contingency in its own terms. The final chapter examines how the current organizationa disembedding process forces the individual to confront its autonomy in a contemporary world of change. 5. The main conclusions of the thesis are: (i) There is a workable concept of personal autonomy, understood sul generis, ie in terms of its own particularity ; (ii) Those organizations enabling the individual to confront contingency in its own terms offer the best hope of autonomy ; (iii) The architect and the entrepreneur are key in illustrating the role of autonomy in a creative relating of order and contingency; (iv) The demise of the metanarrative of permanent and full employment are Inter alla forcing upon the individual the choices of heteronomy (captured in another's metanarrative as consumer and viewer), anomie (whim or chance) or personal autonomy

Commissioning Care Act Advocacy

Local Authorities in England are required under the Care Act 2014 to make independent advocacy available to eligible service users and carers. In October 2014, the Social Care Institute for Excellence (SCIE) launched guidance to support good practice in commissioning independent advocacy. Early studies examining implementation of the Act highlighted lower than expected referrals for independent advocacy support and that many of those potentially eligible for advocacy under the Care Act might not be receiving it. In 2016, the Universities of Birmingham and Central Lancashire were commissioned by SCIE to undertake a rapid appraisal of how advocacy is being commissioned under the Care Act, and to identify the features of promising practice. This involved surveys of and interviews with commissioners and providers; documentary analysis; and a roundtable discussion involving people with experience of using social care services and other stakeholders to identify improvements in the commissioning process

The Role of Community Centre-based Arts, Leisure and Social Activities in Promoting Adult Well-being and Healthy Lifestyles

Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context

Treatment outcomes in patients with Carbapenem Resistant Enterobactericeae bacteremia and factors affecting mortality, a study done in a tertiary care hospital in South India

BACKGROUND: Gram negative bacterial infections have emerged as a large burden on the health care system. With the emergence of ESBL organisms, the Carbapenem group of antibiotics took centre stage in the treatment of these infections. However we are now facing the era of Carbapenem Resistant Enterobactericeae blood stream infections that are a threat to health care practices worldwide. There is a paucity of antimicrobials that are present for treatment of this severe infection. This study was designed to observe treatment outcomes of CRE BSI and antimicrobial use in an attempt to assess factors that predict mortality. METHODS: This was a prospective study designed to include individuals with CRE BSI. Patients with positive blood cultures were recruited and followed up to observe 14 day all-cause mortality Baseline characteristics with regards to demography, physiologic and laboratory parameters were documented on the day that the blood culture was taken. Validated score to assess severity of illness like APACHE II, Pitt’s Bacteremia Score, INCREMENT CPE score and Charlson Comorbidity Index was calculated for all patients. The antimicrobial therapy was left to the decision of the treating team. The outcome at 14 days was the primary outcome of interest in this study, the with search for factors that could affect mortality. RESULTS: In this study, we found that 92 of 163 (56.4%) had an adverse outcome. Survival analysis revealed Hazard ratio of 1.48 (95% CI 0.97 -2.24) p = 0.068 with a greater risk of death in patients with Klebsiella spp than with Escherichia coli. Predictors of mortality with significant outcomes were : hypotension at presentation (OR 7.63, 95% CI 3.23-18.24, p = 4 (OR 9.33, 95% CI 3.59-24, p = < 0.001) and INCREMENT CPE score between 8-15 (OR 10.23, 95% CI 4.75-14, p = < 0.001). Susceptibility pattern that has been ascertained through this study suggests that up to 81% of our isolates are resistant to amikacin. Colistin has a susceptibility rate of 83% when extrapolated for the number of isolates we have information for, and tigecycline has a susceptibility rate of 77%. CONCLUSION: This prospective cohort study, aimed to look at treatment outcomes of patient’s with Carbapenem Resistant Enterobactericeae bloodstream infections. There is an overall mortality of patients with CRE BSI was 56.4%. Significant predictors of mortality included both clinical and indicial parameters. Infections with Klebsiella spp along with primary BSI were found to have worse outcomes. Hypotension at presentation, requirement of mechanical ventilation and altered mental status were predictors of adverse outcomes. As were elevated INCREMENT CPE score (8-15, indicating high mortality score) and Pitts’ Bacteremia score of more than 4. Therapeutic options are limited, and among the available options combination therapy appears to be associated with better outcomes. Meropenem with Colistin is the most widely used combination of choice, especially in the Medical wars, while Tigecycline containing regimens are preferred in the surgical setting