Liaison Psychiatry for every acute hospital: Integrated mental and physical healthcare. College Report 183

Liaison psychiatry is a critical service that should be integral to all acute hospitals. Effective liaison psychiatry can reduce avoidable costs and ineffective or inappropriately located management of mental health problems by reduced length of stay, readmissions and investigations, and improved care of medically unexplained symptoms, dementia and long-term conditions. This report summarises the evidence, provides case examples and outlines key considerations required to set local standards

Older and wiser? Men’s and women’s accounts of drinking in early mid-life

Most qualitative research on alcohol focuses on younger rather than older adults. To explore older people’s relationship with alcohol, we conducted eight focus groups with 36 men and women aged 35 to 50 years in Scotland, UK. Initially, respondents suggested that older drinkers consume less alcohol, no longer drink to become drunk and are sociable drinkers more interested in the taste than the effects of alcohol. However, as discussions progressed, respondents collectively recounted recent drunken escapades, challenged accounts of moderate drinking, and suggested there was still peer pressure to drink. Some described how their drinking had increased in mid-life but worked hard discursively to emphasise that it was age and stage appropriate (i.e. they still met their responsibilities as workers and parents). Women presented themselves as staying in control of their drinking while men described going out with the intention of getting drunk (although still claiming to meet their responsibilities). While women experienced peer pressure to drink, they seemed to have more options for socialising without alcohol than did men. Choosing not to drink alcohol is a behaviour that still requires explanation in early mid-life. Harm reduction strategies should pay more attention to drinking in this age group

Educational supervision and the impact of workplace-based assessments: a survey of psychiatry trainees and their supervisors

<p>Abstract</p> <p>Background</p> <p>Educational supervision (ES) is considered to be an essential component of basic specialist training in psychiatry in the UK. However, previous studies have indicated variation in its provision, and uncertainty about structure and content. Workplace-based assessments (WPBAs) were introduced in 2007 as part of major postgraduate medical training reform. Placing considerable time demands on trainees and supervisors alike, the extent to which WPBAs should utilise ES time has not been specified. As ES and WPBAs have discrete (although complementary) functions, there is the potential for this increased emphasis on assessment to displace other educational needs.</p> <p>Methods</p> <p>All junior doctors and their educational supervisors in one UK psychiatry training scheme were surveyed both before and after the introduction of WPBAs. Frequency and duration of ES were established, and structure, content and process were ascertained. Opinions on usefulness and responsibility were sought. The usage of ES for WPBAs was also assessed.</p> <p>Results</p> <p>The response rate of 70% showed general agreement between trainees and supervisors, but some significant discrepancies. Around 60% reported 1 hour of ES taking place weekly or 3 times per month. Most agreed that responsibility for ES should be shared equally between trainees and supervisors, and ES was largely seen as useful. Around 50% of trainees and supervisors used 25–50% of ES time for WPBAs, and this did not appear to affect the usefulness of ES or the range of issues covered.</p> <p>Conclusion</p> <p>ES continues to be an important component of psychiatric training. However, using ES for WPBAs introduces the potential for tension between trainees' education and their assessment by emphasising certain training issues at the expense of others. The impact of reduced training time, WPBAs and uncertainties over ES structure and content should be monitored to ensure that its benefits are maximised by remaining tailored to individual trainees' needs.</p

Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Minimising the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management. Aim: To review research and explore what patients consider beneficial in risk management practice. Method: A mixed‐studies systematic review utilising PRISMA guidelines, alongside a convergent qualitative design to categorise findings. Results: 12 papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management. Discussion: Connectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family, and peers to widen input and supportive networks beyond clinical relationships. Implications for Practice: Risk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and risk management

Manual assisted cognitive behaviour therapy is as effective as treatment as usual for deliberate self harm but is more cost effective

Copyright © 2004 BMJ Publishing Group Ltd., Royal College of Psychiatrists, & British Psychological SocietyRobert Goldne

ICD-10 predicts risk of relapse and suicide in people diagnosed with a single depressive episode

Copyright © 2004 BMJ Publishing Group Ltd., Royal College of Psychiatrists, & British Psychological SocietyR D Goldne

UK Mental health professionals volunteering in LMIC-benefits to UK and host countries

RESUMO: O Royal College of Psychiatrists tem um programa de voluntariado internacional desde 2005. O interesse no Reino Unido tem crescido nos últimos 15 anos com muitos projetos novos. Os benefícios para vários países têm sido reconhecidos. O que está menos claro são os benefícios da experiência para o Reino Unido e do programa de voluntariado do Royal College of Psychiatrists. O objectivo desta dissertação é explorar os benefícios do voluntariado para o Sistema Nacional de Saúde focando principalmente, mas não exclusivamente, o programa de voluntariado do Royal College of Psychiatrists. Nesta dissertação abordamos primeiro o contexto antes de discutirmos dois grandes estudos de psiquiatras e hospitais do Sistema Nacional de Saúde no Reino Unido. Incluimos no estudo todos os psiquiatras registados como Voluntários no Royal College of Psychiatrists e o Grupo de Interesse Especial associado. Foi ainda possível incluir os Diretores Médicos de todos os hospitais do Reino Unido. Os estudos foram desenhados para analisar as opiniões dos Voluntários do Reino Unido sobre os benefícios para os países recetores de baixo e médio rendimento e para o Reino Unido. Todos os 60 hospitais do Sistema Nacional de Saúde foram incluí dos para analisar a opinião sobre Voluntariado. As limitações dos estudos foram a baixa taxa de resposta, mas esta foi comparável a outros estudos do College. É provável haver um enviezamento de resposta e favorecimento dos que estão envolvidos no Voluntariado. Os resultados mostraram um interesse forte no voluntariado e benefícios no Sistema Nacional de Saúde, nas. áreas de liderança, transculturalismo, gestão e recursos e capacidades pessoais. Os hospitais do Sistema Nacional de Saúde valorizaram o voluntariado e, em contrapartida, o valor acrescido para competências profissionais. Os obstáculos contra o Voluntariado a nível individual e dos hospitais foram maioritariamente de natureza prática, tais como obter dispensa do trabalho, substituição no trabalho e custos. As implicações destes estudos são que o programa de voluntariado do College precisa de ser fortalecido. Para assegurar que este trabalho continua é necessário existir uma sensibilização nacional e maior responsabilização sobre os benefícios para o Reino Unido e a nível global. -------------------------- ABSTRACT: The Royal College of Psychiatrists has had an international volunteering programme since 2005. The interest in UK has grown over the past 15 years with many new projects. The benefits in various countries has been acknowledged. What has been less clear are the benefits of the experience back in the UK and of the Royal College of Psychiatrists Volunteer Scheme. The aim of this dissertation is to explore the benefit of volunteering to the NHS focusing mainly, but not exclusively on the Royal College of Psychiatrists Volunteering scheme. In this dissertation we first look at background information before discussing two large surveys of Psychiatrists and NHS Trusts in UK. We surveyed all those registered as Volunteers at the Royal College of Psychiatrists and the associated Special Interest Group. We also were able to survey the Medical Directors of all UK Trusts. The Surveys were designed to assess views of UK Volunteers of benefits to hosts in LMIC and back in UK. All 60 NHS Trusts were surveyed to assess the view of Volunteering. Limitation of the surveys were the low response rate but this was comparable to other College surveys. There is likely to be a bias in response and favour those who are engaged in the Volunteering agenda. Results showed a strong interest in volunteering and perceived benefits in NHS. These areas included leadership, transcultural, resource management and personal skills. NHS trusts valued volunteering and added value to professional competencies on return. Obstacles to Volunteering at individual and Trust level were mainly practical issues such as getting time off, cover and costs. Implications of these surveys are that the College volunteering scheme needs strengthening. There needs to be a National advocacy to ensure that this work continues and greater accountability as to benefits in UK and globally

Decision analytic model exploring the cost and cost-offset implications of street triage

Objectives To determine if street triage is effective at reducing the total number of people with mental health needs detained under section 136, and is associated with cost savings compared to usual police response. Design Routine data from a 6-month period in the year before and after the implementation of a street triage scheme were used to explore detentions under section 136, and to populate a decision analytic model to explore the impact of street triage on the cost to the NHS and the criminal justice sector of supporting people with a mental health need. Setting A predefined area of Sussex, South East England, UK. Participants All people who were detained under section 136 within the predefined area or had contact with the street triage team. Interventions The street triage model used here was based on a psychiatric nurse attending incidents with a police constable. Primary and secondary outcome measures The primary outcome was change in the total number of detentions under section 136 between the before and after periods assessed. Secondary analysis focused on whether the additional costs of street triage were offset by cost savings as a result of changes in detentions under section 136. Results Detentions under section 136 in the street triage period were significantly lower than in the usual response period (118 vs 194 incidents, respectively; χ2 (1df) 18.542, p<0.001). Total NHS and criminal justice costs were estimated to be £1043 in the street triage period compared to £1077 in the usual response period. Conclusions Investment in street triage was offset by savings as a result of reduced detentions under section 136, particularly detentions in custody. Data available did not include assessment of patient outcomes, so a full economic evaluation was not possible

Online support system for students in higher education: Proof-of-concept study

Background: Providing support to the increasing numbers of students facing mental health difficulties in higher education (HE) can be difficult due to stigma or lack of resources. Alternative and/or complementary sources of support are needed, such as online interventions that are recognised for their therapeutic value and cost-effectiveness. Objectives: We aim to provide evidence supporting the conceptual and practical value of a newly developed online multimedia intervention system for HE students who face mild to moderate symptoms of anxiety and depression and study-skills difficulties. Methods: Students from five universities were invited to participate in a cross-sectional proof-of-concept study. Students were invited through the universities' internal communication channels. Following demonstration of each part of the system, students completed a survey with quantitative and qualitative questions. Results: Response was largely positive. Positive responses on the features of the questionnaire ranged between 65% and 86%; on the features of the workshops ranged between 57% and 91%; on 'My place' ranged between 65% and 79%; on the animated videos ranged between 79% and 92%; and on the overall system ranged between 78% and 89%. Participants indicated areas for improvement and ways in which such improvement could be accomplished; these then guided the development of the system. Conclusions: The results confirm the need for such a system. It can complement student support services (SSS) by dealing with cases with mild to moderate difficulties, hence allowing SSS to prioritise and effectively address more severe cases. Potentially this method can provide a meaningful alternative to SSS; this is worth investigating further

Undertaking clinical audit, with reference to a Prescribing Observatory for Mental Health audit of lithium monitoring

Audit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health