Supporting mental health and emotional well-being among younger students in further education

Over the last 25 years there has been an increase in reported behavioural and emotional problems among young people. Moreover, students in higher education (HE) are reported to have increased symptoms of mental ill health compared with age-matched controls. Some students in further education (FE) are likely to experience similar difficulties, especially as an increasing number may come from backgrounds that may make them more vulnerable to mental health problems. National policies and guidance highlight the importance of promoting the mental health of young people in general and of students in particular. This exploratory study aimed to identify whether, and in what ways, FE colleges were contributing to younger students' (aged 16-19 years) mental health. Interviews with key informants, a survey of FE colleges in England and five case studies of individual FE colleges providing specialised mental-health support services to students revealed some evidence of promising and good practice, but this did not appear to be widespread. Given the current range of college settings, no single approach to improving mental health among students is likely to be the answer. Rather, respondents highlighted a number of factors that influence the provision of support services for students: awareness among professionals of the links between students' mental health and their achievement at college; having in place national and college policies and guidance that address mental health; building an inclusive college ethos; building leadership at senior and middle manager levels; having accessible in-college and/or external support services; and the provision of professional development opportunities for staff

Depression screening measure for school nurses

School nurses lead on delivering the Healthy Child Programme (Department of Health (DH), 2009) for school-aged children, hence they have expertise in health promotion, protection and prevention at an individual, community and population level. Since April 2013, the commissioning of key public health services for school-aged children has transformed with this responsibility being devolved to local authorities. Therefore, the provision of school nursing services has altered with the emphasis on productivity, demonstrating the effectiveness of their role and in providing a framework to deliver improved outcomes which meet the current and future health needs of children and young people (DH and Public Health England (PHE), 2014). One of the key current and future public health issues, which has significantly developed in children and young people over the last decade, is emotional health and wellbeing. Approximately one in ten 5-16 year olds are known to have a diagnosable mental health condition and 50% of these lifetime cases begin by the age of 14 years’ (Green et al, 2005: xxi). Furthermore approximately ‘18% of children living with a parent who has a mental health problem are twice as likely to develop emotional disorders themselves’ (Green et al, 2005: xxi). However, most worrying is the World Health Organization’s (WHO, 2001) prediction that at its current rate depression will be the second most disabling disease globally by 2020

Uncovering anorexia nervosa in a biofeedback clinic for bowel dysfunction

Biofeedback is a conservative treatment based on behavioural techniques, which can be used in the management of bowel dysfunction. This article reports the results of a retrospective review of the clinical notes of 87 female patients attending a biofeedback service at St Mark's Hospital, Harrow. The initial review was conducted to examine the incidence of polycystic ovary syndrome (PCOS) in patients attending this service. Seven percent were found to have PCOS, which is within the normal range. However, a significant proportion of patients (11.5%) had a current history of anorexia nervosa, a higher rate than in the general population, which prompted further investigation. In this article, Sonya Chelvanayagam, Julie Duncan, Brigitte Collins and Lorraine O'Brien report on the results of this review and discuss the significance of its findings. © Copyright Terms & conditions

Alcohol service provision for older people in an area experiencing high alcohol use and health inequalities

UK society is ageing. Older people who drink alcohol, drink more than those from previous generations, drink more frequently than other age groups and are more likely to drink at home and alone. Alcohol problems in later life however are often under-detected and under-reported meaning older people experiencing alcohol problems have high levels of unmet need

An internet survey of psychiatrists who have a particular interest in cognitive behavioural therapy: what is the place for the cognitive behavioural model in their role as a psychiatrist?

A survey of psychiatrists with a special interest in CBT was conducted by email correspondence to answer two main questions: ‘What are the uses and the usefulness of the cognitive behavioural model within the day-to-day practice of psychiatrists?’ and ‘What are the most important roles of the consultant medical psychotherapist who has specialized in CBT?’ Despite the constraints of a low response rate the results still reflected the views of 46 psychiatrists who were particularly experienced in the area of CBT. They reported that the cognitive behavioural model was useful in general psychiatric settings, in particular in the engagement of patients, improving client's insight, adherence to medications, and for trainee supervision. The responders reaffirmed previously held views about the role of the consultant medical psychotherapist (CBT), in particular the roles of the assessment and management of complex cases, of taking responsibility for patients with a combination of medical and psychological issues and of teaching CBT to psychiatrists and other mental health professionals. The challenges of translating CBT competencies into generic non-CBT psychiatric settings are discussed, with the important potential role of the medical psychotherapist in this respect. The key skill of formulating cases in secondary care is emphasized

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology

Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self‐report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs’ service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one‐day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73–151; inter‐quartile range: 111–132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services

Conflict of roles, a conflict of ideas? The unsettled relations between care team staff and independent mental health advocates.

Drawing on a national study of Independent Mental Health Advocacy we explore the social relations of independent advocacy. The study was commissioned by the Department of Health (England) and involved a case study design covering eight different geographies and service configurations, and interviews or focus groups with a total of 289 stakeholders across two phases of inquiry. This paper focuses on analysis of qualitative data relevant to the relationship between mental health care services and independent advocacy services, drawn from interviews with 214 participants in phase two of the study. Discussion of these particular findings affords insights into the working relations of independent advocacy within mental health services beset by reorganizational change and funding cuts, and increasing levels of legally sanctioned compulsion and coercion. We offer a matrix which accounts for the different types of working relationships that can arise and how these are associated with various levels of understanding of independent advocacy on the one hand, and appreciation for the value of advocacy on the other. The discussion is framed by the wider literature on advocacy and the claims by practitioners such as nurses for an advocacy role as part of their professional repertoire

Refeeding Hypophosphatemia in Adolescents With Anorexia Nervosa: A Systematic Review

The rate of adolescents presenting with anorexia nervosa (AN) is increasing. Medically unstable adolescents are admitted to the hospital for nutrition restoration. A lack of global consensus on appropriate refeeding practices of malnourished patients has resulted in inconsistent refeeding practices. Refeeding hypophosphatemia (RH) is the most common complication associated with refeeding the malnourished patient. This review sought to identify the range of refeeding rates adopted globally and the implication that total energy intake and malnutrition may have on RH while refeeding adolescents with anorexia nervosa. Studies were identified by a systematic electronic search of medical databases from 1980 to September 2012. Seventeen publications were identified, including 6 chart reviews, 1 observational study, and 10 case reports, with a total of 1039 subjects. The average refeeding energy intake was 1186 kcal/d, ranging from 125–1900 kcal/d, with a mean percentage median body mass index (% mBMI) of 78%. The average incidence rate of RH was 14%. A significant correlation between malnutrition (% mBMI) and post-refeeding phosphate was identified (R 2 = 0.6, P = .01). This review highlights the disparity in refeeding rates adopted internationally in treating malnourished adolescents with anorexia nervosa. Based on this review, the severity of malnutrition seems to be a marker for the development of RH more so than total energy intake