Probation’s role in offender mental health

Purpose: To examine how the role in offender mental health for the probation service described in policy translates into practice through exploring staff and offenders’ perceptions of this role in one Probation Trust. In particular, to examine barriers to staff performing their role and ways of overcoming them. Design/methodology/approach: Qualitative secondary analysis of data from semi-structured interviews with a purposive sample of 11 probation staff and 9 offenders using the constant comparative method.. Findings: Both staff and offenders defined probation’s role as identifying and monitoring mental illness amongst offenders, facilitating access to and monitoring offenders’ engagement with health services, and managing risk. Barriers to fulfilling this role included limited training, a lack of formal referral procedures/pathways between probation and health agencies, difficulties in obtaining and administering mental health treatment requirements, problems with inter-agency communication, and gaps in service provision for those with dual diagnosis and personality disorder. Strategies for improvement include improved training, developing a specialist role in probation and formalising partnership arrangements Research limitations/implications: Further research is required to explore the transferability of these findings, particularly in the light of the recent probation reforms. Practical implications: Social implications: Originality/value: This is the first paper to explore how staff and offenders perceive probation’s role in offender mental health in comparison with the role set out in policy

A systematic review and meta-synthesis of patients’ experiences and perceptions of seeking and using benzodiazepines and z-drugs: towards safer prescribing

Background Benzodiazepines and Z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people. Objective The aim of this study was to identify and synthesise qualitative studies exploring patients’ experiences and perceptions of receiving benzodiazepines and Z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing. Methods A systematic search of six databases for qualitative studies exploring patients’ experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis. Results Nine papers were included and seven analytical themes were identified relating to patients’ experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and Z-drugs: (1) patients’ negative perceptions of insomnia and its impact, (2) failed self-care strategies, (3) triggers to medical help-seeking, (4) attitudes towards treatment options and service provision, (5) varying patterns of use, (6) withdrawal, (7) reasons for initial or ongoing use. Conclusions Inappropriate use and prescribing of benzodiazepines and Z-drugs is perpetuated by psychological dependence, absence of support and patients’ denial/lack of knowledge of side effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing

Comparing importance and performance from a patient perspective in English general practice: a cross-sectional survey

Background. Patient experience and satisfaction are important indicators of quality in health care. Little is known about where to prioritize efforts to improve patient satisfaction. Objectives. To investigate patient satisfaction with primary care, as part of the Quality and Costs of Primary Care in Europe study in England, identifying areas where improvements could be made from patients’ perspectives. Methods. We conducted a questionnaire survey of general practice patients in three English regions. Patient Values questionnaires assessed what patients thought was important, and Patient Experience questionnaires rated performance of primary care. Fifteen attributes of care were compared using Importance Performance Analysis, a method that simultaneously represents data on importance and performance of a service, enabling identification of its strengths and weaknesses. Results. Patients rated both ‘relational’ and ‘functional’ aspects of care as important. Satisfaction with general practice could be improved by concentrating on specific aspects of access (ensuring that patients know how to access out-of-hours services and find it easy to get an appointment), and one aspect of empowerment (after their visit, patients feel able to cope better with their health problem/illness). However, for other attributes (e.g. proximity of the practice to a patient’s house or, a short waiting time when contacting the practice), investing additional resources is not likely to increase patient satisfaction. Conclusion. Attributes needing most improvement concerned access to primary care and patient empowerment. More research is needed to identify how to improve access without generating unnecessary additional demand or compromising continuity of care

Can health trainers make a difference with difficult-to-engage clients? A multisite case study

A political attempt in the United Kingdom to address health inequalities in the past decade has been the government’s initiative to employ local health trainers (HTs) or health trainer champions (HTCs) to support disadvantaged individuals with aspects of their health-related behaviors. HT/HTCs provide health-related information and support to individuals with healthy eating, physical activity, and smoking cessation. They undertake community engagement and direct individuals to relevant health services. They differ in that HTs are trained to provide health interventions to individuals or groups and to make referrals to specialist health care services when necessary. This article provides an evaluation of HT/HTCs interventions across three sites, including one prison, one probation service (three teams), and one mental health center. An evaluation framework combining process and outcome measures was employed that used mixed methods to capture data relating to the implementation of the service, including the context of the HT/HTCs interventions, the reactions of their clients, and the outcomes reported. It was found that HT/HTCs interventions were more effective in the prison and mental health center compared with the probation site largely as a result of contextual factors