Psychosocial interventions and opioid detoxification for drug misuse: summary of NICE guidance

Drug misuse is an increasing problem that not only impairs the physical and mental health of people who misuse drugs but also negatively affects their families and wider society (for example, in its association with crime). Recently expanded drug services in the United Kingdom involve general practitioners to a considerable degree, who care for at least a third of opioid misusers in treatment. Many clinicians remain pessimistic, however, about the possible benefits of any treatment and how to engage drug users in treatment.1 This article summarises two new NICE guidelines that identify the most effective, safe detoxification regimens for primary and secondary care, the most cost effective psychosocial interventions, and effective ways to promote patient engagement

Developing and evaluating a collaborative care intervention for depression

This thesis is concerned with the development and evaluation of the collaborative care model for the treatment of depression in primary care in the National Health Service (NHS). It begins with an outline of the problems experienced by people with depression and the challenge that their effective care presents to the healthcare system. It then considers the response of evidence-based medicine to this challenge and briefly reviews the commonly used tools of evidence-based medicine (such as systematic reviews and clinical guidelines). The origins of the collaborative care model in the treatment of chronic physical health problems are then reviewed to provide a context for a subsequent review of the current evidence for collaborative care for depression. Following this review the main elements of the effective treatment of depression are examined and include systematic reviews of the major psychological and pharmacological treatments. The competences required to deliver low-intensity brief psychological interventions are also developed and described. The design, implementation and evaluation of an exploratory trial of collaborative care of depression are then described and set in an overall framework for the evaluation of complex interventions as outlined by the Medical Research Council. The outcomes of the trial and a parallel process evaluation are then presented and the limitations of the trial considered. The implications of the trial for the future development and evaluation of collaborative care in the NHS are discussed

Collaboratively setting the priorities for health and social care research for older lesbian, gay, bisexual and trans* people

This paper reports on a novel approach to setting research priorities relevant to the needs of older LGBT people. Research is growing in this area and has recognised the negative impact of contemporary and historical discrimination towards non-normative genders and sexualities. The results of a symposium, survey and agreement analysis are presented to identify the levels of priority placed on sixty different research topics. Discussion focuses on the novelty and/or similarity to existing research patterns on LGBT ageing, as well as prioritising topics such as: how to include unheard voices; exploring trans* people’s experiences and preferences around long-term hormone use; and, embedding research findings into policy and practice

Trends, challenges, and priorities for shared decision making in mental health: The first umbrella review

BACKGROUND: Shared decision making (SDM) is a health communication model promoting patient-centered care that has not been routinely utilized in mental health. Inconsistent definitions, models, measurement tools, and lack of sufficient evidence for the effectiveness of SDM interventions are potential contributors to the limited use of SDM in mental health. AIMS: (1) Provide the first systematic analysis of global development trends and challenges of SDM research; (2) clarify the meaning, role, and measurement of SDM in mental health; (3) create a theoretical framework for key effective SDM components to guide future development and implementation of SDM interventions. METHODS: A comprehensive search strategy was conducted in CINAHL, PubMed, Scopus, MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, and PsycInfo. Included reviews focused on SDM interventions for prevention and/or treatment of mental illness in adults. A narrative synthesis was performed to capture the range of interventions, populations, measurement tools, comparisons, and outcomes. RESULTS: Ten10 systematic reviews of SDM in mental health were included with 100 nested studies spanning from 2006 to 2020. All reviews focused on dyadic and psychopharmacological decision-making. Primary outcomes of SDM in mental health interventions include treatment satisfaction, medication adherence, symptom severity, quality of life, and hospital readmissions. Participant-related factors unique to SDM in mental health, such as stigma and mental capacity, were not reported. CONCLUSIONS: The current landscape of SDM in mental health is overwhelmingly disconnected from the needs and experiences of potential end-users; clients, clinicians, and family members. Most SDM interventions and tools were adapted from physical health and are mainly geared to psychopharmacological decision-making. The SDM in Mental Health Framework (SDM-MH), developed here, expands the scope of decisions to non-psychopharmacological discussions, diversifies the pool of SDM participants and settings, and offers potential primary target outcomes of SDM in mental health to reduce heterogeneity across studies

The impact of mental health support for the chronically ill on hospital utilisation: evidence from the UK

Individuals with common mental disorders (CMDs) such as depression and anxiety frequently have co-occurring long-term physical health conditions (LTCs) and this co-occurrence is associated with higher hospital utilisation. Psychological treatment for CMDs may reduce healthcare utilisation through better management of the LTC, but there is little previous research. We examined the impact of psychological treatment delivered under the nationwide Improving Access to Psychological Therapies (IAPT) programme in England on hospital utilisation 12-months after the end of IAPT treatment. We examined three types of hospital utilisation: Inpatient treatment, Outpatient treatment and Emergency room attendance. We examined individuals with Chronic Obstructive Pulmonary Disease (COPD) (n=816), Diabetes (n=2813) or Cardiovascular Disease (CVD) (n=4115) who received psychological treatment between April 2014 and March 2016. IAPT episode data was linked to hospital utilisation data which went up March 2017. Changes in the probability of hospital utilisation were compared to a matched control sample for each LTC. Individuals in the control sample received IAPT treatment between April 2017 and March 2018. Compared to the control sample, the treated sample had significant reductions in the probability of all three types of hospital utilisation, for all three LTCs 12-months after the end of IAPT treatment. Reductions in utilisation of Emergency Room, Outpatient and non-elective Inpatient treatment were also observed immediately following the end of psychological treatment, and 6-months after, for individuals with diabetes and CVD, compared to the matched sample. These findings suggest that psychological interventions for CMDs delivered to individuals with co-occurring long-term chronic conditions may reduce the probability of utilisation of hospital services. Our results support the roll-out of psychological treatment aimed at individuals who have co-occurring common mental disorders and long-term chronic conditions

The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness

Open dialogue (OD) is a multi-component therapeutic and organizational intervention for crisis and continuing community mental health care with a therapeutic focus on clients’ social networks. The development and implementation of this model of care in the United Kingdom requires considerable contextual adaptations which need to be assessed to support effective implementation. Program fidelity–the extent to which core components of an intervention are delivered as intended by an intervention protocol at all levels–is crucial for these adaptations. Aims: To develop, pilot, and implement a program fidelity measure for community mental health services providing OD and ‘treatment as usual’ (TAU) or standard NHS crisis and community care. Methods: Measure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program. Results: Initial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services

The association between social class and the impact of treatment for mental health problems:a systematic review and narrative synthesis

PURPOSE: This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders. METHODS: Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively. RESULTS: Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates. CONCLUSION: Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness