Diverging trends in smoking behaviours according to mental health status

Introduction: People with mental health disorders are much more likely to smoke compared to those who do not. This study investigates recent trends in smoking behaviors among both these populations in England. Methods: We used survey responses from adults (aged 16 years and older) living in households in England who participated in the Health Survey for England from 1993 to 2011 (n = 11,300 per year on average). Linear regression was used to quantify annual changes over the time period in smoking prevalence, daily cigarette consumption, and desire to quit among respondents with and without 2 indicators of mental disorder (self-reported longstanding mental illness and recent use of psychoactive medication). Results: Among survey respondents who did not report a longstanding mental illness, there were long-term declines in smoking prevalence (−0.48% per year, 95% confidence interval [CI] = −0.56 to −0.40) and daily cigarette consumption (−0.14% per year, 95% CI = −0.17 to −0.11). Similar declines were also seen among respondents not taking psychoactive medications. However, there were no long-term changes in smoking prevalence and cigarette consumption among respondents who reported these indicators of mental disorder, although smoking prevalence among those taking psychoactive medications may have declined during the later part of the study period. Smokers both with and without the 2 indicators of mental disorder showed similar levels of desire to quit smoking. Conclusions: Smoking is largely unchanged since 1993 among those with indicators of longstanding mental disorders or recent psychoactive medication usage, although declines have been observed among those without such indicators of mental disorder

The prevention of offending behaviour by people with intellectual disabilities: a case for specialist childhood and adolescent early intervention

Purpose: Elucidating where antisocial or violent behaviour arises within the life course of individuals with intellectual disability (ID) could improve outcomes within this population, through informing services and interventions which prevent behaviours reaching a forensic threshold. The paper aims to discuss this issue. Design/methodology/approach: The Historical Clinical Risk Management-20, Version 3 assessments of a cohort of 84 inpatients within a forensic ID service were analysed for this study, with a particular emphasis on items concerned with the age at which antisocial or violence first emerged. Findings: For most participants, violent or antisocial behaviour was first observed in childhood or adolescence. The study also highlighted a smaller subgroup, whose problems with violence or antisocial behaviour were first observed in adulthood. Originality/value: The study findings suggest that targeted services in childhood and adolescence may have a role in reducing the offending behaviour and forensic involvement of people with ID. This has implications for the service models provided for children and adolescents with ID with challenging or offending behaviour

Examining 'prevent' from a former combatant perspective

Originality/Value – Although militants from “the Troubles” (a conflict ending in 1998) and Prevent (established in 2003) are speaking about the same country and narrating their “truth” within five years of each other, the differences in how former combatants and Prevent understand the trajectory toward violence have not been considered. This has remained a significant omission of terrorism scholarship

Narratives of reform : The Mental Health Act (MHA) in England and Wales from the 1983 MHA to the Wessley Review (2018)

Purpose This paper examines reform of mental health legislation in England and Wales. It covers the period from the introduction of the 1983 MHA to the proposed reforms out-lined in the Wessley Review that was published in December, 2018. Design/methodology/approach This is a literature based project Findings Reform of mental health legislation reflects two potentially conflicting strands. One is the state’s power to incarcerate the “mad”, the other is the move to protect the civil rights of those who are subject to such legislation. The failures to development ade-quately funded community based mental health services and a series of Inquiries in the 1990s led to the introduction of Community Treatment Orders in the 2007 reform of the MHA. Research limitations/implications The development of mental health policy has seen a shift towards more coercive approaches in mental health. Practical implications The successful reform of the MHA can only be accomplished along-side investment in community mental health services Originality/value The paper highlights the tensions between the factors that contribute to mental health legislation refor

TREC-Rio trial: a randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms [ISRCTN44153243]

Agitated or violent patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians and clinical practice all differ. Systematic reviews show that all relevant studies are small and none are likely to have adequate power to show true differences between treatments. Worldwide, current treatment is not based on evidence from randomised trials. In Brazil, the combination haloperidol-promethazine is frequently used, but no studies involving this mix exist. TREC-Rio (Tranquilização Rápida-Ensaio Clínico [Translation: Rapid Tranquillisation-Clinical Trial]) will compare midazolam with haloperidol-promethazine mix for treatment of agitated patients in emergency psychiatric rooms of Rio de Janeiro, Brazil. TREC-Rio is a randomised, controlled, pragmatic and open study. Primary measure of outcome is tranquillisation at 20 minutes but effects on other measures of morbidity will also be assessed. TREC-Rio will involve the collaboration of as many health care professionals based in four psychiatric emergency rooms of Rio as possible. Because the design of this trial does not substantially complicate clinical management, and in several aspects simplifies it, the study can be large, and treatments used in everyday practice can be evaluated

Transfers from prison to hospital under Sections 47 and 48 of the Mental Health Act between 2011 and 2014

In England and Wales, prisoners with mental disorder of such severity as to warrant inpatient treatment may be transferred to hospital under the Mental Health Act. UK Government guidance recommends that this process should be completed within 14 days; however, evidence suggests that in many cases it can take much longer. This retrospective service evaluation of 64 male prisoners, who were transferred under Section 47 or Section 48, aimed to evaluate transfer durations. The mean time from referral to admission was 76 days. Prisoners with a psychotic disorder were admitted more quickly. Remand prisoners were admitted more quickly than sentenced prisoners. Findings suggest that, in the UK the transfer time of prisoners under Sections 47 and 48 of the Mental Health Act continues to far exceed the 14-day target which raises concern about equivalence of care for prisoners. Our findings support arguments for fundamental amendments to the admissions process

Educating nurses to care for Military Veterans in civilian hospitals: an integrative literature review

Background: In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. Aim: To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. Review methods: A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. Results: The search generated ten papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. Conclusion: Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings

Current practices in managing acutely disturbed patients at three hospitals in Rio de Janeiro-Brazil: a prevalence study

BACKGROUND: The medical management of aggressive and violent behaviour is a critical situation for which there is little evidence. In order to prepare for a randomised trial, due to start in the psychiatric emergency rooms of Rio de Janeiro in 2001, a survey of current practice was necessary. METHODS: A seven day survey of pharmacological management of aggressive people with psychosis in the emergency rooms of all four public psychiatric hospitals in Rio de Janeiro, Brazil. RESULTS: In one hospital data were not available. Of the 764 people with psychosis attending these ERs, 74 were given IM medication for rapid tranquillisation (9.7%, 2.1/week/100,000). A haloperidol-promethazine mix (with or without other drugs) was used for the majority of patients (83%). CONCLUSION: The haloperidol-promethazine mix, given intramuscularly for rapid tranquilization, is prevalent in Rio, where it is considered both safe and efficient. However, scientific evaluation of all pharmacological approaches to rapid tranquilization of psychotic people is inadequate or incomplete and a randomized trial of IM haloperidol-promethazine is overdue