Suchergebnisse

One What is the risk to health care professionals? -- 1. Violence to health care professionals: A health and safety perspective -- 2. Violence in psychiatric hospitals -- 3. Violence to social workers -- 4. Aggression towards general practitioners -- 5. Sexual victimization in the workplace -- Two Reactions to violence -- 6. Reactions to assault -- 7. Compensation and the criminal justice system -- Three Prevention and management of violence at work -- 8. The prediction of violence in a health care setting -- 9. The pharmacological management of aggressive patients -- 10. Coping with violent situations in the caring environment -- 11. Counselling for victims of violence -- 12. Organizational approaches to the prevention and management of violence -- Appendix A Information on professional, trade union and voluntary groups who offer assistance to victims -- Appendix B Bibliography.

The 'homeless' and 'home-based' clients of the Community Psychiatric Nursing service (CPNs) in Bloomsbury described in the first paper were examined further. The referral process and the CPN intervention were compared in the two groups. The homeless clients had different referral pattern, different types of care provided, and had less time spent with them even when control for the type of problems they were presenting with was made. It seems that this difference is due to the multiplicity and severity of homeless clients' problems that the recording system was not designed to record. Also since most of the homeless clients had been referred by informal services that made 'inappropriate referrals' to the CPNs who then needed to refer these clients to another service. These findings support the fact that homeless people need multi-disciplinary mental health services to meet their complex needs.

This literature review summarises the historical background of homelessness. It suggests that the current view of homeless people as chronic mentally ill is the latest phase in a series of the different ways in which society has perceived and labelled the homeless. We have argued that homelessness is a product of the lack of housing provision to the poorest section of society and that the psychiatric needs of many of the homeless might be a direct result of poverty and homelessness. This review also highlights difficulties in interpreting data produced by surveys of homeless people. These difficulties include the multiple definitions of homelessness used and also the major methodological errors which limit the usefulness of their findings. In particular sampling methods used may have overestimated the more visible part of the homeless population, overestimating the levels of psychiatric morbidity. Even if these limitations are ignored the data produced by these studies do not allow planning of effective mental health services for homeless people as their results depend mainly on diagnostic classification rather than disability or need. What is required is a study of needs where the appropriateness of particular services is defined, the sampling method is explicit and the definitions of homelessness are precise and consistent.

We assessed the long-stay inpatients (length of stay >6 months) from a deprived inner-city catchment area with a population of 210000 in 1993 and 1995 on a variety of measures, following up both cohorts after 24 months. Total numbers of long-stay inpatients were reduced from 56 (26.7 per 100,000 total population) to 35 (16.7 per 100,000) between 1993 and 1995, in line with the closure of dedicated long-stay beds. The 1995 cohort were more symptomatic according to the BPRS (t= 2.8, P = 0.007, 95% confidence interval 18.1, 3.0), more commonly detained under the Mental Health Act (χ2 = 6.07 p = 0.05) and more commonly from an ethnic minority (χ2 = 3.7 p = 0.05). At 2 year follow-up 57% of the 1993 cohort were living out of hospital, compared with 60% of the 1995 cohort. Patients were discharged to a variety of settings, some highly supported. For the combined sample the presence of certain challenging behaviours (absconding, disturbance at night, non-compliance with treatment and violence) predicted continuing inpatient status as did three items on the Social Behaviour Schedule (bizarre behaviour, laughing to oneself and violence). Only five (9%) of the original sample remained inpatients for the entire four year follow-up.

BACKGROUND: Cognitive remediation (CR) therapy for psychosis significantly improves recovery but is yet to be widely implemented in NHS services. It is likely to be of value at the earliest stages of psychosis development – at the first episode. Organisational climate is one factor likely to affect implementation into Early Intervention Services (EIS), which serve those experiencing first episode psychosis. We aimed to understand the organisational climate within UK NHS Early Intervention for Psychosis (EIP) services and the barriers and facilitators for the introduction of CR. METHODS: We conducted semi structured interviews with 42 EIS members of four teams in four NHS Trusts. Thematic analysis was used to analyse the data. RESULTS: There were differences between teams, including leadership style, involvement in decision making and willingness to adopt CR. Resource shortages were considered the main barrier for implementation across all teams. The evidence base behind CR and the recognition of there being a clinical need was seen as the main facilitator. Teams with more democratic leadership, and knowledge of both the evidence base and need for CR, may feel better able to successfully incorporate it into their service. CONCLUSION: Despite enthusiasm for novel treatments, EIS teams are limited by their resources. An understanding of the local organisational variables can help teams establish a culture that values innovation. Clear communication of the evidence base for CR is key to help enable staff to implement novel treatments successfully despite these limited resources and time pressures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-07790-0.

Background: The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims: To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. Methods: The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Results: Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Conclusion: Continuity is a dynamic process, influenced significantly by care structures and organizational change.

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer's assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer's assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user's immediate family, lived with them and had had a carer's assessment. Conclusion: The vast majority of the carers had not had a carer's assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers' reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.

Background: In recent years, a growing body of literature has highlighted the role of wearable and mobile remote measurement technology (RMT) applied to seizure detection in hospital settings, whereas more limited evidence has been produced in the community setting. In clinical practice, seizure assessment typically relies on self-report, which is known to be highly unreliable. Moreover, most people with epilepsy self-identify factors that lead to increased seizure likelihood, including mood, behavior, sleep pattern, and cognitive alterations, all of which are amenable to measurement via multiparametric RMT. Objective: The primary aim of this multicenter prospective cohort study is to assess the usability, feasibility, and acceptability of RMT in the community setting. In addition, this study aims to determine whether multiparametric RMT collected in populations with epilepsy can prospectively estimate variations in seizure occurrence and other outcomes, including seizure frequency, quality of life, and comorbidities. Methods: People with a diagnosis of pharmacoresistant epilepsy will be recruited in London, United Kingdom, and Freiburg, Germany. Participants will be asked to wear a wrist-worn device and download ad hoc apps developed on their smartphones. The apps will be used to collect data related to sleep, physical activity, stress, mood, social interaction, speech patterns, and cognitive function, both passively from existing smartphone sensors (passive remote measurement technology [pRMT]) and actively via questionnaires, tasks, and assessments (active remote measurement technology [aRMT]). Data will be collected continuously for 6 months and streamed to the Remote Assessment of Disease and Relapse-base (RADAR-base) server. Results: The RADAR Central Nervous System project received funding in 2015 from the Innovative Medicines Initiative 2 Joint Undertaking under Grant Agreement No. 115902. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation program and European Federation of Pharmaceutical Industries and Associations. Ethical approval was obtained in London from the Bromley Research Ethics Committee (research ethics committee reference: 19/LO/1884) in January 2020. The first participant was enrolled on September 30, 2020. Data will be collected until September 30, 2021. The results are expected to be published at the beginning of 2022. Conclusions: RADAR Epilepsy aims at developing a framework of continuous data collection intended to identify ictal and preictal states through the use of aRMT and pRMT in the real-life environment. The study was specifically designed to evaluate the clinical usefulness of the data collected via new technologies and compliance, technology acceptability, and usability for patients. These are key aspects to successful adoption and implementation of RMT as a new way to measure and manage long-term disorders. International Registered Report Identifier (IRRID): PRR1-10.2196/21840

Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well-being. Within each of them, state-of-the-art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions.

Despite the high impact of mental disorders in society, European mental health research is at a critical situation with a relatively low level of funding, and few advances been achieved during the last decade. The development of coordinated research policies and integrated research networks in mental health is lagging behind other disciplines in Europe, resulting in lower degree of cooperation and scientific impact. To reduce more efficiently the burden of mental disorders in Europe, a concerted new research agenda is necessary. The ROAMER (Roadmap for Mental Health Research in Europe) project, funded under the European Commission's Seventh Framework Programme, aims to develop a comprehensive and integrated mental health research agenda within the perspective of the European Union (EU) Horizon 2020 programme, with a translational goal, covering basic, clinical and public health research. ROAMER covers six major domains: infrastructures and capacity building, biomedicine, psychological research and treatments, social and economic issues, public health and well‐being. Within each of them, state‐of‐the‐art and strength, weakness and gap analyses were conducted before building consensus on future research priorities. The process is inclusive and participatory, incorporating a wide diversity of European expert researchers as well as the views of service users, carers, professionals and policy and funding institutions. Copyright © 2013 John Wiley & Sons, Ltd.