Mental Health Review Journal

Watson, James; Daley, Stephanie

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-02-2015-0007

Purpose– The purpose of this paper is to determine the incidence of the use of section 135(1) of the Mental Health Act 1983 in a London borough and describe the main features of the population subject to that section. Design/methodology/approach– Uses of section 135(1), hospital stay, and demographic data were gathered from service and patient records over one year. Means, medians, modes and standard deviation were calculated for interval data. Nominal data were cross-tabulated and the chi square test applied where appropriate. Study data were compared to census and national hospital data; the significance of proportional population differences were calculated using the Z-test. Findings– In total, 63 uses of section 135(1) were recorded. It was primarily used with people with psychotic diagnoses (79 per cent), and was used predominantly in black populations, and among people aged 40-54. People admitted to hospital after section 135(1) use who had psychosis diagnoses had median spells in hospital that were double the corresponding national median. Research limitations/implications– Total uses of section 135(1) in the borough equated to 25 per cent of the national total for all section 135 admissions recorded in 2012/2013. Hospital statistics in England focusing on admissions alone may fail to reflect a more widespread use of this section. Further research is required to confirm and develop the findings of this small scale study. Practical implications– The repeated use of this section is suggested as a marker for reviewing practice and resource allocation to prevent or shorten hospital admissions for people with psychosis diagnoses. Originality/value– This paper highlights gaps in NHS data collection in England relevant to policy makers, mental health service providers, and the police service.

Long, Clive; West, Rachel; Rigg, Samantha; Spickett, Rebecca; Murray, Lynne; Savage, Paul; Butler, Sarah; Stillman, Swee-Kit; Dolley, Olga

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-09-2014-0036

Purpose– The purpose of this paper is to evaluate the effectiveness of measures designed to increase physical activity in women in secure psychiatric care. Design/methodology/approach– A range of interventions (environmental and motivational) designed to increase participation in physical activities were introduced on two secure wards for women. A pre-post design assessed frequency, duration and intensity of physical activity, attendance at physical activity sessions, exercise motivation, exercise-related mood, attitudes to exercise and health and biological indices. Measures collected over a three-month baseline period were repeated six months post-intervention. Findings– Significant changes occurred in both attitudes to exercise and health, exercise motivation and exercise behaviour following change initiatives. With the exception of resting pulse rate and perceived exertion, the increased level of activity was not reflected in changes in body mass index, body fat or body muscle. Practical implications– Management led, multi-disciplinary interventions to increase physical activity can have a positive impact on both lifestyle behaviours and physical health. Originality/value– This study adds to a small literature on increasing physical activity in women in secure psychiatric settings where obstacles to change are formidable.

Wang, Ruoxi; Shaw, Ian; Middleton, Hugh

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-03-2014-0008

Purpose– The purpose of this paper is to explore the issues surrounding a long planned expansion of Payment by Results (PbR) into mental health services and to highlight the factors responsible for the delay. Design/methodology/approach– PbR relies upon “standardisation” of conditions and treatments. This depends upon a scheme of classification that can realistically predict resources required to execute treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this way have been delayed, and a key reason is the lack of high-quality data. This would require effective “standardisation-to the-average” of both a system of classification and a repertoire of costed treatment pathways. This paper investigated the delay implementation by exploring the difficulties in applying standardisation principles to service provision and tariff calculation. Findings– The paper identified the fundamental difficulty with PbR’s implementation in applying “standardisation” to practice. This is defining the mental disorder that the patient is suffering and designing care pathways at clinical level considering the balance between practical applicability and conceptual/constructional validity. This is necessary to enable the calculation of a national tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional shortcomings which compromised the credibility and validity of Mental Health Clustering Tool regarding making accurate classification in a standardised way. The validity and credibility of calculating a national tariff thus became contentious on the basis of this inaccurate clinical classification system. Originality/value– This paper explored the driving factors of delay in implementing PbR in mental health through connecting the recent reform with the fundamental assumptions of “standardisation-to the-average”, which provided another perspective to illustrate the current obstacles.

Sheldon, Kerry Lynn; Clarke, Simon P.; Moghaddam, Nima

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-11-2014-0043

Purpose– Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy. Design/methodology/approach– Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated. Findings– Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at post-treatment were noted. The service met a number of NICE quality standards concerning the “relational” aspects of care. Research limitations/implications– Clinical effectiveness is evaluated through one outcome measure thereby limiting conclusions. The longer term effectiveness of the service remains unclear. Narrow demographic information limits an assessment of any systematic biases in findings. Little is known about treatment drop-outs. Practical implications– A number of recommendations concerning data collection and future service evaluations are made. Social implications– Returning to paid or unpaid activities has a high public health impact. Originality/value– This paper contributes towards the evidence base for using psychological therapies with clients experiencing chronic pain and related distress. Importantly, the paper complements evidence for general efficacy (from large-scale controlled studies) through an evaluation of real-world effectiveness (i.e. practice-based evidence).

McDonald, Annabel Jane; Towner, Helen

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-09-2014-0037

Purpose– A pragmatic evaluation of the practicality of diabetes screening for users of serotonin specific reuptake inhibitors (SSRI’s). The paper aims to discuss this issue. Design/methodology/approach– This study audited the response of SSRI-users to personal invitation for diabetes screening. One-third of such patients had been screened during the past year. The remaining 217 patients were invited for fasting blood glucose tests and the improvement in screening rates measured. The rate of positive results was compared to a cohort who received fasting blood glucose screening due to physical risk factors for diabetes. Findings– Specific invitation increased the take-up of screening from 34 to 52 per cent of SSRI-users. Engagement was significantly better when patients could be contacted by telephone rather than letter. The SSRI-using cohort had a greater rate of identified diabetes than a cohort with physical risk factors for diabetes. Practical implications– SSRI-users are a difficult group to engage in medical screening and an assertive approach is of value. It is likely that the physical care of these patients would be enhanced by the active maintenance of contact by a practice healthcare professional. Screening of SSRI-users for diabetes is justified by both detection rate and the importance of establishing co-morbidity in terms of treatment decisions. Originality/value– Co-morbidity of diabetes and depression has been observed to result in a poor prognosis for the patient which can be tempered if successful engagement leads to early treatment of both conditions with a more tailored choice of medication and care.

Robinson, Mark; Robertson, Steve; Steen, Mary; Raine, Gary; Day, Rhiannon

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-12-2014-0045

Purpose– The purpose of this paper is to present findings from an evaluation of a mental health resilience intervention for unemployed men aged 45-60. The focus is on examining the place of activities within a multi-dimensional men’s mental health programme, and exploring interactions between social context factors and models of change. Design/methodology/approach– The paper draws on before and after survey data and qualitative interviews, to report results concerning effectiveness in changing men’s perceived resilience, to consider project processes concerning activities, social support and coping strategies, and to situate these within wider environments. Findings– The programme significantly raised the perceived resilience of participants. Activities were engaging for men, while the complex intersection between activities, social networking, and coping strategies course provided opportunities for men to develop resilience in contexts resonant with their male identities. Research limitations/implications– A limitation is that the evaluation could not measure longer term impacts. Practical implications– The paper discusses emerging considerations for resilience building, focusing on gender-sensitive approaches which can engage and retain men by focusing on doing and talking, in the contexts of men’s life-course, highlighting embodied (male) identities not disembodied “mental states”, and facilitating social support. There are challenges to recruit men despite stigma, support men to speak of feelings, and facilitate progression. Social implications– Potential exists for gender-aware programmes to sustain salutogenic change, co-producing social assets of peer support, male-friendly activities, and context sensitive course provision. Originality/value– The paper adds fresh evidence of gendered intervention approaches, including effects on male resilience. Application of a context-sensitive change model leads to multi-component findings for transferring and sustaining programme gains.

Andrews, William Peter; Parsons, Andrew Alexander; Rawle, Heather; Gibbs, Julie

2015 Mental Health Review Journal

doi: 10.1108/MHRJ-08-2014-0030

Purpose– The purpose of this paper is to investigate the treatment effects of Quest cognitive hypnotherapy (QCH) on anxiety and depression, and make comparisons with published data from the Improving Access to Psychological Therapies (IAPT) project. Design/methodology/approach– Adult clients of QCH therapists were invited to enrol in a Practice Research Network (PRN) and completed pre- and post-therapy measures of anxiety (GAD-7) and depression (PHQ-9). Findings– Post-treatment scores were available for 83 of the 106 clients reaching caseness (above the clinical cut-off on either or both measures) on their pre-treatment scores. Totally, 59 clients had moved to recovery, representing 71 per cent of cases where post scores were available and 56 per cent of the intent to treat (ITT) population (106 clients). Additionally, including all cases (both above and below cut-offs) 118 clients had post-treatment measures. In total, 86 (73 per cent) clients improved reliably. The mean number of treatment sessions was between three and four. This compares favourably with 2012-2013 IAPT findings using the same measures. Research limitations/implications– This study was exploratory involving a client group paying privately for treatment. There was no randomised control group or attempt to evaluate the effectiveness of specific components of therapy. Practical implications– QCH may offer a brief effective treatment for clients with clinically significant levels of anxiety and/or depression, widening client choice. Originality/value– As the first study to explore the effectiveness of private QCH this study offers an example of how to use a PRN to compare with published IAPT data using the same measurement tools.