Community Mental Health Team (community + mental_health_team)

Distribution by Scientific Domains
Distribution within Medical Sciences


Selected Abstracts


Nursing staff attitudes towards patients with personality disorder

PERSONALITY AND MENTAL HEALTH, Issue 2 2007
Daniel Webb
Background,The Gwylfa Therapy Service is a specialist outpatient personality disorder (PD) service within Gwent Healthcare NHS trust. Among its key functions, the service is required to develop training procedures that improve the attitudes and capabilities of mental health staff working with patients with PD. Aim,The aim was to assess Community Mental Health Team (CMHT) nurses' attitudes to patients with PD, using the Attitude to Personality Disorder Questionnaire (APDQ), and to compare their scores with published APDQ data for nurses and prison officers working with patients with PDs. Method,Participants were nurses recruited from CMHTs (n = 88) and those who volunteered to attend a PD awareness workshop (n = 29). They completed the APDQ. Results,CMHT nurses reported lower feelings of security, acceptance and purpose compared with all other groups, although at the same time they also reported higher levels of enjoyment in working with PD patients. CMHT nurses who volunteered to participate in an awareness workshop reported higher levels of enjoyment, security, acceptance and purpose when working with patients with PD compared to those who did not volunteer. Discussion,CMHT nursing staff require help to feel safer, more accepting and more purposeful when working with patients with PD. Some of these issues may be addressed through the formulation of policies and good practice procedures, but staff also need to be trained for working with people with PD. The next step is to design suitable training and evaluate its effectiveness with respect to how it changes knowledge, attitudes and skills, and, eventually, how this benefits patients. Copyright © 2007 John Wiley & Sons, Ltd. [source]


Social deprivation and the outcomes of crisis resolution and home treatment for people with mental health problems: a historical cohort study

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2010
Richard Kingsford BA (Hons) MA DipSW MSc
Abstract The development of crisis resolution and home treatment (CRHT) teams has been central to the UK Government's objective of reducing reliance on hospital-based care and is supported by a growing body of evidence. However, there has been no research specifically exploring the relationship between social deprivation and CRHT teams, in spite of evidence of an association between social deprivation and increased pressure on inpatient services. This article reports a study which tested the hypothesis that social deprivation is associated with the outcome of CRHT interventions. Using a historical cohort study design, we examined a total of 260 accepted referrals to a CRHT. Social deprivation was measured by the Index of Multiple Deprivation (Office of the Deputy Prime Minister 2004) as a predictor of CRHT interventions outcomes. CRHT outcomes were dichotomised into successful and unsuccessful and were defined with reference to the CRHT operational policy. Univariate analysis found that people who lived in more socially deprived areas had a poorer outcome, as did older people and those referred from the enhanced community mental health team (CMHT). Logistic regression analysis found that age and referral source were independently associated with outcome. Analysis of the demographic data also suggested a non-significant trend towards men having less successful outcomes. Further analysis exploring the characteristics of the different referral sources to the CRHT found that those referred from the enhanced CMHT were significantly more likely to be from the most deprived area. This suggested a relationship between an enhanced level of mental health need, social deprivation and poor outcome of CRHT intervention. [source]


A qualitative exploration of communication within the community mental health team

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2009
Jenny Donnison
ABSTRACT:, This qualitative study sought to explore conceptual models employed by community mental health team (CMHT) staff in the care of their clients and how CMHT clinicians communicated with one another, particularly in relation to complex clinical work. The qualitative method of interpretive phenomenological analysis was used, and semistructured in-depth interviews with seven UK CMHT clinicians were conducted and analyzed. Four themes were evident in the data and showed that clinicians face complex and competing demands and draw on a range of therapeutic models in their work. It was also clear that much discussion centred primarily on pragmatic issues and lacked conceptual depth. The results underline the complex and challenging nature of CMHT work and suggest that a more systematic approach to interdisciplinary training within teams could be beneficial in increasing clinicians' knowledge, skills, and their understanding of the conceptual models used across different disciplines. [source]


Models of mental health nurse,general practitioner liaison: promoting continuity of care

JOURNAL OF ADVANCED NURSING, Issue 5 2003
Terence V. McCann BA MA PhD RMN RGN RNT
mccann t.v. & baker h. (2003)Journal of Advanced Nursing 41(5), 471,479 Models of mental health nurse,general practitioner liaison: promoting continuity of care Aim and rationale.,Community mental health nurses and general practitioners share a pivotal role in the provision of mental health care in the community. The focus of this study was to identify models of general practitioner collaboration used by these nurses, and analyse the implications of these models for promoting continuity of care. The study was derived from a larger study of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness. Methods.,This qualitative study used interviews and observation to collect data. The study took place in 1999 in regional and rural New South Wales, Australia and involved community mental health nurses. Findings.,The findings show that two models of nurse and general practitioner (GP) collaboration emerged from the data: Shared Care and Specialist Liaison. In the Shared Care model, nurses maintain close contact with GPs throughout the episode of acute care. In the Specialist Liaison model, the community mental health team assumes overall responsibility for care and treatment throughout the acute episode of illness. Contact with GPs throughout the episode of care by the community mental health team is, at best, intermittent. Conclusion.,The findings suggest that the Shared Care model is more consistent with supporting personal and organizational continuity of care, whereas the Specialist Liaison model is limited to encouraging personal continuity of care but further study is needed. [source]


Can the introduction of a quality of life tool affect individual professional practice and the quality of care planning in a community mental health team?

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 10 2009
N. MURPHY rmn dip he bsc (hons) msc pgchepr
Accessible summary ,,Audit should not be restricted to one form of methodology and should embrace mixing methods of data collection. ,,Use of a quality of life tool allows users more of a voice, enhancing the partnership with service providers and presenting an alternate view of risk. ,,Implementation of any change to practice needs to address local level barriers and engage the service providers in the process, therefore, avoiding the common perception of being given more work without negotiation and feelings of alienation. Abstract This practice development paper demonstrates the scope for creativity in mixing audit and methods of investigation. It details the evolution of Quality of Life (QOL) perspectives and relates them to the practice of care planning. The process proved enlightening and affirming to practitioners and engaged them in considering value-based practice (recovery-orientated) from the perspective of the client. It was clear that subtle changes to care planning emerged, and the goal of giving responsibility for self determining issues was addressed. [source]


Does the use of a physical health assessment tool improve the physical health of clients of a community mental health team?

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2009
A. GARTSHORE msc rmn
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Computerized cognitive,behaviour therapy for anxiety and depression: a practical solution to the shortage of trained therapists

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 5 2004
S. VAN DEN BERG bsc
Computerized cognitive,behaviour therapy (CCBT) programmes have been developed to help meet the enormous need for evidence-based psychological treatment of common mental health problems in the context of a severe shortage of trained therapists to meet that need. Randomized controlled trials have confirmed the efficacy of such programmes. We present the experience of a community mental health team (CMHT) resource centre with one such programme, Beating the Blues, together with outcome data on a small sample of its clients. We conclude that experience and data, taken together, demonstrate the practical benefits of CCBT in routine practice. [source]


One-year outcome of an early intervention in psychosis service: a naturalistic evaluation

EARLY INTERVENTION IN PSYCHIATRY, Issue 3 2007
Swaran P. Singh
Abstract Aim: We conducted a 1-year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home-based Outreach Service (ETHOS)) during its first 3 years of operation in South-west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1-year follow-up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non-randomized parallel cohort (comparison group) of first-episode patients treated by community mental health teams. Results: The Early Treatment and Home-based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit. [source]


Milnacipran and pindolol: a randomized trial of reduction of antidepressant latency

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2003
Michael T. Isaac
Abstract Background New, better tolerated and faster treatments for depression are needed. Patients are understandably unhappy with having to wait 3 to 4 weeks for a response to an antidepressant, while experiencing side effects almost immediately. This frequently has an adverse effect on compliance and engagement with treatment. Aims The primary objective was to assess the activity of pindolol on the onset of antidepressive response of milnacipran. The secondary objective was to assess the number of responders among the patients who received milnacipran and pindolol versus patients who received milnacipran and placebo. The tertiary objective was to evaluate the safety of milnacipran and pindolol versus milnacipran and placebo. Method Randomized, double-blind, placebo-controlled study over 42 days. Setting Inner city London community mental health teams. Participants 80 patients were selected and gave written consent to treatment, 78 were randomized (39 in each group) and evaluated for safety (intention-to-treat, ITT, safety data set), 77 (ITT efficacy data set), and 64 (per protocol, PP, data set) were evaluated for efficacy. The mean age was 31.9 for the pindolol group and 32.3 for the placebo. Intervention All patients received milnacipran 50,mg twice a day plus either pindolol 2.5,mg (the ,pindolol group') or matching placebo (the ,placebo group') three times a day. Outcome measures The main efficacy variable was the Montgomery,Åsberg depression rating scale (MADRS) score at days 0, 4, 7, 10, 14, 21, 28, 42 on PP data set in an observation carried (OC) approach. Secondary efficacy variables were clinical global impression (global improvement) and Hamilton depression rating scale (HDRS). Results Improvement in MADRS total score was greater in the pindolol group than in the placebo group from day 7 (p=0.03). Responder rates in the clinical global impression were 97.2% for the pindolol group and 60.6% for the placebo group. The treatment was well tolerated with the most common side effects being nausea (28.2%; 35.9%), vomiting (7.7%; 23.1%), hot flushes (15.4%; 5.1%) and sweating (12.8%; 12.8%). Conclusion The milnacipran and pindolol combination is safe, well tolerated and efficacious in major depression, and represents a rational strategy for the possible acceleration or potentiation of antidepressant action. Copyright © 2003 John Wiley & Sons, Ltd. [source]


Independent mental health nurse prescribing

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2009
A. JONES phd rn
Independent prescribing (IP) is a new form of prescriptive authority for mental health services. Very little is known about where IP is being implemented and factors to support or constrain its adoption. An opportunistic sample of 119 respondents made up of nurses, doctors, support workers, occupational therapists and social workers completed an online survey. The sample worked in adult, old age and substance misuse services. Hospital wards and community mental health teams were identified as the highest ranked areas for implementation. A total of 68% of the sample identified pharmacology as the area for further training. And 40% of the sample felt that IP had been introduced to make services more effective. This opportunistic sample supported IP as a means to offer greater patient choice and as a method to broaden the boundaries of nursing practice. Integral to this development is the link between the psychiatrist and IP nurse in terms of work allocation and supervision. [source]


Redesigning acute mental health services: an audit into the quality of inpatient care before and after service redesign in Grampian

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2005
M. MELVIN rnm dip cog psych
As part of the redesign of adult mental health services in Grampian and in line with the Scottish Framework for Mental Health (1997), the decision was made to close one of the five acute mental health admission wards within Royal Cornhill Hospital. Inpatient services were to be provided within the remaining four admission wards by increasing their bed compliment from 25 to 28 and by increasing the staffing compliment of the community mental health teams serving Aberdeen city and Aberdeenshire. The adult mental health directorate commissioned an audit to measure certain key items in the 6 months leading up to the redesign and in the 6 months post redesign. This audit focused on the number of admissions, the bed occupancy, the number of incidents, the number of days the ward doors were locked, observation levels, sickness levels and the number of bank hours used. These factors were felt to be important indicators in the monitoring of the quality of patient care as any increase in the instance of these factors could be seen as detrimental to patient care. Therefore, a comparison of these factors, pre- and post-ward closure, was seen as a useful method of assessing the effect of the ward closure and the subsequent loss of seven acute inpatient beds. As the results of the audit showed that the rate of these factors had not increased, it was assumed the quality of care in the inpatient service was as at least as good following the redesign as it was before it. Two issues arose from the audit that merit further discussion, that is, the differences in the numbers of observations and in the numbers of times the ward doors were locked. Two G grade community psychiatric nurses were employed on a 0.5 session per week basis to collect and collate the data. [source]


Stress and burnout in community mental health nursing: a review of the literature

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2000
D. Edwards mphil, bsc (hons)
There is a growing body of evidence that suggests that many community mental health nurses (CMHNs) experience considerable stress and burnout. This review aimed to bring together the research evidence in this area for CMHNs working within the UK. Seventeen papers were identified in the literature, seven of which looked at stress and burnout for all members of community mental health teams (CMHTs) and the remaining 10 papers focused on CMHNs. The evidence indicates that those health professionals working as part of community teams are experiencing increasing levels of stress and burnout as a result of increasing workloads, increasing administration and lack of resources. For CMHNs specific stressors were identified. These included increases in workload and administration, time management, inappropriate referrals, safety issues, role conflict, role ambiguity, lack of supervision, not having enough time for personal study and NHS reforms, general working conditions and lack of funding and resources. Areas for future research are described and the current study of Welsh CMHNs is announced. This review has been completed against a background of further significant changes in the health service. In the mental health field, specific new initiatives will have a significant impact on the practice of community mental health nursing. A new National Framework for Mental Health, along with a review of the Mental Health Act (1983), will undoubtedly help to shape the future practice of mental health nursing. [source]


Latest news and product developments

PRESCRIBER, Issue 3 2007
Article first published online: 14 MAR 200
PPIs and hip fracture Treatment with a PPI may increase the risk of hip fracture, with longer use associated with higher risk according to a study in UK patients (J Am Med Assoc 2006;297:2947-53). The case control study compared use of PPIs by 13 556 patients with hip fracture and 135 386 controls in the UK General Practice Research Database. Use of a PPI for more than one year was associated with an increase of 44 per cent in the odds of hip fracture. The risk was higher for longer- term use (59 per cent after four years) and at higher doses (more than doubled with long-term high doses). The mechanism for this possible effect may be impaired calcium absorption associated with hypochlorhydria and reduced bone resorption. CHD NSF Statin prescribing has increased by 30 per cent every year since the publication of the Coronary Heart Disease NSF, the Department of Health says. The estimated number of lives saved attributable to statins had risen to 9700 in 2005. The proportion of patients with acute MI who were given thrombolysis within 30 minutes of admission has increased to 83 per cent. Flu jabs cut pneumonia deaths A US study suggests that flu vaccine protects against death during the flu season in patients admitted with community-acquired pneumonia (Arch Intern Med 2007;167:53-9). Nineteen per cent of patients admitted with pneumonia during the winters of 1999-2003 were known to have been vaccinated against flu. Their risk of death during their hospital stay was 70 per cent lower than that of nonvaccinated individuals. After adjustment for antipneumococcal vaccination and comorbidity, the odds of death were still 39 per cent lower. Model to predict admissions The King's Fund, together with New York University and Health Dialog, has published a model that predicts the risk of emergency hospital admission (see www.kingsfund.org.uk). The model is intended for use by PCTs and draws on data from secondary and primary care to define clinical profiles, allowing patients whose condition is deteriorating to be identified before they need admission. Problem drinking The National Treatment Agency for Substance Misuse (NTA), a special authority within the NHS, has published a critical appraisal of the evidence for various treatments for alcohol problems (www.nta.nhs.uk). The 212-page document estimates that over seven million hazardous or harmful drinkers may benefit from brief interventions by any health workers, and over one million dependent drinkers may benefit from specialist intervention. It concludes that cognitive behavioural approaches to specialist treatment are most effective and that treatment probably accounts for about one-third of improvements made in problem drinking. of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. Stopping anti-TNFs Discontinuation of treatment with anti-TNF agents is more common in clinical practice than in clinical trial populations, a French study has found (J Rheumatol 2006;33:2372-5). The retrospective analysis of a single centre's experience of treating 770 patients with etanercept (Enbrel), infliximab (Remicade) or adalimumab (Humira) found that fewer than two-thirds of patients remained on the same treatment after one year, falling to half at two years and about 40 per cent at three years. Treatment was more frequently stopped for lack of efficacy than for adverse effects. There were no statistically significant differences between the three agents but there was a trend for infliximab to be least well tolerated. Generic statin savings The Department of Health has estimated that prescribing simvastatin and pravastatin generically would save £85 million per year. Its analysis of the ,Better care, better value' indicators (see www.productivity.nhs.uk) shows that statin prescribing has increased by 150 per cent in the past five years, with costs totalling £600 million in 2005. The Department says that if every PCT prescribed pravastatin and simvastatin by generic name in only 69 per cent of cases ,the level achieved by the top quarter of trusts ,the savings would be over £85 million a year. Herceptin reporting Press reports of a two-year trial of trastuzumab (Herceptin) were generally accurate in reporting its effectiveness but few reported an increased risk of adverse effects, according to the NHS National Library for Health (www.library.nhs.uk). The Herceptin Adjuvant (HERA) trial (Lancet 2007;369:29-36) found that, after an average follow-up of two years, 3 per cent of women treated with trastuzumab died compared with 5 per cent of controls; estimated three-year survival rates were 92.4 and 89.7 per cent respectively. All four press articles reported these findings accurately, but only two mentioned the increased risk of adverse effects. Updated guidance on CDs The Department of Health has published updated guidance on the strengthened governance requirements for managing controlled drugs, taking into account new regulations that came into force on 1 January (seewww.dh.gov.uk/asset Root/04/14/16/67/04141667.pdf). Statin adherence lowers MI mortality Patients with acute myocar- dial infarction (MI) who take their statins as prescribed are significantly more likely to survive for two to three years than those with low adherence (J Am Med Assoc 2007;297: 177-86). The four-year observational study of 31 455 patients with acute MI found that, compared with those who had taken at least 80 per cent of prescribed daily doses, the risk of death in those with less than 40 per cent adherence was 25 per cent greater over 2.4 years. For individuals with intermediate adherence (40-79 per cent), the risk was 12 per cent greater. Both differences were statistically significant after adjustment for potential confounding factors. The authors believe their finding is explained by differences in adherence rather than healthier behaviour because the excess risk of low adherence was less marked with beta-blockers and not significant for calcium-channel blockers. Improving community medicines management Mental health trusts need to improve medicines management by their community teams and improve information sharing with GPs, the Healthcare Commission has found (www.healthcare commission.org.uk). Its national report revealed limited evidence of pharmacist involvement in community mental health teams, even though 90 per cent of patients were cared for in the community. Only 11 per cent of assertive outreach patients had the tests necessary to ensure safe use of their medicines. Medication reviews found that 46 per cent of patients in mental health trusts and 12 per cent of those in acute trusts were not taking their medication appropriately. The Commission also reported that acute trusts received a complete drug history from GPs for fewer than half of audited patients when they were admitted to hospital, and only 30 per cent of PCTs reported that GPs received adequate information on patients' medicines on discharge. Copyright © 2007 Wiley Interface Ltd [source]