A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services.

AIMS AND METHOD: This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. RESULTS: Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. CLINICAL IMPLICATIONS: New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study.

PURPOSE: Ethnic inequalities in experiences of mental health care persist in the UK, although most evidence derives from in-patient settings. We aimed to explore service users' and carers' accounts of recent episodes of severe mental illness and of the care received in a multi-cultural inner city. We sought to examine factors impacting on these experiences, including whether and how users and carers felt that their experiences were mediated by ethnicity. METHODS: Forty service users and thirteen carers were recruited following an acute psychotic episode using typical case sampling. In-depth interviews explored illness and treatment experiences. Ethnicity was allowed to emerge in participants' narratives and was prompted if necessary. RESULTS: Ethnicity was not perceived to impact significantly on therapeutic relationships, and nor were there ethnic differences in care pathways, or in the roles of families and friends. Ethnic diversity was commonplace among both service users and mental health professionals. This was tolerated in community settings if efforts were made to ensure high-quality care. Home Treatment was rated highly, irrespective of service users' ethnicity. In-patient care was equally unpopular and was the one setting where ethnicity appeared to mediate unsatisfactory care experiences. These findings highlight the risks of generalising from reports of (dis)satisfaction with care based predominantly on in-patient experiences. CONCLUSIONS: Home treatment was popular but hard to deliver in deprived surroundings and placed a strain on carers. Interventions to enhance community treatments in deprived areas are needed, along with remedial interventions to improve therapeutic relationships in hospital settings.

An evaluation of the implementation of the FACE Health and Social Assessment in routine psychiatric practice.

BACKGROUND: Systematic assessment of patients is seen as an important aspect of mental health care. As yet few UK services have successfully implemented outcome measures. AIMS: To examine the feasibility of using FACE Health and Social Assessment in everyday practice and explore issues raised for staff. METHOD: This comprised a feasibility questionnaire completed by 52 staff, 3 focus groups involving 18 staff and an analysis of patient scores on routinely collected FACE data. RESULT: The questionnaire findings were positive yet only just over half of the patients on Assertive Outreach (AO) teams had some part of FACE completed in the previous year. The focus groups drew attention to many other calls on staff time and the importance of ongoing support. Staff were uncertain about the benefits of FACE for measuring change but believed that it promoted reflective practice. FACE subscores showed some ability to discriminate between patients on Rehabilitation and Recovery and AO teams but there were no significant differences for AO patients over time. CONCLUSIONS: Although competing demands and low priority may underpin the failure to implement FACE it is perhaps clinical staffs lack of conviction in its contribution to improving mental health care that is the fundamental issue.

Services for people with complex psychosis: towards a new understanding.

This paper describes the need for commissioners and service providers to consider the development of a whole-system approach to providing rehabilitation services for patients with complex psychosis, in the context of the current economic pressures and emergence of a competitive market in this area of mental health. The practical and organisational arrangements for the management of risk with such services are described, taking into account the varying provision of rehabilitation services across the UK and considering how these can be developed against the care clustering system and interfaces with other mental health services.

Patient engagement and problematic behaviours in nurse-staffed residential rehabilitation units.

Aims and method To build on previous research findings by examining engagement and problematic behaviours of patients in 10 residential rehabilitation units. Two measures were completed on patients in community rehabilitation, longer-term complex care and high-dependency units (109 patients in total). Data were analysed and categorised into higher-engagement ratings across the domains of engagement and behaviour over the past 6 months and lifetime in terms of presence of the behaviour and likelihood of resulting harm. Results Data were available for 73% of patients. All aspects of engagement were consistently low for all units, with highest levels in community rehabilitation units. Levels of problematic behaviours were similar across all units. Socially inappropriate behaviours and failure to complete everyday activities were evident for over half of all patients and higher for lifetime prevalence. Verbal aggression was at significantly lower levels in community units. Lifetime behaviours likely to lead to harm were much more evident in high-dependency units. Clinical implications Despite some benefits of this type of care, patients continue to present challenges in engagement and problematic behaviours that require new approaches and a change in focus.

North Birmingham assertive outreach evaluation. Patient characteristics and clinical outcomes.

BACKGROUND: Given the adoption of assertive outreach teams into UK mental health policy, it is important to assess whether gains identified in efficacy studies can be replicated in ordinary clinical settings. AIM: The aim of the study was to assess patient characteristics and clinical outcomes in routine assertive outreach services in the UK. METHODS: Patients (N=250), newly taken onto five assertive outreach teams, were followed up over 2 years. Baseline characteristics and outcome measures were compared. RESULTS: Most patients had an International Statistical Classification of Diseases and Related Health Problems, 10th Revision, diagnosis of schizophrenia, schizotypal or delusional disorder and long-standing involvement with psychiatric services. Around a half had a history of substance abuse and violence. At follow-up, the majority had ongoing input from the teams and there was a significant decrease in the use of in-patient care. There was no improvement in symptoms, risk behaviours or social functioning. CONCLUSION: Patients on assertive outreach teams remain in contact with services and spend less time in hospital yet show little change with respect to clinical outcomes.