What drives changes in institutionalised mental health care? A qualitative study of the perspectives of professional experts.

BACKGROUND: Since 1990, the provision of mental healthcare has changed substantially across Western Europe. There are fewer psychiatric hospital beds and more places in forensic psychiatric hospitals and residential facilities. However, little research has investigated the drivers behind these changes. This study explored qualitatively the perspectives of mental health professional experts on what has driven the changes in Western Europe. METHODS: In-depth interviews were conducted with twenty-four mental health experts in England, Germany and Italy, who as professionals had personal experiences of the changes in their country. Interviewees were asked about drivers of changes in institutionalised mental health care from 1990 to 2010. The accounts were subjected to a thematic analysis. RESULTS: Four broad themes were revealed: the overall philosophy of de-institutionalisation, with the aim to overcome old-fashioned asylum style care; finances, with a pressure to limit expenditure and an interest of provider organisations to increase income; limitations of community mental health care in which most severely ill patients may be neglected; and emphasis on risk containment so that patients posing a risk may be cared for in institutions. Whilst all themes were mentioned in all three countries, there were also differences in emphasis and detail. CONCLUSIONS: Distinct factors appear to have influenced changes in mental health care. Their precise influence may vary from country to country, and they have to be considered in the context of each country. The drivers may be influenced by professional groups to some extent, but also depend on the overall interest and attitudes in the society at large.

Explanations of illness experiences among community mental health patients: an argument for the use of an ethnographic interview method in routine clinical care.

Cultural variations in perceptions of mental distress are important issues for healthcare. They can affect communication between patients and professionals and may be a root cause for misdiagnosis, patient disengagement, and disparities in access, outcomes and overall experiences of treatment by patients. Taking into account patients' explanatory models (EMs) of mental distress is fundamental to patient-centred care, and improved outcomes. This paper reports on the outcomes from the Cultural Consultation Service, commissioned in an inner-city London borough. We used a narrative-based ethnographic method of assessment, in which community mental health patients referred for a cultural consultation were interviewed using Barts Explanatory Model Inventory and Checklist (BEMI) to assess the EMs of their mental distress. Patients mainly attributed the causes and consequences of their mental distress to emotional and psychological factors, which were inextricably linked to existing social concerns and interpersonal issues. Desired solutions mainly focused on treatment, social, and systemic interventions. We found that using BEMI could contribute to a comprehensive assessment in routine care and can be used by professionals within a short timeframe and with minimal training. Ethnographic assessment method captures patients' EMs and illness experiences, opening the way for patient-centred interventions and potentially better outcomes and experiences.

A cultural consultation service in East London: experiences and outcomes from implementation of an innovative service.

This paper reports on a feasibility study and evaluation of a new type of cultural consultation service (CCS). This multi-component and systemic complex intervention was offered over 18 months to specialist mental health providers in one of the poorest regions of the UK. The service received 900 clinically related contacts and 99 in-depth consultations. Service users who were referred to the CCS had high levels of clinical needs with an average score of 15.9 on the Health of the Nation Outcomes Scale. Overall, Global Assessment of Function scores improved and there were trends for improvements in symptoms. The level of routine care (and by implication associated costs) significantly reduced after CCS intervention, due to a reduction in use of accident and emergency (A&E) services, psychiatrists and community psychiatric nurses (CPNs)/case managers. Cost analysis indicates that savings amounted to £497 per patient. The cost of intervention was no greater than usual care, and may reduce spend per patient over a 3-month follow-up and perhaps longer. More specifically, clinicians felt the cultural consultation service helped to improve the treatment plan (71%), engagement (50%), medication compliance (21%) and earlier discharge (7%).

Using a cultural formulation for assessment of homicide in forensic psychiatry in the UK.

Healthcare inequalities for black and minority ethnic (BME) patients in forensic mental health services in the UK are stark. Despite the level of attention given to this over the last 15 years there has been little progress to address disparities. There is a great deal of confusion over what is understood by culture, and what aspects of culture signal specific needs of BME patients. In addition, we have a lack of empirical research demonstrating what it means for psychiatrists to be culturally competent. These are all important barriers against progress in this area. Using a homicide case study that illustrates the typical issues encountered in practice, we explore how to use a cultural formulation in order to assess the role of culture within a forensic psychiatry setting. Finally, practical advice is offered to assist expert witnesses in preparing court reports that adequately consider the significance of defendants' cultural beliefs and practices.

Timeliness of second opinion appointed doctors' assessments of treatment plans for patients detained in medium security hospitals in London, UK.

BACKGROUND: Mental health legislation in England & Wales requires assessment by a second opinion appointed doctor (SOAD) to safeguard the rights of patients detained in a hospital under this law if they are either refusing certain treatments or are deemed incapable of consenting to them. AIMS: Our aim was to evaluate timeliness of SOAD assessments. METHOD: Data were collected from the Mental Health Act administrator on all SOAD requests in 1 year for all in-patients in two English medium security hospital units. RESULTS: One hundred and six patients required a SOAD assessment during the 1-year period examined, of a combined resident total of 295, as did a further 14 patients who had been discharged from hospital and were subject to a community treatment order. About half of the inpatients were seen by a SOAD within 30 days and a further quarter within 60 days, but the remaining quarter waited up to 150 days or more. DISCUSSION AND IMPLICATIONS: These results suggest that in these trusts, unlikely to be atypical, neither patients nor clinicians are being adequately protected by legal safeguards on decisions to treat with medication (or electroconvulsive therapy) in the event of impaired competence for decisions about mental health treatments. There should be clear standards for the appropriate length of time from referral to assessment by an independent doctor (SOAD). Compliance with standards should be transparent, so anonymised data on the matter should be routinely collected and stored by health trust Mental Health Act offices. Data should be monitored at agreed intervals by an independent body.

Molecular characterization of eight Indian Snakehead species (Pisces: Perciformes Channidae) using RAPD markers.

Murrels (Perciformes; Channidei; Channidae) are unique group of freshwater air breathing fishes having a confined distribution to African and Asian continents. The phylogenetic relationship among eight Channid species viz. Channa aurantimaculata, Channa bleheri, Channa diplogramma, Channa gachua, Channa marulius, Channa punctatus, Channa stewartii and Channa striatus were investigated using RAPD markers. Eight random oligodecamers viz. OPAC03, OPAC05, OPAC07, OPAC09, OPAC19, OPA10, OPA11 and OPA16 were used to generate the RAPD profile. Estimates of Nei's (Genetics, 89:583-590, 1978) unbiased genetic distance (D) demonstrated sufficient genetic divergence to discriminate the samples of different species and the values ranged from 0.3292 to 0.800 The present RAPD analyses strongly substantiate the view of earlier morphological and osteological studies of Channid species, the closer association among species in "gachua" and "marulius" groups.

Teaching psychiatry to medical students in the time of COVID-19: experiences from UK medical schools.

AIMS AND METHOD: Education leads for undergraduate psychiatry in UK medical schools completed questionnaires on adaptations made to undergraduate psychiatry education, their impact and what lessons could be learnt for the future. RESULTS: Respondents from 24 medical schools across the UK reported a major shift to online teaching delivery, with reduced workplace learning and increased use of teleconferencing, online tasks and self-directed learning. Changes were implemented with some faculty training provided, but little additional funding or resources from medical schools or National Health Service trusts. A variety of challenges and opportunities were reported. CLINICAL IMPLICATIONS: Despite the extraordinary efforts of education leads to maintain undergraduate psychiatry education, the pandemic may affect the development of students' professional competencies and recruitment into psychiatry. Individual clinicians, trusts and medical and foundation schools have much to offer, and need to work with students to replace what has been lost during the pandemic.

Critical Psychiatry Debates; A Neglected Tool in Undergraduate Medical Education.

This article was migrated. The article was marked as recommended. Background: Healthcare professionals must adapt to everyday clinical controversies using their critical thinking and communication skills. Educational debates nurture these skills producing a well-rounded clinician. Their value is well established in healthcare education, yet they are not commonly employed, and there is no literature on their use in undergraduate Psychiatry teaching. Methods: We planned and implemented a one-off educational debate lesson as part of the teaching program of fourth-year medical students on their Psychiatry clinical placements. We collected and analyzed the students' feedback. Results: Although most students had no experience of debates, 79% found the learning event positive. The students also reported improvement in their confidence (58%), oral presentation skills (37%), critical thinking skills (71%) and the ability to cope with conflict (54%). In addition, there was a positive shift in their attitude towards Psychiatry (71%) and the chances of choosing it as a future speciality (33%). Conclusion: Our results showcase the benefit of using debates in shaping future doctors' non-clinical skills and practice attitudes. In this paper, we discuss a thematic analysis of students' feedback comments and reflect on several points in the planning and delivering educational debates. We also include practical recommendations for future applications.

Impact of ethanolic extract of Equisetum arvense (EA1) on pancreatic carcinoma AsPC-1 cells.

The current research was focused on evaluation of the cytotoxic and suppressive action of ethanolic extract of Equisetum arvense (EA1) against human pancreatic carcinoma cell line ASPC-1 after treatment with 25 µg/mL, 50 µg/mL, 100 µg/mL and 200 µg/mL EA1, using MTT assay and Antioxidant activity. Detailed investigations led to reveal the ability of cell patronage through the dreadful upshot of free radicals. The current approach followed MTT assays to examine the long-lasting ability and growth of cells as EA1 restrained the cell viability and growth of ASPC-1. At the end, EA1 showed its potential cytotoxicity and reduced the cellular proliferation of ASPC-1 cells through a pattern, which appeared to be concentration dependent. Our results can form the basis to explore the molecular mechanisms underlying Ethanolic Extract of Equisetum arvense induced cell death in pancreatic cancer cell lines and may serve as an alternative anticancer agent for the treatment of pancreatic carcinoma (PC) with no or least side effects to the patient.

Pathogenesis-related proteins and peptides as promising tools for engineering plants with multiple stress tolerance.

Pathogenesis-related (PR) proteins and antimicrobial peptides (AMPs) are a group of diverse molecules that are induced by phytopathogens as well as defense related signaling molecules. They are the key components of plant innate immune system especially systemic acquired resistance (SAR), and are widely used as diagnostic molecular markers of defense signaling pathways. Although, PR proteins and peptides have been isolated much before but their biological function remains largely enigmatic despite the availability of new scientific tools. The earlier studies have demonstrated that PR genes provide enhanced resistance against both biotic and abiotic stresses, which make them one of the most promising candidates for developing multiple stress tolerant crop varieties. In this regard, plant genetic engineering technology is widely accepted as one of the most fascinating approach to develop the disease resistant transgenic crops using different antimicrobial genes like PR genes. Overexpression of PR genes (chitinase, glucanase, thaumatin, defensin and thionin) individually or in combination have greatly uplifted the level of defense response in plants against a wide range of pathogens. However, the detailed knowledge of signaling pathways that regulates the expression of these versatile proteins is critical for improving crop plants to multiple stresses, which is the future theme of plant stress biology. Hence, this review provides an overall overview on the PR proteins like their classification, role in multiple stresses (biotic and abiotic) as well as in various plant defense signaling cascades. We also highlight the success and snags of transgenic plants expressing PR proteins and peptides.

The PsychSimCentre: teaching out-of-hours psychiatry to non-psychiatrists.

BACKGROUND: Junior doctors have limited experience in psychiatry before starting their training placements. The out-of-hours setting offers specific challenges, and trainees are expected to cope despite being underprepared. We hyphothesised that simulation-based training would increase trainees' competence and confidence in approaching high-risk out-of-hours scenarios. METHODS: A pilot study focused upon the first cohort of psychiatry trainees joining the North East London NHS Foundation Trust in 2012. During their induction (and prior to any clinical duties) each trainee took part in five high-risk clinical scenarios, assessed by a senior psychiatrist and service-user representative. The trainees were required to complete a survey exploring their confidence across nine core psychiatric clinical domains, both before and after the simulation training. RESULTS: The simulation training increased trainee confidence in all nine clinical domains. Before the simulation training, over half of the nine trainees self-rated themselves as having 'no confidence' in six of the nine clinical competencies. After the training, confidence levels had significantly increased, with only two of the competencies scoring any 'no confidence' ratings. There were mixed feelings by trainees on the use of service-user representatives in the training of doctors. Junior doctors have limited experience in psychiatry before starting their training placements DISCUSSION: We found that high-fidelity simulation training is a useful tool to prepare junior trainees in psychiatry to familiarise themselves with some of the high-risk scenarios that they are likely to encounter during out-of-hour on-call duties. We showed that this intervention increased trainees' confidence across a range of core psychiatric skills. This has significant implications in the provision of safe and effective patient care.

BASH: badmouthing, attitudes and stigmatisation in healthcare as experienced by medical students.

Aims and method We used an online questionnaire to investigate medical students' perceptions of the apparent hierarchy between specialties, whether they have witnessed disparaging comments ('badmouthing' or 'bashing') against other specialists and whether this has had an effect on their career choice. Results In total, 960 students from 13 medical schools completed the questionnaire; they ranked medical specialties according to the level of badmouthing and answered questions on their experience of specialty bashing. Psychiatry and general practice attracted the greatest number of negative comments, which were made by academic staff, doctors and students. Twenty-seven per cent of students had changed their career choice as a direct result of bashing and a further 25.5% stated they were more likely to change their specialty choice. Although 80.5% of students condemned badmouthing as unprofessional, 71.5% believed that it is a routine part of practising medicine. Clinical implications Bashing of psychiatry represents another form of stigmatisation that needs to be challenged in medical schools. It not only has an impact on recruitment into the specialty, but also has the wider effect of stigmatising people with mental health disorders.