Childhood bullying victimization is associated with use of mental health services over five decades: a longitudinal nationally representative cohort study.

BACKGROUND: Research supports robust associations between childhood bullying victimization and mental health problems in childhood/adolescence and emerging evidence shows that the impact can persist into adulthood. We examined the impact of bullying victimization on mental health service use from childhood to midlife. METHOD: We performed secondary analysis using the National Child Development Study, the 1958 British Birth Cohort Study. We conducted analyses on 9242 participants with complete data on childhood bullying victimization and service use at midlife. We used multivariable logistic regression models to examine associations between childhood bullying victimization and mental health service use at the ages of 16, 23, 33, 42 and 50 years. We estimated incidence and persistence of mental health service use over time to the age of 50 years. RESULTS: Compared with participants who were not bullied in childhood, those who were frequently bullied were more likely to use mental health services in childhood and adolescence [odds ratio (OR) 2.53, 95% confidence interval (CI) 1.88-3.40] and also in midlife (OR 1.30, 95% CI 1.10-1.55). Disparity in service use associated with childhood bullying victimization was accounted for by both incident service use through to age 33 years by a subgroup of participants, and by persistent use up to midlife. CONCLUSIONS: Childhood bullying victimization adds to the pressure on an already stretched health care system. Policy and practice efforts providing support for victims of bullying could help contain public sector costs. Given constrained budgets and the long-term mental health impact on victims of bullying, early prevention strategies could be effective at limiting both individual distress and later costs.

How mental health nursing can best improve service users' experiences and outcomes in inpatient settings: responses to a national consultation.

Despite a number of national developments in the past few years, concerns remain about the experience and outcomes for service users in inpatient care settings. As part of a national review of mental health nursing in England, a consultation exercise was carried out to ascertain the opinions of a wide range of stakeholders in order to inform subsequent recommendations. The consultation question specifically related to inpatient care was 'How can mental health nurses best improve service users' experiences, and outcomes, in inpatient care settings?' The consultation generated a total of 326 written responses, mostly from groups and organizations. Responses were subject to content analysis and the three largest categories were 'Service users influencing services' (n = 80, 31%), 'Service users involved in own care' (n = 74, 29%) and 'Direct clinical time' (n = 68, 26%), including respondents citing the need for protected therapeutic engagement time. Many of the themes raised in the consultation were subsequently reflected in the recommendations made in 'From values to action; the Chief Nursing Officer's review of mental health nursing'.

National survey of nurse prescribing in mental health services; a follow-up 6 years on.

WHAT IS KNOWN ON THE SUBJECT?: Nurse prescribing allows nurses, after specific training, to prescribe medications under certain conditions. This article describes the third in a series of surveys of mental health services in England to understand how nurse prescribing is being used across the country. While there is research evidence that shows nurse prescribing to be as safe as prescribing by doctors and that service users typically find it at least as acceptable, there is a lack of detailed evidence about current forms of nurse prescribing practice specifically in mental health services. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The survey found that the number of nurse prescribers has increased over the last few years. Nurse prescribers are increasingly prescribing in a form ('independent prescribing') that makes them independently responsible for prescribing decisions without working to a plan laid out by a doctor. Mental health organisations are increasingly planning in a systematic way how to identify, train and ensure good practice in nurse prescribing. This study demonstrates that growth in numbers of nurse prescribers can take place over an extended time period. The study demonstrates that the exact model of nurse prescribing will influence its applicability in different types of service. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurse prescribing is becoming increasingly common in mental health services, changing roles for nurses and the experience of services for service users. However, there is great variation between organisations in this regard. Research is needed regarding the outcomes and any risks of independent nurse prescribing specifically in mental health compared to medical prescribing. ABSTRACT: Introduction This paper reports the latest in a series of national surveys of nurse prescribing in mental health organizations in England. Aim To describe and understand changes and trends in the use of nurse prescribing nationally. Methods Postal survey to all 53 National Health Service Mental Health Trusts (publicly funded provider organizations); 75% responded (n = 40). Results Numbers of nurse prescribers (NPs) have grown significantly in the last 6 years, although remain a small percentage of the total Mental Health Nursing workforce. Most NPs are in community services, particularly community mental health teams and drug/alcohol services. Independent prescribing has now become the most common form of NP, replacing supplementary prescribing. Discussion Overall growth in numbers of NPs has continued, but remains marked by large variance in numbers between organizations. The study evidences that the particular form of nurse prescribing will influence its applicability in different clinical settings and that sustained increase over time in NP numbers is feasible at a national level, even with local variation in uptake. Implications for practice Nurse prescribing has become well embedded in many organizations although large-scale adoption may be hindered by the lack of a definitive evidence base as to outcomes compared with those from medical prescribing.

Asylum nursing in the UK at the end of the Victorian era: Hill End Asylum.

This paper explores aspects of asylum care at the beginning of the 20th century. Archival materials from Hill End, the Hertford County Asylum, provide a single historical case study. The study focuses on the methods and standards by which asylum nursing was monitored and also examines aspects of the origins and work life of the nursing staff. Standards of care were monitored by a number of official bodies visiting the asylum, whilst the medical superintendent's role focused on the supervision and disciplinary control of nursing staff. Evaluation reports at the time were largely favourable in relation to the care given in Hill End Asylum. However, the reports were based on the relatively limited expectations of the time: primarily relating to the cleanliness, quietness and lack of overt complaints regarding care from patients. Further measures reported related to: death rates, wet beds, numbers of staff dismissed, together with the use of mechanical restraints and seclusion. Nursing staff in the asylum were not normally recruited locally and frequently stayed for only short periods of time. Training provided was very limited at Hill End although a national nurse training scheme was well established by this time. The nursing issues important within the asylum were common to all asylums at the time, and some are still significant today. This paper provides an insight into the historical development of the mental health nursing profession in the UK and its relationship with the medical profession. It also provides evidence that current attempts to monitor the quality of care through clinical governance processes are far from new.

Using workload measurement tools in diverse care contexts: the experience of staff in mental health and learning disability inpatient settings.

ACCESSIBLE SUMMARY: What is known on the subject? Difficulties with the recruitment and retention of qualified nursing staff have resulted in nursing shortages worldwide with a consequential impact on the quality of care. It is increasingly recommended that evidence-based staffing levels are central to the development of workforce plans. Due to a paucity of empirical research in mental health and learning disability services the staffing needs and requirements for these settings are undefined and the availability of tools to aid staffing decisions is limited. What this paper adds to existing knowledge? This paper provides a valuable insight into the practical uses of these tools as perceived by staff members with day-to-day experience of the requirements of mental health and learning disability wards. It reveals that while workload measurement tools are considered a valuable aid for the development of workforce plans, they are limited in their ability to capture all aspects of care provision in these settings. It further emphasizes the inapplicability of a one-shoe-fits-all approach for determining nurse staffing levels and the need for individual and customized workforce plans. What are the implications for practice? This study demonstrates that the development of tools for use in mental health and learning disability services is in its infancy, yet no tool that has been validated as such. It highlights the potential for workload measurement tools to aid staffing decisions; however, a more holistic approach that considers additional factors is needed to ensure robust workforce planning models are developed for these services. INTRODUCTION: The critical challenge of determining the correct level and skill mix of nursing staff required to deliver safe and effective health care has become an international concern. It is recommended that evidence-based staffing decisions are central to the development of future workforce plans. Workforce planning in mental health and learning disability nursing is largely under-researched with few tools available to aid the development of evidence-based staffing levels in these environments. AIM: It was the aim of this study to explore the experience of staff using the Safer Nursing Care Tool and the Mental Health and Learning Disability Workload Tool in mental health and learning disability environments. METHOD: Following a 4-week trial period of both tools, a survey was distributed via Qualtrics online survey software to staff members who used the tools during this time. RESULTS: The results of the survey revealed that the tools were considered a useful resource to aid staffing decisions; however, specific criticisms were highlighted regarding their suitability to psychiatric intensive care units and learning disability wards. DISCUSSION: This study highlights that further development of workload measurement tools is required to support the implementation of effective workforce planning strategies within mental health and learning disability services. IMPLICATIONS FOR PRACTICE: With increasing fiscal pressures, the need to provide cost-effective care is paramount within the services of the National Health Service. Evidence-based workforce planning is therefore necessary to ensure that appropriate levels of staff are determined. This is of particular importance within mental health and learning disability services due to the reduction in the number of available beds and an increasing focus on purposeful admission and discharge.

Mortality and migration in Britain, first results from the British Household Panel Survey.

This study investigates the extent to which current geographical variations in mortality are influenced by patterns of migration since birth. It is based on a longitudinal study of migrants which consists of a representative sample of 10264 British residents born after 1890 and enumerated as part of the British Household Panel Study in 1991. Between 1991 and 1996, 527 of the study members died and these deaths were analysed by area of residence at birth and in 1991 at both the regional and local district geographical scales. These were compared with findings from the Office for National Statistics Longitudinal Study. The British Household Panel Survey sample replicates the results of work conducted on the Longitudinal Study which finds that geographical variations in age-sex standardised mortality ratios at the regional scale cannot be attributed to selective migration. However, for the British Household Panel Survey sample, the major geographical variations at district level could be attributed to selective migration. Geographical variations in mortality are not well understood. Restrictions on what it is possible to analyse in the Office for National Statistics Longitudinal Study may have resulted in the underestimation of the importance of local lifetime selective migration in producing the contemporary map of mortality variation across Britain. The British Household Panel Survey is a small, recent, but very flexible study, which can be used to investigate the effects of lifetime migration on mortality patterns for all of Britain. This first report of its results on mortality shows that it produces findings which accord with the much larger Longitudinal Study, but which can be taken further to show that selective migration over the whole life-course at the local level does appear to have significantly altered the geographical pattern of mortality seen in Britain today.

Migration and geographical inequalities in health in Britain.

This paper explores the role of migration in creating geographical inequalities in mortality at the district level in Britain for the British Household Panel Study sample--a representative sample of 10264 British residents born after 1890 and enumerated in 1991. Analysis of the mortality rates of migrants showed that male migration accounts for nearly all the differences in mortality rates between districts. The BHPS was then utilised to look at the lifetime socio-economic characteristics of these migrants and to compare men and women. It was found that the health of both men and women moving from high mortality districts to low mortality districts could be explained by advantage over their lifetimes. The small proportion of men and women moving from low mortality districts to high mortality districts represent a very mixed group and their contribution, whilst small, is intriguing, as is the very different mortality rates of men and women in this group.

Widening inequality in mortality between 160 regions of 15 European countries in the early 1990s.

This paper presents maps of geographical patterns in mortality for the 160 mainland regions of the 15 countries of the European Union. Standardised mortality ratios (SMRs) for all ages are presented for all causes of death and for lung cancer, ischaemic heart disease, road traffic accidents and suicide. All cause standardised mortality ratios (for deaths under the age of 65) for the years 1990 and 1994 are presented. These data show that while most regions of Europe had decreasing SMRs over this time period, SMRs increased for the 10% of the population with the highest SMRs and the gap between the most and least healthy regions grew. Possible reasons for the observed patterns, the limitations of currently available data and the limitations of studying nation states, are suggested.

Where the poor die in a rich city: the case of Oxford.

Research to date has established that there is a relationship between high mortality rates and area deprivation in Britain. However, the majority of this research has looked at the regional level and the few studies that have looked at a smaller area level have tended to focus on London or the North. At a national level a relationship between housing tenure and mortality has also been found. This paper considers the relationship between mortality and place and in particular housing, at ward level in a city in the South East of England. It is found that, in Oxford, there is no straightforward relationship between housing tenure and mortality rates. Rather, it is pockets of poverty within Oxford, expressed in different types of housing, that are associated with high mortality rates. Whilst the very poorest live in the worst quality and least preferred housing, the extent of this relationship is likely to differ in different areas, according to the historical and current patterns of housing provision. A method of identifying such areas nationally is needed, as a reliance on national studies, particular those on tenure, is likely to obscure the true picture and extent of geographical inequalities in health.

Home treatment as an alternative to inpatient admission: characteristics of those treated and factors predicting hospitalization.

In response to the NHS Plan, crisis and home treatment teams will be developed across the UK in order to provide intensive home treatment as an alternative to inpatient admission for individuals with severe, acute mental health problems. This study describes aspects of the work of two teams in Hertfordshire. A total of 293 individuals were taken on for intensive home treatment in a 12-month period. A range of social and demographic variables was recorded at the point of initial assessment regarding each individual, as well as two rating scales: the Brief Psychiatric Rating Scale and the Scale for Suicide Ideation. Sixty-two individuals (21.1%) required admission to hospital after a median period of home treatment of 11 days. The most frequently recorded reason for admission taking place was 'risk to self' (n = 33, 53.2%). Two variables were identified by logistic regression analysis as being predictive of an increased risk of hospitalization: high suicidal ideation at initial assessment (P < 0.01) and previous hospital admission (P < 0.01). Although statistically significant, these variables were only weakly predictive of whether admission would actually take place.

HOVIS -- The Hertfordshire/Oxfordshire Violent Incident Study.

Violence in psychiatric inpatient units is a major and growing problem. Research interest has primarily focussed on patient characteristics. The role of staff factors and the antecedents of violent incidents has been neglected, despite the fact that staff factors and behaviour may be more readily amenable to change than patient characteristics. The HOVIS study sought to obtain the views of a sample of mental health nurses in current clinical practice about staff-related factors, which they perceive to contribute to, or protect against, the occurrence of violent incidents. A total of 108 nurses working in psychiatric acute admission, intensive care and low secure units, in two NHS Trusts were interviewed using a specially designed semistructured interview schedule. These nurses identified a variety of behaviours, clinical skills, personal characteristics and interpersonal skills that they believe impact on the occurrence of violent incidents. These findings are discussed in relation to their possible training and managerial implications.

The use of brief therapy as part of the nursing care plan.

Care plans provide a framework for improving nurse-client communication, increasing the focus on individuals' needs and improving communication between nurses. In order for these benefits to be achieved, the nurse must have an understanding of these and other potential benefits, and the skills to make the process of paperwork as indistinguishable as possible from the process of helping the individual client. This paper describes how the concepts of brief therapy provide one means of achieving this goal.

Supporting clients with suicidal impulses in the community.

This article describes the development of community treatment team services and some of the methods they can employ in working with potentially suicidal clients in their own homes.

An evaluation of team and individual formularies to support independent prescribing in mental health care.

Mental health nurses have been entitled to train to become independent prescribers since May 2006; although the number of trained nurse prescribers seems to have increased steadily, a significant number of them have not actually undertaken prescribing roles on completion of their training or have limited their practice to supplementary prescribing. In order to support existing independent prescribers and to assist those nurses who have trained but are yet to prescribe independently, a mental health trust has piloted the use of individual and team formularies. An evaluation of this project indicated that formularies were well received by existing independent prescribers and were seen as a helpful instrument to support newly qualified and supplementary prescribers in their bid to become independent. Formularies can clarify and formalize each prescriber's area of competence, thus setting clear boundaries, reducing uncertainty and enhancing prescribers' confidence and willingness to take on this new role. Formularies may also be used to enhance communication with service users and further develop shared decision making. Effective procedures need to be in place to ensure formularies are up to date and reflect local practice.

Disengaging from acute inpatient psychiatric care: a description of service users' experiences and views.

The growing number of people worldwide with mental health problems is increasing and making intensive demands on existing services. Recent reorganizations of healthcare provision in the UK have focused predominantly on administrative efficiency, standardization and cost-effectiveness. Although little evidence exists that reorganizations, per se, directly result in improved health nationally, nevertheless, organizational change coupled with improved care provision can have a considerable impact on the mental health of people. It is known that service users want person-centred help with improving their confidence, autonomy and cognitive and social skills so as to be able to manage their lives within the social context in which they live. In this study, semi-structured interviews were used to explore service users' expectations and experiences of acute inpatient care and the early post-discharge period. While the social environment of the wards was seen by many as conducive to promoting safety and interpersonal relationships, others found the experience lacking in assisting them to resume their lives post discharge. If acute care is to become more than a mechanism for addressing and containing risk, better targeted interventions are required to help individuals find strategies that are transferable to the context of their 'real' lives. A number of factors that were identified by respondents in this study are identified and discussed.

Nurse prescribing in mental health: national survey.

Mental health nurses can now train to become independent prescribers as well as supplementary prescribers. Independent nurse prescribing can potentially help to reorganize mental health services, increase access to medicines and improve service user information, satisfaction and concordance. However, mental health nursing has been slow to undertake prescribing roles, and there has been little work conducted to look at where nurse prescribing is proving successful, and those areas where it is less so. This survey was designed to collect information from directors of nursing in mental health trusts about the numbers of mental health prescribers in England, gather views about prescribing in practice, and elicit intentions with regards to the development of nurse prescribing. In some Trusts, the number of mental health nurse prescribers has increased to the point where wider impacts on workforce, the configuration of teams and services are inevitable. Currently, the way that prescribing is used within different organizations, services and teams varies and it is unclear which setting is most appropriate for the different modes of prescribing. Future work should focus on the impact of mental health nurse prescribing on service delivery, as well as on service users, colleagues and nurses themselves.