Developing a social perspective in mental health services in primary care

The influence of Primary Care Trusts (PCTs) on the reorganisation of UK health and social care provision is already considerable. As well as challenging institutionalised processes of care, PCTs are encouraging innovation. This article reflects on a service pioneered by a small group of mental health social workers, which has been reconfigured within a new PCT, illuminated by examples of direct therapeutic work and service user feedback. In the new service, the practical application of a social perspective in mental health provision is demonstrated by eligibility criteria based on social context as well as psychological adversity. Possible developments arising from the prospective, multidisciplinary team membership and interface with secondary care are anticipated.     

Legal, social, cultural and political developments in mental health care in the UK: the Liverpool black mental health service users' perspective

Documentary evidence suggests that attitudes among local health and social services professionals towards the concept of user involvement in health and social care remain deeply polarized, a position characterized by commentators simultaneously as praise and damnation. Perhaps user involvement in health and social care will enhance, and it appears to resonate with the logic of, participatory democracy, in localities where the centralization of power has posed questions as to the nature and purpose of local governance in public services provision. The problems experienced by Britain's black and ethnic minorities within the mental health system have been the subject of exhaustive social inquiry. This essay attempts to explore the way in which legal, social, cultural, and political developments interface with mental health care practice in the UK, in order to assist those responsible for mental health services provision to deliver services that are in line with the Government's expectation of a modernized mental health service that is safe, sound, and supportive. An exploration of these developments within the European, national (UK), and local (Liverpool) contexts is undertaken. An appropriate local response to national priorities will ostensibly cut a swathe through the barriers confronted by the ethnic minority mental health service user in the cross-cultural context, an important prerequisite for the implementation of genuine user involvement.     

Need for social psychiatric services--a management model in scientific evaluation

Social-psychiatric services have for a long time been a focus in the controversial discussion about the further development of outpatient mental health care. Presented is the Baden-Württemberg Social Psychiatric Services model, which is oriented towards outpatient social welfare provision of persons with chronic mental illness, complementing the medical-psychiatric treatment provided by office-practice psychiatrists. Evaluation of the Social Psychiatric Service for its first year of full operation, 1984, has shown that this type of service delivery organization is capable, above all, of reaching persons with "recently" chronic mental illness, who are serviced in the framework of community mental health care systems mainly on an outpatient basis. Provision of care, i.e. of social welfare and counselling measures, may in this group constitute an efficient contribution towards their social rehabilitation. Effective functioning of this organizational model presupposes sufficiently well-established cooperation with other facilities and services involved in service provision, which, as the Baden-Württemberg trial has shown, can in actual fact be ensured.     

Catching life: the contribution of arts initiatives to recovery approaches in mental health

This paper draws on a qualitative study that was undertaken as part of a national research study to assess the impact of participatory arts provision for people with mental health needs. It explores how arts and mental health projects may facilitate some of the key elements of what has been termed a 'recovery approach' in mental health. It is argued that it is precisely these elements--the fostering of hope, creating a sense of meaning and purpose, developing new coping mechanisms and rebuilding identities--which are hard to standardize and measure, yet may be the most profound and significant outcomes of participation in such projects. Therefore, in the context of a growing emphasis on recovery-orientated mental health services, while not necessarily being appropriate for all service users, arts and mental health initiatives could make an essential contribution to the future of mental health and social care provision.     

Needs of older people in the community: issues for PCGs and PCTs

National policy (Department of Health, 1997, 2000) is directing care provision to being appropriate to meet people's needs; to be effective; evidence-based; efficient and economic. Primary care groups (PCGs) and trusts (PCTs) have been identified as being the organizations to deliver such care. Since the introduction of the NHS and Community Care Act 1990, certain issues have been highlighted as having implications for the provision of an 'ideal' service for older people on the community. These issues focus around three main areas: assessment of need; working in partnership and quality of service provision. This article discusses these issues and their implications for PCGs/PCTs in relation to supporting older people in the community.     

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.     

Specialist practice in community mental health nursing

Community mental health nurses (CMHNs) work in an increasingly complex health and social care environment. Over recent years, the evolving direction of general health service and specific mental health policy has directed CMHNs towards: the provision of clinically-effective interventions; a closer attention to meeting the needs of people experiencing severe and long-term mental health problems; the simultaneous provision of services to meet the needs of people experiencing a wide range of mental health problems presenting in primary care settings; greater collaboration with workers representing other disciplines and agencies; and the development of active partnerships with mental health service users. This paper explores the context within which CMHNs practise, and within which education programmes preparing specialist practitioners in community mental health nursing have been developed. One recently-validated specialist practice course for CMHNs is described in detail, with the intention of stimulating discussion and debate surrounding the practice of, and the educational preparation for, community mental health nursing.     

Linguistic sensitivity, indigenous peoples and the mental health system in Wales

This paper presents findings from a pilot research project to explore the significance and availability of mental health services in the medium of Welsh in Wales, UK. Based on small-scale research with Welsh-speaking mental health service users this article argues that being bilingual can be a significant factor in the complex biopsychosocial matrix that underpins mental health problems amongst Welsh speakers. It also argues that the destructive effects of linguistic oppression, and the difficulties of second language communication for mental health service users, are such that an appropriate health and social care response in Wales involves providing services in a user's preferred language. Service users' views about the current state of bilingual service provision in Wales are presented, which suggests that insufficient attention is being paid to the linguistic needs of Welsh speakers. Eight principles are proposed for mental health service policy and practice in Wales.     

Do information systems meet the needs of primary care trusts?

To function effectively, primary care trusts (PCTs) need information from a range of sources. The general practice clinical record is a key source of information for PCTs but has often proved to be of variable quality. PCTs have developed rapidly and now have responsibility for 75% of the healthcare budget. They have a range of information needs that must be met if they are to ensure that healthcare provision meets the needs of patients. Since the abolition of health authorities PCTs have full responsibility for developing practice systems as well as having a key role to play in developing information management and technology (IM&T) within local health economies. The paper describes the problems PCTs face in accessing information to support their core functions and the progress they have made in retrieving data to support service development. It also describes the progress and developments in information and information systems within general practice using data from the National Tracker Survey of Primary Care Groups and Trusts (PCG/Ts). The survey began in 1999 when PCGs were established and has tracked the progress of PCG/Ts over three years. This paper presents the findings from the third survey relating to the development of information to support the needs of PCG/Ts. The findings show that information available to PCG/Ts does not meet their needs in a range of key areas. Many PCG/Ts are collecting data to support the Coronary Heart Disease National Service Framework (CHD NSF) and monitoring some areas of service provision in general practice. The use of information management tools has risen significantly since the second survey and involvement in the Primary Care Information Services (PRIMIS) initiative has more than doubled. The paper concludes that although PCG/Ts and general practices have made substantial progress, there is a long way to go before information providers generate high-quality information to support the needs of PCTs.     

Severe mental illness registers

The concept of creating severe mental illness registers is not entirely new to mental health services, although it has not been applied to any great extent in primary care. This article describes the process of setting up severe mental illness registers, which were implemented by Heartlands primary care trust (PCT) and disseminated to other PCTs in Northamptonshire. Diagnostic criteria, the target population, maintaining the register and the physical health review are discussed.     

Balancing professional and team boundaries in mental health services: pursuing the holy grail in Somerset

The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge.     

Identifying and addressing sexual health in serious mental illness: Views of mental health staff working in two National Health Service organizations in England

People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is ‘neglected’; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care.     

Using administrative data to measure ambulatory mental health service provision in primary care

OBJECTIVE: We sought to determine the accuracy of administrative data for identifying mental health service provision in primary care. STUDY DESIGN: This was a chart abstraction study measuring agreement between billing data and clinical data on the binary variable "mental health visit." Data were collected from the charts and billing records of 5 academic family practice clinics in Toronto, Ontario (1999 to 2000). Billing claims (n = 952) were selected from the billings for all visits by a stratified random sampling technique. A blinded data abstractor reviewed the clinical charts and assigned diagnostic codes for each patient visit associated with the selected claims. Any visit with at least 1 abstracted mental health diagnostic code was defined as a mental health visit. The test characteristics of 4 administrative measures of mental health service provision, based on different combinations of billing codes, were calculated. RESULTS: The accuracy of the administrative data was 86.8% when compared with clinical data. The sensitivity of the 4 administrative measures ranged from 22.3% to 80.7%. The specificity ranged from 97.0% to 99.5%. CONCLUSIONS: This is the first study to establish the performance of administrative data in measuring mental health service provision in a primary care setting. In our setting, broadly defined administrative measures of mental health have excellent specificity and adequate sensitivity for exploring and understanding mental health service utilization.     

Balancing professional and team boundaries in mental health services: pursuing the holy grail in Somerset

The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge.     

Factors influencing cardiometabolic monitoring practices in an adult community mental health service

People with serious mental illness are reported to live up to 25 years less than the general population. Cardiovascular disease and diabetes risk factors, as well as mental health, treatment, lifestyle, service provision, and socioeconomic factors, all contribute to this health inequity. Cardiometabolic monitoring (CMM) is one strategy used to attend to some cardiometabolic risk factors. The present study aimed to explore factors that influence decisions to undertake CMM in an Australian adult community mental health service. A CMM audit tool was designed to capture demographic, clinical, and care‐provision factors. A 6‐month retrospective file audit from the total population of consumers of an adult community mental health service was undertaken, where no existing CMM guidelines or practices were in place. The study findings confirmed a higher prevalence of cardiometabolic disorders in the study population compared to the general population. Complete CMM occurred in 24% of the study population (n = 94). No consumer demographic, socioeconomic, or clinical characteristics, or care‐provision factors, were found to be predictors of complete CMM. The random manner in which CMM was observed to occur in the study highlights the need for standardized CMM guidelines and capacity‐building strategies to improve current CMM practices.     

The training needs of primary care nurses in relation to mental health

Nurses working in primary care are in the front line of providing mental health services. The National Service Framework for Mental Health sets out new standards in service provision, yet this key group of staff is, in many cases, not fully equipped with the necessary skills and knowledge to comply. Michael Nash has conducted a training needs analysis of primary care nurses in a London borough. The results highlight areas of concern and indicate a way forward to ensure appropriate mental health care training for these professionals.     

Recovery and mental health: a review of the British literature

Recovery is not a new concept within mental health, although in recent times, it has come to the forefront of the policy agenda. However, there is no universal definition of recovery, and it is a contested concept. The aim of this study was to examine the British literature relating to recovery in mental health. Three contributing groups are identified: service users, health care providers and policy makers. A review of the literature was conducted by accessing all relevant published texts. A search was conducted using these terms: 'recovery', 'schizophrenia', 'psychosis', 'mental illness' and 'mental health'. Over 170 papers were reviewed. A thematic analysis was conducted. Six main themes emerged, which were examined from the perspective of the stakeholder groups. The dominant themes were identity, the service provision agenda, the social domain, power and control, hope and optimism, risk and responsibility. Consensus was found around the belief that good quality care should be made available to service users to promote recovery both as inpatient or in the community. However, the manner in which recovery was defined and delivered differed between the groups.     

Online information on primary care services for refugees and asylum-seekers

Government initiatives concerning equitable services and information provision aim to provide for the whole community. This includes those recently arrived in England as refugees. This study evaluated the information provided online by 16 London primary care trusts (PCTs) on activities under way to meet the needs of the local refugee population and the extent to which government initiatives are being met. Information published on websites of PCTs with a refugee population estimated to be over 2.5% of the London total refugee population was surveyed using a 13-item framework based on guidelines for health professionals working in refugee health (Burnett and Fassil, 2002). The findings show a disparity between different types of information provided and variations in the overall standards achieved by individual PCTs, indicating a need for considerable work if the requirements of the public and government for access to high quality information about services are to be met. The majority of PCTs, however, provide good information regarding coordination of services and evidence of a thorough health needs assessment. The findings are relevant to health professionals working with refugees and to PCT employees involved in publishing information on the internet.