Redesigning mental health services: lessons on user involvement from the Mental Health Collaborative

Objectives To explore the involvement of mental health service users in the redesign of in‐patient mental health services in six Trusts participating in a multi‐regional NHS modernization programme. Design Semi‐structured interviews and observation of team meetings undertaken as part of an action research study. Participants and setting Users, clinical, medical and managerial staff from six mental health trusts which participated in the Northern & Yorkshire and Trent regions’ Mental Health Collaborative (MHC). Results and conclusions Whilst there were some problems, user involvement was undoubtedly a strength of the MHC in comparison to other modernization programmes within the NHS we have studied. However, the particular challenges posed by the specific context of acute mental health services should not be overlooked. The initial approach taken in each of the sites was to simply invite a user or user representative to join the local project team. In the course of events, various changes were made to this initial mechanism for involving users in the ongoing work of the teams. These changes – and setbacks in some sites – make drawing firm conclusions as to the effectiveness of the various strategies employed problematic. However, our qualitative data suggest a number of broad lessons that will assist both those leading and participating in other redesign initiatives to maximize the benefits to be gained from service user involvement.     

Comparing patients' experience of mental health services in England: a five-Trust survey

The implementation of the Care Programme Approach (CPA) in English mental health services has been slow to proceed despite general support, both in England and in other countries, of its principles of good practice. This study set out to evaluate the implementation of the CPA directly from patients' experience using the "Your Treatment and Care" assessment tool. The results of a survey of 503 patients across five NHS Trusts in England showed that many patients did not have a copy of their care plan and had not been involved in the care planning procedure. Many reported shortcomings in their experience of their key worker and their psychiatrist. However, there was substantial variation in experience across services. "Your Treatment and Care" showed good internal reliability, was acceptable to users, and appeared to be able to access actual experiences better than a traditional "satisfaction" item. It appears to be very useful as a benchmarking tool and is now being used in services across the UK, the USA and Australia.     

Philosophy of public health: lessons from its history in England

In a modern industrialized society it was essential for humankind to be protected by a strong medical presence, to establish a uniform system for public health everywhere in that society, to make public health independent from the welfare system, and to harmonize the relationship between personal hygienic rules and local authority rules. The society in Japan has developed on the basis of those four philosophical principles of public health, and has enabled the people to have the longest life expectancy in the world. However, the public health system in this society is now in a critical situation resulting from the long life expectancy. How can we rebuild the role of public health in this country? A society with a long life expectancy has to face a wide variety of health conditions. However, the health insurance system in Japan does not generally provide any service for a patient without specific symptoms. Consequently, to help people become aware of their own health condition, comprehensive public services such as general health check-ups, screening for cancers, and health counselling have been established locally by all 3250 municipal authorities. In promoting those services, people must learn how to draw the boundary-line between 'public' and 'private' in affairs of health to understand the importance of 'hygienic rules based on counsels for personal self-government', as Simon suggested 100 years ago, and health professionals must develop a public health system which depends not only on regulatory laws but also on scientific findings, as Rumsey advocated 150 years ago.     

A review on mental health and psychiatric services in England]

Psychiatric care in Japan has received criticism not only within Japan but from other parts of the world. By contrast, the services for mentally ill in England is considered to be superior and is therefore presented briefly to benefit the development of better community psychiatric care in Japan. The history of psychiatric services in England is described briefly. After World War II, deinstitutionalization has been occurring and the in-patient rate per 100,000 population which was 354 in 1954 and has decreased to 120 in 1990. Despite a decrease in the in-patient rate, the admission rate per 100,000 population has been increasing gradually during this period. Deinstitutionalization process and the development of community care services are summarized. Among these are alternative services such as primary care, day care and residential services in the community which are considered to be important elements. Problems associated with deinstitutionalization process are also discussed. In developing community care services in Japan, lessons can be learned from the success and failures of England's attempt over the last 30-years to build a better, more community-based system.     

Emergency mental health: lessons learned from flight 3407

Emergency mental health (EMH), a field that is often not well represented when considering emergency preparedness, is nonetheless a vital component to any disaster response. Emergency mental health issues must be considered not only for victims of disasters and their families, friends, and coworkers but also for both on-scene and off-scene responders and members of the community who may have witnessed the disaster. This article describes the EMH preparation for and response to the crash of Continental Airlines flight 3407 in western New York on February 12, 2009, killing all 49 crew and passengers on board and 1 person on the ground. It describes aspects of the response that went as planned and highlights areas for improvement. The lessons learned from this EMH preparation and response can be used to inform future planning for disaster response.     

The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience

Many European mental health systems are undergoing change as community-centred care replaces large-scale institutions. We review empirical evidence from three countries (UK, Germany, Italy) that have made good progress with this rebalancing of care. We focus particularly on the economic consequences of deinstitutionalisation. A systematic literature review was conducted using a broad search strategy in accordance with established guidelines. We searched the International Bibliography of the Social Sciences, Health Management Information Consortium, British Nursing Index and PUBMED/Medline to 2008. The on-line search was supplemented by advice and assistance from contacts with government departments, European Commission, professional networks and known local experts. Community-based models of care are not inherently more costly than institutions, once account is taken of individuals' needs and the quality of care. New community-based care arrangements could be more expensive than long-stay hospital care but may still be seen as more cost-effective because, when properly set up and managed, they deliver better outcomes. Understanding the economic consequences of deinstitutionalisation is fundamental to success. Local stakeholders and budget controllers need to be aware of the underlying policy and operational plan. Joint planning and commissioning or devolving certain powers and responsibilities to care managers may aid development of effective and cost-effective care. People's needs, preferences and circumstances vary, and so their service requirements and support costs also vary, opening up the possibility for purposive targeting of services on needs to improve the ability of a care system to improve well-being from constrained resources. As the institutional/community balance shifts, strategic planning should also ensure that the new care arrangements address the specific contexts of different patient groups. Decision-makers have to plan a dynamic community-based system to match the needs of people moving from institutions, and must take the long view.     

Securing maternal health through comprehensive reproductive health services: lessons from Bangladesh

During the past decade, there has been a noticeable reduction of maternal mortality in Bangladesh, in part because of government policy and program initiatives. Of particular note is the comprehensive reproductive health strategy adopted in 1996 under the country's first Health and Population Sector Strategy and the 5-year Health and Population Sector Programme (1998-2003). The latter includes actions in most of the areas recommended in the World Health Organization's 2004 report, Reproductive Health Strategy to Accelerate Progress Towards the Attainment of International Development Goals and Targets. After assessing Bangladesh's achievements and challenges in the design and implementation of a maternal health strategy, I concluded that mobilizing and nurturing political will is the key to sustaining policy commitment to comprehensive reproductive health.     

"非典"给我国卫生事业的启示

20 0 3年“非典”的大流行和今年“非典”在北京、安徽的再度发生及在我们与之斗争的过程中所暴露出来的问题 ,应该引起每一个医疗卫生人员尤其是卫生事业管理人员的反思 ,我们应该从这些问题中汲取经验和教训 ,为保证在今后出现类似“SARS”这样突发性公共卫生事件时能从容面对 ,而不至于过度恐慌 ,更不能再有医护人员和研究人员感染和传播传染性疾病的现象发生。1　尽快建立公共卫生应急系统国家对疾病控制给予了高度的重视 ,于 2 0 0 2年初成立了中国疾病预防控制中心 ,它主要负责全国疾病预防控制、公共卫生管理、卫生政策研究、公共…     

Developing the public health practitioner workforce in England: lessons from theory and practice

FOCUS: The paper focuses on public health practitioners who collectively represent one of three key workforce groups identified by England's Chief Medical Officer as critical to the successful delivery of national public health policy priorities. QUESTION: We report on two areas of work which attempt to address the following two-part question: in developing the public health practitioner workforce in England, what is needed, and how do we do it? APPROACH: First, we describe a five-component conceptual framework for developing the public health workforce which is grounded in data derived from a national Open Space event hosted by the University of the West of England in March 2005. The five components are (i) strategic support and oversight; (ii) national technical and professional support; (iii) national career building; (iv) local organisational development, and (v) sub-regional skills development. Key elements of each component are described in the paper. Second, we describe in some detail a new multidisciplinary skills development programme which illustrates one of the framework components (sub-regional skills development). The programme, established in January 2005, is aimed at three key groups of public health practitioners: health visitors (specialist community public health nurse), school nurses and environmental health officers. Its main features and some initial evaluation findings are presented. CONCLUSIONS: To be effective, activities aimed at supporting the development of the public health practitioner workforce should, where possible, aim to be congruent with core public health principles of self-determination and collective responsibility. We also conclude that leadership and vision at a national level, combined with local implementation of evidence-based training programme such as the one described could help to achieve much greater and more rapid progress in skilling up the existing public health practitioner workforce than has been possible up to now. But we note that this requires sustained investment, robust sector-wide delivery frameworks, and a group of committed local public health champions.     

Reorganization of public health services and the lessons from the past

The paper addresses the issues related to the restructuring of health services at the present stage of society development, improvement of forms and methods of management. A historical background of new reforms is given. It is shown that not always the restructuring of the existing public health management system leads to positive results.     

Case management in mental health services:the role of community mental health support teams

The progressive reduction in the numbers of hospital places available for people with mental health problems has led to an increasing demand on community support services. One response has been the development within social services departments of community mental health support teams, which employ largely unqualified staff who offer support to people with longer term mental health needs. The paper examines to what extent the practice of one authority's support teams reflects an appropriate ‘case management’ style of service, as developed in the USA to address the needs of long-term community patients. Key features of this approach are identified, and used as the basis of analysis of the support teams' practice in relation to 214 cases. It is concluded that a ‘case management’ model can be appropriate for work involving unqualified staff, provided that the service structure as a whole enables access to other skills as appropriate. Two specific risks are identified: firstly that the service is developed because of cost rather than appropriateness; and secondly that the service can rapidly become silted up with increasing numbers of people who need service of indefinite duration.     

Informing the development of services supporting self-care for long term mental health conditions: A mixed method study of community based mental health initiatives in England

ABSTRACT: BACKGROUND: Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic approaches translate into the mental health context, and by indicating what is specific about supporting self-care for mental health. METHODS: A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for serious and enduring mental health conditions, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. RESULTS: Participants reported improvement in self-care outcomes (e.g. empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. CONCLUSIONS: Generic elements of support for self-care - e.g. peer support groups, personal planning - have value when translated into a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities - issues of control, enabling staff-service user relationships and shared decision making - rather than simply the provision of standardised service components. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.     

Developing mental health indicators in England

OBJECTIVES: This paper reports on the construction of a set of indicators for mental health and the publication of a report for England's Chief Medical Officer. The report was the seventh in a series of reports aimed at initiating public health action to improve health at a regional level in England. STUDY DESIGN: Observational study using routine data. METHODS: A set of over 80 indicators was constructed by an expert group. These indicators were then populated from routine datasets. Commentary was provided on each indicator in the report. RESULTS: A small team compiled this large set of indicators from routine data working in a public health observatory in one region of England. CONCLUSIONS: It is possible to produce a large array of indicators about mental health. The conclusion from examining these indicators is that there are many unexplained differences in mental health across the regions of England. Many of these indicators are closely linked to deprivation. Some indicators show a lack of difference across the country, and in many instances, service provision is inconsistent and does not always relate to need. In some cases, there was a worrying absence of data, e.g. data on ethnicity and the mental health of offenders.     

Who pays more for health services in middle-income countries: lessons from Mexico

An evaluative study with a cross-sectional design was carried out on healthcare cost indicators reported by the 2000 National Health Survey in Mexico, to determine which population group had higher health costs/expenditures in relation to family income. The results suggest that in middle-income countries such as Mexico, families with lower incomes tend to pay more for healthcare services.