Service Provision for Young People with Intellectual Disabilities and Additional Mental Health Needs: Service‐providers’ Perspectives

Background Very little is known about young people with intellectual disabilities who experience additional mental health problems. The perspective of service providers has been highlighted as one unresearched area. Method Semi‐structured interviews were completed with senior service providers. Aims: (1) to explore experiences of working with young people with intellectual disabilities and additional mental health problems and their families; (2) to examine views on services’ ability to meet the needs of this group. Results Service providers identified a gulf between current policy and the reality for this group, not least in terms of all agencies working in partnership. All agencies described instances when young people in this group fall through gaps between services. Interviewees identified a range of factors that promote good outcomes. Conclusions The results suggest that the focus of current policies to promote joint working needs to be broadened beyond health and social services to ensure much improved links with education providers and the voluntary sector if the needs of this group are to be met.     

Working together to safeguard children: challenges and changes for inter-agency co-ordination in child protection

The publication of Working Together to Safeguard Children (DoH, 1999b) and the new Assessment Framework for Children in Need (DoH, 1999) pose considerable challenges for inter-agency work in the child protection field. This paper explores the core themes and objectives of these two policy frameworks. A number of critical tensions within these policy documents are identified particuarly with regards to the definition of 'children in need' and the quality of inter-agency working outside the child protection system. The paper explores the challenges for the inter-agency community of making the shift to a more needs-led approach. A key theme in managing this change is the inter-relationship of three domains of partnership: partnerships with service users, partnerships between agencies/disciplines, and partnerships within agencies/disciplines. Using an adapted version of Howe's (1992) matrix of partnership, these inter-relationships are examined. It is argued that increasing the levels of co-ordination between agencies will only reap benefits if this is based on intra-agency clarity and commitment to child welfare work. The paper concludes by identifying eight implementation issues for Working Together to Safeguard Children.     

A city-wide approach to cross-boundary working with students with mental health needs

The aim of the research was to study a city-wide approach to meet the mental health needs of UK students involving a range of professional and non-professional support. The creation of a network for agencies and individuals concerned with the mental health of students in further and higher education offered an opportunity to examine issues of access to services, transitions between services and the need for inter-agency working. The attitudes and experiences of a range of professional and non-professional providers of support were explored using semi-structured interviews within a multiple case study methodological approach. Inter-agency working across professional and organisational boundaries was believed to offer the best means of enabling students with mental health needs to continue with their studies. However, issues of resources limitations, professional identities, work boundaries, role confusion, codes of ethics and confidentiality presented barriers to integrated support and inter-professional collaboration.     

Youth employment, mental health and substance misuse: a challenge to mental health services

Employment is the cornerstone of social inclusion, the means by which individuals play a full and active part in society and has a pivotal role in helping young people to negotiate the transitional period between the child and adulthood. Employment therefore should be seen as a right and given a higher priority by health and social care agencies. There are numerous difficulties preventing some young people from achieving full employment and these are compounded for young people with concurrent mental health and substance misuse problems (dual diagnosis). The coexistence of these two problems is on the increase and they are recognized as significant barriers to employment. Unemployment may lead to social alienation, criminal or other antisocial activity and a higher incidence of suicide. Consequently, there is a danger of young unemployed people slipping into a spiral of self-defeating, antisocial and risky behaviour. There is little evidence of health and social care agencies working in partnership with voluntary sector organizations to tackle the growing problem of dual diagnosis and youth unemployment, although there are obvious linkages between employment, psychological health, social inclusion and substance misuse. It is therefore worth exploring the issues surrounding work, mental health and substance misuse in young people if we are to generate new ways of thinking about and responding to the needs of this target group. This presents a challenge to mental health services, particularly nurses who face the impact of these issues in their day to day practice but often lack the preparation and support to adequately address them.     

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.     

Cases for change in mental health: partnership working in mental health services

This article examines our current state of knowledge about partnership working between health and social care in UK adult mental health services. Drawing on a narrative review of the literature commissioned by the National Institute for Mental Health, this paper focuses on 43 documents from the review which discuss partnership issues. After exploring the rationale for partnership working, potential barriers and possible ways forward, the paper identifies gaps in the existing literature and discusses the implications of the review for current health and social care policy.     

Essential concepts in developing community-university partnerships. CareLink: the Partners in Caring Model

University and community partnerships are being created to increase community-based educational experiences for nursing students and to assist agencies in facing ever-decreasing resources to pay for health services for clients. Many challenges often burden these partnerships, leading to a less than satisfying experience for all those involved. The Partners in Caring Model described in this article is one approach to forming a successful partnership, proven effective in meeting the educational needs of the University of Connecticut, School of Nursing students, while providing additional resources to the Visiting Nurse Association of Central Connecticut, Inc. Using Anderson and McFarlane's Community as Partner Model as the framework, the essential principles behind the development of this successful partnership are discussed. The Partners in Caring Model demonstrates that community-university partnerships can sustain themselves when the partners have a commitment to care for the population being served, and it is a shared responsibility between education and practice.     

The emergent role of the link worker: a study in collaboration

Partnership working is integral to New Labour's approach to modernising health and social care services for vulnerable groups such as children with complex needs. This paper draws on an initiative from Cornwall and the Isles of Scilly in which strategic and operational change have been promoted across the health and social care community in order to provide co-ordinated assessment and care for children with complex needs and their families. The introduction of link workers has been central, key contacts for families and professionals alike who are drawn from a wide range of backgrounds. The political imperative for partnership, combined with the commitment and commonality of purpose of front-line staff, has proved sufficient to facilitate inter-professional working without many of the enabling factors that are often regarded as important, such as co-location or parity of status. However, a number of organisational barriers to sustainability remain and the degree to which a strong operational lead can secure the necessary breadth of strategic resource allocation and support remains questionable.     

The emergent role of the link worker: a study in collaboration

Partnership working is integral to New Labour's approach to modernising health and social care services for vulnerable groups such as children with complex needs. This paper draws on an initiative from Cornwall and the Isles of Scilly in which strategic and operational change have been promoted across the health and social care community in order to provide co-ordinated assessment and care for children with complex needs and their families. The introduction of link workers has been central, key contacts for families and professionals alike who are drawn from a wide range of backgrounds. The political imperative for partnership, combined with the commitment and commonality of purpose of front-line staff, has proved sufficient to facilitate inter-professional working without many of the enabling factors that are often regarded as important, such as co-location or parity of status. However, a number of organisational barriers to sustainability remain and the degree to which a strong operational lead can secure the necessary breadth of strategic resource allocation and support remains questionable.     

Bridging the gap between the home and the hospital: a qualitative study of partnership working across housing,health and social care

ABSTRACT

Rising demand and financial challenges facing public services have increased the impetus for greater integration across housing, health and social care. To provide insight into the benefits and challenges of partnership, we interviewed 37 housing professionals and held a validation workshop with eight external agencies working within a new, integrated housing service in the United Kingdom. The strength of the initiative rests on the capacity of neighborhood officers to conduct home visits and refer tenants to support agencies. Yet this strength poses problems in partnership building because increased referrals threaten to overwhelm already stretched health services. Despite broadly supporting the initiative, officers expressed concern over losing specialist housing knowledge whilst filling in gaps for services. Tensions over professional role boundaries between officers and social workers, poor communication, lack of capacity in external agencies and difficulties in sharing information were identified as barriers to partnership. Whilst capacity issues were acknowledged, partner agencies welcomed the initiative and called for joint meetings and colocation of services. Lack of capacity of external agencies to respond to referrals threatens integrated housing and health initiatives. Greater interprofessional collaboration and further investment across the system is required to increase capacity and ensure referrals are translated into healthcare outcomes.     

Education needs for integrated care: a literature review

Aim. This paper reports a systematic review to identify the education needs of the workforce within primary care to promote the effective delivery of integrated health and social care services. Background. The need for different professionals to work more closely dominates global health policy. The drive to develop a workforce prepared for the future is crucial to the success of integrated services. However, some have argued that nurses are ill‐equipped to meet the challenges of integrated service provision. The ability to work interprofessionally is an important skill which needs to be developed to support integrated working. Methods. Structured searches were undertaken on organizational websites and the Caredata, CINAHL, Cochrane Library, MEDLINE, Sociofile databases between December 2002 and April 2004 to identify policy documents and primary research studies. The robustness of identified research studies were appraised using recognized appraisal tools. Findings. Six themes were identified which indicate essential elements needed for integrated care. The need for effective communication between professional groups within teams and an emphasis on role awareness are central to the success of integrated services. In addition, education about the importance of partnership working and the need for professionals to develop skills in relation to practice development and leadership through professional and personal development is needed to support integrated working. Conclusion. Education which embeds essential attributes to integrated working is needed to advance nursing practice for interprofessional working. Further research exploring this and its impact on integrated provision is essential to ensure that evidence‐based services are provided. The reinforcement of partnerships between higher education institutions and health and social care organizations should ensure that the workforce is educated to manage continuous change in service delivery. Innovative ways of teaching and learning which promote inter‐professional working need to be explored.     

An evaluation of community learning disability nurse teams in two London boroughs

One of the tasks for all the recently established local learning disability partnership boards is to review the role of specialist learning disability services by autumn 2003. This article presents a summary of a recent operational and strategic evaluation of community learning disability nurse teams working in two boroughs, managed by social services. Overall, local caseloads suggest that there are not enough nurses in the two boroughs. Furthermore, there is no spare capacity to address the Government's directive that specialist staff become health facilitators, and give more time to helping primary and secondary care develop the capacity of their services for people with learning disabilities (Department of Health, 2001). Locally, these findings challenge the partnership boards and social services to adequately resource specialist services, meet Government targets and address nationally acknowledged, disproportionately high, unmet health needs in the learning disability population.     

Implementing assertive community care for patients with schizophrenia. A case study of co-operation and collaboration between mental health care and social services

The aim of this study was to describe the personal experiences of collaboration and co-operation between staff from the community mental health and social services programmes in their daily work with schizophrenic patients. An additional aim was to generate the first step in a theory of how staff in the field of health care and social services manages to integrate their efforts on an individual and organizational level. The study group consisted of five members of a multidisciplinary team who had been working for 2 years with assertive outreach intensive clinical case management. Verbatim-transcribed thematic interviews were analysed according to the comparative method for grounded theory. The analysis was focused on quality of interpersonal interaction between practitioners, representing different professions in community-based mental health care, as well as the professional relationship to the patients/clients and their relatives. In the light of an individual and organizational perspective, different typologies of interpersonal interactions appeared. Three main variables were identified: collaborative relationship, co-operative partnership and professional-amateurism. Our findings on these qualitative differences in interpersonal relations should be taken into account in the continuing reorganization of the community health care services. This knowledge can also help in overcoming barriers between patients, professionals and organizations in the mental health services.     

The Matrix Model of dual diagnosis service delivery

The Matrix Model is essentially a strategy for managing dual diagnosis across a range of agencies. It is a way of implementing partnership working across services and commissioning structures. The Matrix Model was born out of hard experience at the coalface of dual diagnosis treatment at a tier four service in Bristol. A very common experience, which many may recognize, was that clients with complex mental health and addiction needs were being sent from 'pillar to post' in their treatment. Things needed to change. Here is a method of how things can change. Briefly, professionals in the drug/alcohol and mental health fields co-locate, working with clients in each other's workspaces. In doing this, they create nodes of integration. These nodes of integration link through parallel-working to create a matrix. Outcome and key recommendation is that professionals in the drug/alcohol and mental health fields co-locate in each other's agencies, adopting an assertive outreach approach to working with dual diagnosis/complex-needs clients.     

Improving serious mental illness through interprofessional education

Current health policies emphasize partnership between professional groups, between agencies and with users, to ensure more integrated health and social care services. However, a number of reasons have been consistently identified as inhibiting interprofessional working. Among the many factors identified are poor communication, conflicting power relations and role confusion, and these present immense challenges to those who wish to offer interprofessional education and training opportunities. East Gloucestershire NHS Trust worked in partnership with the University of Gloucestershire (formerly the Cheltenham and Gloucester College of Higher Education) to overcome these problems and deliver an important postqualifying interprofessional training for those working with people with serious mental illness - the Thorn-based 'Diploma in Integrated Approaches to Serious Mental Illness'. This collaborative initiative represents a good model by which practitioners of all disciplines can be trained to a high standard and meet the requirements of the National Service Framework for Mental Health. This paper describes the initiative and identifies the extent to which the course has, by mirroring the practice it is seeking to generate, 'pulled together' to ensure interprofessional, intersectoral and professional/user collaboration. The key challenges associated with interprofessional working (with people with serious mental illness and with others) and with course implementation and how these were met are discussed and further opportunities are identified.     

Professional Learning Partnerships: A Collaboration Between Education and Service

Escalating mental health care needs coupled with a decreasing nurse labor force demand a fundamental paradigm shift in undergraduate education and service partnerships among psychiatric-mental health nursing students and practicing nurses. The purpose of this two-group comparative study was to identify factors that contribute to a successful learning partnership between nursing students and practicing nurses engaged in a clinical specialty partnership program within an acute psychiatric-mental health setting. The convenience sample consisted of 51 partners: 33 undergraduate students and 18 practicing nurses. The Learning Partnership Survey was administered to all partners allowing comparison of ranking among factors important to the partner relationship. Contrary to previous research, student and nurse partners were more similar in their factor ranking in the present study. Statistically significant differences were noted in the ranking of 2 of the 15 factors that fostered successful learning partnerships. Implications for professional learning partnerships between nursing academia and service institutions are discussed.     

'Floating support': implications for interprofessional working

This article describes a floating support scheme, provided by a local housing association, which enables single vulnerable people to live independently in their own homes. The study aimed to explore the impact of the scheme from the perspectives of clients, floating support workers and representatives from health, social care and voluntary agencies. It was found that the majority of clients had long-term mental health problems and were supported by a range of professionals. Floating support was flexible in responding to individual needs. A number of themes of relevance to interprofessional working emerged from the data. These included: floating support as a community resource, links with other agencies and confidentiality, information sharing and risk management. Floating support workers worked closely with professionals from health, social care, voluntary and educational services. Although the scheme's contribution to client care was highly valued, a number of barriers to effective interagency working were evident. This study highlighted the need for discussion and presented a forum for developing an ongoing collaborative process to address the specific issues which emerged in focus group discussions.     

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.     

Child and Adolescent Mental Health Services in the UK: Nurse Consultants

TOPIC: Children's mental health services in the UK are transforming. Innovations in health, social welfare, education, and youth justice agencies have all got emotional literacy at their core. The changing face of children's services has called for partnerships and new ways of planning and delivering services in statutory and voluntary sectors. Alongside this, nursing is evolving and developing new ways to meet the challenges that modernization brings. Nurse consultants are children's champions who have a leading role in helping lead children's services into the 21st century. PURPOSE: The following article explores the role of nurse consultants in child and adolescent mental health services (CAMHS).