Positive risk-taking to end long-term stays
By Chris Hampson

The easiest way to minimise risk-taking when working with the most vulnerable client groups, such as people with dual personality disorders, paedophiles and people with severe mental health problems, is to institutionalise them.

We can control their medication, their freedom and their lives, but it is not a long-term solution.
If the pressure of day-to-day work can make risk-review meetings seem to be a low priority, failing to address risk can have serious repercussions. Official enquiries into incidents inevitably seek to identify blame.

So it is not surprising that while those who participated in our recent research on the issue believed in positive risk-taking, many worried about the consequences of decisions.

Risk cannot be eliminated from supported housing schemes, but a clear understanding of risk control processes can promote safety.

We have recently opened one of six pilot projects which house and rehabilitate people with dual personality disorders who have been in a forensic unit - offenders who have not been imprisoned because of their mental ill-health. These are often some of the most politically unpopular client groups and new initiatives to house and provide services to them in the community can result in strong public reactions.

The pilots are a response to the Department of Health’s 2003 guidance, Personality Disorder: no longer a diagnosis of exclusion, and offer some of the few opportunities for people in this client group to live a ‘normal’, uninstitutionalised life.

Local research showed that we could more than fill the rooms with clients who fit the criteria. Yet when it came to receiving new referrals, over-caution from a range of professionals was the biggest barrier.

To rise to the challenge of moving people on from long-term stay in hospitals into the community, the health sector will have to embrace positive risk-taking and work closely with independent providers.

Find out more

Posititve Risk Taking: A good practice guide for supported horusing providers
Look Ahead, August, 2006

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28th September 2006
The role of non-NHS provdiers in mental health
By Emma Dent

A predictable part of modern NHS life is the furore that greets any announcement on the involvement of a private provider in NHS provision. Except, that is, in mental health.

Private companies and voluntary sector organisations are long-standing and widely accepted contributors to NHS mental health services. There are no firm numbers on what proportion of these are provided by non-statutory services, though some sources put it as high as 10 per cent.
Read the full article

Find out more

Department of Health document on role of voluntary sector in the NHS:
Making partnership work for patients, carers and service users: A strategic agreement between the Department of Health, the NHS and the voluntary and community sector
Department of Health, 2004

NHS Confederation report on independent sector:
Independent providers… making a difference
NHS Confederation, 2006

Information on the Mental Health Providers Forum can be found here


Mental health round up

Together guides on service user involvement:
A Good Practice Guide to valuing, respecting and supporting service-user activity for help
Together, 2006
Service-users Together: A Guide for Involvement
An order form for this guide

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7th September 2006
Smoking bans in mental health settings

Implementing smoke-free policy in healthcare settings is generally popular - but not always so in mental healthcare.

Up to a third of mental healthcare staff oppose a smoking ban in their workplace and the inclusion of psychiatric wards in any smoke-free legislation has been described as ‘unrealistic and unethical’ by some mental health organisations.

The government is considering the exemption of some mental health settings from future smoke-free legislation under proposals opened to consultation in July.

Arguments for exempting mental health units from smoke-free policy often make reference to human rights and the fact that many patients are resident in hospital for extended periods and often against their will. But is there a right not to consume tobacco smoke for those sectioned in a mental health unit or working there?

It has been argued that smoking occupies a unique place in the culture of psychiatric care. In mental health settings, smoking rates are high among patients and staff. Smoking rooms are frequently the social hub of a mental health unit and smoking is often a major source of structure and activity to the patients’ day. Studies have reported that mental health staff may often use cigarettes to appease or engage patients.

Surveys of mental health staff suggest resistance to smoke-free policy may, to some extent, reflect the fear that smoking is a stabilising factor and cigarettes keep patients calm. However, reviews of research carried out on the effects of smoking bans have demonstrated that staff tend to predict more adverse effects than actually occur and that they develop a much more positive view after the ban is in place. Smoking bans have rarely been found to lead to increased aggression and adverse incidents and have a positive effect on ward functioning in many cases.

The effect of any policy will, of course, depend largely on how it is implemented. Is it simply ‘handed down’ from the trust board after a cursory ‘consultation’? Or is the policy framed within the context of a wider initiative of health promotion that encourages staff and patient ownership and facilitates new skills and approaches to care?

There is evidence that the latter would be welcomed and that staff often see bans as an opportunity to learn new clinical skills and offer more support in smoking cessation.

Smoking is part of the culture in mental healthcare and its removal inevitably threatens long-standing rites and traditions that are perceived to maintain stability. In this way, the mental healthcare system is as addicted to cigarettes as any individual patient. And quitting is never easy.

Andrew Hayes is tobacco policy manager for London regional public health group. Professor Salman Rawaf is director of public health at Wandsworth teaching primary care trust. Lisa McNally is health psychologist at Wandsworth tPCT.

Find out more

Click here to read the full article, with references and contact details

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31st August 2006
A picture of progress
By Emma Dent

The history of payment by results style funding systems in mental health is neither straightforward nor successful - at least not yet.

When PbR was introduced in the acute sector, the Department of Health said repeating the exercise in mental health would take longer. To begin with it excluded the entire sector from the system.
Read the full article


Find out more

Department of Health factsheets on payment by results in mental health (July 2006)

Department of Health factsheets on payment by results in mental health (November 2005)

South West Yorkshire Mental Health trust document on integrated packages approach to care (July 2006)

South West Yorkshire Mental Health trust document on Kirklees project that developed integrated packages approach to care (May 2005)

The case for OBR in mental health by former HSCIC head of case mix delivery and a trust finance director (September 2005)

Health and Social Care Information Centre press release on some of the earliest work carried out on developing PBR in mental health (2004)

Audit Commission report on managing finances in mental health (June 2006)

Sainsbury Centre for Mental Health report on mental health finance (July 2006)

Guide to Royal College of Psychiatrists’ rating scale, the health of the nation scores (HONOS) (2006)

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31st August 2006
Mental Health Round-Up

Cognitive capacity shortfall
A national survey of cognitive behaviour therapy in specialist child and adolescent mental health services by Bath University has found that there is a lack of capacity in such services to meet National Institute for Health and Clinical Excellence requirements.

NICE guidelines recommend cognitive behaviour therapy for a range of common child and adolescent mental health disorders. One in five CAMHS specialists who responded to the survey reported CBT to be their dominant therapeutic approach while 40 per cent rarely used CBT.

Specialist training had been undertaken by 21 per cent of respondents, with over two-thirds identifying the need to be trained in the core skills of CBT.

The survey concludes there is a need to develop CBT training and supervision infrastructures in CAMHS and for it to be delivered by skilled professionals. Although specialist CAMHS practitioners are likely to have CBT skills as part of their professional training, the extent to which this has equipped them to undertake CBT was variable.

Full-length version of research on cognitive behavioural therapy coverage in child and adolescent mental health services
B by Stallard et al, Bath University, 2006


Tees trust launches ‘walk and talk’
Tees, Esk and Wear trust has launched a ‘walk in and talk service’ in Redcar for people aged 18 or over who feel stressed, worried or unable to cope but do not feel they need a doctor.

A nurse will be available to talk in a private setting in three venues. Each venue will host one session a month.


New chair for Mental Health Alliance
Sainsbury Centre for Mental Health director of public affairs Andy Bell has taken over as chair of the pressure group Mental Health Alliance from Paul Farmer. The new role of vice chair has also been created and will be held by Rowena Daw, head of policy at mental health charity Mind.
Information on the Mental Health Alliance


Psychiatrists cash in on debt booklet
A booklet by the Royal College of Psychiatrists on helping mental health clients with their debt problems has been so popular with mental health professionals that it is no longer available for free but is available for bulk purchasing. The booklet, Final Demand: debt and mental health was originally produced in January.
Information on how to order the Royal College of Psychiatrists’ booklet Final Demand: Debt and Mental health

HSJ is holding a conference on 28 September on the challenges of delivering community mental health services. For more information visit www.hsj-communitymentalhealth.co.uk

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17th August 2006
Working Method
By Stuart Shepherd


Read the full article


Find out more

Vocational services for people with severe mental health problems: Commissioning Guidance
National Social Inclusion Programme, National Institute for Mental Health in England and Care Services Improvement Partership, February 2006

MH Vocational Services Commissioning Guidance PDF

Leading by Example: making the NHS an exemplar employer of people with mental health problems
Sainsbury Centre for Mental Health, in association with the Disability Rights Commission, July 2006

Leading by example PDF

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3rd August 2006
Walk the talk
By Emma Dent

Health improvements that pay for themselves are surely the holy grail for any government exchequer. That was the enticing prospect laid out in June’s Depression Report from the London School of Economics’ mental health policy group. It argued that expanding therapy services will not place an extra burden on health service funding because the cost of psychotherapy treatment would be covered by savings in incapacity benefit and lost tax receipts when the patient is able to return to work.
Read the full article


More Information

Choosing talking therapies, Department of Health
November 2001

Treatment choice in psychological therapies and counselling
Department of Health, February 2001

Organising and delivering psychological therapies
Department of Health, July 2004

NICE guidelines on treatment of anxiety
December 2004

NICE guidelines on treatment of depression
December 2004

Paper for Prime Minister’s strategy unit on the social problems caused by mental ill health
by Lord Professor Richard Layard, January 2005

Sainsbury Centre for Mental Health lecture by Lord Professor Richard Layard
September 2005

Lord Professor Richard Layard on the case for psychological treatment centres
February 2006

Department of Health press release on talking therapies pilots
May 2006

Report from the London School of Economics on depression
June 2006

Berkshire Healthcare trust booklet on improving access to psychological therapies

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3rd August 2006
Mental Health Round-Up - NHS told to lead by example when hiring

The NHS should lead by example in recruiting people with mental health problems, according to a guide by the Sainsbury Centre for Mental Health.

Leading by Example, produced in association with the Disability Rights Commission, shows how trusts can support people with mental health problems to obtain and keep jobs at all levels.

It also offers guidance on how employers can support the mental well-being of all staff, reducing both absences and the likelihood of people who become unwell having to leave.

The guide is based on the work of a mental health and a primary care trust that have pioneered these approaches.

SCMH guide co-author Patience Seebohm says a positive employer approach makes a huge difference to people’s lives. ‘It takes grit and perseverance to achieve the kind of changes the people who contributed to the guide have made to their organisations. But it can be done.’

More choice wanted, more facts needed
Another report by the Sainsbury Centre, Choice in Mental Health Care, has found that users would like more opportunities to choose between different treatment, care and support options. They would like to be involved in care planning, have the option of direct payments and be consulted on changes to local services.

It found that some users get more choices than others and that most do not get enough information to make informed choices.

The report is a summary of research carried out by SCMH and the King’s Fund, commissioned by the Department of Health.

Schizophrenia challenge
An educational campaign has been launched to challenge low expectations of people with schizophrenia.
Part of the ‘1 in 100’ campaign, The Picture’s Looking Brighter aims to promote a positive view of schizophrenia and provide information for service users, their friends and families.

Lynne Jones, Labour MP for Birmingham Selly Oak, who hosted the launch of the publication, said it was important service users could make informed decisions on managing their condition.

‘Schizophrenia is a chronic, long-term condition that, if not treated appropriately, can be devastating for both individuals with the condition and their friends and family.’
www.oneinonehundred.co.uk

HSJ is holding a conference on 28 September about the challenges of delivering community mental health services. For more information visit www.hsj-communitymentalhealth.co.uk


More Information

The NHS should lead by example in recruiting people with mental health problems, according to a guide on employing people with mental health problems by the Sainsbury Centre for Mental Health.
To see the guide click here

A report by SCMH has found service users would like more opportunities to choose between different treatment, care and support options. They would like to be involved in care planning, have the option of direct payments and be consulted on changes to local services.
To see the report click here

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29th June 2006
Ten points for a big difference
By Jackie Ardley

When the NHS Modernisation Agency published the 10 high-impact changes for service improvement and delivery in September 2004, mental health leaders were keen to test the relevance of these changes in practice and to adapt them to improve mental health services.

But while there was a guide for primary care trusts and a guide for clinicians, there was no guide for mental health.
Read the full article

More information

The 10 high impact changes for mental health services can be downloaded here or email queries to info@csip.org.uk

Care Services Improvement Partnership

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22nd June 2006
The safer sex
By Emma Dent

When Avon and Wiltshire Mental Health Partnership trust opened a new, purpose-built secure unit, Fromeside, in Bristol late last year, for the first time in almost 20 years it was about to be able to offer a women’s medium secure service.

It reflected a growing trend in mental health services to provide such care in house, after decades of often having to rely on the private sector for its provision.
Read the full article

More information

Secure Futures for Women
chaired by Dame Rennie Fitchie for the Department of Health, 1999

Women’s Mental Health: Into the Mainstream
Department of Health, 2002

Mainstreaming gender and women's mental health: implementation guidance
Department of Health, 2003

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23rd March 2006
Body of Evidence

Even the most casual watcher of trends in health will have noted that we are increasingly exhorted to think of ourselves as a whole. What you put in your body is likely to affect your mind, and a stressed mind is likely to tell on your physical health.
Read the full article

More information

Disability Rights Commission
Health inequalities experienced by people with schizophrenia and manic depression
April 2005

Disability Rights Commission
Interim report on investigation into health inequalities
October 2005

Sainsbury Centre for Mental Health
The Future of Mental Health: A Vision for 2015

Rethink leaflet on helping service users get more from their GP
August 2005

Sustain hospital food project
November 2005

For further information on the Well Being Support Programme please contact
wellbeing@lilly.com

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2nd March 2006
Mental Health Round-Up

Institute of Health Sciences publicaltion on primary care mental health

Care Improvement Service Partnership - Women at Risk
Guidelines and recommendations on the mental health of women in contact with the criminal justice system

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26th January 2006
Asylum seekers

Acute mental health facilities still suffer from inefficiency and isolation. But a new shift towards integrated service is starting to change things for the better. Mark Gould reports.
Read the full article

More information

National mental health director Professor Louis Appleby will be among the speakers at HSJ’s Mental Health: delivering the NHS modernisation agenda conference in Leeds on 1 March.

Policy implementation guide on acute inpatient care
Department of Health, April 2002

The search for acute solutions: a project to improve and evaluate acute mental health inpatient care
Sainsbury Centre for Mental Health, September 2003

Enhancing the environment at Ladywell
South London and Maudsley trust and King’s Fund project team, November 2002

West Park Hospital, Darlington