bluuebunny/crossref_metadata_2025_split huggingface dataset:
Crisis and emergency services
Authors: Johnson Sonia , Totman Jonathan , Hobbs Lorna 
Published: April 2012

Abstract
Our primary focus in this chapter is people with significant mental illnesses who are experiencing an exacerbation of their mental health or social problems of such severity that they reach the threshold for inpatient admission, or else seem likely very soon to reach this threshold unless pre-emptive action is taken. This is a relatively restrictive definition, excluding, for example, many crisis intervention services that have aimed to optimize the psychological adjustment of people experiencing difficult transitions in their lives. However, a focus on acute care at the threshold of admission is readily justified in economic, pragmatic, and policy terms. From the perspective of service users and carers, easy and prompt access to helpful and acceptable crisis services to help them at the times when they are most distressed is consistently rated as very important, with avoiding inpatient admission whenever possible also often identified as an important priority (Rose, 2001). From an economic and policy point of view, acute care, especially in hospital, consumes a large share of the mental health budget in most countries (Holloway and Sederer, Chapter 19, this volume), making it very desirable that optimal outcomes are achieved as efficiently as possible.
Given these major reasons for regarding acute care as a priority, the evidence base is surprisingly weak. For example, none of the 2009 recommendations of the Schizophrenia Patient Outcomes
Research Team (PORT) (Dixon et al., 2010) related to models of acute care delivery, and the National Institute of Health and Clinical Excellence (NICE) guidelines on schizophrenia and bipolar disorder make in relation to acute care only the general recommendations that crisis resolution and home treatment teams should be available. Despite this lack of robust evidence, mental health crises and, in particular, models aimed at diverting people from hospital admission, have been the focus of considerable innovative service development in the past few decades. In this chapter we complement Holloway and Sederer’s discussion of inpatient care by reviewing four other main types of care: two aimed mostly at initial triage of people experiencing crises (stand-alone emergency services and emergency department services in the general hospital), one combining assessment and provision of a community alternative to acute admission (crisis resolution and home treatment teams), and one mainly aimed at providing an alternative (community residential crisis services).
Acute day care is also excluded from our discussion as it is covered elsewhere, but, as the final section suggests, it should also be seen as a potentially important element in integrated care pathways.
Case management and assertive community treatment
Authors: Killaspy Helen , Rosen Alan 
Published: April 2012

Abstract
Recent decades have seen the relocation of psychiatric care from hospital-based settings to community-based services. The initial phases of deinstitutionalization led to a replication of the general hospital outpatient clinic model for review of community patients by psychiatrists, but gradually services began to expand the support available to people with more severe mental health problems. Over time, the addition of nurses, psychologists, occupational therapists, and social workers led to the establishment of community mental health teams. As community health and social care provision expanded, it became an increasingly complex system to navigate. Case management was developed to address this by assigning individual staff to assess service users’ needs and coordinate their treatment and care. Contemporary mental health services use a variety of models of case management of which assertive community treatment (ACT) is the most intensive and clearly defined form. This chapter explores these models of community mental health care, the evidence for them, and the possible explanations for the discrepancies in their effectiveness reported in the international literature.
Psychiatric outpatient clinics
Authors: Becker Thomas , Koesters Markus 
Published: April 2012

Abstract
Specialist psychiatric outpatient services have not, in recent years, been a priority of either the conceptual development or the study of community mental health care. General (or psychiatric) hospitals or community mental health team bases — at all of which outpatient clinics are held — can be considered community based as they are all located ‘in the community’. However, there may have been an implicit assumption that services should be considered community based only if conceptually they have moved away from hospitals or other institutions. Also, the outpatient clinic model, in its traditional form, has been ‘single-handed’. As such, outpatient clinics lack multidisciplinary input. A recent review of the community-based United Kingdom mental health care system, however, suggests that outpatient clinics are reported by more than two-thirds of so-called local implementation teams (Glover, 2007). There may also be a current trend towards specialized clinics for subgroups of patients, e.g. people with affective disorders, mentally disordered offenders, young adults, new mothers, patients with neuroses and eating disorders. Also, there may be a degree of under-reporting of outpatient clinics in surveys of local mental health services (Glover, 2007). Historically, these services have been a core element in the provision of psychiatric treatment, and it is likely that outpatient care continues to be a service element meeting important clinical needs in a large number of people with mental disorders.
Individual placement and support: the evidence-based practice of supported employment.
Authors: Becker Deborah R. , Bond Gary R. , Drake Robert E. 
Published: April 2012

Abstract
In most societies, employment is a major avenue to social inclusion (Grove et al., 2005). The benefits of working include increasing one’s financial resources, being productive and contributing to society, utilizing one’s skills and talents, enhancing self-esteem, improving self-image, meeting other people, and structuring one’s time. People with severe mental illness benefit from employment in these same ways. In addition, work enables many to recover from the disabling effects of mental illness.
Expectations for people with severe mental illness have changed drastically in the last two decades. Clients who once were relegated to day treatment 5 days a week are now working competitively.
The most successful employment practice to assist people develop a working life is a form of supported employment called individual placement and support (IPS). IPS has been standardized, tested, and implemented in several countries, especially the United States.
Inpatient treatment
Authors: Holloway Frank , Sederer Lloyd, I. 
Published: April 2012

Abstract
‘Inpatient care is, from the research perspective, the Cinderella of contemporary mental health services’ (Szmukler and Holloway, 2001). Research on the day-to-day practice of inpatient care remains a step-child of psychiatry and a policy vacuum on the role of inpatient treatment characterizes our field today. In the majority of advanced mental health economies large mental hospitals and institutional care has been vanquished by deinstitutionalization that has produced vast numbers of inpatient bed reductions.
Deinstitutionalization was driven by many forces: empirical evidence about the harmful effects of large institutions on patients (Wing and Brown, 1970); a general social movement that emphasized the ‘community’ as a positive resource for helping people (Hawks, 1975); scandals surrounding institutional care (Martin, 1984); cost containment (Kluiter, 1997); concerns about the importance of patients’ liberties and quality of life (Peele and Chodoff, 1999); and improvements in treatment technologies, which included medication, rehabilitation, assertive community treatment, psychological treatments, and crisis care (Ramsay and Holloway, 2007). A consensus developed amongst user groups, government and policy makers, service managers, and practitioners that inpatient treatment represented if not a failure then a barrier to an evolving paradigm of comprehensive community care. However, carers, clinicians in inpatient services, and community mental health staff who recognize the limits of community care however well it is done remain sceptical of such an antihospital proposition.
Residential care
Authors: Shepherd Geoff , Macpherson Rob 
Published: April 2012

Abstract
We all need somewhere to live where we feel safe and comfortable. Given this simple fact, it is unfortunate that for far too long, housing has been seen as at the periphery of the concerns of most mental health professionals, service providers, and researchers. While the importance of adequate housing may be recognized in principle, little research has been done to identify staffing and management practices associated with high quality care, or to improve outcomes. Meanwhile, people with severe mental health problems continue to live in substandard accommodation and struggle to gain access to decent and affordable housing (Kirby and Keon, 2006). This chapter explores these issues. We will describe the historical and policy background, review current issues, and bring together the available research to make practical, evidence-based suggestions for improving the quality of residential care. The context is the ‘mixed economy’ of care that now characterizes housing provision for people with mental health problems in the United Kingdom and in most of northern Europe, Australasia, and North America. This has grown up as we have moved away from long-term care in hospital. The ‘total institution’ has thus disappeared, but we now have many smaller ‘institutions’, with different management authorities, cultures, and values. How have we arrived at this point?
Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting
Authors: Shaywitz Jonathan , Marder Stephen 
Published: April 2012

Abstract
In the community setting, four of the most common mental health syndromes affecting individuals include anxiety, depression, psychosis, and bipolar disorder. While the disorders can be quite debilitating, fortunately recent advances in both behavioural therapy as well as pharmacotherapy have helped improve the lives of countless individuals. In this chapter we will focus our discussion on pharmacotherapy with an emphasis on providing practical information that will be particularly useful to the community psychiatrist in selecting the most optimal therapeutic agents for his/her patient. Specifically, we first briefly introduce each clinical syndrome, and the classes of medications used in treatment; then we go on to discuss in detail each disorder within the general syndrome with the current pharmacological treatments variable for each entity, including both their short term and long term efficacy and then discuss the current pharmacological treatments available for each entity, including both their short-term and long-term efficacy. The potential adverse (side) effects associated with each of these medications will also be discussed. Our goal is for this chapter to serve as a clinical tool box providing the reader with a practical and effective approach to these very common psychiatric disorders.
Ethical framework for community mental health
Authors: Rudnick Abraham , Forchuk Cheryl , Szmukler George 
Published: April 2012

Abstract
Community mental health services have been developing in the last few decades and in the process a number of ethical issues have arisen. Some of these deserve special attention as they are relatively distinct from ethical issues related to hospital mental health services. Application of established ethical approaches in the context of community mental health services may require revision of these approaches or alternatives to them. The aim of this chapter is to review key ethics concepts, to discuss ethical issues in community mental health services, and to provide a basis for an ethical framework for community mental health.
We will present definitions and central theories in ethics, an overview of bioethics, ethical issues related to community mental health services, addressing generic as well as distinctive problems. We will consider conservative and radical approaches (the latter partly based on community psychology research and practice), and challenges arising from an ethics of community mental health services (such as the view that social justice as in ‘social inclusion’ goes beyond fair resource allocation).
International human rights and community mental health
Authors: Lewis Oliver , Bartlett Peter 
Published: April 2012

Abstract
This chapter concerns human rights relating to people with mental health problems living in the community. It seeks to explain how international human rights law can work in a variety of ways to foster a person’s equal right to live in the community on an equal basis, with choices equal to others.
Each individual country may have legislation and policy to underpin community living. These may include social security payments and personal budgets to help people live independently, housing arrangements, provision of personal assistance and other supports, as well as non-discrimination provisions relating to vocational training and employment, and more widely to the provision of all goods and services. Such legislation and policy are essential in setting and regulating standards of human rights at the domestic level. These arrangements differ widely between countries, and for practical reasons a comparative analysis lies outside the scope of this chapter.
Instead, this chapter concerns the layers of international law and standards that sit above domestic law, directing and influencing domestic law and policy in order to bring about positive changes to the lived experiences of persons with mental health problems living in the community. The second section of the chapter (‘International human rights law’) is a primer on the treaties, how they are monitored, and how they apply to people with mental health problems living in the community. The third section (‘The dawn of a new era?’) introduces elements of the United Nations Convention on the Rights of Persons with Disabilities (hereinafter ‘CRPD’), and examines its philosophical underpinnings, the obligations on the State to implement it, and sets out its innovative features at the domestic level to coordinate policy action and to monitor implementation. It also outlines the Optional Protocol to the CRPD and the international mechanism established to monitor State compliance. The fourth section (‘Human rights underpinning community mental health’) explains some of the CRPD rights which impact upon community mental health, and the next three sections (‘Right to health’, ‘Right to live in the community’, and ‘Right to legal capacity’) provide an analysis of three of these rights in more depth. The conclusion in the final section suggests actions which community mental health practitioners could take in order to ensure that the State respects, protects, and fulfils the rights of people with mental health problems in the community.
Public knowledge and awareness about mental illnesses
Authors: Jorm Anthony F. 
Published: April 2012

Abstract
For major physical health problems, like cancer and cardiovascular disease, members of the public typically have considerable knowledge about what they can do for prevention or early intervention, or have knowledge of treatments and services available. For example, in the area of cardiovascular disease, there is widespread knowledge about modifiable risk factors like smoking and exercise, people know the value of screening and treatment for hypertension and high cholesterol, many people have the first aid skills to apply cardiopulmonary resuscitation in an emergency, and some would know the warning signs of a stroke and the need to call an ambulance immediately.
Knowledge about mental disorders in the community has generally lagged behind that for major physical diseases. This is surprising given the high prevalence of mental disorders. Community surveys in many countries show high rates, with 1-year prevalence rates of 10 % to 19 % and lifetime prevalence rates of 18 % to 36 % being typical (Kessler et al., 2009). This high prevalence means that the whole population will either be personally affected by a mental disorder or have close contact with other people who are. Given the high exposure to mental disorders in the population, it can be argued that everyone needs some knowledge and skill to take action to improve community mental health.
Using information and evidence to improve mental health policy
Authors: Funk Michelle , Morris Jodi , Saxena Shekhar 
Published: April 2012

Abstract
A mental health policy is the official statement of a government about what they will do to improve the mental health situation in that country. Together with a mental health plan, which details concrete actions to implement the policy, they represent essential tools to improve the way mental health problems are addressed in countries. When well formulated, they can coordinate, through a common vision and plan, all programmes, services, and actions related to mental health. Without this type of organization, mental health problems are likely to be dealt with in an inefficient and fragmented manner. Mental health policies assist to maximize the effectiveness of mental health programmes, to ensure that funds are spent wisely, and to improve coordination among service providers in the community (Funk et al., 2005).
The World Health Organization (WHO) has argued for developing national policies on mental health that are information and evidence based. Though the broad objectives of the policy may remain the same across countries, the starting points are likely to be different across countries (even within the same income category) so much so that background and contextual information become essential for the development of policy and plans.
Methods for evaluating community treatments
Authors: Tyrer Peter 
Published: April 2012

Abstract
New treatments are constantly being introduced to all forms of psychiatry and for most of these the setting in which the treatment is administered is not of special importance. Thus the introduction of a new and effective drug for a mental disorder will require similar testing in hospital, community, or other settings and does not require special description here. However, all treatments given in the community have a common problem associated with them, compliance, or what is now more appropriately termed ‘concordance’ or ‘adherence’ (Mullen, 1997). Because treatment in the community can rarely be supervised satisfactorily, a great deal depends on the motivation of individual patients to continue whatever intervention is being given without the need to be closely monitored. Increasingly, therefore, the evaluation of community treatment is going to involve, 1) some check on whether the treatment is being given appropriately and 2) if not, whether additional treatments are able to be introduced to improve concordance and adherence. New treatments to improve compliance have now been introduced for the major psychoses and shown to be effective (Kemp et al., 1996; 1998; Perry et al., 1999) and these approaches are likely to impinge increasingly on those working in the community and be amongst the areas of competence being evaluated for such workers.
The word ‘evaluation’ is now being used increasingly to describe any type of description of an intervention, and more and more it is being used inappropriately with regard to community treatments. The word ‘evaluate’ is a mathematical expression originally used to give a numerical value to something which previously had no such value. It is still used in this sense in related expressions such as ‘evaluable’, but increasingly it has been broadened in use to describe any form of assessment, whether or not it is quantified accurately.
Developing evidence-based mental health practices
Authors: Mueser Kim T. , Drake Robert E. 
Published: April 2012

Abstract
Evidence-based mental health practices (EPBs) are scientifically validated interventions that help people with mental illnesses to achieve improvements in meaningful areas of their lives. Developing and establishing an EBP requires attention to scientific detail, considerable time, and multiple steps. We have described the major steps as: 1) articulation of the problem area, 2) identification of possible treatments, 3) pilot testing the intervention, and 4) controlled evaluation of the intervention.
Implementing guidelines
Authors: Cheung Amy , Whitty Paula , Eccles Martin P. , Grimshaw Jeremy 
Published: April 2012

Abstract
According to the Institute of Medicine, ‘Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.’ (Institute of Medicine, 1990). Guidelines provide a synthesis of what is known about a specific disorder or set of disorders whether it is regarding screening, diagnosis, or management. Compared to systematic reviews, they provide a broad overview of the management of a disorder or of an intervention.
This chapter will describe how mental health professionals and organizations can follow the steps to implement guidelines to improve clinical care. Resources to assist in this process are also listed at the end of the chapter in the appendix.