bluuebunny/crossref_metadata_2025_split huggingface dataset:
Service innovations: a mental health service for homeless children and families
Authors: Tischler Victoria , Cumella Stuart , Bellerby Tina , Vostanis Panos 
Published: September 2002

Aims and MethodDescription of the development of an outreach mental health service for homeless children and families, and presentation of referrals characteristics and management of 40 families.ResultsFamilies became homeless predominantly because of domestic and neighbourhood violence. They were usually referred to the team for assessment of parents and children, without specific mental health concerns. A range of mental health interventions was offered, as well as liaison with other agencies.Clinical ImplicationsThe development of such services requires coordination of different agencies working with children and their parents. Also, designated staff and resources, because of the potential conflict with generic services.
Distribution of case-load in community mental health teams
Authors: Tyrer Peter , Muderis Omar Al , Gulbrandsen David 
Published: September 2002

Aims and MethodAn audit project was carried out in a mental health trust in North-West London on two successive years to determine the average case-load size of defined severe mental illness for each professional discipline.ResultsThe average case-load for non-consultants varied from 16 (for occupational therapists) through to 98 patients (for senior house officers). Community psychiatric nurses had an average case-load of 21 and consultants had an estimated average case-load of between 185 and 317 patients. The proportion of patients with severe mental illness ranged from 49% to 67%.Clinical ImplicationsThe case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, therefore, need revision.
Problem severity in people using alternative therapies for anxiety difficulties
Authors: Graham Candida , Franses Abigail , Kenwright Mark , Marks Isaac 
Published: September 2002

Aims and MethodThe use of alternative therapies by people with mental health problems seems to be rising. Are the people who access alternative therapies those with mild or more severe problems? A postal survey was undertaken of enquirers responding to a teletext article on self-help psychotherapies for obsessive–compulsive disorder and agoraphobia. Respondents were asked to rate the severity and duration of their problem and the therapies and services they had used.ResultsOf 326 questionnaires sent out, 113 (35%) completed questionnaires were returned. Seventeen (15%) respondents had sought no help for their anxiety problems, 76 (67%) had been treated by their general practitioner (GP), 62 (55%) by a psychiatrist or psychologist and 48 (42%) had used alternative therapies. People who had sought help from their GP did not rate their problems significantly more severe than those who had not sought treatment. Those who had been treated by a psychiatrist or psychologist and those who had used alternative therapies rated their problem as being significantly more severe than those who had not sought help for it.Clinical ImplicationsIn this selected sample it was the more severe anxiety sufferers who had used alternative therapies.
Survey of staff perceptions of illicit drug use among patients in a medium secure unit
Authors: Dolan Mairead , Kirwan Helen 
Published: September 2002

Aims and MethodA survey of staff perceptions of illicit drug use among in-patients in a medium secure unit.ResultsSixty per cent of staff were aware of drug misuse on the unit. While 82% commented on the potential adverse effects of illicit substances on patient psychopathology, 45% were also concerned about the negative impact on the staff–patient relationships. Most (82%) staff cite personal enjoyment as the main reason for drug-taking behaviour and perceive drug use on the unit as a form of antisocial behaviour. Less than one-third of staff were clear about the unit's policy for dealing with in-patient drug use and few have had adequate training in the management of patients with dual diagnoses. Strategies for dealing with drug misuse appear to focus on security rather than therapeutic issues.Clinical ImplicationsServices need to provide adequate training for staff on the management of patients with comorbid substance misuse, introduce patient education programmes and develop and disseminate clear policies that emphasise both therapy and security.
Do trainees have adequate access to computers and computer software?
Authors: Kotak Anita , Butler Rob 
Published: September 2002

Aims and MethodTo find out whether trainees have access to computers and computer software; to estimate the demand for more access and training; and to see whether requests for more computer access over a 2-year period led to change. A questionnaire was sent to trainees in November 1997, and again 2 years later.ResultsOnly half of the senior house officers and three-quarters of specialist registrars said they had access to computers. For those with access, this tended to be for word processing and Medline. Only one-quarter had access to the internet. There was a strong demand for wider access and for more training. There was little change in the provision of computers and software over the 2-year period.ConclusionTo take advantage of developments in technology, psychiatrists need to have access to computers. This survey suggests that trainees are not being adequately prepared for the future.
The future (or not) of the medical member
Authors: Rooth Graham 
Published: September 2002

The present role of the medical member combines considerable common sense strengths with a particular legal weakness. It reflects a compromise between the need to inform the judicial process with an appropriate level of medical expertise, and the risk that information could be presented to the tribunal without being open to challenge by the patient.Concern over this perceived, but unresearched risk, is reflected in the Green Paper on the Reform of the Mental Health Act 1983 (Department of Health, 1999). Here the bold solution to a problem of uncertain significance is to remove the offending medical member.
Audit of in-patient prescription and administration records on acute psychogeriatric wards in a teaching hospital
Authors: Onalaja Oludemilade , Saffrey Ruth , Jones Elaine , Bentham Peter 
Published: September 2002

AIMS and MethodAn audit of in-patient prescription and administration records on acute psychogeriatric wards in a teaching hospital measured the extent of conformity to NHS trust drug policy and improvements following specific interventions. The audit also measured doctors' knowledge of the trust drug policy. Prescription cards of all patients present on the wards were re-audited after 12 months.ResultsThe audit identified important shortcomings in prescription writing, recording and policy awareness. A targeted series of interventions resulted in significant improvements in some of these areas.Clinical ImplicationsContinuous evaluation and feedback via audit can reduce omissions in prescription writing and recording.
Web guide: journals on-line
Authors: Hicks Trevor , Briscoe Martin 
Published: September 2002

Journals on-lineThe British Journal of Psychiatry (BJP), Psychiatric Bulletin and Advances in Psychiatric Treatment have been available at www.rcpsych.org since May 2000 (Fig. 1). During the initial free trial period all users of the internet had access to the full content of these journals on-line. This period ended on 31 January 2001. Access to full text is now limited to subscribers only; but access to electronic tables of contents (eTOCs), abstracts and the ability to search full text will continue to be available. Individuals or institutions who subscribe to BJP in print or are Members of the College are now able to activate an on-line subscription and select a username and password by entering a subscriber number. The eTOC service allows anyone who registers his or her e-mail address to be notified via e-mail when new content goes on-line. Users may choose to receive any or all of the following: notification that a new issue of BJP is on-line; a complete eTOC for new issues; and special announcements from the College.
Inviting a statistician to join an evidence-based journal club
Authors: Swift G. , Crotty F. , Moran M. , McDonough C. M. , Moran A. , Casey P. R. 
Published: September 2002

AIMS AND METHODIn response to frequent cancellations, we recently changed the format of our journal club. We invited a statistician to attend and each meeting focused specifically on critical appraisal and statistical analysis. Active learning principles were used where every participant critically appraised an aspect of the paper presented at each meeting. The aim of this paper was to evaluate the impact of the new format on attendance and satisfaction levels. Attendance and satisfaction levels were measured in the 3 months before and the 3 months after the new format was introduced.RESULTSAverage attendance increased from 10 to 15, with two psychologists and two trainees who did not work in the hospital starting to attend regularly. Satisfaction levels also increased significantly with respect to academic interest, enjoyment, usefulness and overall satisfaction.CONCLUSIONCombining statistical expertise with principles of active learning has led to increased satisfaction levels among participants in our journal club.
Reconciling the information needs of clinicians, managers and commissioners – a pilot project
Authors: Broadbent Matthew 
Published: September 2002

Aims and MethodClinicians are often required, by managers, to provide information that does not appear relevant to clinical practice. Rooted in compromise, an outcome-based information model that supports practice and also provides information for managers was developed. A 9–month pilot project at three sites in South-East London took place to test the feasibility of this model in real clinical settings.ResultsAccurate data were reliably collected. Clinicians at participating sites agreed the model produced potentially useful information and, on condition that support is provided, continue to collect data voluntarily.Clinical ImplicationsThis is not an exclusively clinical model. However, because it also fulfils management needs there is a better chance that clinicians will get the support they need.
Cognitive–behavioural therapy: a survey of the training, practice and views of Scottish consultant psychiatrists
Authors: Le Fevre Peter David , Goldbeck Rainer 
Published: September 2002

Aims and MethodA postal survey of all consultant psychiatrists employed by the NHS in Scotland was performed with the aim of determining the numbers and characteristics of consultant psychiatrists who have received training in cognitive–behavioural therapy (CBT). Additional aims were to ascertain the current practice of CBT, along with general attitudes towards practice and training issues.ResultsNine per cent of consultant psychiatrists had received formal training in CBT. An additional 20% had received informal tuition with supervision of cases. For consultants appointed within the previous five years, 48% had received the recommended amount of supervised experience. In practice, consultants were unable to devote significant amounts of time to formal CBT but were actively using CBT techniques and supported the availability of training opportunities.Clinical ImplicationsThe survey suggests that the current Royal College of Psychiatrists' guidelines do not appear to have been fully implemented for the area surveyed. Further debate is needed to ascertain the exact form that training in CBT should take.
The forgotten children: children admitted to a county asylum between 1854 and 1900
Authors: Gingell Kate 
Published: September 2002

Aims and MethodTo assess the part that the 19th century asylums played in the development of the discipline of child psychiatry. Admissions to the Worcester County Asylum between the years 1854 and 1900 were screened to identify children aged 16 and under. An item sheet was used to record details of the admission.ResultsOne-hundred and ninety-five children were admitted. Risk of suicide and dangerousness were routinely recorded, family history rarely. It was not possible to make retrospective diagnoses. The death rate was high and contact with the family was minimal post admission.Clinical ImplicationsChildren were treated exactly like the adult patients, and therefore asylums did not contribute significantly to the development of the discipline of child psychiatry.
Prescribing of unlicensed medicines or licensed medicines for unlicensed applications in child and adolescent psychiatry
Authors: Johnson Joanne , Clark Andrew F. 
Published: September 2002

Aims and MethodChild and adolescent mental health services in north-west England (n=21) participated in a prospective collection of information regarding all instances of new prescribing of medication over the 6–month period September 1999 to February 2000.ResultsA total of 478 new prescriptions were issued to 411 individuals. Eight prescriptions (2%) were for an unlicensed drug and a further 188 (39%) were of licensed drugs but used in a manner outside of their product licence.Clinical ImplicationsThis level of unlicensed and outside-licence prescribing is similar to levels previously found in studies both within paediatric practice and in adult mental health practice. Anxiety about excessive beyond-licence prescribing by child mental health services is unlikely to be justified.
Trainees' attitudes to single and dual training in old age psychiatry
Authors: Allen Ruth , Butler Rob 
Published: September 2002

AIMS AND METHODSTo undertake a nationwide survey to find out the attitudes of old age specialist registrars (SpRs) towards single and dual training. A questionnaire was sent to all old age SpRs in the UK.ResultsTwo-thirds of SpRs were undergoing dual training. Most trainees favoured a flexible system that offers the choice of single or dual accreditation. Many trainees had concerns about single accreditation. Schemes vary in whether they encourage one type of training or another.Clinical ImplicationsTraining schemes appear to vary unacceptably in their attitudes to training. There needs to be a more consistent approach nationally. Clearer guidance from the College may help.
The experience of patient suicide among trainees in psychiatry
Authors: Courtenay Kenneth P. , Stephens John P. 
Published: September 2002

Aims and MethodWe set out to ascertain how common this is for psychiatric trainees in South Thames and the effects it has, if any. An anonymous postal questionnaire was circulated to 400 trainees.ResultsOf the 400 trainees, 203 (51%) responded and 109 (54%) of the respondents had had one or more patient suicide and 168 suicides were reported.We judged the effect of the suicide on the doctor to be moderate or severe in 126 (75%) of the 168 suicide events.Clinical ImplicationsPatient suicide must have a higher profile in training. Formal systems need to be created to provide support and education in this area.
A national survey of the hospital services for the management of adult deliberate self-harm
Authors: Slinn Rebecca , King Amanda , Evans Jonathan 
Published: September 2002

Aims and MethodServices were compared for the management of deliberate self-harm with existing national guidance. A postal survey was sent to all clinical directors of adult psychiatry at all NHS trusts assessing adult patients admitted to general hospital following deliberate self-harm in England.ResultsResponses were received from 129 (65%) trusts.Thirty per cent of trusts do not use secondary psychiatric services for psycho-social assessment following deliberate self-harm; 52% have designated self-harm liaison staff and 69% of general hospitals have a ward to which most cases of deliberate selfharm are admitted. However, only 18% have staff with psychiatric experience. In 82% of trusts training is provided for junior psychiatrists at induction but in only 56% are observed-assessments undertaken. Forty-two per cent of the trusts have a deliberate self-harm services planning group.Clinical ImplicationsStandards for deliberate self-harm services fall substantially below existing national guidelines, particularly in the areas of planning and training.
Service innovations: Sherbrook partial hospitalisation unit
Authors: Wesson M. L. , Walmsley P. 
Published: September 2002

Aims and MethodNationally, a variety of community care projects are being developed to replace institution-based care. We describe an innovative system of providing mental health care in Southport, combining an extended day service with short-term hospital admission – the partial hospitalisation philosophy.ResultsDuring the first year of operation 438 assessments took place with 27% of patients being admitted to a crisis bed and a further 25% supported via attendance at the unit.Twelve per cent needed in-patient admission and 10% were deemed not to require any involvement of the mental health service.Clinical ImplicationsThe use of short-stay admission coupled with extended day care and crisis line support can provide a viable alternative to admission to the acute ward.
Mental health day centres
Authors: Catty Jocelyn , Burns Tom 
Published: September 2002

Aims and MethodMental health day centres have been little researched. We carried out a 1-week census at the four day centres run by a London borough.ResultsThe centres catered for a g roup with long-standing mental health problems, mostly under community mental health team care. A surprising number were suffering from physical ill health. They attended the centres primarily for social reasons or to participate in creative groups such as music and art.Very few were concurrently attending day hospitals.Clinical ImplicationsFurther work is essential to understand the distinction between NHS day hospitals and Social Services day centres in terms of utilisation and client group.This client group's needs, particularly for physical health care, require urgent attention.
General practitioners and child and adolescent psychiatry: awareness and training of the new commissioners
Authors: Foreman D. M. 
Published: September 2002

Aims and MethodGeneral practitioners' (GPs’) informed awareness of the various medical specialities underpins their ability to manage and commission services for their patients. Three questions, relevant to GP practice, to test awareness of child and adolescent mental health services (CHMHS) were developed and sent to 238 GP principals in North Staffordshire. One hundred and seventy-six responded.ResultsForty-seven per cent had no undergraduate training in CAMHS and 93% had negligible postgraduate experience. Only 27% thought they saw CAMHS cases frequently. Sixty-four per cent usually referred those they saw. Relevant expertise made referral to CAMHS less likely, as did membership of the Royal College of General Practitioners. Seventythree per cent wanted more training, but only 7% thought training easy to obtain.Clinical ImplicationsThese findings confirm the need for child and adolescent psychiatrists to become directly involved in the commissioning of their services and GP training.
Effectiveness of audit in improving interview room safety
Authors: Osborn David P. J. , Tang Sylvia 
Published: September 2002

Aims and MethodsSafety features of rooms used for clinical interviews were assessed throughout our mental health unit. Following this pilot survey, 12 safety standards were agreed and adopted by a multi-disciplinary audit meeting. Recommendations were disseminated throughout the trust. Adherence to the accepted standards for interview room safety was assessed at 6 months and 1 year after baseline. Following each assessment, results were presented so that the audit cycle was completed twice.ResultsAt 6 months 46 interview rooms were assessed against the 12 accepted standards and many were found to be unsatisfactory. After presentation of these results, the 1 year assessment discovered few changes in safety features of the 50 rooms now being used.Clinical ImplicationsUnsafe rooms compromise the safety of staff and patients and this is clearly unacceptable. The audit process in itself failed as amethod of improving standards.
Crisis intervention: the professionals' perspective
Authors: Lazaro Fernando , Kulinskaya Elena , Tobiansky Robert 
Published: September 2002

Aims and MethodTo describe the attitudes of the professionals of a multi-disciplinary crisis intervention service (CIS) towards the service they provide. To establish whether there are differences in attitudes between the different professional disciplines involved. A questionnaire was mailed to all the professionals working in the Barnet CIS (n=94). Differences were analysed using the Kruskal–Wallis test.ResultsThe overall response rate was 84%. Statistically significant differences were found between the different disciplines in 10 of the 37 questions (27%) on the questionnaire. Opinions differed most on issues of safety and acceptance of clinical responsibility.Clinical ImplicationsDespite general ag reement on most issues, we found differences of opinion in important areas such as arrangements for team safety and clinical responsibility. These differences may create tensions within the multi-disciplinary groups and may influence the attitudes of professionals to crisis work. Measures need to be taken to address these issues in order to improve morale and staff satisfaction.
Deliberate self-harm
Authors: Whyte Sean , Blewett Andrew 
Published: September 2002

Aims and MethodA repetition after 5 years of a prospective case note audit, looking at the impact of a recently established deliberate self-harm (DSH) assessment team on the quality of DSH assessments at Kettering general hospital.ResultsAspecialist DSH team achieved improvement in the quality of psychiatric assessments for the majority of patients who harmed themselves. Assessments of mental state by accident and emergency (A & E) and medical staff before referral to the psychiatric team remain problematic.Clinical ImplicationsSetting up aspecialist team to assess patients who harm themselves can improve the quality of the psychiatric care they receive, but emphasis must still be placed on an adequate assessment of mental state by medical and nursing staff in A&E and on medical wards.
Informed consent to medication in long-term psychiatric in-patients
Authors: Billcliff N. , McCabe E. , Brown K. W. 
Published: September 2002

Aims and MethodsWe wished to ascertain to what extent patients had given informed consent to their medications. Therefore, 68 long-term psychiatric in-patients were interviewed about their knowledge and attitudes towards their medications.ResultsTwo-thirds of patients did not know the purpose of their medication; one-tenth knew about the side-effects. Longer length of stay, older age and voluntary status were associated with less knowledge. Despite poor knowledge, most patients accepted their treatment. However, few realised that they had any choice.Clinical ImplicationsThe prevalence of true informed consent is low among this group and raises issues about patients' rights.
The environment psychiatric patients create for themselves: the varying perceptions of professional staff
Authors: Gralton Ernest , Pearson Steve , Sutherland Alastair , Donovan Martin , Lewis Geraint 
Published: September 2002

Aims and MethodsA pilot study was undertaken to investigate whether there was evidence that professional staffs' perception of a patient's environment were significantly altered by certain variables.ResultsGender and, to a lesser extent, age were found to be variables that significantly affect the perception of a patient's personal environment.Clinical ImplicationsPsychiatrists and other mental health professionals should be aware that there may be significant differences between the way individual professionals perceive the same visual environment. Psychiatry may benefit from future links with environmental psychology research.