CBT in the British NHS: Vague imposition or imposition of vagueness?

CBT in the British NHS: Vague imposition or imposition of vagueness? European Journal of Psychotherapy & Counselling, Volume 11 Issue 3 September 2009 , pages 323 – 339

David Pilgrim – School of Social Work, University of Central Lancashire, Preston, PR1 2HE, UK

Abstract:

The multi-faceted controversy created by the ascendance of cognitive behaviour therapy (CBT) in the British mental health industry is outlined. The historical and philosophical nature of this controversy is traced, by looking at CBT as a psychiatric form of treatment and eclectic form of applied psychology. CBT has become a policy battleground, which can be understood by putting its modernist credentials and its appeal to rationalism, pragmatism and techno-centric optimism into a mixed pre-modern and post-modern context. Given that there are diverse representatives of these realms of belief alive today in our society, the current singular policy emphasis on CBT is anti-democratic and insensitive to diversity. The paradox of this restrictive policy is that CBT itself is now a very diverse set of practices held together mainly by a faith in evidence-based practice. Consequently, a version of pluralism is being tolerated on the supply side of mental health services but a full offer of true choice is not being made on the demand side.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

OT – Doing Daily Life: How Occupational Therapy Can Inform Psychiatric Rehabilitation Practice

Doing Daily Life: How Occupational Therapy Can Inform Psychiatric Rehabilitation Practice, Terry Krupa, Ellie Fossey, William A Anthony, Catana Brown, Deborah B Pitts Psychiatric Rehabilitation Journal. Winter 2009. Vol. 32, Iss. 3; pg. 155

Abstract:

TOPIC: This paper provides an overview of occupational therapy in the context of psychiatric rehabilitation and mental health recovery. PURPOSE: The paper delineates practical aspects of occupational therapy’s involvement in the mental health field with a discussion of occupation and the elements of conceptual models that guide the practice of occupational therapy. SOURCES USED: CINAHL, Psych Info, Medline. CONCLUSION: Occupational therapy is a key discipline in the field of psychiatric rehabilitation and brings to the field a strong theoretical and knowledge base along with unique procedures and practices. It is important for the psychiatric rehabilitation field to learn from all disciplines, including occupational therapy.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Mental health outcome measures in the age of recovery-based services

Mental health outcome measures in the age of recovery-based services, British Journal of Nursing (BJN)2009 Aug 13; 18(15): 940-43

Dickens G – Research Nurse and Honorary Lecturer, St Andrew GTs Academic Centre Research Team, Institute of Psychiatry Kings College London, UK

Abstract:

Patient based outcomes tools such as Health of the Nation Outcome Scales can help users and providers to assess whether mental health services promote wellbeing, and can also inform research and clinical audit. With some exceptions, however, completion rates of routine outcomes ratings are poor, and some argue that current tools are not sufficiently service user-oriented. Concurrently, the recovery model as an approach to mental health care, emphasizing concepts such as hope, meaning and sense of self, has come to prominence. The emerging model creates a need to measure whether recovery-led services deliver positive outcomes. To answer this, it is necessary to first ask whether current routine outcomes tools are suitable measures of recovery-related concepts. This article examines the current state of outcomes measurement in UK mental health services in the age of the recovery model and proposes that a twin-track approach is required.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Mental health nurses’ diabetes care skills – a training needs analysis

Mental health nurses’ diabetes care skills – a training needs analysis, British Journal of Nursing (BJN), 2009 May 28; 18(10): 626, 628-30

Nash M – Lecturer in Psychiatric Nursing, School of Nursing and Midwifery, Trinity College, Dublin

Abstract:

This article explores mental health nurses’ diabetes training needs. A survey of inpatient and community mental health nurses was undertaken using a 16-item self-reporting questionnaire. Two hundred and twenty questionnaires were sent out and 138 returned, providing a response rate of 63%. Analysis shows that mental health nurses are currently involved in a range of diabetes care activities, however, their knowledge and skills may not be up to date. Mental health nurses also report the growing impact of diabetes care on their workload. Areas of identified training needs include taking blood glucose readings, giving dietary advice, liaison with diabetes nurse specialists and weight management. Mental health services and education providers need toconsider developing specific training courses for mental health nurses.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

CCBT & Beating the Blues – The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study

The Acceptability of Computer-Aided Cognitive Behavioural Therapy: A Pragmatic Study , Cognitive Behaviour Therapy, 2009

Kate Cavanagh;  David Alan Shapiro;  Susan Van Den Berg;  Sharon Swain;  Michael Barkham; Judy Proudfoot

Department of Clinical Psychology, Newcastle University, Newcastle, UK
Abstract:

The clinical and cost-effectiveness of a computer-aided cognitive behavioural therapy (CCBT) programme, Beating the Blues, is indicated by a number of studies, but relatively little is known about its acceptability for patients with depression, anxiety, or both. This study investigated the acceptability of Beating the Blues offered on eight scheduled clinic visits with brief face-to-face support. Pre and posttreatment measures explored the relationship among programme acceptability, treatment continuation, and outcomes for people accessing the programme in routine care. Two hundred and nineteen patients with depression, anxiety, or both were offered Beating the Blues in 11 primary and secondary care practices. One hundred and ninety-one (87%) completed the pretreatment measures and 84 (38%) completed a treatment feedback questionnaire. Analysis of treatment acceptability for CCBT indicated a positive patient experience with the programme. Pretreatment expectancies predicted CCBT treatment completion but not outcomes. No differences were found between men and women on pretreatment measures. Posttreatment, women reported more favourable responses to the therapy, finding the programme more helpful and more satisfactory, than did men. No relationship between treatment acceptability and age was found. Study limitations, including research methods and attrition rates, and implications for future research are discussed. It is concluded that the Beating the Blues CCBT programme is an acceptable treatment for common mental health problems in routine care.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Reflective Practice in Action – Adopting the principles of Cognitive Therapy into their everyday interactions with service users

Work-based learning with staff in an acute care environment: a project review and evaluation, Mental Health Practice 2009 Jul; 12(10): 31-5

Kemp P; Rooks J; Mess L

Principal lecturer, London South Bank University

Abstract:

A team of nurses working in an acute setting took part in a project to enhance their clinical skills. They were able to reflect more deeply on their work and adopt the principles of cognitive therapy into their everyday interactions with service users. Participants felt that they acquired a wider range of therapeutic communication skills, which gave them more options in problem solving and in responding in clinical situations.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Banishing the Blues – CBT & Computer-based programme

Banishing the blues, Mental Health Practice, 2008 Oct; 12(2): 32-6

Bennett M; Harris N; Learmonth D; Rai S

Abstract:

Mary Bennett and colleagues explore users’ response to a computer-based CBT programme that can be used to treat mild and moderate depression, and make recommendations on ways to improve user experience and adherence.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

New Possibilities in Cognition Enhancement for Schizophrenia

New Possibilities in Cognition Enhancement for Schizophrenia,   Michael F Green. The American Journal of Psychiatry. 2009. Vol. 166, Iss. 7; p. 749 (4 pages)

Abstract:

Cognitive remediation for schizophrenia and other mental disorders can be divided into two distinctly different approaches. Cognition-enhancing approaches train subjects with laboratory tasks designed to improve specific abilities in various cognitive domains, such as perception, learning, or memory. In contrast, compensatory approaches attempt to bypass cognitive deficits and teach strategies to compensate for them by relying on aids or other processes (1,2). The article by Fisher et al. (3) in this issue of* the Journal represents a new development in the cognition-enhancing approach. They applied to schizophrenia a cognitive training program that was well grounded in a neuro scientific rationale. This and similar training studies will set higher expectations for results in functional benefits for patients. To put this study in perspective, it is useful to review the key findings, establish what new terrain was covered by it, and then focus on critical missing pieces of the cognitive training puzzle.

 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

CBT – The importance of choice in therapy: From the perspective of a, hopefully flexible, CBT practitioner

The importance of choice in therapy: From the perspective of a, hopefully flexible, CBT practitioner , European Journal of Psychotherapy & Counselling, Volume 11, Issue 3 September 2009 , pages 311 – 322

Windy Dryden – Goldsmiths University of London, London

Abstract:

The main purpose of this paper is to present a personal account of my therapeutic journey and to show how my practice of CBT is informed not only by orientation-specific variables (e.g. emphases on 1) attitude; 2) perpetuation of disturbance as opposed to its acquisition; 3) specificity; 4) the development of client self-help skills; and 5) homework), but by more general, trans-theoretical variables (e.g. rooting therapy in the bonds, views, goals and tasks domains of the working alliance and dealing effectively with threats to this alliance). In doing so, I hope to show that when practised well CBT draws upon general principles that span different therapeutic approaches as well as on ideas specific to CBT.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Solution-Focused Group Work: Collaborating with Clients Diagnosed with HIV/AIDS

Solution-Focused Group Work: Collaborating with Clients Diagnosed with HIV/AIDS , Journal of Family Psychotherapy, Volume 20, Issue 1 January 2009 , pages 13 – 27

Adam S. Froerer

Abstract:

This article looks at the current trends and challenges faced by persons diagnosed with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Given the lack of resources available to persons living with HIV/AIDS, a rationale for using solution-focused brief group therapy (SFBGT) is presented. The solution-focused approach builds on client resources to move them closer to their desired life despite having a life-threatening illness. SFBT is uniquely suited to facilitating positive outcomes with individuals living with HIV/AIDS. The overall aim of this article is to provide a theoretical explanation and justification of how SFBGT can effectively aid those diagnosed with HIV/AIDS to combat the obstacles they encounter. An example of a group format is also offered as a template for clinicians and practitioners.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Beck never lived in Birmingham – CBT

Beck never lived in Birmingham: why cognitive behaviour therapy (CBT) may be a less useful treatment for psychological distress than is often supposed,  Clinical Psychology, Issue 34, 2004

MOLONEY Paul and KELLY Paul

Abstract:

Begins with a brief discussion of the scope and nature of cognitive behaviour therapy as practiced within the National Health Service, and then critically examines the approach from three perspectives. Looks at psychological research that may case doubt on the approach, presents a critique of the therapy outcome research literature that bears upon the effectiveness of CBT, finally looks at epidemiological evidence which suggests that most of the distress witnessed by psychological therapists arises from pervasive social inequalities.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

NICE – Depression in adults (update)

Depression in adults (update)   NICE, October 2009

Depression: the treatment and management of depression in adults (update)

Click on the title above to access the full-text of this guidance

Abstract:

This guideline is published alongside ‘Depression in adults with a chronic physical health problem: treatment and management’ NICE clinical guideline 91, which makes recommendations on the identification, treatment and management of depression in adults aged 18 years and older who also have a chronic physical health problem.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

NICE – Depression with a chronic physical health problem

Depression with a chronic physical health problem: NICE guideline   NICE, October 2009

Click on the title above to access the full-text to the guidance

Abstract:

This guideline is published alongside ‘Depression: the treatment and management of depression in adults (update)’ (NICE clinical guideline 90), which makes recommendations on the identification, treatment and management of depression in adults aged 18 years and older, in primary and secondary care.

This guideline (and CG90) update recommendations made in NICE technology appraisal guidance 97 for the treatment of depression only. The guidance in TA97 remains unchanged for the use of CCBT in the treatment of panic and phobia and obsessive compulsive disorder

Lancashire Care staff can request the full-text of this guidance, email: susan.jennings@lancashirecare.nhs.uk

NICE – Promoting mental wellbeing at work

Promoting mental wellbeing at work     NICE,  November 2009

Click on the title above to access the full-text of this guidance

Abstract:

The guidance is for those who have a direct or indirect role in, and responsibility for, promoting mental wellbeing at work. This includes all employers and their representatives, irrespective of the size of the business or organisation and whether they are in the public, private, or voluntary sectors. It may also be of interest to professionals working in human resources or occupational health, employees, trade unions representatives and members of the public.

It focuses on interventions to promote mental wellbeing through productive and healthy working conditions.

Mental wellbeing at work is determined by the interaction between the working environment, the nature of the work and the individual.

The five recommendations cover: strategy, assessing opportunities for promoting mental wellbeing and managing risk, flexible working, the role of line managers, and supporting micro, small and medium-sized businesses. They include:

• Promoting a culture of participation, equality and fairness that is based on open communication and inclusion.
• Using frameworks such as Health and Safety Executive management standards for work-related stress to promote and protect employee mental wellbeing.
• Consider particular models of flexible working that recognise the distinct characteristics of micro, small and medium-sized businesses and organisations.

Lancashire Care staff can request the full-text of this guidance, email: susan.jennings@lancashirecare.nhs.uk

Developing MAPPA: Multi-Agency Public Protection Arrangements

Developing MAPPA: Multi-Agency Public Protection Arrangements, Criminal Justice Matters,  Vol.51 (1), 2003, 20 – 29

Tim Bryan; William Payne - Public Protection Unit, National Probation Directorate.
 

Abstract:

The multi-agency public protection arrangements represent a real step forward. The co-operation between the police and probation service has been outstanding in some cases. I have been very impressed by what I have seen.” Hilary Benn, Minister for Prisons and Probation. This endorsement of the multi-agency public protection arrangements (the MAPPA) highlights their significance which the modest public and professional profile they have assumed belies. The lack of general awareness about the MAPPA is indicated in the frequent, erroneous reference to them as the MAPPPs: the MAPPPs (the multi-agency public protection panels) are but one part (albeit, a key part) of the broader arrangements. This low profile is indicative of a lack of awareness generally about the criminal justice system, in which the public and the media have a largely reactive andsensationalist interest.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Multi-agency public protection panels for dangerous offenders: One London forensic team’s experience

Multi-agency public protection panels for dangerous offenders: One London forensic team’s experience, Journal of Forensic Psychiatry & Psychology, Vol.16 (2) 2005, 312 – 327

Susan Young;  Gisli H. Gudjonsson; Humphrey Needham-Bennett 

Abstract:

In this article the authors discuss the contribution of a forensic community team to a multi-agency public protection panel (MAPPP) held in a borough within the South London and Maudsley NHS Trust. The clinical service provision was audited over a 21-month period between October 2001 and July 2003. The purpose of the audit was to evaluate the clinical demand of MAPPP liaison and determine resource implications. This audit identified a number of important issues, which are discussed, including the crucial role and contribution of mental health teams, the additional burden on clinical teams, the absence of increased resources, the lack of protocols and guidelines, ambiguity about the ‘duty to co-operate’, poor integration of criminal justice system members’ views about risk with a forensic mental health perspective, and lack of co-operation of non-patient offenders with mental health teams. A challenging task that faces mental health teams is how to integrate forensic services effectively and ethically with the criminal justice system in such a manner that dangerous offenders can be managed with safety and dignity.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

MAPPA – NOMS – NPS – HMP Prisons

Multi-Agency Public Protection Arrangements  Ministry of Justice – National Offender Management Service

NOMS – National Offender Management Service

National Probabtion Service

HMP Prison Service

Click on the titles above to access the sites

Multi-Agency Public Protection Arrangements (MAPPA) support the assessment and management of the most serious sexual and violent offenders.

The aim of MAPPA is to ensure that a risk management plan drawn up for the most serious offenders benefits from the information, skills and resources provided by the individual agencies being co-ordinated through MAPPA.

MAPPA were introduced in 2001 and bring together the Police, Probation and Prison Services into what is known as the MAPPA Responsible Authority.

Other agencies are under a duty to co-operate with the Responsible Authority, including social care, health, housing and education services.

Each MAPPA area produces an annual report which details performance, statistics, future developments and MAPPA team contact details. 

Risk and Public Protection: Responding to Involuntary and ‘Taboo’ Risk

Risk and Public Protection: Responding to Involuntary and ‘Taboo’ Risk, Social Policy & Administration, Volume 42, Issue 6, Date: December 2008, Pages: 611-629

Hazel Kemshall, Jason Wood – Community and Criminal Justice Division, De Montfort University, Hawthorn Building, Leicester, LE1 9BH

Abstract:

Growing media, political and public concern with high-risk offenders in the community has focused policy attention on the concept of ‘public protection’. A notion that the public has the right to be protected, particularly from ‘monstrous’ offenders such as predatory paedophiles, has infiltrated much recent legislation and penal policy. This article will explore the critical factors in the ‘public protection’ trend and the framing of risk and risky offenders that has ensued. In particular, attention will be given to the new surveillance and intervention mechanisms under the Multi-Agency Public Protection Arrangements (MAPPA) and whether these arrangements manage risk or displace it. To what extent are they driven by the ‘precautionary principle’ and defensive responses to risks that are over-inflated? To what extent does this result in ‘perverse incentives’ to over-manage certain risks and to over-concentrate on restrictive risk management techniques such as electronic tagging, satellite surveillance and curfews rather than treatment? Does the system represent effective risk management or a system for dealing with risk anxiety – both of the public(s) and of politicians?

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Offender health and social care: a review of the evidence on inter-agency collaboration

Offender health and social care: a review of the evidence on inter-agency collaboration, Health & Social Care in the Community, Volume 17, Issue 6, Date: November 2009, Pages: 573-580

Iestyn Williams – Health Services Management Centre, University of Birmingham, Birmingham, UK

Abstract:

The involvement of health and social care agencies in crime reduction partnerships remains key to government strategy despite a growing awareness of the equivocal outcomes of inter-agency working in other settings. This paper reports findings from a literature review designed to assess the extent to which existing crime reduction partnerships have been able to overcome the barriers to joint working. The review focuses in particular on Drug (and Alcohol) Action Teams (D(A)ATs), Crime and Disorder Reduction Partnerships (CDRPs), Multi-Agency Public Protection-Arrangements (MAPPAs) and Youth Offending Teams (YOTs). A comprehensive review of published and unpublished literature suggests that these bodies have experienced similar difficulties to those highlighted in the broader partnership literature. The review further suggests that differences in ethical and professional outlook may be the most critical of these barriers as well as being the least explicitly addressed by recent government interventions. More work is required to build a consensus regarding the ethical underpinnings and fundamental objectives of partnerships across the care-control divide.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

MAPPA – In Cumbria

Multi-Agency Public Protection Arrangements Annual Reports 2008 – 2009  Cumbria

Click on the title above to gain direct full-text access to the report

Abstract:

The Cumbria Youth Offending Team is committed to their involvement with the MAPPA Strategic Management Board and has achieved a 100 per cent attendance record at relevant meetings. We continue to manage the risk that some of our clients present by undertaking an effective assessment to identify those risks. As a multi agency team, most of these risks can be managed by utilising the expertise of our Health Community Practice Nurses, police of education workers, probation of Offending Service staff. In addition, we chair the ‘Prevent and Deter’ meetings, where potential serious offenders of the future are identified agreed among partner agencies, to reduce their risks at an early age.

UK multi-agency teams that manage serious offenders in the community under Multi-Agency Public Protection Arrangement (MAPPA) are being seen as beacons of best practice in public protection by countries around the world.

Countries that have expressed an interest in learning more about MAPPA are America, Canada, South Korea, Jamaica, Norway and Latvia. In the last couple of years, both Scotland and Northern Ireland have introduced MAPPA following its success in England and Wales.

MAPPA teams in England and Wales were put in place eight years ago to provide more robust management systems for those offenders who live in our communities through the sharing of information and expertise. The teams, comprising police, prison, probation and other relevant agencies ensure joint working and enhanced communication to effectively manage risk to the public.

Lancashire Care staff can request the full-text of this report, email: susan.jennings@lancashirecare.nhs.uk

MAPPA Guidance & Statistics – 2009

MAPPA Guidance – 2009       National Probation Service

National Statistics 2008-09 -  Click the title to access the full-text

Click on then title above gain direct full-text access

Abstract:

This Guidance is issued by the Secretary of State under Section 325(8) Criminal Justice Act (2003). This Guidance is therefore statutory. All Responsible Authorities and “co-operating bodies”, being public bodies, have a duty imposed by public law to have regard to this Guidance in exercising their functions under the Multi-Agency Public Protection Arrangements (MAPPA).

 

If they choose to depart from the Guidance they will need to demonstrate, and record, good reasons for doing so.

MAPPA are the statutory arrangements for managing sexual and violent offenders. MAPPA is not a statutory body in itself but is a mechanism through which agencies can better discharge their statutory responsibilities and protect the public in a co-ordinated manner. Agencies at all times retain their full statutory responsibilities and obligations. The Responsible Authority (RA) consists of the Police, Prison and Probation Services. They are charged with the duty and responsibility to ensure that MAPPA is established in their area and for the assessment and management of risk of all identified MAPPA offenders.

The Purpose of MAPPA

The purpose of MAPPA is to help to reduce the re-offending behaviour of sexual and violent offenders in order to protect the public, including previous victims, from serious harm. It aims to do this by ensuring that all relevant agencies work together effectively to:

• Identify all relevant offenders;

• Complete comprehensive risk assessments that take advantage of coordinated information sharing across the agencies;

• Devise, implement and review robust Risk Management Plans; and focus the available resources in a way which best protects the public from serious harm. 

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

 

MAPPA – In Lancashire

Multi-Agency Public Protection Arrangements Annual Reports 2008 – 2009  Lancashire

Click on the title above to gain direct full-text access to the report

Abstract:

Keeping Lancashire safe is the top priority of all those who work within criminal justice in the county. Collectively, we are determined to protect people from potentially dangerous offenders who are being supervised in the community. These include those who commit the most serious sexual and violent crimes.

UK multi-agency teams that manage serious offenders in the community under Multi-Agency Public Protection Arrangement (MAPPA) are being seen as beacons of best practice in public protection by countries around the world.

Countries that have expressed an interest in learning more about MAPPA are America, Canada, South Korea, Jamaica, Norway and Latvia. In the last couple of years, both Scotland and Northern Ireland have introduced MAPPA following its success in England and Wales.

MAPPA teams in England and Wales were put in place eight years ago to provide more robust management systems for those offenders who live in our communities through the sharing of information and expertise. The teams, comprising police, prison, probation and other relevant agencies ensure joint working and enhanced communication to effectively manage risk to the public.

Lancashire Care staff can request the full-text of this report, email: susan.jennings@lancashirecare.nhs.uk

Investigating barriers to implementation of the NICE Guidelines for Depression: a staff survey with Community Mental Health Teams

Investigating barriers to implementation of the NICE Guidelines for Depression: a staff survey with Community Mental Health Teams, Journal of Psychiatric and Mental Health Nursing, 2009

L. RHODES, R. GENDERS, R. OWEN, K. O’HANLON, J. S. L. BROWN

Abstract:

•  The National Institute for Health and Clinical Excellence produce clinical guidelines that make recommendations for treatment of various physical and mental health conditions.

•  Recent research with Community Mental Health Team’s in a South London borough showed that the National Institute for Health and Clinical Excellence guidelines for Depression were not being fully implemented.

•  To find out some of the reasons for this a questionnaire was given to staff about their knowledge and use of these guidelines.

•  Staff reported that the services do not have enough resources to provide the recommended treatments for all people with depression.

•  The majority of staff also reported low levels of confidence in using the guidelines and very few had received any formal training on the guidelines. Many staff stated they would like more support in using the guidelines.

•  The results of this research suggest that changes could be made to increase implementation of the guidelines but that these are limited by the availability of resources; full implementation could only be achieved with additional support and funding.

Clinical guidelines have been designed to lead to significant and consistent improvements in health care but are rarely fully implemented within healthcare services. The study involved a survey of staff at four Community Mental Health Teams, which aimed to assess their knowledge and use of both the psychological recommendations of the National Institute for Health and Clinical Excellence (NICE) guidelines for Depression and specifically of cognitive-behavioural therapy (CBT) based interventions. It also aimed to assess team members’ clinical assessment skills and decision-making patterns when making recommendations about services for patients with depression. The results indicated that while over 90% of staff said they were using the NICE guidelines for Depression, less than 20% were very confident in using them. Most staff had knowledge about CBT and most (88%) would be very willing to refer to CBT but mentioned problems such as lack of resources and/or social problems affecting service delivery. Most staff were generally able to correctly identify the severity and type of depression. Despite this, some staff were making decisions that were not in accordance with the NICE recommendations. Reasons for these patterns are discussed.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Making a difference in Parkinson’s disease: An audit of patient perspectives

Making a difference in Parkinson’s disease: An audit of patient perspectives,   Sharon Reading , Patricia McGee , British Journal of Neuroscience Nursing, Vol. 5, Iss. 11, 13 Nov 2009, pp 496 – 501

Abstract:

Parkinson’s disease (PD) affects approximately 120 000 people in the UK with an age range from people in their 30s upwards. The classic signs of PD are slowness and poverty of movement, tremor and rigidity. Patients experience motor and non-motor complications and some papers suggest up to 80% of patients may go on to develop dementia. PD is a chronic progressive illness with no known cure. Treatment is based on individual need as there is much variation in symptoms. Three years ago, National Institute for Health and Clinical Excellence (NICE) guidelines for the care of people with Parkinson’s were published (2006). However, two leading charities have recently completed surveys which show that large numbers of patients remain unhappy with the overall care they receive.
In Newcastle, a team of Parkinson’s disease nurse specialists conducted an audit of the service they provide. The main aims were to survey the quality of the service from the patients’ perspective and to provide a model for future development based on the findings. The key tool was a patient satisfaction survey of 300 people attending the outpatient clinics.

From 209 completed questionnaires, only two patients reported overall dissatisfaction. This article looks at the areas that patients found particularly helpful such as daily telephone advice lines and home visits and those where there was room for improvement such as access to information.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Mindfulness Special – Recent Developments in Mindfulness-Based Research

Mindfulness Special, Journal of Cognitive Psychotherapy, 2009, Vol. 23 (3)

 
Recent Developments in Mindfulness-Based Research

New Developments in Research on Mindfulness-Based Treatments: Introduction to the Special Issue
Authors: Lau, Mark A.; Yu, Amanda R.

Development and Preliminary Validation of a Trait Version of the Toronto Mindfulness Scale
Authors: Davis, Karen M.; Lau, Mark A.; Cairns, David R.

Do Mindfulness Meditation Participants Do Their Homework? And Does It Make a Difference? A Review of the Empirical Evidence
Authors: Vettese, Lisa Christine; Toneatto, Tony; Stea, Jonathan N.; Nguyen, Linda; Wang, Jenny Jing

Psychological Functioning in a Sample of Long-Term Practitioners of Mindfulness Meditation
Authors: Lykins, Emily L.B.; Baer, Ruth A.

Mindfulness Meditation Training and Self-Referential Processing in Social Anxiety Disorder: Behavioral and Neural Effects
Authors: Goldin, Philippe; Ramel, Wiveka; Gross, James

The Role of Mindfulness-Based Stress Reduction on Perceived Stress: Preliminary Evidence for the Moderating Role of Attachment Style
Authors: Cordon, Shari L.; Brown, Kirk Warren; Gibson, Pamela R

Evolving Conceptions of Mindfulness in Clinical Settings
Author: Carmody, James

Lancashire Care staff only can request one or all 7 of the articles from the special: email: susan.jennings@lancashriecare.nhs.uk

Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients

Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients , International Journal of Geriatric Psychiatry, 2009, Volume 24 Issue 12, Pages 1367 - 1375

Kate Maxmin, Claudia Cooper, Laurence Potter, Gill Livingston

Abstract:

Objectives

There is little information about older adult psychiatric inpatients’ capacity to consent to clinical decisions. In younger adults, lack of capacity is associated with poor insight and psychosis rather than cognitive impairment. We assessed the prevalence and predictors of mental capacity to make treatment and admission decisions in older psychiatric inpatients, and asked their views about who should make these decisions.

Methods

We interviewed 99 participants using the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) in three geographical locations.

Results

Fifty-two (52.5%) participants had capacity for admission and 38 (38.4%) for treatment decisions. Capacity was associated with not having dementia, and higher levels of insight and cognition. Those with depression were more likely to have capacity than those with psychosis. 75% of patients without capacity for admission were not detained legally.

Conclusions

Patients can have capacity to make decisions in one area but not in others. Many people are admitted and treated in a way that is contrary to the human rights legislation. The new Deprivation of Liberty Safeguards in England and Wales are likely to apply to a significant proportion of older inpatients. Most people wanted doctors to make treatment and admission decisions and very few wanted their family to make decisions on their behalf

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

OT – OT’s enable well-being

Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational “categories”     Karen Whalley Hammell. The Canadian Journal of Occupational Therapy,  2009. Vol. 76, Iss. 2; p. 107

Abstract:

Background. Critics contend that occupational therapy’s theories of occupation are culturally specific, class-bound, and ableist, and that the division of all occupations into three simplistic categories of self-care, productivity, and leisure is arbitrary, lacks supportive evidence, and promotes a doctrine of individualism. Purpose. To add to the work of critics who advocate a fundamental rethinking of occupational therapy’s conceptualizations of occupation in terms of subjective qualities of experience that address intrinsic needs. Key issues. This paper suggests that if categories of occupation were informed by the ways in which people experience their occupations, these might be labelled as restorative, as ways to connect and contribute, as engagement in doing, and as ways to connect the past and present to a hopeful future. Implications. If occupational therapists enabled diverse clients’ perspectives to inform occupational categories, perhaps relationships between occupations and well-being might more easily be identified in theory and addressed in practice.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Critical Appraisal – Interpreting meta-analysis in systematic reviews

Interpreting meta-analysis in systematic reviews, Evidence-Based Medicine 2008;13:67-69

Rafael Perera, Carl Heneghan

Centre for Evidence Based Medicine, University of Oxford: Oxford, UK

Abstract:

A meta-analysis is a statistical method used to estimate an average, or common effect, over several studies. With therapeutic interventions (whether drug or non-drug) the meta-analysis is usually based on randomised controlled trials. In this reader’s guide we use the systematic review by Bravata et al¹ of the effects of pedometers to increase physical activity to illustrate these concepts.

A good systematic review should have done a thorough search for all studies, appraised their quality, and selected the better studies for answering the question. We won’t go over the appraisal here but will focus on reading the combined results. Reading a meta-analyses can be broken down into 4 basic steps²:

1. What is the summary measure?

2. What does the Forest Plot show?

3. What does the pooled effect (average effect) mean?

4. Was it valid to combine studies?

Big thanks to Mike Reid, Clinical Librarian at Blackpool, home of Rock!

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

Prevalence of ADHD symptoms among youth in a secure facility: the consistency and accuracy of self- and informant-report ratings

Prevalence of ADHD symptoms among youth in a secure facility: the consistency and accuracy of self- and informant-report ratings, Journal of Forensic Psychiatry & Psychology, 2009

Susan Young;  Gisli Gudjonsson;  Peter Misch;  Philip Collins;  Phillipa Carter;  Jade Redfern; Emily Goodwin

Institute of Psychiatry, King’s College, London, UK

Abstract:

The current study aimed to determine the most reliable source of information about attention deficit hyperactivity disorder (ADHD) symptoms. This was a between-groups cohort study in order to compare the accuracy of three informant groups (self-, teacher-, and keyworker-report ratings) in identifying symptoms of ADHD. The estimate of ADHD prevalence was obtained by comparing the Conners’ rating scales administered to 54, 14-year-old antisocial persons detained in a high-risk care home with a psychiatric assessment conducted on every third child. Overall, teachers were the most valid source and their ratings estimated that 43% of antisocial adolescents might have ADHD with sensitivity and specificity rates of 67% and 75%, respectively. In conclusion, rating scales may assist services in targeting their resources for those with most clinical need in this population, but these should not replace comprehensive assessment procedures.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk

CBT – Happiness – Layard

Reading ‘Happiness’: CBT and the Layard thesis, European Journal of Psychotherapy & Counselling, Volume 10, Issue 3 September 2008 , pages 247 – 260

David Pilgrim – School of Social Work, University of Central Lancashire, Preston, PRI ZHE

Abstract:

This review essay examines an important recent contribution from an economist Richard Layard to debates about the social and economic sources of mental distress and ways of responding to the latter. His book Happiness is one of many contributions from him about these topics. It provides a persuasive case for ‘upstream’ causes of mental health problems, which includes a critique of modern consumerism. A much less persuasive case is made though for therapeutic social engineering in response to psychological casualties of these socio-economic forces.

Lancashire Care staff can request the full-text of this paper, email: susan.jennings@lancashirecare.nhs.uk