Adrian Worrall

Characteristics of the residents of in-patient child and adolescent mental health services in England and Wales

This study describes the characteristics of the young people who use the full range of child and adolescent psychiatric in-patient units in England and Wales. Consultant psychiatrists or key workers were asked to complete a structured schedule about every resident on a census day – 19 October 1999. Schedules were returned from 71 of the 80 units in England and Wales, concerning 663 residents. Residents aged 13 or under had a wide range of diagnoses and more were male (58%). In contrast, two-thirds of residents aged 14–18 were categorized into one of three diagnostic groups – eating disorder, schizophrenia, delusional or psychotic disorders or mood disorders – and about two-thirds were female. In-patients had more severe problems than a group of young people using community services, particularly with hallucinations and delusions, emotional and related problems and problems of self-care and independence. The range of disorders treated by these units demonstrates the need for a range of specialist in-patient services to be available to children and adolescents in all regions.

Cost and impact of a quality improvement programme in mental health services.

Objective To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Methods Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programmes impact within its five broad underlying principles. Results The survey had a 40% response. Total costs ranged between £164,000 and £458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Conclusions Given the difficult contexts, short time-scales and capacity constraints, the programmes lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

The development of a set of quality indicators to evaluate services for people with depression

This article presents a methodological procedure for the development of a set of quality indicators or best practice statements to evaluate the standards of care in services for people with depression. Quality indicators were derived from a literature review and from the output of two stakeholder workshops conducted in Leeds and in London which 64 stakeholders attended. This was an effective method of quickly obtaining a set of quality indicators. The stakeholder workshops provided useful complementary information to that obtained from the literature search. The quality indicators were effective in the field and usefully helped inform the report. These indicators could be used by Primary Care Groups and Trusts as a basis for developing local standards for service evaluation.

The service context for clinical guidelines: Supporting guideline implementation by assuring and improving the quality of service in which clinicians work

Abstract This paper argues that accreditation schemes and quality networks promote good contexts for the implementation of clinical guidelines. It raises questions about how organizational standards should be developed, structured and focused, how clinical guidelines and organizational standards should connect, how to practically increase the number of such schemes and their scope, and the role of professional bodies in this. There is a considerable amount of administration involved in running an accreditation scheme or quality network and there are risks involved in starting in new areas. One way forward is for professional bodies to partner to share risks and to build a common operating platform for the administration of the work across the professional bodies. This platform could be guided by topic experts within the bodies.

Three decades of quality improvement in electroconvulsive therapy: exploring the role of accreditation.

Objectives This study aims to track electroconvulsive therapy (ECT) clinics’ compliance with standards for the administration of ECT before and after the introduction of the Electroconvulsive Therapy Accreditation Service (ECTAS) in 2003. Methods Three audits on the practice of ECT were retrospectively analyzed, and ECTAS data from 2004 to 2011 were prospectively analyzed. Overall compliance with 10 ECT audit standards was presented in 2 ways: annually and for each of the 3 waves of accreditation. Results There have been continuing improvements since the introduction of the accreditation service in compliance with all 10 ECT audit standards whether measured annually or by accreditation cycle, although these improvements have not been linked to changes in clinical outcomes. Conclusions Although improvements in ECT delivery have coincided with the accreditation service, other factors may have also contributed.