Aileen O'Brien

Disengagement from mental health services. A literature review.

This paper reviews the literature on disengagement from mental health services examining how the terms engagement and disengagement are defined, what proportion of patients disengage from services, and what sociodemographic variables predict disengagement. Both engagement and disengagement appear to be poorly conceptualised, with a lack of consensus on accepted and agreed definitions. Rates of disengagement from mental health services vary from 4 to 46%, depending on the study setting, service type and definition of engagement used. Sociodemographic and clinical predictors of disengagement also vary, with only a few consistent findings, suggesting that such associations are complex and multifaceted. Most commonly reported associations of disengagement appear to be with sociodemographic variables including young age, ethnicity and deprivation; clinical variables such as lack of insight, substance misuse and forensic history; and service level variables such as availability of assertive outreach provision. Given the importance of continuity of care in serious mental disorders, there is a need for a consensual, validated and reliable measure of engagement which can be used to explore associations between patient, illness and service related variables and can inform service provision for difficult to reach patients.

Section 136 of the Mental Health Act: a new literature review

Section 136 of the Mental Health Act 1983 (amended) provides police officers in the United Kingdom with the authority to remove individuals who appear to be suffering from a mental illness from any public place to a designated ‘place of safety’ for appropriate assessment. A considerable amount of research has been dedicated to investigate who is detained under this section and how it is implemented. A review of the literature revealed a high prevalence of schizophrenia, personality disorders and mania in individuals detained under Section 136 and an over-representation of black detainees. Several studies also reported poor communication between different agencies and poor levels of knowledge regarding the implementation of the section. There is a lack of qualitative research exploring detainee and professional experience of Section 136 and in particular the patient pathway to mental health care via Section 136 experienced by black detainees. Implications for clinical practice, multi-agency collaboration and future research are discussed.

A retrospective cohort study describing six months of admissions under Section 136 of the Mental Health Act; the problem of alcohol misuse.

Background Section 136 of the Mental Health Act 1983 empowers police to remove a person they believe to be suffering from a mental disorder from a place to which the public have access, if they deem them a risk to themselves or others. In the UK, the number of Section 136 orders is increasing. Objective This retrospective cohort study identified the demographic profiles, circumstances of detention and assessment outcomes of all individuals detained under Section 136 between February 2012 and July 2012 at a London Mental Health Trust. The study explored the relationship between alcohol and/or drug use, the process and outcomes. Design and method This study retrospectively obtained data from electronic notes for a six-month period. Demographic details were recorded. Other variables included previous admissions, reasons for assessment, evidence of intoxication, time taken for assessment and discharge outcomes. The effects of alcohol and/or drug intoxication on the process were recorded. Results A total of 245 individuals were assessed during the time period. Threatening to self-harm (n = 100, 44.8%) was the most common reason for assessment. Of the 245 patients assessed, 108 (44.1%) were found to be intoxicated with drugs and/or alcohol. Intoxication resulted in longer assessment times and a decreased likelihood of admission to hospital (p < .000).

A retrospective cohort study describing admissions to a London Trust's PICU beds over one year: do men and women use PICU differently?

Aims To describe the characteristics of patients admitted over one year to two psychiatric intensive care units in one large mental health trust. To establish the number of admissions, reasons for admission, incidents on the PICU, bed days and destination after discharge. Differences in gender for these factors were explored. Secondary questions were whether patient factors predicted aggressive incidents or predicted requiring long term care. Method The electronic notes for one year of admissions to the PICUs in one trust were examined; sociodemographic and clinical details were recorded. Reasons for admission and incidents on the PICU were coded. Data was analysed to establish significant sociodemographic or clinical differences within the cohort. Results Men were much more likely to require PICU but women stayed longer. There was a trend for women to go on to long term secure placement. Aggression and sexually inappropriate behaviour were common but there were no demographic predictors of aggression. The only predictor of requiring long term placement was having been a long time on the PICU. Conclusion There is evidence that women and men use the PICU differently, with women staying longer. Further research is needed to see if this is a national trend.

Exploration of staff attitudes and experiences towards mixed- and single-sex wards in the National Secure Forensic Service for Young People

Mixed-sex wards in adult forensic secure services have been abolished and replaced by single-sex services. The National Secure Forensic Service for Young People (NSFSYP) continues to use a mixture of single-sex male and mixed-sex wards. This study aimed to explore staff experiences and attitudes towards placing young people in mixed- or single-sex wards in the NSFSYP. Mixed methodology was adopted in the form of focus groups (qualitative) and questionnaires (semi-quantitative). Content analyses of the qualitative data revealed five themes: care of female patients, normalization, safety, commissioning and social representation of women. The questionnaire was developed from the qualitative findings and comprised 22 statements measuring attitudes towards mixed- and single-sex wards. One hundred and forty-five questionnaires were returned: a 44% total response rate. Overall, the responses to the questionnaire confirmed the focus group data. There were statistically significant differences in responses between staff working on mixed- and single-sex wards. Staff working on mixed-sex wards felt that mixing genders on wards is a crucial part of adolescent forensic inpatient treatment. For them, mixed wards provide a more developmentally appropriate environment for young people. The needs of female patients broaden the debate beyond segregating and mixing gender.

Should psychiatrists ‘Google’ their patients?

Since its beginnings in the 1980s the internet has come to shape our everyday lives, but doctors still seem rather afraid of it. This anxiety may be explained by the fact that researchers and regulatory bodies focus less on the way that the internet can be used to enhance clinical work and more on the potential and perceived risks that this technology poses in terms of boundary violations and accidental breaches of confidentiality. Some aspects of the internets impact on medicine have been better researched than others, for example, whether email communication, social media and teleconferencing psychotherapy could be used to improve the delivery of care. However, few authors have considered the specific issue of searching online for information about patients and much of the guidance published by regulatory organisations eludes this issue. In this article we provide clinical examples where the question ‘should I Google the patient?’ may arise and present questions for future research.

A staff self-reported retrospective survey of assaults on a psychiatric intensive care ward and attitudes towards assaults

Introduction Assaults on staff on psychiatric intensive care wards are unfortunately common and have a negative impact on morale. Method Staff on one PICU completed a survey providing an account of any assaults they had experienced over the previous year and a separate survey regarding attitudes towards assaults. Results 65% of staff members reported having being assaulted over the year. Most did not take any time off work. Attitudes towards prosecution of patients varied. Staff valued training in this area. Conclusions Assaults are common on a PICU and staff are ambivalent about prosecuting patients. More training may be of value regarding prediction of assaults, and about the criminal justice interface.

Retrospective cohort follow-up study of individuals detained under Section 136

Background An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated. Aims To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes. Method Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year. Results After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services. Conclusions Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention. Declaration of interest None. Copyright and usage