Emma Griffith

Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in‐patient settings

This proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in‐patient settings, to improve engagement in treatment for drug and alcohol misuse.

A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units: study protocol for a randomized controlled trial

BackgroundSubstance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention.Methods/DesignThis randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention.DiscussionThis pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care.Trial registrationISRCTN43548483 Date of ISRCTN assignation: 4/17/2014.

Exploring the attitudes of staff working within mental health settings toward clients who use cannabis

Aims: This study aimed to explore the attitudes of staff working within mental health settings toward cannabis in general and cannabis use in individuals with severe mental-health problems. Method: Twenty members of staff working within community mental health teams in Birmingham, UK, were interviewed using qualitative research methods. The overarching themes within the staff accounts are described and the interrelationship between themes explored. Findings: Staff use an ‘individualized’ approach when working with cannabis-using clients dependent on a number of key components, including the positive and negative effects of use, wider evidence base, client vulnerability, engagement, professional and personal views and harm reduction. It is suggested that any approach staff may take toward cannabis use at any one time is greatly dependent upon the above factors and these factors are highly client specific. Conclusions: The findings may help to explain why interventions aimed at reducing substance use in people with psychosis might prove less successful when targeting cannabis use.

The impact of training within a comprehensive dual diagnosis strategy:The Combined Psychosis and Substance Use (COMPASS) experience

This article is a service report based on the experience of the Combined Psychosis and Substance Use Programme (COMPASS), which aims to provide integrated treatment for people who experience coexisting mental health and substance use problems. A fundamental role of the service is to deliver a structured training package based on a Cognitive-Behavioural Integrated Treatment approach to staff within mental health services. We aimed to establish whether the needs of staff prior to training were consistent across various service areas and whether our training package can enhance staff confidence and skills to work with this client group. The final aim was to consider if confidence and skills can be maintained over an extended period of time. This article is based on service evaluation data collected between the late 1990s and 2011. Data that had been collected from staff across diverse service areas within a large Mental Health Trust in the UK were analysed. There was a high degree of consistency across the s...

Staff attitude towards cocaine/crack-cocaine use amongst individuals with severe mental health problems in an inner city area of the UK

Background: Cocaine/crack-cocaine use is associated with a number of negative outcomes in people with mental health problems. Aims: To explore the extent of use in individuals with severe mental health problems and impact of client use on mental health service staff. Method: Following Graham et al. (2001), care coordinators within community mental health teams in Birmingham, UK completed a prevalence survey of cocaine/crack-cocaine use in clients on their current caseload to determine the extent of use. Findings were compared to those of Graham et al. Interviews with staff explored the impact of cocaine/crack-cocaine on client outcome and effects on staff within the teams under study. Results: An increase in cocaine/crack-cocaine use is reported (from 5.6% to 11.5% over 8 years). Interview data indicate that despite this increase, staff declare themselves more competent and confident in dealing with cocaine/crack-cocaine use. Conclusions: We propose that the integration of substance use treatment within m...

A Consultation-Liaison Service on Integrated Treatment: A Program Description

Objective: This article reports the results of an evaluation of a consultation-liaison service for people with combined mental health and substance use problems. The service is one component of an overall integrated service framework for this group of clients developed and delivered across one of the largest Mental Health Foundation Trusts in the UK. A full description of the client group referred to consultation-liaison over a 3-year period is provided, as well as a description of different referral pathways and a preliminary evaluation of a brief intervention offered as part of the service. Methods: Service evaluation data were collected through routine practice and provided demographic and diagnostic information on the clients who were referred to the consultation-liaison service (N = 173). A sample of these clients (n = 39) received a full brief motivational intervention consisting of six sessions delivered over a 12-week period. Quantitative questionnaire data collected for clients who received this component subsequently allowed a baseline and follow-up cohort assessment of changes on various substance-related outcomes in those receiving the brief intervention. Results: The results indicated that clients referred to the service (N = 173) were typically male (69.9%), in their mid-30s (M = 36.6 years, SD = 9.98) and considered to be white British (61.8%). They often presented with psychotic (52.6%) or depressive (16.8%) disorders and were commonly using alcohol (67.1%) or cannabis (47.4%). Of the clients who completed the full brief intervention (n = 39), baseline and follow-up outcome measures were available on a subsample (n ranged from 11 to 25 depending on each specific measure) and results showed significant changes in a number of areas, including increased engagement with treatment (p < .001), reduced alcohol (p = .001) and cannabis use (p = .015), fewer signs of hazardous alcohol use (p = .026), and improved confidence to change substance use (p = .006). These findings have to be considered as preliminary given the limitations of the service evaluation methodology. Conclusions: The consultation-liaison service appears to be a helpful component within an overall service framework for dual diagnosis in a number of ways, for example through the enhancement of existing services such as assessment, advice, and consultation, as well as the delivery of a brief intervention.

Clinical psychologists' perceptions of barriers and facilitators to engaging service users in Index Offence Assessment and Formulation in a medium secure unit

Abstract Index offence assessment and formulation (IOAF) helps service users (SU) in secure units to make sense of their index offence, provides detailed understanding of risk and contributes to treatment planning and discharge decisions. Clinical psychologists’ perceptions of barriers and facilitators to engaging SUs in IOAF within the men’s and women’s services of one medium secure unit were explored through focus groups. Thematic analysis identified two relevant domains: person-specific factors and the organisational context. Person-specific barriers included challenges in working with fragmented narratives, conflicting motivations to engage, SU defences and distorted perceptions of clinical psychologists’ roles. Giving clarity and choice to SUs facilitated engagement with the work. Regarding the organisational context, clinical psychologists within both services identified the importance of having adequate resources and care-team support to complete this work. Findings highlight the importance of developing an evidence-based framework for IOAF to be embedded within clear ‘risk’ care pathways through secure services.

Substance misuse brief interventions during psychiatric hospital admissions

Purpose: To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic. Design/methodology/approach: The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health. Findings: The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable. Originality/value: Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission.

Do Females with Bulimia Nervosa and Eating Disorder Not Otherwise Specified Have Selective Memory Biases

BACKGROUND The cognitive model suggests memory biases for weight/shape and food related information could be important in the maintenance of eating disorders. AIMS The current study aims to evaluate this and extend previous research by (a) including females with eating disorder not otherwise specified (EDNOS) as a discreet group; (b) considering whether levels of hunger and the pleasantness of the stimulus words are important in word recall. METHOD The study includes three groups of females, 16 with bulimia nervosa, 18 with EDNOS and 17 non-dieting general population controls. All participants completed a self-referential encoding and memory recall task. RESULTS A main effect of word type (p < .01) with no group by word type interaction or between group difference was found. A priori contrasts indicated that both eating disorder groups recalled significantly more weight/shape and food words compared to all other word categories (p < .01) compared to the control group; with no significant difference found between the eating disorder groups. In relation to the recall of food words, no significant differences were found between groups for levels of hunger. Both eating disorder groups rated the negative weight/shape (p < .01), negative food (p < .01) and neutral body words (p < .01) as more unpleasant than the control group. CONCLUSIONS The implications for cognitive theory and future research are discussed.