Hadi Mohamad

Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1).

Background: Most definitions of severe mental illness (SMI) are categorical and assign the patient to either SMI or not-SMI status. While this is useful for some purposes, it is a rather limited approach. The purpose of the present study is to develop a new method of addressing the issue of ‘severity’, and to develop a dimensional rather than a categorical approach. The paper reports on the acceptability, reliability and validity of a method developed to collect a standard set of data covering the majority of items specified in the academic and policy literature as characterising SMI. Method: A single page form, Matching Resources to Care (MARC-1), containing most of the items used in definitions of SMI was used to collect data from community mental health staff about their current open caseload, in four co-terminous health and social services settings during a census week (n = 2139). In addition to the data from the four pilot sites, we conducted a sub-study (n = 91), in which two raters rated the same cases during the same week. Results: The MARC-1 scores were able to distinguish between patients in receipt, and those not in receipt, of specific types of community care (level of care, eligibility for care and statutory aftercare) (P < 0.001). The MARC-1 score was modestly but significantly correlated (r = 0.28) with the Global Assessment Scale (P < 0.001). The mean percentage inter-rater agreement for the MARC-1 score items was 87%. Conclusion: It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community.

Interventions and outcomes of health and social care service provision for people with severe mental illness in England.

Abstract.Background: Mental health policy in England is undergoing radical change involving the integration of services aimed at improving outcomes for patients. At the same time, there is limited evidence about how conventional services are performing. The present paper reports data on the services provided and short-term outcomes achieved in eight community services in England. Method: A survey of caseloads of nurses and social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024). After 5 months a random sample of psychotic cases was followed up (n = 393). Results: A tendency was observed for health and social care practitioners to use the services available from within their own organisation. Over time, in the most severe cases, there was a substantial increase in provision of the services of the other organisation. Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both professional groups, and both reported similar amounts of met and unmet need (and in the same categories) at follow-up. Conclusion: The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.

Men, sex and context in psychosexual therapy: finding a suitable frame

Abstract This descriptive study explores contextual factors and psychosexual therapy with the first 70 consecutive male clients seen by one therapist in a regional, hospital-based Psychosexual Healthcare clinic. Clinical, demographic and referral data were examined to provide a snapshot of client characteristics, specific sexual problems and more general life adversities. The data were ordered and categorised into biological, psychological, inter-personal and environmental factors to provide a generic taxonomy of (mostly inter-related) client problems across the four dimensions. Findings indicated that good outcome was linked to completion of therapy, individual counselling, and treatment via masturbatory control or sensate focus. Single men or those with non-cohabiting partners were significantly younger than men with live-in partners. Variance across the four biopsychosocial domains centred on alcohol/drug use and smoking, childhood (sexual) abuse and neglect, relationship discord, infidelity, dissatisfaction with previous therapy, and new employment or work re-location. The multiplicity and complexity of the mens adversities suggested that contextual factors, personal and material, figured as highly as the referred psychosexual problems. Practically, the need to harness both biomedical and psychosocial expertise was apparent from the amount of co-working and cross-referral, both in-house and externally. Clinically, the use of ‘non-specific’ factors in therapy risks stretching treatment beyond its specialist frame, but can enhance engagement and subsequent intervention.

Psychiatric morbidity in social workers' clients. A comparison between an inner-city area and a small town.

SummaryThe rate of psychiatric disorder in a social services sample in a small town was compared to the rate in an inner-city sample. Nearly 40% of respondents in the small town had a positive General Health Questionnaire score and 37% had case status (ID greater than 5) on the Present State Examination. Most of these were cases of neurotic depression and were generally recognised as such by the social workers. The type of intervention undertaken by social workers differed in the two settings. Small-town social workers were more likely to offer advice, guidance, exploration and mobilisation of resources. The small-town social workers were more likely to have success in helping their clients with problems of social isolation and marital disharmony than were their inner-city counterparts. Mental illness problems, however, showed less improvement than in the inner-city sample, with over one-third of the small-town cases remaining unwell throughout the 12-month follow-up. Both previous psychiatric history and current depression were indicators of a poor outcome. The present findings provide further support for the argument that unless there is close collaboration between social workers, the medical profession, and health care teams, people who present their problems to social services are unlikely to have their mental health problems addressed adequately.

The support networks of people with severe, long-term mental health problems

Abstract This second paper in the Northern Town survey of mental health service users examines the areas of relationships and professional support. The domestic relationships of the service users who live with other people are examined and whilst the majority express satisfaction, a significant minority indicate serious difficulties. An examination of satisfaction with extended family and friendship networks of service users revealed a substantial minority dissatisfied, and a heavy reliance upon other users and professionals for relationships. Gaps in informal networks did not appear to be compensated for by the support of professionals. An acceptance of impoverished support systems and a difficulty in articulating dissatisfaction or need were a feature of many responses. The survey highlights the tenuous nature of support available to many mental health service users, both in the community and in staffed settings. The authors argue that for real improvements in quality of life, the newly-emerging care ma...

Psychiatric morbidity in clients of social workers: social outcome

Summary141 clients referred to social service department local social work teams (area workers) and general practice attachments were interviewed to assess their levels of psychiatric morbidity. 101 cases received clinical and social reassessment at twelve months. A substantial proportion (63%) had a positive social outcome according to the client and social worker, a finding confirmed by an independent social assessment. Family break up, more common in the area setting, was associated with a better clinical outcome. Attachment clients had significantly higher levels of psychiatric morbidity, and in clinical terms improved more frequently than area cases, but not significantly so. Clinically improved cases had a higher number of GP-social worker contacts. Both social and clinical variables contributed to the prediction of clinical outcome. By reducing the availability of attached workers, social services departments are removing a valuable source of help for people with psychiatric disorders.

Assessment of parents by Approved Social Workers under the Mental Health Act 1983

Abstract Approved Social Workers from seven local authorities were interviewed about Mental Health Act assessments involving parents. Half of all the children in these families were under eight years old, and in 40% of cases there was concern about the childrens safety. Those children perceived as at most risk or in need of alternative care arrangements tended to be children of lone parents, ethnic minority parents, parents who misused drugs or alcohol, or parents who were themselves as as children. The authors conclude that joint approaches with child care colleagues are essential in assessing the risks and needs of children identified through mental health crisis in a parent.