Lynne Callaghan

Costs of the police service and mental healthcare pathways experienced by individuals with enduring mental health needs

Background Substantial policy, communication and operational gaps exist between mental health services and the police for individuals with enduring mental health needs. Aims To map and cost pathways through mental health and police services, and to model the cost impact of implementing key policy recommendations. Method Within a case-linkage study, we estimated 1-year individual-level healthcare and policing costs. Using decision modelling, we then estimated the potential impact on costs of three recommended service enhancements: street triage, Mental Health Act assessments for all Section 136 detainees and outreach custody link workers. Results Under current care, average 1-year mental health and police costs were £10 812 and £4552 per individual respectively (n = 55). The cost per police incident was £522. Models suggested that each service enhancement would alter per incident costs by between −8% and +6%. Conclusions Recommended enhancements to care pathways only marginally increase individual-level costs.

Decision analytic model exploring the cost and cost-offset implications of street triage.

Objectives To determine if street triage is effective at reducing the total number of people with mental health needs detained under section 136, and is associated with cost savings compared to usual police response. Design Routine data from a 6-month period in the year before and after the implementation of a street triage scheme were used to explore detentions under section 136, and to populate a decision analytic model to explore the impact of street triage on the cost to the NHS and the criminal justice sector of supporting people with a mental health need. Setting A predefined area of Sussex, South East England, UK. Participants All people who were detained under section 136 within the predefined area or had contact with the street triage team. Interventions The street triage model used here was based on a psychiatric nurse attending incidents with a police constable. Primary and secondary outcome measures The primary outcome was change in the total number of detentions under section 136 between the before and after periods assessed. Secondary analysis focused on whether the additional costs of street triage were offset by cost savings as a result of changes in detentions under section 136. Results Detentions under section 136 in the street triage period were significantly lower than in the usual response period (118 vs 194 incidents, respectively; χ2 (1df) 18.542, p<0.001). Total NHS and criminal justice costs were estimated to be £1043 in the street triage period compared to £1077 in the usual response period. Conclusions Investment in street triage was offset by savings as a result of reduced detentions under section 136, particularly detentions in custody. Data available did not include assessment of patient outcomes, so a full economic evaluation was not possible.

Longitudinal Evaluation of the Impact of Placement Development Teams on Student Support in Clinical Practice

Aims: To investigate the impact of a new structure for supporting healthcare students and mentors in practice placements (Placement Development Teams). Introduction: The English Model National Partnership Agreement for healthcare education required Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to redesign strategies for student support. Placement Development Teams are one English University’s response to this. Materials and Methodology: This study was phase 2 of a longitudinal qualitative evaluation of Placement Development Teams. Data were collected after establishment of Placement Development Teams, and compared and contrasted with those collected prior to their implementation. Telephone interviews were conducted with key educational stakeholders in Trusts and Strategic Health Authorities. Focus groups were conducted with third year non-medical healthcare students and first year paramedics working in 16 NHS Trusts in the south west peninsula of England. Results: Pre-Placement Development Teams, themes from the students’ data were: Supportive and unsupportive behaviour of staff; Mentor allocation; Placement allocation; Benefits of students to the placement area and Perceived control over the learning experience. Post-Placement Development Teams, the themes were Communication; Supportive and unsupportive behaviour of staff; The effect of peers on the placement experience; Knowledge and perceptions of the work of the PDTs. Form the staff data, pre-Placement Development Teams the themes were: Vision for improving student support. Post-Placement Development Teams themes from the staff data were how they provided a central point of contact for student and mentor support; and how they supported students and mentors. Conclusion: Support of students and mentors is particularly important following the introduction of The English Model National Partnership Agreement for healthcare education. Placement Development Teams can facilitate partnership working between higher education institutions and placement providers for student support.

The development of a scale to assess practitioner capacity to engage in clinical education

Clinical educators play an important role in the development of clinical skills during health care undergraduates’ practice placements. The supportiveness of the learning environment and the attitude of the clinical educator towards student development are considered to be important factors that impact upon practice placement experience, although these influences are multi-factorial. This pilot study is the first phase of an action research project exploring practice placements in podiatry. The aim of this pilot study is to develop a scale to measure podiatrists’ capacity to engage in clinical education using criteria considered to contribute to overall clinical educator capability. An online survey consisting of 74 questions was developed and clinical educators from the podiatry services of 25 English National Health Service (NHS) Trusts were targeted. There was a 66 per cent response rate to the survey. Item–total correlations were calculated and nine subscales identified, all with Cronbach’s alpha coefficients above 0.7. The scale can be used to explore the factors that influence podiatrists’ capacity to engage with clinical education. It may also be utilised in the recognition and prediction of other potential variables that influence clinical educators’ capacity to undertake the role. This may therefore be used to identify support and training requirements. The scale could be adapted for application to other health care professions.

Sweden shows how the Nordic model could improve women’s wellbeing and create a better society

Proponents of the two main opposing models of legislating sex work (full decriminalisation versus the Nordic model) agree that criminalising sellers of sex is counterproductive, but the overall aims of and evidence for the two models were not fully explored by Howard.1 Our experience is that distress, trauma, substance misuse, poverty, or coercion can lead to prostitution, causing further emotional and physical harm.2 Harriet, survivor and activist, …

Attrition and Rape Case Characteristics A Profile and Comparison of Female Sex Workers and Non-Sex Workers

The attrition of rape cases from the criminal justice system (CJS) remains high and there is a paucity of research in relation to marginalized groups. Sex workers (SWs) are vulnerable to sexual violence due to the nature of their work. They are also unlikely to report such violence to police for a range of reasons. Two stages of research sought to describe the victim, perpetrator, and offense characteristics of SW rape and to examine the attrition of these cases. All rapes and attempted rapes (N = 1,146) reported to police in a large city in the South West of England over a 21-year period were examined; 67 cases involved SWs. Data were extracted from police files in line with the variables of interest. Secondary analysis of the total number of SW rapes (n = 67) resulted in a profile of these cases. A matched pairs study revealed significant differences in victim, perpetrator, and assault characteristics between SW (n = 62) and non-sex-worker (NSW) samples (n = 62). Although no significant difference was found in terms of attrition from the CJS, SW cases were observed to secure more convictions for rape than NSW cases. The implications of the findings for practice and future research are discussed.

Improving Student Support in Professional Placement Learning: Findings from the South West Peninsula Pilot of a New English National Placement Quality Assurance and Enhancement Process

English stakeholder collaboration has resulted in a new quality assurance process for non-medical health and social care placement providers and higher education institutions. This study aimed to discover the impact on student support that taking part in a pilot had on participating placement areas. Using a questionnaire survey with longitudinal follow-up one year later, we found that placement staff valued the opportunity to review and improve student support practices. This was still in evidence a year later where the pilot was described as giving the opportunity to provide evidence of aspects of student support practice; communicating and changing or developing aspects of that practice. Benefits accrued from interdisciplinary working in sharing and collaborating with other professions and organisations. Such activity could enhance clinical support staff activities and facilitate strategic partnerships between placement providers and higher education institutions.

Health trainer-led motivational intervention plus usual care for people under community supervision compared with usual care alone: a study protocol for a parallel-group pilot randomised controlled trial (STRENGTHEN).

Introduction People with experience of the criminal justice system typically have worse physical and mental health, lower levels of mental well-being and have less healthy lifestyles than the general population. Health trainers have worked with offenders in the community to provide support for lifestyle change, enhance mental well-being and signpost to appropriate services. There has been no rigorous evaluation of the effectiveness and cost-effectiveness of providing such community support. This study aims to determine the feasibility and acceptability of conducting a randomised trial and delivering a health trainer intervention to people receiving community supervision in the UK. Methods and analysis A multicentre, parallel, two-group randomised controlled trial recruiting 120 participants with 1:1 individual allocation to receive support from a health trainer and usual care or usual care alone, with mixed methods process evaluation. Participants receive community supervision from an offender manager in either a Community Rehabilitation Company or the National Probation Service. If they have served a custodial sentence, then they have to have been released for at least 2 months. The supervision period must have at least 7 months left at recruitment. Participants are interested in receiving support to change diet, physical activity, alcohol use and smoking and/or improve mental well-being. The primary outcome is mental well-being with secondary outcomes related to smoking, physical activity, alcohol consumption and diet. The primary outcome will inform sample size calculations for a definitive trial. Ethics and dissemination The study has been approved by the Health and Care Research Wales Ethics Committee (REC reference 16/WA/0171). Dissemination will include publication of the intervention development process and findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will also be disseminated to stakeholders and trial participants. Trial registration numbers ISRCTN80475744; Pre-results.

Factors affecting sustained engagement in walking for health: A focus group study

Introduction Health guidance recommends walking as a means to achieve advised levels of physical activity. The aims of the research were to consider the experience of the occupation of walking in relation to health and wellbeing, factors that lead to sustained engagement in walking and factors influencing the sustainable provision of walking groups, to inform practice. Method This phenomenological study considered the experience of eight walking group members and six walk leaders. Data were gathered using three focus groups. Transcriptions were thematically analysed. Findings Participants perceived that the experience of walking groups included improved feelings of wellbeing, and meaning derived from social support and connection with nature. Participants reported changes that improved the health of walkers and their families. Factors considered to influence sustained engagement in walking included appropriate challenge and variety, woodland developments, accommodation of routine, use of local green space and consideration of barriers. Factors considered to influence the sustainable provision of walking groups included facilitation style, health champions, marketing approaches and clarity and collaboration with primary care referrers. Conclusion Walking groups can be used to support individuals to engage in health-promoting occupations. An occupational perspective can usefully inform practice.

“It Gave Me My Life Back” An Evaluation of a Specialist Legal Domestic Abuse Service

Community-based advocacy services are important in enabling victims to escape domestic abuse and rebuild their lives. This study evaluated a domestic abuse service. Two phases of research were conducted following case-file analysis (n = 86): surveys (n = 22) and interviews (n = 12) with victims, and interviews with key individuals (n = 12) based in related statutory and community organizations. The findings revealed the holistic model of legal, practical, mental health–related, and advocacy components resulted in a range of benefits to victims and enhanced interagency partnership working. Core elements of a successful needs-led, victim-centered service could be distilled.