Matt Fossey

Improving access to psychological therapies: implications for the mental health workforce

Despite the emergence of NICE guidelines regarding the effectiveness and appropriateness of psychological therapies for the majority of common mental health problems, access to these services is still dramatically underdeveloped and uneven. Estimates of untreated problems such as depression and anxiety in primary care signal the extent of these problems and the scale of investment in new services, if these needs are to be adequately met in the future.The Department of Healths and the Care Services Improvement Partnerships (CSIP) Improving Access to Psychological Therapies (IAPT) programme sets out a framework and a series of co‐ordinated actions, including two national demonstration sites, to begin to address these issues in England.This paper examines the origins and policy drivers that have given rise to the IAPT programme, outlines the progress to date and specifically assesses the implications for the mental health workforce of this programme. Issues addressed include the workforce profiles of existing services, career frameworks for psychological therapists, the capacity of training providers to train new and existing staff in psychological therapies and the challenges implicit in devising a workforce delivery plan to support the IAPT programme.

Transition From the Military Into Civilian Life: An Exploration of Cultural Competence

In this article, we employ the theoretical framework and concepts of Pierre Bourdieu to examine the notion of “transition” from military to civilian life for U.K. Armed Forces personnel. We put Bourdieu’s concepts of habitus, capital, and field to work in highlighting key differences between military and civilian life. The use of social theory allows us to describe the cultural legacy of military life and how this may influence the posttransition course of veterans’ lives. There may be positive and negative transition outcomes for service personnel when moving into civilian life, and by applying Bourdieu’s theoretical concepts, we explain how such outcomes can be understood. We suggest that the “rules” are different in military environments compared to civilian ones and that service personnel must navigate a complex cultural transition when moving between environments. There are numerous and significant implications—including policy applications—from understanding transition through a Bourdieusian lens, and these are highlighted throughout.

Educating nurses to care for military veterans in civilian hospitals: An integrated literature review

BACKGROUND In the UK, military veterans will receive care by civilian nurses in civilian hospitals. We propose that the nurses providing this care require an understanding of the unique experiences and specific health needs of veterans to deliver evidence-based care. AIM To conduct an integrative review of published literature to explore how nursing programmes prepare nurses to care for the military veteran population in civilian hospitals. REVIEW METHODS A systematic search was undertaken of a range of electronic databases, Google Scholar and hand searching of Military and Veteran health journals. Papers that focused on education of civilian nurses about veteran health and included primary research or description of practice-based innovations were included in the review. RESULTS The search generated sixteen papers that were focused on nurse education in higher education institutions. Several papers focused on simulation as a teaching method for veteran-specific health issues or curriculum developments with educational innovations such as online courses. Six papers focusing in continuing professional education of nurses in the clinical setting were included as supplementary information. All papers reviewed were US focused and dated between January 2011 and September 2015. Our search concluded that there is a gap in knowledge in this subject area within a UK context, therefore our review includes UK background information to support the US findings. CONCLUSION Civilian nurses need educational preparation to understand the specific needs of veterans. Educational institutions in the US have responded to nationwide initiatives to undertake that preparation. More empirical studies need to be undertaken to develop, test and evaluate educational innovations for preparing students and nurses delivering care to military veteran in civilian healthcare settings.

Standards, efficiency and effectiveness in consultation-liaison psychiatry

Australian & New Zealand Journal of Psychiatry, 49(2) Given growing clinical, economic and systemic arguments, addressing the mental health needs of patients with physical presentations should be integral to normal service delivery. Consultation-liaison psychiatry (CLP) is a subspecialty which interfaces between general medical and psychiatric services. The variability between models of CLP services has rendered direct comparisons difficult, and a lack of consistency in evaluation studies reflects this (Wood and Wand, 2014). This paper presents recent developments in measuring standards, performance and outcomes in CLP, and suggests directions for further work.

Transition support for vulnerable service leavers in the UK: Providing care for Early Service Leavers.

ABSTRACT There is little research focusing on the transition experiences of early service leavers (ESLs) in the United Kingdom. This article brings together both qualitative and quantitative data to identify key challenges regarding transition. Quantitative results suggest that ESLs are not reporting any concerns on discharge, raising questions about the sensitivity of the tools used for identifying problems or concerns. The challenges for service provision identified by organizations responsible for supporting ESLs suggest a need for better understanding of ESLs, in terms of their specific support needs, and how service provision can be tailored best to meet these needs.

Addressing the knowledge gap: sexual violence and harassment in the UK Armed Forces

Despite media interest in alleged sexual violence and harassment in the UK military, there remains a paucity of UK-based peer-reviewed research in this area. Ministry of Defence and service-specific reports support the suggestion that UK service personnel may be at risk of experiencing sexual harassment. These reports however highlight a reluctance by service personnel to report sexual harassment through official channels. In this article, we discuss the paucity of UK-based research pertaining to the prevalence and impact of sexual harassment in the military, explore potential reasons for this gap in knowledge and outline future directions and priorities for academic research.

Former Armed Forces personnel in the Criminal Justice System

As we commemorate the centenary of World War 1 and the offi cial withdrawal of UK military troops from Afghanistan, the fate of former armed forces personnel has come into sharp focus once again. Most of the current generation of personnel who leave service make successful transitions back into civilian life. However, some personnel do not. A proportion will develop mental health problems, and some will fi nd themselves involved in the Criminal Justice System. In view of the Armed Forces covenant, 1 there is an expectation that more should be done to support the entire military family. An independent review 2 by Stephen Philips on behalf of the Secretary of State for Justice addresses former Armed Forces personnel in the Criminal Justice System. This review was inspired by a rising concern about the proportion of former Armed Forces personnel in prison and on probation for violent and sexual off ences. 3,4 Results from a study 5 showed that, although overall off ending in the UK military was less than expected in a comparable sample of the general population, violent off ending did not follow this trend and was overrepresented in the military sample. The review involved wide consultation with experts in research, mental health, social care, criminal justice, and legal matters and emphasises the need for national guidance on the identifi cation and management of former Armed Forces personnel in the Criminal Justice System. The recurring theme in the recommendations is a call for more training for those working within the Criminal Justice System and judiciary in understanding the needs of former Armed Forces personnel. 6 The review acknowledges the integral link between poor mental health, alcohol and substance misuse, and off ending behaviour. 4,5 The review recommends better collaboration between criminal justice and mental health agencies, both within the National Health Service and the third sector. The review also emphasises the need for greater support and interventions, not just during time in prison and probation, 7 but also earlier in the criminal justice pathway. The review clearly states that identifi cation of former Armed Forces personnel throughout the Criminal Justice System is patchy and in some instances nonexistent. We welcome the recommendations to improve data capture and recording. Although comprehensive in scope, the review was largely reliant on verbal evidence from a range of witnesses, including ourselves. Unfortunately, there is insuffi cient evidence on which to base recom …

A programme theory for liaison mental health services in England

BackgroundMechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice.MethodWe synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems.ResultsWe identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred.ConclusionsOur findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.

Flash to bang: psychological trauma, veterans and military families: can services cope?

In 2008, Joseph Stiglitz, the Nobel laureate and famous economist, first assessed the economic and human cost of the Iraq War. In his book ‘ The Three Trillion Dollar War ’, he quoted the American military psychiatrist, Jonathan Shay, who wrote that ‘ the mental health toll of the Iraq War is