Rachel Perkins

Routes to psychiatric inpatient care in an Inner London Borough.

SummaryA study is reported in which pathways to psychiatric inpatient care were investigated in an Inner London Borough. Data were collected on a series of 52 consecutive admissions of adults to the psychiatric wards serving the area. The most striking feature of the results was the variety of routes taken to inpatient care, combined with a high level of police involvement (23.1% of admissions) and low level of referral from General Practitioners (15.4% of admissions). Significant age differences in routes to care were found: those under 30 years were usually brought to hospital by the police or presented directly to psychiatric emergency services; those over 30 typically came via medical/surgical hospital services, domiciliary psychiatric services or psychiatric outpatients. There were no differences in the routes taken by Afro-Caribbean and white people or by men and women. Higher proportions of Afro-Caribbeans received a diagnosis of schizophrenia, considered themselves to have nothing wrong with them and were compulsorily detained. Higher proportions of whites were diagnosed as depressed and considered themselves to have physical problems rather than psychiatric ones. However, results clearly indicated that it was ethnic status rather than diagnostic category that accounted for the higher rates of compulsory detention of Afro-Caribbean people. The implications of the findings for service development and delivery are considered.

The Individual Placement and Support approach to vocational rehabilitation for young people with first episode psychosis in the UK.

Background: The onset of schizophrenia is associated with a pronounced decline in employment and educational attainment. Aims: The aim of this study was to evaluate the impact of implementing the Individual Placement and Support approach (supported employment) adapted to include supported education within an Early Intervention Team for young people with a first episode of psychosis in the UK. Method: Demographic, clinical and vocational data were collected between November 2001 and July 2006 to evaluate the impact on service user vocational outcomes at 6, 12, 18 and 24 months. Individual vocational pathways are reported for the follow-up periods and fidelity to the implementation of the Individual Placement and Support (IPS) approach. Results: By 6 months, 69% of people were supported in open employment and mainstream education/training and this rose to 81% at 18 months. The open employment rate increased significantly from 13% at baseline to 48% at 18 months and this was maintained through to 24 months. Conclusion: This study suggests that the IPS approach combined with supported education was effective at enabling a significant proportion of young people with a first episode of psychosis in a UK Early Intervention Service to gain/retain open employment and mainstream education.

Compliance or informed choice

Attempts by clinicians to increase compliance with psychotropic medication are examined critically. The ways in which attempts to increase compliance run counter to the goal of enabling people to make informed choices about their treatment are explored. An alternative approach to understanding why people behave in the way that they do is explored within the framework of health belief models of behaviour developed in relation to physical health and illness.

Worlds apart: Working with severely socially disabled people

Socially disabled people who experience the major disturbances of thought, feeling and behaviour associated with disorders such as schizophrenia pose a major challenge to clinicians and non-clinicians alike. This paper considers some of the issues and considerations involved in forming effective working relationships with, and caring for, such people. Approaches and strategies are outlined for minimising the disruptive consequences of problems such as altered perceptions, cognitive confusion and impaired sense of identity.

Beyond mere existence: The auditing of care plans

The importance of auditing and im proving the quality of care plans for people who experience serious ongoing mental health problems is discussed. The development of measures to assess the quality of care planning in a routine clinical setting is described, together with an audit procedure incorporating these assessments in a process of improving the quality of care planning. The assessments performed included the extent to which care plans addressed strengths and problems defined by staff and by the client him/herself in all areas of functioning, and the extent to which the targets set in care plans were based on the results assessments performed and achieved in practice. The results obtained indicated (a) that it was not possible to assume that care plans would be based on assessments performed, (b) that some areas of functioning (especially finances and psychological well-being) received relatively little attention in care plans, (c) that client defined problems were relatively neglected, (d) that care...

Reality out of the Rhetoric: Increasing User Involvement in a Mental Health Trust

aking a reality of user involvement requires a great deal more than the simple inclusion of token representatives on committees or a signature on a care plan. If the involvement of service users is to be meaningful, it requires a major cultural change for service providers at all levels: ■ strategic: input to the development, planning and organisation of services ■ operational: providing feedback about the experience of services – community teams, wards, day facilities, residential units – to inform decisions about the way they are run ■ individual: making decisions about individual treatment and support and the ways in which this will be provided.

An Act to Follow

In relation to employment, mental health difficulties are almost invariably seen as ‘problems’ to be overcome, but this is not always the case. Within services for people with mental health problems, personal experience of such difficulties can afford an expertise not shared by non‐user staff: having ‘been there’ can be positively useful. The User Employment Project at The Pathfinder Mental Health Services NHS Trust has, for over two years, provided supported employment for service users in ordinary, existing clinical posts within teams: mental health support workers, occupational therapy assistants and technicians and physiotherapy assistants. More recently, the Trust has broadened its approach and begun to examine the ways in which its more general employment practices have been discriminatory. This has lead to the development of a ‘Charter for the Employment of People who have Experienced Mental Health Problems’ covering the whole of the Trust.

Seen But Not Heard: Can ‘User Involvement’ Become More than Empty Rhetoric?

Within mental health services, as in other areas of life, ‘professionalism’ is deeprooted. ‘There is a pervasive societal belief that trained professionals are the only people who know how to provide proper assistance. This attitude exists whether our television needs to be fixed or we need help dealing with personal issues. We have grown accustomed to turning to professionals for help because we assume they have special expertise’.1 However, amongst mental health service users/survivors, recognition of the shortcomings of such professionalism is increasingly widespread: more and more people who experience mental distress and disability are turning to sources of expertise other than professionals.2, 3 ‘Ex-patients...are beginning to turn to each other rather than to mental health professionals for emotional and instrumental support. They are finding that often people with experiential knowledge (i.e., having learned through personal experience) are more able to understand their needs than are professionals who have learned through education and training. Moreover, they are finding the support and help they can give each other to be as valuable — or sometimes more valuable — than the interventions of trained professionals’.1 Such trends can be seen in a variety of self-help and user run services.4 This paper is based on the premise that mainstream mental health services cannot survive without the expertise of those who have themselves experienced mental health problems. ‘User involvement’ is not some act of altruism on the part of mental health workers and service providers, neither is it an ‘optional extra’: the ‘icing on the cake’. If services are not to become irrelevant to those who experience mental distress and disability, then people who have experienced these things must be the critical ingredient of the cake itself.

Creating a recovery focused workforce: supporting staff well-being and valuing the expertise of lived experience

Purpose – The purpose of this paper is to argue that if mental health services are to genuinely support the recovery of those who they serve then recovery principles must permeate all facets of the organisation, in particular human resources and workforce development. Design/methodology/approach – This paper draws on the principles of recovery-focused approaches to people who use services and explores how these might guide a recovery-focused approaches to human resources and workforce issues. Findings – The recovery principles like recognising and utilising the expertise of lived experience, co-production and shared decision making, peer support, focusing on strengths and becoming an expert in your own self-care all have as much relevance for creating a recovery-focused workforce as they do in the recovery journeys of those who use services. Everyone who uses services is “more than a mental patient” and everyone who provides services is “more than a mental health practitioner” – we need to use all the ass...

Recovery versus risk? From managing risk to the co-production of safety and opportunity

Purpose – The purpose of this paper is to propose a recovery-focused approach to risk and safety and what this might look like in practice. Design/methodology/approach – Review of recovery approaches and the ways in which traditional approaches to risk might hinder people in their recovery journey. Consideration of the principles of a recovery-focused approach to safety. Findings – A recovery-focused approach to risk based on co-produced safety plans that enable people to do the things they value as safely as possible and shared responsibility for safety. Four key principles of a recovery-focused approach to promoting safety, autonomy and opportunity are proposed. Originality/value – A recovery-focused approach to risk and safety is central to the development of recovery-focused practice within services. This paper outlines such an approach.