Richard Laugharne

Decision making and information seeking preferences among psychiatric patients

Background: The degree to which psychiatric patients want to play a role in decision making and their desire for information regarding their treatment has not been studied in detail. Aims: To measure the information seeking and decision-making preferences of psychiatric patients. Method: The Autonomy Preference Index (API) was adapted for use in psychiatry and administered to patients of a community mental health team (CMHT) and mental health user groups. Results: Desire for information regarding their illness and treatment was very high. There was a great variation in the extent patients wanted to make decisions regarding their care. Desire for decision making was greater for the young and for those in employment. Conclusions: Psychiatric patients want a high degree of information regarding their psychiatric care. Most patients wanted to play some role in decision making. Declaration of interest: The project was jointly funded by East Cornwall Community Mental Health Team and Cornwall Mental Health Forums.

Previous help sought by patients presenting to mental health services in Kumasi, Ghana

Abstract.Objective:There are four services providing mental health care to the people of Kumasi, Ghana. This study aimed to identify previous help sought by patients presenting to the services for an initial assessment.Method:New patients presenting to each of the four services were asked about distance travelled, previous help sought and time since symptoms of illness started. Staff also recorded basic demographic details and clinical diagnoses.Results:Of the 322 patients presenting to the four sites,only 6% had seen a traditional healer whereas 14% had seen a pastor before presentation. There was a greater delay in presenting to that service if the patient had seen a traditional healer or pastor. Many patients had previously used one of the other mental health units in Kumasi.Conclusion:It is possible that fewer patients with mental health problems present to traditional healers in modern, urban Africa compared to rural areas. More patients consult with pastors than traditional healers and liaison with these groups may improve mental health care. It is important to maintain liaison between the four services as patients presenting to one clinic may have presented previously to another local clinic.

Attitudes Toward Psychiatry Among Final-Year Medical Students in Kumasi, Ghana

ObjectiveMost sub-Saharan African countries have fewer psychiatrists than one per one million people. One possible reason could be that medical students have a negative attitude toward the specialty. The authors evaluated the attitudes toward a career in psychiatry of final-year medical students in Kumasi, Ghana, and compare these with attitudes of medical students in Spain and the United States.MethodsMedical students were given a 28-item questionnaire on attitudes toward psychiatry, which was used in previous studies in Spain and the United States.ResultsGhanaian students (N = 94) had a fairly positive view of psychiatry, similar to those in Spain, although less positive than U.S. students. About 15% were considering psychiatry as a career option. There was evidence of significant stigmatization of patients with mental illness and psychiatrists and concern about the use of coercive detention of patients.ConclusionThe difficulty recruiting physicians into psychiatry in Ghana, and perhaps other African countries, is unlikely to be due to negative attitudes and may be due to a lack of opportunity to train in psychiatry.

A community study in Cornwall UK of sudden unexpected death in epilepsy (SUDEP) in a 9-year population sample

PURPOSE Epilepsy-related death, particularly sudden unexpected death in epilepsy (SUDEP), is underestimated by healthcare professionals. One argument that physicians use to justify the failure to discuss SUDEP with patients and their families is that there is a lack of evidence for any protective interventions. However, there is growing evidence of potentially modifiable risk factors for SUDEP; although large-scale trials of interventions are still lacking. We determined the main risk factors associated with SUDEP in a comprehensive community sample of epilepsy deaths in Cornwall UK from 2004 to 2012. METHODS We systemically inspected 93 cases of all epilepsy and epilepsy associated deaths which occurred in Cornwall between 2004 and 2012 made available to us by the HM Cornwall coroner. These are the deaths where epilepsy was a primary or a secondary cause. RESULTS 48 cases met the criteria for SUDEP and we elicited associated relevant risk factors. Many findings from our study are comparable to what has been reported previously. New points such as most of the population had increase in either or both seizure frequency/intensity within six months of death and majority did not have an epilepsy specialist review in the last one year to demise were noted. CONCLUSION This study is the first epidemiological study in England occurring in a whole population identifying systemically all deaths and the first large scale review in UK of SUDEP deaths since 2005. Being a community based study a key issue which was highlighted was that in the SUDEPs examined many might have been potentially preventable.

Changing patterns of suicide in a poor, rural county over the 20th century. A comparison with national trends

Rural suicide rates have been shown to be disproportionately high in several countries. This study compares suicide rates in Cornwall with the rest of England and Wales over a 90-year period (1911–2001). Age and sex standardised mortality ratios were calculated for suicide and undetermined death for Cornwall standardised to England and Wales. From 1911 until the start of the Second World War, suicide rates were lower in Cornwall than England and Wales. Since the 1960s suicide rates in Cornwall have risen significantly above England and Wales. We have shown that the suicide rate in a poor, rural area has increased disproportionately compared to England and Wales over the last 35 years. This change has occurred in both sexes. Prior to this period the suicide rate was lower or about the same as that in England and Wales.

Modified Attitudes to Psychiatry Scale Created Using Principal-Components Analysis

ObjectiveThe Attitudes to Psychiatry Scale (APS) is a tool used to assess medical students’ attitudes toward psychiatry. This study sought to examine the internal validity of the APS in order to identify dimensions within the questionnaire.MethodUsing data collected from 549 medical students from India and Ghana, the authors analyzed 28 questions of the APS independently of the original five dimensions defined by Balon et al. in the original APS questionnaire, using principal-components analysis to test whether questions correlated to form dimensions within the questionnaire. The data were further tested for redundancy by Cronbach alpha.ResultsThe investigation yielded five dimensions, but, on filtering the information, there was good independent correlation in four of the five dimensions emerging from the analysis. These were 1) inspiration from medical school; 2) the stigma of psychiatry; 3) the merits of psychiatry as scientific medicine; and 4) the effectiveness of treatment, from which a suggested edited scale emerged.ConclusionOn examining the APS scale using principal-components analysis, the authors found clusters of questions around four themes that do seem intuitively relevant for attitudes toward psychiatry. They are not the same as Balon et al. ’s original subscales, although there are similarities. Using the questions in the emerging themes, the authors have suggested a modified questionnaire that appears to have good internal validity.

Stigma towards mental illness among medical students in Australia and Ghana.

ObjectiveStigma towards mental illness has been found to impact adversely on medical students’ attitudes towards psychiatry. This study aimed to assess the impact of stigma among final year students at the University of Science and Technology in Kumasi, Ghana, and the University of Western Australia.MethodA 28-item “Attitudes and stigma towards mental health” questionnaire was distributed to final year students at both universities.ResultsThere was a significant difference in questionnaire scores, with Australian students showing more positive attitudes towards mental illness and lower levels of stigma compared with Ghanaian students.ConclusionStigmatization was expressed by Australian and Ghanaian students. A combination of medical school experiences and wider societal and cultural beliefs could be responsible for students’ attitudes towards mental illness. Educators can develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students’ attitudes towards psychiatry as a discipline and mental illness in general.

General practitioners' views of community mental health services: A survey in one London borough

Community mental health teams are increasingly focusing their activities on people with severe mental illnesses. ‘4t the same time, the overall extent of mental health need in primay care ensures general practitioners (GPs) remain key professionals in the co-ordination and provision of mental health services to a wide range of patients. This study sought to establish the views of GPs working in one London borough on community mental health services, and to establish what they believed were appropriate services for community mental health professionals to provide. A postal questionnaire sent to all 104 GI’s working in the borough produced a 48% response rate. GPs believed community mental health teams were useful, and effective in dealing with patients presenting with a variety of mental health problems. Many believed that enhanced primay health care teams, adequately resourced and staffed with attached mental health professionals, could provide a wide range of mental health interventions. Dissatisfaction appeared to be related to the evolving focus of community mental health teams. Many GPs believed that they had lost a valuable service for people with less severe mental health needs.

Mental health professionals and media professionals: a survey of attitudes towards one another

Abstract Background: The general public regard mass media as their main source of information about mental illness. Psychiatrists are reluctant to engage with the media. There is little understanding of why this is the case. Aims: The paper looks to explore attitudes of mental health clinicians and the media towards one another. Method: Media and mental health clinicians in the southwest of England completed self-report surveys. Results: Of 119 questionnaires returned 85 were mental health clinicians and 34 media professionals. Both groups agreed that stigma is a major issue and clinicians have a key role influencing media portrayal of mental illness. The media view their reporting to be more balanced than clinicians and lack awareness of clinician mistrust towards them. Those clinicians with media training (13%) felt significantly more comfortable talking to media and significantly less mistrustful of them. Clinicians who had experience of working with media felt more comfortable doing media work. Only 15% of media professionals had received mental health awareness training. Conclusions: Media training and experience are associated with an increased willingness of mental health professionals to engage with the media. Reciprocal awareness training between media and mental health professionals may be a simple intervention worth pursuing.

Frequency and factors associated with emergency department attendance for people with epilepsy in a rural UK population

Attendance at UK Emergency Departments (EDs) for people with epilepsy (PWE) following a seizure can be unnecessary and costly. The characteristics of PWE attending a UK rural district ED in a 12-month period were examined to foster better understanding of relevant psycho-social factors associated with ED use by conducting cross-sectional interviews using standardized questionnaires. Of the total participants (n=46), approximately one-third of the study cohort attended ED on three or more occasions in the 12-month study period and accounted for 65% of total ED attendances reported. Seizure frequency and lower social deprivation status were associated with increased ED attendance while factors such as knowledge of epilepsy, medication management, and stigma were not. Similarities in frequency of repeat attendees were comparable to a study in urban population but other factors varied considerable. Our findings suggest that regular ED attendees may be appropriate for specific enhanced intervention though consideration needs to be given to the fact that population characteristics may vary across regions.