Val Harrington

Towards integrated community mental health teams for older people in England: progress and new insights

To investigate progress in joint working within community mental health teams for older people (CMHTsOP) against a range of national standards, and to consider team characteristics that may hinder or facilitate integrated practice.

GP perspectives of irritable bowel syndrome – an accepted illness, but management deviates from guidelines: a qualitative study

BackgroundThe estimated prevalence of irritable bowel syndrome (IBS) is 10%. Up to one third of patients develop chronic symptoms, which impact on everyday functioning and psychological wellbeing. Guidelines suggest an increased role for primary care in the management of patients with IBS, and referral for psychological interventions. Literature reports dissatisfaction and frustration experienced by both patients with IBS and healthcare professionals. The aim of this study was to explore the perspectives of general practitioners (GPs) in relation to the diagnosis and management of IBS and their views on the potential use of a risk assessment tool to aid management decisions for patients with IBS in primary care.MethodsThis was a qualitative study using face-to-face semi-structured interviews with GPs in North West England. Interviews were fully transcribed and data analyzed using constant comparison across interviews. Tensions between GP accounts and the NICE guideline for the management of IBS were highlighted.ResultsGPs described IBS as a diagnosis of exclusion and the process as tentative and iterative, with delay in adding a Read code to the patient record until they were confident of the diagnosis. Whilst GPs accepted there was a link between IBS and psychological symptoms they suggested that the majority of patients could be managed within primary care without referral for psychological interventions, in conflict with the NICE guideline. They did not feel that a risk assessment tool for patients with IBS would be helpful.ConclusionsThis study highlights the tensions between evidence recognizing the need to identify patients whose symptoms may become chronic and offer pro-active care, including referral for psychological therapies, and the perspectives of GPs managing patients in every-day clinical practice. The reluctance of GPs to refer patients for evidence-based psychological treatments may have implications for commissioning services and patient care.

Lifetime and current costs of supporting young adults who deliberately poisoned themselves in childhood and adolescence

Background: Little is known about the long-term economic consequences of child and adolescent mental health problems, despite concerns that costs in later life may be significant. Aims: To evaluate current and lifetime costs of young adults who deliberately poisoned themselves in childhood. Method: Prospective cohort study of 129 young adults (mean age 21) who as teenagers had taken part in a randomized trial following deliberate self-poisoning. Lifetime and current costs of public sector services were calculated and compared to those of a matched general population control group. Results: The self-poisoning group incurred significantly greater lifetime costs than the controls. They used more service-provided accommodation, special education and hospital services, incurred greater criminal justice costs and received more social security benefits. Higher costs in the self-poisoning group were significantly associated with conduct disorder, hopelessness, previous suicide attempts, being male and being in care prior to the self-poisoning event. Conclusions: Child and adolescent mental health problems predict significant costs compared to general population controls. This study provides indications of those groups of young people who incur high costs and for whom early intervention should be considered.

CMHTs for older people: team managers’ views surveyed

Purpose – The purpose of this paper is to identify features of community mental health teams (CMHTs) for older people valued by their managers, and those they would most like to change. Design/methodology/approach – Content analysis was used to analyse “free text” responses to open questions from a national survey about CMHTs’ organisational structures and processes. Responses were sorted into statements which were categorised into content areas and higher level dimensions. Findings – Free text information was provided by 376 teams (an 88 per cent response rate). Eight higher level dimensions were identified. One related specifically to integration with social care services, whilst several more included material about other aspects of intra-team integration (e.g. documentation and location). The largest proportion of statements related to staffing and teamwork. Statements about inter-personal and inter-professional issues were largely positive, whilst statements about resources, bureaucracy and integratio...