New CLAHRC research offers the NHS a great opportunity to better support patients with mental health issues arriving at Emergency Departments.
CLAHRC researcher Dr Helen Barratt and colleagues have used NHS data to describe the population of patients who attend Emergency Departments in England, including their sociodemographic characteristics. As part of the first national study of Emergency Department mental health attendances, the researchers analysed over 6 million adult visits at 97 English NHS Trusts between April 2013 and March 2014.
The data will be invaluable to the NHS in estimating the demand for liaison psychiatry services, and resourcing A & E departments to deal with patients presenting with mental health issues in what is already a stressful environment. This work is timely as recently new NHS Access standards for emergency mental health care have been proposed – obliging Trusts to strengthen the availability of care ‘out of hours’ and the provision of resources for individuals requiring admission.
“Those coming to A&E will receive a response from a 24/7 liaison psychiatry team (or equivalent children’s and young people’s service) within the first hour of their referral, and will receive the appropriate, timely support to meet their needs and an evidence-based package of care.” Clinically-led Review of NHS Access Standards Interim Report from the NHS National Medical Director
You can see the key figures in the infographic below
You can see more of the key figures in a presentation Helen put together below
Professor Fonagy is one of the key international figures in the evaluation of mental health interventions. He holds Chairs at UCL, Harvard, Yale and Baylor, and is a NIHR Senior Investigator. In the 1990’s, he co-led the NHS Review of Psychotherapies, evaluating all outcomes data which provided the basis for the radical policy change, Improved Access to evidence-based Psychological Therapies (IAPT), now an important part of the NHS mandate. The report ‘What Works for Whom’ has over 3,000 scholarly citations. Since 2010, he has led the Children and Young People’s Programme for IAPT and achieved a doubling of the Government’s financial commitment to this service transformation programme for CAMHS services to be restructured using evidence based, patient centred therapies. He is a key figure in developing NHS mental health strategy through NICE guidance and chaired the Depression in Children and Young People GDG and co-ordinated the prevention section of guidelines for Antisocial Personality Disorder and Conduct Disorder. He led the development of National Occupational Standards for Psychological Therapies and Chaired the Advisory Group leading to the introduction of routine outcomes assessment in mental health services (HoNOS). He served on several UK Government panels and on the Academic Advisory Board of the Presidential Commission on Violence Prevention, chaired panels at NIMH and the German Research Foundation, and was a UK representative on the Expert Psychological Panel of the European Science Foundation EIRH Programme. He is PI or co-PI on evaluation research programmes in excess of £15M, is Programme Director on the UCLP mental health programme and is leading the largest Clinical Psychology Department and training scheme in the UK, with 150 doctoral students.
Professor Kamaldeep Bhui is Professor of Cultural Psychiatry & Epidemiology at Queen Mary University of London and an Honorary Consultant Psychiatrist in East London Foundation Trust. He is an psychoanalytic psychotherapist. He is Editor of the British Journal of Psychiatry and the International Journal of Culture and Mental Health. Professor Bhui trained at University College London and at Guys and St Thomas’ qualifying in 1988. He proceeded to train in London, completing his higher psychiatric training by 1992, secured a Wellcome Training Fellowship to progress research and secured a first consultant appointment in 1999 followed by a Senior Lecturer and Professorial post at Queen Mary University of London in 2000 & 2003 respectively. His research and practice interests on health include social exclusion, work characteristics, cultural psychiatry, epidemiology, health services research and psychological therapies. He has undertaken original research with communities to understand this complex process called radicalisation and provides evidence on how it works and who is vulnerable.
Professor Bhui heads the Centre for Psychiatry at Barts & the London Medical School. He is also the Director of the Cultural Consultation Service (Culturalconsultation.org), Director of the QMUL MSc Programme, the co-founder of Careif (www.careif.org), an international mental health charity based in London that promotes work for young people and their health through culture, sport and arts and, more recently, the Director of the Synergi Collaborative Centre, a new initiative to transform ethnic inequalities in mental health services, (synergicollaborativecentre.co.uk).
In 2016 he received a CBE (Commander of the British Empire) in the Queen’s New Years’ Honours List for services to mental health care and research.
Black elders dismiss the warning signs of dementia until the condition becomes too severe to ignore or a crisis strikes. They are also less likely to receive a diagnosis of their condition, resulting in delayed treatment and less time to plan for the future.
Our latest BITE – a summary of published CLAHRC research provides an overview of our work with black elders, their families and carers to;
identify barriers and facilitators to seeking help for dementia.
based on what we found, work with dementia patients and their carers, volunteers from the public, clinicians and experts in the treatment and research of dementia to develop an intervention – a leaflet entitled Getting help for forgetfulness (below)
trial the intervention with GP registered patients, who were asked to rate it and evaluate its effect on their intention to seek help from their doctor.
GPs are often faced with patients seeking help and advice on non-clinical issues such as debt, unemployment and housing. Though these issues undoubtedly impact patients’ health and wellbeing, health professionals are not always the best qualified people to tackle them.
We investigated the impact of putting welfare advice, and welfare advisers in GP surgeries on
the ability of low income groups to secure financial support they are entitled to
patients’ anxiety and stress associated with financial related social worries;
and, to GP time spent managing non-clinical issues
New CLAHRC BITEs offer a summary of two papers investigating the impact –
A qualitative study to identify the processes by which co-located services can improve outcomes for GP practices
Co-location of welfare services has many benefits to patients including:
Offering a signposting option for staff in contact with patients with ‘non-clinical’ social needs.
Helping to address underlying patient social issues.
Providing an alternative option for patients seeking help for such issues.
Reducing bureaucratic pressures and time demands on practice staff.
2. A quantitative study, using a controlled comparison, assessing the impact on mental health and service use of co-located welfare advice.
Key Findings – service users receiving welfare advice versus control group
Had the advice service not been at the practice, nearly half of the advice group would not have sought help or consulted their GP instead.
The majority of advice recipients reported improved circumstances after advice (e.g., stress, income, housing etc.)
Compared to those who did not get advice, after 3 months:
Those in the advice group whose circumstances improved experienced a bigger improvement in their well-being.
Those in the advice group experienced a bigger reduction in financial strain, reduced credit card and overdraft use.
Those in the advice group experienced a bigger reduction in symptoms of common mental disorder, especially among recipients who were female, those who identified as Black and those who reported that their circumstances improved as a result of advice.
There was, however no evidence for a reduced frequency of GP consultations.
For every £1 of investment by funders, those receiving co-located advice gained £15 in entitlements on average