CWPT Adult Mental Health

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Re-Audit of Safe Deprescribing on Inpatient Psychiatric Wards After Implementation of an Electronic Prescribing Management and Administration (EPMA) System in an NHS Trust
(Cambridge University Press, 2025-06-20) Onyechere, Udoka; Adeyinka, Toibat; Sahota, Harvir; Tyne and Wear Foundation NHS Trust; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Adeyinka, Toibat; Sahota, Harvir
Aims: The audit aimed to evaluate the effectiveness of transitioning from paper-based patient prescription charts (Kardex) to an electronic prescribing and medication administration system (EPMA) in improving compliance with safe deprescribing practices on inpatient psychiatric wards. Specific objectives included assessing adherence to Trust guidelines, reducing incidents of incorrect medication deprescription, and enhancing clarity regarding medication changes. Methods: This audit was performed in May 2024 on all psychiatric inpatient wards utilising the EPMA system. This system had been in use for over a year in the Trust following a phasing out of the paper Kardex. During this period, the EPMA records of inpatients were evaluated. The findings were compared with that from a previous audit, which examined Kardex records in March 2022. The comparative analysis centred on deprescribing practices, examining whether medications were properly discontinued, entries were completely filled, and justifications for deprescribing were noted. The audit complied with Trust protocols and ethical governance requirements. Results: The transition from the Kardex system to EPMA resulted in significant improvements in safe deprescribing practices. There was 100% compliance in details on the system corresponding to most of the standards measured in the previous audit, including name crossed, row crossed fully, ID, code (reason) and stop date. The sole exception to this was observed when utilising the 'other’ option in EPMA’s dropdown menu, where adherence to providing a stated reason was 94.5%, a metric not evaluated in the initial audit as this was not facilitated by the paper Kardex. In this audit, all the standards were met and the medications were considered safely deprescribed. This stands in contrast to the previous audit where less than 33.88% of deprescribed medications met the standards. Conclusion: The EPMA system demonstrated substantial progress in promoting safe deprescribing practices aligned with Trust guidelines. The notable improvement in compliance clearly demonstrates the significant influence of technology on clinical practice and patient safety in relation to medication prescription and administration in this case.
Co-designing a peer support programme for carers of people treated under the Mental Health Act: views from stakeholders
(BMC, 2025-05-07) Wells, Imogen; Wintsch, Kelly; G-Medhin, Abigail; Lloyd-Evans, Brynmor; Gillard, Steve; McCabe, Rose; Mohamudbucus, Mohamed Yaasir; Mahlke, Candelaria; Nagel, Katharina; Muhxinga, Zhenreenah; Singh, Swaran P; Priebe, Stefan; Giacco, Domenico; University of Warwick; Brunel University London; King’s College London; University College London; University of London; Coventry and Warwickshire Partnership NHS Trust; University Medical Centre Hamburg Eppendorf; East London NHS Foundation Trust; University of Hamburg;; Psychiatry; Medical and Dental; Singh, Swaran; Giacco, Domenico
Background Relatives/friends (carers) of people who are involuntarily admitted to a psychiatric hospital report high levels of stress, feelings of isolation and exclusion from their patient’s care. One-to-one peer support is widely implemented for patients, facilitating mental health recovery. Preliminary evidence reports that peer support may benefit carers too, but a one-to-one peer support programme to help carers when their relatives/friends are in hospital has not been developed. Objective To explore carers’, patients’, and professionals’ views on what an accessible, feasible and helpful one-to-one peer support intervention should consider for carers of patients treated under the Mental Health Act (MHA) in England. Method Nineteen one-to-one interviews were conducted online with five carers, four patients, four clinicians, four independent mental health advocates and two behaviour change experts. Participants had experience of either being treated or supporting someone treated under the MHA within the last 10 years. Audio recordings of the interviews were transcribed, and data were analysed using thematic analysis. Results Five themes were identified: (a) carer availability and awareness; (b) peer support flexibility; (c) early promotion of peer support; (d) appropriate training and support for peers, and; (e) anticipated impact of peer support. Carers’ lack of time and awareness of support were reported as key barriers to accessing peer support. To address this, participants emphasised the need for early introduction of support following patients’ hospitalisation and flexible delivery through various communication channels. They also highlighted the need for robust, interactive training for peer supporters. Expected benefits included improved carer and peer supporter wellbeing and increased carer knowledge and empowerment. Conclusions These findings highlight the need for structured training for peer supporters and a flexible, accessible peer support programme for carers. The findings can inform evidence-based co-production of a carer peer support programme for use in England, which could improve carer wellbeing, knowledge and empowerment.
Improving physical healthcare provided to psychiatric inpatients at an acute mental health trust
(BMJ Publishing Group, 2019-08) Hassan, Shahnaz; Byravan, Swetha; Al-Zubaidi, Hussain; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Hassan, Shahnaz; Byravan, Swetha; Al-Zubaidi, Hussain
Psychiatric patients are at high risk of developing physical health complications. This is due to various factors including medications prescribed, life style choices and diagnostic overshadowing. Admission to a psychiatric unit provides a prime opportunity to review a patient's physical healthcare. We noticed prior to the commencement of this project that this opportunity was not always being used in the inpatient unit, with one in four patients at baseline data collection having no physical health checks. This is despite clear guidance laid out in the trust policy 'Physical Examination of Service Users during Admission to Hospital'. We aimed to improve compliance with these checks to 100%. A number of prior audits in this area had failed to sustain improvement. Therefore, we proposed a quality improvement approach involving a series of plan do study act cycles, in order to test and review processes prior to implementation. The first cycle involved simplification of the paper-based documentation used for physical health checks, which resulted in minimal improvement by 5%. The second cycle involved combining this documentation with the history taking proforma resulting in an overall improvement in compliance to 90%. We learnt that a move away from the more widely used audit towards a more holistic approach of quality improvement allowed an informed continuum of change to take place which likely led to sustained improvement. Post implementation data collected at 1 month revealed compliance remained at 90%. Our initial 100% target was perhaps unrealistic, as there are also longstanding underlying cultural issues around physical healthcare in psychiatric patients that are complex to address and beyond the scope of this project.
The Roles, Responsibilities and Tasks of Peer Support Workers in Coventry and Warwickshire Partnership Trust (CWPT): A Service Review
(Coventry and Warwickshire Partnership NHS Trust, 2024-11) Dunkerley, Laura; Jordan, Martin; Coventry and Warwickshire Partnership NHS Trust; Community Mental Health Services; Cooper, Stacy; Willington, Gary; Additional Clinical Services; Additional Professional Scientific and Technical Field; Dunkerley, Laura; Jordan, Martin
Background: Peer support worker roles were introduced into the Coventry and Warwickshire Partnership Trust (CWPT) workforce in January 2021. A subsequent review highlighted concerns among peer support workers and their employers around the lack of clarity regarding the roles, responsibilities, and tasks of peer support workers. Aim: The aim of this service review was to explore the similarities and differences between the role of peer support workers and their multi-disciplinary team colleagues, and the extent to which there was clarity around peer support worker roles. Additionally, the service review aimed to investigate the broader impact of peer support workers beyond their formal roles, responsibilities and tasks. Methods: A qualitative approach was used, involving semi-structured interviews and focus groups with peer support workers, multi-disciplinary team colleagues, and service users. Data were audio-recorded, transcribed, and analysed thematically. The service review was coproduced, involving peer support workers at all stages. Results: Three focus groups and six individual interviews were conducted with sixteen participants. Thematic analysis revealed similarities between peer support worker and multi-disciplinary team colleagues’ roles, as well as key differences in the use of lived experience and the unique approach of peer support workers. Role clarity improved with increased exposure to peer support workers and better access to role-related information, however, the need for further role clarity was emphasised. Additionally, peer support workers were found to have a significant impact beyond their formal roles, specifically through shaping team culture and providing authentic, person-centred and recovery focused support to service users. Conclusions: This review highlights the ongoing development of peer support worker roles, responsibilities and tasks in CWPT. Recommendations to further develop peer support worker roles include improving role clarity, emphasising the value of lived experience, and supporting effective collaboration between peer support workers and multi-disciplinary team colleagues to improve service delivery.
Non-contact monitoring to support care in acute inpatient mental health
(Taylor & Francis Group, 2024-06) Ndebele, Faith; Wright, Kay; Gandhi, Varsha; Bayley, Daniel; Coventry and Warwickshire Partnership NHS Trust; Oxehealth Limited, Oxford; Research Department; Additional Professional Scientific and Technical Field; Ndebele, Faith; Wright, Kay
Background: Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents. Aim: To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents. Methods: A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability. Results: A -44% relative percentage change in bedroom self-harm incidents and a -48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved. Conclusion: The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.
The development of the Compassion Focused Therapy Therapist Competence Rating Scale
(Wiley, 2019-04) Horwood, Victoria; Allan, Steven; Goss, Kenneth; Gilbert, Paul; University of Leicester; Coventry and Warwickshire Partnership NHS Trust; University of Derby; Clinical Psychology; Additional Professional Scientific and Technical Field; Goss, Kenneth
Objectives Compassion-focused therapy (CFT) has shown promise as a treatment for a number of clinical presentations; however, existing studies have not adequately addressed issues of treatment fidelity. The aims of the present study were to identify initial candidate items that may be included in a CFT therapist competence rating scale and to develop the behavioural indicators to anchor these items. Design The Delphi method was used to develop and operationalize the competencies required for inclusion in a CFT therapist competence rating scale over five rounds. Methods Face-to-face meetings with two CFT experts were conducted in rounds one, two, and five, and these were used to define and operationalize the competencies. Nine other CFT experts were invited to complete online surveys in rounds two and four. An 80% consensus level was applied to the online surveys. Results The resulting Compassion Focused Therapy Therapist Competence Rating Scale (CFT-TCRS) consisted of 23 competencies which were separated into 14 ‘CFT unique competencies’ and nine ‘Microskills’. There was high agreement about the included ‘CFT unique competencies’ and ‘Microskills’; however, there were some differences in opinion about the specific content of some items. Conclusions This is the first study that has attempted to reach consensus regarding the competencies and behavioural anchors for a CFT therapist competence rating scale. The next stage of development for the CFT-TCRS is to establish whether the scale can be reliably and validly used to evaluate CFT practice.
Air Pollution: an environmental risk factor for psychiatric illness?
(Wiley, 2019-11-09) Rowland, Tobias; Majid, Madiha; Warwick Medical School; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Rowland, Tobias; Majid, Madiha
No abstract is available for this article.
Interventions for mental health problems in children and adults with severe intellectual disabilities: a systematic review.
(BMJ, 2018-06-19) Vereenooghe, Leen; Flynn, Samantha; Hastings, Richard P; Adams, Dawn; Chauhan, Umesh; Cooper, Sally-Ann; Gore, Nick; Hatton, Chris; Hood, Kerry; Jahoda, Andrew; Langdon, Peter E; McNamara, Rachel; Oliver, Chris; Roy, Ashok; Totsika, Vasiliki; Waite, Jane; Bielefeld University; University of Warwick; Monash University; Griffith University; University of Central Lancashire; University of Glasgow; University of Kent; Lancaster University; Cardiff University; University of Birmingham; Coventry and Warwickshire Partnership NHS Trust; Aston University; Psychiatry; Medical and Dental; Roy, Ashok
Objective: Mental health problems are more prevalent in people with than without intellectual disabilities, yet treatment options have received little attention. The aim of this study was to identify and evaluate the effectiveness of pharmacological and psychological interventions in the treatment of mental health problems in children and adults with severe and profound intellectual disabilities, given their difficulties in accessing standard mental health interventions, particularly talking therapies, and difficulties reporting drug side effects. Design: A systematic review using electronic searches of PsycINFO, PsycTESTS, EMBASE, MEDLINE, CINAHL, ERIC, ASSIA, Science Citation Index, Social Science Citation Index and CENTRAL was conducted to identify eligible intervention studies. Study selection, data extraction and quality appraisal were performed by two independent reviewers. Participants: Study samples included at least 70% children and/or adults with severe or profound intellectual disabilities or reported the outcomes of this subpopulation separate from participants with other levels of intellectual disabilities. Interventions: Eligible intervention studies evaluated a psychological or pharmacological intervention using a control condition or pre-post design. Outcomes: Symptom severity, frequency or other quantitative dimension (e.g., impact), as assessed with standardised measures of mental health problems. Results: We retrieved 41 232 records, reviewed 573 full-text articles and identified five studies eligible for inclusion: three studies evaluating pharmacological interventions, and two studies evaluating psychological interventions. Study designs ranged from double-blind placebo controlled crossover trials to single-case experimental reversal designs. Quality appraisals of this very limited literature base revealed good experimental control, poor reporting standards and a lack of follow-up data. Conclusions: Mental ill health requires vigorous treatment, yet the current evidence base is too limited to identify with precision effective treatments specifically for children or adults with severe and profound intellectual disabilities. Clinicians therefore must work on the basis of general population evidence, while researchers work to generate more precise evidence for people with severe and profound intellectual disabilities.
Psychological interventions for adoptive parents: a systematic review
(Sage Journals, 2018-03-23) Harris-Waller, Jayne; Granger, Charlotte; Hussain, Misbah; Coventry and Warwickshire Partnership NHS Trust; Norfolk and Suffolk NHS Foundation Trust; South Staffordshire and Shropshire Healthcare NHS Foundation Trust; Clinical Psychology; Additional Professional Scientific and Technical Field; Harris-Waller, Jayne
A systematic review methodology was used to evaluate research regarding psychological interventions for adoptive parents. The effectiveness of the diverse intervention models scrutinised was found to be mixed with regard to a range of parent and child outcomes. When service user feedback was sought, psychological interventions were found to be acceptable to adoptive parents. Overall, findings were weakened by multiple sources of potential bias in the studies reviewed. Further research is needed, with particular attention to the method, site and timing of outcome measurement, before firm clinical recommendations can be made regarding the relative benefit of specific models of psychological intervention for adoptive parents. Implications for future research are discussed with reference to the unique contextual challenges of conducting clinical studies with adoptive families.
What are the attitudes toward patients with substance use disorders (SUD) among medical students in the UK: a systematic review
(Taylor & Francis Group, 2025-01-05) Sinyor, Jessica; Jackson, Jennifer; Collier, Karen; University of Warwick Medical School; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Collier, Karen
Background Patients accessing treatment for substance use disorders (SUD) are often met with negative attitudes from healthcare professionals. Identifying how future doctors perceive these patients is central to tackling stigmatized attitudes, which deter patients from utilizing services. This systematic review explores UK medical students’ prevailing attitudes toward SUD patients. Methods This PROSPERO-registered review is guided by the PRISMA checklist. Database and citation searches identified 1688 papers for screening, of which seven met the inclusion criteria and were quality assessed, extracted and synthesized. Results We found some students held negative attitudes, assigning SUD patients blame for their conditions and considering them more dangerous than other patients. Students also lacked confidence in addressing these patients’ needs. They felt SUD teaching was low priority on their curricula, despite identifying doctors as responsible for overall SUD management. Progression through training appeared to correlate with improved attitudes within the included studies’ limitations, and diverse methods such as expert patients further enhanced student perceptions and knowledge. Conclusion Stigmatizing views of SUD patients remain present among UK medical students. Time and resources allocated to SUD education should better reflect the public health challenge it represents. Further work is needed to explore the effectiveness of stigma-reducing interventions.
(Overcoming) attacks on thinking: the importance of psychoanalytic thinking in surviving systemic fragmentation of the public mental health sector
(Taylor & Francis, 2025-02-03) Norris, James; Coventry and Warwickshire Partnership NHS Trust; CAMHS; Additional Professional Scientific and Technical Field; Norris, James
In the last 15 years, the public mental health sector has been subject to two big policy shifts that have impacted the ability of Community Mental Health Teams (CMHTs) and Specialist Child and Adolescent Mental Health Service (CAMHS) clinics to deliver therapeutic services. This paper discusses the impact of the Improving Access to Psychological Therapies (IAPT) policy and the Health and Social Care Act (2012) on these services and the various barriers to effective treatment that they have created. The author then proposes that, as psychoanalytic psychotherapists, with our particular awareness of unconscious and group processes, we are well-placed to support multidisciplinary colleagues in overcoming feelings of hopelessness, anxiety and impotence that these policy shifts create and takes inspiration from potentially analogous situations with patients as a method to approaching the systemic aspects of our work.
What influences social outcomes among offenders with personality disorder: A systematic review
(Wiley, 2018-06-19) Connell, Catriona; Furtado, Vivek; McKay, Elizabeth A.; Singh, Swaran P; University of Warwick; Birmingham and Solihull Mental Health NHS Foundation Trust; Edinburgh Napier University; Coventry and Warwickshire Partnership NHS Trust; Psychiatry; Medical and Dental; Singh, Swaran P.
Background Personality disorder is highly prevalent in offender populations and is associated with poor health, criminal justice, and social outcomes. Research has been conducted into factors that influence offending and health, but, in order to improve (re)habilitation, service providers must also be able to identify the variables associated with social outcomes and the mechanisms by which they operate. Aim To establish what is known about what influences social outcomes among offenders with personality disorder. Method A systematic review was completed using Cochrane methods, expanded to include nonrandomised trials. Anticipated high heterogeneity informed a narrative synthesis. Results Three studies met inclusion criteria. Two were qualitative studies including only 13 cases between them. All studies were low quality. Conclusions There is insufficient evidence to determine what influences good social outcomes among offenders with personality disorder. Research is required to identify associated variables, to inform the development of effective interventions.
A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services.
(BioMed Central, 2018-07-18) Paul, Moli; O'Hara, Lesley; Tah, Priya; Street, Cathy; Maras, Athanasios; Ouakil, Diane Purper; Santosh, Paramala; Signorini, Giulia; Singh, Swaran Preet; Tuomainen, Helena; McNicholas, Fiona; Consortium, MILESTONE; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Stratford Healthcare; Saint John of God Research Foundation clg; Yulius Academie, Netherlands; Hôpital Saint Eloi; King’s College London; Saint John of God Clinical Research Center, Italy; Lucena Clinic Rathgar, Dublin; University College Dublin; Our Lady’s Children Hospital Crumlin, Dublin; Child and Adolescent Psychiatry; Medical and Dental; Paul, Moli
Background Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. Methods A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Results Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. Conclusions There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.
Self-Control, Plan Quality, and Digital Delivery of Action Planning for Condom and Contraceptive Pill Use of 14–24-Year-Olds: Findings from a Clinic-Based Online Pilot Randomised Controlled Trial
(International Association of Applied Psychology, 2018-09-09) Brown, Katherine; Beasley, Kerrie; Das, Satyajit; Coventry University; Coventry and Warwickshire Partnership NHS Trust; Sexual Health Service; Additional Professional Scientific and Technical Field; Nursing and Midwifery Registered; Beasley, Kerrie; Das, Satyajit
Background: Inconsistent use of the contraceptive pill and condoms contributes significantly to poor sexual health outcomes for young people. There is evidence that action planning interventions may improve pill and condom use, but this approach is not systematically used in sexual healthcare. This study is the first to assess acceptability and feasibility of evaluating a digital intervention to support action plan formation for three sexual health behaviours with clinic attendees. It also considered the role of trait self-control and whether the intervention supported production of quality plans. Methods: Eighty-eight integrated sexual health clinic attendees aged 14-24 years (M = 20.27 years) were recruited to a pilot randomised controlled trial (RCT). Of these, 67 also completed three-month follow-up. Measures included self-reported contraceptive or condom "mishaps", theory of planned behaviour variables, and a measure of self-control. Results: Descriptive analyses supported study acceptability and feasibility. The intervention supported pill and condom users to produce quality plans, though potential improvements were identified. Bivariate correlations suggested that high levels of trait self-control may negatively influence plan quality. Data suggest that the intervention may reduce pill or condom "mishaps". Conclusions: A future full RCT is likely feasible and brief digital action planning interventions may usefully be incorporated within sexual healthcare.
A realist approach to the evaluation of complex mental health interventions
(Cambridge University Press, 2018-07-20) Duncan, Craig; Weich, Scott; Fenton, Sarah-Jane; Twigg, Liz; Moon, Graham; Madan, Jason; Singh, Swaran P; Crepaz-Keay, David; Parsons, Helen; Bhui, Kamaldeep; University of Portsmouth; University of Sheffield; University of Birmingham; University of Southampton; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Mental Health Foundation, UK; The London School of Medicine & Dentistry; Queen Mary University of London; East London NHS Foundation Trust; Psychiatry; Medical and Dental; Singh, Swaran P.
Conventional approaches to evidence that prioritise randomised controlled trials appear increasingly inadequate for the evaluation of complex mental health interventions. By focusing on causal mechanisms and understanding the complex interactions between interventions, patients and contexts, realist approaches offer a productive alternative. Although the approaches might be combined, substantial barriers remain.
A systematic review of co-responder models of police mental health ‘street’ triage
(Springer Nature, 2018-08-15) Puntis, Stephen; Perfect, Devon; Kirubarajan, Abirami; Bolton, Sorcha; Davies, Fay; Hayes, Aimee; Harriss, Eli; Molodynski, Andrew; University of Oxford; Oxford Health NHS Foundation Trust; University of Toronto Faculty of Medicine; Coventry and Warwickshire Partnership NHS Trust; Psychology; Additional Professional Scientific and Technical Field; Hayes, Aimee
Background Police mental health street triage is an increasingly common intervention when dealing with police incidents in which there is a suspected mental health component. We conducted a systematic review of street triage interventions with three aims. First, to identify papers reporting on models of co-response police mental health street triage. Second, to identify the characteristics of service users who come in to contact with these triage services. Third, to evaluate the effectiveness of co-response triage services. Methods We conducted a systematic review. We searched the following databases: Ovid MEDLINE, Embase, PsycINFO, EBSCO CINAHL, Scopus, Thompson Reuters Web of Science Core Collection, The Cochrane Library, ProQuest National Criminal Justice Reference Service Abstracts, ProQuest Dissertations & Theses, EThoS, and OpenGrey. We searched reference and citation lists. We also searched for other grey literature through Google, screening the first 100 PDFs of each of our search terms. We performed a narrative synthesis of our results. Results Our search identified 11,553 studies. After screening, 26 were eligible. Over two-thirds (69%) had been published within the last 3 years. We did not identify any randomised control trials. Results indicated that street triage might reduce the number of people taken to a place of safety under S136 of the Mental Health Act where that power exists, or reduce the use of police custody in other jurisdictions. Conclusions There remains a lack of evidence to evaluate the effectiveness of street triage and the characteristics, experience, and outcomes of service users. There is also wide variation in the implementation of the co-response model, with differences in hours of operation, staffing, and incident response.
Use of a proforma to aid in reducing coercion into informal admission for acute adult psychiatric inpatients in the U.K.
(Elsevier, 2018-11-27) Perry, Benjamin Ian; Ayadurai, Nirmalan; Hess, Emily; Harmer, David; Curry, Thomas; Broom, Rebecca; White, David; Coventry and Warwickshire Partnership NHS Trust; University of Warwick; Adult Psychiatry, Old-Age Psychiatry; Medical and Dental; Perry, Benjamin Ian; Ayadurai, Nirmalan; Hess, Emily; Harmer, David; Curry, Thomas; Broom, Rebecca; White, David
Background People with acute psychiatric illness may be at risk of coercion into informal admission. A lack of capacity assessment (CA) and provision of adequate information (PAI) for informal patients may constitute a risk of coercive admitting practice, resulting in increased use of the mental health act (MHA) in the days following admission. We developed and tested a proforma to aid in ensuring CA and PAI for informal admissions. Method A pilot case-study was conducted in 2015 at a U.K. NHS trust (n = 50), analysing the prevalence of CA & PAI for adult psychiatric inpatient admissions, alongside the prevalence of MHA use in the next 72 h. Case-note audits were completed in 2016 & 2017 (n = 100 each), to assess the impact of the proforma in improving documented CA & PAI, alongside the prevalence of MHA use in the next 72 h. We tested for any demographic associations with CA & PAI using logistic regression. Results CA improved from 39% (2015) to 60% (2017). PAI improved from 9% (2015) to 45% (2017). Use of the MHA in the 72 h following admission fell from 32% (2015) to 7% (2017). Most informal admissions detained within 72 h had no record of CA & PAI. People under the age of 26 years were significantly less likely to have documented CA & PAI. Implications Use of the proforma was successful in improving CA & PAI in a U.K. population. Further improvements could be made. Future research should seek to further examine demographic differences in informal coercion.
QI 152 To Improve Patient Safety for Those at Risk of Choking in an Inpatient Setting
(Coventry and Warwickshire Partnership NHS Trust, 2024) Brown, Karen; Ochel, Anna; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Speech and Language Therapy; Allied Health Professional; Brown, Karen; Ochel, Anna
Aim: To Increase Awareness and Increase Referrals by 30% for Patients at Risk Of Choking Within Learning Disabilities & Autism & Mental Health Inpatient Services. This project has been run jointly across MH and LD&A inpatient services. Across the services there were only small numbers of referrals being received, these were often following very severe choking events. Previous attempts to implement a referral process had been been unsuccessful. The processes, referral information, national guidance etc were reviewed to understand the current situation. Based on this a screening tool and referral process along with awareness training were developed and tested on one ward and gradually rolled out across other wards as the tool and process was adapted. Awareness training has been rolled out across the mental health wards and as part of staff induction in Learning Disabilities and Autism. Tools Used: Driver Diagrams - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf; SPC Charts - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-statistical-process-control.pdf; PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf. Project Impact: Standardised screening tool for assessing risk and making referrals to Dysphagia Service. Monthly report to Dysphagia Service re: choking incidents. Increase in referral rate for dysphagia assessment. Increased staff awareness across inpatient services. Screening being embedded into MH & LD&A admission pathway. Screening being completed as standard within Health Action Plan in LD&A. Facilities awareness and food Modification training.
QI 104 Implementation of MOSAIC (Multi-disciplinary One Stop Assessment and Intervention Clinic) within a Home Treatment Team
(Coventry and Warwickshire Partnership NHS Trust, 2024) Rowland, Tobias; Khurmi, Sanjay; Supported by the Quality Improvement Team, Coventry and Warwickshire Partnership Trust; Coventry and Warwickshire Partnership NHS Trust; Community Mental Health Services; Medical and Dental; Rowland, Tobias; Khurmi, Sanjay
Aim: To reduce the: 1.Proportion of people referred to the Home Treatment Team (HTT) following their initial assessment with the Mental Health Access Hub (MHAH) by 10% 2.Length of stay (LoS) for those patients referred to the Home Treatment Team (90% referrals <42 day length of stay) 3.Waiting time for an initial medical review following referral to the Home Treatment Team by 50%. The initial assessment of patients referred to the HTT should include multi-disciplinary team (MDT) assessment of needs, but involving different professionals often occurs over days to weeks. MOSAIC was introduced as a one stop MDT clinic set up to review newly referred patients who required an urgent assessment. Prior to MOSAIC patients were seen by the MHAH where there was no immediate access to an MDT. The assessment was undertaken by one clinician who determined if the patient required the HTT or another community team. This could lead to delays in the assessment process. Tools Used: Clinical Audit; SPC Charts; Patient/Survey Feedback. Aim Target Achieved Reduce number patients referred to HTT 10% 34% Reduction in LoS (to <42 days) 90% 86% Reduce time to initial medical review 50% 95% Project Impact: Aim - Reduce number of patients referred to HTT - Target 10% - Achieved 34%; Aim - Reduction in LoS (to <42 days) - Target 90% - Achieved 86%; Aim - Reduce time to initial medical review - Target 50% - Achieved 95%.
Architecture and functioning of child and adolescent mental health services : a 28-country survey in Europe
(Elsevier, 2017-06-05) Signorini, Giulia; Singh, Swaran P; Boricevic-Marsanic, Vlatka; Dieleman, Gwen; Dodig-Ćurković, Katarina; Franic, Tomislav; Gerritsen, Suzanne E; Griffin, James; Maras, Athanasios; McNicholas, Fiona; O'Hara, Lesley; Purper-Ouakil, Diane; Paul, Moli; Santosh, Paramala; Schulze, Ulrike; Street, Cathy; Tremmery, Sabine; Tuomainen, Helena; Verhulst, Frank; Warwick, Jane; de Girolamo, Giovanni; Saint John of God Clinical Research Center; University of Warwick; Coventry and Warwickshire Partnership NHS Trust; Psychiatric Hospital for Children and Youth, Zagreb; Erasmus University Medical Centre; University Health Center, Osijek; Clinical Hospital Center Split; Yulius Academy, Rotterdam; University College Dublin; Our Lady's Hospital for Sick Children, Crumlin; Lucena Clinic; CHU Montpellier-St Eloi Hôpital; King's College London; Maudsley Hospital; HealthTracker Ltd; University of Ulm; University of Leuven; Department of Child and Adolescent Psychiatry and Psychology, Rotterdam; Psychiatry; Medical and Dental; Singh, Swaran; Paul, Moli
The WHO Child and Adolescent Mental Health Atlas, published in 2005, reported that child and adolescent mental health services (CAMHS) in Europe differed substantially in their architecture and functioning. We assessed the characteristics of national CAMHS across the European Union (EU), including legal aspects of adolescent care. Using an online mapping survey aimed at expert(s) in each country, we obtained data for all 28 countries in the EU. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, and clinicians and organisations, and delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Neurodevelopmental disorders were the most frequent diagnostic group (up to 81%) for people seen at CAMHS (data available from only 13 [46%] countries). 20 (70%) countries reported having an official national child and adolescent mental health policy, covering young people until their official age of transition to adulthood. The heterogeneity in resource allocation did not seem to match epidemiological burden. Substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents are needed.

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