Dudley and Walsall Mental Health Partnership NHS Trust

Stephen Pilling originated the work, along with Health Education England who commissioned it, and together with Shubulade Smith oversaw its development. Anthony Roth devised the competence framework maps and extracted and wrote the competences, with assistance from Kate Sherratt, Caroline Monnery and Jane Boland. Jessica Barrett wrote the background documents with support from Anna Lawes and Anthony Roth. Kasia Furmaniak conducted preliminary literature reviews. The work was edited by Kate Lorrimer, Clare Taylor and Kasia Trojanowska.

A systematic review concerning whether ‘Mild Cognitive Impairment’ (MCI) is a helpful concept for service users was presented at the FPOP conference in July 2019. This paper will summarise the findings relating to impact and utility of the label, in addition to discussing the clinical implications.

The editorial by Marshall and colleagues immediately resonated with me, as I am sure it has with many other medical colleagues.1 We must realise the interconnectedness of things. A public health …

This article reviews a Court of Protection case involving a woman, Ms X, with two severe medical conditions: anorexia nervosa and end-stage liver cirrhosis due to alcohol dependence. Each of these conditions alone warranted end-of-life care planning. When combined, they provided a far more unique and complex presentation because of the way they were intertwined. Ms X's life was in imminent danger. The Court implemented methodically the principles of the Mental Capacity Act 2005. Ms X was assessed as lacking capacity to make decisions in relation to treatment for her anorexia. However, she retained capacity to make decisions regarding treatment for her liver disease and the continued harmful use of alcohol. The Court ruled that it was not in Ms X's best interests to be subject to further compulsory treatment for her anorexia, even though this may have prolonged her life. It was also in her best interests and lawful not to provide nutrition and hydration with which she did not comply.

In view of forthcoming 'payment by results' (PbR) for mental health, increasing number of National Health Service (NHS) Trusts are reorganizing their community services for working age adults to create care pathways. However, research base for the care pathways model in mental health is limited. Our NHS Foundation Trust was one of the first to introduce care pathways for community psychiatry in the UK. We have carried out a qualitative study to evaluate how this model works out in practice, including its impact on quality of patient care, mental health professionals and primary care. We interviewed doctors, multidisciplinary staff and Trusts managers (19 in total). Transcripts of recorded interviews were coded and analysed thematically using a grounded theory approach. Overall, despite teething problems, working in pathways was generally seen as a positive change. It led to more focused interventions being offered, and practitioners being held to account over clear standards of care. It is more cost-effective and allows for active case management and clear clinical leadership. It is recovery focused and encourages social inclusion. The arbitrary time frame, strict criteria and thresholds for different teams can create issues. Improved communication, flexible and patient-centred approach, staff supervision, and increasing support to primary care were felt to be central to this model working efficiently and effectively. Introduction of care pathways is an important step towards effective implementation of PbR for mental health. Our study would inform future research into care pathways, facilitate organizational learning and help to improve effectiveness of services.

When mental illness affects children and parents within the same family there is a need for close professional collaboration between the respective psychiatric teams. However, there is no nationally established precedence for this, and the area has not been investigated within the published literature. Retrospective case note study of 322 child psychiatric patients to estimate the prevalence of parental mental illness and analyse the degree of professional liaison taking place. Twenty-eight children had parents with concurrent mental health problems. Only four of these cases (14.2%) contained evidence of ongoing professional liaison between child and adult mental health teams. Inadequate liaison between child and adult services is a problem within the UK mental health system and detrimental to patient care. Recent national interest in establishing a more integrated family-focused service is encouraging, but will take time to implement and will not replace the need for separate specialist services. Efficient clinical collaboration must be developed at local levels to create a more comprehensive management strategy for children and parents with concurrent mental health problems.

Understanding the perceptions of direct care staff of their reciprocal relationships at work and levels of burnout may help us improve not only their psychological health but also the service they provide. A cross-sectional survey was undertaken with direct care staff who worked with children, older people and people with intellectual disabilities in residential settings. Staffs were asked to report their levels of burnout and perceived reciprocity in the relationship they had with service users, other staff and the organisation they worked for. Significant relationships were found between some burnout and reciprocity measures. 'Under benefit' in relationships with service users, colleagues and the organization was related to emotional exhaustion. 'Under benefit' in organizational and staff relationships was related to increased depersonalization. Reciprocity is a potentially useful concept for understanding differences in relationships across a broad range of staff and use of the reciprocity questionnaire in this study allows for comparison between diverse groups. The importance of relationships with the employing organization is highlighted in this sample and suggests that burnout is not solely linked with lack of reciprocity in the caregiving relationship per se.

This report highlights the current understanding of personality disorders with specific emphasis on service provision in the context of recent policies and guidelines issued by the Department of Health. It gives an overview of the wide range of perspectives of various stakeholders. It explores the key aspects of collaboration and the implications of a collaborative approach to delivering services for people with personality disorders. It also makes recommendations for implementation and identifies the organisations involved in the process of collaboration.

Abstract Background: Psychiatric intensive care units (PICUs) provide care for patients who may demonstrate agitation and aggressive tendencies. Such behaviour has traditionally been managed using interventions such as seclusion and/or physical restraint. There is little published data about the use of these measures within different PICUs. This paper attempts to provide such evidence as a base for clinical governance. Aims: To describe patterns of seclusion and restraint usage within the care of 332 patients admitted consecutively to seven English PICUs. Method: Prospective, multi-centre patient case note analysis. Results: Within the four units that utilised seclusion in the study period, it was used on 16% of patients who had been admitted. All seven units used control and restraint and 28% of admitted patients were formally restrained at some point during their admission. There was no significant difference in mean duration of restraint or proportion of patients who were restrained between the units that used seclusion and those that did not. Use of seclusion was significantly associated with patient violence and property damage in PICU. Restraint usage was also significantly associated with patient violence and property damage but also with higher two week BPRS scores and a younger patient age. Conclusions: It appears that PICUs manage disturbed behaviour differently, either dependent upon facilities or local policies. In attempting to reduce the use of seclusion and restraint, a multi-faceted approach must be taken both locally and nationally. PICU clinicians and service users should be integral within this.