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> Age Discrimination in
Mental Health Services
The College made
tackling age discrimination a major priority in year one of the
Fair Deal campaign. This has involved campaigining in Parliament to
ensure that the Government outlaws age discrimination in health
serices in the Equality Bill and developing policy to support the
campaign messages.
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> Crisis Resolution and Home
Treatment Services for older people
This project, undertaken on behalf of
the College's Faculty of Old Age Psychiatry, set out to find out
about, and describe, a range of existing models in working age and
old age services of crisis resolution/home treatment and
intermediate care services.
To achieve this, the policy unit
carried out a literature review to find out what has been published
about different models - for example, dedicated older people's
crisis resolution/home treatment services, or crisis
resolution/home treatment services for working age adults which
have dropped their upper age limit. The unit contacted authors of
relevant papers and also followed up a number of contacts resulting
from a call to the Old Age and General & Community faculties to
identify services which might be of interest to this project.
This work resulted in a number of
services being identified. Managers and/or lead clinicians from
these services were then asked to complete a detailed questionnaire
about their service (including any data from evaluation
studies).
This information - essentially a
series of descriptions of the different services identified - is
now available and provides an easy way of comparing and contrasting
approaches. To download an Excel spreadsheet, which will allow you
to scroll between different services, click
here.
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> Forensic Mental Health
Services and the Economic Downturn Project
Building on an
existing work looking at
the impact of the recession on mental health services, the Policy
Unit and the College's Forensic Psychiatry Faculty worked to
identify more specifically what impact the recession and predicted
disinvestment within the NHS might have on forensic mental health
services.
This project
involved a survey of clinical directors working within forensic
mental health services. The survey results formed the basis of
discussion at the Faculty of Forensic Psychiatry Annual General
Meeting in early 2010.
For more
information regarding this project, please contact Masood Khan
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> Inpatients: Do the Right
Thing
Standards for
Working Age Adults in Acute Healthcare Settings
The Royal College of
Psychiatrists’ 2008 Fair Deal manifesto recorded evidence that
mental health services have lagged behind physical health services.
In-patient care in some hospitals did not meet acceptable
standards.
At the end of the 3-year
Fair Deal campaign it is now time to re-examine the issue and
reassess the evidence in the new political and economic climate,
and to identify essential areas for improvement.
Distilled from existing
working-age inpatient ward standards, a new report by the College
aims to (a) offer a useful minimum checklist of standards for
managers and commissioners of services to apply in strategic
planning and in assessing for themselves the quality of their
wards; and (b) to provide elaboration of the ten standards drawing
on the evidence of current practice as found by the reviewing
bodies.
It is hoped that this report
will make the case that in-patient services need continued
investment to make patient experience healthier, safer and more
conducive to proper clinical recovery and rehabilitation.
The former President of the Royal
College of Psychiatrists stressed the importance of inpatient
conditions in a recent article in the Guarding and also included it
in his valedictory speech at the College's international congress
in Brighton in late June 2011.
For information contact Masood Khan
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> In sight and in mind: A
toolkit to reduce the use of out of area mental health
services
Editors: Dr Tony Ryan, Gareth Davies, Andy Bennett,
Dr Helen Killaspy, Richard Meier
Contributing organisations:
Association of Directors of Adult Social Services; Audit
Commission; Department of Health; National Mental Health
Development Unit; NHS Confederation (Mental Health and Provider
Networks); NHS East of England; NHS East Midlands; NHS London; NHS
North Yorkshire and York; NHS West Midlands; Royal College of
Psychiatrists.
In sight and in
mind: A toolkit to reduce the use of out of area mental health
services
Designed to support health, social care and
housing commissioners, In sight and in
mind seeks to assist in developing and commissioning
services that are as close to home as possible for people using
mental health services and their families.
The toolkit is intended to contribute to local actions to
improve quality and individual/system outcomes by:
- Limiting the number of people placed
inappropriately
- Reducing the number of people placed at
distance from families and social networks
- Minimising the length of time that people
spend in out of area services
- Maximising and improving care coordination and
monitoring of placements
- Specifying services to actively promote
independence
- Encouraging services to be commissioned on a
needs basis, at appropriate costs and within commissioning
resources.
A summary of research and knowledge in this field is
provided to give best evidence of the current picture and some of
the issues associated with use of placements out of area.
A systematic seven-step framework to reduce the need
for out of area services is also described, and embedded within the
toolkit is a range of tools that have been developed and used
successfully across the country.
Furthermore, a series of case studies are also
described where people have successfully reduced the need for
unplanned use of out of area services. These contain contact
details of key personnel who are prepared to provide further
information about their work, if required.
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> Integrated Practices:
Mental Health Services in Criminal Justice
System
The College undertook a project to examine practices relating to
offender mental health care and how mental health services are
integrated in the criminal justice system. The aim was to explore
current and good practices that can be used to make a case for
greater integration of the two services. The findings were fed into
a NICE Offender Health seminar held in late September 2010 and may
inform any future NICE guidelines. There is a need for more
pragmatic approaches to offender health, particularly those which
have a sound evidence base, are already working effectively, and
present financial ‘cost-benefit’ investment.
For this project a Working Group was set up by
leads Dr. Nick Kosky, consultant psychiatrist and Dr. Rajesh
Nadkarni, consultant forensic psychiatrist and included other
experts in the field. In order to understand existing practice and
proposals for improvement, a survey was sent to relevant College
members asking about their experiences of cooperation between
mental health and criminal justice services.
There are a variety of different models of
integrated practice for diversion. This project will seek to
identify relevant models across the UK, and to draw upon these to
assist the National Health and Criminal Justice programme board in
developing proposals to improve the health of offenders.
The task of the National Health and Criminal
Justice program is to distribute the care of offenders across
health services generally and to increase understanding around the
management of people with mental health problems who are also
offenders.
It is hoped that the College’s findings will
urge improved practices for mental health care in the criminal
justice system and the case for improved cooperation between the
two.
Briefing
For more information please contact
Masood
Khan
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> NHS Listening Exercise
(England): Initial results from a survey of College
Members
In April 2011, the Government began
its 'Listening Exercise' on the NHS reforms in England. This
'Listening Exercise' was organised by the Future Forum, a
"group of clinicians, patient representatives voluntary sector
representatives and others from the health field, including
frontline staff."
The College made its views known to
the Future Forum and also sent a letter spelling out its concerns
directly to Andrew Lansley.
The Future Forum made its
recommendations to David Cameron, Nick Clegg, and Andrew Lansley at
the end of May 2011.
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> Out of
Area Treatments
This project aims to reduce the use
of unnecessary 'out of area treatments' (i.e. long-term hospital
placements or residential and nursing homes) for people with
complex mental health needs.
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> Prison Transfer
Interfaculty Project
Lord Bradley's
review of people with mental health problems or learning
disabilities in the criminal justice system contained a total of 72
recommendations to Government. Among these were a recommendation
that the Department of Health develop a new minimum target for the
NHS of 14 days to transfer a prisoner with acute, severe mental
illness to an appropriate healthcare setting.
In response to
Lord Bradley's Report, the Government accepted in principle the
direction in respect of 14-day prison transfers and in the House of
Commons Phil Hope, Secretary State for Health, recognised the
importance of ensuring that prisoners with severe mental illness
who require treatment in hospital have timely access to that
treatment.
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> Self-Harm, Suicide and
Risk
Chaired by Lord Alderdice and overseen
by the Policy Unit, the Risk to Self Working Group has
produced a College Report ‘Self-harm,
Suicide and Risk: helping people who self-harm’ which was
launched in June 2010.
The report had the
aims of improving awareness about the non-psychiatric causes of
self-harm, of changing service staff attitudes, and influencing
commissioners and the NHS in service provision. The report also
investigates training needs and barriers to the effective
implementation of existing policy.
The report was
developed by a Working Group and informed by a survey of
psychiatrists' experience of self harm care, as well as evidence
sessions held with experts in the field.
Self-harm, Suicide and
Risk: Implementation Group
In order to ensure the
recommendation from the College's ‘Self-harm,
Suicide and Risk: helping people who self-harm’ report will be
put into practice, we have set up an Implementation Group. This
group includes experts in the field (most of who were on the
report’s working group) including psychiatrists and other mental
health professionals, third sector organisations, academics in the
field, service users, carers as well as members from the College.
The group meets roughly 3 to 4 times a year and aims at developing
strategies of how the recommendations can be achieved.
For more information on the
Implementation Group and what has been done so far, please contact
Masood Khan.
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> Services for Black and
Minority Ethnic patients
In February 2009, an independent
expert panel was held at the Royal College of Psychiatrists.
The panel was instigated by Professor
Dinesh Bhugra (President RCPsych), and chaired by Melba Wilson
(National Director, Delivering Race Equality in Mental Health
Programme/Health Development Unit, England).
The panel reviewed existing standards
employed in the College Centre for Quality Improvement's
accreditation and quality improvement networks which related to the
care of Black and minority ethnic in-patients.
In November 2009, the subsequent
report - Improving in-patient mental health services for
Black and minority ethnic patients - made recommendations
for changes to these existing standards in 11 separate areas.
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> Summary, recommendations
and background material from a Royal College of Psychiatrists’
enquiry into the future development of UK mental health
services
In February and March 2010,
the Royal College of Psychiatrists held hearings, hosted a one-day
seminar and invited written submissions to gather the views of more
than 50 psychiatrists, psychologists, nurses, occupational
therapists, social workers, commissioners, trust chief executives,
academics, health economists, voluntary sector organisation chief
executives, service users, carers, medical directors and national
mental health programme leads on the future of UK mental health
services.
Following on from the publication of
Mental health
and the economic downturn, a report which highlighted the
need for service redesign in mental health, this enquiry - chaired
by John Bowis OBE - asked contributors to consider a number of
areas, including:
- positives and negatives from the last ten years of mental
health service reform
- how best to organise services to provide the best outcomes for
service users
- reconciling any tensions between generalist and specialist
approaches to care
- how best to achieve effective collaboration between different
health services
- how to better manage transitions between services, or parts of
a service, to ensure comprehensive care and continuity for service
users
- how to better integrate health, social care,
non-statutory/voluntary sector, employment and criminal justice
services.
Looking ahead:
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> The Economic Down-turn and
Forensic Mental Health Services
The aim of this
project was to explore the impact of the recession on forensic
psychiatry services accross the United Kingdom and to encourage
strategic thinking at the local and national level about how mental
health professionals might respond to predicted funding cuts.
This project was
building on a broader College initiative looking at the impact of
the recession on mental health services and consider solutions for
those working at a local and national level in service provision
and policy.
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Project Briefing Note: If you would like to read more about the
background to this project, please read the project briefing
note.
- College Report
on Mental Health and the Economic Down-turn: In early September 2009, the College held
an event on mental health and the economic downturn. This event was
convened by the Royal College of Psychiatrists, the Mental Health
Network, NHS Confederation and the London School of Economics and
Political Science. This
report was published in November 2009.
- Dealing
with the Downturn: This
paper
produced by the NHS Confederation, looks at some of the challenges
facing the NHS in light of predicted real term reduction of
£8-10billion in the three years from 2011.
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