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The Royal College of Psychiatrists Improving the lives of people with mental illness

Completed Projects


Projects

> 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.

> 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.


> 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


> 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


> 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.

> 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.

For more information please contact Masood Khan

> 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.

> 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.

> 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.

> 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.


> 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.

> 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:

> 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.

  • 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.