A randomised controlled study of close monitoring of vulnerable psychiatric patients

Tyrer, Peter; Morgan, Janice; Horn, Elizabeth Van; Jayakody, M.; Evans, Kathryn; Brummell, R.; White, Tyler D.; Baldwin, David S.; Harrison-Read, Phil; Johnson, Tony

doi:10.1016/s0140-6736(95)90640-1

Cited by 145 publications

(53 citation statements)

References 10 publications

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“…Please make a note in the notes section to help us understand your response. Less likelihood of patients being lost to follow-up 62,68 Better teamworking across professions 16,68,79 Creative care packages 68 Rigorous documentation 68,79,80 Better care planning 68,79 Improve effectiveness of care 68,70,81,82 No increase in hospitalisation 82 No more/or limited resources to implement CPA. 68,83,86 CPA means more work for staff, 16,68,82,83 especially increased bureaucracy, 16,68,71 which results in time away from patient contact 16,68,83 and the perception of staff that they are overworked 16,68 leading to staff frustration 68 Community psychiatric nurses unclear of role.…”

Section: Data Sharing Statementmentioning

confidence: 99%

“…Assists audit as once in electronic format, the information lends itself to statistical analysis and key words can be searched for 81 Gilleard (1995) 79 Lawson et al (1999) 86 Webb et al (2000) 98 Cornwall (2001) 82 Schneider (1993) 68 Carpenter and Sbaraini (1996) 80 Tyrer et al 62 Allen (1998) 70 74 Simpson et al (2003) 58 Simpson (2005) 16 Lawn et al (2007) 173 Simpson (2007) 63 Swinson et al (2010) 76 Gould ( Margerison 174 (1998)…”

Section: Data Sharing Statementmentioning

confidence: 99%

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Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Simpson

Hannigan

Coffey

et al. 2016

Health Serv Deliv Res

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BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Data Sharing Statementmentioning

confidence: 99%

Section: Data Sharing Statementmentioning

confidence: 99%

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Simpson

Hannigan

Coffey

et al. 2016

Health Serv Deliv Res

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“…They are a useful starting point in our attempt to bring together evidence of cost-effectiveness that might be useful for policymakers in making decisions on resource allocation in this country. A large number of reviews of community mental health teams (CMHTs) suggest that there are benefits to the introduction of generic community-based multidisciplinary teams (Tyrer et al, 1995(Tyrer et al, , 1998(Tyrer et al, , 2003Thornicroft et al, 1998;Burns, 2001;Simmonds et al, 2001). The main findings of these reviews were that mental health care services delivered by CMHTs resulted in greater user and carer satisfaction and fewer people leaving treatment early.…”

Section: Cost-effectiveness Of Community Care Modelsmentioning

confidence: 99%

The Economics of Mental Health Care in Ireland

O’Shea¹,

Kennelly²

2008

PsycEXTRA Dataset

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“…Similarly, the least impressive results are reported by studies of purely 'broker age' interventions (here the main function of the case managers is to assess the client's needs thoroughly and then purchase the necessary services from specialist providers; the case managers themselves do not take part in delivery of the clinical care), with clinical case management falling between these extremes. The handful of studies of care management and CPA in this country are uniformly disappointing, reflecting their similarity to brokerage models in which the nature of treatment is not specified and the keyworker is neither equipped to provide specialist treatments nor has any control over hospitalisation (Marshall et al, 1995;Tyrer et al, 1995).…”

Section: Greater Patient Satisfactionmentioning

confidence: 99%

Assertive community treatment for the severely mentally ill in West Lambeth

Craig¹,

Pathare²

1997

Adv. psychiatr. treat

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The prime duty of specialist mental health services is to provide effective care to often non-compliant and unstable severely mentally ill (SMI) patients. Society expects such care to be humane and effective, but also demands that the severely ill are closely supervised to minimise risk to the public. Sadly, specialist services all too often fail on both counts. In part, this is due to the sheer complexity of care that is needed, going far beyond purely medical or therapeutic interventions. SMI patients have profound difficulties accessing and using everyday services and opportunities. Negative symptoms of apathy, self-neglect and low motivation, coupled with irrational beliefs and compounded by inadequately resourced and tightly rationed provision of social care, require mental health care services to be constantly active across areas of both medical and social provision. Services that ignore the importance of long-term, integrated care do so at their peril. A steady stream of disasters has been blamed on a lack of communication and coordination between agencies (Spokes, 1988; Ritchie et al, 1994), and follow-up studies of SMI patients managed by traditional hospital out-patient services repeatedly note a mismatch between levels of need and service uptake, with the least needy consuming the greater amount of service (Goering et al, 1984; Melzer et al, 1991).

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A randomised controlled study of close monitoring of vulnerable psychiatric patients

Cited by 145 publications

References 10 publications

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

The Economics of Mental Health Care in Ireland

Assertive community treatment for the severely mentally ill in West Lambeth

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