Acute mental health service use by patients with severe mental illness after discharge to primary care in South London

Ramanuj, Parashar Pravin; Carvalho, Carlos; Harland, Robert; Craig, Tom; Byrne, Nicola

doi:10.3109/09638237.2015.1036968

Cited by 7 publications

(28 citation statements)

References 8 publications

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“…Within mental healthcare, a refocusing of resources under the Measure certainly appears to have been achieved through prioritising those with the most serious mental illness to receive expensive secondary care, whilst discharging others to primary care. This overall strategy, in its particular manifestation in the form of the Measure, may be related to a narrow, neoliberalist interpretation of person-centred recovery (Ramanuj et al, 2015). Here, the aim is to increase autonomy and responsibility for people with mental illness, coupled with reduced service dependency (Lester & Gask, 2006).…”

Section: Introductionmentioning

confidence: 99%

Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Weaver

2021

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PurposeTheoretical generalisation provides the basis for tackling problems of service complexity, fragmentation and disrupted care pathways.Design/methodology/approachRecent mental health service transformation in Wales, United Kingdom, has been stimulated by a policy programme underpinned by person-centred recovery values. This paper offers analysis informed by the perspectives of Niklas Luhmann and other noted theorists to examine escalating service system complexity related to this transformation. Analysis builds upon the findings of a qualitative study employing thematic discourse analysis of talk of people with mental illness and associated workers.FindingsIn total, three themes were constructed in participants' talk: “Competing versions of recovery”, “Misaligned service expectations” and “Disrupted care pathways.” Recovery may be understood as a form of moral communication and autopoietic meaning-making activity, according to Luhmann's radical constructionist epistemology. This has the potential to generate competing versions of recovery, a key contributor to escalating complexity.Research limitations/implicationsFindings could be developed further by continued investigation of the relationship between recovery implementation and service fragmentation.Social implicationsA more judicious, balanced policy-implementation may cultivate optimal conditions for recovery pluralism by avoiding polarisation towards either top-down, policy-based recovery implementation or a proliferation of approaches at the grassroots level. Findings have implications for healthcare settings beyond the scope of mental healthcare, given the prevalence of person-centred care internationally.Originality/valueA simplistic view of recovery implementation should be challenged. Recovery should not be considered a “magic bullet” for mental healthcare delivery. Haphazard recovery-implementation may have detrimental effects of escalating complexity, service fragmentation and disrupted care pathways.

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Section: Introductionmentioning

confidence: 99%

Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Weaver

2021

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“…There has been a long debate about who should be referred to specialist mental services or who should receive care in a primary care setting and how the interface should be most efficiently configured to promote joint working between professionals (Gask, Lester, Kendrick, & Peveler, ; Lester, Tritter, & Sorohan, ). However, there are noted deficiencies in the primary care for these patients and a call for more support in primary care services (NHS England ; Ramanuj et al., ; Reilly et al., ).…”

Section: Introductionmentioning

confidence: 99%

Exploring the value of mental health nurses working in primary care in England: A qualitative study

McLeod

Simpson

2017

Psychiatric Ment Health Nurs

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Aims/Question General practice is typically the first point of access to healthcare. This study explores what value a Primary Care Liaison Nurse (PCLN) service, established in 2011, can bring to people with mental health problems in primary care. Method Semi-structured interviews were used to elicit participants' experiences and perspectives on the value of a PCLN service. Participants included ten interviews with seven general practitioners and three senior practitioners working in primary care mental health services. Thematic analysis, based on a 6-phase approach, was used to describe and explore the data collected. Results Five main themes were derived from the thematic analysis of the interviews relating to: integration; clinical effectiveness; patient centred care; access; and efficiency. Discussion The study suggests that the PCLN service can improve the quality of care and is generally highly valued by its stakeholders. The study identifies particularly valued elements of the service, including having a duty worker, as well as aspects which could be improved, such as patient criteria. Implications for practice This is a relatively new service and the cost-effectiveness is not yet fully understood; however, commissioners may want to consider the potential benefits of a similar service in their area.

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“…A recent study in south London highlighted difficulties facing increased primary care for people with SMI (Ramanuj et al, 2015). This study showed that 58.2% of people discharged from secondary to primary care were referred back to secondary care within two years of their original discharge (Ramanuj et al, 2015).…”

Section: The Study Context and Backgroundmentioning

confidence: 99%

“…More recently, it has been argued that primary care is now sufficiently mature as a discipline to take on a lead role in mental health service delivery (Currid et al, 2012;Green and Thoroughgood, 1998;Lester et al, 2004;WHO, 2008). An increased emphasis on primary mental healthcare delivery may also be related to a recovery approach aimed at reducing specialist service dependency and service provision (Lester and Gask, 2006;Ramanuj et al, 2015). Another key driver behind this transition is the notion that primary care is more cost-effective than secondary or hospitalised care (Ramanuj et al, 2015;van Dijk et al, 2014).…”

Section: The Study Context and Backgroundmentioning

confidence: 99%

“…An increased emphasis on primary mental healthcare delivery may also be related to a recovery approach aimed at reducing specialist service dependency and service provision (Lester and Gask, 2006;Ramanuj et al, 2015). Another key driver behind this transition is the notion that primary care is more cost-effective than secondary or hospitalised care (Ramanuj et al, 2015;van Dijk et al, 2014).…”

Section: The Study Context and Backgroundmentioning

confidence: 99%

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Experiences of care continuity and recovery for people at the interface of primary and secondary mental health care in Wales: a thematic discourse analytic approach

Weaver¹

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This study explores talk about experiences of care continuity and recovery for people with serious mental health issues at the interface of primary and secondary mental healthcare in Wales. The approach adopted was qualitative, employing a methodology of thematic discourse analysis of talk generated by in-depth, semi-structured interviews. The study was conducted in two phases, the first round involving (n = 16) service users who had transited from secondary to primary care, and the second round involving (n = 16) workers and practitioners involved in supporting service users at the primary-secondary interface.The main findings were first that participants' expectations were misaligned with transforming service structures and interfaces. Second, participants constructed competing versions of recovery in their talk. Third, analysis of talk revealed experiences of care discontinuities in multiple areas, concentrated particularly at the primary level. On this basis, it is argued that a proliferation of competing recovery versions, and misaligned expectations of transforming But my most heartfelt debt of gratitude is directed towards those closest to me. My wife Zoe's support was crucial so very often, particularly with respect to the two children we have had whilst doing this PhD, Bridget and James, whose infantile support I would also like to acknowledge. From the start I think she has known the sacrifice she would need to make, and she has done so admirably. I would also like to thank God for restoring me to the point of this undertaking, sustaining me continually throughout the journey, and without whom I am nothing. Finally, my many thanks go to my Dad whose support is obvious and gratefully received, and of course my mother-in-law, Diana, who looked after both babies so many times in my stead, thereby allowing me to focus on my work! Contents ContentsChapter 1: Introduction

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Acute mental health service use by patients with severe mental illness after discharge to primary care in South London

Abstract: The majority of the discharged patients were re-referred to mental health services. Although these were more stable, there was no difference from the transferred group on acute service use. Further support may be required in primary care to maintain stability.

Cited by 7 publications

References 8 publications

Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Escalating complexity and fragmentation of mental health service systems: the role of recovery as a form of moral communication

Exploring the value of mental health nurses working in primary care in England: A qualitative study

Experiences of care continuity and recovery for people at the interface of primary and secondary mental health care in Wales: a thematic discourse analytic approach

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