The implementation of the NICE guidelines for schizophrenia: Barriers to the implementation of psychological interventions and recommendations for the future

Berry, Katherine; Haddock, Gillian

doi:10.1348/147608308x329540

Cited by 147 publications

(154 citation statements)

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“…However, one key issue around family work is implementation. Rates of uptake to family interventions are very poor and this is mainly due to the lack of availability of suitable families, which may result from service recipients feeling disempowered, blamed or stigmatized (Berry and Haddock, 2008). This study may offer some guidance on this.…”

Section: Discussionmentioning

confidence: 96%

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

Wearden

Hartley

et al. 2016

Psychiatry Research

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2 Highlights• Patients' self-reports of their relatives being behaviourally controlling in the course of everyday life, namely taking control of them or helping them, were associated with higher levels of negative mood and symptoms.• Relatives' self-reports of behaviourally controlling interactions such as nagging, keeping an eye on the patient or taking control of the patient were significantly linked with fluctuations in relatives' mood, but not with patients' symptoms.• Contact with high-EE relatives (critical and overinvolved), had no association with patients' affect or symptoms in the course of daily life.3 Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis While research using Experience Sampling Methodology (ESM) suggests that, in general, contact with relatives or friends may be protective for psychotic experiences, contact with high-Expressed Emotion (high-EE) relatives can have adverse consequences for patients. This study investigated whether contact with high-EE relatives, and relatives' behaviourally controlling interactions (BCI) are related to patients' symptoms and to both patients' and relatives' affect when measured using structured diary assessments in the course of everyday life. Twenty-one patients experiencing psychosis and their closest relatives provided synchronized self-reports of symptoms (patients only), affect, dyadic contact and BCI over a 6-day period.Relatives' EE was obtained from Camberwell Family Interviews. Multi-level modeling showed that patients' reports of relatives taking control of them and helping them were associated with increased patient negative affect and symptoms. Relatives' self-reports of nagging, taking control and keeping an eye on the patient were related to fluctuations in relatives' affect. No evidence was found for the moderating effect of EE status on the association between dyadic contact and affect or, in the case of patients, symptoms. When measured using an ecologically valid methodology, momentary behaviourally controlling interactions within dyads experiencing psychosis can impact on patients' affect and symptoms.

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Section: Discussionmentioning

confidence: 96%

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

Wearden

Hartley

et al. 2016

Psychiatry Research

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“…In the current economic context, further investment in clinical psychologists seems unlikely, but a greater focus on training and supervising nurses and other staff to deliver psychological interventions has been shown to be possible in some psychosis services, 55 although problems with sustainability have also been identified. 56,57 This might include so-called 'low-intensity' psychological interventions that, although lacking a strong evidence base, may be easier for service users with complex mental health problems to engage with and assist with addressing some of the comorbidities and other issues that impede progress towards successful community discharge (e.g. anxiety management, relapse prevention, motivational interviewing).…”

Section: Discussionmentioning

confidence: 99%

“…through regular supervision with the link person identified to oversee the action plan in each unit). 57 The study was carried out during a time of turbulence in the NHS. The economic downturn meant that many units faced pressure to increase productivity and reduce costs.…”

Section: Discussionmentioning

confidence: 99%

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Killaspy

King

Holloway

et al. 2017

Programme Grants Appl Res

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BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

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“…Tedavi ve bakımdaki gelişmeler, antipsikotik ilaç kullanımı, psikososyal girişimler, destek ve rehabilitasyon hizmetleri, aile ve toplumun desteği şizofrenili bireylerin uzun dönem iyilik halinin olmasını sağlamakta, toplumda etkin olmaları ve yaşamlarını üretken yaşayabilmelerini belirleyebilmektedir (11,12).…”

Section: Etkileri Ve çAlışmanın öNemiunclassified

The İmportance of Employment in People with Schizophrenia

Öz¹,

Barlas²

2017

Jaren

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Hastaların işlevselliğini bozan, hasta yakınlarını ve toplumu olumsuz etkileyen, kişisel ve ekonomik sorunlara yol açan önemli bir halk sağlığı sorunu olan şizofreni, üretkenlik ve yeti yitimi, yüksek maliyet, beklenen yaşam süresinde kısalma ve yük-sek intihar oranları nedeniyle günümüzde en önemli ruh sağlığı sorunlarından birisi olarak görülmekte-dir (6,7).Şizofreni tedavisinde modern bakış açısı düzelmeyi, belirti şiddetlerinin azalması olarak belirleyen geleneksel yaklaşımdan farklı olarak, bağımsız yaşama becerileri, sosyal işlevsellik, istihdam, eğitim, kişile-rarası ilişkiler gibi alanlarda düzelme olmasının, iyileşmenin temel unsurları olduğunu vurgulamıştır (1,8).Gelişen tedavi modelleri arasında şizofrenili bireylerin istihdamın sağlanmasının, bireyin yaşam kalitesi ve işlevselliklerinin arttırılmasının önemi özellikle vurgulanmaktadır (9).Günümüzde "şizofrenili bireylerin ekonomik ve sosyal yaşama katılmalarını sağlamak", dünya genelinde ulaşılmak istenen ortak hedef haline gelmiştir. Bu katılımın sağlanmasında şizofrenili bireylerin işe yerleştirilmesi kilit bir önem taşımaktadır (10). Ancak, bu bireyleri işe yerleştirme sorunları çözümlenmiş değildir. Bu derlemede; şizofrenili bireyleri işe yerleştirmenin önemine ve karşılaştıkları engellere dikkat çekmek amaçlanmıştır.

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The implementation of the NICE guidelines for schizophrenia: Barriers to the implementation of psychological interventions and recommendations for the future

Cited by 147 publications

References 46 publications

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

The İmportance of Employment in People with Schizophrenia

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