Showing papers by "Graham Thornicroft published in 2003"

Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools.

Abstract: Background The persistent and disabling nature of psychiatric stigma has led to the establishment of global programmes to challenge the negative stereotypes and discriminatory responses that generate social disability, but these initiatives are rarely evaluated. Aims To assess the effectiveness of an intervention with young people aimed at increasing mental health literacy and challenging negative stereotypes associated with severe mental illness. Method A total of 472 secondary school students attended two mental health awareness workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural intentions. Results Young people use an extensive vocabulary of 270 different words and phrases to describe people with mental health problems: most were derogatory terms. Mean positive attitude scores rose significantly from 1.2 at baseline to 2.8 at 1-week follow-up and 2.3 at a 6-month follow-up. Changes were most marked for female students and those reporting personal contact with people with mental illness. Conclusions Short educational workshops can produce positive changes in participants' reported attitudes towards people with mental health problems.

Standardised Assessment of Personality - Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder.

Abstract: Background There is a need for a brief and simple screen for personality disorders that can be used in routine psychiatric assessments. Aims To test the concurrent validity and test–retest reliability of a brief screen for personality disorder. Method Sixty psychiatric patients were administered a brief screening interview for personality disorder. On the same day, they were interviewed with an established assessment for DSM–IV personality disorder. Three weeks later, the brief screening interview was repeated in order to examine test–retest reliability. Results A score of 3 on the screening interview correctly identified the presence of DSM–IV personality disorder in 90% of participants. The sensitivity and specificity were 0.94 and 0.85 respectively. Conclusions The study provides preliminary evidence of the usefulness of the screen in routine clinical settings.

Reducing psychiatric stigma and discrimination--evaluating an educational intervention with the police force in England.

Abstract: Background: Across the world there are programmes challenging negative stereotypes of people with mental health problems and associated discriminatory behaviours, but the evidence base describing what works in practice is still underdeveloped. This paper evaluates the effectiveness of a mental health training intervention with the police force in England. Method: A total of 109 police officers attended training workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural interventions. Results: Mean attitude scores fell from 2.4 at baseline to 2.3 at follow-up (p < 0.0001) using a 5-point Likert scale. Five key message statements were assessed – 70 % of cases successfully reported more messages at follow-up as compared to baseline; however, the stereotype linking people with mental health problems with violent behaviour overall was not successfully challenged. Positive impacts on police work, particularly improvements in communication between officers and subjects, were reported by a third of cases. Conclusions: Short educational interventions can produce changes in participants' reported attitudes towards people with mental health problems, and can leave police officers feeling more informed and more confident to support people in mental distress.

Social inclusion, social quality and mental illness.

Abstract: It has been argued that people with a significant mental illness are among the most excluded in society. Sayce ( [2001][1]), for instance, has proposed that psychiatrists should directly embrace social inclusion and recovery as treatment goals. They should indirectly contribute by engaging in the

Characteristics of Subgroups of Individuals With Psychotic Illness and a Comorbid Substance Use Disorder

Abstract: Objectives: The co-occurrence of severe mental illness and substance use disorder, or dual diagnosis, is prevalent and is associated with significant clinical and social problems. Most studies have treated persons with a dual diagnosis as a homogeneous population, grouping together different substances of misuse. This study investigated whether subgroups defined by their main substances of misuse were heterogeneous. The primary hypothesis was that users of stimulants, such as cocaine or amphetamines, would be characterized by especially high rates of inpatient admission, violence, and self-harm. Methods: Case managers’ ratings were used to identify individuals with serious mental illness and comorbid substance abuse or dependence who were being treated by 13 community mental health teams in South London. Standardized instruments were used to elicit sociodemographic, clinical, social, and service use data. Results: A total of 233 cases of comorbid substance use disorder and psychotic illness were identified. On the basis of best available information, 78 (34 percent) patients were classified as alcohol misusers only, 52 (22 percent) as alcohol and cannabis users, 29 (12 percent) as users of cannabis only, and 55 (24 percent) as stimulant users; 19 patients (8 percent) were excluded from the analysis. No significant differences were found between subgroups in the use of inpatient services and lifetime history of self-harm, but there was a significant difference in lifetime history of violence, which was more frequent among stimulant users. The alcohol users were older and more likely to be white, but otherwise few differences between subgroups were suggested by exploratory analyses. Conclusions: Apart from differences in history of violence, little heterogeneity was found among subgroups of patients with different types of substance misuse. (Psychiatric Services 54:554–561, 2003)

Satisfaction with mental health services among people with schizophrenia in five European sites: Results from the EPSILON study

Abstract: Patient satisfaction with services is an important outcome variable that is increasingly used in mental health service evaluation. This study includes 404 people with schizophrenia in five European sites and addresses five questions focused on site, service, and patient characteristics as variables that might explain service satisfaction, using the Verona Service Satisfaction Scale. Patient satisfaction differed significantly across sites (highest in Copenhagen, lowest in London). In all sites, patients were least satisfied with involvement of relatives in care and information about illness. A multiple regression model showed that lower levels of total service satisfaction were associated with living in London or Santander, being retired/unemployed, having more hospital admissions, having more severe psychopathology, having more unmet needs, or having lower satisfaction with life. This model explained 31 percent of variance in service satisfaction. Our data show that service satisfaction can be seen as a result of (1) the ability of the service to provide a standard of care above a certain quality threshold, and (2) the perception of each patient that the care received has been tailored to the patient's own problems.

The needs of older people with mental health problems according to the user, the carer, and the staff

Abstract: SUMMARY Background Individual assessment of needs has been recognised as the most appropriate way to allocate health and social care resources. These assessments, however, are often made by the staff or by a carer who acts as an advocate for the user themselves. Little is known about how these proxy measures compare to how individual patients perceive their own needs. Aim The aim of this study was to measure and compare ratings of need for older people with mental health problems by the older person themselves, their carer, and an appropriate staff member. Method One-hundred and one older people were identified from various mental health services and 87 users, 57 carers, and 95 staff were interviewed using the Camberwell Assessment of Need for the Elderly (CANE) to identify met and unmet needs. Results Users identified significantly fewer of their needs (5.5) than either staff (8.1) or carers (8.3) did, but this difference was accounted for by people with dementia reporting less needs. Users identified fewer psychological or social needs (e.g. daytime activities, company, or carer distress) than staff or carers did. The average Kappa indicating level of agreement between staff and user was 0.52, between user and carer was 0.53, and between carer and user was 0.58. This showed only a fair level of reliability between different ratings of need. Conclusions User perspectives should be given a high priority when assessing individual needs. Fears that assessment of need would be unduly time-consuming or would simply reflect individual demands should be allayed. A user-based assessment will assist healthcare providers to prioritise needs according to what the user themselves consider to be most important, beneficial, and acceptable to them. Reliance solely on assessment by staff or carers may not lead to the most equitable or appropriate use of services. Copyright # 2003 John Wiley & Sons, Ltd.

People with schizophrenia in five countries: Conceptual similarities and intercultural differences in family caregiving

Abstract: The European Psychiatric Services: Inputs Linked to Outcomes and Needs (EPSILON) study was a EU BIOMED-2-funded comparative, cross-national, cross-sectional study aimed (1) to produce standardized versions of five key research instruments in five languages, and (2) to compare the characteristics, needs, and life qualities of people with schizophrenia and their caregivers in these five countries. One of the key instruments was the Involvement Evaluation Questionnaire (IEQ), an instrument to assess caregiving consequences. In this article, the intercultural validity of the IEQ is described. It was concluded that the IEQ covers the same caregiving domains in all five countries: interpersonal tension, worrying, urging, and supervision. Differences in score levels between countries were found. When adjusted for variables known to correlate with IEQ scores (patient, caregiver, and relationship), these differences still persisted. It could not be determined how far the remaining variation could be explained by site-level characteristics, because only limited site-level data had been collected. This means that researchers must still resolve the question of whether levels of caregiver consequences that cannot be explained by the data presented here are caused by cultural factors or by differences in mental health care provision. As long as cultural bias cannot be ruled out, researchers are advised to compose their own national norm groups and use these as a local standard.

Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth

Abstract: Background There has been little research into the health of infants of women with psychotic disorders. Aims To investigate the antenatal care of mothers with a history of psychotic disorders, obstetric outcomes and the subsequent health of their babies. Method A matched, controlled cohort study was carried out using the General Practice Research Database. Women with a history of a psychotic disorder, who gave birth in 1996-1998, were compared with women matched for age and general practice (199 cases and 787 controls) and their infants. Results Cases had a higher proportion of stillbirths (OR=4.03, 95% CI 1.14-4.25, P =0.03) and neonatal deaths ( P <0.001). There was no difference in gestational age at antenatal booking. Mothers with psychotic disorders were less likely than controls to attend for infant immunisations 90-270 days after birth (RR=0.94, 95% CI 0.88-0.99, P =0.03). There was no significant difference in the rates of accidents and hospital contacts for infants. Conclusions There is an increased risk of stillbirth and neonatal death in women with a history of psychotic disorder, and it is therefore important for health care professionals to focus on optimal obstetric care. The physical health of babies who live with mothers with psychotic disorders is not significantly different from that of matched baby controls.

Inverse care for mentally ill prisoners: unmet needs in forensic mental health services

Abstract: Previous studies have demonstrated increasing levels of psychiatric morbidity among the UK prison population. Few studies of this population have been conducted using systematic needs assessment instruments. We tested the hypotheses that mentally disordered offenders (MDOs) who go into prison from the community differ significantly from general adult patients in having (1) more needs and (2) more unmet needs. We compared 73 consecutive male patients who had psychotic illness and were transferred from prison with 84 male patients who had psychotic illness and were in the community. Patients were interviewed using the Camberwell Assessment of Need schedule (CAN). Inmate medical records were examined and prison healthcare staff were interviewed. The results showed that the prison group had significantly more total needs on average and significantly more unmet needs than their general adult patient counterparts. The greater unmet needs were in the following domains: psychotic symptoms, psychological distress,...

Is NHS Direct meeting the needs of mental health callers

Abstract: Background: NHS Direct is a new service that offers 24-hour advice from trained nurses. The National Service Framework for Mental Health and the National Strategy for Carers both mention NHS Direct as an important source of support for people with mental health problems. Aims: This paper reports findings from an evaluation of the Department of Health's NHS Direct mental health initiative. This initiative was established to ensure that NHS Direct can meet the needs of callers with mental health problems by offering additional training to all staff and improving the database of mental health services. Method: The findings reported here are based on routine computer data provided by 12 out of 17 NHS Direct sites, 552 data forms completed by nurse advisers from the 17 sites, and 111 questionnaires administered over the telephone with callers to the 17 sites. Results: Mental health calls accounted for 3% of NHS Direct's workload, although these calls were often longer and more complex than other calls. The maj...

Costs and benefits of a pilot shared care register between primary and secondary healthcare for patients with psychotic disorders

Abstract: This pilot study in a three-GP practice investigated whether using a shared care register (SCR) of psychosis patients (n ¼ 45), updated at bimonthly liaison meetings with a community psychiatrist would (i) enhance GP involvement in severe mental illness (SMI) patients and (ii) improve primary care links with the community mental health team (CMHT). Method: A GP questionnaire was used to rate study practice GPs and a matched sample of comparison GPs with no SCRs. Results : The GP who attended the liaison meetings gave high ratings of satisfaction on communication with the CMHT and had a higher level of SMI involvement than other GPs in the study. His practice colleagues were no more involved with SMI patients and were less satisfied than the comparison GPs. There was no discernible impact of the SCR on patient care for any GPs. Although inexpensive, the advantages of the SCR were only gained by the GP directly involved in the register meetings. The mean cost of the SCR was £59 per patient per year. Conclusions: The benefits conferred by this model of consultation–liaison appear limited to the primary care staff directly involved and half of the local GPs consulted do not want direct involvement in such registers. Although a larger study involving more GP practices is needed to fully examine its value, from the present findings the model may have only partial applicability at a population level.