Showing papers by "Graham Thornicroft published in 2007"

Stigma: ignorance, prejudice or discrimination?

Abstract: The term stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). Most research in this area has been based on attitude surveys, media representations of mental illness and violence, has only focused upon schizophrenia, has excluded direct participation by service users, and has included few intervention studies. However, there is evidence that interventions to improve public knowledge about mental illness can be effective. The main challenge in future is to identify which interventions will produce behaviour change to reduce discrimination against people with mental illness.

Discrimination in health care against people with mental illness.

Abstract: This paper discusses factors associated with low rates of help-seeking and poorer quality of physical healthcare among people with mental illnesses. Evidence is reviewed on the associations between low rates of mental health literacy, negative attitudes towards people with mental illness, and reluctance to seek help by people who consider that they may have a mental disorder. People with mental illness often report encountering negative attitudes among mental health staff about their prognosis, associated in part with 'physician bias'. 'Diagnostic overshadowing' appears to be common in general health care settings, meaning the misattribution of physical illness signs and symptoms to concurrent mental disorders, leading to underdiagnosis and mistreatment of the physical conditions.

250 labels used to stigmatise people with mental illness.

Abstract: Background The stigma against people with mental illness is a major barrier to help-seeking in young people for mental health problems. The objective of this study was to investigate the extent of stigma in relation to treatment avoidance in 14 year-old school students in England in relation to how they refer to people with mental illness.

Mental health policy and practice across Europe : the future direction of mental health care

Abstract: Series Editors' Introduction Foreword 1 Foreword 2 Acknowledgments Mental Health Policy and Practice Across Europe: an overview The Historical Development of Mental Health Services in Europe Inequalities, Social Exclusion and Mental Health Financing And Funding Mental Health Care Services The Evidence Base in Mental Health Policy and Practice A Policy Framework for the promotion of mental health and the prevention of mental disorders Common Mental Health Problems in Primary Care: Policy Goals and the Evidence-Base Reforms In Community Care: the Balance Between Hospital and Community -based Mental Health Care Developments in the Treatment of Mental Disorders Psycho-pharmaceuticals in Europe Mental Health Policy in Former Eastern Bloc Countries Addiction and Substance Abuse Housing and Employment Developing Mental Health Policy: a Human Rights Perspective The User and Survivor Movement in Europe Carers and Families of People with Mental Health Disorders The Mental Health Care of Asylum Seekers and Refugees Global Perspective on Mental Health Policy and Service Development Issues

An investigation of factors associated with psychiatric hospital admission despite the presence of crisis resolution teams.

Abstract: Crisis resolution teams (CRTs) provide a community alternative to psychiatric hospital admission for patients presenting in crisis. Little is known about the characteristics of patients admitted despite the availability of such teams. Data were drawn from three investigations of the outcomes of CRTs in inner London. A literature review was used to identify candidate explanatory variables that may be associated with admission despite the availability of intensive home treatment. The main outcome variable was admission to hospital within 8 weeks of the initial crisis. Associations between this outcome and the candidate explanatory variables were tested using first univariate and then multivariate analysis. Patients who were uncooperative with initial assessment (OR 10.25 95% CI-4.20–24.97), at risk of self-neglect (OR 2.93 1.42–6.05), had a history of compulsory admission (OR 2.64 1.07–6.55), assessed outside usual office hours (OR 2.34 1.11–4.94) and/or were assessed in hospital casualty departments (OR 3.12 1.55–6.26), were more likely to be admitted. Other than age, no socio-demographic features or diagnostic variables were significantly associated with risk of admission. With the introduction of CRTs, inpatient wards face a significant challenge, as patients who cooperate little with treatment, neglect themselves, or have previously been compulsorily detained are especially likely to be admitted. The increased risk of admission associated with casualty department assessment may be remediable.

Prison mental health inreach services.

Abstract: Prison mental health inreach teams have been established nationwide in England and Wales over the past 3 years to identify and treat mental disorders among prisoners. This paper summarises the policy content and what has been achieved thus far, and poses challenges that these teams face if they are to become a clear and effective component in the overall system of forensic mental healthcare.

Fair assessment of the merits of psychiatric research

Abstract: Background Use of bibliometric assessments of research quality is growing worldwide. So far, a narrow range of metrics have been applied across the whole of biomedical research. Without specific sets of metrics, appropriate to each sub-field of research, biased assessments of research excellence are possible. Aims To discuss the measures used to evaluate the merits of psychiatric biomedical research, and to propose a new approach using a multidimensional selection of metrics appropriate to each particular field of medical research. Method Three steps: (a) a definition of scientific ‘ domains’, (b) translating these into ‘filters’ to identify publications from bibliometric databases, leading to (c) the creation of standardised measures of merit. Results We propose using: (a) established metrics such as impact factors and citation indices, (b) new derived measures such as the ‘ worldscale’ score, and (c) new indicators based on journal peer esteem, impact on clinical practice, medical education and health policy. Conclusions No single index or metric can be used as a fair rating to compare nations, universities, research groups, or individual investigators across biomedical science. Rather, we propose using a multidimensional profile composed of a carefully selected array of such metrics.

Assessing the needs of pregnant women and mothers with severe mental illness: the psychometric properties of the Camberwell Assessment of Need - Mothers (CAN-M).

Abstract: There is an absence of standardized validated instruments to assess the complex needs of pregnant women and mothers with severe mental illness. We aimed to develop a standardized assessment of need for pregnant women and mothers with severe mental illness. Staff and service users were asked to identify relevant domains of need. Professional experts and service users were then surveyed and asked to rate the importance of the domains of the Camberwell Assessment of Need - Mothers version (CAN-M). Reliability was established using 36 service user-staff pairs. Concurrent validity was assessed with the Global Assessment of Functioning. Inter-rater reliability (concordance) coefficients for unmet needs were 0.93 (95% confidence interval 0.89 to 0.98) (service users) and 0.83 (95% confidence interval 0.73 to 0.94) (staff); test-retest reliability coefficients were 0.91 (95% confidence interval 0.86 to 0.97) and 0.85 (95% confidence interval 0.73 to 0.96), respectively. Relevant CAN-M domains correlated with the Global Assessment of Functioning-symptom (Spearman's r correlation coefficient = -0.36, 95% confidence interval = -0.62 to -0.04, p = 0.05) and Global Assessment of Functioning-disability subscales (Spearman's r correlation coefficient = -0.52, confidence interval = -0.73 to -0.23, p < 0.01). We conclude that the CAN-M is a reliable and valid instrument for assessing the needs of pregnant women and mothers with severe mental illness.

Effects of training community staff in interventions for substance misuse in dual diagnosis patients with psychosis (COMO study): cluster randomised trial.

Abstract: A cluster randomised controlled trial was used to investigate the effectiveness of training staff in 13 London community mental health teams (CMHTs) to deliver substance misuse interventions to patients with psychosis and comorbid substance misuse (‘dual diagnosis’). The primary hypotheses, which were that experimental group patients would spend fewer days in hospital over 18 months of follow-up and show reduced alcohol and drug consumption, were not confirmed, although confidence intervals were wide for some outcomes. Current UK policy guidance advocates training CMHT professionals to deliver dual diagnosis interventions, but the effectiveness of this strategy has not so far been demonstrated.