Key Messages in Local research Mental Health

1
Key Messages in Local research Mental Health

• Gavin Davidson,
• Team Leader,
• Holywell Hospital.

2
Plan of Presentation

• Key findings a local study completed in 2007
• Implications for practice
• Value of research for practice
• Personal benefits
• Opportunities to research

3
A comparative study of Assertive Outreach and
Community Mental Health Team support for people
with mental health problems in NI

• How should mental health services respond to
  people with severe and enduring mental health
  problems who present a high level of risk but are
  reluctant to engage with services?
• Two main responses Community Mental Health Team
  (CMHT) support and Assertive Outreach (AO)
• This study aimed to compare the effectiveness of
  these interventions

4
The study design

• Quasi-experimental, longitudinal design
• Followed 76 people who met the criteria for
  inclusion/AO over 18 months
• 76 recruited from three Trusts NWBT, Homefirst
  and Causeway
• 38 in AO group and 38 in CMHT group
• 60 provided some form of consent,
• Interviews at baseline, 9 months and 18 months
• Hospital data on all 76, 3 who died excluded

5
Findings

• AO group had a statistically significant 51
  reduction in inpatient bed use compared to the
  CMHTs 19 reduction
• Client satisfaction in the AO group was higher
  than in the CMHT group. Stigma and
  discrimination, Social life and How you spend
  your day had low levels of satisfaction
• Perceived coercion was high in the AO group at
  baseline but dropped below the CMHT level at nine
  and eighteen months

6
Findings continued

• 17/31 (55) reported childhood trauma and the
  trauma groups social functioning deteriorated
  over the eighteen months
• AO reported significantly better medication
  compliance/treatment adherence
• Across both groups only 24/55 (44) had the same
  key worker across the 18 months. A change of key
  worker had a negative impact on hospital use,
  engagement, workers strategies and perceived
  coercion

7
Findings

• The AO group used a statistically significant
  lower number of coercive strategies and both
  groups use of these strategies increased over
  time

8
Implications for Practice

• Daytime activities, company and the effects of
  stigma and discrimination should be of more
  central importance social inclusion
• Increasing use of coercive strategies in
  community based mental health services should be
  addressed as it may be ineffective strengths
  based approach better
• Life Skills Profile could be a useful tool for
  monitoring outcomes

9
Implications for Practice

• Trauma history should be routinely taken and
  responded to
• The team approach may be central to managing risk
  and ensuring continuity
• Additional coercive strategies such as CTOs may
  be unhelpful using less coercion was associated
  with better outcomes

10
Value of research for practice

• Helps understand and explain complex issues
• Describes practice relatively objectively
• Assesses effectiveness
• Provides justification for intervention
• Links practice internationally
• Provokes further questions
• Can directly inform practice and so hopefully
  improve outcomes for service users

11
Personal benefits

• Keeps you thinking
• Influences your own practice
• Develops transferable skills
• Personal links into international social work
• Provides a change from practice
• Opportunity to inform and possibly influence law,
  policy and practice
• Some sense of contributing to the development of
  evidence-based practice

12
Opportunities to research

• RD Office Personal and Doctoral Fellowship
  Schemes
• www.centralservicesagency.com/display/rdo_educatio
  n_and_training
• Research Methods at UU part of MSc in
  Professional Development bj.taylor_at_ulster.ac.uk