Community mental health center board development : a manual for board trainers, board members, CMHC staff, policy-makers /

Contract no. 290-77-0010.

The Large Allen Cognitive Level Screen as an indicator for medication adherence among adults accessing community mental health services

Background: Medication remains the cornerstone treatment for mental illness. Cognition is one of the strongest predictors of non-adherence. The aim of this preliminary investigation was to examine the association between the Large Allen Cognitive Level Screen (LACLS) and medication adherence among a small sample of mental health service users to determine whether the LACLS has potential as a screening tool for capacity to manage medication regimens. Method: Demographic and clinical information was collected from a small sample of people who had recently accessed community mental health services. Participants then completed the LACLS and the Medication Adherence Rating Scale (MARS) at a single time point. The strength of association between the LACLS and MARS was examined using Spearman rank-order correlation. Results: A strong positive correlation between the LACLS and medication adherence (r = 0.71, p = 0.01) was evident. No participants reported the use of medication aids despite evidence of impaired cognitive functioning. Conclusion: This investigation has provided the first empirical evidence indicating that the LACLS may have utility as a screening instrument for capacity to manage medication adherence among this population. While promising, this finding should be interpreted with caveats given its preliminary nature.

An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland.

In mental health services over recent decades, the positive move away from hospital-based care to community-based services has entailed that people with higher levels of need are being supported by community mental health services. This paper begins by reviewing the literature on coercion in the field of community-based mental health care and treatment. It is argued that the lack of a critical understanding of the concept and how it is used by practitioners and agencies can have serious repercussions for the rights of service users. Using a quasi-experimental, longitudinal design, the authors then seek to test some of the ideas about coercion by comparing the activities of assertive outreach and community mental health teams in Northern Ireland, particularly the key ideas of perceived coercion, workers’ strategies and engagement with services. Key findings were that assertive outreach appeared to be more successful at reducing perceived coercion, minimizing the need for coercive strategies, engaging high-risk clients and reducing inpatient bed use. These findings are compared with other studies in this area. The authors also argue that there is a need for greater transparency in the way that practitioners use coercive measures and more explicit guidance is required in this crucial area of mental health practice.

The impact of patient suicide on community mental health teams

Suicide in Scotland is considered an urgent public health issue affecting all aspects of society. The aim of this study was to explore how a patient suicide impacts on members of a community mental health team (CMHT). Six members of one CMHT were interviewed on two occasions, approximately nine months following a patient suicide. An interpretative descriptive model, drawing on elements of grounded theory, phenomenology end ethnography was chosen, using semistructured interviews for data collection. Three main themes of emotional response, communication and clinical implications were clearly described. Emotional response included feelings of shock and surprise, concern and personal impact. Communication included examples of personal, team and management communication in the days and weeks following the suicide. Clinical aspects discussed included the non-replacement of staff and training and experience as sub-themes. Findings in relation to the wider published literature are discussed

Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.

The contribution of psychological assessment to community mental health services

Specialist psychological assessment plays a potentially important role in multidisciplinary community mental health settings. This portfolio describes and evaluates this psychological assessment and provides four case studies.

Dialectical behavior therapy in community mental health settings : an evaluation

Borderline personality disorder causes extreme and enduring suffering. Dialectical Behavior Therapy is a psychological intervention that has been developed to treat the disorder. Two studies were conducted to test the effectiveness of the treatment. Results showed that borderline personality disorder can be treated effectively in the public mental health system. The portfolio presents four case studies to examine the notion that Cognitive Behavior Therapy (CBT) is efficacious in the treatment of anxiety as a comorbid condition.

Staff and patient perspectives on unmet need and therapeutic alliance in community mental health services

Therapeutic alliance between clinicians and their patients is important in community mental healthcare. It is unclear whether providing effective interventions influences therapeutic alliance.