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Background: This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. Aims: Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. Method: Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. Results: The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. Conclusions: Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs. [ABSTRACT FROM AUTHOR]

Objectives: In the UK and elsewhere, specialist community mental health teams (CMHTs) are central to the provision of comprehensive services for older people with mental ill health. Recent guidance documents suggest a core set of attributes that such teams should encompass. This article reports on a systematic literature review undertaken to collate existing evidence regarding the structures and processes of CMHTs for older people and to evaluate evidence linking approaches to effectiveness. Method: Relevant publications were identified via systematic searches, both electronic and manual. Searches were limited to the UK for descriptions of organisation and practice but included international literature where comparisons between different CMHT arrangements were evaluated. Empirical, peer-reviewed studies from 1989 onward were included, extended to non peer-reviewed nationally or regionally representative reports, published after 1998, for the descriptive element. Results: Forty-five studies met inclusion criteria of which seven provided comparative outcome data. All but one were UK based. The most robust evidence related to research conducted in exemplar teams. Limited evidence was found regarding the effectiveness of many of the core attributes recommended in policy directives although their presence was reported in much of the literature. Conclusions: The contrast between presentation and evaluation of attributes is stark. Whilst some gaps can be filled from related fields, further research is required that moves beyond description to evaluation of the impact of team design on service user outcomes in order to inform future policy directives and practice guidance. A framework for an evidence-based model of CMHTs for older people is provided. [ABSTRACT FROM PUBLISHER]

Working with people with severe psychological and social problems can affect workers' mental health. People associated with a diagnosis of personality disorder in particular have been described as evoking high levels of anxiety in workers. This study aimed to explore what mental health workers find most challenging in their work, whether challenging aspects of the work are related to diagnoses of personality disorder and what sources of support staff would find most helpful. This is a qualitative study. Data were collected via a series of focus groups and analysed using a grounded theory approach. An overall model, working with significant distress, brings together eight categories that escribe aspects of working in mental health services, which can be challenging: joint working, eligibility criteria, complexity of reality, models of understanding, system processes, needs of workers, interventions and interface with diagnosis. Workers report that the most challenging aspects of their work involve struggles within and between different parts of systems, rather than being associated with particular diagnoses. A number of suggestions are made for better meeting the needs of workers. [ABSTRACT FROM AUTHOR]

Increasing integration of services for adults with severe mental health problems has highlighted the challenges to services posed by clients who are difficult to engage. There is a dearth of studies on direct work with individuals who are reclusive and difficult to contact, in contrast with the bulk of literature where the patient and network are present and available. This paper describes the work of a busy CMHT with such clients; barriers to collaborative work are explored and some of the team's strategies to overcome these barriers are delineated. Long, slow and persistent contact is observed to be a core feature of the work. The paper goes on to examine the fit between the realities of ongoing work with such clients and the available therapeutic and service discourses. [ABSTRACT FROM AUTHOR]

Background: The physical health of people with mental illness is often poor. There is a need for mental health services to address the issue. Aims: The Physical Health Check (PHC) is a short tool designed to be used by mental health staff to assess physical health needs. It was developed by a multidisciplinary research group, with the intention that it should be quick and easy to use, and acceptable to service users. Results: When administered to 60 CMHT clients a high level of unmet physical needs were detected. These included the need for health promotion, as well as specific medical or other interventions. A comparison with routine practice in a neighbouring CMHT, suggests that use of the PHC significant improves the recording of physical health information. Conclusions: the PHC is a useful tool, designed to be used routinely by mental health staff to assess physical health needs. Declaration of interest: A small education grant from Eli Lilly was used to design and print copies of the PHC. [ABSTRACT FROM AUTHOR]

The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge. [ABSTRACT FROM AUTHOR]

INTRODUCTION: It was noticed that over some years the number of referrals to the outpatient clinic (from various sources) which were marked 'urgent' had increased. We aimed to examine who makes these urgent referrals and the clinical factors associated with 'urgent' status. METHODS: A sample of 201 referrals over a 26-month period was examined. Details of the referral requests were collected using a specially designed form. After each 'urgent' assessment, the referral was scored for appropriateness. This gave an indication of the agreement between referrer and clinic doctor as to what should constitute an urgent' referral. RESULTS: The majority of urgent referrals were from community psychiatric nurses, who, together with psychiatric social workers, make the most appropriate referrals. The more appropriate referrals clearly specified the clinical factors associated with urgent need for review. Patients regarded as suicidal were not associated with significantly higher appropriateness scores. CONCLUSION: Referrers should try and make 'urgent' outpatient requests as specific as possible: more clinical detail gives a clearer picture to the clinic doctor. Telephone consultations with general practitioners may help to ascertain a clearer picture of urgent requests if detail is lacking. Health professionals may all benefit from education in suicidal risk assessment. (Int J Psych Clin Pract 2000; 4: 233 - 235). [ABSTRACT FROM AUTHOR]