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This article explores the meanings and uses of a hospital corridor through 98 diary entries produced by the staff of an English specialist hospital during the early stages of the COVID‐19 pandemic. Drawing on Lefebvre's (1991, The production of space. Blackwell) threefold theorisation of space, corridors are seen as conceived, perceived and lived spaces, produced through and enabling the reconfiguration and reinterpretation of social interactions. The diaries depict two distinct versions of the central hospital corridor: its 'normal' operation prior to the pandemic when it was perceived as a social and symbolic space for collective sensemaking and the 'COVID‐19 empty corridor' described as a haunting place that divided hospital staff along ostensibly new social and moral boundaries that impacted negatively on lived work experiences and staff relationships. The mobilisation of the central hospital corridor in the daily social construction of meaning and experience during a period of organisational and societal crisis suggests that corridors should not be only seen as a material backdrop for work relationships but as social entities that come into being and are maintained and reproduced through the (lack of) performance of social relations. [ABSTRACT FROM AUTHOR]

Charity regulation is increasing internationally, leading to divergent views on what might constitute "better regulation." The purpose of a charity regulator and appropriate regulation may also be contested. Many modern charity regulators are required to maintain public trust and confidence in charities in order to bolster ongoing charity support from funders and the donating public. Nevertheless, public trust and confidence is precarious. At its nadir, in England and Wales "the person in the street" was deemed more trustworthy than charities, with donations diminishing in the current environment and the charity sector close to crisis. Further, charities contribute to crises when they incite negative media interest in their operations, fail to comply with regulatory filing deadlines, and/or manipulate their accounts. Charity regulators must maintain legitimacy within a changing regulatory space, despite often being resource‐constrained themselves. Yet, some suggest regulators could "do more" to increase sector‐wide resilience and to increase public trust and confidence. Hence, this raises the question of how charities should be regulated and whether (and how) a regulator could build resilience. We depict charity‐sector crises as a vehicular incident and ponder: should the regulator act as a "Guardian Angel" to prevent crises through interventions to build and maintain sectoral resilience, or should it appear postincident as a "Tow Truck" to clear the road for other traffic through closely bounded regulatory action focused on sanctions and deregistration. We address this question by analyzing publicly available regulatory data from the Charity Commission of England and Wales and semistructured interviews, which provide additional "behind the scenes" depth to our analysis and findings. We contribute to literature on charity regulation and expected regulatory responsibilities within a confined but permeable regulatory space. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Emergency departments (ED) are key settings to support and manage suicidal crisis; thus, ED staff are often the first point of contact for people in suicidal crisis. Despite this, some ED staff receive little training and/or education on how to best support such patients. What the paper adds to existing knowledge: Previous research focuses on one staffing role (e.g. triage nurses) whereas this paper includes staff working across the ED pathway. Administrative staff have often been excluded from research, despite representing a key part of the clinical pathway and being a person's initial contact with the ED.Overall findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. Staff also perceive there to be a negative ED culture, which often leads to poor attitudes towards suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention.Findings build upon previous research to highlight key challenges different staff face along the clinical pathway and the implications this can have on a patient's journey and follow‐up care provided. What are the implications for practice?: Findings are of particular importance and relevance to ED managers, and more broadly NHS England. Negative ED culture, poor staff attitudes and confidence can have a detrimental impact on both staff health and wellbeing, as well as a patient's journey throughout the ED, resulting in repeat presentations and absconding as appropriate support is not received.Policymakers need to consider staff burnout and lack of resources in mental health care strategies, and training programmes should be developed to improve culture and confidence among ED staff and managers to improve care for people attending EDs in suicidal crisis. Introduction: Emergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway. Aims: To explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis. Method: Qualitative study guided by thematic analysis of semi‐structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England. Results: Findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention. Discussion: Staff felt unequipped to deal with suicide‐related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction. Implications for Practice: Findings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED. [ABSTRACT FROM AUTHOR]

Background: Rates of compulsory (also known as involuntary) detention under mental health legislation have been rising over several decades in countries including England. Avoiding such detentions should be a high priority given their potentially traumatic nature and departure from usual ethical principles of consent and collaboration. Those who have been detained previously are at high risk of being detained again, and thus a priority group for preventive interventions. In a very sparse literature, interventions based on crisis planning emerge as having more supporting evidence than other approaches to preventing compulsory detention. Method: We have adapted and manualised an intervention previously trialled in Zürich Switzerland, aimed at reducing future compulsory detentions among people being discharged following a psychiatric admission that has included a period of compulsory detention. A co-production group including people with relevant lived and clinical experience has co-designed the adaptations to the intervention, drawing on evidence on crisis planning and self-management and on qualitative interviews with service users and clinicians. We will conduct a randomised controlled feasibility trial of the intervention, randomising 80 participants to either the intervention in addition to usual care, or usual care only. Feasibility and acceptability of the intervention and trial procedures will be assessed through process evaluation (including rates of randomisation, recruitment, and retention) and qualitative interviews. We will also assess and report on planned trial outcomes. The planned primary outcome for a full trial is repeat compulsory detention within one year of randomisation, and secondary outcomes include compulsory detention within 2 years, and symptoms, service satisfaction, self-rated recovery, self-management confidence, and service engagement. A health economic evaluation is also included. Discussion: This feasibility study, and any subsequent full trial, will add to a currently limited literature on interventions to prevent involuntary detention, a goal valued highly by service users, carers, clinicians, and policymakers. There are significant potential impediments to recruiting and retaining this group, whose experiences of mental health care have often been negative and traumatising, and who are at high risk of disengagement. Trial registration: ISRCTN, ISRCTN11627644. Registered 25th May 2022, https://www.isrctn.com/ISRCTN11627644. [ABSTRACT FROM AUTHOR]

Background: In England, one in six children aged 5–19 has a probable diagnosable mental health disorder. This is a major public health problem, with multiple agencies adopting varying approaches to care delivery for children and young people (CYP) in crisis. Objectives: To examine the organisation of crisis services across education, health, social care and voluntary sectors; the experiences and perceptions of CYP, families and staff; the effectiveness of current approaches to care and the goals of crisis intervention. Methods: A systematic review of all relevant English language evidence regarding the provision and receipt of crisis support for CYP aged 5–25 (PROSPERO‐CRD42019160134). Seventeen databases were searched from 1995 to 2021 and relevant UK‐only grey literature was identified. Critical appraisal was conducted using appropriate design specific appraisal tools. A narrative approach to synthesis was conducted. Results: In total, 138 reports (48 reports covering 42 primary research studies; 36 reports covering 39 descriptive accounts of the organisation services and 54 UK‐only grey literature reports) were included. The evidence suggests that crisis services were organised as follows: triage/assessment‐only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, four themes were identified: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) children's, young people's and families' experiences of crisis services; and (d) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of crisis services were identified. Discussion: Despite a lack of high‐quality international studies, findings suggest that support prior to reaching crisis point is important. From this work, various aspects of crisis care have been identified that can be incorporated into existing services across education, health, social care and the voluntary sector. [ABSTRACT FROM AUTHOR]

Background: Psychotic disorders are severe and prevalent mental health conditions associated with long-term disability, reduced quality of life, and substantial economic costs. Early Intervention in Psychosis (EIP) services aim to provide timely and comprehensive treatment for psychotic disorders, and EIP service input is associated with improved outcomes. However, there is limited understanding of the specific components of EIP care that contribute to these improvements. There is significant nationwide variability in the commissioning and delivery of EIP, with individuals receiving different packages of components from different services. In this study, we seek to explore associations between EIP components and clinically significant outcomes, in order to understand the mechanisms underlying improved psychosis care. Methods: This national retrospective cohort study will utilize data from the 2019 National Clinical Audit of Psychosis (NCAP), examining the care received by 10,560 individuals treated by EIP services in England. Exposure data from the NCAP, capturing the components of care delivered by EIP services, will be linked with outcome data from routine NHS Digital datasets over a three-year follow-up period. This will be the first study to use this method to examine this population in England. The primary outcomes will be surrogate measures of relapse of psychosis (hospital admission and referral to community-based crisis intervention services). Secondary outcomes include duration of admissions, emergency hospital attendances, episodes of detention under the Mental Health Act, and all-cause mortality. We will use multilevel regression to examine associations between exposures and outcome events. We will handle missing data using appropriate imputation techniques. Discussion: This study aims to provide valuable insights into the long-term effects of variations in EIP service delivery. The study involves a large, diverse cohort including individuals treated by every EIP service in England. While there are limitations inherent in the observational nature of the study, any associations identified will be of great relevance to clinicians, researchers, and policymakers seeking to optimize EIP care. The results will enable more targeted treatment planning, resource allocation, and potential innovations in EIP care, ultimately leading to improved prognoses for people experiencing psychosis. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the structured clinical management model for treating people with borderline personality disorder (BPD) • To acknowledge the need for community-based crisis interventions in BPD to avoid hospital admission • To read about a 'managing distress pathway' developed by a home-based treatment team for people with BPD Structured clinical management is an evidence-based intervention for people with borderline personality disorder (BPD). There is a lack of evidence on crisis interventions for people with BPD, who are often admitted to hospital or supported in emergency care settings when they present with acute mental health needs. The home-based treatment team (HBTT) at an English NHS mental health trust undertook a pilot service improvement project in which they designed a 'managing distress pathway' – a crisis intervention for people with BPD adapted from the structured clinical management model. A small-scale evaluation of the project found that, after the intervention, patients spent less time in hospital and staff's skills and confidence in supporting patients had improved. Patients reported high levels of satisfaction with their care. By using the principles of structured clinical management within an HBTT, non-specialist mental health practitioners can deliver effective community-based crisis interventions for people with BPD. [ABSTRACT FROM AUTHOR]

Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol‐using patients treated by Crisis Resolution Teams (CRTs), an intensive community‐based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London‐based Crisis Resolution Teams, with death‐by‐any‐cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk‐assessment, AUDIT, or ICD‐10 diagnosis) with death‐or‐recontact at (i) 30‐days and (ii) 1‐year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1‐year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death‐or‐recontact at 30‐days (AOR 1.17, 95%CI 0.73, 1.88) or 1‐year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death‐or‐recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use. [ABSTRACT FROM AUTHOR]

Introduction: An NHS Mental Health Trust in England recently used an experimental staffing model by including Occupational Therapists (OT) in the staff numbers on ten working age adult acute inpatient wards. Aims: This study aims to compare different staffing models involving occupational therapists and make recommendations for preferred staffing models. Methods: This is a longitudinal comparative study of archived patient and multi-disciplinary electronic records and data collected from Kent and Medway NHS and Social Care Partnership Trust. Areas of analysis included quantitative data and qualitative coding and theming, covering the period February 2016-June 2019 during the experimental staffing model, and July 2019-March 2021, when the model ended and teams were Occupational Therapy-led. Full ethical approval and consent was gained in 2020 from the Trust and University to request and access data to complete this research. Results: This experimental staffing model resulted in less delivery of Occupational Therapy specific interventions, resulting in poorer retention rates and impacting on patient and student experiences. Since working in Occupational Therapy led teams, the quality of Occupational Therapy interventions, job retention, student experiences, patient care and safety have improved. Conclusions: The recommended staffing model for working age acute mental health wards has Occupational Therapists embedded in OT-led teams. Staffing tools need to be developed that involve Allied Health Professional leaders and this field needs more research. [ABSTRACT FROM AUTHOR]

Communities are vital sources of support during crisis, providing collective contexts for shared identity and solidarity that predict supportive, prosocial responses. The COVID‐19 pandemic has presented a global health crisis capable of exerting a heavy toll on the mental health of community members while inducing unwelcome levels of social disconnection. Simultaneously, lockdown restrictions have forced vulnerable community members to depend upon the support of fellow residents. Fortunately, voluntary helping can be beneficial to the well‐being of the helper as well as the recipient, offering beneficial collective solutions. Using insights from social identity approaches to volunteering and disaster responses, this study explored whether the opportunity to engage in helping fellow community members may be both unifying and beneficial for those engaging in coordinated community helping. Survey data collected in the UK during June 2020 showed that coordinated community helping predicted the psychological bonding of community members by building a sense of community identification and unity during the pandemic, which predicted increased well‐being and reduced depression and anxiety. Implications for the promotion and support of voluntary helping initiatives in the context of longer‐term responses to the COVID‐19 pandemic are provided. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Perinatal mental health services are a current NHS priority and services are being increased for women. There is limited research on mothers' perspectives of these services and most research focuses on mother and baby units (MBUs). This study explored women's views of their experiences of generic wards, MBUs and crisis resolution teams. A qualitative thematic analysis was conducted on written feedback on a service-user-designed questionnaire. One hundred and thirty-nine women recruited across 42 mental health trusts made comments. Two key themes were identified: support networks and staff authority. Support networks included subthemes relating to families, peers and staff. The theme of staff authority incorporated subthemes about communication, confidence in staff and service-user autonomy. All themes contributed to whether mothers felt safe in these services. Mothers reported the benefits of positive, non-coercive relationships with family and staff for their recovery. The findings highlight that the challenges women face in perinatal settings reflect the literature on general psychiatric services, particularly around coercion. Specific implications for mothers accessing perinatal mental health services: 1) integrated mental health care and support with babies; 2) support with separation from babies for mothers in acute wards; 3) improvement of women's relationships with social services across all services. [ABSTRACT FROM AUTHOR]

This study explored the psychological experience of a small cohort of nursing and midwifery students who had been deployed to work in the NHS during the COVID-19 pandemic. The students were employed on band 4 contracts within an acute NHS Trust in the South of England. Overall, students found the experience of being deployed into clinical practice during a major public health emergency a valuable and unique experience that strengthened their resilience. However, students reported a significant level of personal obligation to opt-in to deployment. Working within clinical areas caused heightened anxiety and uncertainty, which was alleviated by managerial support. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has affected millions of people, and some researchers postulate that a mental health crisis will follow. The immediate effects of the COVID-19 pandemic on children's mental health are now starting to be published, and results appear to be mixed. There is no research, to the authors' knowledge, that empirically examines the functioning of young people following intervention from Child and Adolescent Mental Health Services (CAMHS) Crisis Teams in the UK during the COVID-19 pandemic. This service evaluation aims to do this using data from an NHS trust that supports 1.4 million people in the North East of England. We compared functioning, as measured by the Outcome Rating Scale (ORS), before and after treatment for young people discharged from the CAMHS Crisis Team between December 2019 and December 2020. ORS scores were significantly higher at the end of treatment (t(420) = −57.36, p < 0.001) with a large effect size (d = −1.56). Fifty eight percent of patients exhibited significant and reliable change (i.e. functioning improved to a 'healthy' level). No patients significantly deteriorated in functioning after accessing the crisis service. [ABSTRACT FROM AUTHOR]

Anyone in England over 18 whose health or wellbeing suddenly deteriorates at home will have access to an urgent community response (UCR) team within 2 hours by April 2022. Community nursing services are providing the core service model to provide these crisis response services. Nurse leads from three UCR accelerator sites (Kirklees, Warrington and Bromley) elaborate on how they are making waves of change for the better, using their clinical skills and building key relationships with other health services. Acutely unwell patients are being seen by practitioners with advanced assessment skills, which keeps eight out of 10 patients at home safe, avoiding hospital admission. [ABSTRACT FROM AUTHOR]

In England in the early twentieth century, mental observation wards in workhouses developed as a parallel service to the asylums for emergency mental health admissions under the 1890 Lunacy Act, particularly in urban areas and especially London on account of local policy. The purpose of the wards was initial patient assessment and early discharge or certification, and there was controversy between their medical supporters and the Board of Control about any extension of their remit which might usurp the role of the mental hospitals. Their significance declined with changing policy in the NHS era, as more emergency admissions went to mental hospitals, and local treatment units emerged. This article explores the history of these services in the context of the changing legal and policy frameworks. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the aspects of continuity of care that are important to service users and healthcare professionals • To understand the challenges that services may experience in achieving continuity of care • To develop ideas for measuring and improving continuity of care in your service This article details an audit that was undertaken to explore the extent to which a crisis resolution team (CRT) service in Leicestershire, England, provided continuity of care to service users. Data were collected from a sample of 100 service users over a period of 12 months, from January 2019 to December 2019. The audit found that 91% (n=91) of service users had a care plan and 87% (n=87) had been given a copy. All service users were allocated a key worker from the team covering their locality, but only 55% (n=55) of service users were seen at least once by their key worker during an episode of CRT care. The mean number of healthcare professionals seen by service users was seven, while the mean number of different CRT locality teams involved in visiting service users was three. Only 6% (n=6) of service users experienced the minimum of one team involved in their episode of care. These findings indicate that the CRT service's standard operating procedure requires further development to incorporate the main elements of continuity of care. A practice development project is proposed to engage staff in this and implementing service improvements. [ABSTRACT FROM AUTHOR]

Background: Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey.Methods: We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area.Results: We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced.Conclusions: The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established. [ABSTRACT FROM AUTHOR]

Summary: Mark Fisher's Capitalist Realism, published in 2009, has been recognised as one of the most important contributions chronicling the rise, application and consequences of neoliberalism. However, Fisher's ideas have until now only garnered passing mention in the study of neoliberalism in children and families social work in England, despite there being extensive research, argument and publication on the subject more broadly. This article attempts to rectify this gap and apply Fisher's theory to the recent reforms in children and families social work in England. Findings: The article applies Fisher's commentary on the co-option of language, invoking crisis, bureaucracy and proposing change to implement no change, to the reforms in children and families social work that began with the implementation of Reclaiming Social Work in 2008. Since that time, the original architects of Reclaiming Social Work have gained significant positions of power and influence and been instrumental in introducing neoliberal reforms throughout children and families social work in England. Applications: Through applying the approach and concepts of Mark Fisher, this article concludes that it is possible to determine that the current reforms are, at their core, neoliberal in nature and driven by an ideological imperative to transform children and families social work in England into a neoliberal edifice, with less public sector and state input and oversight and an increase in the influence of 'not-for-profits', charities and international for-profit consultancies. [ABSTRACT FROM AUTHOR]

Psychiatric decision units have been developed in many countries internationally to address the pressure on inpatient services and dissatisfactory, long waits people in mental health crisis can experience in emergency departments. Research into these units lags behind their development, as they are implemented by healthcare providers to address these problems. This is the first‐ever national survey to identify their prevalence, structure, activities, and contextual setting within health services, in order to provide a robust basis for future research. The response rate was high (94%), and six PDUs in England were identified. The results indicated that PDUs open 24/7, accept only voluntary patients, provide recliner chairs for sleeping rather than beds, and limit stays to 12–72 hours. PDUs are predominantly staffed by senior, qualified mental health nurses and healthcare assistants, with psychiatry input. Staff:patient ratios are high (1:2.1 during the day shift). Differences in PDU structure and activities (including referral pathway, length of stay, and staff:patient ratios) were identified, suggesting the optimal configuration for PDUs has not yet been established. Further research into the efficacy of this innovation is needed; PDUs potentially have a role in an integrated crisis care pathway which provides a variety of care options to service users. [ABSTRACT FROM AUTHOR]

Purpose: Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors' knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach: This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings: There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications: Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a "healthy" level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people's functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value: This paper evaluates a young person's functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the topic?: MHST represents transformation at the forefront of policing and mental health to people in crisis with the aim of providing a better and more efficient response.Current knowledge has largely focused on service development, informed by narratives of risk, and this study applies an alternative focus by considering the interplay in practice. What the paper adds to existing knowledge?: This paper adds to emerging work on mental health street triage, offering original insights into the interplay of police officers and mental health nurses in practice.The evidence presented shows how the dynamics between officers and nurses were informed by perceptions of trust, belonging and legitimacy which shaped decision‐making and outcomes.This study also reveals the impacts of leadership continuity and staff turnover to service efficacy and the potential of strategic "drift." What are the implications for practice?: Nurses who work in MHST operations should be prepared to share knowledge, learning and insight into how different mental health conditions present in practice and support the assessment of risk posed to officers.Alternative pathways available to detainment by police under the Mental Health Act should be identified and communicated to officers, both in the control room and in situ, to avoid unnecessary detentions.Strategies should be developed to extend the communication of mental health education and knowledge beyond those immediately involved in MHST to support the police to better respond to mental health. Introduction: The limited evidence on mental health street triage (MHST) is largely focused on service development and is overly police‐centric dominated by narratives of risk. This paper considers the interplay between officers and CPNs in practice situated within strategic and operational contexts, illustrating the importance of place to service developments and trust within practice. Aim: This study was conducted to compare the processes, experiences and perceptions of MHST in three sites in England. Method: Semi‐structured interviews were completed with 27 police and health service staff in strategic and operational roles over a three‐month period in three sites in England. Results: Four themes were identified: "Reducing and improving the use of mental health detainments," "Importance of local contexts and partnerships," "Enhancing officer confidence" and "Developing street triage." Discussion: Mental health street triage decision‐making and outcomes were influenced by issues of trust, belonging and legitimacy within the interplay between officers and nurses. Continuity and staff turnover influenced strategic and operational development. However, MHST was perceived to be an effective and cost‐saving model. Implications for practice: Mental health nurses are well positioned to lead awareness and education of officers in relation to mental health crisis response. Staff need to develop communication strategies that extend beyond those immediately involved in MHST. [ABSTRACT FROM AUTHOR]

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Background: Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.Aims: To evaluate a 1-year programme to improve CRTs' model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).Method: Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated.Results: All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes.Conclusions: The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions. [ABSTRACT FROM AUTHOR]

Background: A brief intervention whereby GPs opportunistically facilitate an NHS-funded referral to a weight loss programme is clinically and cost-effective.Aim: To test the acceptability of a brief intervention and attendance at a weight loss programme when GPs facilitate a referral that requires patients to pay for the service.Design and Setting: An observational study of the effect of a GP encouraging attendance at a weight loss programme requiring self-payment in the West Midlands from 16 October 2018 to 30 November 2018, to compare with a previous trial in England in which the service was NHS-funded.Method: Sixty patients with obesity who consecutively attended primary care appointments received an opportunistic brief intervention by a GP to endorse and offer a referral to a weight loss programme at the patient's own expense. Participants were randomised to GPs who either stated the weekly monetary cost of the programme (basic cost) or who compared the weekly cost to an everyday discretionary item (cost comparison). Participants were subsequently asked to report whether they had attended a weight loss programme.Results: Overall, 47% of participants (n = 28) accepted the referral; 50% (n = 15) in the basic cost group and 43% (n = 13) in the cost comparison group. This was significantly less than in a previous study when the programme was NHS-funded (77%, n = 722/940; P<0.0001). Most participants reported the intervention to be helpful/very helpful and appropriate/very appropriate (78%, n = 46/59 and 85%, n = 50/59, respectively) but scores were significantly lower than when the programme was NHS-funded (92% n = 851/922 and 88% n = 813/922, respectively; P = 0.004). One person (2%) attended the weight loss programme, which is significantly lower than the 40% of participants who attended when the programme was NHS-funded (P<0.0001).Conclusion: GP referral to a weight loss programme that requires patients to pay rather than offering an NHS-funded programme is acceptable; however, it results in almost no attendance. [ABSTRACT FROM AUTHOR]

This article presents findings from a quantitative study of the national data-sets for statutory children's social care services in England. The aim of the study was to examine how demand management varied in local authorities with differing levels of area deprivation. About 152 local authorities census returns and other statistical indicators covering the period 2014–2017 were combined into a single data-set. Statistical analysis was undertaken to explore trends over time and correlations between indicators that might indicate patterns in the way demand was managed. Findings showed that high levels of deprivation have continued to be strongly linked to high levels of activity and that local authorities have continued to increase their use of protective interventions relative to referrals. Evidence was found for three interconnected mechanisms, through which local authorities tended to manage demand for services: screening, rationing and workforce churn. The article describes these mechanisms and comments on their significance for the current crisis of demand in the sector. [ABSTRACT FROM AUTHOR]

The financial crisis of 2008, has led central governments in industrialized nations to seek to reduce public expenditure at the same time that demands upon the welfare state are increasing. Using the example of statutory social work with children and families in England, this article explores whether the concept of rationing might be a more useful way of describing practices at the front line that seek to meet the objectives of policymakers, while also being financially responsible. In doing so, the article challenges social work to see austerity as less of a descriptor of the straightened financial times we live in but rather as an ideology that is seeking to reshape the very nature of the welfare state and to push responsibility for dealing with the consequences of these decisions away from politicians and policymakers onto front line staff. [ABSTRACT FROM AUTHOR]

A recent Patient Safety Alert stipulates that all patients at risk of adrenal crisis are provided with a Steroid Emergency Card. This article discusses which patients are at risk, how to identify adrenal crisis and why urgent action is needed when it occurs. It also summarises the requirements of the new alert. [ABSTRACT FROM AUTHOR]

Abstract: In response to pressures on mental health inpatient beds and a perceived ‘crisis in acute care’, Crisis Resolution Teams (CRTs), acute home treatment services, were implemented nationally in England following the NHS Plan in the year 2000: an unprecedentedly prescriptive policy mandate for three new types of functional community mental health team. We examined the effects of this mandate on implementation of the CRT service model. Two hundred and eighteen CRTs were mapped in England, including services in all 65 mental health administrative regions. Eighty‐eight percent (n = 192) of CRT managers in England participated in an online survey. CRT service organization and delivery was highly variable. Nurses were the only professional group employed in all CRT staff teams. Almost no teams adhered fully to government implementation guidance. CRT managers identified several aspects of CRT service delivery as desirable but not routinely provided. A national policy mandate and government guidance and standards have proved insufficient to ensure CRT implementation as planned. Development and testing of resources to support implementation and monitoring of a complex mental health intervention is required. [ABSTRACT FROM AUTHOR]

The medical model continues to dominate research and shape policy and service responses to suicide. In this work we challenge the assumption that the medical model always provides the most effective and appropriate care for persons who are suicidal. In particular, we point to service user perspectives of health services which show that interventions are often experienced as discriminatory, culturally inappropriate, and incongruent with the needs and values of persons who are suicidal. We then examine ''humanistic'' approaches to care that have been proposed as a corrective to an overly medical model. We argue that the focus on improving interpersonal relations set out in humanistic approaches does not mitigate the prevailing risk management culture in contemporary suicide prevention and may impede the provision of more effective care. Finally, we draw attention to the tradition of nonmedical approaches to supporting persons who are suicidal. Using Maytree (a U.K. crisis support service) as a case study, we outline some of the key features of alternative service models that we consider central to the design of more culturally appropriate and effective interventions. We conclude by making three key recommendations for improving services to persons who are suicidal. [ABSTRACT FROM AUTHOR]

Aims To implement and evaluate a nurse-led, multi-agency drop-in clinic for young people with attention deficit hyperactivity disorder (ADHD). Method A repeated measures observational study over 12 months exploring clinic attendance and user satisfaction, crisis management and did not attend (DNA) rates, consultant time spent with patients, benefits to quality of care, and service flexibility. Results A total of 62 service users participated. A significant improvement in service user experience was observed (P=0.001). Crisis management attendances significantly increased (P=0.005). DNA rates did not reduce significantly (P=0.057). Service users attended for their medication review before or on their due date (P=0.011). Those who needed to were able to spend more time with the staff (P=0.001). Conclusion The clinic improved service accessibility and flexibility. It allowed adherence to clinical guidance, including uptake of psychosocial interventions. There was an overwhelmingly positive improvement in service user experience. Importantly, as contact with the ADHD nurse specialists increased, this significantly reduced the amount of time consultant community paediatricians spent with service users. Further research should examine the cost-effectiveness and longitudinal effect of the drop-in model. [ABSTRACT FROM AUTHOR]

Background: As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity.Methods/design: Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme.Discussion: Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams.Trial Registration: Current Controlled Trials ISRCTN47185233. [ABSTRACT FROM AUTHOR]

District nurses are increasingly required to manage the physical health needs of patients who misuse substances or have mental health problems. Some patients have a mental health crisis in the community and come to the attention of the police. Concern over the use of police powers to detain people in a mental health crisis and in particular the use police cells as a place of safety has led to changes in the law. In this article the author updates district nurses on the amendments to police powers under the Mental Health Act 1983 introduced by the Policing and Crime Act 2017, part 4 chapter 4 designed to better manage those people experiencing a mental health crisis. [ABSTRACT FROM AUTHOR]

Aim To estimate sex differences in health-care utilization among harmful/hazardous drinkers in the period before alcoholic cirrhosis diagnosis, and estimate sex differences in the extent to which alcohol use and brief alcohol interventions were documented for these individuals compared with a control cohort. Design Retrospective study using linked general practice and hospital admissions data in England. Setting Three hundred and fifty-seven general practitioner (GP) practices in England. Participants A total of 2479 individuals with alcoholic cirrhosis (mean age at diagnosis = 56years), of whom 67% were men; and 24 790 controls without the disease. Measurements Rates of primary care visits and hospital admissions prior to the diagnosis of alcoholic cirrhosis for men and women, and the proportion of men and women with alcohol consumption and/or alcohol brief intervention documented in their medical record. Findings Compared with the general population, patients with alcoholic cirrhosis used primary and secondary health-care services more frequently in the years leading up to their diagnosis. In the years prior to diagnosis, men used primary and secondary health-care services more than did women ( P for sex interaction P < 0.0001). Men were more likely than women to have their alcohol use recorded [odds ratio (OR) men = 1.96, 95% confidence interval (CI) = 1.7-2.3; women = 1.63, 95% CI = 1.4-1.8, P for sex interaction P < 0.0017]. By contrast, alcohol interventions were recorded more commonly among women (OR men = 4.3, 95% CI = 3.7-4.9; women = 5.8, 95% CI = 4.7-6.9, P for sex interaction = 0.07), although less common with increasing age ( P for age interaction = 0.009). Conclusions In the United Kingdom, prior to alcoholic cirrhosis diagnosis, excess health-care utilization is higher in men than women and men are more likely than women to have their alcohol use recorded. However, women appear to be more likely than men to receive alcohol brief interventions. [ABSTRACT FROM AUTHOR]

Outcomes for individuals with psychosis remain far from acceptable. Recently, prominent psychiatrists have called for an improved understanding of the impact of social contexts, and how social contexts might influence the development and maintenance of mental health problems. A key social context for individuals with psychosis is the therapeutic relationship. As part of a trial of joint crisis planning in England, this qualitative study aimed to determine the mechanism through which joint crisis planning might affect the therapeutic relationship. Results suggest that routine processes in mental health care are affected by policy and organizational requirements for risk mitigation—aspects that undermine person-centered approaches. In contrast, strong therapeutic relationships are characterized by individualized care and reliable and respectful treatment. The Joint Crisis Plan intervention partially succeeded in reducing contextual influences on routine role enactments, facilitating the demonstration of respect and improving the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Crisis resolution and home treatment teams (CRHT) are integral to acute psychiatric services. This survey quantifies staff burnout using the MBI-HSS (Maslach Burnout Inventory) and notes sources of stress and satisfaction before (2012) and after (2013) service transformation of a CRHT in Leeds into a single point of access, with home treatment devolved to community teams. Moderate to high Burnout scores were observed over the study period, with a rise in the mean depersonalisation score from 5.8 to 7.2 over the study period. Contact with colleagues; work with patients and variety of work emerged as rewarding while themes of suicide and violence were most linked with stress, with clinicians reporting self-doubt in the face of difficult clinical decisions. Clinicians positively rated a weekly psychoanalytic reflective practice group. A pictorial representation of qualitative results uses psychoanalytic theory inconceptualising 'skins' around various aspects of the clinical setting, which then become semipermeable in response to a patient in crisis when clinicians feel poorly supported by the changing organisation. [ABSTRACT FROM AUTHOR]

This article explores the work of a rapid response team (RRT) in an English city. The RRT is a multiprofessional intermediate care team that is able to support patients to remain at home during clinical crises and changes to their social care needs. The service is popular with patients and cost effective. The National Audit of Intermediate Care is in its fourth year and benchmarks how intermediate care services are delivered across England. RRT data are compared with the national data, and show that keeping the team as a crisis intervention service has enabled it to maintain capacity to support patients at home without requiring hospital admission. [ABSTRACT FROM AUTHOR]

Background: Home treatment teams (HTTs) have limited evidence of altering hospital admissions. There is no consensus on what HTTs 'do', and a considerable lack of data on whether they deliver patient-relevant meaningful care. The Royal College of Psychiatrists has recently established the Home Treatment Accreditation Scheme (HTAS) to institute a quality standard for HTTs, though it is unclear whether such accreditation could of itself measure effective care. Aims: To explore opinions of HTT service users on the care they received to guide future research and service provision. Method: Ten ex-HTT patients were interviewed on the care they had received, using thematic analysis of semi-structured interviews. Results: Positive aspects of HTT intervention included a rapid, accessible and crisis-focused approach, though changing staff and appointment times were considered unhelpful. Proposals were made for greater psycho-and occupational-therapeutic inputs to manage long-term care, and for provision of peer-support within HTTs. Conclusions: HTTs were valued but service users' focus was on goals notably different to factors generally assayed by existing research. There is a severe lack of longitudinal clinical and patient-centred outcome data. HTAS provides a potential vehicle through which this could be addressed. [ABSTRACT FROM AUTHOR]

This paper outlines the findings from an English research study using an Interpretive Phenomenological Analysis methodology with service users of the Unified Adolescent Team (UAT) that was carried out in 2009. The UAT worked with adolescents between the ages of twelve and twenty and who had complex needs which led them to be identified as a 'hard to reach group'. The research identifies three super-ordinate themes that reflect the their experiences of receiving services from the UAT: in crisis and out of control, new helping relationships and building new lives. This paper discusses these findings and contextualises the work of the UAT with in the existing literature on positive engagement with this client group. [ABSTRACT FROM AUTHOR]

The authors reflect on the long cultural narrative of child protection in England. They provide an overview on the child protection policy and practice in Great Britain. They also looks in to how the government has recognised and responded to the prevalence of sexual abuse and exploitation in ordinary families in the country.

Background: In 2000, the Department of Health for England recommended the creation of crisis resolution and home treatment teams (CRHTs) in order to reduce the number and length of psychiatric hospital admissions. Central to this was the role of gate-keeping all potential admissions. Aim: To examine the interface between crisis resolution and home treatment and other mental health services. Methods: Semi-structured interviews with mental health professionals ( n = 25) at eight sites within one Strategic Health Authority region. Results: Despite wide variation in approach and provision, all teams were confronting common issues related to tensions at both ends of the service user trajectory - on initial assessment and on discharge. Conclusion: The CRHT model is likely to be most effective when there is low staff turnover, flexibility in inter-team working arrangements and senior practitioners have both acute and community experience. Rather than being seen primarily as gatekeeper to the acute service, it would be better to take a system approach and view the CRHT as a resource for clients awaiting discharge or seeking to avoid hospital admission that is equally available to both acute and community services. [ABSTRACT FROM AUTHOR]

The National Service Framework (NSF) for Mental Health in 1999 was central to the modernisation of mental health services under the New Labour government of 1997. It placed an emphasis on universal clinical standards and set out a vision for service developments over the next 10 years. One such proposal was the development of crisis resolution teams, aimed at reducing the psychiatric admissions rate by providing care at home. This article provides a critical analysis of policies relating to the provision of 24-hour access to mental health services, focusing on the specifications for creating crisis resolution teams, as laid out in the NSF for Mental Health and the NHS Plan. First, it looks at the historical context surrounding the policy, examining the content of the NSF and NHS plan and how policy was disseminated and implemented nationally and locally. Then it examines the effects and changes this policy brought about and, specifically, whether it has achieved its aims of reducing the nationwide acute psychiatric inpatient admission rate. [ABSTRACT FROM AUTHOR]

This paper undertakes an international comparison of parent engagement in the USA and England. Research from both countries is reviewed to establish the extent to which parent engagement is achieving the benefit of an improved fit between need and services and what, if any, differences exist between the experiences of parents in the USA and England. Despite some unique differences, research from both countries identifies similar experiences among parents. Those studies indicate that parent engagement is not yet contributing to the provision of services that are more timely, appropriate, or adequate in meeting parent need. The barriers to achieving a better fit between needs and services are explored and system-wide issues that limit the effectiveness of engagement with parents are discussed. The paper presents the Munro Review of Child Protection in England as a catalyst for change in improving the child welfare system's approach to parent engagement and establishing a better fit between needs and services. Consideration of the applicability of the Munro Review findings to the USA child welfare system or replication of such a review is proposed. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to positively confirm a new and different approach used to engage with entrenched rough sleepers, using the more personalised approach already adopted in social care. Design/methodology/approach – This is a first hand experience of the impact of the approach. Findings – That a personalised approach can achieve positive results with a hard to reach client group. Originality/value – This is the first published paper on this particular project. [ABSTRACT FROM AUTHOR]

This article documents the experiences of a service user through a mental health crisis, the experience of detention under Section 136 of the Mental Health Act, admission to hospital and eventual recovery. It gives a unique first person account of the experience of a psychotic episode together with a reflective commentary based upon the service user's auto-ethnographic analysis of both the event itself and her medical records, which were obtained post-recovery, as well as interviews with professional practitioners. The reflective commentary considers the practice of various professionals encountered during the service user's illness, treatment and recovery. The service user, whilst critical of some of the treatment she received, has engaged in a positive way with her local police force, involving herself in training sessions for officers about good practice under the Mental Health Act. [ABSTRACT FROM PUBLISHER]

This paper explores the use of a psychosocial approach to researching drugs, race and ethnicity. It produces an analysis of interviews with Bobby, a mixed-race man in recovery from addiction. Sociological and psychoanalytic perspectives are brought to bear on the data in order to consider the character of Bobby's opportunities, identifications, crises and resolutions. Despite the affective components of the wider discourse on drugs and race, the majority of previous research on the subject has focused on the production of rational explanations produced within objectivist epistemological frames. In contrast, the methods used in this project seek an explicit engagement with the irrational and unconscious aspects of researching these subjects. The paper concludes by reflecting on the value of psychosocially oriented narrative methods in this field. [ABSTRACT FROM PUBLISHER]

A hospice service in south east England determined to develop a new hospice-at-home service to enable greater patient choice and facilitate patients dying at home, which is often a patient's preferred place. As a first step, a literature review was commissioned to establish the evidence base to inform the design of the new service. A range of research had been reported on hospice-at-home services, but the service configurations evaluated in these studies and the context in which they operated had not been described in detail. This paper briefly summarises the results of the literature review and then describes the new service that was established, including the setting and context. Experiences with the service in terms of activity, acceptability, and problems are described. The aim is to assist providers and commissioners seeking to establish or develop similar services and to help them predict the likely impact of such services. INSETS: Box 1. Case study illustrating how the new hospice-at-home...;Box 2. Examples of carers¿ comments on the new hospice-at.... [ABSTRACT FROM AUTHOR]