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Describes the transformation of care management on mental health services in Southwark in England, London. Recognition of the roots of case management; Definition of case management on practice; Implementation of care management.

Investigates the risk factors of readmission to hospital for long term psychiatric patients after discharge to the community in London, England. Rate of readmitted patients in the hospitals; Role of staffed group homes in reducing the number of admission beds required; Influence of variations in provision of mental health services on readmission rates.

Investigates risk factors for failure to resettle long stay patients in community facilities as part of closure of psychiatric hospitals in London, England. Characteristics of patients with psychosis; Reason for readmission and remaining in hospitals; Functions of psychiatric hospital.

Objective The aim of this study was to establish consensus among clinicians in order to produce recommendations to optimise the diagnosis of physical illness in patients with mental illness who present in Emergency Departments (EDs). Method A list of recommendations was derived from qualitative interviews conducted with 39 doctors and nurses working in EDs in four general hospitals in England. Using a modified nominal group technique, we then asked a selected group of 15 doctors and nurses to take part in a group discussion with two voting rounds in order to decide which recommendations are most beneficial and feasible. Results Five recommendations met the a priori criteria to be considered ‘strongly supported’. These included: having a psychiatric liaison team staff available 24 hours a day in the vicinity of the ED; developing detailed guidelines regarding intoxicated patients and regarding parallel assessment of patients by both ED and psychiatric staff; and having regular meetings between representatives of both departments. Conclusion In addition to suggesting specific recommendations, the study stresses the advantages in increasing the accessibility of psychiatric staff in the ED but also identifies challenges regarding joint work and division of responsibilities between them and the ED acute team. [ABSTRACT FROM AUTHOR]

Background There are few mental health data for Somali people. This is due to the absence of culturally validated appropriate assessment instruments and methodological challenges. We aimed to develop a culturally appropriate instrument, and address the methodological challenges and assess some risk factors for mental disorder among Somalis in London. Methods Following a comprehensive process of cultural adaptation of the MINI Neuropsychiatric Interview, we assessed ICD-10 mental disorders among 143 Somalis recruited from GP registers and community sites. Associations with demographic and economic characteristics, sampling venues, cultural and migration related risk factors are reported. Results A higher risk of mental disorders was found among Somalis who used Khat (OR = 10.5, 1.1-98.3) claimed asylum at entry to the UK (OR = 12.8, 2-81.4) and recruits from primary care rather than from community sites (OR = 5.9, 1.4-25.8). A lower risk of mental disorders was found amongst Somalis in employment (OR = 0.03, 0.01-0.61), and those receiving education in the UK and in Somalia (OR = 0.13, 0.02-0.92). Over a third of subjects had any mental disorder (36.4%, 28.4-44.4), mainly common mental disorders (CMD) (33.8%, 26-41.5) and post-traumatic stress disorder (PTSD) (14%, 8.8-20.8). CMD were found among 80% of those with PTSD. Conclusion Public health interventions for Somalis should focus on CMD as well as PTSD, khat use and mental health screening for suicide risk and mental disorders on arrival. [ABSTRACT FROM AUTHOR]

Objectives: Severely mentally ill people have high levels of mortality and physical morbidity. As greater numbers of people with severe mental illness have moved into community accommodation, responsibility for their physical health needs is often unclear. This study investigates whether patients receive better physical health treatment if they attend their GP, a Community Mental Health Team, or both. Design: Five hundred and sixty-six representative annual period prevalence cases of psychotic disorders were ascertained in a case identification exercise in South London and 309 were randomly selected for interview. The information sought included details of their physical health problems, the physical health treatment they received and their pattern of service use. Setting: Two south London community psychiatry catchment areas. Results: Patients who had seen their GP in the previous 6 months were more likely to be satisfied with the amount (p=0.014) and type (p=0.16) of service provided for their physical health. Only 7% reported unmet physical needs and 75 % reported that they received the right type of help. Contact with any member of their community mental health team or with none did not affect the patient's report of their physical health care. Conclusions: All patients with a psychotic disorder should be registered with a GP. It should be clear to all involved that the GP is responsible for physical health service provision. There is a strong argument for a routine annual check up of the severely mentally ill by their GPs. [ABSTRACT FROM AUTHOR]