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Croak B, Greenberg N, Lamb D, Stevelink SAM, Wessely S. Does it matter if there are errors in GHQ-12 response items? Lancet Psychiatry 2024; 11:409-410. [PMID: 38648804 DOI: 10.1016/s2215-0366(24)00109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Bethany Croak
- Department of Psychological Medicine, King's College London, London SE5 9RJ, UK
| | - Neil Greenberg
- Department of Psychological Medicine, King's College London, London SE5 9RJ, UK
| | - Danielle Lamb
- Department of Applied Health Research, NIHR ARC North Thames, University College London, London, UK
| | | | - Simon Wessely
- Department of Psychological Medicine, King's College London, London SE5 9RJ, UK.
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Lamb D, Milton A, Forsyth R, Lloyd-Evans B, Akther S, Fullarton K, O'Hanlon P, Johnson S, Morant N. Implementation of a crisis resolution team service improvement programme: a qualitative study of the critical ingredients for success. Int J Ment Health Syst 2024; 18:18. [PMID: 38704589 PMCID: PMC11069280 DOI: 10.1186/s13033-024-00638-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place. METHODS Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis. FINDINGS A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All participating stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a 'bigger whole' was valuable. CONCLUSION CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Alyssa Milton
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Kitto C, Lamb D, Billings J. Responding to the call of the NHS Nightingale, but at what cost? An auto-ethnography of a volunteer frontline mental health trainer's experiences during the COVID-19 pandemic. J Health Psychol 2024; 29:534-551. [PMID: 38083867 DOI: 10.1177/13591053231213478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
Healthcare workers, globally, volunteered time and skills to the COVID-19 pandemic frontline response. In March 2020, the predicted high demand for extra critical care beds led to the rapid construction of the UK National Health Service (NHS) Nightingale field hospital, London. I volunteered to develop and deliver psychological preparedness training - coined 'Psychological PPE' - to over 2300 frontline staff over an 8-week period. Existing research has identified broad themes of the impact working on the COVID-19 frontline has on healthcare workers but does not capture in-depth accounts of individuals' experiences. Using autoethnographic enquiry, this research explores my frontline experience at the NHS Nightingale during this time, and the personal impact this had on me. Reflexive thematic analysis explored themes of recognition and sacrifice, emotional lability and fragility, and the impact of transitions. Findings inform personal recovery, as well as future research and policy development pertaining to the sustainable recovery of our NHS people.
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Affiliation(s)
- Chloe Kitto
- UCL, UK
- Royal National Orthopaedic Hospital, UK
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Croak B, Lamb D, Stevelink SAM. Re: investigating the impact of financial concerns on symptoms of depression in UK healthcare workers: data from the UK REACH nationwide cohort study. BJPsych Open 2024; 10:e74. [PMID: 38600762 PMCID: PMC11060077 DOI: 10.1192/bjo.2024.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024] Open
Abstract
This editorial comments on the paper by Martin McBride and the UK REACH team (published in 2023) investigating financial concerns in UK healthcare workers and depressive symptoms. The research concludes that reporting future financial concerns at baseline increased the odds of depressive symptoms at follow-up around 18 months later. We discuss these findings in the context of the cost-of-living crisis and pay disputes within the NHS, important policy implications and directions for future research.
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Affiliation(s)
- Bethany Croak
- Department of Psychological Medicine, King's College London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, UK
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Shaw P, Mifsud A, Osborn D, Nahata N, Hall C, Prenelle I, Lamb D. An integrated primary care service to reduce cardiovascular disease risk in people with severe mental illness: Primrose-A - thematic analysis of its acceptability, feasibility, and implementation. BMC Health Serv Res 2024; 24:255. [PMID: 38418971 PMCID: PMC10900648 DOI: 10.1186/s12913-024-10628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A. METHODS Semi-structured audio-recorded interviews with eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews. FINDINGS Overall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients' mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19. CONCLUSIONS Intervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: (1) training sufficiency (covering physical and mental health, including addiction), (2) adequate staffing to deliver the intervention, (3) facilitation of clear communication pathways between staff, and (4) supporting administrative processes.
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Affiliation(s)
- Philippa Shaw
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF, London, United Kingdom
| | - Annabel Mifsud
- Department of Applied Health Research, UCL, 1-19 Torrington Place, WC1E 7H, London, United Kingdom
| | - David Osborn
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF, London, United Kingdom
- Camden and Islington NHS Trust, 4 St Pancras Way, NW1 0PE, London, United Kingdom
| | - Nitisha Nahata
- Camden Health Partners LTD, St Pancras Hospital, 4 Saint Pancras Way, South Wing, NW1 0PE, London, United Kingdom
| | - Cerdic Hall
- Camden and Islington NHS Trust, 4 St Pancras Way, NW1 0PE, London, United Kingdom
| | - Ian Prenelle
- Camden and Islington NHS Trust, 4 St Pancras Way, NW1 0PE, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, UCL, 1-19 Torrington Place, WC1E 7H, London, United Kingdom.
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Holland TJ, Simms A, Lamb D, King K. Influence of employment characteristics on seeking help for mental health conditions in the UK Defence Medical Services. BMJ Mil Health 2023:e002570. [PMID: 37989533 DOI: 10.1136/military-2023-002570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/27/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Toby James Holland
- Academic Department of Military General Practice, Research and Clinical Innnovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - D Lamb
- Academic Department of Military Nursing, Research and Clinical Innovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, UK
| | - K King
- Academic Department of Military General Practice, Research and Clinical Innnovation, Defence Medical Directorate, HQ Surgeon General, Birmingham, UK
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Nicholls H, Lamb D, Johnson S, Higgs P, Pinfold V, Billings J. "Fix the system … the people who are in it are not the ones that are broken" A qualitative study exploring UK academic researchers' views on support at work. Heliyon 2023; 9:e20454. [PMID: 37860508 PMCID: PMC10582291 DOI: 10.1016/j.heliyon.2023.e20454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
Recent evidence suggests that it remains difficult for academic researchers to preserve global well-being when working in the UK higher education sector. Our study aimed to explore academic researchers' perspectives on how they feel their mental health and well-being could be better supported within the UK higher education system. Using a combination of semi-structured and narrative interviewing techniques, we gathered the perspectives of 26 researchers. Narrative and reflexive thematic analysis were then used on the data collected. Our findings highlight the need to tackle systemic issues such job insecurity and unrealistically high workloads, given the risk they can pose to researchers' mental health and well-being. Our findings also highlight the key influence of managers and supervisors in creating a supportive environment, and the importance of going beyond what support is offered. That is, it is vital to effectively promote any existing or emerging support systems, and to be proactive in offering this support. Given the diversity identified in researchers' individual situations, it is important that support is flexible and takes into consideration individual requirements and preferences. Higher education authorities and institutions need to determine how they can foster a healthy, caring environment for researchers working in this sector going forwards.
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Affiliation(s)
- Helen Nicholls
- Division of Psychiatry, University College London, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Paul Higgs
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Jo Billings
- Division of Psychiatry, University College London, London, United Kingdom
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Williamson V, Lamb D, Hotopf M, Raine R, Stevelink S, Wessely S, Docherty M, Madan I, Murphy D, Greenberg N. Moral injury and psychological wellbeing in UK healthcare staff. J Ment Health 2023; 32:890-898. [PMID: 36883341 DOI: 10.1080/09638237.2023.2182414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 12/13/2022] [Accepted: 01/28/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Potentially morally injurious events (PMIEs) can negatively impact mental health. The COVID-19 pandemic may have placed healthcare staff at risk of moral injury. AIM To examine the impact of PMIE on healthcare staff wellbeing. METHODS Twelve thousand nine hundred and sixty-five healthcare staff (clinical and non-clinical) were recruited from 18 NHS-England trusts into a survey of PMIE exposure and wellbeing. RESULTS PMIEs were significantly associated with adverse mental health symptoms across healthcare staff. Specific work factors were significantly associated with experiences of moral injury, including being redeployed, lack of PPE, and having a colleague die of COVID-19. Nurses who reported symptoms of mental disorders were more likely to report all forms of PMIEs than those without symptoms (AOR 2.7; 95% CI 2.2, 3.3). Doctors who reported symptoms were only more likely to report betrayal events, such as breach of trust by colleagues (AOR 2.7, 95% CI 1.5, 4.9). CONCLUSION A considerable proportion of NHS healthcare staff in both clinical and non-clinical roles report exposure to PMIEs during the COVID-19 pandemic. Prospective research is needed to identify the direction of causation between moral injury and mental disorder as well as continuing to monitor the longer term outcomes of exposure to PMIEs.
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Affiliation(s)
- Victoria Williamson
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Department of Experimental Psychology, Anna Watts Building, University of Oxford, Oxford, UK
| | - Danielle Lamb
- Department of Applied Health Research, NIHR ARC North Thames, UCL, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, NIHR ARC North Thames, UCL, London, UK
| | - Sharon Stevelink
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Mary Docherty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Trust and King's College London, London, UK
| | - Dominic Murphy
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
- Combat Stress, Tyrwhitt House, Leatherhead, UK
| | - Neil Greenberg
- Institute of Psychology, Psychiatry and Neuroscience, King's Centre for Military Health Research, King's College London, London, UK
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Rabin S, Kika N, Lamb D, Murphy D, AM Stevelink S, Williamson V, Wessely S, Greenberg N. Moral Injuries in Healthcare Workers: What Causes Them and What to Do About Them? J Healthc Leadersh 2023; 15:153-160. [PMID: 37605753 PMCID: PMC10440078 DOI: 10.2147/jhl.s396659] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/26/2023] [Indexed: 08/23/2023] Open
Abstract
Moral injury (MI) refers to the persisting distress which may occur following exposure to potentially morally injurious events (PMIEs). The COVID-19 pandemic has drawn attention to MI in healthcare workers, who have been found to experience more frequent PMIEs in their day-to-day work than those in other occupational groups such as the military. These events may occur on an individual, team, organizational or system level and have been associated with increased clinician burnout and distress, and poor psychological wellbeing. This paper focuses on healthcare workers' experiences of MI, including potential causes and ways to reduce them. There are myriad challenges that influence the development of MI, such as chronic understaffing and the pressure to treat high numbers of patients with limited resources. There are also multiple impacts of MI: at the individual-level, MI can lead to increased staff absences and understaffing, and prolonged patient contact with limited decision-making power. COVID-19 exacerbated such impacts, with a lack of organizational support during a time of increased patient mortality, and uncertainty and heightened pressure on the clinical frontline associated with scarce resources and understaffing. Potential methods for reduction of MI in healthcare workers include pre-exposure mitigation, such as fostering work environments which treat PMIEs in the same way as other occupational hazards and post-exposure mitigation, such as facilitating healthcare workers to process their experiences of PMIEs in peer support groups or with spiritual advisors and, if MI is associated with mental ill-health, talking therapies using trauma-focused and compassion-oriented frameworks.
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Affiliation(s)
- Sarah Rabin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Natalia Kika
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Dominic Murphy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Department, Combat Stress, Leatherhead, UK
| | - Sharon AM Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Victoria Williamson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Simms A, Leightley D, Lamb D. Caring for the carers: an evaluation of the recovery, readjustment and reintegration programme (R3P). BMJ Mil Health 2023:e002359. [PMID: 37487658 DOI: 10.1136/military-2023-002359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION The challenges faced by healthcare workers, not least during the response to the COVID-19 pandemic, have been extensively studied, and concerns continue to be highlighted in relation to their long-term mental health. Identifying the need to support their personnel, a leader-led structured programme of reflection: the recovery, readjustment and reintegration programme (R3P) was designed by the UK Defence Medical Services to mitigate the potential stressors associated with this outbreak and enhance the resilience of the workforce. METHODS 128 military personnel completed an evaluation of R3P. A survey included measures of anxiety before and after the intervention, perceptions of the discussion themes and whether these brought a sense of closure to areas of distress, and attitudes to help-seeking. RESULTS Most respondents (86%-92%) rated the five discussion themes either 'helpful' or 'very helpful', 51% of respondents reported a sense of closure about an issue that had been causing distress and 72% of respondents felt better able to seek help should it be necessary. Evaluating the effect R3P had on anxiety, a Wilcoxon signed rank test elicited a statistically significant difference in anxiety pre-R3P and post-R3P; Z=-3.54, p<0.001. The median anxiety rating was 3.5 (IQR 4.75, 95% CI 1.25 to 6.00) before undertaking R3P, which decreased to 3 (IQR 4.75, 95% CI 1.00 to 5.75) after undertaking R3P. 39.1% of participants reported decreased anxiety, 18.8% reported increased anxiety and 42.2% reported no change. CONCLUSION This evaluation has identified several positive aspects to R3P with many personnel reporting a reduction in anxiety, a sense of closure and increased likelihood of help-seeking. Several participants did report an increase in anxiety and the long-term impact of R3P on mental health and well-being is unclear. Further mixed-methods evaluation incorporating a longer follow-up is required.
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Affiliation(s)
- Amos Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - D Leightley
- King's Centre for Military Health Research, King's College London, London, UK
| | - D Lamb
- RCDM (Research and Academia), MOD, Birmingham, UK
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Padmanathan P, Lamb D, Scott H, Stevelink S, Greenberg N, Hotopf M, Morriss R, Raine R, Rafferty AM, Madan I, Dorrington S, Wessely S, Moran P. Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study. PLoS One 2023; 18:e0286207. [PMID: 37343030 PMCID: PMC10284388 DOI: 10.1371/journal.pone.0286207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. METHODS In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical). RESULTS Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation. CONCLUSION Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.
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Affiliation(s)
- Prianka Padmanathan
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Hannah Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sharon Stevelink
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Neil Greenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Richard Morriss
- The Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Anne Marie Rafferty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ira Madan
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Dorrington
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Simon Wessely
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Le Novere M, Johnson S, Lloyd-Evans B, Marston L, Ambler G, Clarke CS, Osborn D, Lamb D, Hunter RM. Cost-effectiveness of peer-supported self-management for people discharged from a mental health crisis team: methodological challenges and recommendations. Front Psychiatry 2023; 14:1031159. [PMID: 37333912 PMCID: PMC10272352 DOI: 10.3389/fpsyt.2023.1031159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/27/2023] [Indexed: 06/20/2023] Open
Abstract
Background Mental health acute crisis episodes are associated with high inpatient costs. Self-management interventions may reduce readmission by enabling individuals to manage their condition. Delivery of such interventions by Peer Support Workers (PSWs) may be cost-effective. CORE, a randomized control trial of a PSW self-management intervention compared to usual care, found a significant reduction in admissions to acute mental healthcare for participants receiving the intervention. This paper aims to evaluate the cost-effectiveness of the intervention over 12 months from a mental health service perspective. Analysis methods of increasing complexity were used to account for data missingness and distribution. Methods Participants were recruited from six crisis resolution teams in England from 12 March 2014 to 3 July 2015 (trial registration ISRCTN: 01027104). Resource use was collected from patient records at baseline and 12 months. The EQ-5D-3L was collected at baseline and 4 and 18 months, and linear interpolation was used to calculate 12-month values for quality-adjusted life-years (QALYs). The primary analysis of adjusted mean incremental costs and QALYs for complete cases are calculated separately using OLS regression. Secondly, a complete-case non-parametric two-stage bootstrap (TSB) was performed. The impacts of missing data and skewed cost data were explored using multiple imputation using chained equations and general linear models, respectively. Results Four hundred and forty-one participants were recruited to CORE; 221 randomized to the PSW intervention and 220 to usual care plus workbook. The probability that the PSW intervention was cost-effective compared with the workbook plus usual care control at 12 months varied with the method used, and ranged from 57% to 96% at a cost-effectiveness threshold of £20,000 per QALY gained. Discussion There was a minimum 57% chance that the intervention was cost-effective compared to the control using 12-month costs and QALYs. The probability varied by 40% when methods were employed to account for the relationship between costs and QALYs, but which restricted the sample to those who provided both complete cost and utility data. Caution should therefore be applied when selecting methods for the evaluation of healthcare interventions that aim to increase precision but may introduce bias if missing data are heavily unbalanced between costs and outcomes.
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Affiliation(s)
- Marie Le Novere
- Research Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Sonia Johnson
- Divison of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Brynmor Lloyd-Evans
- Divison of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Louise Marston
- Research Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Gareth Ambler
- Department of Statistical Science, Faculty of Mathematical & Physical Sciences, University College London, London, United Kingdom
| | - Caroline S. Clarke
- Research Department of Primary Care and Population Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - David Osborn
- Divison of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Rachael Maree Hunter
- Department of Applied Health Research, Faculty of Population Health Sciences, University College London, London, United Kingdom
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Lamb D, Stevelink SAM, Scott HR, Greenberg N, Wessely S. COVID-19 and the mental health of health-care workers. Lancet Psychiatry 2023; 10:245. [PMID: 36931774 PMCID: PMC10017111 DOI: 10.1016/s2215-0366(23)00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/21/2023] [Accepted: 02/21/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Danielle Lamb
- NIHR ARC North Thames, University College London, London, UK.
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah R Scott
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Gnanapragasam SN, Tinch-Taylor R, Scott HR, Hegarty S, Souliou E, Bhundia R, Lamb D, Weston D, Greenberg N, Madan I, Stevelink S, Raine R, Carter B, Wessely S. Multicentre, England-wide randomised controlled trial of the 'Foundations' smartphone application in improving mental health and well-being in a healthcare worker population. Br J Psychiatry 2023; 222:58-66. [PMID: 36040419 PMCID: PMC10895508 DOI: 10.1192/bjp.2022.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. AIMS We aimed to determine the effectiveness of the 'Foundations' application (app) on general (non-psychotic) psychiatric morbidity. METHOD We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD). RESULTS Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44⋅3 years (interquartile range (IQR) 34-53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = -1.39, 95% CI -2.05 to -0.74), improvement in well-being (aMD = 0⋅54, 95% CI 0⋅20 to 0⋅89) and reduction in insomnia (adjusted odds ratio (aOR) = 0⋅36, 95% CI 0⋅21 to 0⋅60). No other significant findings were found, or adverse events reported. CONCLUSIONS The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.
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Affiliation(s)
- Sam N. Gnanapragasam
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK and South London and Maudsley NHS Foundation Trust, UK
| | - Rose Tinch-Taylor
- Department of Biostatistics and Health Informatics and King's Clinical Trials Unit, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Hannah R. Scott
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Emilia Souliou
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, UK
| | - Danny Weston
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas’ NHS Foundation Trust, UK
| | - Sharon Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics and King's Clinical Trials Unit, Institute of Psychiatry Psychology and Neuroscience, King's College London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, Weston Education Centre, UK
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Clarkson C, Scott HR, Hegarty S, Souliou E, Bhundia R, Gnanapragasam S, Docherty MJ, Raine R, Stevelink SA, Greenberg N, Hotopf M, Wessely S, Madan I, Rafferty AM, Lamb D. 'You get looked at like you're failing': A reflexive thematic analysis of experiences of mental health and wellbeing support for NHS staff. J Health Psychol 2023:13591053221140255. [PMID: 36597919 PMCID: PMC10387714 DOI: 10.1177/13591053221140255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Staff in the National Health Service (NHS) are under considerable strain, exacerbated by the COVID-19 pandemic; whilst NHS Trusts provide a variety of health and wellbeing support services, there has been little research investigating staff perceptions of these services. We interviewed 48 healthcare workers from 18 NHS Trusts in England about their experiences of workplace health and wellbeing support during the pandemic. Reflexive thematic analysis identified that perceived stigma around help-seeking, and staffing shortages due to wider socio-political contexts such as austerity, were barriers to using support services. Visible, caring leadership at all levels (CEO to line managers), peer support, easily accessible services, and clear communication about support offers were enablers. Our evidence suggests Trusts should have active strategies to improve help-seeking, such as manager training and peer support facilitated by building in time for this during working hours, but this will require long-term strategic planning to address workforce shortages.
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Scott HR, Stevelink SAM, Gafoor R, Lamb D, Carr E, Bakolis I, Bhundia R, Docherty MJ, Dorrington S, Gnanapragasam S, Hegarty S, Hotopf M, Madan I, McManus S, Moran P, Souliou E, Raine R, Razavi R, Weston D, Greenberg N, Wessely S. Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study. Lancet Psychiatry 2023; 10:40-49. [PMID: 36502817 PMCID: PMC9731576 DOI: 10.1016/s2215-0366(22)00375-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. METHODS We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. FINDINGS The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1). INTERPRETATION The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. FUNDING UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.
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Affiliation(s)
- Hannah R Scott
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Rafael Gafoor
- Department of Applied Health Research, University College London, London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Sam Gnanapragasam
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sally McManus
- NatCen Social Research, London, UK; Violence and Society Centre City, University of London, London, UK
| | - Paul Moran
- Department of Population Health Sciences, Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emilia Souliou
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Reza Razavi
- Wellcome/EPSRC Centre For Medical Engineering, London, UK
| | - Danny Weston
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lamb D, Wright L, Scott H, Croak B, Gnanapragasam S, Docherty M, Greenberg N, Hotopf M, Stevelink SAM, Raine R, Wessely S. Capturing the experiences of UK healthcare workers during the COVID-19 pandemic: A structural topic modelling analysis of 7,412 free-text survey responses. PLoS One 2022; 17:e0275720. [PMID: 36206241 PMCID: PMC9543686 DOI: 10.1371/journal.pone.0275720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Healthcare workers (HCWs) have provided vital services during the COVID-19 pandemic, but existing research consists of quantitative surveys (lacking in depth or context) or qualitative interviews (with limited generalisability). Structural Topic Modelling (STM) of large-scale free-text survey data offers a way of capturing the perspectives of a wide range of HCWs in their own words about their experiences of the pandemic. METHODS In an online survey distributed to all staff at 18 geographically dispersed NHS Trusts, we asked respondents, "Is there anything else you think we should know about your experiences of the COVID-19 pandemic?". We used STM on 7,412 responses to identify topics, and thematic analysis on the resultant topics and text excerpts. RESULTS We identified 33 topics, grouped into two domains, each containing four themes. Our findings emphasise: the deleterious effect of increased workloads, lack of PPE, inconsistent advice/guidance, and lack of autonomy; differing experiences of home working as negative/positive; and the benefits of supportive leadership and peers in ameliorating challenges. Themes varied by demographics and time: discussion of home working decreasing over time, while discussion of workplace challenges increased. Discussion of mental health was lowest between September-November 2020, between the first and second waves of COVID-19 in the UK. DISCUSSION Our findings represent the most salient experiences of HCWs through the pandemic. STM enabled statistical examination of how the qualitative themes raised differed according to participant characteristics. This relatively underutilised methodology in healthcare research can provide more nuanced, yet generalisable, evidence than that available via surveys or small interview studies, and should be used in future research.
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Affiliation(s)
| | | | | | | | | | - Mary Docherty
- South London and Maudsley NHS Trust, London, United Kingdom
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18
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Lamb D, Banerjee R, Emanuel T. New Canadians Working amid a New Normal: Recent Immigrant Wage Penalties in Canada during the COVID-19 Pandemic. Can Public Policy 2022; 48:60-78. [PMID: 38629967 PMCID: PMC10234262 DOI: 10.3138/cpp.2022-003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has exposed and arguably intensified many existing inequalities. This analysis explores the relationship between recent immigrant earnings and the pandemic. Specifically, we attempt to empirically answer the question "Has the COVID-19 pandemic exacerbated (or mitigated) recent immigrant-non-immigrant employment and wage gaps?" We find that the pandemic did not change the labour force activity profile of recent or long-term immigrants. Moreover, the pandemic did not disproportionately disadvantage recent immigrants' earnings. In fact, recent immigrant men who were employed during the COVID-19 crisis experienced a small but statistically significant earnings premium. This was insufficient, however, to overcome the overall earnings discount associated with being a recent immigrant. In addition, we find that the recent immigrant COVID-19 earnings boost is observable only at and below the median of the earnings distribution. We also use Heckman selection correction to attempt to adjust for unobserved sample selection into employment during the pandemic. The fact that COVID-19 has not worsened recent immigrant earnings gaps should not overshadow the large, recent immigrant earnings disparities that existed before the pandemic and continue to exist regardless of the COVID-19 crisis.
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Affiliation(s)
- Danielle Lamb
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Rupa Banerjee
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Talia Emanuel
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada
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19
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Nicholls H, Nicholls M, Tekin S, Lamb D, Billings J. The impact of working in academia on researchers' mental health and well-being: A systematic review and qualitative meta-synthesis. PLoS One 2022; 17:e0268890. [PMID: 35613147 PMCID: PMC9132292 DOI: 10.1371/journal.pone.0268890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand how researchers experience working in academia and the effects these experiences have on their mental health and well-being, through synthesizing published qualitative data. METHOD A systematic review and qualitative meta-synthesis was conducted to gain a comprehensive overview of what is currently known about academic researchers' mental health and well-being. Relevant papers were identified through searching electronic databases, Google Scholar, and citation tracking. The quality of the included studies was assessed and the data was synthesised using reflexive thematic analysis. RESULTS 26 papers were identified and included in this review. Academic researchers' experiences were captured under seven key themes. Job insecurity coupled with the high expectations set by the academic system left researchers at risk of poor mental health and well-being. Access to peer support networks, opportunities for career progression, and mentorship can help mitigate the stress associated with the academic job role, however, under-represented groups in academia are at risk of unequal access to resources, support, and opportunities. CONCLUSION To improve researchers' well-being at work, scientific/academic practice and the system's concept of what a successful researcher should look like, needs to change. Further high-quality qualitative research is needed to better understand how systemic change, including tackling inequality and introducing better support systems, can be brought about more immediately and effectively. Further research is also needed to better understand the experiences and support needs of post-doctoral and more senior researchers, as there is a paucity of literature in this area. TRIAL REGISTRATION The review protocol was registered on PROSPERO (CRD42021232480).
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Affiliation(s)
- Helen Nicholls
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Matthew Nicholls
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Sahra Tekin
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Jo Billings
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
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Hegarty S, Lamb D, Stevelink SAM, Bhundia R, Raine R, Doherty MJ, Scott HR, Marie Rafferty A, Williamson V, Dorrington S, Hotopf M, Razavi R, Greenberg N, Wessely S. 'It hurts your heart': frontline healthcare worker experiences of moral injury during the COVID-19 pandemic. Eur J Psychotraumatol 2022; 13:2128028. [PMID: 36276556 PMCID: PMC9586685 DOI: 10.1080/20008066.2022.2128028] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Moral injury is defined as the strong emotional and cognitive reactions following events which clash with someone's moral code, values or expectations. During the COVID-19 pandemic, increased exposure to Potentially Morally Injurious Events (PMIEs) has placed healthcare workers (HCWs) at risk of moral injury. Yet little is known about the lived experience of cumulative PMIE exposure and how NHS staff respond to this. Objective: We sought to rectify this knowledge gap by qualitatively exploring the lived experiences and perspectives of clinical frontline NHS staff who responded to COVID-19. Methods: We recruited a diverse sample of 30 clinical frontline HCWs from the NHS CHECK study cohort, for single time point qualitative interviews. All participants endorsed at least one item on the 9-item Moral Injury Events Scale (MIES) [Nash et al., 2013. Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652] at six month follow up. Interviews followed a semi-structured guide and were analysed using reflexive thematic analysis. Results: HCWs described being routinely exposed to ethical conflicts, created by exacerbations of pre-existing systemic issues including inadequate staffing and resourcing. We found that HCWs experienced a range of mental health symptoms primarily related to perceptions of institutional betrayal as well as feeling unable to fulfil their duty of care towards patients. Conclusion: These results suggest that a multi-facetted organisational strategy is warranted to prepare for PMIE exposure, promote opportunities for resolution of symptoms associated with moral injury and prevent organisational disengagement. HIGHLIGHTS Clinical frontline healthcare workers (HCWs) have been exposed to an accumulation of potentially morally injurious events (PMIEs) throughout the COVID-19 pandemic, including feeling betrayed by both government and NHS leaders as well as feeling unable to provide duty of care to patients.HCWs described the significant adverse impact of this exposure on their mental health, including increased anxiety and depression symptoms and sleep disturbance.Most HCWs interviewed believed that organisational change within the NHS was necessary to prevent excess PMIE exposure and promote resolution of moral distress.
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Affiliation(s)
- Siobhan Hegarty
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | | | - Hannah R Scott
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Victoria Williamson
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Reza Razavi
- King's Wellcome Trust EPSRC Centre For Medical Engineering, London, UK
| | - Neil Greenberg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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21
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Lamb D, Gomez R, Moghaddas M. Unions and hazard pay for COVID-19: Evidence from the Canadian Labour Force Survey. Br J Ind Relat 2021; 60:BJIR12649. [PMID: 34898681 PMCID: PMC8652733 DOI: 10.1111/bjir.12649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/11/2021] [Indexed: 06/07/2023]
Abstract
In this article, we examine whether (and by how much) workers in Canada have been compensated for the 'novel' risks associated with COVID-19. We create a unique dataset from a system that scores occupations in the US O*NET database for COVID-19 exposure. We then combine those COVID exposure scores with Canadian occupational data contained in the Public Use Microdata File of the Labour Force Survey. This allows us to categorize Canadian occupations based on COVID-19 exposure risk. We find a long-tailed distribution of COVID-19 risk scores across occupations, with most jobs at the lower end of the risk spectrum and relatively few occupations accounting for most of the high COVID-19 exposure risk. We find that workers who are already more vulnerable in the labour market (i.e. youth, women and immigrants) are also more likely to be employed in occupations with high COVID-19 exposure risk. When we look at the relationship between high-COVID exposure risks in occupation and wages, we find negative compensating differentials both at the mean (negative 8%) and across the earnings distribution. However, when workers are covered by a union, they enjoy a sizeable hazard pay premium (11.7% on average) as compared to their non-union counterparts. Furthermore, we find that the moderating effects of unionization for workers at high risk of COVID exposure to be largest at the bottom of the earnings distribution (i.e. the 10th percentile of unionized earners receives a 12.3% risk premium for high-COVID exposure, whereas the 90th percentile receives only a 2%).
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Affiliation(s)
- Danielle Lamb
- Ted Rogers School of ManagementRyerson UniversityTorontoOntarioCanada
| | - Rafael Gomez
- Centre for Industrial Relations and Human ResourcesUniversity of TorontoTorontoOntarioCanada
| | - Milad Moghaddas
- Ted Rogers School of ManagementRyerson UniversityTorontoOntarioCanada
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22
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Lamb D, Gnanapragasam S, Greenberg N, Bhundia R, Carr E, Hotopf M, Razavi R, Raine R, Cross S, Dewar A, Docherty M, Dorrington S, Hatch S, Wilson-Jones C, Leightley D, Madan I, Marlow S, McMullen I, Rafferty AM, Parsons M, Polling C, Serfioti D, Gaunt H, Aitken P, Morris-Bone J, Simela C, French V, Harris R, Stevelink SAM, Wessely S. Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic. Occup Environ Med 2021; 78:801-808. [PMID: 34183447 PMCID: PMC8245285 DOI: 10.1136/oemed-2020-107276] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/12/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. METHODS Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale. RESULTS Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse. CONCLUSIONS Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | | | - Neil Greenberg
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Rupa Bhundia
- Department of Psychological Medicine, King's College London, London, UK
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Matthew Hotopf
- Maudsley NHS Foundation Trust, London, UK
- National Institute of Health Research Biomedical Research Centre, London, UK
| | - Reza Razavi
- Life Sciences and Medicine, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Sean Cross
- Department of Psychological Medicine, King's College London, London, UK
| | - Amy Dewar
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mary Docherty
- Department of Psychological Medicine, King's College London, London, UK
| | - Sarah Dorrington
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani Hatch
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Daniel Leightley
- Academic Department of Military Mental Health, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Ira Madan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sally Marlow
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isabel McMullen
- Department of Psychological Medicine, King's College London, London, UK
| | | | - Martin Parsons
- Mental Health Liaison Team, King's College London, London, UK
| | - Catherine Polling
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Danai Serfioti
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Helen Gaunt
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Chloe Simela
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Veronica French
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Rachel Harris
- Cornwall Partnership Foundation NHS Trust, Cornwall, UK
| | - Sharon A M Stevelink
- Academic Department of Military Mental Health, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, King's College London, London, UK
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Babu A, Eden N, Meng Z, Lamb D, Bhatia R, Voon V. Can echocardiographic parameters predict mortality in COVID-19? Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), otherwise known as the coronavirus (COVID-19) pandemic presents one of the greatest medical challenges of our generation. Whilst commonly causing a viral pneumonitis, myocardial damage has also been suggested by elevated serum troponin values greater than the 99th centile in up to 30% of individuals who require hospitalisation and correlates with increased mortality.
Purpose
We aim to identify whether transthoracic echocardiography (TTE) parameters can elucidate the phenomenon of abnormal troponin levels. Furthermore, we seek to characterise the most frequent demographic, biochemical, echocardiographic features and co-morbidities associated with adverse outcomes in this cohort.
Methods
A retrospective analysis was conducted utilising electronic patient records of consecutive hospitalised patients with a positive COVID-19 swab between 1st March and 31st October 2020 who underwent a TTE at our institution. Pertinent variables were collected including: the clinical indication, demographics including cardiovascular (CV) risk factors, peak troponin values and fundamental echocardiographic parameters.
Results
During this 8-month period, a total of 90 patients underwent a TTE. The mean age of the cohort was 63 years of age and 56% were male. More than half (56.6%) were admitted to the intensive care unit (ICU). A salient 41.1% (n=37) of our cohort succumbed to this devastating virus. Notably, 38.9% (n=35) were of black and minority ethnic origin (BAME). A striking 64.9% (n=24) of patients who died had hypertension. The mean troponin levels were 168.7 ng/L and 176.6 ng/L (0–34 ng/L) in the survivors and non-survivors group respectively. With regards to TTE, the left ventricular parameters were similar between both groups with a mean left ventricular ejection fraction (LVEF) of 60.6% in the non-survivors. Conversely, both right ventricular (RV) dysfunction (37.8%) and raised pulmonary artery systolic pressures (PASP) (51.4%) were markedly more frequent in the patients who perished due to COVID-19 infection.
Conclusion
Remarkably, in this extremely ill group of patients who died, 91.9% of patients had a preserved LVEF. There were no overt differences between troponin levels in the survivors and non-survivors. However, hypertension, RV dysfunction and raised PASP were distinctly more prominent in the non-survivors. Thus, providing insight that a normally functioning left ventricle does not preclude to poor outcomes. Overall, this single-centre retrospective study demonstrates that the echocardiographic phenotype associated with mortality is consistent with a severe respiratory illness rather than direct myocardial injury from COVID-19. A multi-modality imaging approach may facilitate the identification of adverse tissue characterisation changes associated with this novel virus as well as guiding further risk stratification and patient management on a case-by-case basis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Babu
- Homerton University Hospital, London, United Kingdom
| | - N Eden
- Homerton University Hospital, London, United Kingdom
| | - Z Meng
- Homerton University Hospital, London, United Kingdom
| | - D Lamb
- Homerton University Hospital, London, United Kingdom
| | - R Bhatia
- St George's University Hospital NHS Foundation Trust, Cardiology, London, United Kingdom
| | - V Voon
- Homerton University Hospital, London, United Kingdom
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Osborn D, Lamb D, Canaway A, Davidson M, Favarato G, Pinfold V, Harper T, Johnson S, Khan H, Kirkbride J, Lloyd-Evans B, Madan J, Mann F, Marston L, McKay A, Morant N, Smith D, Steare T, Wackett J, Weich S. Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams.
Objectives
To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units.
Design
Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout.
Setting and participants
Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England.
Results
Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15).
Limitations
In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data.
Conclusions
Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - James Kirkbride
- Division of Psychiatry, University College London, London, UK
| | | | - Jason Madan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Farhana Mann
- Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Division of Psychiatry, University College London, London, UK
| | - Adele McKay
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | | | - Scott Weich
- Mental Health Research Unit, University of Sheffield, Sheffield, UK
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25
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Osborn DPJ, Favarato G, Lamb D, Harper T, Johnson S, Lloyd-Evans B, Marston L, Pinfold V, Smith D, Kirkbride JB, Weich S. Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas. BJPsych Open 2021; 7:e136. [PMID: 34275509 PMCID: PMC8329766 DOI: 10.1192/bjo.2021.961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas. AIMS To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs. METHOD We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission. RESULTS Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10-88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80-1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline. CONCLUSIONS Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.
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Affiliation(s)
- David P J Osborn
- Division of Psychiatry, University College London, and Camden and Islington NHS Foundation Trust, UK
| | | | - Danielle Lamb
- Division of Psychiatry, University College London, UK
| | - Terri Harper
- Department of Primary Care and Population Health, University College London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, and Camden and Islington NHS Foundation Trust, UK
| | | | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | | | | | | | - Scott Weich
- Mental Health Research Unit, Sheffield University, UK
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Lamb D, Greenberg N, Hotopf M, Raine R, Razavi R, Bhundia R, Scott H, Carr E, Gafoor R, Bakolis I, Hegarty S, Souliou E, Rafferty AM, Rhead R, Weston D, Gnangapragasam S, Marlow S, Wessely S, Stevelink S. NHS CHECK: protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers. BMJ Open 2021; 11:e051687. [PMID: 34193505 PMCID: PMC8249177 DOI: 10.1136/bmjopen-2021-051687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of National Health Service (NHS) HCWs, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, and investigate associated factors such as occupational contexts and support interventions available. METHODS AND ANALYSIS All staff, students and volunteers working in the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow-up surveys sent 6 months and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational/organisational factors, experiences of COVID-19, validated measures of symptoms of poor mental health (eg, depression, anxiety, post-traumatic stress disorder), and constructs such as resilience and moral injury. These surveys will be complemented by in-depth psychiatric interviews with a sample of HCWs. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are collected via Qualtrics online survey software, pseudonymised and held on secure university servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services if participants feel they need it. Only those consenting to be contacted about further research will be invited to participate in further components. Findings will be rapidly shared with NHS Trusts, and via academic publications in due course.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Reza Razavi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rafael Gafoor
- Department of Applied Health Research, University College London, London, UK
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siobhan Hegarty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emilia Souliou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Danny Weston
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam Gnangapragasam
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sally Marlow
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sharon Stevelink
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Lamb D, Steare T, Marston L, Canaway A, Johnson S, Kirkbride JB, Lloyd-Evans B, Morant N, Pinfold V, Smith D, Weich S, Osborn DP. A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England. BJPsych Open 2021; 7:e68. [PMID: 33736743 PMCID: PMC8058818 DOI: 10.1192/bjo.2021.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. AIMS We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. METHOD We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick-Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54-1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4-3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4-2.1, P = 0.004), and lower depression scores (-1.7, 95% CI -2.7 to -0.8, P < 0.001), than CRT participants. CONCLUSIONS Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.
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Affiliation(s)
- Danielle Lamb
- NIHR ARC North Thames, Department of Applied Health Research, University College London, UK
| | - Thomas Steare
- Division of Psychiatry, University College London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | | | - Sonia Johnson
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
| | | | | | - Nicola Morant
- Division of Psychiatry, University College London, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, UK
| | - David P Osborn
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
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Morant N, Davidson M, Wackett J, Lamb D, Pinfold V, Smith D, Johnson S, Lloyd-Evans B, Osborn DPJ. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC Psychiatry 2021; 21:146. [PMID: 33691668 PMCID: PMC7944597 DOI: 10.1186/s12888-021-03140-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. METHODS We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. RESULTS Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. CONCLUSIONS Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
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Affiliation(s)
- Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael Davidson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Wackett
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Danielle Lamb
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Deb Smith
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - David P J Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Paxman E, Lamb D, Findlay S. Is there a role for an advanced practitioner in UK military prehospital care? BMJ Mil Health 2021:bmjmilitary-2021-001781. [PMID: 33664094 DOI: 10.1136/bmjmilitary-2021-001781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/04/2022]
Abstract
Recruitment and retention of doctors have been highlighted as some of the leading causes of the current perceived crisis within civilian emergency care. Indeed, the NHS recognises the contribution made by other healthcare professionals by supporting accreditation in advanced practice to mitigate the risks associated with these capability gaps. Consequently, roles such as the advanced clinical practitioner are now well established. Previous research and clinical experience in the civilian sector suggest that the advanced practitioner (AP) role could be used within Defence. Operationally, the role could be advantageous for the Defence Medical Services in the delivery of deployed healthcare. However, there is no available research that defines the role of UK military APs and, more specifically, their potential to support deployed prehospital care. Further work is required to determine how an AP might be effectively used within the military prehospital patient care pathway.
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Affiliation(s)
- Elizabeth Paxman
- Faculty of health sciences, University of Southampton, Southampton, Hampshire, UK
| | - D Lamb
- RCDM (Research and Academia), MOD, Birmingham, UK
| | - S Findlay
- Headquarters, Defence Medical Services Group, Lichfield, UK
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Affiliation(s)
- Danielle Lamb
- Ted Rogers School of Management Ryerson University Toronto ON Canada
| | - Rupa Banerjee
- Ted Rogers School of Management Ryerson University Toronto ON Canada
| | - Anil Verma
- Centre for Industrial Relations and Human, Resources and Rotman School of Management University of Toronto Toronto ON Canada
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Affiliation(s)
- Danielle Lamb
- NIHR ARC North Thames, Department of Applied Health Research, University College London, London, WC1E 7HB, UK.
| | - Neil Greenberg
- Health Protection Research Unit, King's College London, London, UK; King's College London, London, UK
| | - Sharon A M Stevelink
- Weston Education Centre and Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Department of Psychological Medicine, King's College London, London, UK
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Lloyd-Evans B, Osborn D, Marston L, Lamb D, Ambler G, Hunter R, Mason O, Sullivan S, Henderson C, Onyett S, Johnston E, Morant N, Nolan F, Kelly K, Christoforou M, Fullarton K, Forsyth R, Davidson M, Piotrowski J, Mundy E, Bond G, Johnson S. The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial. Br J Psychiatry 2020; 216:314-322. [PMID: 30761976 PMCID: PMC7511901 DOI: 10.1192/bjp.2019.21] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/18/2018] [Accepted: 01/03/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
| | - David Osborn
- Professor of Psychiatric Epidemiology, Division of Psychiatry, University College London; and St Pancras Hospital, Camden and Islington NHS Foundation Trust, UK
| | - Louise Marston
- Principal Research Associate, Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus); and Priment Clinical Trials Unit, UK
| | - Danielle Lamb
- Research Associate, Division of Psychiatry, University College London, UK
| | - Gareth Ambler
- Associate Professor in Medical Statistics, Department of Statistical Science, UCL, UK
| | - Rachael Hunter
- Senior Research Associate, Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus); and Priment Clinical Trials Unit, UK
| | - Oliver Mason
- Reader in Clinical Psychology, School of Psychology, University of Surrey, UK
| | - Sarah Sullivan
- Research Fellow, Epidemiology and Health Services Research, CLAHRC West, UK
| | - Claire Henderson
- Clinical Senior Lecturer, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | | | - Elaine Johnston
- Principal Research Associate, Division of Psychiatry, University College London, UK
| | - Nicola Morant
- Associate Professor, Division of Psychiatry, University College London, UK
| | - Fiona Nolan
- Professor of Nursing, School of Health and Human Sciences, University of Essex, UK
| | - Kathleen Kelly
- Consultant Psychiatrist, Barnes Unit, John Radcliffe Hospital, Oxford Health NHS Foundation Trust, UK
| | | | - Kate Fullarton
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Rebecca Forsyth
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Mike Davidson
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Jonathan Piotrowski
- Research Assistant, Avon and Wiltshire Mental Health Partnership NHS Trust, Research & Development Office, UK
| | - Edward Mundy
- Research Assistant, Division of Psychiatry, University College London, UK
| | - Gary Bond
- Professor of Psychiatry, Westat, Rivermill Commercial Center, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, University College London; and St Pancras Hospital, Camden and Islington NHS Foundation Trust, UK
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Lamb D, Lloyd-Evans B, Fullarton K, Kelly K, Goater N, Mason O, Gray R, Osborn D, Nolan F, Pilling S, Sullivan SA, Henderson C, Milton A, Burgess E, Churchard A, Davidson M, Frerichs J, Hindle D, Paterson B, Brown E, Piotrowski J, Wheeler C, Johnson S. Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology. Int J Ment Health Nurs 2020; 29:187-201. [PMID: 31566846 DOI: 10.1111/inm.12658] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
Abstract
Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services.
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Affiliation(s)
| | - Brynmor Lloyd-Evans
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | - Kathleen Kelly
- Northamptonshire Healthcare NHS Foundation Trust, London, UK
| | | | - Oliver Mason
- North East London NHS Foundation Trust, London, UK
| | | | - David Osborn
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Fiona Nolan
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steve Pilling
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | - Sonia Johnson
- University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
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Lamb D, Davidson M, Lloyd-Evans B, Johnson S, Heinkel S, Steare T, Pinfold V, Weich S, Morant N, Kirkbride J, Marston L, Canaway A, Madan J, Osborn D. Adult mental health provision in England: a national survey of acute day units. BMC Health Serv Res 2019; 19:866. [PMID: 31752861 PMCID: PMC6868849 DOI: 10.1186/s12913-019-4687-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England. Methods English NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions. Results Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services. Conclusions The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.
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Lamb D, Hofman A, Clark J, Hughes A, Sukhera A. Taking a seat at the table: an educational model for nursing empowerment. Int Nurs Rev 2019; 67:118-126. [DOI: 10.1111/inr.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- D. Lamb
- Academic Department of Military NursingRoyal Centre for Defence Medicine, Medical Directorate, Birmingham Research ParkBirmingham UK
| | | | - J. Clark
- Headquarters 2 Medical Brigade Army Medical Services Training Centre York UK
| | - A. Hughes
- Royal Centre for Defence Medicine, Medical Directorate, Birmingham Research Park BirminghamUK
| | - A.M. Sukhera
- Pakistan Army Medical Corps and Director General Medical Services (Inter‐Services) Rawalpindi Pakistan
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Rigon G, Casner A, Albertazzi B, Michel T, Mabey P, Falize E, Ballet J, Van Box Som L, Pikuz S, Sakawa Y, Sano T, Faenov A, Pikuz T, Ozaki N, Kuramitsu Y, Valdivia MP, Tzeferacos P, Lamb D, Koenig M. Rayleigh-Taylor instability experiments on the LULI2000 laser in scaled conditions for young supernova remnants. Phys Rev E 2019; 100:021201. [PMID: 31574771 DOI: 10.1103/physreve.100.021201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 06/10/2023]
Abstract
We describe a platform developed on the LULI2000 laser facility to investigate the evolution of Rayleigh-Taylor instability (RTI) in scaled conditions relevant to young supernova remnants (SNRs) up to 200 years. An RT unstable interface is imaged with a short-pulse laser-driven (PICO2000) x-ray source, providing an unprecedented simultaneous high spatial (24μm) and temporal (10 ps) resolution. This experiment provides relevant data to compare with astrophysical codes, as observational data on the development of RTI at the early stage of the SNR expansion are missing. A comparison is also performed with FLASH radiative magnetohydrodynamic simulations.
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Affiliation(s)
| | - A Casner
- Université de Bordeaux-CNRS-CEA, CELIA, UMR 5107, F-33405 Talence, France
| | | | | | | | - E Falize
- CEA-DAM, DIF, F-91297 Arpajon, France
| | - J Ballet
- AIM, CEA, CNRS, Université Paris-Saclay, Université Paris Diderot, Sorbonne Paris Cité, F-91191 Gif-sur-Yvette, France
| | | | - S Pikuz
- Joint Institute for High Temperature RAS, Moscow 125412, Russia
- National Research Nuclear University "MEPhi," Moscow 115409, Russia
| | - Y Sakawa
- Institute of Laser Engineering, Osaka University, Osaka 565-0871 Japan
| | - T Sano
- Institute of Laser Engineering, Osaka University, Osaka 565-0871 Japan
| | - A Faenov
- Joint Institute for High Temperature RAS, Moscow 125412, Russia
- Open and Transdisciplinary Research Initiative, Osaka University, Osaka 565-0871, Japan
| | - T Pikuz
- Joint Institute for High Temperature RAS, Moscow 125412, Russia
- Open and Transdisciplinary Research Initiative, Osaka University, Osaka 565-0871, Japan
| | - N Ozaki
- Institute of Laser Engineering, Osaka University, Osaka 565-0871 Japan
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - M P Valdivia
- Department of Physics and Astronomy, Johns Hopkins University, Baltimore, Maryland 21218, USA
| | - P Tzeferacos
- University of Chicago, Chicago, Illinois 60637, USA
| | - D Lamb
- University of Chicago, Chicago, Illinois 60637, USA
| | - M Koenig
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
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Gabrielsen J, Lamb D, Lipshultz L. 059 Profession is an Independent Predictor of Testosterone Levels in Men. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lloyd-Evans B, Christoforou M, Osborn D, Ambler G, Marston L, Lamb D, Mason O, Morant N, Sullivan S, Henderson C, Hunter R, Pilling S, Nolan F, Gray R, Weaver T, Kelly K, Goater N, Milton A, Johnston E, Fullarton K, Lean M, Paterson B, Piotrowski J, Davidson M, Forsyth R, Mosse L, Leverton M, O’Hanlon P, Mundy E, Mundy T, Brown E, Fahmy S, Burgess E, Churchard A, Wheeler C, Istead H, Hindle D, Johnson S. Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs. Programme Grants Appl Res 2019. [DOI: 10.3310/pgfar07010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background
Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high.
Aims
The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a model of best practice for CRTs, develop a measure to assess adherence to this model and evaluate service improvement resources to help CRTs implement the model with high fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support.
Methods
Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT model fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up.
Results
Workstream 1 – a 39-item CRT fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in model fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes.
Limitations
Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements.
Conclusions
The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT model fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care.
Study registration
The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
| | | | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Oliver Mason
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | - Sarah Sullivan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Claire Henderson
- Health Service and Population Research, King’s College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Fiona Nolan
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Richard Gray
- Department of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
| | - Tim Weaver
- Mental Health Social Work and Interprofessional Learning, Middlesex University London, London, UK
| | | | | | - Alyssa Milton
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Elaine Johnston
- Division of Psychiatry, University College London, London, UK
| | - Kate Fullarton
- Division of Psychiatry, University College London, London, UK
| | - Melanie Lean
- Division of Psychiatry, University College London, London, UK
| | - Beth Paterson
- Division of Psychiatry, University College London, London, UK
| | | | | | - Rebecca Forsyth
- Division of Psychiatry, University College London, London, UK
| | - Liberty Mosse
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | - Edward Mundy
- Division of Psychiatry, University College London, London, UK
| | - Tom Mundy
- Division of Psychiatry, University College London, London, UK
| | - Ellie Brown
- Psychiatric Health Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Sarah Fahmy
- Division of Psychiatry, University College London, London, UK
| | - Emma Burgess
- Division of Psychiatry, University College London, London, UK
| | | | - Claire Wheeler
- Division of Psychiatry, University College London, London, UK
| | - Hannah Istead
- Division of Psychiatry, University College London, London, UK
| | - David Hindle
- Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Johnson S, Lamb D, Marston L, Osborn D, Mason O, Henderson C, Ambler G, Milton A, Davidson M, Christoforou M, Sullivan S, Hunter R, Hindle D, Paterson B, Leverton M, Piotrowski J, Forsyth R, Mosse L, Goater N, Kelly K, Lean M, Pilling S, Morant N, Lloyd-Evans B. Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial. Lancet 2018; 392:409-418. [PMID: 30102174 PMCID: PMC6083437 DOI: 10.1016/s0140-6736(18)31470-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis. METHODS We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104. FINDINGS 221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43-0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group). INTERPRETATION Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission. FUNDING National Institute for Health Research.
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Affiliation(s)
- Sonia Johnson
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - David Osborn
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Oliver Mason
- Division of Psychology and Language Sciences, University College London, London, UK; School of Psychology, University of Surrey, Guildford, UK
| | - Claire Henderson
- Health Service and Population Research, King's College London, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Alyssa Milton
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | | | - Sarah Sullivan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - David Hindle
- Division of Psychiatry, University College London, London, UK
| | - Beth Paterson
- Division of Psychiatry, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | | | - Rebecca Forsyth
- Division of Psychiatry, University College London, London, UK
| | - Liberty Mosse
- Division of Psychiatry, University College London, London, UK
| | | | | | - Mel Lean
- Division of Psychiatry, University College London, London, UK
| | - Stephen Pilling
- Division of Psychology and Language Sciences, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
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Bowley DM, Lamb D, Rumbold P, Hunt P, Kayani J, Sukhera AM. Nursing and medical contribution to Defence Healthcare Engagement: initial experiences of the UK Defence Medical Services. J ROY ARMY MED CORPS 2018; 165:143-146. [DOI: 10.1136/jramc-2017-000875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/04/2022]
Abstract
IntroductionThe WHO Constitution enshrines ‘…the highest attainable standard of health as a fundamental right of every human being.’ Strengthening delivery of health services confers benefits to individuals, families and communities, and can improve national and regional stability and security. In attempting to build international healthcare capability, UK Defence Medical Services (DMS) assets can contribute to the development of healthcare within overseas nations in a process that is known as Defence Healthcare Engagement (DHE).MethodsIn the first bespoke DMS DHE tasking, a team of 12 DMS nurses and doctors deployed to a 1000-bedded urban hospital in a partner nation and worked alongside indigenous healthcare workers (doctors, nurses and paramedical staff) during April and May 2016. The DMS nurses focused on nursing hygiene skills by demonstrations of best practice and DMS care standards, clinical leadership and female empowerment. A Quality Improvement Programme was initiated that centred on hand hygiene (HH) compliance before and after patient contact, and the introduction of peripheral cannula care and surveillance.ResultsAfter a brief induction on the ward, it was apparent that compliance with HH was poor. Peripheral cannulas were secured with adhesive zinc oxide tape and no active surveillance process (such as venous infusion phlebitis (VIP) scoring) was in place. After intensive education and training, initial week-long audits were undertaken and repeated after a further 2 weeks of training and coworking. In the second audit cycle, HH compliance had increased to 69% and VIP scoring compliance to 99%. In the final audit cycle, it was noted that nursing compliance with HH (75/98: 77%) was significantly higher than the doctors’ HH compliance (76/200: 38%); p<0.0001.ConclusionsDHE is a long-term collaborative process based on the establishment and development of comprehensive relationships that can help transform indigenous healthcare services towards patient-centred systems with a focus on safety and quality of care. Short deployments to allow clinical immersion of UK healthcare workers within indigenous teams can have an immediate impact. Coworking is a powerful method of demonstrating standards of care and empowering staff to institute transformative change. A multidisciplinary group of Quality Improvement Champions has been identified and a Hospital Oversight Committee established, which will offer the prospect of longer term sustainability and development.
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Lloyd-Evans B, Lamb D, Barnby J, Eskinazi M, Turner A, Johnson S. Mental health crisis resolution teams and crisis care systems in England: a national survey. BJPsych Bull 2018; 42:146-151. [PMID: 29792390 PMCID: PMC6436049 DOI: 10.1192/bjb.2018.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/15/2018] [Accepted: 02/23/2018] [Indexed: 11/23/2022] Open
Abstract
Aims and methodA national survey investigated the implementation of mental health crisis resolution teams (CRTs) in England. CRTs were mapped and team managers completed an online survey. RESULTS Ninety-five per cent of mapped CRTs (n = 233) completed the survey. Few CRTs adhered fully to national policy guidelines. CRT implementation and local acute care system contexts varied substantially. Access to CRTs for working-age adults appears to have improved, compared with a similar survey in 2012, despite no evidence of higher staffing levels. Specialist CRTs for children and for older adults with dementia have been implemented in some areas but are uncommon.Clinical implicationsA national mandate and policy guidelines have been insufficient to implement CRTs fully as planned. Programmes to support adherence to the CRT model and CRT service improvement are required. Clearer policy guidance is needed on requirements for crisis care for young people and older adults.Declaration of interestNone.
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Muller SA, Kaczala DN, Abu-Shawareb HM, Alfonso EL, Carlson LC, Mauldin M, Fitzsimmons P, Lamb D, Tzeferacos P, Chen L, Gregori G, Rigby A, Bott A, White TG, Froula D, Katz J. Evolution of the Design and Fabrication of Astrophysics Targets for Turbulent Dynamo (TDYNO) Experiments on OMEGA. Fusion Science and Technology 2018. [DOI: 10.1080/15361055.2017.1396097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. A. Muller
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - D. N. Kaczala
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | | | - E. L. Alfonso
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - L. C. Carlson
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - M. Mauldin
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - P. Fitzsimmons
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - D. Lamb
- University of Chicago, Department of Astronomy and Astrophysics, Chicago, Illinois 60637
| | - P. Tzeferacos
- University of Chicago, Department of Astronomy and Astrophysics, Chicago, Illinois 60637
| | - L. Chen
- University of Oxford, Department of Physics, Oxford OX1 3PU, United Kingdom
| | - G. Gregori
- University of Oxford, Department of Physics, Oxford OX1 3PU, United Kingdom
| | - A. Rigby
- University of Oxford, Department of Physics, Oxford OX1 3PU, United Kingdom
| | - A. Bott
- University of Oxford, Department of Physics, Oxford OX1 3PU, United Kingdom
| | - T. G. White
- University of Oxford, Department of Physics, Oxford OX1 3PU, United Kingdom
| | - D. Froula
- University of Rochester, Laboratory for Laser Energetics, Rochester, New York 14623
| | - J. Katz
- University of Rochester, Laboratory for Laser Energetics, Rochester, New York 14623
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Morant N, Lloyd-Evans B, Lamb D, Fullarton K, Brown E, Paterson B, Istead H, Kelly K, Hindle D, Fahmy S, Henderson C, Mason O, Johnson S. Crisis resolution and home treatment: stakeholders' views on critical ingredients and implementation in England. BMC Psychiatry 2017; 17:254. [PMID: 28716022 PMCID: PMC5512942 DOI: 10.1186/s12888-017-1421-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis resolution teams (CRTs) can provide effective home-based treatment for acute mental health crises, although critical ingredients of the model have not been clearly identified, and implementation has been inconsistent. In order to inform development of a more highly specified CRT model that meets service users' needs, this study used qualitative methods to investigate stakeholders' experiences and views of CRTs, and what is important in good quality home-based crisis care. METHOD Semi-structured interviews and focus groups were conducted with service users (n = 41), carers (n = 20) and practitioners (CRT staff, managers and referrers; n = 147, 26 focus groups, 9 interviews) in 10 mental health catchment areas in England, and with international CRT developers (n = 11). Data were analysed using thematic analysis. RESULTS Three domains salient to views about optimal care were identified. 1. The organisation of CRT care: Providing a rapid initial responses, and frequent home visits from the same staff were seen as central to good care, particularly by service users and carers. Being accessible, reliable, and having some flexibility were also valued. Negative experiences of some referral pathways, and particularly lack of staff continuity were identified as problematic. 2. The content of CRT work: Emotional support was at the centre of service users' experiences. All stakeholder groups thought CRTs should involve the whole family, and offer a range of interventions. However, carers often feel excluded, and medication is often prioritised over other forms of support. 3. The role of CRTs within the care system: Gate-keeping admissions is seen as a key role for CRTs within the acute care system. Service users and carers report that recovery is quicker compared to in-patient care. Lack of knowledge and misunderstandings about CRTs among referrers are common. Overall, levels of stakeholder agreement about the critical ingredients of good crisis care were high, although aspects of this were not always seen as achievable. CONCLUSIONS Stakeholders' views about optimal CRT care suggest that staff continuity, carer involvement, and emotional and practical support should be prioritised in service improvements and more clearly specified CRT models.
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Affiliation(s)
- Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Brynmor Lloyd-Evans
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Danielle Lamb
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Eleanor Brown
- 0000 0001 0526 7079grid.1021.2IMPACT SRC, Deakin University, Victoria, Australia
| | - Beth Paterson
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Hannah Istead
- Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU UK
| | - Kathleen Kelly
- 0000 0001 2306 7492grid.8348.7Oxford Health NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - David Hindle
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Fahmy
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Claire Henderson
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department P029, King’s College London Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF UK
| | - Oliver Mason
- 0000 0004 0407 4824grid.5475.3School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
| | - Sonia Johnson
- 0000000121901201grid.83440.3bDivision of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
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Stone RJ, Guest R, Mahoney P, Lamb D, Gibson C. A 'mixed reality' simulator concept for future Medical Emergency Response Team training. J ROY ARMY MED CORPS 2017; 163:280-287. [PMID: 28062529 DOI: 10.1136/jramc-2016-000726] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/28/2016] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
Abstract
The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in 'mission-specific' contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other platforms in other branches of the Armed Forces). This paper describes the development of an inexpensive, reconfigurable and transportable MERT training concept based on 'mixed reality' technologies-in effect the 'blending' of real-world objects of training relevance with virtual reality reconstructions of operational contexts.
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Affiliation(s)
| | - R Guest
- University of Birmingham, EESE, Birmingham, UK
| | - P Mahoney
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
| | - D Lamb
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - C Gibson
- Clinical Policy, Royal Army Medical Corps, Royal Centre for Defence Medicine, Birmingham, UK
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Lloyd-Evans B, Bond GR, Ruud T, Ivanecka A, Gray R, Osborn D, Nolan F, Henderson C, Mason O, Goater N, Kelly K, Ambler G, Morant N, Onyett S, Lamb D, Fahmy S, Brown E, Paterson B, Sweeney A, Hindle D, Fullarton K, Frerichs J, Johnson S. Development of a measure of model fidelity for mental health Crisis Resolution Teams. BMC Psychiatry 2016; 16:427. [PMID: 27905909 PMCID: PMC5133753 DOI: 10.1186/s12888-016-1139-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Accepted: 11/24/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence. METHODS A concept mapping process was used to develop a CRT fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day fidelity review process. Trained reviewers (n = 16) rated CRT service fidelity in a vignette exercise to test the scale's inter-rater reliability. RESULTS There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT model. A 39-item measure of CRT model fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT model fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). CONCLUSIONS The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
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Affiliation(s)
| | - Gary R. Bond
- Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766 USA
| | - Torleif Ruud
- Division Mental Health Services, Akershus Unieversity Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ada Ivanecka
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Richard Gray
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - David Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Fiona Nolan
- Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Oliver Mason
- Research Department of Clinical, Education and Health Psychology, University College London Gower Street, London, WC1E 6BT UK
- School of Psychology, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Nicky Goater
- West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Kathleen Kelly
- Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Gareth Ambler
- Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- Onyett Entero Ltd, care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - Danielle Lamb
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sarah Fahmy
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Ellie Brown
- Mental Health Sciences Department, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Beth Paterson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Angela Sweeney
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - David Hindle
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Kate Fullarton
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Johanna Frerichs
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
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46
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Li CK, Tzeferacos P, Lamb D, Gregori G, Norreys PA, Rosenberg MJ, Follett RK, Froula DH, Koenig M, Seguin FH, Frenje JA, Rinderknecht HG, Sio H, Zylstra AB, Petrasso RD, Amendt PA, Park HS, Remington BA, Ryutov DD, Wilks SC, Betti R, Frank A, Hu SX, Sangster TC, Hartigan P, Drake RP, Kuranz CC, Lebedev SV, Woolsey NC. Scaled laboratory experiments explain the kink behaviour of the Crab Nebula jet. Nat Commun 2016; 7:13081. [PMID: 27713403 PMCID: PMC5059765 DOI: 10.1038/ncomms13081] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/31/2016] [Indexed: 11/09/2022] Open
Abstract
The remarkable discovery by the Chandra X-ray observatory that the Crab nebula's jet periodically changes direction provides a challenge to our understanding of astrophysical jet dynamics. It has been suggested that this phenomenon may be the consequence of magnetic fields and magnetohydrodynamic instabilities, but experimental demonstration in a controlled laboratory environment has remained elusive. Here we report experiments that use high-power lasers to create a plasma jet that can be directly compared with the Crab jet through well-defined physical scaling laws. The jet generates its own embedded toroidal magnetic fields; as it moves, plasma instabilities result in multiple deflections of the propagation direction, mimicking the kink behaviour of the Crab jet. The experiment is modelled with three-dimensional numerical simulations that show exactly how the instability develops and results in changes of direction of the jet. The periodical change of the Crab nebula's jet direction challenges our understanding of astrophysical jet dynamics. Here the authors use high-power lasers to create a jet that can be directly compared to the Crab nebula's, and report the detection of plasma instabilities that mimic kink behaviour.
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Affiliation(s)
- C K Li
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - P Tzeferacos
- Department of Astronomy and Astrophysics, University of Chicago, 5640 South Ellis Avenue, Chicago, Illinois 60637, USA
| | - D Lamb
- Department of Astronomy and Astrophysics, University of Chicago, 5640 South Ellis Avenue, Chicago, Illinois 60637, USA
| | - G Gregori
- Department of Physics, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - P A Norreys
- Department of Physics, University of Oxford, Parks Road, Oxford OX1 3PU, UK
| | - M J Rosenberg
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - R K Follett
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14627, USA.,Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - D H Froula
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14627, USA.,Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - M Koenig
- LULI-CNRS, Ecole Polytechnique, CEA: Université Paris-Saclay; UPMC Univ Paris 06: Sorbonne Universités, F-91128 Palaiseau cedex, France.,Institute of Laser Engineering, Osaka University, Suita, Osaka 565-0871, Japan
| | - F H Seguin
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - J A Frenje
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - H G Rinderknecht
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - H Sio
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - A B Zylstra
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - R D Petrasso
- Plasma Science and Fusion Center, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139 USA
| | - P A Amendt
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - H S Park
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B A Remington
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - D D Ryutov
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - S C Wilks
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - R Betti
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14627, USA.,Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - A Frank
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14627, USA.,Department of Physics and Astronomy, University of Rochester, Rochester, New York 14627, USA
| | - S X Hu
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14627, USA
| | - T C Sangster
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14627, USA
| | - P Hartigan
- Department of Physics and Astronomy, Rice University 6100 S. Main, Houston, Texas 77521, USA
| | - R P Drake
- Department of Atmospheric, Ocean and Space Science, University of Michigan, 2455 Hayward Street, Ann Arbor, Michigan 48103, USA
| | - C C Kuranz
- Department of Atmospheric, Ocean and Space Science, University of Michigan, 2455 Hayward Street, Ann Arbor, Michigan 48103, USA
| | - S V Lebedev
- The Blackett Laboratory, Imperial College London, London SW7 2BW, UK
| | - N C Woolsey
- Department of Physics, University of York, York YO10 5D, UK
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47
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Affiliation(s)
- D Lamb
- Department of Pathology, University of Edinburgh, University Medical School, Teviot Place, Edinburgh, EH8 9AG
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48
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Smith JE, Withnall RDJ, Rickard RF, Lamb D, Sitch A, Hodgetts TJ. A pilot study to evaluate the utility of live training (LIVEX) in the operational preparedness of UK military trauma teams. Postgrad Med J 2016; 92:697-700. [DOI: 10.1136/postgradmedj-2015-133585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/22/2015] [Accepted: 04/17/2016] [Indexed: 11/04/2022]
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Lloyd-Evans B, Fullarton K, Lamb D, Johnston E, Onyett S, Osborn D, Ambler G, Marston L, Hunter R, Mason O, Henderson C, Goater N, Sullivan SA, Kelly K, Gray R, Nolan F, Pilling S, Bond G, Johnson S. The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial. Trials 2016; 17:158. [PMID: 27004517 PMCID: PMC4804533 DOI: 10.1186/s13063-016-1283-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
| | - Kate Fullarton
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Danielle Lamb
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Elaine Johnston
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- />Onyett Entero Ltd, Care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - David Osborn
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Gareth Ambler
- />Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Louise Marston
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Rachael Hunter
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Oliver Mason
- />Department of Clinical Education and Health Psychology, UCL, Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- />Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Nicky Goater
- />West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Sarah A. Sullivan
- />Epidemiology and Health Services Research, CLAHRC West, Lewins Mead, Bristol, BS1 2NT UK
| | - Kathleen Kelly
- />Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard Gray
- />Mental Health Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Fiona Nolan
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Stephen Pilling
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Gary Bond
- />Department of Psychiatry, Dartmouth Psychiatric Research Centre, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 USA
| | - Sonia Johnson
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
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50
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Lamb D, Berthnal EM. Editorial. J ROY ARMY MED CORPS 2015; 161 Suppl 1:i1. [PMID: 26621805 DOI: 10.1136/jramc-2015-000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D Lamb
- RCDM (Research and Academia), MOD, Birmingham, UK
| | - E M Berthnal
- RCDM (Research and Academia), MOD, Birmingham, UK
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