Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
To send this article to your account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send this article to your Kindle, first ensure firstname.lastname@example.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The UK Mental Health Act 1983 does not apply in prison. The legal framework for the care and treatment of people with mental illness in prison is provided by the Mental Capacity Act 2005. We raise dilemmas about its use. We highlight how assessing best interests and defining harm involves making challenging judgements. How best interests and harm are interpreted has a potentially significant impact on clinical practice within a prison context.
It is generally stated that the Mental Health Act 1983 does not apply to prisoners, and this is a useful shorthand to remind those unfamiliar with British prisons that treatment cannot be administered under the Mental Health Act, even to the most severely mentally ill prisoners. However, the legal situation is actually more nuanced given that the Mental Health Act does make provision for prisoners – intending that they be promptly transferred to hospital for treatment. This does not happen in practice for service reasons. It is not clear whether the Mental Capacity Act 2005 applies to those falling through the cracks.
To evaluate the suitability of 80 patients referred for assertive outreach treatment (AOT) and their treatment outcomes, by comparing clinical and social data during the treatment period with data before treatment began. To control for service development across the board, patients on ordinary community treatment were identified and matched to patients undergoing AOT for age, gender, clinical diagnosis and duration, and data acquired for the same time period as the patients on AOT. This was a retrospective mirror-image evaluation with contemporaneous controls.
The patients referred for AOT were more socially disadvantaged and had used more clinical resources than the control patients. Overall, AOT reduced resource uptake markedly following referral, while resource uptake by control patients during the same period remained static or increased; AOT, however, did not lessen most aspects of social disadvantage.
The advantages of AOT include much reduced use of services but not the resolving of social exclusion. Some ordinary community provision may fail to afford the quality of AOT and thus suffer by comparison. The demise of AOT may be premature in such services.
Religion and spirituality are very important personal aspects of many people's lives. Little work has looked at the beliefs of mental health professionals and how they reconcile or benefit from the potential differences of religious faith and evidence-based mental health practice. This study used semi-structured interviews to qualitatively explore how professionals from different occupations and faiths conceptualise the relationship between their beliefs and their work.
The commonly cited ‘conflict’ of science and religion was noted, as was the personal support that faith provides for many people. Participants felt their beliefs made them better at their job, not only by reconciling differences from the two paradigms but also by allowing them to recognise compatible attributes of seeking meaning to subjective experience; this had positively influenced their choice of career in mental health. A desire for ongoing opportunity to express and discuss this interface was strongly expressed, but with concern about how this would occur and be perceived.
There is a lack of qualitative research on the religious beliefs of mental health staff. In the UK generally, the role of faith in public life is a strongly debated topic in the context of an increasingly secular and yet multicultural and multi-faith society. Our data suggest that professionals' beliefs positively influence their choice of career in mental health and make them feel better equipped to undertake their roles and provide good-quality patient care. There is an expressed need for further opportunities for staff to discuss their beliefs – or lack thereof – and to consider the individual impact of beliefs on their professional life.
To investigate in-patient satisfaction with psychiatrists, comparing National Health Service (NHS) trusts with sector consultants against NHS trusts with separate in-patient and community consultants (the functional model). The Care Quality Commission's in-patient survey was used, comparing mean scores on four questions concerning patient satisfaction with consultants.
Patients scored higher for being treated with respect in trusts with sector consultants. In questions concerning trust, being listened to and getting adequate time, patient satisfaction scores were again higher for sector consultants, but did not reach 5% significance.
Moving to a split between in-patient and community consultants may reduce in-patient satisfaction with care. The continuity of care with sector-based consultants may be a factor in greater in-patient satisfaction.
To explore the patterns of alcohol consumption and its impact on clinical outcomes in schizophrenia in low- and middle-income countries. We performed a cross-sectional survey of 315 patients with schizophrenia and calculated the prevalence of alcohol consumption and alcohol use disorder. The patients' sociodemographic profiles and clinical outcomes, including Brief Psychiatric Rating Scale (BPRS) scores, were compared between abstainers and drinkers using the χ2- and t-tests.
The 1-year prevalence of drinking, hazardous drinking and alcohol dependence was 16.8% (95% CI 12.9–21.4), 5.7% (95% CI 3.4–8.9) and 2.5% (95% CI 1.1–4.9), respectively. Male gender, single or post-marital status, higher education and being economically active were significantly associated with alcohol consumption. Alcohol drinkers were significantly more likely to be on combination psychotropics compared with abstainers. The mean total BPRS score was significantly lower in alcohol drinkers compared with abstainers. Drinking alcohol was associated with fewer deficit symptoms.
Cultural settings have a significant impact on the prevalence of alcohol use disorder in schizophrenia.
To describe an interim service set up to examine the breadth of UK ex-service personnel's concerns in relation to their mental health and military service and provide a record of the first 150 individuals assessed following conformation of military service and examination of all available military and civilian medical records.
The majority of attendees were White male ex-soldiers. Average age, service and time to assessment were 44.5, 15.8 and 11.7 years respectively. Two-thirds were receiving help from the National Health Service and ex-service nongovernmental organisations. Rates of post-traumatic stress disorder were similar to previous UK studies. Obsessional symptoms were of relevance to the clinical presentation in a third. Fabrication and/or exaggeration occurred in about 10%.
The spread of diagnoses and delay in help-seeking are similar to civilians. The link between mental disorders and military service is seldom straightforward and fabrication or exaggeration is difficult for civilians to recognise. Verification and contextualisation of service using contemporaneous service medical records is important given the possible occupational origin of mental health conditions.