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To investigate implementation of National Institute for Health and Clinical Excellence (NICE) guidelines in mental health, focusing on the schizophrenia guideline. Data analyses centred on implementation of the guideline, as well as looking at a set of markers mapped to the NICE principles of implementation and other identified clinical prerequisites. A self-report questionnaire tool was sent to senior executives at mental health trusts containing questions linked to the markers of implementation and clinical prerequisites; responses were analysed with data from the Healthcare Commission audit of implementation of the guideline to show key relationships.
Information from both data-sets (senior executive data collection and the audit) showed that implementation is patchy, with pockets of good implementation. Findings indicate that higher levels of implementation are linked to corporate commitment and leadership, as well as support from commissioners.
Implementation might be improved by corporate commitment and leadership and better support from commissioners.
Expert clinical judgement combines technical proficiency with humanistic qualities.
To test the psychometric properties of questionnaires to assess the humanistic qualities of working with colleagues and relating to patients using multisource feedback.
Analysis of self-ratings by 347 consultant psychiatrists and ratings by 4422 colleagues and 6657 patients.
Mean effectiveness as rated by self, colleagues and patients, was 4.6, 5.0 and 5.2 respectively (where 1=very low and 6=excellent). The instruments are internally consistent (Cronbach's alpha > 0.95). Principal components analysis of the colleague questionnaire yielded seven factors that explain 70.2% of the variance and accord with the domain structure. Colleague and patient ratings correlate with one another (r=0.39, P<0.001) but not with the self-rating. Ratings from 13 colleagues and 25 patients are required to achieve a generalisability coefficient (Eρ2) of 0.75.
Reliable 360-degree assessment of humane judgement is feasible for psychiatrists who work in large multiprofessional teams and who have large case-loads.
To explore relationships between different styles of working and measures of occupational pressure in consultant psychiatrists. A random sample of 500 consultant psychiatrists were sent a questionnaire about working patterns and lifestyle factors, with other sections using validated tools (such as the 12-item General Health Questionnaire; GHQ).
There were 185 useable questionnaires returned (an adjusted response rate of 39%). Significant relationships were identified between job content and GHQ and burnout scores, indicating that occupational pressures are rendering some consultant posts ‘problem posts', leading to problematic levels of psychological distress among some consultants.
Although consultant psychiatrists are more satisfied than not with their jobs, steps need to be taken to address the causes of ‘problem posts', to reduce attrition in the most pressured individuals.
Previous research suggests that social workers experience high levels of
stress and burnout but most remain committed to their work.
To examine the prevalence of stress and burnout, and job satisfaction
among mental health social workers (MHSWs) and the factors responsible
A postal survey incorporating the General Health Questionnaire, Maslach
Burnout Inventory, Karasek Job Content Questionnaire and a job
satisfaction measure was sent to 610 MHSWs in England and Wales.
Eligible respondents (n=237) reported high levels of
stress and emotional exhaustion and low levels of job satisfaction; 111
(47%) showed significant symptomatology and distress, which is twice the
level reported by similar surveys of psychiatrists. Feeling undervalued
at work, excessive job demands, limited latitude in decision-making, and
unhappiness about the place of MHSWs in modern services contributed to
the poor job satisfaction and most aspects of burnout. Those who had
approved social worker status had greater dissatisfaction.
Stress may exacerbate recruitment and retention problems. Employers must
recognise the demands placed upon MHSWs and value their contribution to
mental health services.
The aim of the study was to explore how different styles of working relate to measures of occupational pressure experienced by consultant psychiatrists. A questionnaire was sent to a random sample of 500 consultant psychiatrists enquiring about work patterns, roles and responsibilities; it also contained validated tools, including the 12-item General Health Questionnaire.
A total of 185 usable questionnaires were returned; an adjusted response rate of 41%. More ‘progressive’ styles of working were found to be linked with less occupational pressure on consultant psychiatrists. Three scales were derived: positive workload pattern, clarity of role and perceived support.
Alterations in working style may be helpful in combating occupational stress, and therefore in reducing attrition in the psychiatric workforce. Consultants and their teams should give consideration to reviewing their roles and patterns of working.
The project gathered data from a cohort of 300 flexibly trained female consultants in psychiatry in order to understand how their careers had progressed since the completion of their training. A postal questionnaire was used to gather this information.
These consultants were generally satisfied with their training, and were succeeding in pursuing their careers. Flexible training was developed to enable people with family commitments to train in psychiatry, and this is what it is being used for.
Flexible training is an important avenue for an increasing number of psychiatrists to continue in their profession. With the current shortfall in consultant numbers, flexible training should be maintained and developed, and should be seen as a useful route to a consultant position.
This survey gathered data on the retirement intentions of consultant psychiatrists over the age of 50 years, in order to address retention issues. A questionnaire was sent to all 1438 consultants over this age in the UK.
A total of 848 questionnaires were returned, an adjusted response rate of 59%. The mean age at which consultants intended to retire in this sample was 60 years (s.d. 4.16), suggesting a potential loss of 5725 consultant years. Reasons for early retirement are complex: factors encouraging retirement include too much bureaucracy, lack of free time and heavy case-loads; those discouraging retirement include enjoyment of work, having a good team and money. Mental Health Officer status is an important determinant in the decision to retire early.
With numerous vacancies in consultant psychiatrist posts throughout the UK, premature retirement is a cause for concern, possibly contributing to an overall reduction in consultant numbers of 5%. Addressing factors that influence consultants' decisions to leave the health service early should form an important part of an overall strategy to increase consultant numbers.
This study aimed to examine in-patient child and adolescent consultant psychiatrists' knowledge of and attitude to the Mental Health Act 1983 (MHA), the Children Act 1989 and issues around consent. A questionnaire form was sent to all in-patient consultants in England and Wales.
The consultants who responded (n=51, 67%) reported a desire for more training in legal issues. Knowledge of the MHA was better than for the Children Act 1989; those who used the MHA at least once every 6 months scored more correct answers to questions about the MHA than did those who used it less frequently or never.
Although the study indicates specific gaps in knowledge, the main message is that training should consider the legal framework as a whole, with an emphasis on practical issues about its application in the in-patient setting.
To identify psychiatrists' concerns relating to the use of legislation in children and young people with mental health problems. Four hundred and eighty members of the child and adolescent faculty of the Royal College of Psychiatrists were asked to list their main concerns.
Two hundred and fifty-eight members responded. The four most reported themes were: choosing between the Mental Health Act and the Children Act; general issues around consent to treatment; issues with social services departments; and the stigma associated with using the Mental Health Act.
The range of themes identified from this survey have served to focus the evaluation of the use of the Children Act and the Mental Health Act in Children and Adolescents in Psychiatric Settings (CAMHA-CAPS), and informed the design of subsequent data collection tools. The project report has now been submitted to the Department of Health for consideration.
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