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Community mental health team (CMHT) services in many Western countries have been remodelled to focus on people with the most severe illnesses and complex problems. Complexity scores using the Matching Resource to Care (MARC2) measure from CMHT cases in 2004–2005 (n=1481) are compared with scores in 1997–1998 (n=3178) in the same locations, before the introduction of the National Service Framework, and before the impact of the creation of integrated mental health trusts in England.
The 2004–2005 baseline complexity scores are all worse than those in 1997–1998.
If increased targeting brought about by the National Service Framework and other reforms has led to a greater proportion of people with complex problems in case-loads, what care services, if any, are now being received by people who were in receipt of CMHT services before the reforms?
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.
This paper is concerned with issues in the routine measurement of quality of life in a mental health context. It is in three parts. In the first part the first author reviews briefly, lessons from a decade of experience in the use of data produced by routine measurement using the Colorado Client Assessment Record (CCAR) in the Mental Health Centre of Boulder County (MHCBC) in Colorado, USA. In the second part, the specific issues surrounding quality of life assessment as a routine outcome measure are considered. Evidence is presented to counter some of the commonly held beliefs about QoL measurement problems. Finally, general problems that affect QoL and all other routine measures are described and analysed using a framework devised by Peterson (1989).
To describe the extent and variation in the use of Guardianship nationally. The Directors of Social Services were asked to provide details about Guardianship cases on two separate occasions one year apart.
There were 428 new Guardianship cases in 12 months. At the second enumeration, 73% of cases were within the mental illness category and 47% of these had serious mental illness.
There is much variation in the use of Guardianship. Further developments of this study will explore the reasons for this variation and will ascertain clinicians' views on Guardianship, supervised discharge and other community treatment orders.
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