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To develop an evidence-based approach that supports the improvement of front-line delivery of adult acute in-patient services. Key factors of effective organisational change were identified from the literature. These were adopted as part of an ‘evidence-based service development’ programme. This approach was used by the Health Advisory Service in a project with an NHS Trust in south east England.
Significant progress was made in improving the quality of local acute in-patient services.
Further development and evaluation of this approach should be undertaken, since it seems to offer significant opportunities to deliver real improvements in the quality of services.
Recognition of the additional social handicaps and distress that people with mental illnesses experience as a result of prejudice.
To determine opinions of the British adult population concerning those with mental illnesses as baseline data for a campaign to combat stigmatisation.
Survey of adults (n=1737 interviewed; 65% response) regarding seven types of common mental disorders. Responses evaluated concerned eight specified perceptions.
Respondents commonly perceived people with schizophrenia, alcoholism and drug addiction as unpredictable and dangerous. The two latter conditions were also viewed as self-inflicted. People with any of the seven disorders were perceived as hard to talk with. Opinions about effects of treatment and prognosis suggested reasonable knowledge. About half the respondents reported knowing someone with a mental illness.
Negative opinions indiscriminately overemphasise social handicaps that can accompany mental disorders. They contribute to social isolation, distress and difficulties in employment faced by sufferers. A campaign against stigma should take account of the differences in opinions about the seven disorders studied.
The Clinical Standards Advisory Group was asked by UK health ministers to advise on the standards of clinical care being achieved for people with schizophrenia. A subcommittee commissioned a review of standards, followed by research into how far these were reflected in contracts and met by providers.
No comprehensive but practical set of standards was found. A protocol of 143 items of good service practice was constructed, and applied by teams visiting services in 11 UK districts. The team appraisals were summarised in 20 key points, each scored 0 (absent) to 4 (excellent performance). Seven points were used to assess standards of commissioning and 13 for standards of service provision.
When placed into rank order, the mean key point scores for commissioners and providers in the same district tended to be very similar. Total district scores were then used to assign districts to one of three groups. Four performed reasonably well, five were moderate and two were poor.
One of the key elements associated with these differences was the local level of morale. After wide consultation, a revised protocol of 26 key points for direct rating was drawn up and has since been further tested.