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There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness.
This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK.
We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages.
The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years.
The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
The present volume, a festschrift for Professor A.J. (Tony) Pollard, owes its existence to an initiative by one of his former postgraduate students, Professor Anne Curry. The essays collected here, offered by three generations of his friends and pupils, celebrate Tony's outstanding career and pay tribute to his scholarship and enduring influence in furthering our understanding of late medieval England and France. Drawing inspiration from his own research interests and writing, which illuminate the military, political and social interactions of the period, they focus on three main themes: the contrasting styles of governance adopted by English monarchs from Richard II to Henry VII; the differing responses to civil conflict revealed in a variety of localities; and the lives of men recruited to fight overseas during the Hundred Years’ War and beyond the border with Scotland. These topics take us across England from the far north to the Channel, to London, the south-west and the Welsh lordship of Gower, while on the way also examining how townsmen resisted taxation, the gentry administered their estates and the western marches were ruled.
We are grateful to all the contributors for their help in the volume's production, and we owe particular thanks to Anne Curry for her staunch support and guidance, and to Tony's wife Sandra, whose excavations in files and bookshelves enabled the compilation of a comprehensive bibliography of his published works.
Biographers addressing the conundrum of men and women who lived in the late Middle Ages try to find in the sources at their disposal a distinguishing feature of the subject's personality, character, piety or interests to provide a peg on which to hang their tale. The search is nearly always in vain; reliance has to be placed on the commonplace recitation of family background, land-holdings, career projection, patrons and so forth. Yet the contributors to this volume of The Fifteenth Century series have in various ways succeeded in casting light on a number of individuals. Through a study of the wills of monarchs from Edward III to Edward IV, Chris Given-Wilson brings into focus their contrasting personalities. Richard II, who sought to ensure his entry to heaven by ‘scattering armfuls of gold’, made his enormous bequests conditional on his successor observing all the statutes of the parliament of 1397–8. By contrast, the will of that successor, Henry IV, who refused to be bound by Richard’s political programme, stands out as the first royal will to be written in English, and which, taking the form of a ‘lollard will’, presented the testator as a ‘sinful wretch’ begging his subjects’ forgiveness for any mistreatment he had inflicted upon them. Those who succeeded to the throne as adults not infrequently frustrated the intentions of their predecessors: Henry's chantry at Canterbury was not to be constructed for nearly twenty years after he died, owing to his son's failure to release funds to the executors. Other negative traits of the hero of Agincourt are revealed through Samuel Lane's examination of the letters Henry V wrote to the governors of London. Constituting subtle propaganda, the letters aimed to ensure ongoing financial support for the king's military campaigns by a partial presentation of news, stressing Henry’s martial prowess, portraying him as invariably merciful to his adversaries, and offering misleading accounts of peace negotiations. These epistles shaped how posterity would regard Henry V for centuries to come.