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Purpose: The purpose of this paper is to examine lived experiences of opioid agonist treatment (OAT) during and immediately following release from detention in prisons in England and Scotland., Design/methodology/approach: Surveys were completed by serving prisoners in both countries and by those recently released from prison (England only). The survey findings were discussed in focus groups of people with lived experience. The combined findings from the surveys and focus groups were shared with an expert group of prison OAT providers and people with lived experience with the purpose of making recommendations for more accessible and effective OAT in custodial environments and continuity of OAT on release., Findings: The quality and accessibility of OAT varied considerably between establishments. It was reported to be harder to access OAT in Scottish prisons. It was often hard for people in prison to get the dosage of OAT they felt they needed and it was generally harder to access buprenorphine than methadone in English prisons. Only Scottish people in prison were aware of long-lasting forms of buprenorphine. People in English prisons had mixed experiences of the help available in prison, with no improvement recorded since a 2016 study. People in Scottish prisons were more likely to rate the help available as poor., Research Limitations/implications: The number of people accessed while actually in prison (73) was reduced by the impact of the pandemic, making it more difficult to access people in prison and because some were resistant to participating on the basis that they had already been consulted for a wide variety of research projects focused on the impact of COVID. The Scottish cohort (a total of 19 individuals comprising 14 survey respondents and five focus group members) is clearly too small a number on which to base robust claims about differences in OAT provision between the English and Scottish prison systems.., Practical Implications: The study identifies key barriers to accessing OAT in prisons and suggests key components of more user-friendly approaches., Social Implications: This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release and offers valuable recommendations on how to make service provision more effective and consistent., Originality/value: This study provides an overview of the recent lived experiences of people accessing OAT in prison and on release in England and Scotland and offers valuable recommendations on how to make service provision more effective and consistent., (© Emerald Publishing Limited.)

Purpose – During 2011, the Making Every Adult Matter (MEAM) coalition supported three pilots to better coordinate existing local services for people facing multiple needs and exclusions. These individuals experience a combination of problems such as homelessness, substance misuse, mental health problems and offending. Many face difficulties consistent with dual diagnosis in its broadest sense. The purpose of this paper is to summarise the evaluation of the pilots, undertaken by FTI Consulting/Compass Lexecon in partnership with Pro Bono Economics. Design/methodology/approach – The evaluation examined the three pilots, which took place in Cambridgeshire, Derby and Somerset in England. The study looked at two main effects as individuals engaged with better coordinated services: changes in wellbeing and, changes in the use and cost of wider local services. Primary wellbeing data were collected from clients and primary service use data were collected directly from relevant local agencies (police, health, housing etc). The study followed 39 individuals across the pilot sites. The average period between initial and final measurements was nine months.Findings – The findings show significant improvements in wellbeing for nearly all clients across three quantitative measures. The evaluation also recorded changes in the use and cost of local services. Some costs decreased in the first year of the pilot, for example, criminal justice costs in the Cambridgeshire and Somerset pilot areas. Other costs increased in the first year as people accessed the help they needed. In Cambridgeshire, the reduction in crime costs (£100,000 or 31 percent) was large enough to lead to an overall cost reduction. The total cost of service use in the first year increased in the other two areas. Originality/value – Collecting primary data on clients' actual service use directly from local agencies provides a strong methodological base. The evaluation will continue for a further year to examine the longitudinal impact of the pilots. The evaluation findings are of relevance to service providers, commissioners and policy makers interested in improving services for people facing multiple needs and exclusions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to discuss the methodological challenges to evaluating one of the 50 vanguard sites of the new care model (NCM) programme for integrated care in England, and make the case for a modified realist approach to this kind of evaluation. Design/methodology/approach: The paper considers three challenges to evaluating the NCM in this particular vanguard: complexity, strategy and rhetoric. It reflects on how the realist approach negotiates these philosophical challenges to delivering integrated care, in order to provide contextualised accounts of who a programme works for, in what context, and why. Findings: The paper argues that, in the case of this particular vanguard site, the tangible benefit of the realist approach was not in providing a firm epistemological basis for evaluation, but rather in drawing out and articulating the ontological rhetoric of such large-scale transformation programmes. By understanding the work of the NCM less as an objective "system", and more as a dynamic form of persuasion, aimed at securing the "adherence of minds" (Perelman and Olbrechts-Tyteca, 2008, p. 8) in multiple audiences, the paper suggests that realist evaluation can be used to address both the systematic issues and localised successes the NCMs encountered. Originality/value: The paper identifies a number of aspects of new models of integrated care for evaluators to consider. It offers ways of negotiating the challenges to conventional outcome-focused evaluation, by drawing attention to the need for contextualised, time-situated and audience-sensitive value of NCMs. [ABSTRACT FROM AUTHOR]

The article discusses race inequality in England in terms of accessing health services. It highlights the barriers faced by older people in ethnic groups in availing quality health services, which include lack of information, communication barriers and the expectations on the services available. An overview of the government solutions to mitigate the gap and inequality is given, such as the programs under the Race Relations Act of 2000 and Equality and Human Rights Commission. These initiatives include training of medical staff and investment in interpreting services to lessen language barriers.

Purpose: This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges. Design/methodology/approach: This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study. Findings: Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people's mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the "surreal" experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement. Practical implications: The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language. Originality/value: As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. Design/methodology/approach: This paper aims to present a thematic synthesis of mental health policies published in England from 1999 to 2020. The authors specifically focus on ethnicity-related mental health issues highlighted in policies, policy recommendations and performance measurements of policy implementation. Findings: Findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the past two decades. Ongoing issues include a lack of data on the ethnicity of mental health services users. Where data is available, these highlight ethnic inequalities in access to, experiences of and outcomes of mental health services, as well as a lack of cultural capability in health-care professionals. Policy recommendations have also remained the same during this time and include: collecting data on the ethnicity of service users, raising awareness of the cultural needs of Black and Minority ethnic populations amongst health-care professionals, recruiting BME staff into mental health care services and improving community engagement. The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Practical implications: The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Originality/value: This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. [ABSTRACT FROM AUTHOR]

Purpose: Policies on integrated care have waxed and waned over time in the English health and care sectors, culminating in the creation of 42 integrated care systems (ICSs) which were confirmed in law in July 2022. One of the four fundamental purposes of ICSs is to tackle health inequalities. This paper reports on the content of the overarching ICS plans in order to explore how they focus on health inequalities and the strategies they intend to employ to make progress. It explores how the integrated approach of ICSs may help to facilitate progress on equity. Design/methodology/approach: The analysis is based on a sample of 23 ICS strategic plans using a framework to extract relevant information on health inequalities. Findings: The place-based nature of ICSs and the focus on working across traditional health and care boundaries with non-health partners gives the potential for them to tackle not only the inequalities in access to healthcare services, but also to address health behaviours and the wider social determinants of health inequalities. The plans reveal a commitment to addressing all three of these issues, although there is variation in their approach to tackling the wider social determinants of health and inequalities. Originality/value: This study adds to our knowledge of the strategic importance assigned by the new ICSs to tackling health inequalities and illustrates the ways in which features of integrated care can facilitate progress in an area of prime importance to society. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them. Design/methodology/approach: IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned. Findings: There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning. Practical implications: This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research. Originality/value: To the best of the authors' knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the impact of the Health and Social Care Act, 2012 on London’s rough sleepers as seen from the perspective of one former homeless service user (currently working as a support worker in a day centre providing outreach and “drop in” facilities for people who are street homeless and other vulnerable adults including female sex workers). The discussion centres on some of the unintended impacts of changes to healthcare commissioning; the new arrangements for patient, public representation; and the enhanced role of local councils.Design/methodology/approach This paper is grounded in front line practitioner reflection/opinion and draws on practical experience and observation at Spires, as well as research and government papers published by other service providers. The aspirations of the Health and Social Care Act, 2012 are set out before its practical application are examined from the rough sleeper’s dimension.Findings Putting clinicians and GPs centre stage in the commissioning and purchasing of healthcare may have some benefits for individual patient choice, but it can also dilute patient public involvement in health and social care with negative effects for vulnerable and excluded groups, including rough sleepers. The terms of reference ascribed to Local Healthwatch Organisations, the official representatives of the people, are narrower than previously and limit their ability to influence official policy. The Act centralises control whilst devolving operational responsibility, especially for public health provision on which rough sleepers often rely. It is suggested that local voluntary organisations and specialist “inclusion” health groups are increasingly being expected to take over responsibility for delivering health and social care and that mainstream collaboration is much reduced rather than enhanced by this fragmentation.Research limitations/implications This review is based on the opinion of an “expert by experience” which may not be representative.Originality/value This is one of few papers which present a front line service user/practitioner perspective on the impact of clinical commissioning on services for marginalised groups. [ABSTRACT FROM AUTHOR]

Purpose: Integrated service models aim to simplify access, enable effective delivery, remove duplication and provide a holistic and person-centred approach. This project explored the development of integrated well-being services in two local authorities in North-East England. The purpose of this paper is to address this issue. Design/methodology/approach: Underpinned by public health and co-production approaches, the project utilised a mixed-methods approach. Data were collected via online surveys (n = 95), virtual interviews with members of the local population (n = 8) and practitioners and commissioners (n = 8) to explore needs for a new service. Thematic analysis was used to identify key themes and issues. Findings: Several benefits of an integrated service were highlighted by both staff and service users, with a central anticipated benefit being the provision of holistic care. Improvement in information sharing was also seen to increase the efficiency of services and communication barriers between services. Beneficial aspects and barriers related to the COVID-19 pandemic on current service provision were reported that have informed our future recommendations. Originality/value: The authors' findings provide a much deeper insight into function, care, social inclusion and ongoing support needs, from both the perspectives of staff and service users. Service users and staff saw value in an integrated model for themselves, as well as the wider community. The authors' findings indicate that the integrated service model is a promising one for the development of services within local authorities. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a synthesis of current and previous government policies and strategies, in relation to people with learning disabilities and employment, to facilitate a better understanding of the current situation and future challenges. Design/methodology/approach – A search was completed to identify government policies relating to the employment of people with learning disabilities. Key policies were identified and their impact was discussed in the paper. Findings – It appears there is a necessity to identify how successful pilot projects can be replicated on a national scale, with clear targets and measures and initial financial support to set up these services. Alongside this there is a need for interventions targeting not just employers, but the general population, educating people about the importance of including and valuing people with learning disabilities in the workforce. Originality/value – It is important that policy is analysed and the impact of it is assessed to determine whether more action is necessary. This paper adds updates to some of the issues discussed in Melling et al.’s (2011) paper about “Supported employment for people with learning disabilities”. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach: A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings: Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value: This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe three dementia assessment services for people with intellectual disabilities to provide professionals with insight into planning this type of service. Design/methodology/approach: Three services in England were contacted via email and telephone to collect data on their service provision. They were asked about the average age of individuals when receiving a baseline assessment, frequency of follow-up assessment, assessment instruments used and descriptive aspects of their services. Findings: All three services offered proactive dementia assessment services to people with Down's syndrome (DS), with one service providing systematic screening via the GP. None offered proactive screening to people with intellectual disabilities who did not have a diagnosis of DS. All offered reactive assessment to this population if they experienced a decline in function. Services differed in terms of age at which baseline assessments were offered, frequency of follow-up and instruments used. Originality/value: To the best of the authors' knowledge, this is the first paper to compare dementia assessment provision between different services in England. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings: Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications: Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value: This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the barriers to accessing mental health support for people experiencing multiple disadvantage along with some potential solutions for attempting to overcome these. It draws on evidence and learning from 12 voluntary sector-led partnerships in England funded by the National Lottery Community Fund's Fulfilling Lives programme. Design/methodology/approach: Qualitative research was undertaken with frontline staff, senior leaders, volunteers, beneficiaries and stakeholders from Fulfilling Lives partnerships. This comprised focus groups (21 participants) and individual face-to-face interviews (41 participants), both of which explored barriers and local solutions to accessing statutory mental health services. Following a thematic analysis of transcripts, research participants and stakeholders were invited to a face-to-face workshop to review and validate emerging findings (34 participants). Findings: People experiencing multiple disadvantage face significant barriers in accessing support for their mental health. These include a complex system that is difficult to navigate, long waiting lists, high eligibility thresholds and models of support that lack flexibility. Fulfilling Lives partnerships have had the funding and the flexibility to trial different approaches. Promising solutions to barriers include the use of navigators, person-centred support and multi-agency networks and training. However, overcoming systemic barriers remains the most difficult challenge. Originality/value: Fulfilling Lives was a rare example of substantial and long-term (eight years) funding to work with people experiencing multiple disadvantage. This provided a unique opportunity to try different approaches and gather learning. The programme evaluation provides insights into the experiences of people facing multiple disadvantage and those who support them and offers evidence-based suggestions for policy and practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how any proposed Women's Health Strategy could address the needs of women affected by dementia in England. Design/methodology/approach: The authors take the following three perspectives: women living with dementia, female carers and female practitioners supporting people with dementia. Findings: In this paper, the authors explore the current evidence about dementia and female gender under three main strands relating to policy and practise. Originality/value: There is worldwide interest amongst policy communities in gender inequalities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the effectiveness of reablement as an outcome-focussed commissioning model within the English domiciliary care market from the perspective of two private domiciliary care agency (PDCA) managers/owners within one local authority (LA) in the North West of England. Specifically, it focusses on owner/managers' perceived ability to effect change from a dependency to a reablement model within the English domiciliary care market. Design/methodology/approach: Qualitative interviews with two contrasting owners/managers of PDCAs within one LA in the North West of England were carried out. Explorative analysis followed a constructionist grounded theory methodology. Findings: Findings revealed how two main factors interacted to effect change from a dependency model to a reablement model of domiciliary care: internal organisational structure and individual emotional investment of the owners/managers. Additionally, fiscal and external organisational systems impact on these drivers, and are perceived to act as potential barriers to the adoption of a reablement model of domiciliary care by PDCAs. Originality/value: Although based on only two idiographic accounts, the findings shed light on the policy and practice of commissioning models of domiciliary care within England and suggest further studies in this area of practice. [ABSTRACT FROM AUTHOR]

Purpose In the past 40 years, both health policy and educational policy in England have adopted commitments to reducing socially created inequalities. However, an inequalities perspective has only begun to emerge in relation to child protection, and child welfare services more widely. The purpose of this paper is to chart evidence of these green shoots of a new policy direction which focusses on two aspects: equalising service provision and outcomes for looked after children.Design/methodology/approach The paper provides an analysis of trends in policies as expressed in official documents, research studies and policy statements.Findings The paper outlines the argument for a more comprehensive approach to addressing inequalities in child protection and child welfare services, and concludes by suggesting some implications for policy and practice.Originality/value The paper develops the concept of an inequalities perspective in child protection and outlines key implications. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe service user involvement, explain some of the key issues that define, affect or protect mental health in later life and show how involvement may contribute to better mental health in later life.Design/methodology/approach The paper reviews existing definitions of involvement and mental health in later life; provides a more detailed review of some examples of involvement at a range of levels and illustrates how these could have a positive impact on mental health.Findings Active involvement and engagement at all levels offers significant opportunities for older people to protect and improve their own mental health and the mental health of society as a whole.Research limitations/implications This research does not set out to promote any particular intervention or involvement technique. The examples given have been evaluated in a variety of ways.Practical implications Service user involvement should be considered as an important potential contributor to mental health in later life.Social implications The paper encourages people in later life to be considered as a community resource rather than a problem that needs to be solved.Originality/value This paper brings together existing research with a focus on the relationship between involvement and individual and collective mental health. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to present data about access to and use of health and social care services by adults with learning disabilities during the COVID-19 pandemic in England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected in three waves between December 2020 and September 2021 and concerned the use of health and social care services during the COVID-19 pandemic. Data were collected at one or more time-points directly from 694 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 447 adults with learning disabilities. Findings: Many people with learning disabilities who reported regularly accessing services/supports pre-pandemic were not receiving them during the timeframe of this study. There were indications of increasing access to some services and supports between Wave 2 and 3, but this was not universal. Practical implications: People in Cohort 2, who were likely to have severe/profound learning disabilities, were less frequently reported to access online community activities than people in Cohort 1, which is likely to exacerbate existing social isolation for this cohort and their family carers. Service providers should seek to ensure equitable access to services and activities for all people with learning disabilities in the event of future lockdowns or pandemics. Originality/value: This is the largest longitudinal study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. We primarily collected data directly from adults with learning disabilities and worked with partner organisations of people with learning disabilities and family members throughout the study. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to give an overview of the issue of loneliness, an update of issues heard of from across the country, as well as some positive stories and projects being delivered to alleviate loneliness in older age.Design/methodology/approach - This paper describes the current research into loneliness in older age, including related health issues and anecdotal evidence from local groups linking reductions in services with increased levels of loneliness in older age.Findings - Loneliness is a highly subjective emotion that is difficult and complex to measure. However, research has shown that men and women are affected differently. It has been shown to have strong links to health issues such as depression, Alzheimer's and heart disease as well as having been shown to be a bigger risk factor in early mortality than lifelong smoking and obesity.Originality/value - This paper highlights the first steps being taken by organisations working, under the umbrella of a recently launched Campaign to End Loneliness, towards further reducing loneliness in older age. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a commentary on “A summary of government initiatives relating to employment for people with learning disabilities in England”. Design/methodology/approach – In her paper, Blamires outlines the development of policy in employment for people with learning disabilities. This commentary explores whether this policy development is having any impact. Findings – The statistics indicate that development of policy does not appear to be making a difference. It is concluded that this is about how it is being implemented and the time it takes for policy to have an impact. What is needed to fully implement these changes is a huge cultural shift, changing people’s mindset about what people with learning disabilities can achieve. Originality/value – This paper provides an individual perspective on the impact of policy on the lives of people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe the principal challenges facing the health and care system in England arising from an ageing population, assess the track record of the coalition government in addressing these and offer a perspective on the priorities likely to be faced by the next incoming government in relation to health and social care for older people. Design/methodology/approach - Assessment of key policy documents and legislation and interpretation of published data on trends in health and social care activity and expenditure. Findings - An ageing population requires a fundamental shift towards a new model of care that offers better coordinated care and promotes independence and healthy ageing. The Care Act 2014 is a significant achievement and NHS spending has been protected, but resulting cuts to local government budgets have since sharp reductions in social care for older people. The next incoming government will need to address a deepening financial crisis in health and care system; the increasingly unsustainability of means tested and rationed social care alongside universal free health care; and the need to make faster progress in developing a new models of integrated care closer to home. Originality/value - The issues raised in this paper affect older people as voters, tax payers and as existing or potential users of health and social care services. As a group they will attract significant attention from political parties in the next election campaign. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide information concerning trends over time and geographical variations in the number of adults with learning disabilities in England using self-directed support (SDS) and direct payments (DPs). Design/methodology/approach – Analysis of local authority returns to the Health and Social Care Information Centre (RAP Table SD1) concerning the number of working age adults with learning disabilities accessing SDS and DPs from 2009/2010 to 2011/2012. Findings – From 2009/2010 to 2012/2013 there has been a rapid increase in the number of working age adults with learning disabilities using SDS, particularly in the form of council services only, with the number of people using DPs staying largely static. There are wide geographical variations in the likelihood of adults with learning disabilities accessing all forms of SDS/DP. Originality/value – This paper analyses trends over time and geographical variations that have not previously been published in a peer-reviewed journal. [ABSTRACT FROM AUTHOR]

Purpose The perspectives of people with dementia and their care partners regarding “extra care” housing are currently unknown. The purpose of this paper is to report findings of a consultation study exploring the perceived barriers and facilitators of a relocation to extra care housing, from the perspective of people living with dementia, and their care partners.Design/methodology/approach Fieldwork consisted of paired or 1-1 interviews and small focus groups with potential users of an alternative model of extra care support for people living with dementia in the South of England. The consultation took place between June and August 2013. The interviews and focus groups were audio recorded, transcribed verbatim. The transcripts were analysed thematically.Findings Benefits of extra care were identified as the opportunity for couples to remain living together for longer, creating a supportive, dementia-friendly community, and a reduction in the strain experienced by the care partners. Barriers centred on a sense of loss, stress and uncertainty. Living and caring at home was perceived as preferable to shared care.Research limitations/implications The findings presented here have limited generalisability for two reasons. First, the shared care approach consulted on was very specific. Second, the participants form a purposive sample and as such are not representative of a wider population. Despite best intentions, the voice of people with dementia, are underreported in this consultation. Only one person with early on-set dementia was interviewed and the remaining two people with dementia were interviewed alongside their care partner.Practical implications The findings cast doubt on the viability of extra care facilities, designed for couples living with dementia, if extra care continues to be conceptualised and marketed as a preventative lifestyle choice. The findings indicate the value of consulting with people with dementia, and their care partners, when designing new forms of housing with care specifically for people living with dementia.Social implications The findings of this consultation exemplify the wish of couples living with dementia to remain together, in what they perceive to be “home”, for as long as possible. Couples living with dementia are therefore unlikely to wish to move into an extra care facility as a lifestyle choice option, early into their journey with dementia. This raises questions about the suitability of extra care, as a form of housing with care, for couples living with dementia.Originality/value This paper contributes to the body of literature, exploring the feasibility of new and innovative alternative care and housing options, for people with dementia. This paper is one of the first to explore extra care as a housing and social care option for couples with dementia. [ABSTRACT FROM AUTHOR]

Purpose The provision of information and advice for older people arranging their own care is a policy objective. The purpose of this paper is to explore the range and scope of web-based information about care coordination activities for older people in the non-statutory sector in England.Design/methodology/approach Non-statutory organisations were identified through a structured internet search. Services were screened to identify those providing at least one care coordination activity. A postal survey of services was conducted in 2014 and results compared with the initial findings of the web search.Findings Almost 300 services were identified, most of which were provided by three organisations: Age UK; Alzheimer’s Society; and the British Red Cross. Brokerage was the most frequently reported care coordination activity; the majority of services focussed on help to stay at home; and carers and older people (including those with dementia) were the target groups most often identified. Comparison of the two information sources revealed a significant agreement between two care coordination’s activities: compiling support plans and monitoring and review.Research limitations/implications Findings are based on a purposive sample of organisations and therefore care must be exercised in generalising from them.Originality/value This study is one of the first to systematically explore the nature and extent of information about care coordination activities provided by the non-statutory sector in England. It was conducted when policy advocated both an increased role for the non-statutory sector and an increase in self-directed support. [ABSTRACT FROM AUTHOR]

Purpose -- This article aims to bring readers up to date with policy developments in England and Northern Ireland in the last two years since the journal first reported on these issues. Design/methodology/approach -- As well as looking at changes to policy and legislation, the paper highlights not only the differences but also the shared concerns for people with intellectual disability living in the two countries, e.g. equal access to healthcare as experienced by the general population. Findings -- In spite of shared visions of inclusion and equality in mental health care, there are major differences in how both countries approach these issues. Recently this has been highlighted by significant shifts in policy. In Northern Ireland strategies designed to inform the delivery of evidence based services for the future have been witnessed. Whilst in England there has also been a move towards public protection within mental health legislation and the reaffirmation of the need to move towards more individual services. Whilst policy initiatives in both countries have been encouraging; they need to be implemented so issues such as access to healthcare and geographical disparity are addressed by local providers. Social implications -- Although there is a desire for change, the reality is that the policies and legislation introduced to address issues such as accessing mental health care and service standards have still to make a significant impact to people's daily lives. Originality/value -- This paper offers an update of current practice and policy relating to mental health for people with intellectual disabilities in England and Northern Ireland. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to report on a study of outcome-focused care for older people in one English local authority. The aim of the research is to examine whether altering the delivery of care to an outcome-focused model would improve the individual participant's subjective well-being and save money for the local authority. Design/methodology/approach – In order for the aim of the research to be established, a pilot study was devised. This was a longitudinal study over 18 months, using a quantitative design. The sample was of 40 service users aged 65 and over whom all had critical and substantial care needs. Half of the sample of service users was receiving the new form of outcome-focused care and the other half were a comparison group who were receiving care packages according to the traditional form of delivery that could be characterised as a "task-focused" model. The service users were administered the Measure Yourself Concerns and Wellbeing Questionnaire (MYCAW). This questionnaire involves respondents identifying quality of life issues; where they are seeking improvement; and measures change over time in relation to these. Findings – The research established that there was a greater improvement in subjective well-being in the group receiving outcome-focused care, when compared with the comparison group receiving the traditional task-focused model. Practical implications – This paper will assist managers in their decision making to implement a more outcome-focused model of home care with older people. Originality/value – To use MYCAW in a social care context is an innovative aspect of this study as it has previously been used only in mainstream and complementary medicine. The focus of this paper is to examine the impact of two models of home care delivery for older people, and how these two models impact on the older persons' self-reported well-being. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to provide an overview of key issues involved in older men's mental health and well being and describes a service improvement project called Grouchy Old Men? that focused on older men who were isolated and at risk of depression and suicide.Design/methodology/approach - Grouchy Old Men? was a two-year project that used a "change agent" model of organisational development, which aimed to improve the mental health and well being of older men through gathering and disseminating examples of good practice and piloting a training module to raise awareness about the mental health of older men.Findings - The project was successful in supporting and promoting a number of local initiatives and organisations, as well as a national network, seeking to develop services to better meet the needs of this group, as well as raising awareness more generally about older men's mental health.Practical implications - The paper suggests ways that services for older people can develop in order to make themselves more accessible to older men with mental health needs.Originality/value - The paper brings together policy, research, and practical service improvement initiatives that will be of interest and relevance to policy makers, practitioners, and anyone with an interest in the mental health of older men. [ABSTRACT FROM AUTHOR]

Purpose: The offender personality disorder (OPD) pathway faces the difficult task of identifying individuals who are eligible for their service from the entire probation caseload. The offender assessment system personality disorder (OASys PD) screen is a national screening tool used by the pathway to help with this task. This paper aims to describe an evaluation of the effectiveness of this plus an additional screening tool currently used to identify eligible individuals for the OPD service in the South of England. Recommendations for improvements were made as necessary. Design/methodology/approach: A mixed methods design used a quantitative analysis of data on the effectiveness of the OASys PD for correctly identifying individuals and a thematic analysis of a focus-group conducted with clinicians within the service. Findings: The analysis revealed a positive predictive value of the OASys PD screen of 72% and a negative predictive value of 91%. Key themes from the focus-group revealed what worked well about the screening process, what was difficult and what needed to be improved. Practical implications: The OASys PD performed better than the clinicians had expected. It was recommended that the service continued to use the combination of the screening tool and the interviews with minor adjustments. Originality/value: This is the first research study of its kind on the effectiveness of the OASys Personality Disorder Screening tool. Using such a tool with some caution (the addition of consultation) creates a useful and effective process for tackling the very difficult task of identifying people for the community component of the Offender Personality Disorder Service. This research provides some evidence for the validity of such a process that is currently used throughout the National Probation Service in England and Wales. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine how the role in offender mental health for the probation service described in policy translates into practice through exploring staff and offenders' perceptions of this role in one probation trust. In particular, to examine barriers to staff performing their role and ways of overcoming them. Design/methodology/approach Qualitative secondary analysis of data from semi-structured interviews with a purposive sample of 11 probation staff and nine offenders using the constant comparative method. Findings Both staff and offenders defined probation's role as identifying and monitoring mental illness amongst offenders, facilitating access to and monitoring offenders' engagement with health services, and managing risk. Barriers to fulfilling this role included limited training, a lack of formal referral procedures/pathways between probation and health agencies, difficulties in obtaining and administering mental health treatment requirements, problems with inter-agency communication, and gaps in service provision for those with dual diagnosis and personality disorder. Strategies for improvement include improved training, developing a specialist role in probation and formalising partnership arrangements. Research limitations/implications Further research is required to explore the transferability of these findings, particularly in the light of the recent probation reforms. Originality/value This is the first paper to explore how staff and offenders perceive probation's role in offender mental health in comparison with the role set out in policy. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to compare the pharmacy services provided to people taking psychotropic and cardiovascular medications and examine the association between pharmacists’ attitudes towards mental illness and provision of pharmacy services. The paper also considers pharmacists’ opinions of the pharmaceutical care needs of people with mental illness including their physical health. Design/methodology/approach – A survey instrument was sent by facsimile to a random sample of community pharmacists in England and Wales. Findings – Community pharmacists had generally positive attitudes towards mental illness but provided significantly fewer pharmacy services (and were less comfortable providing them) to patients taking psychotropic medications than to patients taking cardiovascular medications. Awareness of the higher prevalence of physical health conditions among people with severe mental illness was not high. Provision of pharmacy services was associated with pharmacists’ attitudes towards mental illness and comfort providing pharmaceutical care. Other factors that may contribute to these disparities in service provision are discussed. Practical implications – The study findings indicate the need for enhanced mental health education for pharmacy students to improve attitudes, knowledge and confidence in mental health and the inclusion of mental health in pharmacy advanced services. Originality/value – Few studies have examined the relationship between attitudes towards mental illness and provision of pharmacy services. This was the first study to examine the attitudes of British community pharmacists towards mental illness. [ABSTRACT FROM AUTHOR]

Purpose – The IAPT programme has been rolled out across England in the last ten years. Although undoubtedly many people have benefited from having greater access to psychological therapy there are several issues with the practicalities of Improving Access to Psychological Therapies (IAPT) and also with its ideology. The paper aims to discuss these issues. Design/methodology/approach – This is a personal reflection of working within the IAPT system for several years. Significant statements heard or interpretations of what has been said are presented alongside an analysis of the implications. Findings – A number of important concerns are presented. The overarching concept of the “McDonaldization” process is discussed as a way of encapsulating the IAPT experience; with its theoretical reliance on the medical model and the real world impact of tendering for services in the modern NHS. The impact of IAPT on cognitive behavioural psychotherapy is also highlighted. Originality/value – A lot has been written in the press and online about IAPT. Many of the criticisms seem to derive from people outside of the IAPT system, many of whom have their own personal or professional agenda for attacking IAPT and Cognitive Behavioural Therapy (CBT); often the criticisms are uninformed. This paper is a reflection of working within the IAPT system and not just an uninformed critique of CBT. Several concerns are raised that without remedy may seriously hold back the progress that psychological therapy has made in recent years. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore integration and complexity through the evaluation of a case study service which supports multiply excluded homeless people. Design/methodology/approach - A mixed methods theory based evaluation. Data gathering included semi-structured interviews with external stakeholders, analysis of referral and outcome data, focus groups with frontline staff members and managers, and interviews with people living in the service. Findings - The service was highly rated by its stakeholders due to its ability to meet the immediate needs of many individuals and to facilitate access and engagement with community and specialist resources. However, not every individual responded to the support that was an offer, and a number were unable to access the service due to the nature of their needs or a lack of capacity in the service. Whilst the service was able to engage community and specialist services this often appeared to be within the parameters set by these services rather than flexibly around the needs of the individual. Research limitations/implications - The research is based in one case study service and findings may not be transferable to different local contexts and providers. However, the findings are consistent with previous studies. Practical implications - It is possible for commissioners to intervene in the complexities that multiply excluded homeless people experiences through the introduction of a new service. However, this is unlikely to address all of the gaps and fragmentation that people in these circumstances face. It is therefore important that partners are sensitive to such limitations and have a shared willingness to respond to continuing gaps and shortfalls. Social implications - Despite specific national policies people continue to experience multiple exclusion homelessness which suggest that more still needs to be done to prevent people from this extremely disadvantaged social circumstance. Whilst specialist services can provide excellent support the response is still fragmented for some people meaning that work to better integrate their responses must continue. Originality/value - The paper contributes to the evidence base of support models for multiple excluded homeless people and the factors that can enable a housing support service to respond to such needs. It also provides comment on the relevance of the concept of complex adaptive systems to the study of integration. [ABSTRACT FROM AUTHOR]

Purpose Pre- and post-immigration trauma and stress make refugees a particularly vulnerable group in terms of mental health and well-being. The purpose of this paper is to describe a listening project undertaken in Plymouth, UK, which sought the views of 17 service users (n=12) and staff (n=5) from four local support organisations, for people with refugee and asylum seeker status and those with diverse cultural backgrounds. Aims of the project were to expand Western-centric understandings regarding beneficial support and the promotion of good mental health and well-being in this population.Design/methodology/approach Responses were subjected to thematic analysis, co-conducted with a service user. Participants were asked about their personal understandings of mental health and well-being and what supports or hinders well-being.Findings The findings enabled the development of a model incorporating 10 threads which support and 9 holes that can hinder well-being.Research limitations/implications The relatively small numbers of participants compared with the numbers of asylum seekers and refugees in Plymouth may not be fully representative of the general population in Plymouth and the UK.Originality/value Despite increasing cultural diversity within the UK population, available mental health services exist mainly as developed from a Western psychological model of mental distress and treatment. This research provides services with a more informed understanding of mental health for asylum seekers and refugees. As such it is of value towards future service design in Plymouth and the UK. Findings also contributed to a successful funding bid to set up a peer-led support project in the city. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the views and opinions of offender supervisors and offender managers regarding the sequencing of interventions for prisoners in England. More specifically, the research aims to gain an understanding of any barriers to implementing desired practice.Design/methodology/approach Semi-structured interviews were conducted with ten participants located across four HM prisons in the West Midlands. Questions were designed to gather information and views regarding: current practice in the area of sequencing of interventions; opinions on the potential importance of coherent sequencing of interventions; views on how interventions should be sequenced; and what, if any, issues impacted upon coherent sequencing. Thematic analysis was used to identify, analyse and report themes within the interviews.Findings Participants discussed current practice regarding the sequencing of interventions and made suggestions regarding tailoring the sequence of interventions to the individual offender. The issue of readiness to change was emphasised (i.e. engagement with interventions will increase where offenders are able to participate in an intervention when they feel ready to do so). In addition, participants commented that they felt there to be insufficient resources at their disposal which led to barriers to the coherent sequencing of interventions (e.g. waiting lists for treatment programmes).Practical implications Suggestions were made by participants regarding the coherent sequencing of interventions; for example, providing prisoners with experience of a generic group intervention prior to an offence-specific intervention, prioritising motivation to change and being responsive to the needs of individual offenders.Originality/value The study provides insight regarding the sequencing of interventions from the perspective of offender supervisors and offender managers who are involved in the planning of treatment programmes across the course of an offender’s sentence. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the operation of multidisciplinary team (MDT) meetings within a forensic hospital in England, UK.Design/methodology/approach Mixed methods, including qualitative face to face interviews with professionals and service users, video observations of MDT meetings and documentary analysis. Data were collected from 142 staff and 30 service users who consented to take part in the research and analysed using the constant comparison technique of grounded theory and ethnography.Findings Decisions taken within MDT meetings are unequally shaped by the professional and personal values and assumptions of those involved, as well as by the power dynamics linked to the knowledge and responsibility of each member of the team. Service users’ involvement is marginalised. This is linked to a longstanding tradition of psychiatric paternalism in mental health care.Research limitations/implications Future research should explore the nuances of interactions between MDT professionals and service users during the meetings, the language used and the approach taken by professionals to enable/empower service user to be actively involved.Practical implications Clear aims, responsibilities and implementation actions are a pre-requisite to effective MDT working. There is a need to give service users greater responsibility and power regarding their care.Originality/value While direct (video) observations were very difficult to achieve in secure settings, they enabled unmediated access to how people conducted themselves rather than having to rely only on their subjective accounts (from the interviews). [ABSTRACT FROM AUTHOR]

Purpose – One Stop Shops (OSSs) are a model of integrated delivery, where a range of needs are met in one place through a bespoke, person-centred service that works across organisational and sectoral boundaries. Third Sector Organisations provide OSSs for women in the criminal justice system and whilst they are shown to be effective in meeting complex needs, how this effectiveness is generated needs explaining. The purpose of this paper is to set out a preliminary framework for explaining their effectiveness. Design/methodology/approach – A realist review was conducted to research the way in which context influences how OSSs work. This approach was chosen because it is designed to synthesise evidence on social programmes and policies which are complex. The review was conducted in two phases: theory building and theory refinement. Findings – The review explains how individual, interpersonal, institutional and infrastructural contexts influence the effectiveness of OSSs. The evidence suggested that the organisational or legal form of the provider is not as important as the values and attitudes of their staff. Originality/value – The paper adds to our understanding of how OSS services work, and gives insight for commissioners and Third Sector providers of services by beginning to explain how this effectiveness is generated. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe an intervention with a group of homeless men from the Horn of Africa, service users of the Horn of Africa Health and Wellbeing Project in London. The group was conceived by the second author who noted the presence of significant psychosocial issues for her clients, but equally their reluctance to access mainstream mental health or social care services.Design/methodology/approach Designing the group and introducing it to the men involved threw up some challenges which are explored, and the impact of the group on participants is evaluated.Findings Overall both the participants and the facilitators evaluated the group positively and it appeared to have led to lasting change for some of the group members, and this is described. The authors argue that this sort of group may be a more acceptable way to work on psychosocial issues than something more directly focused on mental health intervention. The group protocol is outlined along with suggestions for future work in this area.Originality/value This intervention represents a creative alternative to more mainstream psychological interventions for homeless or exiled men. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore potential benefits in aligning Joint Strategic Needs Assessments (JSNAs) with implementation of the Equality Delivery System (EDS) to improve commissioning of healthcare for minority ethnic groups. Design/methodology/approach – The paper draws on data gathered for a large research study carried out in England exploring the use of evidence in commissioning for multi-ethnic populations, to present a reflective discussion on the potential synergies between JSNA and EDS processes. Qualitative data were collected from 62 interviews with stakeholders in Sheffield, Leeds and Bradford, who, as part of their normal role, had an active responsibility to contribute to decision making for commissioning healthcare. 19 individuals working in national roles with experience in evidence use, ethnicity and commissioning across NHS, local authorities and third sector were also interviewed. Observational data were collected through regular attendance at an NHS Equality Group, which had Equality Delivery System implementation within its remit, and from a regional workshop focussing on Joint Strategic Needs Assessment improvements. Observations also came via participation in local EDS implementation meetings across Sheffield, Leeds and Bradford. These data were supplemented by a review of local and national policy literature about implementing JSNA and EDS. Findings – Formally strengthening the connection between JSNAs and the EDS has potential benefits for enhancing the evidence base about health and wellbeing needs of minority groups in general, and ethnic minorities in particular. Originality/value – NHS and Local Authority organisations need to establish structural processes to formally connect these two workstreams and to ensure adequate resource is made available, with clear direction from senior management. [ABSTRACT FROM AUTHOR]

Purpose – The mental health experience of people from ethnic minorities differs from that of the majority, including differential access to services and treatments. The 2014 National Health Service (NHS) Community Mental Health survey gathered data from 13,787 individuals in 57 NHS trusts in England, providing one means of monitoring such experience. The purpose of this paper is to analyse survey variables describing treatments offered to respondents for evidence of differential access or treatment experiences associated with ethnicity. Design/methodology/approach – Secondary analysis of survey data. Proportions for target variables were modelled using multilevel logit models. Ethnic background, age and gender were entered as independent variables. Findings – Respondents in most minority groups were more likely to be on the care programme approach (CPA) to provision than white British respondents and less likely to report receiving psychological treatments. Unmet need for psychological treatment was relatively high in certain Asian groups. Medication use was consistently high across respondents, but differences by ethnic background were evident. Research limitations/implications – The study was dependent on existing survey data of a relatively limited nature, and potentially subject to non-response bias. The survey excludes users of certain types of service, giving an incomplete cross-section. Originality/value – This represents a novel use of the data from the Community Mental Health survey, and complements evidence from a range of other sources. The findings mostly concur with other evidence but provide important new data in relation to medication, unmet needs in psychotherapy and use of the CPA. They remain suggestive of the complex nature of discrimination and/or unequal access and treatment in mental health services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to consolidate policy, research, evidence and good practice around strategies tackling fuel poverty and affordable warmth for older people aged over 60 to support the development of more effective services for this life course stage and to tackle physical and mental health inequalities. Design/methodology/approach – The authors consolidate current policy, research, evidence and examples of good practice in exploring effective interprofessional approaches that contribute to affordable warmth for older people through “desktop analysis”. The authors support this with qualitative data from Health and Wellbeing Boards (HWBs), health inequalities and environmental health from research comprising four longitudinal case studies in the Midlands and North of England over 18 months and semi-structured interviews with members and support officers. A total of 50 interviews were undertaken and 55 hours of HWB meetings observed. Findings – There are numerous older people living in fuel poverty. The depth of fuel poverty increases with age particularly the over 75s and physical and mental ill health are affected. There are an increasing number of tools to help estimate health care costs around the cost effectiveness of interventions and there is a real need for more local evidence about what is working well, how and why. However, there is no mandatory requirement for fuel poverty strategies and more creative local strategies are required taking organisational and interprofessional relationships into account. The emphasis in integrated care provides new impetus and scope to encourage preventative services but these new partnerships need to be effective in what is a complex policy environment. There is still a long way to go in places. The challenges of ageing are numerous, complex and not fully understood and sit across multiple policy areas. Originality/value – Fuel poverty strategies tend to be delivered on a geographical or income bases rather than by life course approach and a focus on older people. We need to focus more specifically on older people, a rapidly growing population and to better understand thermal properties of our ageing housing stock and how best to intervene to protect and improve health and safety. Emerging approaches need to overcome artificial statutory and non statutory divides and move towards sustainable, evidence based affordable warmth strategies for older people to protect and improve health. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore current practice, barriers and facilitators to identifying and responding to alcohol problems in memory clinics. Design/methodology/approach – A questionnaire sent to professionals in 55 memory clinics in England, Wales and the Isle of Wight and two focus groups with professionals from three memory clinics in England. Findings – Only 1/35 clinics that responded to the questionnaire was using a standardised alcohol screening tool but all attempted to gain some information about alcohol use. Without screening tools, practitioners found it difficult to determine whether alcohol use was problematic. Barriers to identification/intervention included cognitive impairment, service-user being “on guard” during assessment, presence of family members/carers, time constraints and a perception that brief interventions were not within the remit of memory clinics. Facilitators were obtaining visual clues of problem drinking during home visits and collateral information from family members/carers. Research limitations/implications – Focus group participants were recruited through convenience sampling and a small number of professionals took part. This means that the findings may be subject to selection bias and limits the generalisability of the findings. Practical implications – Memory clinics should provide guidance and training for practitioners on how to intervene and respond to alcohol misuse. Further research is required to determine the most effective way to identify alcohol problems in people with cognitive impairment and how to deliver brief alcohol interventions that take account of cognitive deficits. Originality/value – This is the first study to examine alcohol screening and interventions in memory clinics and identifies a need for guidance, training and further research. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach -- The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings -- There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications -- This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications -- There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications -- An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value -- This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review. [ABSTRACT FROM AUTHOR]

Purpose -- The NHS Improving Access to Psychological Therapies (IAPT) programme provides access to psychotherapy in England through a stepped care approach for adults with depression and anxiety disorders. This evaluation sought to investigate IAPT recovery and reliable change rates of those who scored severe on depression (PHQ-9), anxiety (GAD-7) or impaired functioning (WASA). The paper aims to discuss this issue. Design/methodology/approach -- This evaluation employed a within groups design: a single case evaluation follow-up. Routine service data (from services set-up in 2008-2009 to February 2012) from 25,034 patients treated at four IAPT services was analysed. Findings -- The analysis revealed that 29 per cent (n = 7,059) of patients were assessed as being in the WASA severe range, 41 per cent (n = 10,208) in the PHQ severe range, and 57 per cent (n = 14,612) in the GAD-7 severe range; with 14 per cent (n = 3,548) in the severe range on all three measures combined. There were significant falls on all three measures and a large effect size. The percentage of patients who recovered to a point below the recovery threshold was 30 per cent for depression, 34 per cent for anxiety, 18 per cent for impaired functioning, and for those presenting severe on all measures: recovery rates were 21 per cent for anxiety, 26 per cent for depression, and 15 per cent for impaired functioning. Reliable change for anxiety was found to be greater than IAPT patients overall. Originality/value -- The results show that IAPT enables approximately a third of people scoring severe to recover, lower than IAPT recovery rates overall. Reliable change may be a more effective measure of patient progress. [ABSTRACT FROM AUTHOR]

Advocacy has long been identified as a valuable mechanism for providing support to individuals who experience difficulties in accessing services and whose voices often remain unheard in decisions relating to meeting their individual needs. However, the advocacy needs of older people age 65 and over with mental health problems remains a relatively under-researched area.This paper presents findings from a small study undertaken in partnership with Sandwell Advocacy, a voluntary sector organisation, and researchers from Coventry University in one local authority area in the West Midlands. The aims of the study were to explore the advocacy needs of people aged 65 years and over with mental health problems and to determine the current level of demand or need for advocacy among this user group. A key motivation for this study was to explore the ways in which advocacy could provide a 'voice' to those whose needs are often marginalised in both social care service provision and wider society. [ABSTRACT FROM AUTHOR]

Previous literature about race equality in social care has identified specific examples of good practice, but also a lack of widespread action by services to address both race discrimination and cultural competence. This paper is based on work by the Commission for Social Care Inspection to produce a practice-focussed bulletin for social care service providers about providing appropriate services for black and minority ethnic people. It is based on evidence from self-assessment work by services and importantly, the views and experiences of black and minority ethnic people using social care services. The findings suggest that only a minority of services are taking specific action on race equality and that there is an under-reporting of concerns by black and minority ethnic people using services. The key to appropriate services is not adapting existing services based on generalisations about ‘culture’ but providing culturally competent, personalised support that addresses individual needs alongside a systematic approach to remove barriers to race equality in the service. [ABSTRACT FROM AUTHOR]

This paper explores access to palliative care services by people with learning disabilities. It is based on a study of specialist palliative care professionals in London, involving 32 semi-structured interviews and 543 postal questionnaires. We focus on one aspect of the findings, related to the current use of specialist palliative care services by people with learning disabilities. The results indicate that such services are under-used by this group. We discuss possible reasons for low referral rates, including late diagnosis and lack of understanding among both learning disability services and palliative care services about each other's roles. We highlight the importance of collaboration, and the need for further staff training. [ABSTRACT FROM AUTHOR]

Purpose -- The paper aims to ascertain how local authorities and other services are responding to central government strategies to make support for family carers a priority. Design/methodology/approach -- A web-based audit of local authority public information for carers was undertaken (n = 50). The sample covered different parts of England and different local authority types. Findings -- A small minority of local authority web sites mention that they operated Carers' Registers. Overall local authorities offer different resources to carers, ranging from discounts in the local area to access to emergency card registration. Some use online information as a communication channel. Overall local authority online information for carers seems to be variable in quality, accessibility and purpose. We conclude that growth in the collection of information by primary care services in England risks duplicating some of the functions of, and problems with, local authority activities. Local commissioning should minimise confusion and make optimal use of carers' information. Carers should not have to navigate confusing, variable, parallel systems and outreach is needed for those who do not use electronic media, such as some older carers. Research limitations/implications -- This was a small-scale study nested within a larger project. It is possible that the web sites we interrogated were atypical, although we did take steps to prevent this. Originality/value -- The study's strength lies in its originality of approach undertaking a specific audit of material that is publicly available and reflecting on a subject that has not previously been explored in the context of information for carers. [ABSTRACT FROM AUTHOR]