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The COVID-19 pandemic initiated a mass switch to psychological therapy being delivered remotely, including at Anxiety UK, a national mental health charity. Understanding the impact of this forced switch could raise implications for the provision of psychological therapies going forwards.
Aims
To understand whether the forced switch to remote therapy had any impact on outcomes, and if certain groups should continue to be routinely offered certain delivery modalities in future.
Method
Data were available for 2323 individuals who accessed Anxiety UK services between January 2019 and October 2021. Demographic data, baseline and discharge anxiety and depression symptoms, and mode of therapy delivery were available.
Regression models were built to model (a) the mode of therapy delivery received pre-pandemic using logistic regression, and (b) outcomes pre- and post-pandemic onset within demographic groups.
Results
No statistically significant changes in baseline anxiety symptoms, demographics or outcomes were observed before and after the onset of the COVID-19 pandemic.
Pre-pandemic, males were more likely to receive online video therapy than telephone therapy (Relative Risk Ratio (RRR) 1.42, [1.01, 1.99]), while older clients were less likely to receive online video therapy (RRR 0.98, [0.97, 0.99]). However, no differences in outcomes were observed post-pandemic onset within these groups, with only the number of sessions of therapy being a significant predictor of outcomes.
Conclusions
Anxiety UK services remained effective throughout the pandemic. We observed no evidence that any demographic group had worse outcomes following the forced switch to remote therapy.
Selection into core psychiatry training in the UK uses a computer-delivered Multi-Specialty Recruitment Assessment (MSRA; a situational judgement and clinical problem-solving test) and, previously, a face-to-face Selection Centre. The Selection Centre assessments were suspended during the COVID-19 pandemic. We aimed to evaluate the validity of this selection process using data on 3510 psychiatry applicants. We modelled the ability of the selection scores to predict subsequent performance in the Clinical Assessment of Skills and Competencies (CASC). Sensitivity to demographic characteristics was also estimated.
Results
All selection assessment scores demonstrated positive, statistically significant, independent relationships with CASC performance and were sensitive to demographic factors.
Implications
All selection components showed independent predictive validity. Re-instituting the Selection Centre assessments could be considered, although the costs, potential advantages and disadvantages should be weighed carefully.
Situational judgement test (SJT) scores have been observed to predict actual workplace performance. They are commonly used to assess non-academic attributes as part of selection into many healthcare roles. However, no validated SJT yet exists for recruiting into mental health services.
Aims
To develop and validate an SJT that can evaluate procedural knowledge of professionalism in applicants to clinical roles in mental health services.
Method
SJT item content was generated through interviews and focus groups with 56 professionals, patients and carers related to a large National Health Service mental health trust in England. These subject matter experts informed the content of the final items for the SJT. The SJT was completed by 73 registered nurses and 36 allied health professionals (AHPs). The primary outcome measure was supervisor ratings of professionalism and effectiveness on a relative percentile rating scale and was present for 69 of the participating nurses and AHPs. Personality assessment scores were reported as a secondary outcome.
Results
SJT scores statistically significantly predicted ratings of professionalism (β = 0.31, P = 0.01) and effectiveness (β = 0.32, P = 0.01). The scores demonstrated statistically significant incremental predictive validity over the personality assessment scores for predicting supervisor ratings of professionalism (β = 0.26, P = 0.03).
Conclusions
These findings demonstrate that a carefully designed SJT can validly assess important personal attributes in clinicians working in mental health services. Such assessments are likely to represent evidence based, cost-effective tools that can support values-based recruitment to mental health service roles.
In this editorial we define ‘productivity’ and ‘efficiency’ in a mental health service context, outlining the key challenges to measuring these in practice. We attempt to bring clarity of thought to this often debated, but rarely researched area.
Machine learning methods are being increasingly applied to physical healthcare. In this article we describe some of the potential benefits, challenges and limitations of this approach in a mental health context. We provide a number of examples where machine learning could add value beyond conventional statistical modelling.
Out-of-area (OOA) placements occur when patients cannot be admitted to local facilities, which can be extremely stressful for patients and families. Thus, the Department of Health aims to eliminate the need for OOA admissions. Using data from a UK mental health trust we developed a ‘virtual mental health ward’ to evaluate the potential impact of referral rates and length of stay (LOS) on OOA rates. The results indicated OOA rates were equally sensitive to LOS and referral rate. This suggests that investment in community services that reduce both LOS and referral rates are required to meaningfully reduce OOA admission rates.
Declaration of interest
P.A.T. holds an honorary consultant contract with the Tees, Esk and Wear Valleys NHS Foundation Trust.
The schizophrenias are uncommon before the age of 14 but
incidence/prevalence figures are lacking. The 1-year incidence, clinical
features and short-term outcomes in childhood-onset schizophrenia spectrum
disorder were evaluated via the Child and Adolescent Psychiatry Surveillance
System. Fifteen children with a provisional diagnosis were reported. Outcome
data were obtained for 12 individuals, 8 of whom met the diagnostic
criteria, equating to an estimated incidence of 0.21/100 000 (95% CI
0.08–0.34). Delusions and thought disorder were a more consistent predictor
of ‘caseness' than hallucinations. Illness outcomes at 1 year were generally
poor. Childhood-onset schizophrenia appears to be a rare but serious
disorder.
To evaluate the feasibility of integrating a clinical librarian (CL) within four mental health teams. A CL was attached to three clinical teams and the Trustwide Psychology Research and Clinical Governance Structure for 12 months. Requests for evidence syntheses were recorded. The perceived impact of individual evidence summaries on staff activities was evaluated using a brief online questionnaire.
Results
Overall, 82 requests for evidence summaries were received: 50% related to evidence for individual patient care, 23% to generic clinical issues and 27% were on management/corporate topics. In the questionnaires 105 participants indicated that the most common impact on their practice was advice given to colleagues (51 respondents), closely followed by the evidence summaries stimulating new ideas for patient care or treatment (50 respondents).
Clinical implications
The integration of a CL into clinical and corporate teams is feasible and perceived as having an impact on staff activities. A CL may be able to collate ‘personalised evidence’ which may enhance individualised healthcare. In some cases the usual concept of a hierarchy of evidence may not easily apply, with case reports providing guidance which may be more applicable than population-based studies.
Professionals working with young people often encounter individuals who pose a risk of violence to others. Risk evaluation in those under 18 differs in a number of respects when compared to adults. Assessment must ultimately lead to risk management strategies. The current trend is to make structured professional judgements. Violence risk assessment also needs to take into account the presence or absence of protective factors. Evaluation of violence risk in young people requires a formulation about the likelihood of a specific future risk and in what circumstances and time frame. There are several structured assessment tools designed for use with young people. Some of these tools include: the Structured Assessment of Violence in Youth (SAVRY), and the Early Assessment Risk List for Boys (EARL-20B). More generalized personality assessment tools such as the Millon Adolescent Clinical Inventory (MACI) may also facilitate a deeper psychological understanding of a young person's needs.
Early intervention in psychosis services serving the 14–35 age range often receive input from psychiatrists from both child and adolescent as well as adult mental health services. Differences in staff attitudes or practices could potentially affect the experience of care that an individual with first-episode psychosis receives on the basis of their age. In order to investigate such potential variation a questionnaire-based survey was conducted targeting the relevant psychiatrists working in a large mental health trust in north-east England.
Results
Only subtle differences in attitudes between the two staff groups were noted. However, a number of significant differences in prescribing preferences were reported.
Clinical Implications
Attitudes towards first-episode psychosis show marked variation between psychiatrists but may not be especially associated with sub-specialty. Further national guidance should be drawn up, disseminated and implemented to help ensure that service users across the age range receive the safest and most effective medications for an episode of psychotic illness, regardless of age.
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