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Web alert: quality in mental health care Amy Dunn

Amy Dunn BA MA LibDip

Assistant Librarian, The Library, Sussex Education Centre, Mill View Hospital, Hove, UK

Ben Skinner BSc (Hons) MA*

Evidence-Based/Knowledge Management Librarian, KnowledgeShare, The Library, Audrey Emerton Building, Royal Sussex County Hospital, Brighton, UK

Corresponding Author:
Ben Skinner
Evidence Based/Knowledge Manage-ment Librarian
KnowledgeShare, The Library, Audrey Emerton Building
Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
Tel: +44 (0)1273 523307
Fax: +44 (0)1273 523305
Email: [email protected]
Website: www.KnowledgeShare.nhs.uk

Received date: 22 August 2008 Accepted date: 25 August 2008

 
Visit for more related articles at Quality in Primary Care

Introduction

Mental health symptoms are common in the general population, and people with mental health disorders consult their general practitioner (GP) twice as often as those without. Mental health disorders comprise about a quarter of all general practice consultations.[1]

The last few years have seen a raft of new legislation and policies regarding primary care and mental health. The NHS Plan (2000) was the largest attempt at reform in the history of the NHS.[2] It introduced a new contract for GPs,[3] and highlighted the need for better mental health services. The vision of The NHS Plan is of a health service designed around the patient, and patients’ expectations of GPs and other primary care staff ‘are rising as they demand more convenient and quicker access to advice and treatment’.[4] Primary care staff need to feel confident that they can meet these expectations, to be able to find mental health infor-mation on which to base their treatment, and to provide their patients with the information, advice and sup-port they require.

The Quality and Outcomes Framework (QOF), designed to financially reward GP practices on the basis of the quality of care delivered to patients, has been revised recently in order to amend the clinical indi-cators for mental health and introduce new clinical areas of depression and dementia. These amendments reflect the National Institute for Health and Clinical Excellence (NICE) guidelines for depression set out in 2004,[5] introducing primary care screening for and monitoring of depression, and a stepped care model of treatment for depression. The new dementia area high-lights early recognition of dementia, health promotion, and ongoing support for people with dementia, and their carers.[6]

Mental health was the first of the government’s health priority areas to be addressed with a National Service Framework,[7] setting standards it expected to be met within ten years. Standard Two of the National Service Framework relates to the role of primary care in assessment and treatment of people with mental health problems. Standard One relates to promoting mental health and combating stigma and discrimin-ation – areas where the work of organisations such as SANE and the Mental Health Foundation is vital. We will look at resources provided by these organisations, among others, in this article.

In 2005 the Royal College of General Practitioners (RCGP) produced a position statement, recommend-ing that primary care organisations ‘make mental health a priority’, and that primary care practitioners become ‘aware of the full range of interventions and resources available to address mental health prob-lems’.[8]

In the light of all of this, now more than ever, it is vital that primary care practitioners make the best use of the information and resources available to them in promoting mental health and providing care for the large number of people who are ‘chronically blighted’ by mental distress.[8]

National Institute for Mental Health in England:  www.nimhe.csip.org.uk

The National Institute for Mental Health in England (NIMHE) is part of the Care Services Improvement Partnership (CSIP) commissioned by the Department of Health and the strategic health authorities (SHAs). It was formed in 2002 to help the mental health system to implement The National Service Framework for Mental Health and The NHS Plan.[2,7]

CSIP promotes a collaborative approach between primary care and specialist mental health care, and provides guidance for primary care practitioners on, amongst other things, early detection of psychosis (see  www.earlydetection.csip.org.uk).

NIMHE’s primary care programme provides prac-tical support for frontline practitioners to improve care.

In the ‘News’ section of the website you can down-load NIMHE’s bi-monthly newsletter, Mental Health Today.

A useful section of this site is the ‘Publications’ section, where you can find clear, concise guides on topics including practice-based commissioning, men-tal health promotion, and best practice guidance for primary care clinicians using the mental health do-mains in the QOF. For more publications, you can also look at CSIP’s Knowledge Community website  (http://kc.csip.org.uk).

Sainsbury Centre for Mental Health: www.scmh.org.uk

The Sainsbury Centre for Mental Health is a charity that works to improve practice and influence policy in mental health. The Sainsbury Centre’s reports and studies are available to download or to order from their website, including papers on practice-based commissioning and the National Service Framework for Mental Health.

This website has a wealth of information about policy and law in mental health. By clicking the ‘Mental Health Policy’ tab you can find consultations and investigations on mental health issues, a useful overview of the last 20 years of policy in mental health services, and much up-to-date information on mental health law, Department of Health guidance and gov-ernment policies.

The ‘Primary Care’ area of the site has a list of diagnostic tools for GPs and a training pack for primary care teams.

The charity’s priority areas are criminal justice and employment, and particularly relevant for primary care is their work on education and training for GPs supporting patients to stay in work or return to work, and how this relates to the government’s ‘Health, Work and Well-being’ initiative. Click on the ‘Em-ployment’ tab to find information on primary care and employment.

Royal College of Psychiatrists: www.rcpsych.ac.uk

In addition to its roles in representing, educating and otherwise supporting the psychiatrists of the UK, the Royal College of Psychiatrists also produces documents and resources that will be of use to primary care pro-fessionals with an interest in mental health. Selecting the ‘Publications’ tab on the college’s home page provides information on their books and journals, which one can pay for, as well as a list of college reports that can be freely downloaded from the site. These are listed by date of publication, and focus on mental health in different settings (such as primary care, prisons, etc) and recommendations for different patient groups (including vulnerable patients and patients with chal-lenging behaviour), and look at the full range of psychiatric conditions and interventions. Also available from the ‘Publications’ section is a monthly podcast featuring conversations with the authors of the latest, most important journal articles in neurosciences, psychiatry and psychology.

The website’s section on ‘Press & Parliament’ is worth looking at for the College’s responses to recent governmental reports, bills and debates, and ‘CRTU’ (which stands for the College Research and Training Unit) has details on research projects with which the college is involved. Finally, information for patients and the public can be downloaded free of charge from the site by going to ‘Mental Health Information’. The leaflets here cover the different psychiatric therapies, for example electroconvulsive therapy, complementary medicines, etc, and conditions from alcohol problems to stress. There are materials for children of all ages, and their teachers, and materials aimed at the elderly. Many of the leaflets are available in languages other than English.

Mental Health Foundation: www.mentalhealth.org.uk

The Mental Health Foundation is a UK charity that works to reduce the stigma attached to mental illness and learning disabilities, and to increase public aware-ness and understanding. The foundation develops and supports research and community projects. It pro-vides information on mental health issues for the general public and for healthcare professionals.

The Mental Health Foundation’s research aims to develop better services and influence policy. Research areas include the link between diet and mental health, and the effectiveness of exercise therapy as a treatment for mild to moderate depression.

The foundation publishes a wide range of booklets, covering topics from anger management to mental health in the workplace, and it is an excellent source of materials such as posters and postcards, many of which are available in several languages. The Mental Health Foundation also produces educational materials, and designs training courses for mental health workers.

Mind: www.mind.org.uk

The Mind website offers a very comprehensive source of news and information, as well as services for people with mental health problems. The site is extremely clear and easy to navigate using the section headings to the left of the screen.

In the ‘About Mind’ section of the website, there are details of Mindinfoline, a mental health information service which will answer questions, and give infor-mation on treatments, and legal information. Mind has a database of organisations that provide mental health services. The telephone line is accessible to enquirers who are deaf, speech impaired, and speakers of foreign languages.

The ‘Shopping’ section contains details of the bi-monthly magazine produced by Mind, Openmind, and a well-stocked bookshop of titles published by both Mind and other health publishers.

Look in the ‘Information’ section for factsheets and booklets, many of which are translated into a range of different languages, and details of conferences and training.

SANE: www.sane.org.uk

SANE’s website provides a valuable source of support and information for people with mental illness. Pro-fessionals can find publications and publicity materials under the ‘About SANE’ tab. These include useful one-page information sheets, posters, leaflets, factsheets and handbooks. All these materials can be downloaded or ordered free of charge.

SANE is a charity whose objectives are to raise awareness of and respect for people with mental illness, undertake research, and provide help and information to those experiencing mental health problems, their families and carers. This website provides clear advice for people experiencing mental health problems. It recommends self-help books, includes a section on information about latest research (under the ‘News’ tab), and provides information about SANE’s services.

SANE runs a telephone helpline, SANEline, and an email support service, SANEmail. These services aim to provide useful information about mental health issues, and advice on accessing treatments and where to go for help. The website also hosts a discussion board for members to share feelings, experiences, advice and support.

Alzheimer’s Society: www.alzheimers.org.uk

For comprehensive information and practical advice for improving the quality of life of people with dementia, look at the Alzheimer’s Society website.

The Alzheimer’s Society is a care and research charity for people with dementia and those who care for them. The society campaigns for the rights of people with dementia and their carers, and provides help and information to people affected by dementia. The website provides information on living with dementia, and over 100 factsheets are available, cover-ing topics including causes, treatments, legal issues and hospital care. There is a wide range of information for both people with dementia and carers of people with dementia, and the factsheets can be printed out in portable document format (pdf).

The ‘Local Information’ section gives information on the branches and support groups across England, Wales and Ireland (for Scotland see www.alzscot. org), with detailed information about services offered in each area, including where to find local groups, drop in centres, and carers’ support.

For health professionals there is also a ‘Researchers and Professionals’ area of the website, where publi-cations and resources can be downloaded or ordered online. There are booklets, leaflets and posters that can be downloaded for free, and DVDs, books and other resources available to purchase. Here you can search the ‘Dementia Catalogue’, which contains records of published materials on dementia care and research, including books, journal articles, DVDs and training resources.

The Alzheimer’s Society is aiming to address the issues raised by an Audit Commission study (2002) which found that not enough information about dementia and local services was available at GP sur-geries, and that GPs felt that they needed more support diagnosing dementia and treating people with de-mentia.[9] GPs and primary care teams should look at the sections on ‘Primary Care’ and ‘Training’. Re-sources and leaflets for GP surgeries are suggested, and the society’s publication Dementia in the Community: management strategies for primary care. Training and seminars (which can be held in house), run by the Alzheimer’s Society and other organisations are detailed.

Depression Alliance: www.depressionalliance.org

Another important site for patient support is that of Depression Alliance, a UK charity for people with depression. The alliance runs a national network of self-help groups, enabling the sharing of coping strat-egies and experiences. These are developed and run by volunteers, whose names and email addresses are provided for cities across the country. In some cases the groups’ own websites are given. For those who don’t have a self-help group nearby, there is a related ‘pen-friend’ scheme in which the alliance will put people affected by depression, including carers, in touch with one another. Click on ‘Self-help’ in the left-hand menu bar.

Leaflets, booklets and posters can be purchased through the site, and the leaflets can also be downloaded free of charge (although a donation is requested). These cover topics such as depression during or after preg-nancy, seasonal affective disorder, depression in chil-dren and young people, and St John’s Wort. There is also a list of recommended reading, with links through to Amazon.

Information about the charity’s national campaigns, awareness-raising activity, and fund raising is also available from the site

National Library for Health – Mental Health Specialist Library:  www.library.nhs.uk/mentalhealth

There are a number of places to look for online evidence-based information in mental health. As always, the best starting point is the National Library for Health, whose Mental Health Specialist Library collects together high-quality evidence on all aspects of mental illness and mental health promotion. UK guidelines from the Department of Health, NICE, British associations, royal colleges, etc are gathered and arranged in a hierarchy that lets you browse by age group and condition. The specialist team behind this resource also tracks down new systematic reviews and meta-analyses, new Reference materials, and patient infor-mation leaflets, and brings them all together in one place. To gain a rapid understanding of what exactly has been published on, for example, phobic disorders in adults, or attention-deficit hyperactivity disorder, this constantly updated site is the place to look.

The Specialist Library also produces regular evi-dence reviews, known as ‘Hot Topics’, which outline the current state of research in different areas of psychiatry. You can sign up to their RSS feed of new additions to the site, or join their discussion group in order to question other experts in the field.

Centre for Evidence-Based Mental Health: http://cebmh.warne.ox.ac.uk

The Centre for Evidence-Based Mental Health is one of a number of national centres for evidence-based health care. It aims to address the fact that most healthcare professionals lack the skills and knowledge to critically evaluate published research, promoting the teaching of these skills, and investigating improved methods of using research in practice. The centre provides a series of training programmes, conducts research, and produces publications on evidence-based practice within mental health.

The ‘Research’ tab of their website provides details of the randomised trials in which the centre is involved, and also as a complete list of the Cochrane reviews that they have completed, as well as those that are currently in progress. The ‘Education’ section of the site in-cludes downloadable critical appraisal checklists and a CATmaker that aids in the creation of critically appraised topics (CATs). You will also find details of their forthcoming workshops here. Perhaps the most useful section of the site is ‘Dissemination’, which has a current awareness bulletin with selected news items on mental health, a collection of evidence-based med-icine (EBM) links, and a set of downloadable presen-tations on understanding diagnostics and teaching EBM.

The Centre for Evidence-Based Mental Health pro-duces a bi-monthly journal, making clinicians aware of the best new mental health research in the areas of aetiology, diagnosis, therapy, and healthcare econ-omics. In order to produce this, their team scours more than 100 of the top mental health publications looking for new studies and then critiques these for methodological validity and clinical significance. The best studies are summarised and presented along with a commentary from an expert in the field. This journal, Evidence-Based Mental Health, can be found online at http://ebmh.bmj.com. The full text is avail-able to staff in NHS England through the use of an NHS Athens password.

Clinical Knowledge Summaries – Mental Health: http://cks.library. nhs.uk/clinical_topics/by_clinical_ specialty/mental_health

More evidence-based summaries on aspects of mental health are available at the Clinical Knowledge Sum-maries (CKS) site. At the time of writing, the topics coveredare:alcoholandopioid dependence,Alzheimer’s, attention-deficithyperactivity disorder(ADHD),depres-sion, eating disorders, insomnia and schizophrenia, but new topics are being added frequently. Unlike systematic reviews that focus on the evidence for one specific intervention, or guidelines, which give an overview of a condition but soon go out of date, these evidence-based summaries provide regularly updated information on every aspect of their topics. Quick answers and more detailed information are provided on assessment, management, referral and prognosis. Further information is given on medicines manage-ment, and there are patient information leaflets avail-able for download. Everything is fully Referenced and based on frequent, comprehensive searches for the best evidence.

From the homepage of CKS you can also navigate to DynaMed (via a link on the right-hand side), which gives similar summaries on a wider range of topics, but without the ‘quick answer’ format that busy clinicians may prefer. GP Notebook (www.gpnotebook.co.uk) is

another similar resource, and naturally it has a section on psychiatry. Unfortunately, there is less clarity here about the evidence behind the site’s statements, the layout involves more clicking to get to the answers you need, and those answers tend to be less informative. For these reasons, GP Notebook is not highly recom-mended.

The Guardian – Mental Health:  www.guardian.co.uk/society/mentalhealth

This site is one of a number of news sites focusing on mental health issues. In addition to regular features on patient experience, and items on new research or government statistics, there are links to related dis-cussions in their blogs. Particularly worth looking out for is Ben Goldacre’s ‘Bad Science’ column, which unpicks the evidence behind the news.

Conclusion

The websites mentioned above provide an excellent selection of resources to support mental health work in general practice and primary care. However, staying on top of the rapidly expanding world of mental health research is not easy. Staff in most primary care trusts and mental health partnership trusts across the UK will have access to a dedicated team of NHS librarians, and their use is recommended. These information specialists will help you to identify policy information and evidence for best practice in mental health, and keep you up to date with the latest key documents. You can search for your local library team at the Health Library & Information Service Directory (www.hlisd.org).

Reference

Peer Review

Commissioned, not externally peer reviewed.

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