Pennine Care NHS Trust is an NHS foundation trust in northern England, providing mental health and learning disability services in parts of Greater Manchester and Derbyshire.It provides mental health and learning disability services in Bury, Rochdale, Oldham, Stockport, Tameside and Glossop.The trust also provided community care until 2019, when most community services transferred to the Northern Care Alliance, an NHS Group formed around the same time by combining Pennine Acute Hospitals NHS Trust and Salford Royal NHS Foundation Trust. Community services based in Trafford transferred to Manchester University NHS Foundation Trust.In 2017, the Greater Manchester Resilience Hub was set up in response to the Manchester Arena attack, to co-ordinate care and support for thousands of children, young people and adults whose mental health and/or emotional wellbeing was affected. This service is hosted by Pennine Care in partnership with Greater Manchester Mental Health NHS Foundation Trust, Manchester University NHS Foundation Trust and Northwest Boroughs Healthcare NHS Foundation Trust.The trust set up a new system, the Street Triage service, to provide 24-hour advice to police officers and paramedics in Tameside on the best place to take patients during incidents. This is intended cut the number of people detained in custody under the Mental Health Act.The trust was established in April 2002, and in July 2008 it was the 100th trust to be awarded Foundation status..
Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths. Adults hospitalised with psychiatric illness vary in their risk of VTE, and therefore in their likelihood of benefiting from thromboprophylaxis. There is a paucity of evidence-based practice guidelines addressing VTE prophylaxis for this population despite recognition of additional VTE risk factors in this population. To develop an evidence-based guideline on VTE prophylaxis for patients hospitalised with psychiatric illness using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). An international, multidisciplinary, guideline panel including clinical experts, methodologists, and a patient partner was recruited by invitation. Panelists were selected based on methodological and clinical expertise on this subject. Panel members were diverse in geography (from Ireland, the United Kingdom, France, and Canada), expertise and gender. The panel was composed of four advanced specialist psychiatric pharmacists, four consultant haematologists, four consultant psychiatrists, one advanced nurse practitioner in psychiatry, one advanced nurse practitioner in anticoagulation, a methodologist with expertise using GRADE, and a patient partner with lived experience of VTE. The panel prioritised two clinical questions and related population, interventions, outcomes, and secondary analyses according to their importance for patients. GRADE was used to assess certainty of evidence and to move from evidence to risk-stratified recommendations. The panel made three recommendations: a strong recommendation against parenteral pharmacological prophylaxis for patients at low risk of VTE (moderate-certainty evidence); a conditional recommendation in favour of parenteral pharmacological prophylaxis in high-risk patients (low-certainty evidence); and a strong recommendation against graduated compression stockings in patients at high risk of VTE with a contraindication to parenteral pharmacological prophylaxis (low-certainty evidence). Clinicians should not use parenteral pharmacological prophylaxis in adults hospitalised with psychiatric illness at low risk of VTE; and should consider using parenteral pharmacological prophylaxis for high-risk adults with no contraindications. Graduated compression stockings are not recommended in high-risk patients when parenteral pharmacological prophylaxis is contraindicated. These GRADE- based recommendations offer one of the first evidence-based practice guidelines for thromboprophylaxis decisions in psychiatric in-patient settings.
Background Restrictive interventions are used in the treatment of some people with severe mental disorders such as psychosis - including psychiatric intensive care unit (PICU) admission, seclusion and restraint. Early Intervention in Psychosis (EIP) service input may improve outcomes in psychosis, but it is unclear whether specific components of EIP care reduce the need for restrictive practice.Aims To examine associations between EIP care components, demographic characteristics and restrictive interventions.Method We conducted a retrospective cohort study of 14 874 people who used EIP services in England, using linked data from the National Clinical Audit of Psychosis and the Mental Health Services Data Set. We examined associations between EIP components and time to PICU admission (primary outcome) alongside seclusion/physical restraint/injected chemical restraint/requests for police assistance (secondary outcomes), using multilevel Cox regression, adjusting for demographic factors and clustering by service.Results Higher hazards of restrictive interventions were observed among men, younger people and several minority ethnic groups. Individuals eligible for clozapine who were not offered it (hazard ratio 1.51, 95% CI 1.20-1.91) or refused it (hazard ratio 1.46, 95% CI 1.02-2.10) had higher hazards of PICU admission than those not eligible, whereas those who were eligible for clozapine and received it did not. There was weaker evidence of similar effects on hazards of physical restraint and seclusion. Receipt of CBT for psychosis was associated with reduced hazards of PICU admission (hazard ratio 0.80, 95% CI 0.67-0.95) and physical restraint (hazard ratio 0.68, 95% CI 0.47-0.98). Substance use was associated with increased hazards of PICU admission and requests for police assistance, although substance use interventions appeared to partially mitigate this.Conclusions Marked demographic disparities exist in the use of restrictive practice. Specific EIP care components may be associated with reductions. Strengthening evidence-based EIP provision and addressing structural inequalities may support progress towards less coercive and more equitable care.
BACKGROUND:The purpose of the present study was to conduct a feasibility trial of i-Minds, a digital mental health intervention (DMHI) designed to improve mentalisation in young people (YP) who have experienced technology-assisted sexual abuse (TASA). Enhancing mentalisation may reduce the risk of re-victimisation, strengthen resilience, and support management of TASA-related distress. However, evidence-based interventions for TASA are nascent. METHODS:We determined the feasibility, acceptability, and safety of a 6-week mentalisation-based DMHI for YP with TASA in a pre-registered multicentre non-randomised clinical trial (ISRCTN43130832). YP aged 12-18 years recruited across child and adolescent mental health services in two sites completed baseline and post-treatment assessments. RESULTS:Forty-six people were recruited; 43 were allocated to the i-Minds app; 86% completed follow-up assessments. The average participant age was 15.42 years. Most participants identified as female (69.8%), White British (95.3%); a notable percentage identified as non-binary/third gender or preferred not to disclose their gender identity (16.3%), and 20.9% reported their gender did not match their sex assigned at birth. We found signals of post-treatment improvement in TASA-related post-traumatic symptoms, resilience, internalising symptoms, and reflective functioning. User feedback indicated that participants generally had a positive experience of using the app, positively impacting their knowledge/understanding of their own mental health and their motivation to address their mental health difficulties. There were no related adverse events. CONCLUSION:It is possible to recruit and retain participants for a DMHI trial of TASA. The i-Minds app was safe, acceptable and showed promising signals of efficacy on valuable outcomes. Following further refinements, a powered efficacy trial is warranted to confirm and extend findings.
Aims: The Eating Disorder Online Activity Questionnaire was developed within a specialist Community Eating Disorder Service (CEDS) to explore online activity of Children and Young People presenting with eating disorders. The authors proposed a research project to evaluate its psychometric properties in adolescents receiving care from CEDS. Despite this being a low-risk observational study with no funding requirements, the research team have encountered several challenges resulting in significant delays to the planned timeline. This study aims to present practice-based reflections on the barriers to conducting low-risk research studies within the NHS. Methods: A literature search was conducted to review current evidence relevant to NHS research processes. Journal articles and policy documents were synthesised to highlight barriers and facilitators for conducting research in the NHS. Authors used Gibbs reflective cycle to reflect on key challenges which contributed to a twelve-month timeline from first developing their research proposal to sponsorship application. Authors categorised factors which led to the delay and then used these categories to create an analysis and draw conclusions. Analysis and conclusions were linked back to the results from the literature search. Final conclusions and background literature were used to inform recommendations for research policy. Results: Delays reflect major structural challenges within NHS research processes. Research teams face several systemic challenges, even for small-scale, low-risk studies. Key issues include a lack of clear and accessible guidance, complex and inconsistent application processes, and under-resourced Research and Innovations (R&I) departments. Organisations were reluctant to agree to sponsorship of an unfunded study despite low risks associated and costs being accounted for within the practitioners training scheme. Sponsorship applications added a high administrative burden and were inconsistent across different organisations. Conclusion: Small-scale research projects are integral to the national ambition to increase research active organisations and allow early access to treatment, improve patient outcomes and increase staff satisfaction. Despite this, low risk studies face significant challenges and are routinely de-prioritised by sponsorship organisations due to lack of funding. In the case study, these delays had implications for academic progression within the team and it was reflected that these issues are likely to discourage practitioners balancing clinical and academic responsibilities from taking part in research. Recommendations: A standardised application process across trusts and organisations to improve transparency and reduce administrative burden on practitioners. A simplified, streamlined process for small-scale, low-risk studies which do not present significant financial costs or ethical considerations.
