Background: Many children and young people (CYP) presenting with mental health crises are admitted to hospital due to concerns around illness severity and risk. Whilst inpatient admissions have an important role for such children, there are a number of burdens associated with them, and safe avoidance of admissions is favourable. We systematically reviewed the literature for studies of interventions reported as alternatives to a hospital admission in CYP presenting with mental health crises, in any inpatient setting. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The quality of most included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. The best quality studies and greatest evidence for efficacy came from in-home interventions, in particular multisystemic therapy, which improved psychological outcomes, and though a large number of CYP still ended up being admitted, there appeared to be decreased length of stay. Conclusions: Overall, we could not recommend a particular intervention as an alternative to inpatient admission; however, our review describes benefits across a range of types of interventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.
Aims and MethodWe carried out a web-based survey to establish the proportion of London psychiatry senior house officers who undertake personal psychotherapy. Demographics, training characteristics and psychotherapy experience were examined using descriptive statistics. Predictors of personal psychotherapy status were examined using logistic regression.ResultsThe majority of trainees who undertook personal psychotherapy included training as a reason for doing so. of the participants, 16% had undergone personal psychotherapy and of the remainder, 73% reported that they would consider it in the future. Ethnicity was the only predictor of psychotherapy status, with White British trainees nearly four times more likely to pursue it.Clinical ImplicationsPersonal psychotherapy appeared to have relevance to training from both a pastoral and a learning perspective. If training schemes wish to support this practice they will need to address difficulties trainees may face in accessing therapy. Trainees might also be encouraged to think about the effect of cultural factors on their attitudes towards psychological therapies.
Background: Increasingly more children and young people (CYP) present in mental health crises, many being hospitalised due to concerns around illness severity and lack of community services. To release the burden of admission, we systematically reviewed the literature on the effects of proposed alternatives to CYP in crises. Methods: Three databases (PsychInfo, PubMed and Web of Science) were searched for peer-reviewed papers in October 2020, with an updated search in May 2021. Results: We identified 19 papers of interventions delivered in the emergency department, the home, outside of home but outside of clinics and in hospital clinics. The best evidence came from in-home interventions, in particular multisystemic therapy (MST), which proved to be promising alternatives by improving psychological outcomes and decreasing length of inpatient stay. The quality of included studies was low, with less than half being randomised controlled trials and only half of these at low risk of bias. Conclusions: We could not recommend a particular intervention as an alternative to inpatient admission, however our review describes benefits across a range of types of inteventions that might be considered in multi-modal treatments. We also provide recommendations for future research, in particular the evaluation of new interventions as they emerge.
Since April 2003 the UK government has been phasing out paper pension books. Previously, many older people received their pension benefits by using paper slips which were exchanged for cash at the Post Office. Now, the state pension is transferred directly into a bank account and cash obtained by using a bank card, keypad and a four digit personal identification (PIN) number. The system is believed to be more secure and mirrors wider changes in the UK retail sector. People with dementia or early memory problems are likely to have difficulty remembering their four-digit PIN number, however, there has been little research into the level of cognitive ability a person requires to be able to manage their financial affairs.This cross-sectional study was conducted on 35 consecutive attendees at a medical day hospital, and 15 from a local community centre. All were community dwelling, aged over 65 with no acute medical or psychiatric illness, gave consent and were fluent in English. Ethical committee approval was obtained. Our main hypothesis was that cognitive impairment could be associated with difficulty in using a PIN number and keypad.Cognitive impairment was measured using the Mini-Mental State Examination (MMSE;Folstein et al., 1975). Participants were asked to identify a bank debit card, supermarket loyalty card, a PIN keypad (identical to those used in UK Post Offices) and a pension book. They then generated a four-digit PIN number of their choice and immediate recall of this was checked. The researcher returned 2-4 h later (mean 3.2 h) and asked the participant to enter the number into a keypad. Correct input (after a maximum of three attempts) of the chosen PIN number into the keypad was the main outcome. We documented the use of glasses or hearing aids and participants' current banking arrangements. Functional impairment was rated on the Barthel Index (BI; Mahoney and Barthel, 1965).We chose a high cut-off on the MMSE ( 26) as we hypothesised that this is a complex task requiring a high level of cognitive functioning. The BI was used as a dichotomous variable cut at the median. The relationship between cognitive impairment and categorical variables was investigated using the chi-squared test and the t-test used for continuous variables.The sample was predominantly female (62%) and all were over the age of 70 years (mean 82.6, range 70-90). The mean MMSE score was 25 (range 12-30) and mean BI score 81.3 (range 21-100). Most participants (92%) used glasses and 20% a hearing aid. Two-thirds (64%) were able to enter their number correctly into the keypad. Table 1 demonstrates how INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2007; 22: 492-493. Published online in Wiley InterScience (www.interscience.wiley.com)an MMSE score of 26 was significantly associated with inability to use the keypad.There were no significant associations between age, gender, functional ability (BI) or the use of spectacles/ glasses and the ability to correctly use the keypad. Subjects who could not use the keypad h...
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