Invited commentary on… Continuity of care in the community for people with severe mental illness: does it matter?

In this issue, MacDonald et al have used data from the South London and Maudsley NHS Foundation Trust electronic patient record to investigate the relationship between service change, routine outcome data and 'continuity of care'. The period they have looked at was one of huge change in the configuration of services and the background to this is explored here.Declaration of interestF.

Clinical outcomes and costs for people with complex psychosis; a naturalistic prospective cohort study of mental health rehabilitation service users in England.

Background: Mental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10-20 % of all those with psychosis, they absorb 25-50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area.

In-patient rehabilitation: clinical outcomes and cost implications.

Aims and method A retrospective evaluation was undertaken of the clinical and economic effectiveness of three in-patient rehabilitation units across one London National Health Service trust. Information on admission days and costs 2 years before and 2 years after the rehabilitation placement, length of rehabilitation placement and the discharge pathway was collected on 22 service users. Results There were statistically significant reductions in hospital admission days in the 2 years following rehabilitation compared with the 2 years before, further reflected in significantly lower bed costs.

Comparision of how old age psychiatry and general adult psychiatry services meet the needs of elderly people with functional mental illness: cross-sectional survey.

Background: There is little research evidence as to whether general adult psychiatry or old age psychiatry should look after old people with enduring mental illness.

Aims: To compare the extent to which general adult and old age psychiatric services meet the needs of older people with enduring mental illness.

Method: A total of 74 elderly patients with functional psychiatric disorders were identified by reviewing the notes of patients over the age of 60 living in a defined inner urban catchment area.

Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial.

Background: Mental health inpatient rehabilitation services focus on people with complex psychosis who have, for example, treatment-refractory symptoms, cognitive impairment, and severe negative symptoms, which impair functioning and require lengthy admission. Engagement in activities could lead to improvement in negative symptoms and function, but few trials have been done. We aimed to investigate the effectiveness of a staff training intervention to increase patients' engagement in activities.

Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial.

Background: We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention.

Method: We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy.

Study protocol: cluster randomised controlled trial to assess the clinical and cost effectiveness of a staff training intervention in inpatient mental health rehabilitation units in increasing service users' engagement in activities.

Background: This study focuses on people with complex and severe mental health problems who require inpatient rehabilitation. The majority have a diagnosis of schizophrenia whose recovery has been delayed due to non-response to first-line treatments, cognitive impairment, negative symptoms and co-existing problems such as substance misuse. These problems contribute to major impairments in social and everyday functioning necessitating lengthy admissions and high support needs on discharge to the community.

Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

Background: Current health policy assumes better quality services lead to better outcomes.

Aims: To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes.

Method: Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu.

Presidential address.

Frank Holloway was installed as the new President of the British Dental Association at the 2012 British Dental Conference and Exhibition held in Manchester on 26-28th April 2012. The following is his presidential address.

Mental health rehabilitation services in Ireland: vision and reality.

Objectives: The Irish national mental health policy document, A Vision for Change , included recommendations to develop specialist rehabilitation mental health services. This survey was conducted as part of a multicentre study to investigate current provision of mental health rehabilitation services in Ireland and factors associated with better clinical outcomes for users of these services. The aim was to carry out a detailed national survey of specialist rehabilitation services in order to describe current service provision.

Increased use of antipsychotic long-acting injections with community treatment orders.

Background: Community treatment orders (CTOs) are increasingly being used, despite a weak evidence base, and problems continue regarding Second Opinion Appointed Doctor (SOAD) certification of medication.

Aims: The aim of the current study was to describe current CTO usage regarding patient characteristics, prescribed medication and CTO conditions.

Method: A 1-year prospective cohort study with consecutive sampling was conducted for all patients whose CTO was registered in a large mental health trust.

Dietary essential fatty acids and gender-specific behavioral responses in cranially irradiated rats.

Specific memory deficits, reduced intellectual processing speed, and a variety of social and behavioral problems have been implicated as long-term effects of cranial radiation therapy (CRT). These deficits are thought to be related to changes in brain cytology and structure associated with microvascular aberrations. N-3 fatty acids may serve as protectants in pediatric patients who receive CRT for brain tumors.

Is cannabis an anti-antipsychotic? The experience in psychiatric intensive care.

Background: Cannabis use is a major problem in inner cities and has been causally implicated in psychosis. Very few of the available hospital-based studies of the implications of cannabis usage have involved psychiatric intensive care units (PICU); but PICU receive many of the most challenging and resource-hungry-and incompletely understood-patients in the mental health system.

Aims: To study the clinical impact of cannabis abuse in a PICU, and to compare the use of atypical and typical antipsychotics in this setting.

The impact of severe mental illness, co-morbid personality disorders and demographic factors on psychiatric bed use.

Background: The use of inpatient psychiatric services has been correlated with certain demographic and clinical variables. However, there is limited information about the impact of personality disorder.

Aims: To describe the impact of severe mental illness, personality disorders and demographic variables on psychiatric bed use amongst people in contact with a Community Mental Health Team (CMHT).

5-HT3 antagonist ICS 205-930 enhances naltrexone's effects on ethanol intake.

Opioid receptor antagonist naltrexone has shown some efficacy in decreasing ethanol consumption in humans. However, naltrexone treatment is not always efficacious and produces several aversive effects such as nausea, anxiety and weight loss. Serotonin-3 (5-HT3) receptor antagonists also modulate some of the behavioral effects of alcohol and may decrease alcohol consumption.

An RCT of early intervention in psychosis: Croydon Outreach and Assertive Support Team (COAST).

Background: Despite considerable interest in early intervention in psychosis, the evidence base for its effectiveness is sparse. We aimed to evaluate a new service in South London, UK, Croydon Outreach and Assertive Support Team (COAST) using a randomised controlled trial (RCT) during its first year.

Method: Referrals were taken from local adult community mental health teams of those with documented first service contact in the last 5 years and a diagnosis of any functional psychosis.

Micro1-opioid antagonist naloxonazine alters ethanol discrimination and consumption.

The endogenous opioid system is implicated in excessive ethanol-drinking behavior. However, the role of individual opioid receptor subtypes in the mechanism underlying excessive ethanol-drinking behavior is not yet well understood. Therefore, we investigated the ability of a selective micro1-opioid antagonist, naloxonazine, to modulate ethanol-drinking behavior and ethanol discrimination in a rat model with the use of ethanol self-administration and drug discrimination paradigms.

Treatment with the atypical antipsychotic, olanzapine, prevents the expression of amphetamine-induced place conditioning in the rat.

Place conditioning (PC) experiments were conducted as a means to further elaborate the treatment potential of the atypical antipsychotic, olanzapine (OLZ), for stimulant abuse. The resulting preference/aversion provides an indirect measure of the incentive salience (i.e.

Rehabilitation in the United Kingdom: research, policy, and practice.

Objective: To review research, policy, and practice in psychiatric rehabilitation in the UK.

Method: We undertook a literature review and review of government policy documents.

Findings: Most individuals with severe, disabling mental illnesses are cared for by generic community mental health services under the Care Programme Approach (CPA).