Longitudinal trends in using physical interventions to manage aggression and self-harm in mental health services.

Objectives: Repetitive aggression by a patient receiving mental health inpatient care is likely to elicit various patterns of response from care staff over time. This study sought to examine patterns of coercive physical intervention in relation to repeated episodes of aggression by particular patients.

Methods: A data set of 9,945 aggression and self-harm incidents over a five-year period in one mental health service in England was constructed.

Quantitative findings from a mixed methods evaluation of once-weekly therapeutic community day services for people with personality disorder.

Background: Quantitative findings are presented from a mixed methods study of four one-day-a-week therapeutic communities for people with personality disorder (qualitative findings from the same study are reported in a separate paper). The evaluation assessed both the clinical efficacy of the model and its acceptability to service users, service employees and those who refer clients to the services.

Aims: The study aimed to clarify whether one-day therapeutic communities can be effective for people with personality disorder.

Qualitative findings from a mixed methods evaluation of once-weekly therapeutic community day services for people with personality disorder.

Background: This paper presents qualitative findings from a mixed methods study of four one-day-a-week therapeutic communities (TCs) in the north of England for people with personality disorder. Quantitative findings from the study are presented separately.

Aims: The study aimed to ascertain whether one-day-a-week TCs can be effective in addressing the problems associated with personality disorder.

Impact of exudate and odour from chronic venous leg ulceration.

Aims: To explore depression in people treated for chronic venous leg ulceration, and to assess the impact of excessive exudate, leading to leakage and odour, on their daily lives, overall health and quality of life.

Methods: Completion of a questionnaire and Hospital Anxiety and Depression Scale to determine the prevalence of anxiety and depression in people with chronic leg ulceration (n = 196), and interviews with 20 people living with chronic leg ulceration.

Findings: Odour and excessive exudate leading to leakage had an adverse effect on patients' psychological state, leading to feelings of disgust, self-loathing and low self-esteem.

Depression in patients with chronic venous ulceration.

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of "caseness".

A survey of psychological wellbeing in an adult population.

The British government has called on all NHS staff to help promote good psychological wellbeing in the population. This article reports results from a survey conducted in Merseyside, England, into the prevalence of poor psychological wellbeing across a large part of the region. People registered with one of five Merseyside primary care trusts were stratified by age group and deprivation, and a questionnaire was mailed to 28,000 who had been randomly selected from those aged 15 or over.

Self-harm patients who take early discharge from the accident and emergency department: how do they differ from those who stay?

There is evidence that patients presenting at a hospital Accident and Emergency (A&E) department with self-harm are considerably more likely than many others to discharge themselves before their assessment or treatment are complete. This paper reports a study that is part of a broader analysis of all self-harm presentations to a hospital A&E department over a five-year period. Self-harm patients who chose to remain for assessment and treatment were compared with those who chose to discharge themselves prematurely.

Registering concern: the case of primary care registers for people with severe and enduring mental illness.

As the focus of mental health care has shifted from the hospital to the community, so the importance of effectively targeting resources on those with the greatest need has become paramount. One approach to identifying and targeting people deemed to have severe and enduring mental health problems is the establishment of mental health case registers at primary care level. This paper raises a number of conceptual issues associated with these registers and, on the basis of the available literature, offers suggestions to guide those who are contemplating their introduction.

The impact of community mental health reform on service users: a cohort study.

British mental health services have undergone considerable reform in recent years. This paper reports a study designed to assess the impact of these changes on service users. The functioning of 100 randomly selected users of community mental health services in a North Wales town was assessed before the advent of two significant service changes - the establishment of a local Community Mental Health Team (CMHT) and the introduction of the main community care reforms in April 1993.