Simon Tulloch and Stefan Priebe
Population‐based indices of needs have an influence on mental health care funding. Over the last 30 years, a number of needs indices have been developed that utilise…
Abstract
Population‐based indices of needs have an influence on mental health care funding. Over the last 30 years, a number of needs indices have been developed that utilise sociodemographic and service utilisation data to calculate a proxy indicator of population‐based need. This approach is used because indicators of socio‐economic disadvantage expressed as weighted deprivation show a strong relationship with mental health morbidity. In this paper, we review the existing indices, illustrate the application of these indices using east London as an example, and consider the methodological and conceptual limitations of these indices. Although none of the current indices provide a definitive picture, commissioners and providers may find them to be a useful source of contextual information, which may be useful in combination. In England, this is particularly relevant in the light of the increased liberalisation of commissioning services and changes in the funding process.
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Stefan Priebe and Donna Wright
There has been a recent initiative in England to establish a wider provision of psychotherapy. Studying the models of psychological treatment and experiences in other countries…
Abstract
There has been a recent initiative in England to establish a wider provision of psychotherapy. Studying the models of psychological treatment and experiences in other countries may enable policy makers in England to learn lessons and avoid pitfalls. This paper assesses and compares the provision of psychotherapy for adults in a selected number of European and non‐European countries. A structured list of psychotherapy features was used to collect information from each country on the number of psychotherapists, professional qualifications, the settings and models of psychotherapy, the referral procedures, funding arrangements, quality management and outcome assessments. These data were then compared in a non‐systematic way. Comparison of levels of provision was the most difficult to establish, but the findings suggest that psychotherapy that is broadly free at the point of entry is more widely available in other EU countries than in England. They also show that the plans currently being discussed for a psychotherapy service in England differ from those provided in most of the other countries in this study. The differences include the lack of statutory accreditation rules and lower qualification thresholds for psychotherapists, the concept of treatment centres, the low number of sessions, and the regular assessment of outcome data. Therefore, based on this comparison, the necessity of these features, their priority and possible alternatives may need to be considered.
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Alfonso Ceccherini‐Nelli and Stefan Priebe
The purpose of this paper is to explore the association between economic factors (consumer price index, real gross domestic product per capita, base discount rate, and rate of…
Abstract
Purpose
The purpose of this paper is to explore the association between economic factors (consumer price index, real gross domestic product per capita, base discount rate, and rate of unemployment) and numbers of hospital psychiatric beds.
Design/methodology/approach
Time series analytical techniques (unit root and cointegration tests) were applied to two regional data sets from the nineteenth century (North Carolina, USA; Berkshire, UK) and three national data sets in the twentieth century (US; UK; Italy) to test the hypothesis of a relationship.
Findings
All data sets suggest a long‐run relationship between economic factors and psychiatric bed numbers. Increase of consumer price predicted a decrease of hospital beds (and vice versa) in all data sets and was the strongest predictor of changes in psychiatric bed numbers. Hence, economic factors appear to be an important driver for the supply of hospital beds.
Research limitations/implications
Cointegration tests are not true causality tests as they only measure the ability to forecast the value of an X variable knowing the value of N other variables. Therefore, one cannot rule out that the relationship between economic factors and psychiatric hospital beds is an indirect one, caused by another unidentified factor. Also, this study alone does not provide evidence to decide whether economic factors mainly influence demand or supply, although various findings suggest the latter.
Practical implications
CPI is of particular significance for changes in psychiatric bed provision, and co‐integration tests are a useful method to explore such association.
Originality/value
This study is the first one to apply time series analytical techniques to explore the role of economic factors in the processes of psychiatric institutionalisation and deinstitutionalisation.
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This study aims to examine sociodemographic characteristics, levels and patterns of mortality experiences amongst Indian prisoners over the past two decades (1998–2018).
Abstract
Purpose
This study aims to examine sociodemographic characteristics, levels and patterns of mortality experiences amongst Indian prisoners over the past two decades (1998–2018).
Design/methodology/approach
This study used prison statistics in India to analyze occupancy rate, percentage distribution, annual/decadal change, male–to–female ratios, prison mortality rate and causes of natural/unnatural deaths.
Findings
During 1998–2018, prisons in India grew by 18% and prisoners by 69%, leading to overcrowded jails. Males outnumbered female prisoners. Seventy percent of prisoners had an educational attainment level lower than 10th grade. In 2018, over 14 per 1,000 prisoners suffered from a mental illness and 384 per 100,000 died. Unnatural deaths accounted for 8%–11% of all prisoner deaths; 84% were by suicide. Illness accounted for 95% of all natural deaths in 2018; one–quarter was due to heart diseases.
Research limitations/implications
The study did not establish an association between sociodemographic characteristics with mental illness and mortality due to the non-availability of data.
Social implications
The pattern of a deteriorating living environment, rise in mental illnesses and mortality among Indian prisoners calls for immediate action from the authorities to protect them. Almost all unnatural deaths were by suicide (mostly by hanging). This detailed study would help authorities to take corrective measures for prisoner safety and well-being. There is also a need to develop a scientific database for this population.
Originality/value
To the best of the authors’ knowledge, this is the first study to examine morbidity and mortality experiences of the prisoner population using national statistics.
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Sacha Evans, Faisil Sethi, Oliver Dale, Clive Stanton, Rosemary Sedgwick, Monica Doran, Lucinda Shoolbred, Steve Goldsack and Rex Haigh
The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in…
Abstract
Purpose
The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003.
Design/methodology/approach
A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken.
Findings
The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population.
Research limitations/implications
The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour.
Originality/value
This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.