Community services in psychiatry

Question 1

Agenda launched by DoH in 1999 for mental health services with an emphasis on community psychiatry

Answer 1

National Service Framework for Mental Health

Question 2

Three critical targets within the NHS plan set up to meet the National Service Framework proposals

Answer 2

1. 50 early intervention teams to be in place by 2004
2. 335 crisis resolution teams by 2004
3. 220 assertive outreach teams by 2003

Question 3

Six objectives of the Mental Health Strategy for England proposed in 2011

Answer 3

1. More people will have good mental health
2. More people with mental health problems will recover
3. More people with mental health problems will have good physical health
4. More people will have a positive experience of care and support
5. Fewer people will suffer avoidable harm
6. Fewer people will experience stigma and discrimination

Question 4

Model of community based mental health care for people whose poor mental health affects their ability to engage with services

Answer 4

Assertive community treatment (ACT) model

Question 5

Model of community care where the main worker co-ordinates various services without actively providing input

Answer 5

Brokerage model

Question 6

Model of community care where a single professional is responsible for all long term aspects of a patient’s care

Answer 6

Case management model

Question 7

Most important predictor of outcome of an ACT service

Answer 7

Caseload

Question 8

Model of community care for hard to engage patients which follows ACT principles but individuals have case loads rather than groups of professionals managing cases

Answer 8

Intensive case management

Question 9

Advantage of intensive case management compared to ACT model

Answer 9

Less time spent discussing cases

Question 10

Disadvantage of intensive case management compared to ACT model

Answer 10

Staff burn out and high responsibility on individual staff members

Question 11

Model of community care where the patient directs their input and no goals are imposed on the patient

Answer 11

Personal strengths model

Question 12

Care Programme Approach levels

Answer 12

Enhanced
Standard

Question 13

Critical period in early psychosis

Answer 13

First 3-5 years where the greatest impact can be made if interventions are started

Question 14

Drug used in PRIME study looking to prevent progression from a premorbid state to full psychosis

Answer 14

Olanzapine

Question 15

Drug used alongside CBT in the EPPIC study

Answer 15

Risperidone

Question 16

Identified duration of untreated psychosis as a prognostic factor

Answer 16

Wyatt

Question 17

DoH target for maximum individual DUP

Answer 17

6 months

Question 18

DoH target for median DUP

Answer 18

3 months

Question 19

Four main elements of the care programme approach

Answer 19

Assessment
Care plan
Key worker (now called care co-ordinator)
Regular review

Question 20

Term now used for people previously known as key workers within the care programme approach

Answer 20

Care co-ordinator

Question 21

Credited with describing pathways to care

Answer 21

Goldberg and Huxley

Question 22

Condition which has the most evidence for phototherapy

Answer 22

Seasonal affective disorder

Question 23

Model which accounts for how mental illness interacts with the healthcare system and how patients are filtered out at increasingly intensive levels of treatment

Answer 23

Pathways to care

Question 24

Four filters found in the pathways to care model which explain decreasing numbers of cases at each level

Answer 24

1. The patient’s own recognition
2. Recognition, decision to refer by the GP
3. At the outpatient CMHT level
4. At the inpatient psychiatry level

Question 25

Event which triggered the introduction of the care programme approach

Answer 25

The killing of a social worker by a patient