Over the past 15 years there has been a move away from consultants having responsibility for the ... more Over the past 15 years there has been a move away from consultants having responsibility for the care of patients both in the community and when in hospital towards a functional split in responsibility. In this article Tom Burns and Martin Baggaley debate the merits or otherwise of the split, identifying leadership, expertise and continuity of care as key issues; both recognise that this move is not evidence based.
Health expectations : an international journal of public participation in health care and health policy, Aug 29, 2015
Continuity of care (COC) is central to the organization and delivery of mental health services. T... more Continuity of care (COC) is central to the organization and delivery of mental health services. Traditional definitions have excluded service users, and this lack of involvement has been linked to poor conceptual clarity surrounding the term. Consequently, very little is known about the differences and similarities in the conceptualization of COC by mental health service users and professionals. To explore and compare mental health service users' and professionals' definitions of COC. Using an exploratory, qualitative design, five focus groups with 32 service users each met twice. Data were analysed thematically to generate a service user-defined model of COC. In a cross-sectional survey, health and social care professionals (n = 184) defined COC; responses were analysed thematically. Service user and professional definitions were conceptually mapped and compared to identify similarities and differences. There was crossover between the service user and professional derived m...
Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people... more Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT), a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this. Methods/Design In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one o...
Aims and MethodTo test the National Institute for Clinical Excellence (NICE) assertion that chara... more Aims and MethodTo test the National Institute for Clinical Excellence (NICE) assertion that characteristics of participants in the majority of clinical drug trials in schizophrenia do not reflect clinical practice. In particular they were concerned about the relative exclusion of women, older adults and patients with comorbidity. The baseline characteristics of a sample of 600 patients with schizophrenia recruited to be as representative as possible of UK community practice were compared with those from one of the largest international drug trials of an atypical antipsychotic.ResultsAlthough comparisons could only be made on a limited range of characteristics the two samples were broadly comparable.Clinical ImplicationsCurrent drug trials from pharmaceutical companies may have more relevance to clinical practice than their stated exclusion criteria may indicate.
consensus on the essential components of schizophrenia care. This paper reports a Delphi approach... more consensus on the essential components of schizophrenia care. This paper reports a Delphi approach to the identification of these components. This approach identifies and measures the degree of consensus, using a structured iterative series of questionnaires by a group of experienced UK and Irish psychiatrists (n = 15) on the essential components. Pharmacotherapy, inpatient care and community mental health team (CMHT) staffing were explicitly excluded from the study. In total, 106 components were identified
BACKGROUND: Bibliometric research has used publication or funding databases to compare the amount... more BACKGROUND: Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database. AIMS: The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields. METHOD: The numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions. RESULTS: Ratios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials. CONCLUSIONS: There is a relative dearth of research activity on bipolar disorder compared with schizophrenia.
The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as a... more The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available. As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice. Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process. We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice. Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implem...
Research has shown that there are different seasonal effects in suicide. The aim of this study is... more Research has shown that there are different seasonal effects in suicide. The aim of this study is to demonstrate that the decrease in suicide rate at the end of the year is extended over the last weeks of the year and represents a specific type of seasonal effect. Suicide data were extracted from individual records of the Swiss mortality statistics, 1969-2003. The data were aggregated to daily frequencies of suicide across the year. Specifically, the period October-February was examined using time-series analysis, i.e., the Box-Jenkins approach with intervention models. The time series models require a step function to account for the gradual drop in suicide frequencies in December. The decrease in suicide frequencies includes the whole Advent and is accentuated at Christmas. After the New Year, there is a sharp recovery in men's suicide rate but not in women's. The reduction in the suicide rate during the last weeks of the year exceeds the well-recognised effect of reduced rates on major public holidays. It involves valuable challenges for suicide prevention such as timing of campaigns and enhancement of social networks.
Over the past 15 years there has been a move away from consultants having responsibility for the ... more Over the past 15 years there has been a move away from consultants having responsibility for the care of patients both in the community and when in hospital towards a functional split in responsibility. In this article Tom Burns and Martin Baggaley debate the merits or otherwise of the split, identifying leadership, expertise and continuity of care as key issues; both recognise that this move is not evidence based.
Health expectations : an international journal of public participation in health care and health policy, Aug 29, 2015
Continuity of care (COC) is central to the organization and delivery of mental health services. T... more Continuity of care (COC) is central to the organization and delivery of mental health services. Traditional definitions have excluded service users, and this lack of involvement has been linked to poor conceptual clarity surrounding the term. Consequently, very little is known about the differences and similarities in the conceptualization of COC by mental health service users and professionals. To explore and compare mental health service users' and professionals' definitions of COC. Using an exploratory, qualitative design, five focus groups with 32 service users each met twice. Data were analysed thematically to generate a service user-defined model of COC. In a cross-sectional survey, health and social care professionals (n = 184) defined COC; responses were analysed thematically. Service user and professional definitions were conceptually mapped and compared to identify similarities and differences. There was crossover between the service user and professional derived m...
Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people... more Background Alcohol dependence is a significant and costly problem in the UK yet only 6% of people a year receive treatment. Current service provision based on the treatment of acute episodes of illness and emphasising personal choice and motivation results in a small proportion of these patients engaging with alcohol treatment. There is a need for interventions targeted at the population of alcohol dependent patients who are hard to engage in conventional treatment. Assertive Community Treatment (ACT), a model of care based on assertive outreach, has been used for treating patients with severe mental illnesses and presents a promising avenue for engaging patients with primary alcohol dependence. So far there has been little research on this. Methods/Design In this single blind exploratory randomised controlled trial, a total of 90 alcohol dependent participants will be recruited from community addiction services. After completing a baseline assessment, they will be assigned to one o...
Aims and MethodTo test the National Institute for Clinical Excellence (NICE) assertion that chara... more Aims and MethodTo test the National Institute for Clinical Excellence (NICE) assertion that characteristics of participants in the majority of clinical drug trials in schizophrenia do not reflect clinical practice. In particular they were concerned about the relative exclusion of women, older adults and patients with comorbidity. The baseline characteristics of a sample of 600 patients with schizophrenia recruited to be as representative as possible of UK community practice were compared with those from one of the largest international drug trials of an atypical antipsychotic.ResultsAlthough comparisons could only be made on a limited range of characteristics the two samples were broadly comparable.Clinical ImplicationsCurrent drug trials from pharmaceutical companies may have more relevance to clinical practice than their stated exclusion criteria may indicate.
consensus on the essential components of schizophrenia care. This paper reports a Delphi approach... more consensus on the essential components of schizophrenia care. This paper reports a Delphi approach to the identification of these components. This approach identifies and measures the degree of consensus, using a structured iterative series of questionnaires by a group of experienced UK and Irish psychiatrists (n = 15) on the essential components. Pharmacotherapy, inpatient care and community mental health team (CMHT) staffing were explicitly excluded from the study. In total, 106 components were identified
BACKGROUND: Bibliometric research has used publication or funding databases to compare the amount... more BACKGROUND: Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database. AIMS: The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields. METHOD: The numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions. RESULTS: Ratios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials. CONCLUSIONS: There is a relative dearth of research activity on bipolar disorder compared with schizophrenia.
The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as a... more The appropriate medical treatment test (ATT), included in the Mental Health Act (MHA) (1983, as amended 2007), aims to ensure that detention only occurs when treatment with the purpose of alleviating a mental disorder is available. As part of the Assessing the Impact of the Mental Health Act (AMEND) project, this qualitative study aimed to assess professionals' understanding of the ATT, and its impact on clinical practice. Forty-one professionals from a variety of mental health subspecialties were interviewed. Interviews were coded related to project aims, and themes were generated in an inductive process. We found that clinicians are often wholly relied upon for the ATT. Considered treatment varied depending on the patient's age rather than diagnosis. The ATT has had little impact on clinical practice. Our findings suggest the need to review training and support for professionals involved in MHA assessments, with better-defined roles. This may enable professionals to implem...
Research has shown that there are different seasonal effects in suicide. The aim of this study is... more Research has shown that there are different seasonal effects in suicide. The aim of this study is to demonstrate that the decrease in suicide rate at the end of the year is extended over the last weeks of the year and represents a specific type of seasonal effect. Suicide data were extracted from individual records of the Swiss mortality statistics, 1969-2003. The data were aggregated to daily frequencies of suicide across the year. Specifically, the period October-February was examined using time-series analysis, i.e., the Box-Jenkins approach with intervention models. The time series models require a step function to account for the gradual drop in suicide frequencies in December. The decrease in suicide frequencies includes the whole Advent and is accentuated at Christmas. After the New Year, there is a sharp recovery in men's suicide rate but not in women's. The reduction in the suicide rate during the last weeks of the year exceeds the well-recognised effect of reduced rates on major public holidays. It involves valuable challenges for suicide prevention such as timing of campaigns and enhancement of social networks.
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Papers by Tom Burns