Exploring unintended consequences of policy initiatives in mental health: the example of CAMHS in England

Foreman, D.M. BMJ Open. 2016. 6:e010714


Objectives: The impact of policy and funding on Child and Adolescent Mental Health Service (CAMHS) activity and capacity, from 2003 to 2012, was assessed. The focus was on preschool children (aged 0–4 years), as current and 2003 policy initiatives stressed the importance of ‘early intervention’.

Settings: National service capacity from English CAMHS mapping was obtained from 2003 to 2008 inclusive. English Hospital Episode Statistics (HES) for English CAMHS was obtained from 2003 to 2012. The Child and Adolescent Faculty of the Royal College of Psychiatrists surveyed its members about comparative 0–4-year service activity and attitudes in 2012.

Participants: CAMHS services in England provided HES and CAMHS mapping data. The Child and Adolescent Faculty of the Royal College of Psychiatrists are child psychiatrists, including trainees.

Outcome measures: CAMHS mapping data provided national estimates of total numbers of CAMHS patients, whereas HES data counted appointments or episodes of inpatient care. The survey reported on Child Psychiatrists’ informal estimates of service activity and attitudes towards children aged 0–4 years.

Results: The association between service capacity and service activity was moderated by an interaction between specified funding and age, the youngest children benefiting least from specified funding and suffering most when it was withdrawn (Pr=0.005). Policy review and significant differences between age-specific HES trends (Pr<0.001) suggested this reflected prioritisation of older children. Clinicians were unaware of this effect at local level, though it significantly influenced their attitudes to prioritising this group (Pr=0.02).

Conclusions: If the new policy initiative for CAMHS is to succeed, it will need to have time-limited priorities attached to sustained, specified funding, with planning for limits as well as expansion. Data collection for policy evaluation should include measures of capacity and activity.

Read the full article here

Patients with “too high” BMI refused eating disorder treatment

Campbell, S. YoungMinds. Published online: 3 August 2016

New information sheds light on the amount of people who are refused treatment for an eating disorder because their BMI (Body Mass Index) is considered too high.

The information, acquired through the BBC, highlights a significant amount of sufferers who felt overlooked after being told they were not thin enough to receive care, even though they displayed symptoms of an eating disorder.

BMI Youngminds
Image source: YoungMinds

Not only is BMI alone an unreliable way of detecting an eating disorder, it ignores the emotional stress that comes with it. There is also a danger of allowing the sufferer’s symptoms to grow in severity before an intervention is made.

Figures from the Beat: Beating Eating Disorders charity found the following:

  • More than 725,000 people in the UK are affected by an eating disorder.
  • The National Institute of Health and Care Excellence estimates around 11% of those affected by an eating disorder are male.
  • Figures published in February 2014 by The Health and Care Information Centre show an 8% rise in the number of inpatient hospital admissions in the 12 months to October 2013.
  • An estimated 40% of people with an eating disorder have bulimia, 10% anorexia, and the rest other conditions, such as binge-eating disorder.

While BBC Newsbeat discovered:

  • The number of hospital admissions across the UK for teenagers with eating disorders has nearly doubled in the last three years (959 13 to 19-year-olds in 2010/11 to 1,815 in 2013/14)

Read the full news story here

Mental health – our attitudes and awareness

Image source: Hey Paul Studios – Flickr // CC BY 2.0

Understanding what works to keep us mentally healthy and support those experiencing mental health problems is fundamental to reducing health inequalities.

PHE have been working with the National Centre for Social Research (NatCen) to understand more about public attitudes to mental wellbeing and mental illness and commissioned a series of questions on attitudes to mental health as part of the latest British Social Attitudes survey. This blog goes through some of the findings.

Two distinct pictures of public attitude emerged from the findings. On one hand people are being positive and aware about mental wellbeing, but on the other, we are still seeing negative attitudes towards mental health problems, despite widespread prevalence.

Topics covered include:

  • Mental wellbeing
  • Stigma

Read the full blog post here

Avoiding unconscious bias – a guide for surgeons via @RCSnews

rcs bias
Image source: RCS

The Royal College of Surgeons has today published a guide for surgeons on how to avoid unconscious bias.

Everyone has unconscious biases – where our judgements and thought processes are influenced, often without us realizing, by personal experiences, our background and societal expectations.

The guide – ‘Avoiding unconscious bias’ – aims to encourage surgeons to be aware of this, and sometimes adjust their behavior so that their trainees and fellow staff do not misinterpret their actions.

Consultant Orthopaedic Surgeon, Mrs Scarlett McNally, who helped to write the guidance, said:

“We want to develop a diverse, inclusive, and positive culture in the surgical profession and the NHS as a whole.

“By addressing their own unconscious biases and working to correct them, surgeons can be leaders in the NHS and inspire those around them to behave in an exemplary manner.

“We also want organisations to reduce their unconscious bias. For example, small changes in the applications processes for committees can encourage more diverse applicants to the decision-making groups.”

Although this guidance has been written for surgeons, the principles can apply to anyone working in healthcare.

Read the full report here

NICE calls for wider supply of condoms to reduce STIs

Wise, J. BMJ. 2016. 354:i4332

condom-538601_960_720The National Institute for Health and Care Excellence (NICE) has called for free condoms to be given out to men who have sex with men and other high risk groups in order to reduce rates of sexually transmitted infections.

There were an estimated 435 000 sexually transmitted infections diagnosed in England in 2015, including 200 000 cases of chlamydia. Syphilis and gonorrhoea rates rose by 76% and 53% respectively between 2012 and 2015. The highest rates of gonorrhoea and syphilis were found in men who have sex with men, while the highest rates of chlamydia, genital herpes, and genital warts were found in people aged between 16 and 24.

In a draft consultation guideline, NICE recommended increasing the availability of condoms and female condoms to those most at risk of sexually transmitted infections. It said that a range of condom distribution schemes should be provided to meet the needs of local populations. It also recommended that condoms should be sold at cost price to the wider population.

Read the full article here

Read the draft guidelines here

Drinking filter coffee could reduce the risk of malignant melanoma – results from the (NOWAC) Study.

Lukic, M. et al. BMC Cancer. 2016 16:562


Background: Coffee contains biologically-active substances that suppress carcinogenesis in vivo, and coffee consumption has been associated with a lower risk of malignant melanoma. We studied the impact of total coffee consumption and of different brewing methods on the incidence of malignant melanoma in a prospective cohort of Norwegian women.

Methods: We had baseline information on total coffee consumption and consumption of filtered, instant, and boiled coffee from self-administered questionnaires for 104,080 women in the Norwegian Women and Cancer (NOWAC) Study. We also had follow-up information collected 6–8 years after baseline. Multiple imputation was used to deal with missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for malignant melanoma by consumption category of total, filtered, instant, and boiled coffee.

Results: During 1.7 million person-years of follow-up, 762 cases of malignant melanoma were diagnosed. Compared to light consumers of filtered coffee (≤1 cup/day), we found a statistically significant inverse association with low-moderate consumption (>1–3 cups/day, HR = 0.80; 95 % confidence interval [CI] 0.66–0.98) and high-moderate consumption of filtered coffee (>3–5 cups/day, HR = 0.77; 95 % CI 0.61–0.97) and melanoma risk (p trend = 0.02). We did not find a statistically significant association between total, instant, or boiled coffee consumption and the risk of malignant melanoma in any of the consumption categories.

Conclusions: The data from the NOWAC Study indicate that a moderate intake of filtered coffee could reduce the risk of malignant melanoma.

Read the full article here

Are Current Electronic Prescribing Systems Facilitating Antimicrobial Stewardship in Acute National Health Service Hospital Trusts in East of England?

Ladenheim, D. et al. Journal of Hospital Infection. Published online: July 29, 2016


Antimicrobial stewardship (AMS) programs in hospitals seek to optimise antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs, slow the spread of antimicrobial resistance and reduce the incidence of healthcare associated infections. The Start Smart – then Focus toolkit published by Public Health England provides an evidenced-based approach for improving antimicrobial prescribing for acute National Health Service (NHS) Hospital Trusts in England.

Read the abstract here