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DEVELOPMENTS IN EVIDENCE BASED MENTAL HEALTH NURSING

Kevin Gournay, Institute of Psychiatry, London. 2. CHANGES IN MENTAL HEALTH SERVICES IN EIRE. MENTAL HEALTH LEGISLATIONDEINSTITUTIONALISATIONCOMMUNITY APPROACHESPRIMARY CAREDRUGS AND MENTAL ILLNESSCHANGING PROFESSIONAL ROLES - BLURRING OF BOUNDARIESCNS and ANP roles. Kevin Gournay, Institute

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DEVELOPMENTS IN EVIDENCE BASED MENTAL HEALTH NURSING

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    1. DEVELOPMENTS IN EVIDENCE BASED MENTAL HEALTH NURSING PROF KEVIN GOURNAY CBE FRCPsych (Hon) FMedSci FRCN PhD CPsychol RN HEALTH SERVICES RESEARCH DEPARTMENT; INSTITUTE OF PSYCHIATRY, LONDON

    2. Kevin Gournay, Institute of Psychiatry, London 2 CHANGES IN MENTAL HEALTH SERVICES IN EIRE MENTAL HEALTH LEGISLATION DEINSTITUTIONALISATION COMMUNITY APPROACHES PRIMARY CARE DRUGS AND MENTAL ILLNESS CHANGING PROFESSIONAL ROLES - BLURRING OF BOUNDARIES CNS and ANP roles

    3. Kevin Gournay, Institute of Psychiatry, London 3 FUTURE FOCI Community Mental Health Teams – Serious Mental Illness Primary Care – Common Mental Disorders Improved In patient Care

    4. Kevin Gournay, Institute of Psychiatry, London 4 Nursing workforce issues Need to consider numbers of CNS’s and ANP for CMHT’s and Primary Care respectively ( eg case loads in assertive Community Treatment ie for most acutely ill set at 12-15 in UK) Need to deal strategically

    5. Kevin Gournay, Institute of Psychiatry, London 5 EVIDENCE – Serious and Enduring Illnesses ( eg Scizophrenia, Manic Depression) Medication ( nb medication management) Assertive Community Treatment (including home treatment, crisis resolution) Family Interventions CBT Early Intervention ?Dual Diagnosis

    6. Kevin Gournay, Institute of Psychiatry, London 6 Evidence – Common Mental Disorders Medication ( range of conditions – with or without CBT) CBT – Panic, Phobias, OCD, PTSD CBT/IPT – Some depression NB No evidence to support dynamic psychotherapy, counselling

    7. Kevin Gournay, Institute of Psychiatry, London 7 OPTIONS FOR CNS TRAINING GENERIC - “SKILLS FOR EVERYTHING” FOCUS ON SEMI OR CMD

    8. Kevin Gournay, Institute of Psychiatry, London 8 ARGUMENTS FOR FOCUSSED TRAINING AVOID SKILLS DILUTION CURRICULUM TIME DIFFICULT TO SWITCH OVERARCHING APPROACH FOR PATIENT GROUP

    9. Kevin Gournay, Institute of Psychiatry, London 9 POSSIBLE OPTIONS FOR CNS TRAINING GENERIC FOUNDATION MODULE FOLLOWED BY EITHER SEMI OR CMD MODULE DIRECTLY INTO SEMI OR CMD TRAINING

    10. Kevin Gournay, Institute of Psychiatry, London 10 THORN PROGRAMME FOR SERIOUS AND ENDURING MENTAL ILLNESS

    11. Kevin Gournay, Institute of Psychiatry, London 11 Key characteristics of training for CPN’s “The Thorn Programme” Commenced in 1992 Specifically designed for schizophrenia Now the National UK Training model “Evidence” based Community approach Skills orientated Multidisciplinarity (of students and teachers) Now at 12 English Universities plus 2 in Ulster Other similar courses ( MSc:Sainsbury CMH)

    12. Kevin Gournay, Institute of Psychiatry, London 12 Thorn Programme - Core Modules ACT Family interventions Psychological Interventions

    13. Kevin Gournay, Institute of Psychiatry, London 13 ADDITIONAL THORN MODULES MEDICATION MANGEMENT DUAL DIAGNOSIS IN PATIENT CARE

    14. Kevin Gournay, Institute of Psychiatry, London 14 MEDICATION MANAGEMENT

    15. Kevin Gournay, Institute of Psychiatry, London 15 MEDICATION MANAGEMENT 50-80% of patients non compliant Important role in out , day and in patient care Nurse skills poor Doctor skills sometimes not much better

    16. Kevin Gournay, Institute of Psychiatry, London 16 Medication management training programme Manualised 80 hour training programme Key components Assessment Psychopathology, side effects, attitudes towards treatment, insight Cognitive and compliance therapy skills Treatment rationale, video role-play, supervision Psychopharmacology Maudsley prescribing guidelines Clinical supervision COMPOSED A MEDICATION MANAGEMENT TRAINING PROGRAMME -TARGETING ASSESSMENT SKILLS -CBT PROGRAMME FOR COMPLIANCE IMPROVEMENT -PSYCHOPHARMACOLOGYCOMPOSED A MEDICATION MANAGEMENT TRAINING PROGRAMME -TARGETING ASSESSMENT SKILLS -CBT PROGRAMME FOR COMPLIANCE IMPROVEMENT -PSYCHOPHARMACOLOGY

    17. Kevin Gournay, Institute of Psychiatry, London 17 Methodology Recruitment of CPNs Geographical clusters Randomised Experimental Control Patients recruited (2 Per CPN) Baseline assessments Research worker Trained Blind to training Experimental group receive training Control group continue with standard care Week 26 assessments Enhanced care in experimental group Control group receive training Week 52 assessments

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