Papers by George Szmukler
Mental Health and Social Inclusion, Mar 14, 2016
Purpose – The National Institute of Health Research MHRN established the Feasibility and Support ... more Purpose – The National Institute of Health Research MHRN established the Feasibility and Support to Timely recruitment for Research (FAST-R) service in 2011, to provide rapid patient and carer feedback on research documents, prior to ethical review. The aims were to improve the feasibility of studies, to speed up regulatory processes and enhance study set up and completion. The purpose of this paper is to explore whether and how the FAST-R service benefits the review process. Design/methodology/approach – An independent evaluator analysed the comments made by FAST-R members on 85 studies over the past 3.5 years. The evaluation team reflected on the nature of these comments and the implications for future practice. Findings – The FAST-R members’ comments fell into seven categories relating to: the quality of the information, the informed consent process, care and protection of participants, practical arrangements for participants, data protection and confidentiality, recruitment and research design. Based on the evaluation team’s experience of research document review, some of these comments were similar to those made by ethics committees. In other cases, the FAST-R Panel provided a different kind of input by identifying concerns specific to service users and carers. Practical implications – Patient/carer involvement in reviewing research documents brings added benefits to existing processes because their views are informed by their knowledge and experience. They are able to question assumptions and highlight concerns that people lacking their perspective might otherwise miss. These findings suggest that patient/carer involvement should form an integral part of ethical review, and that the FAST-R model might be usefully applied to other areas of health and social care research. Originality/value – This original work adds value to the practice of patient and public involvement in research.
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The Psychiatrist, Sep 1, 2011
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Background Littleisknownabouttheproportionofpsychiatricin-patientswholackcapacitytomaketreatmentd... more Background Littleisknownabouttheproportionofpsychiatricin-patientswholackcapacitytomaketreatmentdecisions,or theassociationsoflackofcapacity.ortheassociationsoflackofcapacity.Aims Todeterminetheprevalenceofpsychiatricin-patientswholackcapacitytomakedecisionsaboutcurrenttreatmentandtoidentifydemographicandclinicalassociationswithlackofmentalcapacity.Method Patients(n¼112) wereinterviewedsoonafteradmissiontohospitalandabinaryjudgementofcapacitywasmade,guidedbytheMacArthur CompetenceToolforTreatment.Demographicandclinicalinformationwascollectedfromaninterviewandcasenotes.Results Ofthe112participants,49(43.8%)lackedtreatment-relateddecisionalcapacity.Maniaandpsychosis,poorinsight,delusionsandBlackandpoorinsight, delusionsandBlackandminorityethnicgroupwereassociatedwithmentalincapacity.Ofthe49patientslackingcapacity,30 (61%) were detainedlackingcapacity,30 (61%) weredetainedundertheMental HealthAct1983.Oftheunder theMentalHealthAct1983.Ofthe63withcapacity,6(9.5%)weredetained.Conclusions Lackoftreatment-relateddecisionalcapacityisacommonbutbynomeansinevitablecorrelateofadmissiontoapsychiatricin-patientunit.Declarationof interest None.ThestudywasfundedbytheWellcomeTrust.
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Psychological Medicine, Jul 31, 2012
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Cambridge University Press eBooks, Aug 31, 2021
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Current Opinion in Psychiatry, Sep 1, 1998
ABSTRACT
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BMJ supportive & palliative care, Sep 1, 2015
Background A Joint Crisis Plan (JCP) aims to empower patients whilst facilitating early detection... more Background A Joint Crisis Plan (JCP) aims to empower patients whilst facilitating early detection and treatment of relapse. Two studies have suggested that JCPs might reduce compulsory treatment and improve therapeutic relationships. Aim The CRIMSON randomised controlled trial compared JCPs with treatment as usual for people with severe mental illness. Methods Eligibility criteria were: at least one psychiatric admission in the previous two years and on Enhanced Care Programme Approach register. The settings were 64 community mental health teams. The intervention was the JCP, a negotiated statement by a patient of treatment preferences for any future psychiatric emergency. Hypotheses tested were that, compared to the control group, the intervention group would experience: (1) fewer compulsory admissions; (2) fewer psychiatric admissions; (3) shorter psychiatric stays; (4) lower perceived coercion; (5) improved therapeutic relationships; and (6) improved engagement. Results 569 participants were randomised (285 experimental, 284 control group). No significant treatment effect was seen for the primary outcome (56 (20%) in the control arm and 49 (18%) in the JCP arm; odds ratio 0.90 (95% CI 0.58 to 1.39, p = 0.63) or admissions outcomes, however there was evidence for improved therapeutic relationships (17.3 (7.6) v 16.0 (7.1); adjusted difference –1.28 (95% CI –2.56 to –0.01, p = 0.049). Qualitative data supported this finding. Discussion The results contrast with two earlier studies. There is evidence to suggest the JCPs were not fully implemented in all sites. Conclusion The study raises important questions about implementing new interventions in routine practice.
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Law, Mind and Brain, 2017
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BMJ, 2017
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The British journal of psychiatry : the journal of mental science, Dec 1, 2016
As general medicine moves away from 'paternalism' and places an increasing emphasis on pa... more As general medicine moves away from 'paternalism' and places an increasing emphasis on patient choice and autonomy, George Szmukler and Brendan D. Kelly debate whether conventional mental health legislation should be replaced with a model that focuses on the person's decision-making capabilities.
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International Journal of Mental Health and Capacity Law, 2014
Part I Principles<br />Part II General provisions<br />Part III Serious medical treat... more Part I Principles<br />Part II General provisions<br />Part III Serious medical treatment<br />Part IV Informal patients needing care and treatment<br />Part V Compulsory provision of care and treatment<br />Part VI Forensic provisions<br />Part VII The Mental Capacity Tribunal<br />Part VIII Patient safeguards
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Epidemiology and psychiatric sciences, 2014
Background. In England, people with a serious mental illness are offered a standardized care plan... more Background. In England, people with a serious mental illness are offered a standardized care plan under the Care Programme Approach (CPA). A crisis plan is a mandatory part of this standard; however, the quality and in particular the level of individualisation of these crisis plans are unknown. In this context, the aim of this study was to assess the quality of crisis planning and the impact of exposure to a specialized crisis planning intervention. Method. The crisis plans of 424 participants were assessed, before and after exposure to the Joint Crisis Plan (JCP) intervention, for 'individualisation' (i.e., at least one item of specific and identifiable information about an individual). Associations of individualisation were investigated. Results. A total of 15% of crisis plans were individualised at baseline. There was little or no improvement following exposure to the JCP. Individualised crisis plans were not associated with a history of prior crises or incidences of harm...
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British Journal of Medical Psychology, 1984
A case is presented, based on clinical observation and a sharing of fundamental features, for vie... more A case is presented, based on clinical observation and a sharing of fundamental features, for viewing anorexia nervosa as a dependence disorder. This view lends a coherence to the clinical picture and generates some new hypotheses for research.
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The Psychiatrist, 2011
Aims and methodA group of lawyers, psychiatrists, best interest assessors and independent mental ... more Aims and methodA group of lawyers, psychiatrists, best interest assessors and independent mental capacity advocates were asked to make binary judgements about whether real-life situations in 12 vignettes amounted to deprivation of liberty. Kappa coefficients were calculated to describe the level of agreement within each professional group and for the total group of professionals.ResultsThere was total agreement between all professionals about deprivation of liberty in only 1 of the 12 cases. The overall level of agreement for judgements made by all professionals was ‘slight’ (κ=0.16, P < 0.01).Clinical implicationsThere are practical difficulties involved in making reliable deprivation of liberty judgements within the Deprivation of Liberty Safeguards (DoLS) legislation. A clear interpretation of deprivation of liberty is necessary to facilitate professionals' decision-making in this area.
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Therapeutic advances in psychopharmacology, 2011
Community treatment orders (CTOs) are increasingly being used, despite a weak evidence base, and ... more Community treatment orders (CTOs) are increasingly being used, despite a weak evidence base, and problems continue regarding Second Opinion Appointed Doctor (SOAD) certification of medication. The aim of the current study was to describe current CTO usage regarding patient characteristics, prescribed medication and CTO conditions. A 1-year prospective cohort study with consecutive sampling was conducted for all patients whose CTO was registered in a large mental health trust. Only the first CTO for each patient was included. Measures included sociodemographic variables, psychiatric diagnosis, CTO date of initiation and conditions, psychotropic medication and date of SOAD certification for medication. This study was conducted in the first year of CTO legislation in England and Wales. A total of195 patients were sampled (mean age 40.6 years, 65% male, 52% black ethnic origin). There was significant geographical variability in rates of CTO use (χ(2) = 11.3, p = 0.012). A total of 53% h...
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Psychological Medicine, 2012
Involving service users in research improves its quality and relevance. Many research organizatio... more Involving service users in research improves its quality and relevance. Many research organizations funding and supporting research now ask researchers about involvement as part of their application process. Some researchers are facing challenges in taking forward involvement as the research infrastructure is not always facilitative. Researchers need greater reward and recognition for carrying out good quality involvement to encourage more effective processes.
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Psychiatric Services, 2008
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Papers by George Szmukler