ABSTRACT
The NHS & Community Care Act 1990 heralded a new era in community care in the UK. Needs-led assessment and case management were to form the cornerstone of high quality care. Practitioners were challenged to alter their attitudes and practice to accommodate the needs-led approach. Previously they had assessed need to ascertain eligibility for statutory services, now they were required to identify "need" per se. The pivotal role given to assessment meant the success, or otherwise, of the reforms lay in part on the ability of practitioners to make this transition. However, to make needs-led assessment a reality, practitioners would have both to overcome conceptual barriers--need being an unclear concept, with no clear framework existing to assess need--and also to deal successfully with the conflicting requirement to ration services. In order to investigate whether the shift to needs-led practice had been possible, the opinions of social and healthcare practitioners providing services for older people in North Wales were sought through semi-structured interviews in 1994-1995 and 1998-1999. Supports and constraints to practice were also explored. Practitioners indicated that whilst they welcomed the needs-led philosophy, putting it into practice was difficult, if not impossible. The main constraints were a lack of resources (financial, service provision and staffing) and the conceptual difficulty of separating "need" from the "need for a particular service". Ever-tightening budgets and service eligibility criteria over the period of the study indicate that a shift of focus from assessment of need to rationing has taken place.
Subject(s)
Attitude of Health Personnel , Gatekeeping , Health Services for the Aged/organization & administration , Needs Assessment/organization & administration , Aged , Case Management , Health Care Rationing , Health Care Reform , Humans , Quality Assurance, Health Care , State Medicine/organization & administration , WalesABSTRACT
This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.
Subject(s)
Antidepressive Agents/therapeutic use , Cognitive Behavioral Therapy/methods , Depressive Disorder, Major/prevention & control , Depressive Disorder, Major/therapy , Thinking , Adult , Combined Modality Therapy , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/drug therapy , England , Female , Humans , Male , Middle Aged , Ontario , Outcome Assessment, Health Care , Psychiatric Status Rating Scales , Secondary Prevention , Survival AnalysisABSTRACT
Previous research on depressed and suicidal patients and those with posttraumatic stress disorder has shown that patients' memory for the past is overgeneral (i.e., patients retrieve generic summaries of past events rather than specific events). This study investigated whether autobiographical memory could be affected by psychological treatment. Recovered depressed patients were randomly allocated to receive either treatment as usual or treatment designed to reduce risk of relapse. Whereas control patients showed no change in specificity of memories recalled in response to cue words, the treatment group showed a significantly reduced number of generic memories. Although such a memory deficit may arise from long-standing tendencies to encode and retrieve events generically, such a style is open to modification.
