Original article
Knowledge and confidence of the mental health act in Scotland: a survey of general practitioners
Medicine, Science and the Law 2015, Vol. 55(1) 30–34 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0025802414524386 msl.sagepub.com
Lisa Conway1, Nabiha Mohammed2, Charles Jardine3 and James Crabb4
Abstract Aims and method: Front-line clinician general practitioners may be required to assist in the administration of mental health legislation. Limited training has been an issue previously identified. This study aims to ascertain levels of training, knowledge and confidence of general practitioners in Scotland in relation to the mental health act. An anonymous online survey of all general practitioners in one Scottish health board was completed. Results: Eighty general practitioners in Forth Valley responded to the survey; 55% had never received any previous training in the mental health act. The majority rated knowledge of the act as fair (50%) and confidence in using the act as poor (44%). No relationship was found between previous training and current knowledge or confidence. Previous practical use of the act was associated with better current knowledge (p ¼ 0.0074) and confidence in using the act (p ¼ 0.0005). Of the respondents, 99% were keen to pursue further training in the act. Clinical implications: Further practical training for general practitioners in the use of the mental health act is required to improve knowledge and confidence in this important area. Keywords forensic psychiatry, legal system, medical law
Introduction
suggested there has been limited training and knowThe Mental Health (Care & Treatment) (Scotland) ledge of referral pathways and local resources. A need Act 2003 came into force in October 2005. It affects for further training in various aspects of mental health the work of all health and social care professionals in work was identified.6,7 In the UK, GPs have suggested Scotland. The impetus for the new act came largely that this lack of training and knowledge may contribfrom a change in psychiatric practice with the move ute to lack of confidence in the management of towards care in the community.1 patients with mental health problems in a primary care setting.7 In relation to mental health act work, General practitioners (GPs) are front-line clinicians and the cornerstone of community psychiatry. They training in its practical use has been identified as a are expected to use the mental health act in emergency requirement for GPs.8 Training sessions have been psychiatric situations to protect the safety of some of identified as one factor which may increase uptake the most vulnerable patients they serve. Although and confidence in using mental health resources infrequent, this process can be complicated and time among primary care physicians, but the research in consuming and it is therefore vital they are knowthis area is limited.9 2,3 ledgeable and confident in using this legislation. Training and education of health care professionals is necessary to achieve sustainable improvements in 1 ST6 General Adult Psychiatry, Forth Valley Royal Hospital, Castlehill, patient care and safety. Theoretically, training United Kingdom should improve mental health literacy and improve 2 CT2 Psychiatry Gartnavel Royal Hospital, United Kingdom confidence in using the mental health act. This 3 General Practitioner, Doune Health Centre, Castlehill, improved confidence would hopefully lead to more United Kingdom 4 Consultant Psychiatrist, Forth Valley Royal Hospital, Castlehill, front-line clinicians becoming involved in emergency United Kingdom psychiatric situations and feeling they have the skills to do so.4,5 Corresponding author: Previous studies in the UK and Australia have Lisa Conway, Forth Valley Royal Hospital, Stirling Road, Larbert, looked at attitudes of GPs towards dealing with Scotland, FK54WR. Email: [email protected] mental health problems in primaryDownloaded care. from These have msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
Conway et al. Most studies in this area have looked at training and knowledge in the mental health act in England and Ireland. Many of these have also focussed on psychiatrists rather than GPs. No previous studies have been conducted in Scotland in this important area to establish the knowledge, confidence and training requirements in the mental health act amongst GPs.
Aim The aim of this study was to examine GPs’ knowledge and confidence in the use of the Mental Health Act (2003) and of local policy. It was our aim to establish the relationship between previous training in this area and current knowledge and confidence. We also looked to identify the relationship between previous practical experience in using the act and current knowledge and confidence. Finally, we looked to explore GPs’ views on the need for further training and the aspects of training they would find beneficial.
Method An anonymous ten-question online survey was devised. The survey asked GPs to self rate knowledge, training and confidence in using the Mental Health Act. It also asked about knowledge of local protocols and procedures relating to the use of the mental health act in the Forth Valley area. Finally, it asked if GPs would be interested in accessing an online learning module in this area. There was space at the end of the survey for free text comments. The survey was distributed by nhs.net email to all GPs in Forth Valley Health board. A contact mailing list was kindly provided by primary care which identified 252 contacts. The survey was initially distributed in January 2013 and a reminder email sent in February 2013. The online survey was open for a period of 2 weeks. Data were analysed using Microsoft Excel spreadsheets and statistical analysis done via Graph Pad software using Fischer’s exact test. Statistical analysis was used to explore the correlation between training and knowledge, training and confidence, previous use and knowledge and finally previous use and confidence. In order to perform Fischer’s exact test, GPs’ responses on knowledge and confidence were dichotomised into two groups (fair / better and poor / worse). As this was a survey of NHS staff, the local ethics committee did not consider ethical approval to be necessary.
31 act and current self-rated knowledge (p ¼ 0.1734). Similarly, no statistically significant association was found between previous teaching and training in the act and current confidence (p ¼ 0.3792). Previous use of the act was associated with better current knowledge (p ¼ 0.0074). Previous use of the act was also associated with higher current confidence in using the act (p ¼ 0.0005). Nine respondents (11%) made free text comments. A number of respondents commented on difficulties in communication between primary and secondary care when using the mental health act and felt this was an area which could be improved. Some commented on the procedures that required to be followed when using the mental health act and felt they could be simplified and made easier to use. One respondent felt it essential that the process for using the Mental Health Act and transporting the patient to hospital is as straightforward as possible. Two respondents suggested an interactive meeting between primary care and mental health services may be a positive step to improving learning in this area.
Discussion
This was the first study in Scotland looking at GPs training, knowledge and confidence in the use of the mental health act. Less than half of the GPs surveyed had experienced any previous training in the use of this important piece of legislation. This is in keeping with previous studies in Ireland, which identified only one in two GPs as having had training in the use of the Irish mental health act.8 Despite the lack of training, three quarters of our respondents had previously used this legislation. The overwhelming majority were keen to explore further teaching and training in this area and this is something that is in keeping with the limited previous research in this area.6,7,10 The majority of respondents felt their knowledge of the mental health act was fair or better, with a third of respondents identifying their knowledge of this legislation as poor. Some previous studies have found a lack of knowledge amongst psychiatrists and general hospital doctors with regard to the assessment of mental capacity, however there is limited literature on knowledge of GPs, particularly in Scotland.10,11 More than half of respondents rated their confidence in using the act is poor or worse. NICE guidelines on service user experience set out that those performing assessments under the mental health act should do so ‘‘in a calm and considered way’’ and this is something that would likely be affected by the confidence of the medical practitioner involved.12 Results Our study would suggest that previous teaching and training does not significantly impact the current A total of 80 responses were received from a total of levels of knowledge or confidence in using the act. A 252 GPs contacted, giving a response rate of 32%. previous study found that training in the use of the The results are shown in Table 1. mental health act increased user-friendliness, with no There was no statistically significant association distinction between formal or informal training. This found between previous teaching and training in the Downloaded from msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
32
Medicine, Science and the Law 55(1) Table 1. Survey results. % (n) 1. How would you rate your current knowledge of the Mental Health Act? Excellent Good Fair Poor Very Poor 2. During your time as a GP, have you ever received any teaching or training in the Mental Health Act? Yes No 3. How often do you use the Mental Health Act in your day to day work? Frequently Occasionally Rarely Never 4. How often do you use the Mental Health Act in your out of hours work? Frequently Occasionally Rarely Never Don’t do OOH 5. In your time as a GP, have you ever detained a patient under the Mental Health Act? Yes No 6. How would you rate your confidence in utilising the Mental Health Act when required? Excellent Good Fair Poor Very Poor 7. How would you rate your knowledge of the local Psychiatric Emergency Plan Excellent Good Fair Poor Very Poor 8. Are you aware of procedure and policy relating to transfer of patient to hospital following detention in community? Yes No 9. Would you be interested in using an online learning module relating to the Mental Health Act should this become available? Yes No
1.3 11.3 50 33.8 3.8
(1) (9) (40) (27) (3)
45 (36) 55 (44) 1.3 6.3 80 12.5
(1) (5) (64) (10)
0 11.3 17.5 2.5 68.8
(0) (9) (14) (2) (55)
75 (60) 25 (20)
1.3 12.5 30 43.8 12.5
(1) (10) (24) (35) (10)
1.3 8.8 23.8 48.8 17.5
(1) (7) (39) (9) (14)
26.3 (21) 72.7 (59)
98.7 (79) 1.3 (1)
study did not analyse the relationship between trainliterature, which stresses the importance of practical ing and knowledge or confidence.8 and situational knowledge along with professional Our findings suggest previous practical experience experience and judgement in improving workplace in using the act does appear to significantly improve confidence and competence. These studies have not current knowledge and confidence levels. These findhowever focussed on our target population or the ings would be in keeping with both Downloaded recent from and historic mental health act.13–16 msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
Conway et al. There is no current literature that looks at levels of knowledge and confidence and how this effects mental health act practice or service user experience. This is clearly an area that requires further research. There are some of limitations to this study. Firstly we recognise the low response rate of 32%. This is clearly a lower response rate than would be desirable but appears to be in keeping with response rates to other online surveys of medical staff which have been published in the literature. Secondly, the results of this survey are limited to one health board and therefore cannot be generalised to the full of Scotland or indeed the United Kingdom. There are a number of strengths of this study. This is clearly an area which has been poorly researched previously and we are the first to shed some light into this important issue in Scotland. Our study has also highlighted areas for further important research. Our findings could potentially provide a basis for the design of interventions to improve Mental Health Act training. Following interventions there would hopefully be an improvement in mental health act practice, service user experience and patient safety.
Clinical implications
33 to transfer their learning and experience between specialties. It also gives trainees the opportunity to gain broader experience of delivering patient care across the various health care sectors. With trainees spending a minimum of 6 months in both psychiatry and general practice during this programme before deciding on which specialty to pursue, this could be an ideal time to gain valuable skills in managing psychiatric emergencies in the community and using the mental health act.20 Our study found that most GPs in Scotland are not trained in the mental health act. They are however receptive to the concept of having more training. Practical use of the mental health act, however, seems to improve self-rated knowledge and confidence more than actual training itself. For training to meet the needs to GPs, it therefore needs to be experiential. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors
Declaration of conflicting interests The authors declare that they do not have any conflict of interest.
The academy of medical royal colleges has set out References recommendations that all health practitioners should 1. Thomson L. The Mental Health (Care and Treatment) have training in mental health and that competencies (Scotland) Act 2003: Civil legislation. The Psychiatrist need to be checked. They have also highlighted that 2005; 29: 381–384. training in primary care requires improvement. They 2. Corney R. Developing mental health services in the comsuggest a role for secondary care mental health spemunity: current evidence of the role of general practice cialists in training, supervising and supporting priteams. J Royal Soc Med 1994; 87: 408–410. mary care staff to acquire and maintain skills in 3. Bennet S, Harrison M, Gilmore M, et al. The role of the mental health.17 With other research in this field highGP in United Kingdom Mental Health Legislation. lighting informal training as beneficial and our free InnovAiT 2011; 4: 675–684. 4. Armstrong G, Kermode M, Raja S, et al. A mental text comments suggesting interactive learning sessions health training program for community health workers between primary and secondary care, perhaps this in India: impact on knowledge and attitudes. Int J would be a way forward in establishing improvements Mental Health Syst 2011; 5: 17. in this area. 5. Arora S, Sevdalis N, Ahmed M, et al. Safety skills trainWith our study highlighting the importance of past ing for surgeons: a half-day intervention improves knowpractical experience, this brings into light the issue of ledge, attitudes and awareness of patient safety. Surgery psychiatric rotations as part of GP training schemes. 2012; 152: 26–31. This is something that has been widely debated previ6. Mina IH, Klimidis S and Kokanovic R. Impact of ously with some suggesting that these rotations should Australia’s ‘Better outcomes in mental health care initiabe mandatory. This is an issue of course not only tive in Melbourne.’ Primary Care Mental Health 2005; 3: related to mental health act practice but to the man111–112. 7. Lucas H, Scammell A and Hagelskamp C. How do agement of mental health problems as a whole.18 The GP registrars feel about dealing with mental health Royal College of Psychiatrists and the Royal College issues in the primary care setting? A qualitative of General Practitioners recently recommended that investigation. Primary Health Care Res Develop 2005; GPs in training would benefit from spending an 6: 60–71. attachment in Liaison Psychiatry, but there remains 8. Jabbar F, Docherty AM, Aziz M, et al. Implementing 19 no fixed guidance on this that must be followed. the Mental Health Act 2007 in British general practice: With the introduction of the new broad-based lessons from Ireland. Int J Law Psychiatr 2011; 34: training programme in England this year, we are per414–418. haps looking at a changing time in medical training 9. Hodgins G, Judd F, Davis J, et al. An integrated which may address some of these issues. The new approach to general practice mental health training: broad-based training programme aims to train docthe importance of context. Austr Psychiatr 2007; 15: 52–57. tors in a way that is flexible in order that they are able Downloaded from msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
34
Medicine, Science and the Law 55(1)
10. Richards F and Dale J. The Mental Health Act 1983 and incapacity: what general hospital doctors know. Psychiatric Bull 2009; 13: 176–178. 11. Hill SA, Mather GI, James AJ, et al. Assessing decision-making capacity: a survey of psychiatrists’ knowledge. Med Sci Law 2006; 13: 66–68. 12. NICE. Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services. NICE 2011. 13. Eraut M, Alderton J, Cole G, et al. Development of knowledge and skills at work. In: Coffield F (ed.) Differing visions of a learning society. vol 1: 2000, pp.231–262. 14. Katajavouri N, Lindblom-Yla¨ Nne and Hirvonen J. The significance of practical training in linking theoretical studies with practice. Higher Education 2006; 51: 439–464. 15. Van De Vijver E and Devroey D. Lack of confidence in administering emergency care among Dutch-speaking
16.
17.
18.
19.
20.
family physicians in Belgium. Int J Gen Med 2013; 17: 589–596. Dare A. Training the intern: the value of a pre-intern year in preparing students for practice. Med Teacher 2009; 31: 345–e350. Guthrie E, Palmer L, Lelliot P, et al. No health without mental health. Academy of Medical Royal Colleges 2009. Centre for Economic Performance. How Mental Illness Looses out in the NHS. Centre Economic Performance 2012. Royal College of Psychiatrists and Royal College of General Practitioners. The management of patients with physical and psychological problems in primary care: a practical guide Report of a joint working group. (CR152). Royal College of Psychiatrists and Royal College of General Practitioners 2009. Rowell J and Hayden J. The new broad based training programme. BMJ Careers2012.
Downloaded from msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
Knowledge and confidence of the mental health act in Scotland: a survey of general practitioners
Medicine, Science and the Law 2015, Vol. 55(1) 30–34 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0025802414524386 msl.sagepub.com
Lisa Conway1, Nabiha Mohammed2, Charles Jardine3 and James Crabb4
Abstract Aims and method: Front-line clinician general practitioners may be required to assist in the administration of mental health legislation. Limited training has been an issue previously identified. This study aims to ascertain levels of training, knowledge and confidence of general practitioners in Scotland in relation to the mental health act. An anonymous online survey of all general practitioners in one Scottish health board was completed. Results: Eighty general practitioners in Forth Valley responded to the survey; 55% had never received any previous training in the mental health act. The majority rated knowledge of the act as fair (50%) and confidence in using the act as poor (44%). No relationship was found between previous training and current knowledge or confidence. Previous practical use of the act was associated with better current knowledge (p ¼ 0.0074) and confidence in using the act (p ¼ 0.0005). Of the respondents, 99% were keen to pursue further training in the act. Clinical implications: Further practical training for general practitioners in the use of the mental health act is required to improve knowledge and confidence in this important area. Keywords forensic psychiatry, legal system, medical law
Introduction
suggested there has been limited training and knowThe Mental Health (Care & Treatment) (Scotland) ledge of referral pathways and local resources. A need Act 2003 came into force in October 2005. It affects for further training in various aspects of mental health the work of all health and social care professionals in work was identified.6,7 In the UK, GPs have suggested Scotland. The impetus for the new act came largely that this lack of training and knowledge may contribfrom a change in psychiatric practice with the move ute to lack of confidence in the management of towards care in the community.1 patients with mental health problems in a primary care setting.7 In relation to mental health act work, General practitioners (GPs) are front-line clinicians and the cornerstone of community psychiatry. They training in its practical use has been identified as a are expected to use the mental health act in emergency requirement for GPs.8 Training sessions have been psychiatric situations to protect the safety of some of identified as one factor which may increase uptake the most vulnerable patients they serve. Although and confidence in using mental health resources infrequent, this process can be complicated and time among primary care physicians, but the research in consuming and it is therefore vital they are knowthis area is limited.9 2,3 ledgeable and confident in using this legislation. Training and education of health care professionals is necessary to achieve sustainable improvements in 1 ST6 General Adult Psychiatry, Forth Valley Royal Hospital, Castlehill, patient care and safety. Theoretically, training United Kingdom should improve mental health literacy and improve 2 CT2 Psychiatry Gartnavel Royal Hospital, United Kingdom confidence in using the mental health act. This 3 General Practitioner, Doune Health Centre, Castlehill, improved confidence would hopefully lead to more United Kingdom 4 Consultant Psychiatrist, Forth Valley Royal Hospital, Castlehill, front-line clinicians becoming involved in emergency United Kingdom psychiatric situations and feeling they have the skills to do so.4,5 Corresponding author: Previous studies in the UK and Australia have Lisa Conway, Forth Valley Royal Hospital, Stirling Road, Larbert, looked at attitudes of GPs towards dealing with Scotland, FK54WR. Email: [email protected] mental health problems in primaryDownloaded care. from These have msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
Conway et al. Most studies in this area have looked at training and knowledge in the mental health act in England and Ireland. Many of these have also focussed on psychiatrists rather than GPs. No previous studies have been conducted in Scotland in this important area to establish the knowledge, confidence and training requirements in the mental health act amongst GPs.
Aim The aim of this study was to examine GPs’ knowledge and confidence in the use of the Mental Health Act (2003) and of local policy. It was our aim to establish the relationship between previous training in this area and current knowledge and confidence. We also looked to identify the relationship between previous practical experience in using the act and current knowledge and confidence. Finally, we looked to explore GPs’ views on the need for further training and the aspects of training they would find beneficial.
Method An anonymous ten-question online survey was devised. The survey asked GPs to self rate knowledge, training and confidence in using the Mental Health Act. It also asked about knowledge of local protocols and procedures relating to the use of the mental health act in the Forth Valley area. Finally, it asked if GPs would be interested in accessing an online learning module in this area. There was space at the end of the survey for free text comments. The survey was distributed by nhs.net email to all GPs in Forth Valley Health board. A contact mailing list was kindly provided by primary care which identified 252 contacts. The survey was initially distributed in January 2013 and a reminder email sent in February 2013. The online survey was open for a period of 2 weeks. Data were analysed using Microsoft Excel spreadsheets and statistical analysis done via Graph Pad software using Fischer’s exact test. Statistical analysis was used to explore the correlation between training and knowledge, training and confidence, previous use and knowledge and finally previous use and confidence. In order to perform Fischer’s exact test, GPs’ responses on knowledge and confidence were dichotomised into two groups (fair / better and poor / worse). As this was a survey of NHS staff, the local ethics committee did not consider ethical approval to be necessary.
31 act and current self-rated knowledge (p ¼ 0.1734). Similarly, no statistically significant association was found between previous teaching and training in the act and current confidence (p ¼ 0.3792). Previous use of the act was associated with better current knowledge (p ¼ 0.0074). Previous use of the act was also associated with higher current confidence in using the act (p ¼ 0.0005). Nine respondents (11%) made free text comments. A number of respondents commented on difficulties in communication between primary and secondary care when using the mental health act and felt this was an area which could be improved. Some commented on the procedures that required to be followed when using the mental health act and felt they could be simplified and made easier to use. One respondent felt it essential that the process for using the Mental Health Act and transporting the patient to hospital is as straightforward as possible. Two respondents suggested an interactive meeting between primary care and mental health services may be a positive step to improving learning in this area.
Discussion
This was the first study in Scotland looking at GPs training, knowledge and confidence in the use of the mental health act. Less than half of the GPs surveyed had experienced any previous training in the use of this important piece of legislation. This is in keeping with previous studies in Ireland, which identified only one in two GPs as having had training in the use of the Irish mental health act.8 Despite the lack of training, three quarters of our respondents had previously used this legislation. The overwhelming majority were keen to explore further teaching and training in this area and this is something that is in keeping with the limited previous research in this area.6,7,10 The majority of respondents felt their knowledge of the mental health act was fair or better, with a third of respondents identifying their knowledge of this legislation as poor. Some previous studies have found a lack of knowledge amongst psychiatrists and general hospital doctors with regard to the assessment of mental capacity, however there is limited literature on knowledge of GPs, particularly in Scotland.10,11 More than half of respondents rated their confidence in using the act is poor or worse. NICE guidelines on service user experience set out that those performing assessments under the mental health act should do so ‘‘in a calm and considered way’’ and this is something that would likely be affected by the confidence of the medical practitioner involved.12 Results Our study would suggest that previous teaching and training does not significantly impact the current A total of 80 responses were received from a total of levels of knowledge or confidence in using the act. A 252 GPs contacted, giving a response rate of 32%. previous study found that training in the use of the The results are shown in Table 1. mental health act increased user-friendliness, with no There was no statistically significant association distinction between formal or informal training. This found between previous teaching and training in the Downloaded from msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
32
Medicine, Science and the Law 55(1) Table 1. Survey results. % (n) 1. How would you rate your current knowledge of the Mental Health Act? Excellent Good Fair Poor Very Poor 2. During your time as a GP, have you ever received any teaching or training in the Mental Health Act? Yes No 3. How often do you use the Mental Health Act in your day to day work? Frequently Occasionally Rarely Never 4. How often do you use the Mental Health Act in your out of hours work? Frequently Occasionally Rarely Never Don’t do OOH 5. In your time as a GP, have you ever detained a patient under the Mental Health Act? Yes No 6. How would you rate your confidence in utilising the Mental Health Act when required? Excellent Good Fair Poor Very Poor 7. How would you rate your knowledge of the local Psychiatric Emergency Plan Excellent Good Fair Poor Very Poor 8. Are you aware of procedure and policy relating to transfer of patient to hospital following detention in community? Yes No 9. Would you be interested in using an online learning module relating to the Mental Health Act should this become available? Yes No
1.3 11.3 50 33.8 3.8
(1) (9) (40) (27) (3)
45 (36) 55 (44) 1.3 6.3 80 12.5
(1) (5) (64) (10)
0 11.3 17.5 2.5 68.8
(0) (9) (14) (2) (55)
75 (60) 25 (20)
1.3 12.5 30 43.8 12.5
(1) (10) (24) (35) (10)
1.3 8.8 23.8 48.8 17.5
(1) (7) (39) (9) (14)
26.3 (21) 72.7 (59)
98.7 (79) 1.3 (1)
study did not analyse the relationship between trainliterature, which stresses the importance of practical ing and knowledge or confidence.8 and situational knowledge along with professional Our findings suggest previous practical experience experience and judgement in improving workplace in using the act does appear to significantly improve confidence and competence. These studies have not current knowledge and confidence levels. These findhowever focussed on our target population or the ings would be in keeping with both Downloaded recent from and historic mental health act.13–16 msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
Conway et al. There is no current literature that looks at levels of knowledge and confidence and how this effects mental health act practice or service user experience. This is clearly an area that requires further research. There are some of limitations to this study. Firstly we recognise the low response rate of 32%. This is clearly a lower response rate than would be desirable but appears to be in keeping with response rates to other online surveys of medical staff which have been published in the literature. Secondly, the results of this survey are limited to one health board and therefore cannot be generalised to the full of Scotland or indeed the United Kingdom. There are a number of strengths of this study. This is clearly an area which has been poorly researched previously and we are the first to shed some light into this important issue in Scotland. Our study has also highlighted areas for further important research. Our findings could potentially provide a basis for the design of interventions to improve Mental Health Act training. Following interventions there would hopefully be an improvement in mental health act practice, service user experience and patient safety.
Clinical implications
33 to transfer their learning and experience between specialties. It also gives trainees the opportunity to gain broader experience of delivering patient care across the various health care sectors. With trainees spending a minimum of 6 months in both psychiatry and general practice during this programme before deciding on which specialty to pursue, this could be an ideal time to gain valuable skills in managing psychiatric emergencies in the community and using the mental health act.20 Our study found that most GPs in Scotland are not trained in the mental health act. They are however receptive to the concept of having more training. Practical use of the mental health act, however, seems to improve self-rated knowledge and confidence more than actual training itself. For training to meet the needs to GPs, it therefore needs to be experiential. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors
Declaration of conflicting interests The authors declare that they do not have any conflict of interest.
The academy of medical royal colleges has set out References recommendations that all health practitioners should 1. Thomson L. The Mental Health (Care and Treatment) have training in mental health and that competencies (Scotland) Act 2003: Civil legislation. The Psychiatrist need to be checked. They have also highlighted that 2005; 29: 381–384. training in primary care requires improvement. They 2. Corney R. Developing mental health services in the comsuggest a role for secondary care mental health spemunity: current evidence of the role of general practice cialists in training, supervising and supporting priteams. J Royal Soc Med 1994; 87: 408–410. mary care staff to acquire and maintain skills in 3. Bennet S, Harrison M, Gilmore M, et al. The role of the mental health.17 With other research in this field highGP in United Kingdom Mental Health Legislation. lighting informal training as beneficial and our free InnovAiT 2011; 4: 675–684. 4. Armstrong G, Kermode M, Raja S, et al. A mental text comments suggesting interactive learning sessions health training program for community health workers between primary and secondary care, perhaps this in India: impact on knowledge and attitudes. Int J would be a way forward in establishing improvements Mental Health Syst 2011; 5: 17. in this area. 5. Arora S, Sevdalis N, Ahmed M, et al. Safety skills trainWith our study highlighting the importance of past ing for surgeons: a half-day intervention improves knowpractical experience, this brings into light the issue of ledge, attitudes and awareness of patient safety. Surgery psychiatric rotations as part of GP training schemes. 2012; 152: 26–31. This is something that has been widely debated previ6. Mina IH, Klimidis S and Kokanovic R. Impact of ously with some suggesting that these rotations should Australia’s ‘Better outcomes in mental health care initiabe mandatory. This is an issue of course not only tive in Melbourne.’ Primary Care Mental Health 2005; 3: related to mental health act practice but to the man111–112. 7. Lucas H, Scammell A and Hagelskamp C. How do agement of mental health problems as a whole.18 The GP registrars feel about dealing with mental health Royal College of Psychiatrists and the Royal College issues in the primary care setting? A qualitative of General Practitioners recently recommended that investigation. Primary Health Care Res Develop 2005; GPs in training would benefit from spending an 6: 60–71. attachment in Liaison Psychiatry, but there remains 8. Jabbar F, Docherty AM, Aziz M, et al. Implementing 19 no fixed guidance on this that must be followed. the Mental Health Act 2007 in British general practice: With the introduction of the new broad-based lessons from Ireland. Int J Law Psychiatr 2011; 34: training programme in England this year, we are per414–418. haps looking at a changing time in medical training 9. Hodgins G, Judd F, Davis J, et al. An integrated which may address some of these issues. The new approach to general practice mental health training: broad-based training programme aims to train docthe importance of context. Austr Psychiatr 2007; 15: 52–57. tors in a way that is flexible in order that they are able Downloaded from msl.sagepub.com at UNIV OF GEORGIA LIBRARIES on June 16, 2015
34
Medicine, Science and the Law 55(1)
10. Richards F and Dale J. The Mental Health Act 1983 and incapacity: what general hospital doctors know. Psychiatric Bull 2009; 13: 176–178. 11. Hill SA, Mather GI, James AJ, et al. Assessing decision-making capacity: a survey of psychiatrists’ knowledge. Med Sci Law 2006; 13: 66–68. 12. NICE. Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services. NICE 2011. 13. Eraut M, Alderton J, Cole G, et al. Development of knowledge and skills at work. In: Coffield F (ed.) Differing visions of a learning society. vol 1: 2000, pp.231–262. 14. Katajavouri N, Lindblom-Yla¨ Nne and Hirvonen J. The significance of practical training in linking theoretical studies with practice. Higher Education 2006; 51: 439–464. 15. Van De Vijver E and Devroey D. Lack of confidence in administering emergency care among Dutch-speaking
16.
17.
18.
19.
20.
family physicians in Belgium. Int J Gen Med 2013; 17: 589–596. Dare A. Training the intern: the value of a pre-intern year in preparing students for practice. Med Teacher 2009; 31: 345–e350. Guthrie E, Palmer L, Lelliot P, et al. No health without mental health. Academy of Medical Royal Colleges 2009. Centre for Economic Performance. How Mental Illness Looses out in the NHS. Centre Economic Performance 2012. Royal College of Psychiatrists and Royal College of General Practitioners. The management of patients with physical and psychological problems in primary care: a practical guide Report of a joint working group. (CR152). Royal College of Psychiatrists and Royal College of General Practitioners 2009. Rowell J and Hayden J. The new broad based training programme. BMJ Careers2012.
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