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Purpose: This study aims to draw together what is known regarding the characteristics and context of adult family violence, and to consider what practitioners and organisations in the UK might learn from the literature. Design/methodology/approach: This study reviews literature on adult family violence and parricide and includes illustrative cases from a study of domestic homicide review reports involving older adults. Findings: Adult family violence most often involves mothers killed by their adult sons. Mental health issues, alcohol/substance misuse and criminality are common themes for perpetrators. Caregiving responsibilities is a theme for both victims and perpetrators. Previous research identified two main categories of adult family homicide: perpetrators with major psychotic illness, and victims-perpetrators in complex relational contexts. Practical implications: This study considers how practitioners respond to situations of adult family violence and learning for policymakers, agencies and practitioners. Originality/value: This paper summarises what is known, argues that more research is needed and suggests practical ways forward for policymakers, relevant agencies and practitioners. [ABSTRACT FROM AUTHOR]

Purpose: Without effective support and intervention, young people with learning disabilities and severe challenging behaviour are at risk of placement in out-of-area residential settings or highly specialist child and adolescent mental health service (CAMHS) units. Such placements may be inappropriate and result in significant reductions to the quality of life of young people and their families. This paper aims to evaluate the effectiveness of the Bradford positive behaviour support (PBS) service model in terms of its aims to improve quality of life, develop skills and maintain children living with their families in their own homes. Design/methodology/approach: A service evaluation using quantitative and qualitative data from a range of sources to review the effectiveness of the PBS model being applied in Bradford and Calderdale was the methodology used. Findings: When consistently implemented, the Bradford positive behaviour support–in reach service may improve quality of life, facilitate skill development in young people and their carers and reduce placements in residential and CAMHS inpatient units. Avoidance of such placements is likely to reduce the overall costs of service commissioning in Bradford. Originality/value: This paper evaluates a novel approach being applied by a third sector agency to implement effective PBS with a small group of children, their families and networks. There is scope for this model to be successfully implemented in other areas. [ABSTRACT FROM AUTHOR]

Purpose Services for people with intellectual disabilities in the UK have evolved over the years from hospital-based care to more community provision. There are multiple reasons for these changes, however, often it was due to changes in social policy or following a scandal in provision. The paper aims to discuss these issues.Design/methodology/approach Providing services to meet the health and social care needs of people with intellectual disabilities is well-established in the four countries of the UK with support from legislation. There are often specialist mental health and social care teams. Dedicated professionals work with people with intellectual disabilities who experience mental health problems with a focus on support in the community. A range of services for children and adults and for offenders exist across the UK that often vary in composition and structure.Findings The challenges in providing mental health services for children and adults with intellectual disabilities in the future include recruitment and training of the workforce with the remit of enhancing community support and reduced in-patient care.Practical implications This paper helps the reader to understand how ID mental health services are organised in the UK.Originality/value This paper gives a summary of the ID mental health services in the UK. Even though there are various papers looking at different aspects of mental health services for people with ID in the UK, this paper brings all that information together to help reader get a better understanding of the mental health services for people with ID. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide qualitative evidence from the experience of Chinese service users in the UK to expand the literature on the use of intersectionality analysis in research on the mental health of ethnic minority groups.Design/methodology/approach Repeated in-depth life-history interviews were carried out with 22 participants. Interviews were analysed using the constant comparative method.Findings Four areas of life are identified for their possible negative impact on mental health for this minority group: labour market and work conditions, marriage and family, education, and ageing. The findings illustrate how these intersecting variables may shape the social conditions this ethnic minority group face. For this ethnic minority group in the UK, inequalities can intersect at national as well as transnational level.Originality/value This paper highlights how power relations and structural inequalities including class, gender, age and ethnicity could be drawn upon to understand the interplay of determinants of mental health for ethnic minority groups. As the multi-factorial social forces are closely related to the emergence of poor mental health, it is suggested that interventions to reduce mental health problems in ethnic minority communities should be multi-level and not limited to individualised service responses. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disability (ID) experience significant health and social inequality compared to their non-disabled peers. Individuals with ID who access mental health services can have complex comorbidities and presentations. In the UK, a significant proportion of individuals with ID are supported within general adult mental health services not by specialist ID teams. The purpose of this study is to explore whether psychiatry trainees in the Maudsley Training Programme (MTP) feel adequately skilled to support individuals with ID. Design/methodology/approach: An online survey of trainee psychiatrists in the MTP was completed to evaluate self-perceived skills and knowledge in the care of individuals with ID in mental health services. Statistical analysis of the results was completed. Findings: Experience of working in specialist ID teams is positively associated with greater confidence and skills among trainees in the care of people with ID; this is beyond what would be expected based on seniority alone. Research limitations/implications: The response rate was 16.7 per cent; a larger sample size would add strength to the study. Like all online surveys, there exists the risk of selection bias. Practical implications: UK Policy states that people with ID should be supported to access mainstream services where possible, including psychiatric care. Practical experience for all psychiatry trainees involving specialist ID services and people with ID could improve the care given to that particularly disadvantaged group. Originality/value: This is the only paper known to the authors that has focused specifically on the skills and knowledge of psychiatry trainees in the UK with regards to ID. [ABSTRACT FROM AUTHOR]

Purpose: Individuals living in areas of higher deprivation are more likely to have requested mental health treatment but are less likely to have received treatment or benefitted from it. Less is known about the extent of access equality and treatment outcomes for individuals with a long-term health condition who experience mental health difficulties. The purpose of this paper is to evaluate the extent to which the neighbourhood Index of Multiple Deprivation predicted access to treatment, appointment attendance, treatment completion and clinical outcomes in a British health psychology clinic. Design/methodology/approach: Retrospective data were used from 479 individuals referred to a health psychology clinic over 12 months. Clinical outcomes were measured using the Clinical Outcomes in Routine Evaluation – Outcome Measure. Patient data were linked with their neighbourhood Index of Multiple Deprivation decile. Data were analysed using correlation, linear regression and Fisher's exact test. Findings: There were no significant associations between deprivation and whether an individual attended assessment, attended treatment or completed treatment or between deprivation and patients' clinical outcomes. Exploratory evidence indicated that individuals from higher deprivation neighbourhoods may be over-represented in clinic referrals, and individuals from lower deprivation neighbourhoods may be under-represented, compared with local population distribution estimates. Originality/value: This evaluation provides insights into treatment outcomes and deprivation in those with physical health difficulties. Further evaluation using a larger sample and comparing referrals with local prevalence estimates of comorbid mental and physical health problems would enable greater confidence in the conclusion that no evidence of inequality on the basis of neighbourhood deprivation was found. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe and explain trauma-informed approaches (TIAs) to mental health. It outlines evidence on the link between trauma and mental health, explains the principles of TIAs and their application in mental health and explores the extent to which TIAs are impacting in the UK.Design/methodology/approach The approach is a conceptual account of TIAs including a consideration of why they are important, what they are and how they can become more prevalent in the UK. This is supported by a narrative overview of literature on effectiveness and a scoping of the spread of TIAs in the UK.Findings There is strong and growing evidence of a link between trauma and mental health, as well as evidence that the current mental health system can retraumatise trauma survivors. There is also emerging evidence that trauma-informed systems are effective and can benefit staff and trauma survivors. Whilst TIAs are spreading beyond the USA where they developed, they have made little impact in the UK. The reasons for this are explored and ways of overcoming barriers to implementation discussed.Originality/value This paper – authored by trauma survivors and staff – describes an innovative approach to mental health service provision that, it is argued, could have immense benefits for staff and service users alike. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration. Design/methodology/approach – The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice. Findings – Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care. Research limitations/implications – Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic. Practical implications – Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors. Social implications – The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise. Originality/value – This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”. [ABSTRACT FROM AUTHOR]

Purpose In Scotland, individuals referred for NHS psychological therapies are expected to commence “treatment” within 18 weeks of receipt of referral. With high demand, high non-attendance rates and limited capacity, this can be a challenging goal. The service discussed here was keen to develop a way of seeing individuals referred sooner and improving the efficiency of the assessment process. The purpose of this paper is to look at the impact of introducing assessment (“Signpost”) appointments on waiting times, attendance, and treatment planning.Design/methodology/approach Signpost appointments were offered to all existing, and any new referrals, to an adult psychological therapies team (PTT) in NHS Lanarkshire. Clinicians kept a record of the outcomes of these appointments over a six month period. Waiting times and attendance figures were compared before and after the introduction of the Signpost system.Findings Following the introduction of Signpost appointments, individuals were seen sooner for both assessment and therapy. Attendance at first appointments improved and Signpost appointments helped inform treatment planning. Although alternatives were discussed, the majority of clients were still offered individual therapy. Service user and staff satisfaction was high.Practical implications The results from this study led to assessment (“Signpost”) appointments being rolled out across other adult PTTs in NHS Lanarkshire.Originality/value There is little research looking at the impact of assessment/signpost appointments on adult mental health services in the UK. In the current climate of public service cuts, this study provides an innovative way of reducing waiting times and maintaining service user satisfaction, without requiring more resources. [ABSTRACT FROM AUTHOR]

Purpose Creating more positive individual narratives around illness and identity is at the heart of the mental health care recovery movement. Some recovery services explicitly use personal storytelling as an intervention. The purpose of this paper is to look at individual experiences of a personal storytelling intervention, a recovery college Telling My Story (TMS) course.Design/methodology/approach Eight participants who had attended the TMS course offered at a UK recovery college were interviewed. Data were analysed using interpretative phenomenological analysis.Findings Five key themes, namely a highly emotional experience, feeling safe to disclose, renewed sense of self, two-way process and a novel opportunity, were emerged.Originality/value The findings suggest that storytelling can be a highly meaningful experience and an important part of the individual’s recovery journey. They also begin to identify elements of the storytelling process which might aid recovery, and point to pragmatic setting conditions for storytelling interventions to be helpful. More time could be dedicated to individuals telling their story within UK mental health services, and the authors can use this insight into the experience of personal storytelling to guide any future developments. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to give an account by a rehabilitation psychiatrist of many years of involvement in shared housing for former long-stay hospital residents and other long-term mental health service users. Design/methodology/approach -- The paper offers a personal view based on developments in one locality of East London, blending case study narrative with cited earlier published papers that confirm and/or give greater detail on specific aspects of the experience gained. Findings -- Long-term mental health service users, given the opportunity via shared housing to develop more lasting and natural relationships, proved to have social and interactive capacity that was obscured by both the conditions of hospital wards and by isolating accommodation "in the community". The experience provides lessons for a better understanding of patients' problems. Practical implications -- Shared housing is often seen as simply a poor substitute for independent living; but the experience recounted here suggests that shared living may have particular value for some client groups. Originality/value -- The housing developments and the associated research remain unusual and of potential value for planners of long-term services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to demonstrate that the common and statutory law governing children's capacity or competence to consent to and to refuse medical treatment is unsatisfactory and to suggest solutions. Design/methodology/approach – Critical legal analysis of the law on assessing minors’ decision-making capacity in relation to legal recognition of their consent to and refusal of medical treatment. Findings – Without legal mechanisms which protect both children and their rights, all children and young people are effectively disabled from exercising age and capacity-related autonomy and participation in decisions affecting their lives. Yet in English law, inconsistencies between legal and clinical measures of decision-making capacity, situations where compulsory medical or mental health treatment is lawful, and tensions between rights and duties associated with human rights, autonomy, best interests and protections for the vulnerable create difficulties for clinicians, lawyers and patients. Research limitations/implications – As the paper acknowledges in its recommendations, the views of stakeholders are needed to enrich and inform legal reforms in this area. Originality/value – The paper makes suggestions to amend the law and clinical practice which are original and far reaching. The paper suggests that in order to observe children's rights while protecting them appropriately, the Mental Capacity Act 2005 and Deprivations of Liberty Safeguards should be applied to minors. The paper recommends the establishment of Mental Capacity Tribunals, similar in nature and purpose to Mental Health Tribunals, to provide legal safeguards and mechanisms to foster the supported decision-making envisaged in recent United Nations Conventions. [ABSTRACT FROM AUTHOR]

Purpose -- With population projections indicating that the number of older adults in the UK (those aged 65 years and over) will increase from 9. 6 million in 2005 to 12. 7 million in 2021, the numbers of those growing older with a serious mental illness (SMI) is likely to rise. Currently there is a lacuna of both policy and quality research evidence on how to meet the needs of this vulnerable group of citizens. The purpose of this paper is to add to the emerging debate and discourse around current policy and practice in this field. Design/methodology/approach -- The authors have undertaken a general review of both the literature and current UK policy guidance to determine the current state of provision for people with a SMI. Findings -- Much of the relevant literature the authors identified originates from the USA, with older adults with SMI perceived as an under-served population in need of urgent attention. Additionally, UK policy provision is patchy with very limited pockets of good practice currently available to guide clinicians and inform service users. Research limitations/implications -- Clinicians, researchers and other stakeholders must engage with service users, their family and/or friends to produce quality and meaningful research to improve outcomes for this vulnerable group of citizens. Finally, the policy, practice and service user communities need to collaborate in a spirit of "boundary spanning" working across disciplines to generate practical policies which can be operationalised by organisations and individuals. Originality/value -- This paper highlights the distinct lack of literature, evidence and policy which currently exists in the UK addressing the needs of older adults with a serious mental illness. [ABSTRACT FROM AUTHOR]

Purpose – This paper describes an ongoing process of engagement with carers of people with intellectual disabilities currently being monitored by an out of area service for both carers of people placed both in area and out of area within a local Mental Health Learning Disabilities team in South London. Design/methodology/approach – Using a series of consultation events, carers were asked to participate in a free dialogue which focussed on everyday issues for carers. This included financial implications of caring, knowledge of care pathways/systems in care, carer's needs and expectations and the support they currently receive. Findings – This paper highlighted a number of issues and concerns that carers face in their daily lives when supporting one or more people. These include lack of recognition, financial difficulties, lack of training and support. Originality/value – This project offered a valuable insight into current carer perceptions and will help develop further discussion and promote greater engagement by services and mutual understanding with this often neglected group. [ABSTRACT FROM AUTHOR]

Purpose Occupational therapists working in mental health services in the UK are under increasing scrutiny to provide both clinically and cost-effective services. The profession has indicated that a stronger evidence base would help promote the unique contribution of occupational therapy when influencing service managers and government bodies. The paper aims to discuss these issues.Design/methodology/approach The Royal College of Occupational Therapists (RCOT) and its Specialist Section – Mental Health carried out a survey to gauge recent research capacity among occupational therapists working in mental health services in the UK and to seek their views about how to further increase research capacity and partnerships.Findings Of the 145 participants approximately half had been involved in research in the past five years, and most had involved research partnerships. A number had successfully applied for funding and about half of the research carried out had been disseminated. The participants felt that methods to increase research capacity and partnerships should continue to include improving research leadership and networks; promoting research skills through formal studies and increasing research dissemination.Originality/value A variety of methods will continue to be required to expand the evidence base. RCOT and its Specialist Sections continue to have an important role developing research capacity and partnerships. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore the potential impact on families of a greater emphasis on safeguarding for vulnerable adults, from both a legal and a lay perspective. Design/methodology/approach – Case examples are used to illustrate some of the issues and problems that can arise in safeguarding situations. Findings – In community settings there can be a tendency for Social Services to take an antagonistic rather than a conciliatory approach when communicating with families. In the setting of a care home, an example of the appropriate use of safeguarding is outlined. Practical implications – The authors argue that Social Services should take a more conciliatory approach and be prepared to work in partnership with families. Originality/value – The discursive format and narrative approach of this paper represents a useful and informative way of presenting important and topical insights. [ABSTRACT FROM AUTHOR]

Purpose – Leave is an important part of life for both patients and clinicians in secure mental health and learning disability settings. Patients breaching leave conditions (i.e. absconding or failing to return) represent a small percentage of leave episodes; however when incidents occur there can be far reaching negative outcomes for potential victims, the patient and the service. The purpose of this paper is to devise a risk assessment specifically for leave decision making based on the literature available. Design/methodology/approach – Using the approach followed in the violence risk assessment field, a literature review was carried out of papers relating to absconding. The results were used to develop the leave/abscond risk assessment (LARA). Findings – There are a number of problems with the available literature: there is a dearth of research, definitions for absconding are varied (often including escape) making comparisons difficult and much of the literature focuses on psychiatric acute wards making it difficult to translate into secure environments. Characteristics of absconders vary and are not idiosyncratic enough from which to develop a risk assessment. Socio-environmental factors are perhaps more important and so the LARA was devised around assessment of these. Research limitations/implications – The limitations of this paper are clear: a risk assessment tool is proposed that has not been evaluated or validated in any way. The authors feel that the process warrants publication and invite readers to use the tool for clinical and/or research purposes. Originality/value – The LARA is proposed as a specific leave-decision-making risk assessment tool for teams working in secure environments. [ABSTRACT FROM AUTHOR]

Purpose -- This paper seeks to consider the Deprivation of Liberty Safeguards (DoLS) and, in particular, the extent to which the functions of supervisory bodies can, or should be, performed as part of wider "safeguarding" responsibilities. Design/methodology/approach -- The paper reports the views of practitioners, given in response to comments made by the Care Quality Commission. Findings -- Some practitioners believe that DoLS and safeguarding functions should be consolidated, and some, that they should remain discrete; most, however, accept that the two functions should work closely together, and also that an understanding of the Mental Capacity Act is important for each; there is a suspicion that DoLS-activity is greatest where the two functions are kept discrete (and, it is assumed, DoLS practitioners therefore have more to prove); there is also concern about financing, particularly within discrete DoLS services, and, furthermore, some suspicion about the whole business of "safeguarding"; the Neary case continues to cast a long shadow. Originality/value -- This is believed to be the first time practitioners' views have been sought or at least published on this question. [ABSTRACT FROM AUTHOR]

Purpose -- The paper's aim is to explain the development of the concept of personalisation and its dependence upon prior innovations such as independent living, person-centred planning and individual budgets and explore its meaning, limitations and future prospects. Design/methodology/approach -- The paper takes the form of an analytical and historical review of ideas that have been important in the recent history of public policy for people with learning disabilities. Findings -- People with learning disabilities, along with other disabled people, have been engaged in a struggle to achieve full citizenship. The recent reforms that go by the name of "personalisation" may mark an important stage in the development of a fairer system, but on their own they will be insufficient to achieve that objective. Originality/value -- Personalisation is placed, with all its strengths and limitations, within the wider context of the development of policies for people with learning disabilities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to discuss and examine the implications of holding mental health tribunals in public. Design/methodology/approach -- The paper discusses the functioning of tribunals, compares tribunals with other legal processes in the UK and elsewhere, and reviews the legal reasoning for holding tribunal hearings in public. Findings -- The first tribunal hearing has already been held in public and another public hearing is agreed. Public hearings should allow for greater transparency and scrutiny than has thus far been possible, and may change the behaviour of attendees. Originality/value -- Public tribunal hearings have not yet been widely discussed in the academic literature, yet are expected to have implications for all involved. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to explain the reasons for use of a therapeutic community for personality disorder in a high secure intellectual disability service. Design/methodology/approach - The paper describes the rationale for, and early experiences of, a therapeutic community intervention for people with mild intellectual disability and personality disorder in a high secure setting. Findings - No empirical findings are reported. Evaluation is being undertaken and will be reported in due course. Originality/value - The therapeutic community approach has not been applied in forensic intellectual disability before, and this paper therefore describes an original and, in many ways, radical intervention. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of the paper is to report the findings of a small scale indicative research project. The project explores the assessment of detained persons in police custody by Forensic Physicians (FP). Design/methodology/approach -- A range of information was collected in every case where custody staff had identified a mental health concern and requested an FP assessment. As well as information about demographic factors, this would include questions regarding any links that the individuals had with community-based mental health services. As well as this information, anonymous custody records and force adverse incident records for the month were examined. Findings -- In the month of the project, 59 FP assessments were requested. Only six members of this group had any contact with community-based mental health services: two with a social worker , two with a CPN and two with a psychiatrist. Of this group, three had not been in contact with mental health services for over a month. Research limitations/implications -- The size of the cohort and variety of arrangements for providing nursing and social care support in custody settings may limit the generalisation of the findings. Practical implications -- This study highlights that there is a group of individuals whose mental health causes concern to the police in a custody environment. In this study, the overwhelming majority of the group have no contact with mental health services. The research supports the recommendations of the Bradley Review for wider health care provision in custody settings. Originality/value -- The paper highlights that fully effective community mental health services need to consider police custody settings as a key point for intervention. [ABSTRACT FROM AUTHOR]

Purpose – Stemming from substantial criticism during the late twentieth and early twenty-first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions. Design/methodology/approach – This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service. Findings – While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed. Originality/value – Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to highlight the challenges in evaluating psychological input into acute wards using more traditional methods; and also to provide an example of how it is possible to evaluate such services capturing outcomes at multiple levels. Design/methodology/approach – Data were gathered from multiple levels including staff, patients and the wider organisation mainly using self report questionnaires. The paper looks at the impact on satisfaction, service utilisation, development of recovery principles, quality of therapeutic environment and alliance with treatment teams following the introduction of a dedicated psychology team. Findings – The results show positive trends in patient experiences of the ward environment, alliance with treating teams and staff recovery principles, along with reduced readmission rates and length of stay in hospital. Qualitative data demonstrate the value of the service to both staff and patients. Research limitations/implications – Much of the data do not meet the criteria for more sophisticated statistical analysis. Originality/value – The paper provides an example of evaluation of a contemporary model of service delivery for which there is currently a limited evidence base and looks to stimulate current thinking on the practice of mental health service delivery. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to describe the origins of the concept of a psychologically informed environment (PIE), as now adopted and applied in homelessness resettlement, placing this in the context of work recently carried out under the aegis of the Royal College of Psychiatrists' Centre for Quality Improvement to recognise and promote "enabling environments" in all areas of social practice. Design/methodology/approach – This paper gives an historical account of the contemporary development of new thinking and practical applications for enhancing community mental health and well-being. Findings – The concept of an enabling environment (EE) arose out of efforts to up-date for the twenty-first century the post-war concept of a therapeutic community, for all services working with the same basic core values and psycho-social awareness. The EE approach now applies this framework more flexibly, yet with a clear operational focus in each sector, to a wider range of organisational contexts, social practice and agencies outside the therapy and care services world. From the outset, homelessness resettlement and social housing practice was seen as a key part of the overall ambition. Practical implications – Understanding the values base behind social-psychological approaches in social practice environments helps to translate these ideas into service-led improvements in actual frontline services practice. In particular, the enabling environments approach offers a handy tool for self-assessment and service improvement, which is fully compatible with the PIE's philosophy. Originality/value – The concept of a PIE is currently acquiring momentum within homelessness resettlement work in the UK. In helping to establish the underlying values framework for psychologically-informed services; and also provide tools for such services to use, this paper makes a contribution to help inform developing practice. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to describe the first 15 months of operation of an innovative specialist national public health observatory for intellectual disability. Design/methodology/approach – The paper provides a narrative account of aims and achievements of the service. Findings – In the first 15 months of operation the observatory has: made available to those involved in commissioning health and social care services, a wealth of information on the health needs of people with intellectual disabilities; identified specific improvements that could viably be made to increase the quality of future information; and begun working with local agencies to support them in making the best use of the available information. Originality/value – People with intellectual disabilities experience significant health inequalities. This paper describes an innovative approach to helping local agencies make the best use of available information in order to commission services that may reduce these inequalities. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the operation of a review into service user involvement within mental health services, which was led by service users using appreciative enquiry (AE). Design/methodology/approach -- The paper gives a descriptive account of the operation of the project and highlights the barriers to its success and how these were addressed. The project itself used AE methods to overcome some of the challenges to engaging service users around improvement activity. The approach was different to the conventional application of AE as people were engaged individually through interviews and their views generalised collectively by the service user team conducting the interviews. Findings -- The project findings are reported through considering the recommendations made as a result of the work but the wider aims of challenging power relationships and developing service user leadership are also discussed. Practical implications -- The paper suggests that replicating and developing the use of AE driven by service users is a positive tool in empowering recipients of mental health services. Social implications -- The author suggests that this method could be a valuable tool in meeting the current UK Government policy of empowering local communities to take greater control of public service provision. Originality/value -- This project is an example of enabling leadership to arise from the grassroots of an organisation, turning the conventional concept of leadership on its head and challenges senior staff as to who might know best about how to improve services. It represents a novel approach to taking forward the empowerment agenda widely supported in Western democracies. [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to give insight into the role of a liaison worker.Design/methodology/approach - This paper presents a first person account of someone in the role of Mental Health and Housing Liaison Officer.Findings - The paper offers insight into a day in the life of a liaison worker, including information about how they work and communicate with clients and their various different situations.Originality/value - The paper demonstrates that communication is central to delivering good and appropriate services for clients. Joint working between housing and mental health needs to become the norm, and a role such as this is the fore-runner to what the author hopes will become part of every mental health service in the country. [ABSTRACT FROM AUTHOR]

Purpose – The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice. Design/methodology/approach – Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts. Findings – Three main themes were identified: participants identified their normative task as the promotion of “moving on” (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults. Originality/value – Staff working in a inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood. [ABSTRACT FROM AUTHOR]

Purpose – There is growing interest in self-management support for people living with mental health problems. The purpose of this paper is to describe the evaluation of a co-designed and co-delivered self-management programme (SMP) for people living with depression delivered as part of large scale National Health Service quality improvement programme, which was grounded in the principles of co-production. The authors investigated whether participants became more activated, were less psychologically distressed enjoyed better health status, and quality of life, and improved their self-management skills after attending the seven-week SMP. Design/methodology/approach – The authors conducted a longitudinal study of 114 people living with depression who attended the SMP. Participants completed self-reported measures before attending the SMP and at six months follow up. Findings – Patient activation significantly improved six months after the SMP (baseline M=49.6, SD=12.3, follow up M=57.2, SD=15.0, t(113)=4.83, p < 0.001; d=0.61). Participants’ experience of depression symptoms as measured by the Patient Health Questionnaire-9 significantly reduced (baseline M=15.5, SD=6.8, follow up M=10.6, SD=6.9, t(106)=7.22, p < 0.001, d=−0.72). Participants’ anxiety and depression as measured by the Hospital Anxiety Depression Scale also decreased significantly (baseline anxiety: M=13.1, SD=4.2, follow up M=10.2, SD=4.4, t(79)=6.29, p < 0.001, d=−0.69); (baseline depression: M=10.3, SD=4.6, follow up M=7.7, SD=4.5, t(79)=5.32, p < 0.001, d=−0.56). The authors also observed significant improvement in participants’ health status (baseline M=0.5, SD=0.3, follow up M=0.6, SD=0.3, t(97)=−3.86, p < 0.001, d=0.33), and health-related quality of life (baseline M=45.4, SD=20.5, follow up M=60.8, SD=22.8, t(91)=−2.71, p=0.008, d=0.75). About 35 per cent of participant showed substantial improvements of self-management skills. Originality/value – The co-produced depression SMP is innovative in a UK mental health setting. Improvements in activation, depression, anxiety, quality of life and self-management skills suggest that the SMP could make a useful contribution to the recovery services in mental health. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore how staff attend to their well-being when working in an inpatient mental health setting with older adults with dementia and complex mental health needs; how staff understand the link between their well-being and the well-being of patients. Design/methodology/approach – A semi-structured group interview was held with 11 members of two multidisciplinary teams. The discussion was audio-recorded and analysed using thematic analysis. Findings – Staff reported managing their well-being by both connecting with and avoiding the difficult emotions of the work. The team avoided the gravity of the work through humour, a task-focus, an absence of thinking and the displacement of workplace frustrations onto an outgroup. Connecting with emotions was done in tolerable ways: in contained reflective spaces, in the presence of supportive others, through genuine connections with patients as people and when the organisation demonstrated care for the staff. Practical implications – Avoidant strategies appeared to represent short-term ways of maintaining staff well-being, while connecting with the gravity of the work appeared to represent what we hope is a more sustainable approach to managing well-being. A crucial premise for staff well-being is teams embedded within organisations that care for their employees. Originality/value – Poor staff well-being can have serious consequences for an organisation, particularly in the existentially challenging environment of dementia care. This study offers a unique opportunity to explore staff well-being in a UK inpatient mental health setting with older adults with dementia and complex mental health needs. [ABSTRACT FROM AUTHOR]

Purpose -- The "outcomes revolution" in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service. Design/methodology/approach -- Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013. Findings -- The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment. Research limitations/implications -- There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies. Originality/value -- There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to appraise local absent without leave/missing persons policy in use across the nine NHS mental health trusts providing services across the Greater London region. Design/methodology/approach -- A review of the literature on best practice management was conducted, evidence collated and an appraisal tool produced. This tool was used to systematically appraise individual policies. Findings -- Despite some core consistency in policy, there was some notable variability in guidance. Novel and unique approaches to management were also identified. Research limitations/implications -- It is recognised that policies often arise from pragmatic approaches using local multi-agency agreements and therefore some variability across London was expected. It is also recognised that the audit tool produced is unvalidated but does reflect the best available evidence. Practical implications -- The authors have shown policy variability in the management of what is a common psychiatric problem across a relatively homogenous population. Standardisation of policy is likely to improve the efficiency in managing these incidents as well as encourage sharing of innovative practice. The authors also illustrate practical implications for local policy benchmarking in the absence of clearly defined national standards. Originality/value -- This study has shown the variability of policy in managing a common problem faced on psychiatric wards. It also highlights issues related to policy development on a local and regional level. [ABSTRACT FROM AUTHOR]

Purpose – This paper explores the perspectives of patients subject to supervised community treatment (SCT) within two mental health teams in Merseyside. Design/methodology/approach – A structured survey tool was developed to explore patient perspective. In total, 17 patients agreed to participate in the study subject to informed consent. Findings – The majority of patients believed SCT facilitated early hospital discharge but felt uninvolved in the process. A significant proportion lacked the motivation or ability to understand the verbal and written information pertaining to their legal rights at the time it was given, usually immediately prior to hospital discharge. All felt they must strictly abide to the SCT conditions to remain in the community. There was a lack of knowledge about the harm criteria and the responsible clinician's ability to recall a service user to hospital even if they abided by the conditions. Research limitations/implications – This study is based upon a small sample size. There is no attempt to generalise the results. Originality/value – There have been few studies exploring the perspective of patients subject to SCT. A fuller awareness and understanding of patient perspective is important to promote involvement and therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Purpose – There is ongoing discussion around how to structure psychiatric services to meet the needs of people with intellectual disability and co-morbid mental illness and several different models have been suggested. With research evidence lacking, there is a lack of consensus as to the best model of service provision. This paper aims to review the current knowledge in this area and discuss the salient issues. Design/methodology/approach – This is a review article summarising the current debate. Evidence from original research is presented and combined with opinion from clinical experience. Findings – The authors find a lack of robust research evidence to support any particular model of service provision. However, it seems to be increasingly accepted that purely generic models of care for people with intellectual disabilities and co-morbid mental illness are not appropriate. Integration of the expertise from specialist services within mainstream services is presented as potentially the most advantageous approach. Originality/value – This article will be of benefit to clinicians working in the field of intellectual disability and mental illness, and to managers and commissioners with responsibility for providing services. It will also be useful for those new to the discipline to gain an overview of the current issues and debate within service planning for this population. [ABSTRACT FROM AUTHOR]

Purpose – The use of accessible, portable, mental health crisis information in people with intellectual disabilities has not been previously reported. The purpose of this paper is to explore whether crisis information could be modified to be made accessible and meaningful for people with intellectual disabilities. Design/methodology/approach – Personalized information to help in a mental health crisis was recorded on folded A4 sized sheets that could be carried in a conveniently sized wallet. Findings – Three quarters of the participants carried their crisis information wallets on a daily basis for six months before evaluation. They and their carers expressed positive feedback about them carrying the crisis information. No one carrying the information actually experienced a mental health crisis in the six months follow up period so their usefulness in such crises could not be evaluated. However, they were unexpectedly used in other non-mental health settings and reported to have been helpful. Originality/value – The sample size in this was small but the findings suggested that the carrying of crisis information might be a helpful measure for some people with intellectual disabilities. A further, larger scale trial is warranted. [ABSTRACT FROM AUTHOR]

Purpose – The Zone of Parental Control (ZPC) is a concept that has been introduced in the Code of Practice for the revised Mental Health Act 1983, but guidance on its scope remains scanty. The purpose of this paper is to bring together recent rulings from case law and the original guidance, and make suggestions for clinicians when deciding if an intervention is within the Zone. Design/methodology/approach – Review and examination of case law, legislation and legal guidance. Findings – Deprivations of liberty fall outside the ZPC, but restrictions of liberty lie within; parental disagreement with care correlates strongly with care that lies outside the ZPC. Originality/value – The findings of this article should aid clinicians in deciding whether a treatment regime lies within the ZPC. [ABSTRACT FROM AUTHOR]

Purpose – It is widely acknowledged that people with intellectual disabilities are highly likely to experience mental health problems, but that support workers' knowledge and skill in this area is sometimes lacking. There is little research explicitly exploring knowledge about the mental health of older people with intellectual disabilities and the purpose of this paper is to attempt to fill this gap. Design/methodology/approach – In total, 14 support workers completed a questionnaire in which three vignettes presented progressively worsening indicators of dementia in an older person with intellectual disabilities. Participants explained what they thought was happening and what action they would take. Data were analysed using Braun and Clarke's framework. Findings – Few participants had undertaken any mental health training, and only one in relation to older people. They were generally poor at judging early and intermediate indicators of dementia, but were able to identify more overt later signs. However, they believed these advanced indicators to be the onset of dementia. Nonetheless, they would generally take appropriate action, such as observation and referral. Abuse was often considered as a causal factor. Practical implications – The most significant implication is the need for training in the mental health needs of older people and in particular, the general and specific indicators and expected trajectory of dementia in this population. Originality/value – The study adds to the limited research on staff knowledge about older people with intellectual disabilities and dementia, using a novel methodology. [ABSTRACT FROM AUTHOR]

Purpose – Commissioned as part of a Joseph Rowntree Foundation scoping programme, this consultation aims to explore the views of disabled people and service users about risk. Design/methodology/approach – The consultation reached nine individuals and one focus group, reaching a total of 17 disabled people and service users. Their views were supplemented by the literature. Findings – The landscape of risk and rights is highly complex. Disabled people and service users have quite different concerns about risk to those of the professionals and the regulatory bodies acting on their behalf. Many people talked of the fear of losing their independence, of asserting their rights and the fear of powerlessness in the face of bureaucracy and (sometimes) uncaring staff. Research limitations/implications – The profile of rights needs to be raised in an accessible and acceptable way: it is necessary to make the language of rights more commonplace. There is a particular need to reach into mental health and residential care services to find ways of enabling people to have their rights realised. The report has implications for risk assessment and risk management as well as for the regulatory bodies responsible in adult social care. Raising awareness among professionals and policy makers about the risks that service users themselves fear and experience should demonstrate just how important it is that the people whose risk is under consideration are involved in the process. Originality/value – This paper highlights the views of users of adult social care about risk; their views have rarely been documented. [ABSTRACT FROM AUTHOR]

Purpose -- This article aims to describe the development of secure services for women with intellectual disability in the UK and to outline what is known about their mental health needs. Design/methodology/approach -- The paper is a general review which is based on what is known historically about the subject, findings from the current literature and the author's own personal knowledge of these specialist services. Findings -- Secure services for women with intellectual disability have developed out of mainstream forensic and learning disability services. Originality/value -- Although there is a reasonable body of literature on offending in the intellectually disabled population as a whole, little of this is specific to women. Despite this, the evidence there is suggests that women continue to require secure services and that they have significant mental health needs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to evaluate the introduction of a voluntary sector pilot project to develop innovative mental health services for young people. Design/methodology/approach – A combination of observation, interview and group discussion with service providers and users was used to build a picture of the relationships between context, mechanism and outcome. Findings – The project was perceived as successful and beneficial in all three pilot sites, although there were differences of perception as to whether it complemented or challenged existing statutory services. Practical implications – Learning about what adolescents and young adults with complex mental health needs find helpful may help to develop more appropriate and acceptable services. A mental health service for young people delivered by the voluntary sector offers the opportunity for radical service innovation. Synergy may be achieved as a result of statutory and voluntary sectors working together but the ethos of the voluntary service may challenge that of the statutory services. Originality/value – The research is original in that it examines the process of introducing an innovative voluntary sector project into an existing traditional service framework. [ABSTRACT FROM AUTHOR]

This paper describes two different services within the UK, both of which aim to better address the needs of offenders with personality disorder. Both services have been developed in the light of recent policy and practice guidance, which recognises the need to develop new ways of working with this hard-to-reach population.The importance of developing boundaries and optimistic therapeutic relationships in order to foster motivation and engagement is emphasised. It is within these that assessment and interventions to address risk, mental health and social integration issues can be undertaken. In addition, the need for different agencies to work together in partnership to better address these needs is also emphasised.Resettle is a stand-alone service in the pilot stage whilst the probation link-work role is a resource within an established community personality disorder service. [ABSTRACT FROM AUTHOR]

The custody environment is not designed nor can it hope to meet the needs of individuals who are experiencing acute mental distress. The article reports the findings of analysis of the recorded incidents of self-harm that occurred in the custody of one English police force during an eight-month period in 2006. There were 168 such incidents in this period. The ratio of male/female detained persons, who harmed themselves was 3:1. The most common method used was a ligature either from the detained person's own clothes or the paper suits that are used in custody. Alcohol or substance misuse was identified as a clear risk factor. The police response is analysed and recommendations made for improved access to health care for those in custody. [ABSTRACT FROM AUTHOR]