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Since the outbreak of Covid-19 health communicators around the globe have had to reach, urge, and persuade individuals and communities to adopt appropriate health protective behaviors. They have used a mix of communication channels, including outdoor media and public signage which are the focus of this paper. Drawing on a comparative linguistic landscape analysis, this paper critically examined the amount, content, and prominence of Covid-19 signage in Hackney, a London borough severely hit by the first wave of the pandemic. Having analyzed 1288 signs collected between May and July 2020, we found significant differences in Covid-19 signage between deprived and less deprived areas. These differences (e.g., in messaging about staying at home) have created inequalities in access to Covid-19 related health information and guidance. We also explored the changes in Covid-19 signage over time and the tailoring of risk and health messages to minority communities. [ABSTRACT FROM AUTHOR]

The findings presented here derive from a wider study that sought to establish a baseline understanding of mental health and wellbeing among the agricultural community in England and Wales. This paper focuses on selected questions that investigated levels of anxiety and associated stress factors among farm women, a group which has been relatively neglected within previous research on farming mental health in the United Kingdom. A questionnaire survey was widely distributed to members of the agricultural community in England and Wales (n = 15,296) in both paper and online formats. The survey included a number of standardised instruments to assess mental health and wellbeing, including the Generalised Anxiety Disorder-7 scale (GAD-7). Focusing on a sub-sample of female respondents (n = 3487), this paper details the findings from the GAD-7, alongside those from a selection of other questions investigating sources of stress, loneliness and perceived business viability. A significant proportion of female respondents were experiencing anxiety at the time of survey completion, with 23.3% reaching the threshold for clinically relevant anxiety based on their GAD-7 scores (medium or severe anxiety, scores≥10). A further 34.6% were classified as experiencing mild anxiety (scores 5–9) whilst 42.1% were not suffering from anxiety (scores 0–4). Medium/severe anxiety was identified as being associated with a number of stress factors, feelings of loneliness and pessimistic perceptions of farm business viability. There were important age-based differences, with working-aged women identified as more likely to suffer from anxiety, loneliness and certain stressors than older women. The findings reported here indicate concerning levels of anxiety among farming women and this should be seen as a call to action. There are clear associations between anxiety and a range of stressors and, although we cannot ascertain causality, these point to issues that demand attention in efforts to improve mental health within this social group. The factors contributing to anxiety are, however, multiple and complex and farm women may be affected by particular gender-based challenges that have not yet been explicitly explored in relation to mental health. Further research is needed to investigate and understand these issues in greater depth. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic led to an increase in the use of online platforms for Christian worship and emphasised the need for a simple psychometric instrument that is sufficiently general to assess affect responses to a range worship services. This paper reports on the development of the six-item Scale of Perceived Affect Response to Online Worship (SPAROW) during the third UK pandemic lockdown in 2021. The scale items were included in an online survey completed from January to July 2021 by 2,017 Anglicans living in England and 1713 Roman Catholics from the UK or the Republic of Ireland. Exploratory Factor Analysis (principal components extraction and varimax rotation) in the Anglican sample indicated a single-dimensional scale that had excellent internal consistency reliability for those who accessed pre-recorded services (α =.90, n = 1238) and live-streamed services (α =.91, n = 1492). Confirmatory Factor Analysis on the Roman Catholic sample using a Structural Equation Model showed a good fit to a single-dimensional scale. [ABSTRACT FROM AUTHOR]

There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty's Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a 'whole-prison approach' to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective. [ABSTRACT FROM AUTHOR]

Older carers play a vital role supporting population health and protecting health and social care systems, yet there has been little research on understanding the effect of the pandemic on this group. In this paper, we investigate caring as a factor contributing to mental and self-rated health. We investigate cross-sectional and longitudinal associations between provision of family care and mental health and wellbeing using longitudinal data from 5,149 members of the English Longitudinal Study of Ageing who responded to Wave 9 (2018/2019) and two COVID-19 sub-studies (June/July 2020; November/December 2020). We use logistic or linear regression models depending on outcome measures, controlling for pre-pandemic socioeconomic, demographic, and health-related variables. Before the pandemic, 21% of respondents cared for family or friends. Older people caring for someone inside the household mostly continued to provide care during the pandemic, with more than a quarter reporting an increase in the amount of care provided. Co-resident carers were disproportionately female, older, in the lowest wealth quintile, and more likely to report disability and chronic conditions. Both cross-sectional and longitudinal analyses suggest that, compared to those caring for people living outside the household, co-resident carers were significantly more likely to report poorer mental health and self-rated health. The health of older carers worsened disproportionately in the first year of the pandemic, a period also characterised by disruptions to support and closure of respite services. Support for carers' mental and physical health requires greater policy attention, especially in pandemic conditions. [ABSTRACT FROM AUTHOR]

In England, drug use in young people increased significantly between 2014 and 2017. This upward trend continues despite implementation of drug use policies to reduce supply, possession and manufacture of illicit drugs. Taking the view that drug use is a learnt behaviour, the purpose of this paper is to evaluate whether social learning (SL) factors explain drug use in English adolescents across: a) nine regions b) by age (11 to 15 years) and c) by gender using the Social Structure Social Learning (SSSL) theory as a framework. This study addresses a gap in the literature on English adolescent students by identifying the strongest SL pathway to drug use (imitation, parental reinforcement, attitudes, peer association). Cumulative mediation analyses were carried out on data from the Smoking Drinking Drug Use Survey 2016 (N = 12,051) on adolescents aged 11–15 years across England. The results show that imitation, peer association, attitudes and parental reinforcement mediate drug use at ages 12–14 and for some regions but not for gender. Drug use is a socially learnt behaviour in adolescents students living in England. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

This paper is based on a research study which explores Social Workers' feelings about professionals touching children during statutory child protection visits to clients' homes in one part of a southern English county. The study focussed on Social Worker visits to children aged between two and ten years who were subject to child protection plans following Section 47 enquiries of the Children Act 1989. A convenience sample of ten completed questionnaires recorded the types of touch, which were reported during the last visit made by the social worker. Semi-structured interviews followed with a further ten Social Workers. Analysis of the data revealed that most of the Social Workers in the study did touch children in a range of ways and for a variety of reasons during visits. 'Touch' was a term which some found uncomfortable and this paper considers whether terminology obstructs open reflection on the topic. Practitioners were keen to discuss the subject more amongst their peers in order to share best practice. [ABSTRACT FROM AUTHOR]

Children's experience of harm and abuse has a profound impact on their health and well-being. In response, school-based prevention programmes have been developed and delivered by external organisations with the aim of improving children's awareness and understanding of forms of harm and abuse which may affect them, encouraging them to seek help if needed. In September 2020, Relationships Education became statutory within the primary school curriculum in England and this ratification is likely to increase demand for externally delivered classroom-based programmes, which address the broad range of topics to be covered within this field. However, evidence is required to understand the impact and acceptability of such programmes. This paper presents qualitative findings from a larger mixed-methods study. Focus group discussions with 29 children explored their responses to one Healthy Relationships programme delivered to primary school children aged 10 and 11 in England. Analysis focuses specifically on responses to the topics of sexual abuse prevention and help-seeking. Children's widespread support for the programme indicates that topics are relevant and the opportunity to explore these issues is valued. However, for effective programme implementation, schools and parents need to be prepared, and prevention messages should continue to be embedded throughout children's school lives. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [ABSTRACT FROM AUTHOR]

Infants' experience of the early caregiving environment is fundamental to the development of positive social and emotional functioning. The Leeds Infant Mental Health Service was established to provide early intervention to infantsunder two and their caregivers, where there are concerns about the attachment relationship. This paper describes preliminary data to evaluate its effectiveness. Improved parent-infant relationships and parental well-beingare achieved by asmall multidisciplinary workforce through direct therapeutic work with infants and their caregivers and by up-skilling other professionals who are in contact with infants, through specialist training and consultation. Launched in 2012, the service has trained over 2500 professionals.Over 500 reflective case discussions and 200 case consultations have been delivered to practitioners, many of whom work with vulnerable infants. Ascreening tool has been developed to enable health visitors to identify infants at risk of developing poor attachment relationships with their caregivers. Direct therapeutic work has been completed with over 531 families, the majority (71%) before the infant was 6 months old. Caregivers and professionals are positive about the service. The model represents a clinically and cost-effective way to deliver city-wide infant mental health provision. Future research is needed on effectivess, particularly long-term outcomes. [ABSTRACT FROM AUTHOR]

This paper reports on a six-year qualitative study of social worker's perspectives on factors influencing decision-making in children and families social work in England. Data collected between 2010 and 2016 reflect frontline practice during a period of substantial change and reform in UK social work. This paper builds on an earlier analysis with data from all three stages of the study capturing the lived experiences of practitioners ranging from student social workers to qualified advanced practitioners in management roles. Data from 9 focus groups comprising 51 participants were analysed using grounded theory. Data analysis generated four representative categories: developing agency in the social work role; troubling emotions; transitions in the development of expertise and the impact of organisational cultures in children and families social work services. An emerging theoretical framework is presented. This identifies the significance of transitions and threshold concepts in the development of the social work professional from the role of students as 'outside players looking in' through to the expertise of qualified practitioners as 'inside players' within organisations. Recognising periods of liminality, transitional learning and uncertainties in developing decision-making expertise may be of significant benefit to social work education and the profession. [ABSTRACT FROM AUTHOR]

This paper explores the psychometric properties of the seven-item Astley-Francis Scale of Attitude toward Theistic Faith among Muslim secondary school students (N = 1,146) in England, surveyed alongside Christian (N = 575) and religiously unaffiliated (N = 361) students, in a sample in which Muslim students comprise the majority. The data demonstrated a satisfactory level of internal consistency reliability among all three groups, although less good among the Muslim students: Muslim (α =.79), Christian (α =.92), and religious unaffiliated (α =.86). The shorter five-item Astley-Francis Scale of Attitude toward Theistic Faith Revised provided a higher level of internal consistency reliability across all three groups: Muslim (α =.85), Christian (α =.94), and religiously unaffiliated (α =.95) and is commended for further use. [ABSTRACT FROM AUTHOR]

Previous research with older gay men has overlooked their concerns about dating. This paper addresses the gap by analysing in-depth interviews conducted with 25 self-identified single gay men over the age of 50, who lived in England. The paper focuses on the research question: “What factors do older, single gay men consider when they contemplate dating?”. Five factors were identified which affected their decisions about whether to date. Because the same factors operated simultaneously to encourage and to discourage them to contemplate dating, feelings of tension and ambivalence were reported by participants. Although some of these issues are similar to the ones older straight people considered, some of the concerns identified in this study were distinctively different for older gay men. The findings can help to make therapists aware that being single among older gay men is not only a personal experience, but is heavily influenced by social ideals and historical development of gay rights. It also can inform therapists of the factors that encourage and discourage older gay men from contemplating dating. This awareness can help therapists with developing effective strategies for working with clients on the topic of relationships. [ABSTRACT FROM PUBLISHER]

Introducing continental European approaches to UK child welfare practice raises a problem of comparison: to what extent are the problems and issues similar to or different from one country compared to another. Social pedagogues trained in continental Europe and working in English residential care services often encountered the phrase ‘our young people are worse’ from their English colleagues, with the implication that the social pedagogic approach was not suitable for the client group. This paper examines two propositions: (1) that in the context of introducing the continental European approach of social pedagogy into children's residential care services in England, young people are ‘different’ in England compared to other European countries and (2) that the placement options and practices for young people living away from their birth parents in continental European countries differ from those in England. Using data from a five nation study of young people from public care backgrounds, the paper argues that while family backgrounds are remarkably similar there are marked differences in the child welfare systems that might account for the perception that young people in care are ‘worse’ in England. [ABSTRACT FROM AUTHOR]

The facilitation of children's emotional intelligence (EI) through social and emotional learning (SEL) and wider pastoral support schemes is common practice in schools. Although the benefits of enhanced EI have been widely reported, little is known about its 'dark side': emotional manipulation, or how this may manifest in school settings. Focus group and individual interview data gathered from staff members working across case study schools located in a town in the North West of England inform the points raised in this paper. The article explores the extent to which emotional manipulation takes place in the strategies and forms of support utilised by schools to enhance children's social, emotional and behavioural skills. The ramifications of emotionally manipulative behaviours are discussed and recommendations for future directives are made. [ABSTRACT FROM AUTHOR]

Background: Sleep problems are common amongst people who use alcohol and other drugs, but treatment options are limited. This paper explores how people in residential treatment for alcohol and other drug problems perceived and described 'non-problematic' sleep to provide insights that might inform sleep interventions for this population. Methods: Qualitative interviews were conducted with 28 residents (19 women, 9 men; ages 24–83 years) in two residential drug and alcohol treatment centres in England during 2014/15. Interviews were audio-recorded, transcribed, and coded. Accounts of non-problematic sleep were then analysed inductively. Results: Non-problematic sleep comprised three linked components: i. personal sleep patterns and routines; ii. sleep perceptions; and iii. sleep metacognitions. Some participants reported they slept well; others described their sleep as problematic but improving. Participants believed that sleep improved naturally with residential treatment and abstinence, but perceptions of 'good' sleep varied greatly. Participants used a range of metacognitive strategies (e.g. downgrading the importance of sleep; adapting their sleeping patterns; and focusing on sleep quality alongside sleep quantity) to manage sleep problems and render them non-problematic. Conclusions: Metacognitive strategies that focus on changing perceptions of sleep can potentially inform sleep interventions for people with a history of alcohol and other drug use. [ABSTRACT FROM AUTHOR]

In mental health, communication is thesine qua non, not only for considering a diagnosis, but also for developing a treatment plan. Words, on the one hand, and the relationship between the clinician and the service user, on the other, are two of the main components of mental health and therapeutic treatment. The presence of an interpreter has the potential to have an effect on the dynamics of the mental health or therapeutic encounter. This may pose a series of challenges and opportunities for all three members of the triad. This paper reports on a study conducted with interpreters working with recent migrants, mainly refugees and asylum seekers at two organisations based in the South of England. Two focus-groups with interpreters were conducted. Several differences between interpreting in mental health and interpreting in other settings were noted by the interpreters. Five overarching themes were identified in this study. These were: the role of the interpreter in the mental health encounter, the dynamics within the therapeutic triad, the interpreter-clinician relationship, power and alliances within the room and the personhood of the interpreter. The first two themes are presented within this paper, although the themes are not entirely discrete categorisations. [ABSTRACT FROM PUBLISHER]

This paper draws on findings from an analysis of interviews with young people aged 14–18 years, to explore the peer influences in young people's informal social networks which can affect their access to sexual health services. The research focuses on the social meanings of a C-Card condom distribution scheme in North East England. Such schemes are widespread in the UK as a way of providing access to condoms and sexual health advice for young people in health and community settings. Focusing on one aspect of a broader study, the paper outlines the important social, emotional and practical resources provided by young people's chosen friendship groups in the process of acquiring a C-Card, which offers a route to accessing sex and relationships advice and condoms. Informal peer networks inform attitudes and expectations which can influence gendered patterns of behaviour. Through a focus on the educational possibilities of the C-Card scheme, the study suggests a need to revisit the dynamics of young people's peer relationships and harness their potential to influence sexual attitudes and behaviour in positive ways, rather than simply seeing these always as a source of negative pressure. [ABSTRACT FROM AUTHOR]

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed. [ABSTRACT FROM PUBLISHER]

Background: A play about dementia care was taken on tour, funded by the Big Lottery through Arts Council England, to six cities. This paper explores its impact, mainly on professional carers. Methods: Mixed methods were applied; semi-structured self-completion questionnaires and subsequent telephone interviews to a stratified sample of respondents. Framework analysis was used, paying particular attention to critical comments. Results: Post-show questionnaires were submitted by 1035 (19%) and 64 people were later interviewed. Audience members expressed heightened awareness of the needs of people with dementia, with greater appreciation of the care process itself and of the challenges faced by professional dementia carers in hospitals and other long-term settings. Conclusions: This production ofInside Out of Mindafforded an effective medium for knowledge transfer. It engaged audiences with key issues – including dignity, identity and loss – and enabled them to reflect on these issues, while encouraging appropriate practical responses. [ABSTRACT FROM AUTHOR]

This paper reports findings from a qualitative research project, using interviews, focus groups and participant observations, which sought to investigate 'good practice' in a nurse-led prison hospital wing for male prisoners. The study raised issues about tensions between 'caring' and 'control' of prisoners from the perspectives of professionals working or visiting the wing. This paper discusses collaborative working between professionals from different backgrounds, including nurses and healthcare (prison) officers who were based on the wing and others who visited such as probation, medical, Inreach team or Counselling Advice, Referral, Assessment and Through Care team staff (CARAT). The key finding was that there is a balance between therapy and security/risk. In order to maintain this, the two main groups based on the hospital wing - nurses and prison officers - moved between at times cooperating, coordinating and collaborating with each other to maintain this balance. Other themes were care and control, team working, individual and professional responsibilities and communication issues. Enhancing the role of nurses should be encouraged so that therapy remains paramount, and we conclude with some recommendations to encourage collaborative working in prison healthcare settings to ensure that therapy continues to be paramount while security and safety are maintained. [ABSTRACT FROM AUTHOR]

This paper describes the conceptual underpinnings, structure and operations of a novel service, the City and Hackney Primary Care Psychotherapy Consultation Service – a service set up partly with the aim of addressing the needs of patients who present with ‘medically unexplained symptoms’. As part of the Tavistock and Portman NHS Trust, this service moves its clinical base, staff members and daily work, as well as the foundations of psychoanalytic thinking that define the Trust's work, into the heart of a community, and provides psychoanalytically informed clinical practice and consultation to patients and general practitioners in the City and Hackney, one of London's (and the UK's) most deprived and ethnically diverse boroughs. The authors describe the psychoanalytical underpinnings of the model, the design and structure of the service, patient demographics and preliminary outcome data, as well as an example of consultation work with general practitioners. The authors propose that psychoanalytic applications have a place in primary care and that psychoanalytic thinking can help general practitioners and patients alike, even when the clinical interventions offered are not solely based on psychoanalytic technique or therapeutic approaches. The paper concludes with thoughts about the model, its origins and its future. [ABSTRACT FROM PUBLISHER]

This paper focuses on the evaluation of the therapeutic use of photocards by prisoners and facilitators in a counselling psychology led European project, based on responses to open-ended questionnaires. It is part of a wider project, involving seven partner organisations in six European countries (England, Finland, Greece, Italy, Malta and Romania), which developed and trialled four different approaches to using photography in the context of counselling in prisons. Of the 51 inmates that participated in the project, 48 (94%) completed the questionnaires; of those, 39 (77%) were available for individual analysis due to prison restrictions in one partner organisation only allowing group data. Of those 39, who returned their completed questionnaires, over 92% found the therapeutic use of photographs either very helpful (56.4%) or helpful (35.9%), and the remaining 7.7% described it as average. From the thematic analysis, main themes emerging regarding inmates’ experiences of working with photocards were that it: facilitates emotional expression and sharing; unlocks memories and reconnects with life outside; fosters insight, reflection and self-growth; breaks the monotony of prison life and, overall aids emotional learning. A thematic analysis of 11 psychological therapists/facilitators’ perspectives showed that the use of photocards: gives clients a voice; provides a safe and collaborative frame and a therapeutic relationship; and, provides a useful icebreaker, helpfully overcoming anxieties of both client and psychotherapist/facilitator. Overall, photocards were considered useful as their projective nature can help facilitate prisoners’ strong need for expression in a context where there are limited opportunities and trust is fragile. [ABSTRACT FROM PUBLISHER]

Objectives:Subjective memory complaints (SMC) are common in older people and previous research has shown an association with mood problems, such as depression and anxiety. SMC form part of the criteria for many definitions of mild cognitive impairment (MCI), but there is controversy over whether they should be included as they may be related more strongly to mood than to objective cognitive impairment. This study aims to clarify the relationship between mood and SMC in people with MCI. Method:This paper reports an analysis of data from the Medical Research Council Cognitive Function and Ageing study. Structured interviews were conducted with community-dwelling older people to assess a range of aspects of cognitive functioning and mood. Data from two time points approximately 24 months apart were used in this analysis. At baseline, participants without dementia or severe cognitive impairment were categorised into three groups according to cognitive status. Mood was investigated by assessing symptoms of anxiety and depression which were defined using a diagnostic algorithm. Associations were tested using logistic regression and chi square analyses. Results:A clear association was shown between SMC and mood, both cross-sectionally and over time. The relationship between our two competing definitions of MCI suggested that mood problems were more strongly related to the presence of SMC than objective cognitive impairment. Conclusion:SMC may be a function of anxiety and depression rather than being related to objective cognitive function. This questions whether SMC should be included in definitions of MCI. [ABSTRACT FROM AUTHOR]

This paper explores the concept of reflection and its changing role in the journey of the student teacher. It presents part of the findings of a year-long investigation into the reflective practice of student teachers during their training year. Specifically, it investigates the reflections of the student teachers’ lessons during the PGCE (Post/Professional Graduate Certificate of Education) year at a higher education institution (HEI) in England. The strengths and weaknesses of the student teachers’ lessons are analysed and how these reflections change as they reach Newly Qualified Teachers (NQT) status. [ABSTRACT FROM PUBLISHER]

Background:Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method:Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results:Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions:This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support. [ABSTRACT FROM AUTHOR]

The paper presents an educational initiative to develop a separate well-being curriculum for a federation of schools in south-east London. A mixed-methods study was undertaken to evaluate the feasibility of the curriculum run biweekly in Year 7 (age 11–12,N = 96). The study utilised a non-randomised repeated measures design with a control group (N = 68) using general life satisfaction, domain life satisfaction and affect balance as outcome variables. In addition, semi-structured interviews were conducted with four students, two teachers and the principal of the intervention school. The results indicated significant buffering effect of the intervention in protecting students against the decline of satisfaction with self, satisfaction with friends, positive affect and the increase in negative affect throughout the first year of middle school. The qualitative data shed light on explicit learning, psychological outcomes and challenges associated with the programme. Overall, the data indicate a positive impact of the well-being curriculum. [ABSTRACT FROM PUBLISHER]

This paper describes a preliminary investigation on the effectiveness of Dynamic Interpersonal Therapy (DIT). The research was undertaken in an inner London primary care psychological therapies service. Outcome data on the symptoms of depression [Patient Health Questionnaire-9 (PHQ-9)] and anxiety [Generalised Anxiety Disorder-7 (GAD-7)] were collected from service-users (n = 24) at the first and last episodes of treatment. There were statistically significant reductions in depression (PHQ-9) and anxiety (GAD-7) associated with DIT, with medium and large effect sizes, respectively. Overall, 75% of patients showed an improvement on the PHQ-9 and GAD-7 following DIT. When this was calculated as statistically reliable change, the improvements reduced to 42% for anxiety and 25% for depression. As this study was uncontrolled, the significance cannot be reliably attributed to DIT. Future research may aim to investigate DIT's effectiveness in different settings with a larger sample size, using appropriate comparison groups under controlled conditions. [ABSTRACT FROM PUBLISHER]

Across Europe and North America, few young people meet the recommended levels of physical activity (PA) of 1 hour of moderate to vigorous PA per day. However, the lives of young people cannot simply be polarised as either completely sedentary or active. Drawing on findings from the World Health Organization Health Behaviour in School-aged Children cross sectional international study, this paper examines the domains of adolescent life associated with young people's participation in overall PA, including health behaviours, social relationships and family activities. Consideration is also given to gender differences. Information in England was collected from 4404 students aged 11, 13 and 15 years, using anonymised self-completed questionnaires. Physical aspects of lifestyle were determined using internationally validated items for measuring PA that met international guidelines for activity and the frequency and duration of vigorous exercise undertaken during leisure activities. Separate analyses were conducted for boys and girls. Levels of PA and vigorous exercise were compared using the chi-squared test for trend. The findings draw attention to the value for the health and well-being of young people participating in some form of PA, even if they do not meet the recommended levels. Medium levels of PA appear to be associated with high levels of life satisfaction, self-rated health and an improved sense of body image. Significant health gains are likely to be made for adolescents in encouraging sedentary young people to undertake some form of PA. [ABSTRACT FROM PUBLISHER]

This study is the first empirical investigation that has explored levels of athletic identity in elite-level English professional football. The importance of understanding athletes’ psychological well-being within professional sport has been well documented. This is especially important within the professional football industry, given the high attrition rate (Anderson, G., & Miller, R. M. (2011).The academy system in English professional football: Business value or following the herd?University of Liverpool, Management School Research Paper Series. Retrieved fromhttp://www.liv.ac.uk/managementschool/research/working%20papers/wp201143.pdf) and distinct occupational practices (Roderick, M. (2006).The work of professional football. A labour of love?London: Routledge). A total of 168 elite youth footballers from the English professional football leagues completed the Athletic Identity Measurement Scale (AIMS). Multilevel modelling was used to examine the effect of playing level, living arrangements and year of apprentice on the total AIMS score and its subscales (i.e., social identity, exclusivity and negative affectivity). Football club explained 30% of the variance in exclusivity among players (P = .022). Mean social identity was significantly higher for those players in the first year of their apprenticeship compared to the second year (P = .025). All other effects were not statistically significant (P > .05). The novel and unique findings have practical implications in the design and implementation of career support strategies with respect to social identity. This may facilitate the maintenance of motivation over a 2-year apprenticeship and positively impact on performance levels within the professional football environment. [ABSTRACT FROM AUTHOR]

Background The majority of deaths in the UK occur in acute hospitals, and older people have the highest hospital death rates. Improved palliative care for older people has been identified as an international priority, yet little is known about the profile of older patients with palliative care needs in hospitals. Objective To describe the profile of older hospital inpatients (≥85 years), and to explore the prevalence and nature of palliative care needs among this group. Methods A cross-sectional survey of palliative care need in older people was undertaken in two UK acute hospitals. Hospital case notes were examined for evidence of palliative care need according to Gold Standards Framework (GSF) prognostic indicator criteria. Patients (or consultees) completed assessments of palliative care need. Subjects Data were collected for 654 consenting patients/consultees. This paper describes data from 110 patients aged ≥85 years. Results Forty per cent of the older patients were identified as having palliative care needs according to GSF criteria. Frailty was the most common indicator of palliative care need (16.7%). The most common reason for admission to hospital was general frailty (25.5%). Conclusions While this study is limited by its small sample size, the results suggest that older people with frailty conditions constitute a substantial proportion of hospital inpatients with palliative care needs. However, it is unclear whether a specialist palliative care framework is the most appropriate model for this group. The care provided to older people at the end of life may best be provided by generalists such as geriatricians, as part of a comprehensive generalist-led palliative care framework. [ABSTRACT FROM AUTHOR]

Working carers are a key focus of UK policies on health and social care and employment. Complementing national and European evidence, this paper presents a local case study of working carers. It draws on data from a county-wide survey containing a module on caring. Data were primarily categorical and were analysed using SPSS. Three quarters of all carers who responded to the survey were of working age: two thirds were employed and one third had been employed previously. The majority of working carers were mid-life extra-resident women. Over half of cared for relatives were elderly parents/in law; ‘physical illness’ was the primary cause of dependency. A tenth provided intensive care and half reported that caring adversely affected their health. Both were triggers for leaving employment. Two thirds of households received input from services and/or friends/family; being a co-resident carer appeared to mitigate against service allocation. Four issues were identified as pivotal to facilitating employment: access to advice and information, the availability of a matrix of affordable good-quality social-care services, ‘joined up’ needs assessment of the carer and cared for person, and employers identifying carers in their workforce. Europe's ageing profile underscores the study's timeliness. [ABSTRACT FROM AUTHOR]

The paper examines assessment and outcomes of alcohol misuse and dual diagnosis from liaison psychiatry services for older people. The authors used a retrospective case note survey for referrals to four older adult liaison psychiatry services was carried out on consecutive anonymised in-patient records for admissions from 2006 to 2011. Notes were examined for all older people with alcohol-related problems seen by liaison psychiatry services, with documentation of reason for admission, accompanying mental disorder, referral to mental health services and 6 month follow-up. Four hundred and twenty unique case notes were identified, with 108 patients being eligible for inclusion. Sixty patients were admitted with alcohol withdrawal syndrome, 42 of whom were given a diagnosis of alcohol-related brain injury (ARBI). Fifty patients were taken on by community mental health teams (CMHTs); a further 14 were placed in continuing care facilities. Of the patients under CMHTs, 19 patients (38%) had achieved abstinence from alcohol or controlled drinking at 6 month follow-up. Patients with ARBI were less likely than those without it to have changed their drinking behaviour after 6 months. This is the first UK naturalistic study to show positive outcomes from community treatment of alcohol misuse and dual diagnosis. In spite of the high rate of referral to mental health services and positive outcomes, there was little indication of clear pathways being used in the assessment, treatment and referral of older people with alcohol misuse in medical wards. [ABSTRACT FROM PUBLISHER]

The reported absence of distinguishing features upon British Gypsy-Traveller memorials has been used to support the widely accepted, and influential, argument that dead people are not the focus of social continuity within Gypsy-Traveller society. However, based upon cemetery surveys and interviews with members of the Gypsy-Traveller community in Sheffield, England, this paper demonstrates that explicit displays of ethnicity are now common upon memorials, and describes their characteristics. The reasons behind this apparent shift in mortuary practices are discussed in relation to wider socio-political factors. Based upon these findings, we argue for a reconsideration of the relationship between living and dead people within British Gypsy-Traveller society, and a recognition of the importance of commemoration in the negotiation of identity and social reproduction within these communities. [ABSTRACT FROM PUBLISHER]

The aim of the current paper was to examine externalizing and internalizing behaviors in adolescents with gender dysphoria. One hundred forty-one young people (84 natal females and 57 natal males, M age = 15.13, SD = 1.70) attending the Gender Identity Development Service in London completed the Youth Self Report form at the end of the assessment period (4 to 6 sessions). The main findings indicated that, overall, the adolescents showed significantly more internalizing than externalizing behaviors. Using cutoff points provided by Achenbach and Rescorla (2001), the mean internalizing score fell within the clinical range and the mean externalizing score within the normal range. There was also a significant positive relationship between these two behaviors both in the natal females and the natal males. The natal males presented with significantly more internalizing behaviors than the natal females; however, no significant difference was observed between the genders in terms of the number of externalizing behaviors and total problems. We discuss the implications of these findings with regard to clinical work. [ABSTRACT FROM AUTHOR]

Theories of offender motivation for treatment have proposed that external factors may be as important as internal factors in creating a state of readiness for treatment. This paper reports an exploratory study of the barriers to treatment for incarcerated sexual offenders. Qualitative and quantitative analysis of interview and questionnaire data from treatment refusers and accepters suggested that refusers were less aware of the effectiveness of treatment, reported seeing negative side effects of treatment in others and felt they had a higher social status in prison which could be damaged by attending treatment. While this study does not demonstrate a causal link between these experiences and the decision to refuse treatment, it seems reasonable to suggest that take-up of treatment could be increased by more sustained efforts to build relationships with treatment refusers and by the provision of accessible information about treatment and its potential benefits. [ABSTRACT FROM AUTHOR]

Research has identified a significant relationship between social, emotional and behavioural difficulties (SEBD) and speech, language and communication difficulties (SLCD). However, little has been published regarding the levels of knowledge and skill that practitioners working with pupils experiencing SEBD have in this important area, nor how they might more effectively detect and support SLCD in the children and young people with whom they work. This paper outlines a small-scale project intended to evaluate said knowledge and skills within an SEBD support team in central England, and to increase this team's effectiveness in detecting and supporting children experiencing SLCD. [ABSTRACT FROM PUBLISHER]

A small, self-selected convenience sample of male and female contraceptive users in the United Kingdom (n = 34) were interviewed between 2006 and 2008 concerning their feelings about the body and their contraceptive attitudes and experiences. The interviewees were a sub-sample of respondents (n = 188) who completed a paper-based questionnaire on similar topics, who were recruited through a poster placed in a family planning clinic, web-based advertisements on workplace and university websites, and through direct approaches to social groups. The bodily metaphors used when discussing contraception were analyzed using an interpretative phenomenological analytical approach facilitated by Atlas.ti software. The dominant bodily metaphor was mechanistic (i.e.,“body as machine”). A subordinate but influential bodily metaphor was the “natural” body, which had connotations of connection to nature and a quasi-sacred bodily order. Interviewees drew upon this “natural” metaphorical image in the context of discussing their anxieties about hormonal contraception. Drawing upon a “natural,” non-mechanistic body image in the context of contraceptive decision-making contributed to reluctance to use a hormonal form of contraception. This research suggests that clinicians could improve communication and advice about contraception by recognizing that some users may draw upon non-mechanistic body imagery. [ABSTRACT FROM PUBLISHER]

This paper reports the findings of research on relationships between depression and participation in learning using data from a large sample of older adults. The objective was to establish whether learning can reduce the risk of depression. Data were obtained from the English Longitudinal Study of Ageing, a nationally-representative sample of adults aged 50 and above. The eight-item Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure depressive symptoms. Participation in learning covered the acquisition of qualifications; taking formal training courses, learning at arts, music or evening classes; and participation in gym/exercise classes. Multiple regression analyses were conducted with the change in the measure of depressive symptoms between two waves of the longitudinal survey as the response variable. There was limited evidence that participation in learning reduced the risk of depression in later life. Only learning leading to qualifications was significantly associated with the outcome after controlling other factors. But learning leading to qualifications was undertaken only by a small minority of the sample, mainly the youngest and most highly educated. Other types of learning were not significantly associated with depression. It appears that learning has, at best, a small role to play in addressing the risk of depression in later life. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about the role of a psychiatrist are anecdotally widespread but have been under researched. Aims: This study aimed to establish views on training and working in psychiatry amongst preclinical medical students at a South London Medical School and amongst a general public sample. Methods: A semi-structured online questionnaire was used to survey medical students, with a similar paper questionnaire being used to survey members of the public in a general practice waiting room using a convenience sampling method. Results: Strikingly, the majority of the public thought that psychiatrists did not need a medical degree (54%) or postgraduate training (56%). There were significant misconceptions about treatments used in mental health, for example 16% of the public sample thought psychiatrists never use medication and 31% of medical students (and 14% of the public) thought psychiatrists never use electroconvulsive therapy (ECT). In response to 'do you believe a psychiatrist is able to know what people are thinking?', 45% of students and 57% of the public answered 'sometimes'. Conclusion: The results have important implications for public education, as lack of awareness about psychiatry may inhibit help seeking for mental illness, and have a negative impact on recruitment to psychiatry amongst medical students. [ABSTRACT FROM AUTHOR]

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic. People with dementia and their carers completed assessments before (July 2019–March 2020; 206 dyads) and after (July–October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline. In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness. Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study is to critique and extend psychological approaches to resilience by examining retrospective accounts of LGBT people in England who had directly experienced or witnessed events that were salient as significantly negative or traumatic. Pre-screening telephone interviews identified ten individuals who matched inclusion criteria (mean age: 39 years; range 26–62 years) as part of a larger study. Interviews were semi-structured and informed by a literature review undertaken at the start of the study. We identified three themes of that extend the resilience literature for LGBTQ+ people: (1) identifying and foregrounding inherent personal traits – how non-contextual inborn qualities or attributes needed external effort to be recognised and operationalised; (2) describing asymmetric sources of social support and acceptance – the importance of positive environment is unequally available to LGBT people compared to heterosexuals, and uneven within the LGBT group; and (3) blurring distinctions between resilience and coping – experiential approaches to moving beyond distress. We suggest that narratives of resilience in the accounts of LGBT people can inform the development of resilience promotion models for minoritized individuals and support movement away from deficit-focused approaches to health policy. [ABSTRACT FROM AUTHOR]

Objective. The objective of this study was to describe the psychiatric symptoms, management and outcomes in a consecutive series of patients being managed medically for symptoms of withdrawal from gamma-hydroxybutyrate (GHB) and its analogue gamma-butyrolactone (GBL) in a general hospital setting. Methods. A toxicology database was used to identify patients presenting with a history suggestive of withdrawal from GHB and analogues. Electronic and paper medical records were searched for demographic features, neuropsychiatric symptoms, psychiatric management while in hospital and overall outcome. Results. There were 31 presentations with withdrawal from the drugs involving 20 patients. Of these 17 (54%) were referred to and seen by the liaison psychiatry team. Anxiety (61.3%) and agitation (48.4%) were the most common symptoms. Of the 17 cases seen by the liaison psychiatry team, 52.9% required close constant observation by a mental health nurse and 29.4% required to be detained in hospital under mental health legislation. Conclusions. The significant proportion of patients presenting with neuropsychiatric symptoms and requiring intensive input from the liaison psychiatry team during withdrawal from GHB and its analogues points to the importance of close liaison between medical and psychiatric teams in managing these patients in the general hospital. [ABSTRACT FROM AUTHOR]

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Studies have highlighted an association between motor laterality and speech production laterality. It is thought that common demands for sequential processing may underlie this association. However, most studies in this area have relied on relatively small samples and have infrequently explored the reliability of the tools used to assess lateralization. We, therefore, established the validity and reliability of an online battery measuring sequence-based motor laterality and language laterality before exploring the associations between laterality indices on language and motor tasks. The online battery was completed by 621 participants, 52 of whom returned to complete the battery a second time. The three motor tasks included in the battery showed good between-session reliability (r ≥.78) and were lateralized in concordance with hand preference. The novel measure of speech production laterality was left lateralized at population level as predicted, but reliability was less satisfactory (r =.62). We found no evidence of an association between sequence-based motor laterality and language laterality. Those with a left-hand preference were more strongly lateralized on motor tasks requiring midline crossing; this effect was not observed in right-handers. We conclude that there is little evidence of the co-lateralization of language and sequence-based motor skill on this battery. [ABSTRACT FROM AUTHOR]

This exploratory study examines how social work practitioners in England integrate service users' religion, belief and spiritual identities. The study involved 34 semi-structured interviews with Qualified Social Workers and took a qualitative investigational perspective. By means of thematic analysis, the study suggests that practitioners employ either avoidant or utilitarian approaches, which may indeed be a coping strategy before the vast religious plurality in practice. The study also highlights when professionals perceive religion, belief and spirituality important. Those times are a) initial assessments, b) conditional intervention, c) referrals and d) response to this subject when safeguarding and child protection issues arise. [ABSTRACT FROM AUTHOR]

To establish whether ethnic inequalities exist in levels of self-reported hearing difficulty and hearing aid use among middle-aged adults. Cross-sectional data from the UK Biobank resource. 164,460 participants aged 40–69 who answered hearing questions at an assessment centre in England or Wales. After taking into account objectively assessed hearing performance and a corresponding correction for bias in non-native English speakers, as well as a range of correlates including demographic, socioeconomic, and health factors, there were lower levels of hearing aid use for people from Black African (OR 0.36, 95% CI 0.17–0.77), Black Caribbean (OR 0.38, 95% CI 0.22–0.65) and Indian (OR 0.60, 95% CI 0.41–0.86) ethnic groups, compared to the White British or Irish group. Men from most ethnic minority groups and women from Black African, Black Caribbean and Indian groups were less likely to report hearing difficulty than their White British or Irish counterparts. For equivalent levels of hearing loss, the use of hearing aids is lower among ethnic minority groups. Inequalities are partly due to lower levels of self-reported hearing difficulty among minority groups. However, even when self-reported hearing difficulty is considered, hearing aid use remains lower among many ethnic minority groups. [ABSTRACT FROM AUTHOR]

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular 'upstream-downstream' story, and what it means to work 'upstream' to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants' research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences. [ABSTRACT FROM AUTHOR]

Background: A lack of consensus exists concerning how to identify "heavy users" of inpatient mental health services. Aim: To identify a statistical approach that captures, in a clinically meaningful way, "heavy" users of inpatient services using number of admissions and total time spent in hospital. Methods: "Simple" statistical methods (e.g. top 2%) and data driven methods (e.g. the Poisson mixture distribution) were applied to admissions made to adult acute services of a London mental health trust. Results: The Poisson mixture distribution distinguished "frequent users" of inpatient services, defined as having 4 + admissions in the study period. It also distinguished "high users" of inpatient services, defined as having 52 + occupied bed days. Together "frequent" and "high" users were classified as "heavy users". Conclusions: Data driven criteria such as the Poisson mixture distribution can identify "heavy" users of inpatient services. The needs of this group require particular attention. [ABSTRACT FROM AUTHOR]