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Purpose: Many health-care professionals leave clinical practice temporarily or permanently. Interventions designed to facilitate the return of health-care professionals fail to consider returners' psychosocial needs despite their importance for patient care. This study aims to evaluate the efficacy of a psychoeducational intervention in improving personal skills and well-being among UK-based health-care professionals returning to clinical practice. Design/methodology/approach: In total, 20 health-care professionals took part in the one-day intervention and completed measures of demographics, self-efficacy, positive attitudes towards work and perceived job resources before and after the intervention. A baseline comparison group of 18 health-care professionals was also recruited. Findings: Significant associations were detected between return-to-work stage and study group. Following the intervention, participants reported improvements in self-efficacy and, generally, perceived more job resources, whereas positive attitudes towards work decreased. While none of these changes were significant, the intervention was deemed acceptable by participants. This study provides modest but promising evidence for the role of psychoeducation as a tool in supporting the psychosocial needs of returning health-care professionals. Research limitations/implications: Additional research is needed to clarify the reliability of intervention effects, its effectiveness compared to alternative interventions, and the impact across different subgroups of returning health-care professionals. Practical implications: Return-to-practice interventions should address the psychosocial needs of health-care professionals in terms of their personal skills and well-being. Psychoeducation can increase self-efficacy and perceptions of job resources among returning health-care professionals. Originality/value: This study sheds light on a relatively understudied, but fundamental area – the psychosocial challenges of health-care professionals returning to clinical practice – and further justifies the need for tailored interventions. [ABSTRACT FROM AUTHOR]

Mentally disordered offenders may be vulnerable yet also pose particular risk to the public. Achieving appropriate sentencing poses complex challenges for judges in properly determining culpability and punishment, protecting the public, and meeting any identified treatment needs of the defendant. With respect to all three elements there is likely to be necessary reliance upon psychiatric expertise. Despite much previous statutory guidance, there has not – until very recently – been available specific sentencing guidelines from the Sentencing Council (SC) to assist the judiciary in what is a profoundly difficult exercise. This review describes and considers the guidance available to the judiciary in the Crown Courts of England and Wales regarding the various disposal options – including that which 'hybridises' penal and treatment disposal – in addition to facilitating and properly limiting the role of expert evidence. A specific focus is on contextualising, and commenting upon, the SC's recently published Guidance, Sentencing Offenders with Mental Disorders, Developmental Disorders or Neurological Impairments, which seeks to consolidate information, improve knowledge, reduce confusion, and assist the courts towards properly and consistently addressing the relevance of mental disorder to sentencing. In doing so, in the authors' view, it privileges punishment over public safety, leaving judges to address public safety largely without the benefit of the explicit 'routes to sentencing' approach of the Guidance. [ABSTRACT FROM AUTHOR]

Purpose: During COVID-19, Maudsley Simulation successfully pivoted to fully online delivery of simulation-based education (SBE) in mental health. In migrating digitally, the simulation faculty experienced a range of new phenomena and challenges. The authors' experiences may be transferable to other specialities and for other educator groups. By sharing the authors' experiences, this study aims to support others adapt to online SBE. Design/methodology/approach: This piece represents the authors' collective reflections on the challenges of adapting their facilitation skills to the online environment. It also offers various suggestions on how to improve the learner experience in view of these challenges. Findings: Beyond merely platform orientation and operating procedure familiarisation, the team gained insights into ensuring optimal learning, engagement and participant experience during online deliveries. Delivery of online SBE brings several potential barriers to psychological safety and these warrant careful consideration by experienced simulationists. Practical implications: Optimising participant engagement and psychological safety remain key considerations despite this novel medium. Facilitators must be willing to adapt accordingly to begin delivering high-quality online SBE. Originality/value: From their experience, facilitators must reframe their debriefing expectations and adjust how they engage participants and manage group dynamics given the inherently different nature of this new learning environment. [ABSTRACT FROM AUTHOR]

Purpose: Financial abuse can be difficult to detect, and it is deemed to have the same potential to cause distress as other forms of abuse. The delegation of financial affairs brings with it the scope for degrees of exploitation. This study aims to assess the adequacy of the statutory provisions and courts in England and Wales at protecting at risk older people from the harm of financial abuse. Design/methodology/approach: This review focuses on the enduring power of attorney and the lasting power of attorney provisions. Cases discussed were selected based on their judgments' significance in relation to these powers, the range of issues illustrated and the extent of associated commentary and attention received in the literature. This piece is presented as a narrative review, and as such, references to case law and associated commentary are non-exhaustive. Findings: Shortcomings and vulnerabilities are identified and explored with respect to both provisions. These are contrasted and contextualised in view of the broader challenges and complexities associated with preventing financial abuse within society. Key consideration is given to powers of creation, registration, supervision, objection and revocation in addition to the role and powers of both the Office of the Public Guardian and the Court of Protection. Originality/value: Given these powers of attorney are exercised during a donor's lifetime, they will directly experience their effects. This review illustrates there remains scope for further reform to introduce new safeguards and bolster existing ones to mitigate the risk of financial exploitation and to support people to plan and safeguard their financial future with increased confidence and security. [ABSTRACT FROM AUTHOR]

Purpose: East London NHS Foundation Trust (ELFT) is a major provider of mental healthcare and community health services. Quality improvement (QI) has become central to its organisational policy and goals for which it has received national and international attention. Design/methodology/approach: This piece reflects on the Trust's transformation and its approach. It provides many examples and discusses several of the associated challenges in building and sustaining QI momentum. It is the result of a range of perspectives from staff involved in planning and building large-scale QI capability. It contextualises QI's current status in UK mental healthcare. Findings: Several key factors were identified: board-led commitment to organisational transformation; investment in training and resources to support staff motivation; clear and realistic project goals in line with the service's over-arching strategic direction; support for service users and staff at all levels to get involved to address issues that matter to them; and, finally, placement of a high value on service user and staff qualitative feedback. Practical implications: Building QI capability represents a significant challenge faced by all large healthcare providers. Sharing experiences of change can assist other organisations achieve the necessary buy-in and support the planning process. Originality/value: Achieving and sustaining lasting organisational change in healthcare is challenging. This article provides a background on QI at ELFT and reflects on the pathway to its present position at the forefront of the application of QI within healthcare. [ABSTRACT FROM AUTHOR]

Purpose: The prominence of the best interests principle in the Mental Capacity Act 2005 represented an important transition to a more resolutely patient-centred model regarding decision-making for incapable adults ("P"). This paper aims to examine the courts' consideration of P's values, wishes and beliefs in the context of medical treatment, reflect on whether this has resulted in a wide interpretation of the best interests standard and consider how this impacts clinical decision makers. Design/methodology/approach: A particular focus will be on case law from the Court of Protection of England and Wales and the Supreme Court of the UK. Cases have been selected for discussion on the basis of the significance of their judgements for the field, the range of issues they illustrate and the extent of commentary and attention they have received in the literature. They are presented as a narrative review and are non-exhaustive. Findings: With respect to values, wishes and beliefs, the best interests standard's interpretation in the courts has been widely varied. Opposing tensions and thematic conflicts have emerged from this case law and were analysed from the perspective of the clinical decision maker. Originality/value: This review illustrates the complexity and gravity of decisions of the clinical decision makers and the courts have considered in the context of best interests determinations for incapacitated adults undergoing medical treatment. Subsequent to the first such case before the Supreme Court of the UK, emerging case law trends relating to capacity legislation are considered. [ABSTRACT FROM AUTHOR]

"Aftersun - Psychiatry in film" is a 2022 film directed by Charlotte Wells that takes place at a Turkish resort in the mid-1990s. The film follows Calum, a separated father, and his 11-year-old daughter Sophie as they navigate their relationship during a holiday. Calum struggles with maintaining his own equilibrium while trying to create a memorable experience for Sophie. The film explores themes of adolescence, parenthood, memory, and loss through a melancholic lens. [Extracted from the article]

Humans generally exhibit a pervasive future bias in favour of optimism. We overestimate the likelihood of success in work, relationships and fi nancial investments. Similarly, we underestimate the probability of experiencing negative events such as, serious illness or fi nancial ruin. The optimism bias is widely considered as one of the most reproducible, prevalent and robust cognitive biases observed in psychology and behavioural economics. The catastrophic impact of the recent economic collapse has laid this cognitive bias bare. In this introductory overview, current understanding of the neural basis of the optimism bias is explored. Topics considered include: converse negative biases in depressive illnesses, the role of dopamine in optimism bias generation and modulation and evidence from functional neuroimaging studies. Research on the optimism bias has afforded us a unique window into decision-making, reward-processing and the potential for systematic irrationality in the human mind. [ABSTRACT FROM AUTHOR]

Decision-making has traditionally been viewed as detached from the neural systems of sensory perception and motor function. Consequently, motor areas have played a relatively minor role in discussions surrounding the control processes and neural origins of decision-making. Empiric evidence, catalysed by technological advances in the past two decades, has proven that motor areas have an integral role in decision-making. They are involved in the generation, modulation, maintenance and execution of decisions and actions. They also take part in a complex hierarchical assessment of multi-modal inputs to ensure that the most appropriate action is generated given the context presented. Clinical conditions such as, alien hand syndrome and utilisation behaviour exemplify the importance of these regulatory controls. This review charts the trajectory of our understanding of the hidden role of motor areas in decision-making and reflects upon the implications of our deepened understanding. The convergence of evidence from multiple modalities underpinning our current knowledge is discussed and the potential applications thereof considered. [ABSTRACT FROM AUTHOR]

Edna O'Brien's I In the Forest i (2002) describes the life of Michen O'Kane and a triple homicide in the west of Ireland. In the novel, Michen O'Kane experiences early loss, institutionalisation, abuse, imprisonment, worsening mental health and a deepening alienation from his rural community. Eight years on from the tragedy, O'Brien's novel is a fictionalised account of the deaths of Imelda Riney (28), her son Liam (3) and Father Joseph Walsh (37) at the hands of Brendan O'Donnell in 1994. [Extracted from the article]

Background: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others. Methods: In this retrospective observational cohort study, 28 patients on a 12 bed male admissions unit in a secure psychiatric hospital were assessed daily for six months. Data on adverse incidents were collected from case notes, incident registers and legal registers. Using the functional assessment sequence of antecedents, behaviours and consequences (A, B, C) we devised and applied a multivariate framework of structured professional assessment tools, common adverse incidents and preventive clinical interventions to develop a tool to analyse clinical practice. We validated by testing assumptions regarding the use of restrictive and intrusive practices in the prevention of violence in hospital. We aimed to provide a system for measuring contextual and individual factors contributing to adverse events and to assess whether the measured seriousness of threating and violent behaviours is proportionate to the degree of restrictive interventions used. General Estimating Equations tested preliminary models of contexts, decisions and pathways to interventions. Results: A system for measuring adverse behaviours and restrictive, intrusive interventions for prevention had good internal consistency. Interventions were proportionate to seriousness of harmful behaviours. A 'Pareto' group of patients (5/28) were responsible for the majority (80%) of adverse events, outcomes and interventions. The seriousness of the precipitating events correlated with the degree of restrictions utilised to safely manage or treat such behaviours. Conclusion: Observational scales can be used for restrictive, intrusive or coercive practices in psychiatry even though these involve interrelated complex sequences of interactions. The DRILL tool has been validated to assess the necessity and demonstrate proportionality of restrictive practices. This tool will be of benefit to services when reviewing practices internally, for mandatory external reviewing bodies and for future clinical research paradigms. [ABSTRACT FROM AUTHOR]