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Despite anecdotal evidence that the out of pocket costs of OCD can be substantial in some cases, there is no evidence on how many people they affect, or the magnitude of these costs. This paper explores the type and quantity of out of pocket expenses reported by a large sample of adults with OCD. Data on out of pocket expenses were collected from participants taking part in the OCTET multi-centre randomised controlled trial. Participants were aged 18+, meeting DSM-IV criteria for OCD, and scoring 16+ on the Yale Brown Obsessive Compulsive Scale. Individual-level resource use data including a description and estimated cost of out of pocket expenses were measured using an adapted version of the Adult Service Use Schedule (AD-SUS): a questionnaire used to collect data on resource use. Forty-five percent (208/465) reported out of pocket expenses due to their OCD. The mean cost of out of pocket expenses was £19.19 per week (SD £27.56 SD), range £0.06–£224.00. Future economic evaluations involving participants with OCD should include out of pocket expenses, but careful consideration of alternative approaches to the collection and costing of this data is needed. [ABSTRACT FROM AUTHOR]

Mental illness in people experiencing homelessness is common and a key reason for attendance at emergency departments and admission to hospital. This paper describes how the KHP Pathway homeless team impacted use and cost of health and wider services. The Pathway model had never been adopted by a mental health hospital, and there had never been an economic analysis to evaluate service use before and after intervention. Service use was measured using an adapted version of the Client Service Receipt Inventory (CSRI) with a simple before and after design at admission, 3 months and 6 months after discharge from hospital. During the first 3-month follow-up, over half the participants saw a GP, with an increase in the proportion seeing a psychiatrist, social worker and a mental health nurse. Attendance at emergency departments was substantially lower than at baseline. The mean total service cost was £818 at base line and £414 at 3 months. The adapted version of the CSRI demonstrates that patients seen by the Pathway Homelessness Team were supported to use community and scheduled health and care services. The service overcomes barriers, frequently experienced by people experiencing homelessness, in accessing support and community healthcare in the UK. [ABSTRACT FROM AUTHOR]

Background: This paper examines the introduction and operation of a number of support roles in mental health services. This is done in the context of concerns about the effectiveness of CMHTs. Aims: Three questions are addressed: the degree to which concern for the work of consultant psychiatrists informed the introduction of the new roles; what the reforms implied for the work of the psychiatrist and those in new roles; and the impact of any changes on the operation of CMHTs. Method: Data were collected as part of a national-level evaluation. The main means of collection was the semi-structured interview. Results: The study shows: that reform was underpinned by concerns about the workload of psychiatrists; and that while in principle the responsibilities of the psychiatrist were to be distributed across other team members, those in new roles felt themselves to be isolated. Conclusions: Despite the intentions of policy, the creation of the new roles did little to extend the idea of distributed responsibility in CMHTs. [ABSTRACT FROM AUTHOR]

Background: There are significant challenges across the research pathway, including participant recruitment. This paper aims to explore the impact of clinician recruitment decision-making on sampling for a national mental health survey. Method: Clinical teams in 20 English mental healthcare provider organisations screened caseload lists, opting-out people whom, in their judgement, should not be approached to participate in a survey about stigma and discrimination. The reasons for each individual opted-out were requested. We assess these reasons against study recruitment criteria and investigated the impact of variations in opt-out rates on response rates and study findings. Results: Over 4 years (2009-2012), 37% (28,592 people) of the total eligible sampling frame were excluded. Exclusions comprised three categories: clinical teams did not screen their lists within recruitment period (12,392 people: 44%); protocol-specified exclusions (8364 people: 29%); clinician opt-outs queried by research team (other reasons were given) (7836, 28%). Response rates were influenced by decision-making variations. Conclusions: Large numbers of people were denied the opportunity to choose for themselves whether to participate or not in the Viewpoint Survey. The clinical research community, and their employing organisations, require support to better understand the value of research and best practice for research recruitment. [ABSTRACT FROM AUTHOR]

A commentary on the Mental Health Research Goals paper, emphasising the importance of the involvement of young people at all stages of mental health research pertaining to their demographic. Examples are highlighted from the UKRI Emerging Minds Network's research challenge on the impact of racism on young people's mental health in the UK, which has implications for research on racism and youth mental health specifically but also mental health research generally. [ABSTRACT FROM AUTHOR]

Objectives: The current paper aimed to explore doctor-patients' views about their treatment from the Practitioner Health Programme (PHP), a UK-based service treating health professionals with mental health/addiction problems. Aims were to gain insights into the issues most important to patients and consider whether a service specifically for doctors is important in helping to overcome barriers to accessing mental healthcare. Methods: Nine doctor-patients attending PHP took part in semi-structured interviews between September 2010 and June 2011. Thematic analysis was used to explore recurring patterns in the data. 134 written comments from PHP patients were also included. Results: Participants reported difficulties in finding appropriate treatment; problems were often severe by the time PHP was involved. Concerns about confidentiality, judgement and impact on career were obstacles to help-seeking and important issues during treatment. Analysis of written comments provided further support for these findings. Conclusion: Whilst some of the needs of mentally unwell doctors mirror the needs of patients in general – e.g. a supportive and non-judgemental attitude from clinicians – they do have specific needs related to confidentiality and stigma. [ABSTRACT FROM PUBLISHER]

Background: Psychiatric ward design may make an important contribution to patient outcomes and well-being. However, research is hampered by an inability to assess its effects robustly. This paper reports on a study which deployed innovative methods to capture service user and staff perceptions of ward design. Method: User generated measures of the impact of ward design were developed and tested on four acute adult wards using participatory methodology. Additionally, inpatients took photographs to illustrate their experience of the space in two wards. Data were compared across wards. Results: Satisfactory reliability indices emerged based on both service user and staff responses. Black and minority ethnic (BME) service users and those with a psychosis spectrum diagnosis have more positive views of the ward layout and fixtures. Staff members have more positive views than service users, while priorities of staff and service users differ. Inpatient photographs prioritise hygiene, privacy and control and address symbolic aspects of the ward environment. Conclusions: Participatory and visual methodologies can provide robust tools for an evaluation of the impact of psychiatric ward design on users. [ABSTRACT FROM AUTHOR]

Background: Patient and Public Involvement is now an essential part of health-related research. Evidence suggests that research that involves patients and members of the public can enhance methodological rigor and facilitate the implementation of research findings. Aims: Our paper describes the development of a youth research group (Youth Speak) aimed at increasing youth engagement in mental health research. Method: We provide a selective review of the literature and outline the challenges and benefits of involving young people in research. Examples of how our group has facilitated involvement and the challenges we have encountered are also discussed. Results: Meaningful involvement of young people in mental health research is poorly documented or significantly lacking given the dearth of published literature. This may reflect the difficulty of obtaining sustained funding which is required to facilitate non-tokenistic involvement or a perception that young people are unable to provide meaningful contributions in this area. Conclusions: By establishing groups such as Youth Speak, which focus on the long-term involvement and development of young people in all stages of the research process, we hope to empower young people so that they can reshape youth mental health services. [ABSTRACT FROM AUTHOR]

The author comments on the practice in England of installing closed circuit television (CCTV) on mental health wards and the wearing by nurses of body-worn cameras (BWC) in inpatient mental health settings as a way to prevent or reduce violence and aggression against staff. Topics include studies exploring the effectiveness of modern surveillance methods in reducing violence and aggression and the need of more studies on the therapeutic benefits of CCTV and BWC in mental health settings.

Evidence from treatment trials shows that the most effective pharmacological treatment for Psychotic Major Depression (PMD) is combined antidepressant and antipsychotic pharmacotherapy. This study investigates the use of antidepressant and antipsychotic treatment for PMD in clinical practice and examines how treatment profiles correlate with demographic and clinical symptoms. Anonymised electronic health records of 2,837 individuals with PMD were followed up for 12-months post-diagnosis in a historic open cohort design. The use of antidepressants and antipsychotics, alone or in combination, were described using frequency statistics. Demographic and clinical characteristics associated with each treatment were assessed using logistic regression analyses. Antidepressant and antipsychotic combination pharmacotherapy was the most used treatment for PMD with 69.9% users, compared to antidepressant monotherapy (10.9%) and antipsychotic monotherapy (10.3%). The remaining 8.9% of individuals did not receive antidepressant or antipsychotic treatment. The presence of delusions was strongly associated with the use of antipsychotics, both alone (odds ratio =3.99, 95% confidence intervals = 2.72–5.83, p<.001) and in combination with antidepressants (OR = 2.7, 95% CI = 2.09–3.67, p<.001), rather than antidepressant treatment alone. Combined antidepressant and antipsychotic pharmacotherapy is the most common treatment of PMD in clinical practice, showing that clinical practice is in line with evidence from treatment research. [ABSTRACT FROM AUTHOR]

Although mental health in higher education is increasingly recognised as a public health issue, postgraduate research students are often overlooked. Recent studies indicate a high prevalence of mental distress in this population. This study assesses the experience of doctoral researchers and identifies factors influencing mental wellbeing and perceived stress. A cross-sectional study examined how key demographic, individual and contextual factors related to stress and mental wellbeing in a sample of 431 doctoral researchers in the United Kingdom. Respondents gave positive reports about their supervisory relationship and identified feeling confidently prepared for their work. Family support, good general health, sleep and low levels of self-depreciation predicted stronger mental wellbeing and lower levels of stress. Students who were confident about their future career and felt well prepared for their studies were less stressed and those who were achievement orientated had better mental wellbeing. Focused attention on exploring career options and building confidence may help reduce stress among doctoral researchers. Taking steps to tackle the imposter phenomenon may help further. These could include addressing fear of failure, improving confidence in research ability and clarifying the role of doctoral researchers within the wider academic community. [ABSTRACT FROM AUTHOR]

Little is known about the economic impact of military mental health screening. To investigate (a) whether post-deployment screening of military personnel affects use and cost of services and (b) the impact of psychiatric morbidity on costs. Participants were recruited from UK Royal Marine and Army platoons and randomised to an intervention group (which received tailored advice predicated upon mental health status) or a control group (which received general advice following assessment of mental health status). The intervention costs were calculated while service use and associated costs were assessed at 12-month follow-up. Data were available for 6323 participants. Mean screening cost was £34. Service costs were slightly higher in the control group compared to the intervention group (£1197 vs. £1147) which was not statistically significant (bootstrapped 95%CI, −£363 to £434. In both groups, screening and control, costs were significantly higher for those who screened positive for mental health problems. Costs were not affected by screening. In countries that have already implemented post-deployment screening, the political cost of disinvestment needs careful consideration. Those who develop psychiatric morbidity have substantially higher care costs than those who do not. [ABSTRACT FROM AUTHOR]

There are significant pressures and quality issues in acute adult mental health services in the UK To understand the contribution of psychologists in acute services to patient care and service quality. Forty-nine psychologists with experience in Adult Mental Health Inpatient Services, Crisis Resolution Home Treatment Teams and Liaison Mental Health Services responded to a questionnaire-based survey. The first theme "Direct interventions" identified the value of psychological assessment, formulation and adapted brief interventions. The second theme "Indirect Interventions", viewed psychology as an integral part of the Multi-Disciplinary Team, enabling psychologically informed care, increasing psychological skills in the workforce and supporting staff wellbeing. The third theme outlined a lack of psychological resources in services and limited understanding about their potential benefits. The potential of increased resources to promote psychologically informed cultures, staff wellbeing, and improve patient choice through greater access to psychological treatments was noted. This is the largest UK study of psychologists within acute mental health care, identifying benefits for patients and services. Further research is needed on the impact of psychological interventions on patient outcomes and workforce wellbeing. [ABSTRACT FROM AUTHOR]

Meeting psychological needs for autonomy, competence and relatedness as described by Self-Determination Theory (SDT) has been associated with increased well-being and job satisfaction in mental health staff and improved care outcomes for patients. The study investigated whether psychological need satisfaction predicted stress, turnover intention and job satisfaction in health care assistants (HCA) working in inpatient mental health hospitals in the United Kingdom including full time (FT) and temporary agency worker (TAW) staff. A cross-sectional survey explored need satisfaction between FT (n = 63) and TAW (n = 39) staff using the Work-Related Basic Need Satisfaction Scale. Multiple regression was used to explore whether satisfaction of the needs for autonomy, competence and relatedness predicted scores on measures of stress, job satisfaction and turnover intention. Results were comparable between FT and TAW staff. Autonomy was the need least satisfied, a need which predicted self-reported job satisfaction, stress and turnover intention. Relatedness also predicted job satisfaction and turnover intention. Recommendations are made to explore experiences of (and barriers to) autonomy and relatedness in inpatient HCA staff to target and improve autonomy and relatedness in this workforce. Implications of doing so are considered at a staffing, organisational and patient level. [ABSTRACT FROM AUTHOR]

Mental disorders and alcohol misuse are often comorbid, and this comorbidity is more common in those who develop mental disorders following exposure to traumatic events. To investigate the relationship between combat exposure and operational role (support versus combat) with mental disorders and associated comorbidity in a UK military cohort. 4896 participants from a UK military cohort reported their operational role and frequency of exposure to combat events during deployment. Outcome measures included self-reported post-traumatic stress disorder, common mental disorder and alcohol misuse. Personnel reporting higher levels of combat exposure were more likely to meet criteria for two or more co-occurring mental disorders (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.73–5.58). While having a combat role increased the risk of developing co-occurring disorders compared to having a support role (OR 1.67, 95% CI 1.26–2.23), this effect diminished following adjustment for variables including combat exposure (OR 0.89, 95% CI 0.62–1.27). Combat exposure may play a greater role in the development of comorbid mental disorders than operational role, i.e. job title. Clinicians treating military personnel should be alert to the increased risk of comorbid mental disorders and alcohol misuse among those with a history of combat exposure. [ABSTRACT FROM AUTHOR]

A significant proportion of young British Muslims identify themselves by religious identity rather than ethnicity however very few mental health studies have focused on this cohort. To explore whether young British Muslims' knowledge, awareness and perceptions of mental illness differ to their non-Muslim peers. Population based survey of second generation Muslims (n = 83) and non-Muslims (n = 76) aged 18–35. Anonymised 38-item questionnaire on mental health attitudes, perceptions and help seeking behaviours. Muslims were less likely to correctly identify symptoms of mental illness compared to their non-Muslim peers. Stigma and awareness remains a major issue. A third of Muslims would consider stopping medication on advice of a religious leader. Nearly half of Muslims were more likely to attend a dedicated ethnic/religious mental health service. British Muslim views and attitudes of mental health differ from their non-Muslim counterparts. Services should ensure they are religiously sensitive. [ABSTRACT FROM AUTHOR]

Reservists often have different experiences to regular military personnel which may impact their mental health. To investigate the incidence of mental health problems in both active and veteran reservists and determine how this compares to regular service personnel and ex-regular veterans. Five studies which included reservist and/or veteran participants, a validated assessment of mental health problems, and provided primary data were included in the synthesis. Common mental health disorders, post-traumatic stress disorder and alcohol use disorder were examined. Nondeployed mobilized reservists were significantly less likely to report common mental health disorders than nondeployed regulars. There were no other significant differences between groups. Regardless deployed reservists reported more mental health problems than nondeployed reservists. Similarly, ex-regular deployed veterans were more likely to experience mental health difficulties than nondeployed ex-regular veterans. Notably, a large proportion of non-deployed reservists reported probable alcohol use disorders, indicating that problematic alcohol consumption may not be due to deployment in this group. These results highlight the need for ongoing support for military regular, ex-regular and reservist personnel. Additional research is needed to examine potential risk and protective factors for mental health problems in both deployed and nondeployed reservists. Overall, mobilized deployed reservists were more likely to experience mental health problems than non-deployed reservists. Nondeployed regulars reported significantly more common mental health problems than nondeployed mobilized reservists. Reservists and (ex-)regulars reported similar rates of PTSD. This suggests reservists are vulnerable to developing PTSD following non-combat related trauma that may not lead to PTSD in regulars and this warrants future research. Reservists were less likely to report problematic alcohol consumption compared to regular personnel and ex-regular veterans. The greatest amount of reservist problematic drinking was reported in non-deployed veteran reservists. This indicates problematic alcohol consumption is not deployment related in this group and highlights the need for ongoing formal support for alcohol use disorders in the UK Armed Forces. [ABSTRACT FROM AUTHOR]

Research to date suggests older adults prefer a passive involvement in the clinical decision-making process; however, the empirical evidence underlying this claim in the mental health context is yet to be reviewed systematically. To understand whether older adults desire involvement in mental health-related clinical decisions. A systematic review was conducted to identify primary research that explored mental-health decision-making preferences of people with a mean age of over 55 from January 1990 through to December 2018. Three independent studies of varying design and quality were included. Study settings were in the USA, Germany, and the UK. A preference for shared decision-making was seen in two studies, while a preference for active decision-making was identified in one. In contrast to other reviews on clinical decision-making, this review focused on mental health-related decisions of older adults. The evidence suggests older adults desire involvement in mental health-related clinical decisions. Given the political drive to empower patients and the need to ensure evidence-based clinical practice, more high-quality research regarding the shared decision-making preferences and outcomes of older adults with mental ill-health is needed. Systematic Review Registration PROSPERO: CRD42018102009 [ABSTRACT FROM AUTHOR]

The press' representation of mental illness often includes images of people as dangerous, and there is evidence that this contributes to stigmatising understandings about mental illness. Little is known about how newspapers portray mental health on their Twitter feeds. To explore the representation of mental health in the UK national press' Twitter feeds. Content analysis was used to code the Tweets produced by UK national press in two time periods, 2014 and 2017. Chi-square analysis was used to identify trends. The analysis identified a significant reduction in the proportion of tweets that were characterised as Bad News between 2014 and 2017 (χ2 = 14.476, d.f.=1, p < 0.001) and a significant increase in the tweets characterised as Understanding (χ2 = 9.398, d.f.=1, p = 0.002). However, in 2017, 24% of the tweets were still characterised as Bad News. Readers did not retweet Bad News stories significantly more frequently than they were produced. There is a positive direction of travel in the representations of mental health in the Twitter feeds of the UK press, but the level of Bad News stories remains a concern. [ABSTRACT FROM AUTHOR]

Well-being is a multifaceted construct, and measuring well-being, both within particular groups and at a national level, is a priority for policy and practice. This national agenda on measuring well-being is mirrored in the Higher Education sector. This is the first conceptual review of how well-being is measured among university students in the UK. The aims of the review were to identify (i) the definitions or conceptualisations of well-being guiding the selection of well-being indicators for research within this population and (ii) measures of well-being used in university students in the UK. A scoping review method was used. Twenty-eight validated indicators used to measure well-being in UK students were identified. While many were direct measures of (primarily mental or psychological) well-being, indirect "proxy" indicators, including measures of mental health symptoms, were identified. This review has highlighted that there are inconsistencies in defining and measuring university student well-being, and the measures that have been used in this population are focused on subjective experience. These findings are in line with reviews of well-being measures in the general population. Implications for further research are discussed. [ABSTRACT FROM AUTHOR]

People with existing mental health conditions may be particularly vulnerable to the psychological effect of the COVID-19 pandemic. But their positive and negative appraisals, and coping behaviour could prevent or ameliorate future problems. To explore the emotional experiences, thought processes and coping behaviours of people with existing mental health problems and carers living through the pandemic. UK participants who identified as a mental health service user (N18), a carer (N5) or both (N8) participated in 30-minute semi-structured remote interviews (31 March 2020 to 9 April 2020). The interviews investigated the effects of social distancing and self-isolation on mental health and the ways in which people were coping. Data were analysed using a framework analysis. Three service user researchers charted data into a framework matrix (consisting of three broad categories: "emotional responses", "thoughts" and "behaviours") and then used an inductive process to capture other contextual themes. Common emotional responses were fear, sadness and anger but despite negative emotions and uncertainty appraisals, participants described efforts to cope and maintain their mental wellbeing. This emphasised an increased reliance on technology, which enabled social contact and occupational or leisure activities. Participants also spoke about the importance of continued and adapted mental health service provision, and the advantages and disadvantages associated with changes in their living environment, life schedule and social interactions. This study builds on a growing number of qualitative accounts of how mental health service users and carers experienced and coped with extreme social distancing measures early in the COVID-19 pandemic. Rather than a state of helplessness this study contains a clear message of resourcefulness and resilience in the context of fear and uncertainty. [ABSTRACT FROM AUTHOR]

The COVID-19 outbreak raised questions about how people experience their mental health, quality of life (QoL), wellbeing and loneliness in the context of social distancing, and the use of social media during this time To examine the experience of mental health, QoL, wellbeing and loneliness and use of social media among people living in Norway, USA, UK and Australia. A cross-country comparative survey of people living in Norway, USA, UK and Australia. Relevant statistical analyses were used to examine differences between the countries and to explore associations between demographic, mental health and psychosocial variables and use of social media. There were 3810 respondents from four countries, of which 50 − 74% showed a high level of emotional distress. The Norwegian population reported significantly better mental health, QoL and wellbeing and lower levels of loneliness compared to the other countries. High-frequent use of social media after the COVID-19 outbreak was associated with poorer mental- and psychosocial health. The results suggest that the COVID-19 outbreak took a toll on people's experience of mental health, QoL, wellbeing and experienced loneliness, and high-frequent use of social media was associated with these factors. [ABSTRACT FROM AUTHOR]

Diagnoses are controversial but ubiquitous in mental health; however, whether they are essential features of service entry has not been analysed. To investigate the use of diagnosis in the service entry criteria of UK NHS adult mental health services. Freedom of Information requests were made to 17 NHS adult mental health Trusts; responses were analysed thematically. Four service types were identified: broadly diagnostic, problem-specific, supporting specific life circumstances and needs-led. Diagnoses were used frequently but not universally. Non-diagnostic factors were central to service entry criteria. Diagnoses were neither necessary nor sufficient in-service entry criteria. Broad clusters of difficulties were used rather than specific diagnoses. Extensive exceptions revealed diagnoses as inefficient proxies for risk, severity and need. Differences across criteria appeared largely driven by professional competencies. Implications for innovative care pathways include preventative services and working with psychosocial factors. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that most psychiatric patients do not receive a thorough physical examination (PE). Aim: To explore factors contributing to the underperformance of the PE on psychiatric patients. Method: All psychiatrists in the UK who were registered or affiliated to the Royal College of Psychiatrists were invited to complete an online survey regarding their attitudes towards PEs in psychiatry. Results: Responses from 15% of the psychiatrists showed that most (89%) believe that the PE is important. The majority (61%) indicated that their PE skills had diminished since working in psychiatry and this was reported more by senior psychiatrists than junior trainees (64% vs. 49%). Most respondents considered that the PE should not be done by another type of health professional (45% vs. 28%). Conclusions: Likely reasons for poor performance of PEs include shortage of time and equipment, challenges associated with agitated and uncooperative patients, the perceived incongruence of the PE with the patient's presenting symptoms and a degree of skill atrophy, especially in senior psychiatrists which is leading to lack of supervision of junior trainees in this area. Further research is needed to investigate if strategies addressing these factors would improve the standard of PEs on psychiatric patients. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various topics within the issue, including college student mental health, mental health research, depression, and social support.

Background: Unaccompanied refugee minors present with disproportionately high prevalence of emotional and psychological morbidities. However, their utilization of mental health services has been shown to be significantly poorer than the indigenous population of the country they seek asylum in. Despite this, there is limited research exploring their perspectives on the barriers they face. Aims: This research aims to understand unaccompanied refugee minors' and their carers' perceptions of the barriers to utilize mental health services and to explore issues perceived to be related to poor engagement with services. Methods: Semi-structured interviews with 15 unaccompanied refugee minors and their carers were conducted. This was to elicit their views, perceptions and beliefs based on their experience of receiving treatment from a specialist mental health service in the UK. Results: Thematic analysis was used and the findings were categorised into two broad themes; the participants' perceptions of the intervention and perceptions of the professionals. Salient aspects of these are discussed. Conclusions: The findings have potential to stimulate further research into gaining a better understanding of the barriers these young people face in accessing help, and may contribute to developing services that are more efficient in engaging this vulnerable group and meeting their specific needs. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health (PMH) problems are a major public health concern because they may impair parenting ability which potentially has an immediate and long-term impact on the physical, cognitive and emotional health of the child. Aims: We evaluated a Perinatal Support Service (PSS) which supports positive attachment between mothers with PMH problems and their child, to evidence its impact on maternal mental health and maternal-infant interaction. Method: Using a mixed-methods approach, anonymised pre- and post-service outcomes data from 123 clients, 14 interviews and a focus group discussion were analysed. Results: We found significant improvement in anxiety (t (55) = 6.96, p < 0.01, 95% CI [3.15, 5.70]), and depression (t (55) = 6.58, p < 0.01, 95% CI [3.03, 5.68]) on the HADS, and on the GAD-7 (t (12) = 4.541, p = 0.001, 95% CI [3.48, 9.90]) after the PSS. Anxiety post service (M = 9.08, SD = 4.96) was lower than baseline anxiety (M = 15.77, SD = 4.68). Receiving emotional and practical support contributed to improvements in mental health and mother–child interaction. Conclusion: Given the paucity of PMH services in the UK, it is imperative that services such as the PSS continue to receive funding to address unmet PMH needs. [ABSTRACT FROM AUTHOR]

Background: This study attempted to ascertain whether people had better mental vs physical health literacy by comparing their knowledge of six conditions. Aims: The aim was to link two different literatures which have remained apart. Methods: In all, 186 young British participants (52% male) with an average age of 25 years completed an online questionnaire describing six vignettes characters. Three described mental health conditions (anorexia, bipolar disorder and schizophrenia) and three physical health conditions (asthma, diabetes and osteoarthritis). Participants were required to name the illness and rate how treatable and manageable they believed the condition is. They were also asked to rate how much the problem would affect an individual's daily life and suggest whether the individual should seek professional help. Results: The recognition of specific mental health conditions (anorexia, borderline personality disorder, schizophrenia) was marginally higher than the recognition of physical health conditions (arthritis, asthma, diabetes). Ratings about treatment and the effect of each illness showed considerable variation. Conclusion: The results suggest that people are equally and relatively poorly informed about relatively common mental compared to physical illnesses. [ABSTRACT FROM AUTHOR]

Background: Early identification of probable post-traumatic stress disorder (PTSD) can lead to early intervention and treatment. Aims: This study aimed to evaluate supervised machine learning (ML) classifiers for the identification of probable PTSD in those who are serving, or have recently served in the United Kingdom (UK) Armed Forces. Methods: Supervised ML classification techniques were applied to a military cohort of 13,690 serving and ex-serving UK Armed Forces personnel to identify probable PTSD based on self-reported service exposures and a range of validated self-report measures. Data were collected between 2004 and 2009. Results: The predictive performance of supervised ML classifiers to detect cases of probable PTSD were encouraging when compared to a validated measure, demonstrating a capability of supervised ML to detect the cases of probable PTSD. It was possible to identify which variables contributed to the performance, including alcohol misuse, gender and deployment status. A satisfactory sensitivity was obtained across a range of supervised ML classifiers, but sensitivity was low, indicating a potential for false negative diagnoses. Conclusions: Detection of probable PTSD based on self-reported measurement data is feasible, may greatly reduce the burden on public health and improve operational efficiencies by enabling early intervention, before manifestation of symptoms. [ABSTRACT FROM AUTHOR]

Background: Uncertainty remains as to whether the effects of debt on common mental disorder (CMD) are persistent over time and what impact it has on mental health service use (MHSU). Aims: To determine the distribution of debt across sociodemographic and socioeconomic statuses; to examine whether debt influences CMD recovery over time; and to determine the effects of episodic and/or long-term debt and CMD on MHSU outcomes. Methods: Data were collected from phase 1 (N = 1698) and phase 2 (N = 1052) of the South East London Community Health (SELCoH) study, a population-based survey. Results: 37.2% of participants who reported debt at SELCoH 1 and 46.6% at SELCoH 2 experienced concurrent CMD. Those with concurrent exposure to debt and CMD at SELCoH 1 were at greater risk of CMD at SELCoH 2. Debt accumulation was strongly associated with CMD cross-sectionally; however, this somewhat dissipated over time. Reporting any debt at SELCoH 2 or debt at both time-points were strongly associated with MHSU in the past year in the fully adjusted model adjusting for prior mental health. Conclusions: More focus is needed on concurrent exposure to debt and CMD with regards to subsequent psychological impact and consequences for MHSU. [ABSTRACT FROM AUTHOR]

Background: The British Psychological Society proposes that clinical psychologists are well placed to move beyond psychiatric diagnoses and develop alternative practices. Aims: This study sought to explore what the application of these guiding principles looks like in clinical practice, the challenges faced and possible routes forward. Methods: A purpose-designed survey was completed by 305 respondents and a thematic analysis completed. Results: Thematic analysis was used to identify five superordinate themes relating to individuals, relational, others, structures and society, comprising of a total of 21 group themes. The presented group themes highlight an array of approaches to practicing beyond diagnosis and factors that help and hinder such action; from scaffolding change, becoming leaders, relating to the multi-disciplinary team, restructuring services and the processes of change. A key concept was “playing the diagnostic game”. Conclusions: “Playing the diagnostic game” enables psychologists to manage an array of tensions and anxieties: conflicts between belief and practice, relationships with colleagues, and dilemmas of position and power. It also potentially limits a concerted questioning of diagnosis and consideration of alternatives. An alternative conceptual framework for non-diagnostic practice is needed to aid the collective efforts of clinical psychologists developing their practice beyond diagnosis, some of which have been highlighted in this study. Until then, ways of mitigating the perceived threats to questioning diagnosis need further exploration, theorising and backing. [ABSTRACT FROM AUTHOR]

Background: Student mental health is a global issue. Macaskill reported that the second year was associated with the most significant increases in psychiatric symptoms in UK students. Qualitative data were collected to explore this further. Method: Twenty-three second-year undergraduate students were interviewed using a narrative interviewing method to explore their experience of their second year of study. They also completed the General Health Questionnaire-28. Students were grouped according to their psychiatric caseness scores, giving two groups, a well group with scores ≤5 and a clinical case group with scores ≥6 and their interview data were compared. Results: Using thematic analysis, various themes and subthemes were identified. While both groups identified the same issues namely, the first-year concerns impacting on the second year, course issues, careers and future employability and student debt, the groups reported very different coping styles. Conclusion: There were shared anxieties across both groups. The majority related to institutional practices and the unintended impact they may be having on student mental health. While specialist interventions would help the clinical caseness group, arguably the anxiety levels of both groups would benefit equally from relatively easy to implement, inexpensive institutional changes and/or additions to current practices in universities. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various reports in the issue on the topics including one on public concern for mental health, other on psychodynamic therapy, and the third on increased tuition fees.

Background: This study looked at the relationship between “bright-side” and “dark-side” personality variables by focusing on the controversial trait ofPassive-Aggressiveness. Around 4800 British adults completed the NEO-PI-R which measures the Big Five Personality factors at the Domain and the Facet level, as well as the Hogan Development Survey (HDS) which has a measure of Passive-Aggressiveness called Leisurely. Aim: To determine to what extent the well-established Big Five traits measured at both domain and facet level can account for the variance in a measure of passive-aggressiveness. Findings: Correlations and regressions indicated that Leisurely individuals are introverted, closed-minded Neurotics, with particular needs for order and deliberation. Neuroticism facets accounted for most of the variance. Overall, the Big Five measured at Domain and Facet level accounted for relatively small amounts of variance, suggesting the divergent validity of this measure of PAPD. Conclusions: This scale measures something that is not captured by comprehensive taxonomies of personality. Limitations and implications for clinical practice are noted. [ABSTRACT FROM PUBLISHER]

Background: Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches. Aims: (1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme. Method: ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention. Results: The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measuret-tests demonstrated significant decrease in distress (p < 0.0005) and significant increase in confidence in self-management of mental health (p < 0.0005). Conclusion: Evaluation shows that ISP can be delivered in routine care in an acute mental health service and results in improvement in self management skills and facilitation of recovery. [ABSTRACT FROM PUBLISHER]

Background: Improving Access to Psychological Therapies (IAPT) was introduced in the United Kingdom in 2006 to provide more effective and efficient services to people experiencing mild to moderate mental ill health. The model represents a paradigm shift in how we provide psychological care to large populations. Aims: We wanted to document how the IAPT program impacted on patients' understanding of their mental health, and mental health treatment. Methods: We used Foucauldian Discourse Analysis to analyze six semi-structured research interviews with patients from one IAPT service in a major UK city. Results: Participants constructed their mental health problems as individual pathologies. Constructions of mental health and of treatment evidenced the privileging of personal responsibility and social productivity over dependency on others and the state. Conclusions: Services are functioning well for some. The role of IAPT in pathologizing those who are dependent on people and services requires further commentary and action. [ABSTRACT FROM AUTHOR]

Background: UK social firms are under-researched but are a potentially important vocational option for people with mental health problems. Aims: To describe the clinical profile, satisfaction levels and experiences of social firms employees with mental health problems. Method: Clinical, work and service use characteristics were collected from social firms' employees with mental health problems in England and Wales. Workplace experience and satisfaction were explored qualitatively. Results: Predominantly, social firms' employees (N = 80) report that they have a diagnosis of depression (56%) and anxiety (41%). People with schizophrenia (20%) or bipolar disorder (5%) were a minority. Respondents had low symptom and disability levels, high quality of life and job satisfaction and experienced reductions in secondary mental health service use over time. High-workplace satisfaction was related to flexibility, manager and colleague support and workplace accommodations. Conclusions: The clinical profile, quality of life and job satisfaction level of employees with mental health problems suggest social firms could be a useful addition to UK vocational services for some people. Current employees mainly have common mental disorders, and social firms will need to shift their focus if they are to form a substantial pathway for the vocational recovery of people currently using community mental health teams. [ABSTRACT FROM AUTHOR]

Background: Individual placement and support (IPS) is an effective form of supported employment for people with severe mental illness. Little is known about service users' experiences of these programmes during economic recession. Aims: Obtain service users' views of an IPS programme implemented in the UK during recession. Method: Thirty-one service users enrolled in an IPS programme were interviewed using a semi-structured protocol. The questions covered several areas of their experience, including problems faced in seeking work, perceived barriers in returning to work and what they found helpful in employment support. Results: Unsurprisingly, a large number of service users had problems in finding work due to the number of appropriate jobs available. Nevertheless, many service users felt positively about the support they had received (90% were satisfied with IPS), and would advise others in their position to seek employment. Personal and practical support from employment specialists (ES) was the most useful aspect of the service. Conclusions: Despite economic recession, an IPS service was implemented and regarded as satisfactory to service users seeking work. Although many found obtaining employment difficult, they would still advise others that work is worthwhile, suggesting that the context of recession has not discouraged them. [ABSTRACT FROM AUTHOR]