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Objective. Recovery from psychosis has been greatly studied, especially in relation to outcome. However, it is still a poorly defined concept and there has been minimal impact of service user definitions of recovery. It is a term that is being increasingly used in relation to mental health policies and guidelines; hence it is important to ensure that recovery is well defined and guided by service users' experience of recovery. Therefore, the aim of this study was to examine what factors are important to service users in recovery from psychosis. Design. A Q-method approach was adopted to allow a wide qualitative exploration of recovery. Method. An opportunity sample ( N= 40) was recruited, aged between 18 and 65, who experienced symptoms of psychosis for at least 1 year within mental health services in the North West of England. Results. Analysis revealed four distinct perspectives in relation to recovery from psychosis. The first placed importance on collaborative support and understanding, the second on emotional change through social and medical support, the third group emphasized regaining functional and occupational goals, and the last group identified self-focused recovery as being important factors. Conclusions. Although recovery from psychosis may have common elements, there are a number of idiosyncratic perspectives that should be taken into account when conceptualizing recovery and this should be reflected in service provision. Practitioner Points • This paper provides insight into the idiosyncratic nature of recovery and provides clarity to the current understanding of the concept. • It outlines distinct recovery styles and explores their clinical implications. [ABSTRACT FROM AUTHOR]

Objectives: Suicide is a leading cause of death worldwide. People experiencing psychosis are at increased risk of death by suicide. Talking therapies can alleviate suicidal thoughts, plans, and attempts. Therapies need to also be acceptable to recipients. The aim of this study was to investigate the views on psychological therapy for people experiencing psychosis and suicidality using the Theoretical Framework of Acceptability. Design: Qualitative interview study. Methods: Participants were recruited from a randomised controlled trial comparing suicide prevention psychological therapy with treatment as usual. Individuals had a diagnosis of non‐affective psychosis and experience of suicidal thoughts, plans and/or attempts. To assess the acceptability of the therapy, semi‐structured interviews were conducted with 20 participants randomised to receive therapy. Data were deductively analysed using an adaptation of the Theoretical Framework of Acceptability. Results: Interviews (Mean = 45 min) were conducted and audio recorded with 21 participants. Data were organised into six themes: 1. Affective attitude, 2. Burden, 3. Alliance, 4. Intervention coherence, 5. Perceived effectiveness, and 6. Self‐efficacy. There was no evidence of issues relating to domains of ethicality and opportunity costs associated with receiving therapy. Conclusions: Talking about suicide was difficult and, at times, distressing, but it was perceived to be useful for understanding experiences. To be acceptable, it is important for therapists to ensure that clients' understanding of therapy aligns with expectations of effectiveness and to invest in building strong therapeutic alliances. Future research will benefit from examining therapists' experiences of delivering therapy through different modes (e.g. online, telephone). [ABSTRACT FROM AUTHOR]

Purpose: To investigate the clinical perspectives and experiences of therapists when engaging in direct dialogue with auditory hallucinations. Method: Therapist accounts were explored via a qualitative study nested within a pilot randomized controlled trial of a novel intervention for supporting distressed voice‐hearers (Talking with Voices). Five therapists were involved, none of whom had substantive previous experience of the technique. All agreed to take part in two semi‐structured, in‐depth interviews which were arranged prior to delivering therapy and again after therapists had experience of conducting dialogues. Data were analysed using inductive thematic analysis. Results: Participants described their impressions of seeking to improve the relationship between voice(s) and voice‐hearer using dialogue. The findings are organized within three main themes and associated subthemes: (1) Commitment to delivery (professional values, mentorship, professional growth); (2) Communication and collaboration (therapeutic alliance, relationships with voices, managing clinical perceptions); and (3) Challenges of delivery (client/voice engagement, impact of trauma, systemic issues). A series of recommendations are derived from the findings to support implementation and guide the practice of therapists undertaking dialogue work with clients who hear voices. Conclusion: Despite clinical challenges, therapists also identified professional gains from conducting their work. Their accounts demonstrate that it is possible for practitioners with no previous formal experience to engage in direct communication with voices within a context of appropriate training and supervision. Practitioner points: Therapists with no previous experience of dialogue work can be trained and supported to verbally engage with the voices heard by people experiencing psychosis.Therapeutic alliance and therapist values are important components of successful therapy.Confidence for dialoguing with voices can be increased through drawing on therapist's existing transferable clinical skills.The emotional and practical needs of therapists undertaking such work should be addressed through training and regular group supervision. [ABSTRACT FROM AUTHOR]

Objectives: To assess progress towards improving the administering of electroconvulsive therapy (ECT) in England since an audit covering 2011, 2013, and 2015. The same information was gathered, for 2019, on usage, demographics, consent, and adherence to national guidelines and the Mental Health Act. Design and Methods: Freedom of Information Act requests were sent to 56 National Health Service Trusts. Results: Thirty‐seven trusts (66%) provided data. The gradual decline in the use of ECT in England has levelled off at about 2,500 people per year. There was a 47‐fold difference between the Trusts with the highest and lowest rates per capita. Most recipients are still women (67%) and over 60 (58%). Only one Trust could report how many people received psychological therapy prior to ECT, as required by government (NICE) guidelines. More than a third of ECT (37%) is still given without consent, with 18% of Trusts non‐compliant with legislation concerning second opinions. There were slight declines, compared to a previous audit, in the use of standardized depression scales, down to 30%, and standardized measures of cognitive dysfunction, down to 24%. Only six Trusts provided any data for positive outcomes and seven for adverse effects. None provided data on efficacy or adverse effects beyond the end of treatment. Twelve Trusts used identical sentences to each other, verbatim, in response to one or more questions. Conclusions: Given the apparent failure of current monitoring and accrediting of ECT clinics in England, by the Royal College of Psychiatrists' ECT Accreditation Service (ECTAS), an independent government sponsored review is urgently needed. Practitioner points: Psychologists and other mental health staff should ensure that people are offered evidence‐based psychological treatments before being offered E.C.T.All staff should ensure that patients are fully informed of the high risk of memory loss and the smaller risk of cardiovascular failure and mortality.Individuals receiving ECT should be closely monitored for adverse cognitive effects, and treatment immediately terminated if these become apparent.Because of increased risk of memory loss for women and older people, the use of ECT should be kept to a minimum and avoided where possible, with these two groups. [ABSTRACT FROM AUTHOR]

Objectives There is consensus that empowerment is key to recovery from mental health problems, enabling a person to take charge of their life and make informed choices and decisions about their life. However, little is known about the mechanisms through which empowerment affects mental health in young people. The current study involved young people aged 16-29 years and examined empowerment as a potential mediator of the relationship between psychological factors (psychosocial, cognition, coping, and control) and mental health, well-being, and recovery from personal problems. Methods A cross-sectional, Internet-based questionnaire study recruited 423 young people aged between 16 and 29 attending universities in England ( n = 336) and Ireland ( n = 87). Psychological factors, mental well-being, empowerment, and recovery from personal problems were measured using self-report measures. Results Mediation analysis in both the single and one over-arching mediator models revealed that empowerment mediates the relationship between psychological factors (psychosocial, self-efficacy, thinking style, coping, and control) and mental health, well-being, and recovery from general life problems. Conclusions This study demonstrates the importance of empowerment, showing that it mediates the relationship between psychological processes and mental health, well-being, and recovery in young people. Clinical implications for working with young people within mental health services, and facilitating their empowerment are discussed. Practitioner points Empowerment is currently a poorly defined concept. This study demonstrates how empowerment mediates the relationship between psychological processes and mental health, well-being, and recovery in young people., Clinicians working with young people might benefit from a structured means of understanding and assessing the different ways in which individuals manage their thinking styles., Empowerment in young people is influenced by the manner in which clinicians facilitate them in establishing social networks in support of employment, education, family/social relations and to encourage young people to take an assertive role in their own care. [ABSTRACT FROM AUTHOR]