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Objectives: The objective of this study is to explore what ageing well means to older adults with bipolar disorder. Methods: Older adults with bipolar disorder took photographs of aspects of their lives that they felt represented ageing well. They then completed audio‐recorded photo elicitation interviews to explore what it meant to age well with bipolar disorder in detail. Data were analysed using reflexive thematic analysis. Results: Seventeen participants met the criteria for bipolar disorder I or II. The analysis resulted in four key themes to ageing well with bipolar disorder: (1) Lifelong learning – referring to how participants accumulated a wealth of knowledge about bipolar disorder and used this to maintain stability in later life; (2) Finding where you belong – relating to how participants prioritised finding new communities, utilised family support and refined their support networks over time to age well; (3) Recognising your value and worth – which involved participants using their strengths and experiences to support others; and (4) Continuity of support – older adults with bipolar disorder highlighted the benefits of continuous support that allowed them to be actively involved in their treatment. Conclusions: Participants ageing with bipolar disorder identified unique challenges indicating that services require adaptation to meet their needs and support them to age well. Findings suggested that services should provide continuous care that allows this group to actively engage with their treatment, build upon their strengths, and develop meaningful connections with professionals and peers. This approach may enhance support for older adults with bipolar disorder and reduce the inequalities they experience. [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: Friends and family members can be important sources of support for people who are or have been suicidal. This review aimed to synthesise qualitative evidence regarding carers' perspectives of supporting someone who has experienced suicidal behaviour. Methods: Five electronic databases (Web of Science, CINAHL, PsychINFO, MEDLINE, and SocINDEX) were searched from inception to May 2022. Eligible qualitative studies were published in English and investigated the caring experiences of friends or family members of people who had experienced suicidal behaviour, defined as any form of suicidal ideation and/or attempts. Studies focused on non‐suicidal self‐injury or suicide bereavement were excluded. Data from 19 eligible studies were analysed using thematic synthesis. Results: Initial carer reactions to suicidal behaviour included profound anxiety and intensive monitoring for signs of increased suicide risk amongst those they supported. Carers also reported significant challenges with understanding how to provide effective interpersonal support following suicidal crises. Professional support was perceived to be most effective when provided in a timely, interpersonally sensitive and safety‐focused manner. However, several studies detailed carers' difficulties accessing appropriate support and challenges managing their own distress. Conclusions: Carers face significant challenges with knowing how to respond to suicidal behaviour, where to find appropriate help, and how to manage their own distress. Future research should seek to investigate the effectiveness of easily accessible methods of information provision and support tailored for carers of people who have experienced suicidal behaviour. [ABSTRACT FROM AUTHOR]

Objectives In the United Kingdom ( UK), the government has set out priorities to support relatives and carers. Despite this, many relatives of people experiencing psychosis continue to feel unsupported by mental health services. This may be due to lack of funding, high caseloads for mental health professionals, or due to a lack of understanding of what relatives experience as a result of their family member's psychosis. This research aimed to explore relatives' experiences of supporting a relative in early psychosis. Design Thematic analysis was used to conduct an in-depth study of relatives' experiences of supporting a family member in early psychosis. Methods Eligible individuals were recruited via local National Health Service Early Intervention Teams and other carer support agencies. Four focus groups were conducted, each with a range of five to seven participants. Results Four key themes 'reflecting relatives' understanding and management of psychosis were identified: 'Psychosis from the relatives' perspective'; 'Relatives' fight with the mental health 'system'; 'Is anybody listening? Does anyone understand?'; and 'Relatives' coping'. Clinical implications of these themes are discussed. Conclusions This study has clear implications for improvement in how relatives are supported in the United Kingdom, such as; clearer guidance for staff about confidentiality, treating relatives as partners in care and providing better quality information for relatives. Practitioner points Continue to improve the Care Plan Approach process to include relatives as partners in care., Information available about psychosis needs to be clear and, where possible, clarify the processes and protocols by which services operate and how to access appropriate help., Move away from simplistic rules about confidentiality and formalise procedures to allow relatives and carers access to the information they need, without impeding service users' rights. For example, providing additional training for professionals such as Rethink's 'Carers and Confidentiality' online resource ()., Improved support, supervision and training are needed for staff to deal with relatives' distress and the impact of psychosis., Relatives' experiences of services is more positive in specialist Early Interventions Services for psychosis, than in other health service teams. [ABSTRACT FROM AUTHOR]

Objective. Expressed emotion (EE) refers to the emotional climate within a family. High EE significantly increases the risk of relapse in people with psychosis. The focus of research to date has largely been on understanding mechanisms underlying high EE. A greater understanding of low EE would help guide family interventions to build strengths within the family. The aim of this study was to understand how low EE relatives respond to having a close family member with psychosis. Design. A subsample of eight low EE relatives, from a larger study investigating relatives' adaptation to recent onset psychosis, was interviewed. Transcripts were analysed following the principles of interpretive phenomenological analysis (IPA). Method. Semi-structured interviews were carried out with each relative covering broad areas of their experience, including their awareness of the development of mental health problems and relationship with their relative. Results. Four core themes emerged: witnessing the distress; empathy through acceptance and understanding; a broad range of coping strategies to reduce distress; and realistic optimism for the future. Conclusions. The study highlights that, although relatives described distressing experiences and feelings of frustration and anger, they showed empathy and commitment to support the person. They demonstrated psychological mindedness about the psychosis and related behaviours, had developed coping strategies, and had adjusted their expectations for the future. Further research is warranted to investigate the findings in larger samples, with a view to informing the development of more effective ways of supporting families. Practitioner Points When working with low EE families practitioners should recognize that, despite the low EE rating, these relatives may have witnessed distressing and frightening experiences., Practitioners should support relatives to develop a cognitive model to understand the illness, including illness identity, cause and consequences, with particular attention paid to the illness appraisals., Family interventions may helpfully focus on working with relatives to develop proactive coping strategies and move towards a recovery-focused model of the illness with realistic expectations for the future. [ABSTRACT FROM AUTHOR]

Objectives Design Methods Results Conclusions Higher education students experience elevated levels of suicidal ideation, but often face barriers in accessing support. The Mental Imagery for Suicidality in Students Trial (MISST; ISRCTN13621293; NCT05296538) tested the feasibility and acceptability of a six‐session imagery‐based approach called Broad‐Minded Affective Coping (BMAC). This qualitative evaluation explored the experiences of MISST participants and staff.A qualitative study using one‐to‐one qualitative interviews with participants and staff recruited from MISST. Reflexive thematic analysis was used to explore trial participant and staff experiences to inform a future definitive trial.Student participants (n = 16), research assistants (n = 4) and the trial therapist (n = 1) were interviewed and transcripts analysed using reflexive thematic analysis.Four key themes were identified. The first theme highlights the value and challenges for students in talking about suicide. The ways in which communication and rapport can be built to facilitate this conversation are explored in theme 2. Theme 3 explains how working with the BMAC therapist increased participants’ awareness of their current mood, drew their attention to positive moments in their lives and helped them to actively recall these moments to interrupt negative cycles of rumination and suicidal ideation. The extent to which the BMAC is ‘fit for purpose’ is outlined in theme 4, generating specific recommendations for future intervention development.The BMAC offers a positive, time‐limited, structured intervention that is well suited to meet the needs of higher education students experiencing suicidal ideation. Further research is needed to test the effectiveness on mental health and suicide‐related outcomes. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Stephen Pilling on the rationale and process for the development of clinical guidelines for mental health and another by Mark Barkham and Glenys Parry on the appropriateness of the evidence used to guide the development of clinical guidelines.