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Watchful waiting is a concept that is traditionally not associated with severe and enduring mental illness. This paper, however, boldly argues that the concept could be used as a ground‐breaking and accessible antidote to the perceived inequality experienced by black service users experiencing both mild and severe mental illnesses in England. The novel concepts proposed in this paper are not intended to be consensual, but rather uncompromising to provoke critical thinking in mental health practice. A conceptual framework for watchful waiting in mental health is suggested. [ABSTRACT FROM AUTHOR]

Increasing frailty or a medical crisis threatens older people's autonomy. Further threats may arise from adult children if such changes or events are perceived as permitting or signalling a need to assume greater control over their parent's life. In the context of reablement—a time‐limited intervention seeking to help older people regain their confidence and ability to live as independently as possible—this is observed in cases where adult children resist, or seek to sabotage, reablement. This runs counter to the notion of family being a valuable resource and partner to reablement services in achieving the desired outcomes. Notions of autonomy and legitimate authority, which often co‐occur in care relationships, provide a useful lens to understand this phenomenon. The aims of this study were to explore reablement staff's accounts of the ways adult children seek to assume control over their parents' reablement, and how they manage such situations. We undertook a secondary analysis of a qualitative dataset comprising transcripts of 11 focus groups with staff (n = 78) in five reablement services in England and Wales conducted for the purposes of a study investigating the factors affecting older people's engagement with reablement. Staff's accounts included descriptions of the different ways adult children can seek to exert control over the reablement process. Staff believed that, when aware this was happening, older people ceded control to their child(ren) because preserving the relationship with their child(ren) was a greater priority than maximising their independence. Staff's descriptions of the different strategies they used to protect family relationships whilst supporting the older person's autonomy shed light on the skills reablement staff require. Findings support person‐centred approaches to reablement which understand and respond to the wider family context. They also point to possible limitations or gaps in workforce training and supervision. [ABSTRACT FROM AUTHOR]

Background: Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals' exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a result of 'evidence biased' medicine.Main Text: This paper explores the research regulation provisions for proxy decision making for those unable to provide informed consent for themselves, and the subsequent legal and practical difficulties for decision-makers. There are two separate regulatory regimes governing research involving adults who lack capacity to consent in England and Wales. The Mental Capacity Act 2005 governs how incapacitated adults can be involved in research, however clinical trials of medicinal products are separately regulated by the Medicines for Human Use (Clinical Trials) Regulations 2004. There are significant differences under these dual regimes in the provisions for those lacking capacity to participate in medical research. The level of risk permitted differs, with a greater requirement for justification for participation in a clinical trial than other types of research. Who acts as proxy decision maker, how much information is provided to the person lacking capacity, and whether they retain the power of veto also significantly differs.Conclusion: The development of two separate regulatory regimes has resulted in significant differences between the provisions for clinical trials and other forms of research, and from usual medical practice. The resulting uncertainty has reinforced the tendency of those approving and conducting research to exclude adults lacking capacity to avoid difficult decisions about seeking consent for their participation. Future developments, such as the incoming EU Regulations, may address some of these differences, however the justification and level of risk permitted requires review to ensure that requirements are appropriate and proportionate to the burdens and risks for the individual, and also to the benefits for the wider population represented. [ABSTRACT FROM AUTHOR]

Background: More people are dying at home with dementia and Alzheimer's disease. While informal caregivers are the main providers of care for people with dementia dying at home, they require support from health and social care services. However, little is known about how they experience these services. Aim: To explore informal caregivers' views and experiences of health and social care services when looking after a person with dementia at home at the end-of-life. Design: A qualitative interview study. Data were analysed using thematic analysis. Setting/Participants: Twenty-nine bereaved informal caregivers who had looked after a person with dementia at home during the last 6 months of life. Results: Specialist palliative care for people with dementia dying at home is rare and care is mostly managed by General Practitioners and domiciliary care workers. Four overarching themes were identified: Poor continuity of care; Lack of expertise; Limited advance care planning; and Loss of autonomy. Conclusions: End-of-life care at home for people with dementia must be proactively planned with an emphasis on advance care planning. Policy makers should recognise the critical role of domiciliary care services in end-of-life care and ensure that they are adequately qualified and trained. [ABSTRACT FROM AUTHOR]

Transition to a care home often follows a hospital admission and can be distressing. Care home settings play an important role in the care of many people at the end of life. This longitudinal study employed a narrative approach, aiming to explore the perspectives of older care home residents on transitions to, and life and death within, care homes. Five participants, aged 85 years and over, were recruited from two privately owned care homes in the South-West of England. All participants had a diagnosis of an advanced progressive condition (excluding advanced dementia), or were thought to be frail. Longitudinal interviews (19 in total) were conducted over a ten-month period. A structural narrative analysis was performed and participants' narratives are presented under three headings, with one participant's story chosen to illustrate each narrative type: 'becoming a care home resident', 'living in a care home' and 'death and dying'. Findings revealed that care home residents experience a loss of autonomy and a lack of agency; they are often excluded from decision-making. Older care home residents have few choices with regard to care at the end of life. Further work is required to improve transition into care homes, including support and advocacy during decision-making, which often takes place in hospitals at a time of crisis. [ABSTRACT FROM AUTHOR]

There has been growing concern about the quality of health services, including mental health services, within the world’s and prisons. The purpose of the current qualitative interpretive meta-synthesis (QIMS) is to examine the prison environment and how it influences the mental health services delivered to prisoners. It is the hope of these authors that with this QIMS, knowledge improvements and modifications to current policies and practices can begin to take shape. A total of five studies published between 2003 and 2013 were utilized for this QIMS. Participants in all five studies included males and females incarcerated in England, Wales, and the United States. Three overarching themes were identified after analysis: difficulties with accessing services, difficulties with primary staff, and isolation. In each overarching theme, sub-themes are reviewed in detail. These three broad categories are discussed in relation to the person-in-environment system, demonstrating its application in an incarcerated setting. [ABSTRACT FROM AUTHOR]

Background: The community matron (CM) role was introduced in England to provide a single point of access to patients living with comorbid long-term conditions who had, or were at risk of, frequent emergency hospitalisation. Aim: This study explored the factors that affected embedding of the CM role. The qualitative study was undertaken in community health services in two cities and a rural area in central England. Method: Participants comprised health professionals (n=30) including CMs, community service managers, and service commissioners; patients (n=10); and their family carers (n=5). Results: Findings reveal that participants were largely positive about the role. However, difficulties with role setup had led to numerous changes in service delivery, which affected how the role has embedded. Conclusion: Many aspects of the CM role are invisible to other health professionals. Invisibility of community nursing, rather than autonomy of the CM role, seems to be a key factor in the challenges of embedding the role. [ABSTRACT FROM AUTHOR]