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Background: Research has indicated that having financial difficulties may increase mental health problems and prevent recovery when receiving psychological treatment. A combined approach within the Improving Access to Psychological Therapies (IAPT) service could help clients by tackling their financial difficulties alongside supporting their mental health., Aims: We aimed to explore the experiences and views of a potential combined intervention by speaking to IAPT service users who have/had experiences of money worries, as well as IAPT therapists and Citizen's Advice (CA) money advisers., Method: We conducted online semi-structured interviews with 16 IAPT service users, 14 IAPT therapists/practitioners, and 6 CA money advisors. Interviews were transcribed verbatim and analysed thematically., Results: Themes discussed including the impact of money worries and mental health, the benefits of a combined intervention, how and when it should be introduced to clients and delivered, and how information should be shared between the services. It was felt by most participants that such an intervention would improve mental health and provide a more holistic service with a better referral pathway., Conclusions: Our findings provide a blueprint for a combined money advice and psychological therapy service within IAPT, which both service users and staff identified would be beneficial.

Mental health problems bring substantial individual, community and societal costs and the need for innovation to promote good mental health and to prevent and treat mental health problems has never been greater. However, we know that research findings can take up to 20 years to implement. One way to push the pace is to focus researchers and funders on shared, specific goals and targets. We describe a consultation process organised by the Department of Health and Social Care and convened by the Chief Medical Officer to consider high level goals for future research efforts and to begin to identify UK-specific targets to measure research impact. The process took account of new scientific methods and evidence, the UK context with a universal health care system (the NHS) and the embedded research support from the National Institute for Health Research Clinical Research Network, as well as the views of individual service users and service user organisations. The result of the consultation is a set of four overarching goals with the potential to be measured at intervals of three, five or ten years.

Background: Mental health stigma on social media is well studied, but not from the perspective of mental health service users. Coronavirus disease-19 (COVID-19) increased mental health discussions and may have impacted stigma. Objectives: (1) to understand how service users perceive and define mental health stigma on social media; (2) how COVID-19 shaped mental health conversations and social media use. Methods: We collected 2,700 tweets related to seven mental health conditions: schizophrenia, depression, anxiety, autism, eating disorders, OCD, and addiction. Twenty-seven service users rated them as stigmatising or neutral, followed by focus group discussions. Focus group transcripts were thematically analysed. Results: Participants rated 1,101 tweets (40.8%) as stigmatising. Tweets related to schizophrenia were most frequently classed as stigmatising (411/534, 77%). Tweets related to depression or anxiety were least stigmatising (139/634, 21.9%). A stigmatising tweet depended on perceived intention and context but some words (e.g. "psycho") felt stigmatising irrespective of context. Discussion: The anonymity of social media seemingly increased stigma, but COVID-19 lockdowns improved mental health literacy. This is the first study to qualitatively investigate service users' views of stigma towards various mental health conditions on Twitter and we show stigma is common, particularly towards schizophrenia. Service user involvement is vital when designing solutions to stigma.

Background: 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., Objective: To explore the emotional experiences, thought processes and coping behaviours of people with existing mental health problems and carers living through the pandemic., Methods: 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., Results: 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., Conclusion: 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.

Background: Cognitive difficulties are a core deficit for people with schizophrenia and are generally assessed with neuropsychological tests. Self-report assessments are also useful in understanding difficulties from the service user's perspective. This study aims to introduce and test the shorter version of the Subjective Scale to Investigate Cognition in Schizophrenia (SSTICS) to improve its acceptability and comprehensibility. Methods: In consultation with service users and clinicians, we identified items from the original 21-item SSTICS that were found difficult and these were excluded. The reduced scale was explored with Confirmatory Factor Analysis (CFA) in two independent samples in the UK and Canada. Convergent validity with symptoms and IQ was assessed and compared between the original and the reduced scale. Results: Six-hundred and seven people with schizophrenia and first-episode psychosis took part in this study. Seven items were removed to produce the SSTICS-Brief. This had good reliability and the CFA confirmed a unidimensional structure. Convergent validity with symptoms and IQ were optimal between the long and short versions. Conclusions: The SSTICS-B has better acceptability than its longer form and could be administered in less time. The resulting measure is likely to be a valuable short self-assessment of cognitive complaints for people with schizophrenia.

Background: Study feasibility and deliverability can benefit from involving patients and carers in the research process, known as patient and public involvement (PPI). There is less evidence on the experiences of patients and carers themselves and we require more information across a range of studies, health conditions and research stages., Aims: This study explored how patients and carers in eight diagnostic research specialties have been involved in research, their motivations and the impact involvement had on them., Method: 143 patients and carers across the Clinical Research Network (CRN) responded to an online semi-structured questionnaire (developed using participatory methodology). Quantitative and qualitative data were analysed., Results: A range of benefits were reported, including providing a life focus and an improved relationship with illness. Less positive experiences regarding time and money and lack of acknowledgement were also reported, along with suggestions for improvement., Conclusions: PPI confers many benefits on patients and carers which could increase PPI recruitment if made explicit. More involvement in study recruitment and dissemination would increase the effectiveness of PPI input. Involving a more varied socioeconomic demographic and at an earlier stage is vital. Financial support for lower earners and greater feedback following involvement should also be explored.

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.

Introduction: Deficits in Social Cognition are common in people with schizophrenia. However, it is not clear if these deficits are a vulnerability marker and whether they are independent to cognitive difficulties. This study investigates these two issues in individuals with a genetic liability to psychosis., Methods: Twenty-one healthy siblings of patients with schizophrenia were compared with 21 healthy individuals on a range of cognitive and social cognitive measures. Significant differences in cognitive domains were controlled for when comparing the two groups on measures of social cognition., Results: Siblings of people with schizophrenia performed significantly worst on tests of theory of mind and social perception but not on affect recognition. Scores on tests of executive function, processing speed and general IQ were also lower in the sibling group. When controlled for differences in cognitive tests, the two groups still retained significant differences in theory of mind and social perception. However, executive function significantly contributed to theory of mind and processing speed to social perception differences., Conclusions: These results further suggest that difficulties in some domains of social cognition are associated with a genetic vulnerability for schizophrenia. In these areas, cognitive difficulties account only partially for social cognition problems suggesting that these two domains may represent relatively independent liability factors.

Introduction: Processing speed has been advanced as one of the core cognitive deficits of schizophrenia. Several methods were developed to assess this domain; however, most tasks, despite indexing several cognitive and motor components, tend to characterise processing speed as a unitary construct. This study explores potential subcomponents of processing speed in schizophrenia and their relationship with demographic, clinical, and neuropsychological characteristics., Methods: One hundred and sixty participants with a diagnosis of schizophrenia were assessed on neuropsychological tasks measuring processing speed, executive function, and memory. Demographics and clinical characteristics were also recorded. Three independent measures were extracted to account for subcomponents of processing speed: behavioural execution, response processing, and accuracy., Results: The identified components of processing speed were differently predicted by demographic characteristics, clinical characteristics, and overall intelligence estimates. Age and symptom severity were important predictors for behavioural execution; intelligence and social withdrawal predicted response processing; and accuracy was predicted by illness duration. Correlations showed executive function and memory to be associated with response processing and accuracy but not with behavioural execution., Conclusions: Distinct characteristics of schizophrenia seem to predict processing speed subcomponents. Distinguishing between behavioural, processing, and accuracy may be a useful way forward to refine our understanding of processing speed impairment in schizophrenia.

Background: New health information technology (HIT) increasingly plays a role in health care as technology becomes cheaper and more widespread. However, there is a danger that those who do not use or have access to technology will not benefit from HIT innovations, thus creating a "digital divide"., Aims: To assess the extent to which mental health service users have access to, skills in using and appetite for various technologies., Methods: A cross-sectional survey was used to assess technology use and access patterns of 121 people from community mental health services. Data were analysed using logistic regression., Results: Technology use and access were very similar to that of the general population with older individuals reporting less familiarity, access and confidence across a range of technologies. Black, minority and ethnic (BME) groups were more likely to access computers outside of their own homes than white individuals. Older participants experiencing psychosis indicated a desire to increase their computer use., Conclusions: The findings reported here contrast with recent evidence suggesting that those who do not engage with technology are "self-excluders". Furthermore, BME groups may need extra support regarding provision of technology in order to engage with HIT.

Background: Service users express dissatisfaction with inpatient care and their concerns revolve around staff interactions, involvement in treatment decisions, the availability of activities and safety. Traditionally, satisfaction with acute care has been assessed using measures designed by clinicians or academics., Aims: To develop a patient-reported outcome measure of perceptions of acute care. An innovative participatory methodology was used to involve services users throughout the research process., Method: A total of 397 participants were recruited for the study. Focus groups of service users were convened to discuss their experiences and views of acute care. Service user researchers constructed a measure from the qualitative data, which was validated by expert panels of service users and tested for its psychometric properties., Results: Views on Inpatient Care (VOICE) is easy to understand and complete and therefore is suitable for use by service users while in hospital. The 19-item measure has good validity and internal and test-retest reliability. Service users who have been compulsorily admitted have significantly worse perceptions of the inpatient environment., Conclusions: A participatory methodology has been used to generate a self-report questionnaire measuring service users' perceptions of acute care. VOICE encompasses the issues that service users consider most important and has strong psychometric properties.

Background: Little is known about service users' views of measures used to evaluate treatments in mental health., Aims: To identify the views of people with psychosis and affective disorder about the relevance and acceptability of commonly used outcome measures., Methods: Twenty-four widely used outcome measures were presented to expert groups of service users. Nominal group methods were used to develop consensus about the appropriateness of each measure. Comments made by service users about how outcomes should be assessed were also recorded., Results: Group members expressed concern about the ability of some outcome measures to capture their experiences. Patient-rated measures were assessed as more relevant and appropriate than staff-rated measures, and the need to examine negative as well as the positive effects of treatments was emphasised. Specific concerns were raised about some widely used measures including the Global Assessment of Functioning and the European Quality of Life scale., Conclusions: We consider it essential that service users' views are taken into account when selecting measures to evaluate treatment outcomes. Providing insight into views of users of mental health services, our findings serve as a starting point for discussion.

It is becoming increasingly recognized that conventionally derived outcome measures in mental health research are problematic. This is both because of the methodology used and because a 'good' outcome is framed from the perspective of clinicians and researchers. This paper describes a methodology for developing outcome measures for use in large studies entirely from the perspective of mental health service users. It is a mixed methods model starting with a participatory and qualitative methodology and proceeding to psychometric testing. At all stages, the researchers are themselves mental health service users. In the first phase of the model, focus groups are convened comprising people who have received the treatment or service being measured. The focus groups meet twice resulting in a draft mixed-methods questionnaire devised from thematic analysis of the focus group data. This is then taken to expert panels, again comprising individuals who have received the treatment or service being evaluated for refinement. Following this, a feasibility study is conducted with N ∼ 50 participants and changes made iteratively to the questionnaire in light of feedback. The final measure is subject to psychometric testing both to ensure it is robust and to explore similarities and differences with conventionally derived measures.

Hearing voices is often one of the most distressing aspects associated with a diagnosis of psychosis. These voices are often resistant to medication treatments. This review article discusses the development of complementary approaches to the treatment of voices--psychological and particularly cognitive treatments. It is clear that there are psychological rather than merely physical factors associated with the occurrence of, and distress caused by, voices. These factors can be engaged in the process of psychological therapy in order to reduce the distress that they cause and improve quality of life. Psychological therapies have produced some improvements but very few have shown durable effects. Most psychological therapies have been individual with an emphasis on cognitive behavioural approaches. This paper describes the development of a new approach--group cognitive treatment--that might provide further success either as a single therapy for voices or as a complement to individual approaches. This type of therapy builds on the therapies and supports provided within the consumer movement as well as harnessing group and cognitive facilitators for change in beliefs. Some evidence is provided about the usefulness of such therapy in the health services. In addition, the evaluation of treatments for specific symptoms, particularly the appropriate outcome measures is discussed.