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Aims and Method A retrospective service evaluation of the first 500 referrals to a new community forensic service (FCAMHS) describing profiles of young people accessing the service. The evaluation aims to understand the impact of changes in health service care models and diversion from youth justice services over the last two decades in England. Accessibility to enhance opportunity for prevention of high-risk behaviours for all ages up to 18 is evaluated. Results The majority of referrals were living with their families, had no social care status, attended mainstream school and had an average age of 14 (range 7–18). Most referrals were for aggression, followed by harmful sexual behaviour and fire setting. Half the referrals had no formal mental health diagnosis or criminal status. Neurodevelopmental disorders were present in a quarter of referrals. Despite lower numbers of female referrals, the reasons for referral were similar to males. Clinical Implications The service evaluation highlights the changing face of forensic services and the move towards early intervention by pioneering an accessible and flexible model of care. [ABSTRACT FROM AUTHOR]

Background: Despite wide usage of the Questionnaire about the Process of Recovery 10 (QPR), the minimum important difference (MID) for the measure has not been identified. Establishing the MID for the QPR is required in order to facilitate the interpretation of outcomes in clinical practice and the use of this scale in research, to measure meaningful change in people with psycho- sis. Methods: Using an anchor-based method, data from four existing trials of interventions for people with psychosis (N = 681) were used to identify the MID for the QPR. Changes in QPR total scores between baseline and end of treatment were assessed for correspondence with several anchor measures which had established MIDs or face-value clinical meaning. A range of MID values were calculated. Results: Based on anchor measures that were orientated towards service- user priorities, a within-person MID of 5 points and a between-group MID of 4 points are suggested. Results also indicated that the reliability and validity of the 15-item version of the QPR was high, which provides support for its use in clinical practice and research. Conclusions: Implications for future research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Background: There is extensive literature documenting the nature of recovery in mental health in adult populations, but there is very little exploring its nature and meaning for young people. Aims: To gain a detailed understanding from the perspective of young people about the concept of recovery in young people's mental health. Method: Semi structured interviews were conducted with 23 young people. Interviews were transcribed verbatim and analysed using thematic analysis. Results: Themes emerging from the interviews included young people's dynamic conceptualisations of recovery, awareness of others views of recovery, polarised goals of recovery, and facilitators and barriers of recovery. Conclusions: To be relevant for young people, the mental health recovery model must incorporate individual needs, developmental considerations and fluctuations in goals. It must also be embedded within the young person's ecological system such as family, friends and school, and be focussed around an explicit and collaborative recovery discussion with the young person. [ABSTRACT FROM AUTHOR]

Providing care can be demanding and is associated with increased financial, emotional and psychological distress. Relatives of individuals with At-Risk Mental State (ARMS) of psychosis provide significant emotional, practical and economic support but are often a neglected group. The current study aimed to investigate the barriers and facilitators for those supporting ARMS individuals. Semi-structured interviews with fourteen family members from the Individual and Family Cognitive Behavioural Therapy (IFCBT) trial were conducted. Key barriers included relatives' unmet needs and limited confidence accessing and providing support. Facilitating factors included open communication with the individual, flexible, understanding employers and feeling that they themselves were supported. Those who identify multiple barriers may have increased levels of worry and distress that negatively impact their own health and wellbeing. Services in contact with ARMS individuals should provide families support to sustain an adequate level of care, including psychoeducation around the individual's experiences and behaviours, discussions around talking to employers and help exploring more adaptive coping strategies including accessing support from social networks. Clinical teams and/or family peer-support workers that look to support relatives early in their caregiving journey could help improve outcomes in relative's quality of life and consequently benefit the ARMS individual. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines recommend cognitive behaviour therapy (CBT) for people with psychosis, however, implementation is poor and not everyone wishes to engage with therapy. Understanding service user (SU) preferences for receiving such treatments is a priority for services. Aims: To explore SU preferences and outcomes of different methods of delivering CBT for psychosis. Method: SUs experiencing psychosis could choose between treatment as usual (TAU); TAU plus telephone-delivered CBT with self-help, CBT recovery manual (TS); high support CBT (HS - TAU plus TS plus group sessions) or randomisation. Participants received their option of choice and were followed-up on several outcomes over 9 and 15 months. Results: Of 89 people recruited, three chose to be randomised and 86 expressed a treatment preference (32 chose TAU, 34 chose TS, 23 chose HS). There were few differences between those who chose therapy compared to those who chose TAU. Those who had more positive impacts from their symptoms were significantly more likely to choose TAU. Conclusions: Most people had strong preferences about treatment delivery and a substantial number did not wish to receive additional therapy. These findings have to be considered when planning and allocating resources for people with psychosis. [ABSTRACT FROM AUTHOR]

Aims: Ongoing NICE guidance recommends research on the clinical and cost effectiveness of psychological treatment alone, compared to antipsychotic medication and compared to psychological treatment and antipsychotic medication combined. The COMPARE study (Cognitive behaviour therapy or Medication for Psychosis- A Randomised Evaluation) was a pilot trial designed to inform a definitive trial to answer this question. Method: COMPARE was a single-site pilot randomised controlled trial to compare a standardised Cognitive Behaviour Therapy (CBT) intervention to treatment with antipsychotic medication (APs) and a combined treatment (CBT plus APs) in adults with psychosis. Participants were assessed using the Positive and Negative Syndrome Scale (PANSS) and followed up at 6, 12, 24 and 52 weeks. The primary outcomes were recruitment and retention of participants. We surveyed a wider population of staff and service users to further inform feasibility of a definitive trial. Results: We report the characteristics of the recruited sample at baseline (n = 75) and results from surveys. Conclusions: The study recruited to target demonstrating it is feasible to identify and recruit participants to a study of this kind. The survey results also suggest that such trials are feasible. [ABSTRACT FROM AUTHOR]

This study presents a qualitative evaluation of a novel cognitive behavioural therapy targeting suicidal thoughts and behaviours for people experiencing psychosis. Eight participants from four NHS Trusts in the northwest of England were interviewed. The interview schedule was collaboratively developed with a Service User Reference Group whose membership included people with experience of psychosis. Thematic analysis captured participants’ experiences of recovery from suicidal thoughts and behaviours following therapy. Two themes were identified: “Acceptability” depicted participants’ views about the process of therapy and the therapeutic relationship; “In-recovery from suicidality” illustrated participants’ views of the impact of the therapy. [ABSTRACT FROM PUBLISHER]

Young people in custodial care are known to have high levels of mental health and emotional problems, and recent policy and service developments have sought to improve their access to services. However, little is known about how they cope or about what would increase their uptake of services (when such services are available). This study aimed to develop, validate and use a standardised measure to examine the coping, help-seeking and attitudes of a larger cohort of young people in custody. There was a marked reluctance to seek help for any but the most serious of problems, but there were also indicators of what would make services more acceptable to this population, with implications for both commissioning and delivering services. In particular, greater involvement of parents and carers, offering a wider range of interventions and offering them more flexibly, and challenging stigma within the secure environment may increase uptake of services. [ABSTRACT FROM PUBLISHER]

Health inequalities are high among offending groups. The comprehensive health assessment tool (CHAT) is a semi-structured assessment developed to provide a standardised approach to health screening for all young offenders admitted to the secure estate. The four sections of the CHAT (physical health, mental health, substance misuse and neurodisability) were evaluated within a two-phased study of male adolescents (aged 15–18?years) within a young offenders institution in the north-west of England. Within Phase 1, a consecutive sample of 127 new receptions was assessed using the physical health, mental health and substance misuse sections of the CHAT against a range of reference standard assessments. Phase 2 of the study evaluated the neurodisability section on 93 male adolescents against reference standard tools. The four sections of the CHAT demonstrated fair to good convergent validity when compared against reference standard tools in male offenders. The diagnostic accuracy rate was 76% for mental health, 63% for physical health, 83% for substance misuse and 53% for neurodisability when compared against reference standard assessment tools. The introduction of the CHAT offers the opportunity to enhance existing reception screening practices and create an integrated approach to the assessment of health needs across the secure estate. [ABSTRACT FROM PUBLISHER]

Recent conceptualisations of recovery from psychosis have recognised the importance of psychosocial aspects as well as the presence or absence of symptoms. Qualitative research and personal accounts of recovery highlight its subjective and idiosyncratic nature. This study aims to explore subjective judgements of recovery from the perspective of service users, and examine the agreement and consistency in such judgements across different measures of recovery. It also aims to investigate the relationships between subjective judgements of recovery and psychosocial factors. A total of 122 participants with experience of psychosis completed three self-report measures of recovery judgements, as well as measures of psychological functioning (including self-esteem, optimism, anxiety and depression) and socio-demographic measures. Judgements about recovery from psychosis across the three measures, while showing a trend, also show within-person variability. Recovery judgements were significantly correlated with each other and with all psychological variables, but were not associated with socio-demographic variables except for age. Regression analyses showed that recovery judgements were predicted by mood, optimism and self-esteem. Subjective judgements of recovery were seen to be idiosyncratic, with people appearing to have different thresholds for perceived recovery. The conclusions of the existing qualitative research and first-person accounts appear generalisable to larger samples. [ABSTRACT FROM AUTHOR]

Mental health services are being encouraged to adopt a recovery approach, creating a requirement for standardised measures of recovery to be developed and embedded within services. Measurement of this unique concept is inherently difficult, but it is feasible and valid provided that service users and clinicians work collaboratively. To evaluate which measures of recovery have clinical utility and are acceptable to service users. Instruments included in this review are (1) quantitative self-report measures, (2) published in a peer reviewed English language journal and (3) designed to measure personal recovery. The review team included two service-user researchers to allow evaluation of acceptability to service users. Twenty-five measures of recovery were identified; six of these met the inclusion criteria. A summary table of the measures is included to enable readers to make an informed choice of measure for their specific needs, along with an overview of each measure. The Recovery Assessment Scale appears to be the most acceptable and valid measure currently available. No "gold-standard" measure of recovery has been developed to date. Further research is required to examine the longitudinal reliability of existing tools, and their utility within clinical services and as outcome measures. [ABSTRACT FROM AUTHOR]

The aim of this study was to conduct a preliminary evaluation of a mental health consultation process provided to staff working in residential care settings for young people. Using a semi-structured interview approach, qualitative information was gathered from six participants about their experiences of the consultation. A thematic analysis of the interviews generated four key themes, which appear to reflect the different stages of consultation. These included: initiating consultation; building the consultative relationship; overcoming obstacles; and seeing the value of consultation. These themes, along with prevalent sub-themes, are discussed with reference to the effectiveness of the consultation process and the implications for use of psychological consultation in clinical practice. Implications for future practice include providing information to potential consultees before the consultation process, being accessible informally to the consultee and adopting a variety of approaches based on the consultee's needs. The limitations of this study and recommendations for future research are also discussed. [ABSTRACT FROM AUTHOR]

Relatively few studies have investigated the prevalence of young females with sexually abusive behaviours, and there is a lack of research comparing females with sexually abusive behaviours to a sample of non-sexually abusive delinquent females. The current pilot study explored the prevalence of sexually abusive behaviours in a sample of delinquent females referred to an outpatient Forensic Adolescent Consultation and Treatment Service (FACTS). A retrospective casenote study was conducted to compare the characteristics, offending behaviours and mental health of those with sexually abusive behaviours to their non-sexually abusive peers. Of the 258 females in the study, 31 (12%) presented with sexually abusive behaviours. Consistent with previous studies, females with sexually abusive behaviours were significantly more likely to have been victims of abuse themselves and to have learning disabilities/difficulties. They were less likely to engage in other antisocial behaviours, including aggression and violence, criminal damage, self-harm and substance misuse. [ABSTRACT FROM AUTHOR]

Aprocedure for assessing posthypnotic recognition amnesia is described. A set of items for the Harvard Group Scale of Hypnotic Susceptibility Form A and for the Stanford Hypnotic Susceptibility scale, Form C were developed and analyzed for reliability and their ability to discrimhate individuals who demonstrate posthypnotic amnesia. Recognition amnesia could be assessed as reliably as recall amnesia, and posthypnotic recognition amnesia identified a select subgroup of high hypnotizable individuals who had higher scores on the screefling scales. These items may prove useful for assessing posthypnotic recognition amnesia in Conjunction with widely used scales of hypnotic susceptibility [ABSTRACT FROM PUBLISHER]