Search

Abstract: Background: It has been established that mental health‐care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context. Objective: To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders. Settings and participants: Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health‐care services. Methods: Fifty‐four semi‐structured interviews were conducted with participants and analysed utilizing a qualitative framework approach. Findings: Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users. Discussion and conclusions: Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate eye movement desensitization and reprocessing (EMDR) as a treatment for obsessive–compulsive disorder (OCD), by comparison to cognitive behavioural therapy (CBT) based on exposure and response prevention. Method: This was a pragmatic, feasibility randomized controlled trial in which 55 participants with OCD were randomized to EMDR (n = 29) or CBT (n = 26). The Yale‐Brown obsessive–compulsive scale was completed at baseline, after treatment and at 6 months follow‐up. Treatment completion and response rates were compared using chi‐square tests. Effect size was examined using Cohen's d and multilevel modelling. Results: Overall, 61.8% completed treatment and 30.2% attained reliable and clinically significant improvement in OCD symptoms, with no significant differences between groups (p > .05). There were no significant differences between groups in Yale‐Brown obsessive–compulsive scale severity post‐treatment (d = −0.24, p = .38) or at 6 months follow‐up (d = −0.03, p = .90). Conclusions: EMDR and CBT had comparable completion rates and clinical outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper reports on a survey of mental health clinician views of including people with psychosis and negative symptoms in outcome research. A questionnaire was forwarded to clinicians (the majority of whom were mental health nurses) completing post-registration undergraduate and postgraduate degree courses in psychosocial interventions for psychosis. Fifty questionnaires were returned (a response rate of 84.7%). A total of 47% of respondents indicated that they might refrain from offering this group as potential participants to clinical trials. Thematic analysis suggests views that negative symptoms are not amenable to treatment inform such decisions. The results highlight the potential difficulties faced by researchers investigating new treatments for people with negative symptoms, and suggest further exploration of clinician views of referring this group to research and psychosocial treatments is warranted. [ABSTRACT FROM AUTHOR]

The National Institute of Clinical Excellence (NICE) has produced a nationally coordinated programme of clinical guidelines which provide rigorous and systematically derived statements of best evidence to improve patient care. Successful implementation of the NICE guidelines into clinical practice is complex and challenging and this paper focuses on the specific barriers and facilitators of implementing the obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) guidelines. Particular challenges for this guideline are the very nature of OCD/BDD, the adoption of the stepped care model and specific treatment and training issues. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to investigate the administration and use of routine outcome monitoring session by session in the context of improving guided‐self‐help interventions when delivered remotely at Step 2 care in the English Improving Access to Psychological Therapies (IAPT) services. Design: Qualitative research using recordings of telephone‐treatment sessions. Method: Participants (11 patients and 11 practitioners) were recruited from four nationally funded IAPT services and one‐third sector organisation commissioned to deliver Step 2 IAPT services, in England. Data collection took place prior to the COVID‐19 pandemic. Transcripts of telephone–treatment sessions were analysed using thematic analysis. Results: Four themes were identified: (1) lack of consistency in the administration of outcome measures (e.g. inconsistent wording); (2) outcome measures administered as a stand‐alone inflexible task (e.g. mechanical administration); (3) outcome measures as impersonal numbers (e.g. summarising, categorising and comparing total scores); and (4) missed opportunities to use outcome measures therapeutically (e.g. lack of therapeutic use of item and total scores). Conclusions: The administration of outcome measures needs to ensure validity and reliability. Therapeutic yield from session‐by‐session outcome measures could be enhanced by focusing on three main areas: (1) adopting a collaborative conversational approach, (2) maximising the use of total and items scores and (3) integrating outcome measures with in‐session treatment decisions. Shifting the perception of outcome measures as impersonal numbers to being process clinical tools ensures a personalised delivery of psychological interventions and has the potential to enhance engagement from practitioners and patients what may reduce drop‐out rates and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The impact of the COVID‐19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England.Time‐series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6–24 years. The 41‐month observation period was split into three epochs: Pre‐pandemic (1/2019–2/2020); Pandemic Phase 1 (3/2020–6/2021); Pandemic Phase 2 (7/2021–5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood‐level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression.Depression and anxiety disorder rates were highest in females, CYP aged 19–24, and White and ‘Other’ ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre‐pandemic. In Pandemic Phase 2, rates in Black and Mixed‐ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non‐White females and males. The temporal trends were mostly homogeneous across deprivation quintiles.The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation. [ABSTRACT FROM AUTHOR]

Aim: Recent years have seen innovation in 'mHealth' tools and health apps for the management/promotion of physical health and fitness across the general population. However, there is limited research on how this could be applied to mental healthcare. Therefore, we examined mental healthcare professionals' current uses and perceived roles of digital lifestyle interventions for promoting healthy lifestyles, physical health and fitness in youth mental healthcare. Methods: A sequential, mixed‐methods design was used, consisting of a quantitative online survey, followed by qualitative in‐depth interviews. Results: A total of 127 mental healthcare professionals participated in the online survey. Participants had limited mHealth experience, and the majority agreed that further training would be beneficial. Thirteen mental healthcare professionals were interviewed. Five themes were generated (i) digital technology's ability to enhance the physical healthcare; (ii) Conditions for the acceptability of apps; (iii) Limitations on staff capability and time; (iv) Motivation as the principal barrier; and (v) Practicalities around receiving lifestyle data. Systematic integration of data produced novel insights around: (i) staff involvement and needs; (ii) ideal focus and content of digital lifestyle interventions; and (iii) barriers towards implementation (including mental healthcare professionals own limited experience using digital lifestyle interventions, which aligned with the appeal of formal training). Conclusions: Overall, digital lifestyle interventions were positively received by mental healthcare professionals, particularly for health behaviour‐tracking and mHealth support for exercise and nutrition. Practical suggestions for facilitating their uptake/implementation to improve availability of physical health interventions in mental healthcare are presented. [ABSTRACT FROM AUTHOR]

This article presents the co‐production principles underpinning the co‐creation of a multimedia theatre production on young people's mental health. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Obsessive‐compulsive disorder (OCD) is usually treated with cognitive behavioural therapy (CBT) based on exposure and response prevention principles; although eye movement desensitisation and reprocessing (EMDR) has also been proposed as a potentially helpful treatment. Aim: To investigate patients’ experiences of the process and outcome of CBT and EMDR. Method: We conducted in‐depth qualitative interviews with 24 (EMDR = 14; CBT = 10) patients who participated in a randomised controlled trial. Interviews were conducted after the end of therapy, transcribed verbatim and interpreted using thematic analysis. Results: Three superordinate themes were identified, including (1) common experiences and specific experiences of (2) CBT and (3) EMDR. Common experiences of therapy included difficulties in disclosing OCD problems; perceptions about therapists as approachable and nonjudgemental; sudden symptomatic improvements; difficulties in engaging with treatment; general satisfaction with therapy; and viewing OCD as a long‐term condition. Some differences between these interventions were also found in patients’ understanding of the treatment rationale, their experiences and difficulties with specific treatment procedures. Conclusions: Common process factors were especially prominent in patients’ accounts, although it is possible that these interact with more specific change mechanisms such as desensitisation. [ABSTRACT FROM AUTHOR]

Background: 5%–10% children and young people (CYP) experience specific phobias that impact daily functioning. Cognitive Behaviour Therapy (CBT) is recommended but has limitations. One Session Treatment (OST), a briefer alternative incorporating CBT principles, has demonstrated efficacy. The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) investigated the non‐inferiority of OST compared to multi‐session CBT for treating specific phobias in CYP. Methods: ASPECT was a pragmatic, multi‐center, non‐inferiority randomized controlled trial in 26 CAMHS sites, three voluntary agency services, and one university‐based CYP well‐being service. CYP aged 7–16 years with specific phobia were randomized to receive OST or CBT. Clinical non‐inferiority and a nested cost‐effectiveness evaluation was assessed 6‐months post‐randomization using the Behavioural Avoidance Task (BAT). Secondary outcome measures included the Anxiety Disorder Interview Schedule, Child Anxiety Impact Scale, Revised Children's Anxiety Depression Scale, goal‐based outcome measure, and EQ‐5DY and CHU‐9D, collected blind at baseline and six‐months. Results: 268 CYPs were randomized to OST (n = 134) or CBT (n = 134). Mean BAT scores at 6 months were similar across groups in both intention‐to‐treat (ITT) and per‐protocol (PP) populations (CBT: 7.1 (ITT, n = 76), 7.4 (PP, n = 57), OST: 7.4 (ITT, n = 73), 7.6 (PP, n = 56), on the standardized scale‐adjusted mean difference for CBT compared to OST ‐0.123, 95% CI −0.449 to 0.202 (ITT), mean difference −0.204, 95% CI −0.579 to 0.171 (PP)). These findings were wholly below the standardized non‐inferiority limit of 0.4, suggesting that OST is non‐inferior to CBT. No between‐group differences were found on secondary outcomes. OST marginally decreased mean service use costs and maintained similar mean Quality Adjusted Life Years compared to CBT. Conclusions: One Session Treatment has similar clinical effectiveness to CBT for specific phobias in CYP and may be a cost‐saving alternative. [ABSTRACT FROM AUTHOR]

Background: Mental illnesses are the leading causes of global disease burden. The impact is heightened in low‐ and middle‐income countries (LMICs) due to embryonic care systems and extant barriers to healthcare access. Understanding children and adolescents' conceptualisations of mental health wellbeing in these settings is important to optimize health prevention and promotion initiatives. Objective: To systematically review and synthesize children and adolescents' conceptualisations and views of mental health and wellbeing in LMICs. Design: Ten databases were systematically searched from inception to July 2020 and findings from included studies were synthesized. Results: Twenty papers met eligibility criteria comprising qualitative, quantitative and mixed methods studies. Children and adolescents identified aspects of mental health and wellbeing, including positive affect and outlook and having sufficient personal resources to face daily challenges. Identified factors recognized the importance of activating both kin and lay networks in supporting and maintaining wellbeing. Conceptualisations of mental health and wellbeing were varied and influenced by culture, developmental stage and gender. Discussion and Conclusions: Irrespective of environmental and sociocultural influences on concepts of wellbeing and mental health, children and adolescents in LMICs can conceptualise these constructs and identify how they pursue positive mental health and wellbeing important for developing age and culture‐appropriate community mental health strategies. Our review highlights the need to extend inquiry to wider developmental stages and both across and within specific populations in LMICs. Patient and Public Involvement: Initial results were presented at stakeholder workshops, which included children, adolescents, parents and health professionals held in Indonesia in January 2019 to allow the opportunity for feedback. [ABSTRACT FROM AUTHOR]

Acute mental health inpatient wards have been criticized for being nontherapeutic. The study aimed to test the feasibility of delivering a psychologically informed intervention in these settings. This single‐arm study evaluated the feasibility of clinical psychologists delivering a ward‐based psychological service model over a 6‐month period on two acute mental health wards. Data were gathered to assess trial design parameters and the feasibility of gathering patient/staff outcome data. Psychologists were able to deliver key elements of the intervention. Baseline staff and patient participant recruitment targets were met. However, there was significant patient attrition at follow‐up, with incorrect contact details on discharge being the primary reason. Implementation of a ward‐based psychological intervention appears feasible when implemented flexibly. It is feasible to recruit staff and patient participants and to collect staff outcome measures over a 6‐month period. However, greater efforts need to be taken to trace patient movement following discharge. [ABSTRACT FROM AUTHOR]

Background: Best‐practice guidelines recommend that appropriate support be provided to public contributors to facilitate their involvement in research. One form of support is research awareness training. Older people with dementia and care partners were involved in four Research User Groups (RUGs) in the UK, France, Cyprus and Greece. We delivered research awareness training (RAT) to the RUGs. The aim of this study was to evaluate the acceptability and perceived outcomes of the training from the perspective of RUG members. Methods: At the end of each research training session, participants completed the Training Acceptability Rating Scale‐section 2, which records the respondent's impressions of the training process and the outcomes of training. Participants were also invited to take part in semi‐structured interviews at the end of the programme. Results: Thirty‐four RUG members completed the TARS‐section 2 with 23 completing semi‐structured interviews. Over two‐thirds (67%) of participants rated their overall satisfaction with the RAT 'a great deal'. Qualitative responses indicated that participants found group work to be beneficial for learning, the structure of training activities and topics covered appropriate. The type and format of the training materials were viewed as helpful, and they valued the new knowledge gained. Conclusions: The training contents were applicable, useful and relevant to the participants' role within the research. We highlight the importance of facilitating participation by (a) fostering awareness of relevant research issues and (b) tailoring delivery of training according to the needs of the participants. [ABSTRACT FROM AUTHOR]

Objectives: This paper outlines best practice recommendations for the clinical psychologist's role in inpatient settings and also presents a methodology for deriving evidence‐based recommendations, which may be replicated by health care professionals in other areas of service development. Methods: Twenty‐three, nationally drawn experts, deemed expert by profession and/or experience attended a one‐day conference. Participants were presented with findings from previous research and key unanswered questions in terms of how psychological services should be delivered in inpatient settings. Participants discussed the information presented within small groups and then independently responded to the questions posed. Responses to questions either involved ranking priorities or choosing the best possible option in terms of what or how aspects of the model should be delivered. Results: We were able to identify referral priorities for formulation, nurse‐led psychosocial interventions and psychological therapy using ranking questions. Consensus (defined as 70% agreement) was achieved within 1–3 voting rounds for all questions which involved selecting one of a range of possible options. These responses provided information about how to deliver formulation, supervision of nurse‐led psychosocial interventions, staff well‐being interventions, and one‐to‐one therapy, as well as psychologists' own training and supervisions needs. Conclusions: Findings provide recommendations relating to five different service areas for inpatient settings seeking to implement a psychological service model: formulation, nurse‐led interventions, one‐to‐one therapy, staff well‐being, and psychologist training and supervision. Additionally, we showcase a methodology for synthesizing knowledge and decision‐making that can be implemented by researchers and health care professionals seeking to design interventions or service models in other settings. Practitioner points: Psychologists working on inpatient wards should endeavour to develop a team formulation for each patient, prioritizing patients with longer length of stay, repeated admissions, and who staff find challenging.Psychologists should offer 1:1 therapy with patients who have complex needs that cannot be addressed by nurse‐led interventions.Reflective practice sessions should be a key component of the psychologist's role on inpatient wards with the function of improving staff well‐being.Consensus conferences are useful methodology to synthesize knowledge and undertaking decision‐making in relation to the design of interventions or service models. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) has the potential to strengthen mental health systems in Indonesia and improve care for people living with psychosis. Current evidence from other parts of the world demonstrates the need to understand the contexts in which PPI is to be enacted to ensure optimal implementation. Objective: To understand service users' and carers' views on the current use and potential applicability of PPI within Indonesian mental health services. Design: Qualitative study incorporating focus groups analysed using thematic analysis. Setting and participants: Participants included 22 service users and 21 carers recruited from two study sites in Indonesia (Jakarta and Bogor). All participants had experience of psychosis either as a service user or carer. Results: Despite the value attributed to PPI in relation to improving services and promoting recovery, current use of such activities in Indonesian mental health services was limited. Participants expressed a desire for greater levels of involvement and more holistic care but felt community organizations were best placed to deliver this because PPI was considered more congruent with the ethos of third‐sector organizations. Additional barriers to PPI included stigma and low levels of mental health literacy in both health services and communities. Discussion and conclusion: Participants felt that there was potential value in the use of PPI within Indonesian mental health services with careful consideration of individual contexts. Future aspirations of involvement enactment should ensure a central design and delivery role for third‐sector organizations. Facilitators to global collaborative research in the context of the current study are also discussed. [ABSTRACT FROM AUTHOR]