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Abstract Background People with mental disorders have a higher prevalence of physical illnesses and reduced life expectancy as compared with the general population. However, there is a lack of knowledge across Europe concerning interventions that aim at reducing somatic morbidity and excess mortality by promoting behaviour-based and/or environment-based interventions. Methods and design HELPS is an interdisciplinary European network that aims at (i) gathering relevant knowledge on physical illness in people with mental illness, (ii) identifying health promotion initiatives in European countries that meet country-specific needs, and (iii) at identifying best practice across Europe. Criteria for best practice will include evidence on the efficacy of physical health interventions and of their effectiveness in routine care, cost implications and feasibility for adaptation and implementation of interventions across different settings in Europe. HELPS will develop and implement a "physical health promotion toolkit". The toolkit will provide information to empower residents and staff to identify the most relevant risk factors in their specific context and to select the most appropriate action out of a range of defined health promoting interventions. The key methods are (a) stakeholder analysis, (b) international literature reviews, (c) Delphi rounds with experts from participating centres, and (d) focus groups with staff and residents of mental health care facilities. Meanwhile a multi-disciplinary network consisting of 15 European countries has been established and took up the work. As one main result of the project they expect that a widespread use of the HELPS toolkit could have a significant positive effect on the physical health status of residents of mental health and social care facilities, as well as to hold resonance for community dwelling people with mental health problems. Discussion A general strategy on health promotion for people with mental disorders must take into account behavioural, environmental and iatrogenic health risks. A European health promotion toolkit needs to consider heterogeneity of mental disorders, the multitude of physical health problems, health-relevant behaviour, health-related attitudes, health-relevant living conditions, and resource levels in mental health and social care facilities.

The very concept of evidence, the possibility of arriving at “truth” in psychotherapy, changes due to new philosophical currents (e.g. postmodernism), but also in connection with living therapeutic experience. The therapist often witnesses the traumatic experience that altered the patient, but also affects the listener. Comprehension of this change, observations of the therapeutic relation and situations recreated in the therapist’s office become crucial for the therapeutic process. In order for the latter to take place we require lucidly defined frames, which as such fulfil a healing function by granting therapy stability and rhythm that “uphold” both the patient and the therapeutic relation. Hence psychotherapy is the co-creation of reality by the patient and the therapist - interpretations, insight, and comprehension depend on this specific dyad. Even if we assume the existence of ”objective reality” it could be recognised solely via the subjectivity of the patient and the therapist. [ABSTRACT FROM AUTHOR]

The frames of testimony can be comprehended as social and political, into which a story is inserted, and as frames created for such a story by specially selected listeners – therapists, family members, friends. Upon the example of two texts written immediately after the war by a Holocaust Survivor and a description of the same events made many years later the author indicates the way in which changing frames impact the contents and form of oral tradition. Survivors pass away and the successive generation faces the question of how to make use of tradition created by “moral witnesses” of history. [ABSTRACT FROM AUTHOR]

The article refers to the concept of the body as an archive of own and previous generations’ experiences. This applies in particular to trauma, unconsciously determining our behaviour, and undergoing embodied enactment. In a specific therapeutic situation there may take place a reconstruction of body sensations, affect, and fantasies associated with the traumatic situation. Basin herself on the Torok and Abraham theory of the crypt and the phantom, the author shows how the body becomes a narrative area. She describes Dori Laub’s project of recording accounts of Holocaust survivors hospitalized in psychiatric institutions as an example of “archive fever”. Archiving trauma is a special case of archive fever because traumatic experience that cannot be archived in the mind is sought in the recording. It is an archive search outside the archive, despite the inability to archive. [ABSTRACT FROM AUTHOR]

The Monument to the Ghetto Heroes in Warsaw has two sides - Struggle and the Holocaust Procession. The monument in question links the topos of Procession and Funeral Procession, but it is "Struggle" that is selected as the site of social practices. The author of the article wonders whether both this and other monuments are helpful for working through trauma or negate loss by concealing their "other side". The fundamental question asks: "Can commemoration fulfil a function concurrent with the term ‘memory site', change the ‘non-represented' into a symbol and thus lead towards integration of experience?". Social and personal experience shows that memory sites can be of help in making contact with a traumatic event, but ultimately the process of social working through is a sum of individual processes of integrating traumatic experience. [ABSTRACT FROM AUTHOR]

The article deals with the changed meaning of words - a consequence of the Holocaust. During the war "ordinary" and "innocent" words were used to describe successive stages of murdering people. It is difficult to find suitable words for describing the experiences of the Holocaust but new words connected with Shoah continue to appear. Problems with using words and the emergence of new terms reflect those connected with the transmission of mourning between generations. The author proposes a hypothesis claiming that members of the "third generation" - the grandchildren of the victims, perpetrators and witnesses - are ready to go through mourning, which could restore the correct meanings of words. This does not signify putting an end to the period of mourning. In the case of the Holocaust there exists a constant need for mourning, described by Derrida as demi-deuil, i.e. remaining in a position "between" - an oscillation between incorporation and introjection. Such a oscillation can also pertain to words, which can alter their meaning - they can be a thing or a symbol. [ABSTRACT FROM AUTHOR]

The relationship between traumatic experience and psychosis is exemplified in this paper by two cases. The first patient was described by Maurycy Bornstein in 1916. The other is a Holocaust survivor currently provided psychotherapy by the author. Both cases demonstrate that trauma may underpin psychotic disorders and that the contents of psychotic symptoms may closely relate to traumatic experiences. Interpretation of symptom contents depends largely on the therapist’s ability to recognize trauma cues in the material provided by the patient. The Bornstein case shows how difficult it can be for us therapists to hear contents that relate to our repressed fears since such cues undermine our sense of security and comprehensibility of the surrounding world. The other case evidences the constant presence of the “Shoah complex” involving guilt feelings, and also the resulting difficulties in thinking and talking about the Holocaust in the community of therapists in Poland. The essential component of any therapy for people with psychotic symptoms and a history of trauma consists in helping them to connect these events and contain feelings of fear, shame and guilt. [ABSTRACT FROM AUTHOR]

Aim. To study the therapeutic relationship in community mental health care, in terms of patients' socioeconomic status and their experience of interpersonal bonds. Method. Research study included patients treated in community mental health care (N=64) who met the criteria for psychosis, and the professionals who managed their treatment. Patients' psychotic symptoms were measured with the use of the PANSS scale, whereas the STAR scale was used to assess the therapeutic relationship, in separate models for evaluating patients and clinicians. The patients' socioeconomic data was collected, as was information about the therapists. results. Patients' experience of bonds, understood as a current or past marriage or parenthood, correlated positively with their views on the therapeutic relationship. Patients assessed therapeutic relationships more favourably than their therapists. Therapists assessed the therapeutic relationship in the "positive clinician input" dimension more favourably than did financially independent patients. Conclusions. Patients' experience of interpersonal bonds enhances their chances of establishing a successful therapeutic relationship and it also contributes to establishing a good therapeutic relationship in the opinion of therapists. [ABSTRACT FROM AUTHOR]

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Background. A constant effort is observed all over the world to displace treatment from mental hospitals and other long stay institutions to a community form of care. Community care is poorly developed in Poland. This induces surveys estimating the effectiveness of community care recently formed. Aim. The aim was to estimate the efficacy of a new community model of treatment of patients with schizophrenia. It was expected that community care decreases hospitalizations and enables better functioning in the environment, which in turn improves their quality of life. Method. The study was carried out on 37 patients and 25 caregivers assessed at the referral to the community care and after one year in care. The study uses PANSS, Birchwood Scale and the Quality of Life Scale. Polish questionnaires: Family Burden Questionnaire and Questionnaire of Burdensome Behaviour were used to measure family burden in the patients' and their relatives' views. The focus group was used to evaluate treatment satisfaction. Cost assessment was made using the data form Administrative Departure of the institution. Results. Improvement in psychic state, contacts with family and satisfaction from life were achieved. Reduction in destructive behaviours was noted. Improvement occurred in withdrawal and undertaking social roles. Reduction in costs occurred due to a major decrease in the length of hospitalisations. Conclusions. Community care enables social inclusion through improving social functioning and subjective quality of life and sense of freedom. The community model is cost effective as a result of reduction of hospitalisations. [ABSTRACT FROM AUTHOR]

Abstract: This study explored the role of the sense of coherence (SOC) in predicting the scope and impact of stigma experiences in 229 patients with schizophrenia or affective disorders. Findings revealed that SOC significantly predicted lower levels of stigma, accounting for 13% of the variance in stigma experiences and 4% of the variance in stigma impact, over and above that explained by background characteristics, diagnosis and the psychiatric symptoms of the participants. [Copyright &y& Elsevier]