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Background: The number of people growing older with severe mental illness (SMI) is rising, reflecting societal trends towards an ageing population. Evidence suggests that older people are less likely to seek help, be referred for and receive psychological therapy compared with younger people, but past research has focused on those with mild to moderate mental health needs., Aims: This research aims to identify the specific barriers faced by older people with SMI., Method: We interviewed 53 participants (22 service users with SMI aged over 50 years, 11 carers of people with SMI, and 20 health care professionals) about their views and experiences of accessing therapy for SMI in later life., Results: Thematic analysis revealed five themes: organizational and resource issues; myths about therapy and attitudinal barriers; stigma; encouraging access to therapy; and meeting age-specific needs., Conclusions: Barriers faced by older people with SMI are not only age-related, but also reflect specific issues associated with having a SMI over many years. Improving awareness of the benefits of psychological therapies is important not only for older people with SMI themselves, but also for their carers and staff who work with them.

Background: Suicide prevention is a global priority. Psychiatric hospitalization presents an opportunity to intervene positively with, for example, psychological therapies. However, evidenced-based suicide-prevention psychological treatments are rarely available on in-patient wards. Understanding staff engagement with research investigating suicide-prevention psychological treatments is crucial for their effective, efficacious, and pragmatic implementation. A pilot randomised control trial and feasibility study of Cognitive Behavioural Suicide Prevention therapy provided the opportunity for a qualitative investigation of staff experiences and views of a psychological intervention for people with suicidal experiences on psychiatric in-patient wards., Aims: To investigate staff acceptability of Cognitive Behavioural Suicide Prevention therapy for psychiatric inpatients based on their perceptions of their experiences during the conduct of a clinical trial., Method: Transcribed audio-recordings of qualitative interviews and a focus group (n = 19) of purposively sampled staff from eight psychiatric wards were analysed using inductive Thematic Analysis., Results: Facilitators and barriers were identified for: i) the conduct of the research, and, ii) the suicide-prevention intervention (Cognitive Behavioural Suicide Prevention therapy). Research-related barriers comprised communication difficulties between staff and researchers, and increased staff workload. Research-related facilitators included effective staff/researcher relationships, and alignment of the intervention with organisational goals. Suicide-prevention intervention-related barriers comprised staffs' negative beliefs about suicide which impacted on their referral of inpatients to the clinical trial, and staff perceptions of insufficient information and unfulfilled expectations for involvement in the therapy. Facilitators included staff beliefs that the therapy was beneficial for inpatients, the service and their own clinical practice., Conclusions: Staff beliefs that 'suicide-talk' could precipitate suicidal behaviour resulted in covert gatekeeping and restricted referral of only inpatients judged as stable or likely to engage in therapy, which may not be those who could most benefit. Such threats to sample representativeness have implications for future therapy research design. The findings provide novel information for researchers and practitioners regarding the conduct of psychological treatment and research in psychiatric units., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Yvonne Awenat is a Trustee for a North-West England mental health charity affiliated to Mind. Professor Christopher Armitage is supported by NIHR Manchester Biomedical Research Centre and NIHR Greater Manchester Patient Safety Translational Research Centre. All other authors confirm that they have no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objectives: Prior research has examined various components involved in the impact of public and internalized stigma on people with mental health problems. However, studies have not previously investigated the subjective experiences of mental health stigma by those affected in a non-statutory treatment-seeking population., Design: An in-depth qualitative study was conducted using thematic analysis to investigate the experiences of stigma in people with mental health problems., Methods: Eligible participants were recruited through a local mental health charity in the North West of England. The topic of stigma was examined using two focus groups of thirteen people with experience of mental health problems and stigma., Results: Two main themes and five subthemes were identified. Participants believed that (1) the 'hierarchy of labels' has a profound cyclical impact on several levels of society: people who experience mental health problems, their friends and family, and institutional stigma. Furthermore, participants suggested (2) ways in which they have developed psychological resilience towards mental health stigma., Conclusions: It is essential to utilize the views and experiences gained in this study to aid understanding and, therefore, develop ways to reduce the negative impact of public and internal stigma., Practitioner Points: People referred to their mental health diagnosis as a label and associated that label with stigmatizing views. Promote awareness and develop improved strategies (e.g., training) to tackle the cyclical impact of the 'hierarchy of labels' on people with mental health problems, their friends and family, and institutional stigma. Ensure the implementation of clinical guidelines in providing peer support to help people to combat feeling stigmatized. Talking about mental health in psychological therapy or health care professional training helped people to take control and develop psychological resilience., (© 2018 The British Psychological Society.)

WHAT IS KNOWN ON THE SUBJECT?: The strength of a relationship between people with mental health difficulties and professionals has been linked to patients feeling suicidal. A relationship has been found between how defeated and trapped people with mental health difficulties feel and how suicidal they feel. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study explored the relationship between alliance, suicidality, defeat and entrapment in people admitted to mental health wards as previous research has focused on people in the community. Patient-rated defeat, entrapment and suicidality are related in this sample of people admitted to mental health wards. A relationship was found between how well nurses said they bonded with their named patient and how trapped the patients felt by their environment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should consider if patients are feeling defeated or trapped when helping people with mental health difficulties to feel less suicidal., Abstract: Introduction Suicidality is prevalent worldwide, particularly in people who access mental health services. The quality of therapeutic alliance between people with mental health difficulties and staff has been associated with suicidality but only in community settings. Defeat and entrapment are correlated with suicidality and may mediate any relationship between alliance and suicidality. Therefore, this exploratory study explored these relationships in people admitted to mental health wards. Aim To explore defeat, entrapment, suicidality and alliance between nurses and people admitted to mental health wards. Method Fifty inpatient nurse-patient dyads completed questionnaires regarding demographics, defeat, entrapment, suicidality and alliance with their named nurse. Nurses completed questionnaires on demographics, alliance with their patient and the patients' suicidality. Results Defeat, entrapment and suicidality were correlated. A correlation between nurse-rated bond and external entrapment was found, but no other correlations between alliance, defeat, entrapment and suicidality were statistically significant. Discussion and clinical implications Ward-based nurses should consider the relationship between defeat, entrapment and suicidality when developing interventions to improve suicidality. Although there was no evidence of a relationship between total alliance and suicidality, developing closer bonds with patients may reduce patients' feelings of being trapped by their environment., (© 2017 John Wiley & Sons Ltd.)

Purpose: Schema therapy was first applied to individuals with borderline personality disorder (BPD) over 20 years ago, and more recent work has suggested efficacy across a range of disorders. The present review aimed to systematically synthesize evidence for the efficacy and effectiveness of schema therapy in reducing early maladaptive schema (EMS) and improving symptoms as applied to a range of mental health disorders in adults including BPD, other personality disorders, eating disorders, anxiety disorders, and post-traumatic stress disorder., Methods: Studies were identified through electronic searches (EMBASE, PsycINFO, MEDLINE from 1990 to January 2016)., Results: The search produced 835 titles, of which 12 studies were found to meet inclusion criteria. A significant number of studies of schema therapy treatment were excluded as they failed to include a measure of schema change. The Clinical Trial Assessment Measure was used to rate the methodological quality of studies. Schema change and disorder-specific symptom change was found in 11 of the 12 studies., Conclusions: Schema therapy has demonstrated initial significant results in terms of reducing EMS and improving symptoms for personality disorders, but formal mediation analytical studies are lacking and rigorous evidence for other mental health disorders is currently sparse., Practitioner Points: First review to investigate whether schema therapy leads to reduced maladaptive schemas and symptoms across mental health disorders. Limited evidence for schema change with schema therapy in borderline personality disorder (BPD), with only three studies conducting correlational analyses. Evidence for schema and symptom change in other mental health disorders is sparse, and so use of schema therapy for disorders other than BPD should be based on service user/patient preference and clinical expertise and/or that the theoretical underpinnings of schema therapy justify the use of it therapeutically. Further work is needed to develop the evidence base for schema therapy for other disorders., (© 2016 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of the British Psychological Society.)

Objectives: Recent inquiries highlight the anti-therapeutic nature of inpatient psychiatric care. We aim to assess the feasibility and potential efficacy of a ward-based psychological intervention to improve staff-patient relationships in psychiatric rehabilitation settings., Methods: A single-blind cluster randomized design compared the intervention with treatment as usual (TAU) on measures of relationships, staff well-being, and patient functioning. Assessments were carried out at baseline and at 6 months., Results: Fifty-one patients and 85 staff were recruited across 10 wards. Fifteen patients and 11 staff were lost to follow-up, with primary reason being ward discharge. Uptake to the intervention was variable but on average lower than anticipated (mean number of sessions 3.5, range 0-11). Despite this lower than anticipated uptake, compared with TAU, patients in the intervention arm felt significantly less criticized by their key workers and reported improvements in ward atmosphere. Staff in the intervention arm also reported significantly lower levels of depersonalization post-intervention. Although trend level data favoured the intervention group, in this relatively small feasibility study, we were not able to demonstrate statistically significant differences between the groups in terms of staff perceptions of relationships, staff stress, and longer-term patient outcomes., Conclusions: This psychologically informed ward-based intervention shows potential in improving relationships, although findings and feasibility may be enhanced if further measures are put into place to ensure that all members of the team attend intervention sessions on a more frequent basis. Loss at follow-up due to discharge also needs to be factored into future power calculations., Practitioner Points: It is feasible to implement and trial a ward-based psychological intervention (team-based formulation) in long-stay psychiatric settings using a cluster randomized design. Developing psychological formulations with frontline ward staff around patients' needs has the potential to improve staff-patient relationships. The small sample size and loss of data at follow-up may have limited the power of the study to detect the full range of treatment effects. Larger trials are needed to assess the reliability and generalizability of our findings across different wards., (© 2015 The British Psychological Society.)

Background: Suicide is a major cause of preventable death, and suicidal behaviour is prevalent in acute psychiatric wards. People admitted to acute psychiatric wards often experience repeated episodes of suicidal behaviour, causing great distress and heavy use of NHS services. There is little research investigating effective psychological treatments for suicidal patients in inpatient settings although previous research has found support for psychological therapies which specifically target suicidal behaviour. This paper describes the protocol of a single blind RCT to investigate the acceptability and feasibility of a cognitive behavioural intervention targeting suicidality (CBSP) for suicidal people in acute psychiatric wards., Methods/design: A single blind RCT comparing treatment as usual (TAU) to TAU plus Cognitive Behavioural Suicide Prevention (CBSP) therapy (TAU + CBSP). Sixty participants (aged 18-65 years) who are suicidal, or have been within the past 3 months, will be recruited from NHS trusts in the North West of England. Our primary objective is to determine whether CBSP is feasible, acceptable and efficacious when compared to patients who receive TAU alone. Secondary aims are the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use and psychological factors associated with suicide. Assessments take place at baseline, 6 weeks and 6 months (end of treatment). The analysis will report on the feasibility and acceptability of CBSP. Qualitative data from staff and service users will inform feasibility and acceptability data., Discussion: Psychiatric inpatients are a high-risk group and the use of psychological therapies in these settings is rare and requires evaluation. This study is essential to investigate the unique contextual challenges involved in delivering psychological therapy to suicidal inpatients and to identify any necessary modifications required within inpatient settings. The findings will inform a larger, definitive trial., Trial Registration: 15 March 2012, PB-PG-1111-26026, NIHR ISRCTN17890126 .

Background: Ensuring good quality staff and patient relationships are key goals of long-stay inpatient services. It is therefore essential that staff have a good understanding of patients' needs and how to work with the challenges that can present in these environments., Aims: We evaluated the feasibility and acceptability of a workshop to help psychiatric staff with challenging behaviours., Design: We used a quasi experimental design with assessments carried out at baseline and post intervention. We provided the training to staff on one low secure psychiatric unit and recorded the uptake of outcome assessments and the workshop itself. We assessed staff-patient relationships, burnout and ward atmosphere and staff also completed satisfaction questionnaires., Results: Sixty-six percent of staff (n = 25) who were eligible to participate in the project completed initial outcome measures, but only 42% (n = 16) attended the workshop and only 34% (n = 13) completed follow-up measures. The workshop had no predicted effects on any of the outcomes assessed, but staff satisfaction with the training was generally positive., Conclusions: Building up positive relationships with staff, addressing negative expectations and seeking support from all levels of management are essential in terms of reducing barriers to training in psychiatric settings.

People who suffer from long term mental illness may be vulnerable to loneliness and isolation when living in community settings. Befriending by volunteers may be an effective way of combating such problems and helping clients to develop social networks. The findings of a small scale project to evaluate the views of people suffering from long term mental illness of an organized befriending scheme are reported. Nine subjects who suffer from severe mental illness were interviewed, all subjects felt befriending was helpful to them, and 67% of subjects thought it had improved their confidence when in social situations. Subjects who lived alone indicated a preference to see volunteers at home, whilst those who lived with carers preferred support in going out socially. The value of befriending schemes as part of community care services for this needy client group are discussed.

This study describes the use of reliable scales to rate the clinical skills of mental health nurses when working with individuals and families with severe mental health problems. The Cognitive Therapy Scale and the Schizophrenia Family Work Scale were adapted for the study and were shown to have good inter-rater reliability when assessing audio-taped interviews carried out by mental health nurses during their usual course of work with patients with severe mental health problems and their families. The sample of mental health nurses studied were shown to have significantly better general therapy skills than specific cognitive therapy technical skills. The implications for training are discussed.

A follow-up study of patients from two long-stay psychiatric hospitals in East Yorkshire health authority looked at a sample of patients who had been discharged into the community and a sample within the institution. The study looked particularly at the quality of life of patients who had been discharged and at any differences between them and patients still living in the institution.