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WHAT IS KNOWN ON THE SUBJECT?: Traditional mental health services are not meeting the needs of service users. Peer support is an alternative approach of providing support founded on relationship where there is respect and shared responsibility. Peer support relationships are mutual and reciprocal. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The experience of peer-led care can be transformative. A key aspect is the validation and valuing of lived experience and being seen as a person not as an illness. The nature and quality of relationships is paramount and needs to be based on equity. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Nurses have a key role to advocate and promote peer support services. Relationships need to be based on respect and "being alongside" service users in their recovery journey rather than trying to "fix the problem." ABSTRACT: Introduction Peer-led services provide an approach to support based on mutuality, respect and shared experience. Aim To provide an understanding of my experiences of receiving help from a peer-led service. Method Journaling experiences captured in detail the reality of my experiences at the time and were used to inform this paper. Results The Narrative describes entering a Peer-Led Acute Alternative Service when I was amid a mental health crisis and feeling broken. Here, relationships were based on connecting with others who have experienced similar struggles, being seen as an individual rather than a patient, treated with dignity and respect, being heard, having my feelings acknowledged rather than medicated and feeling understood. This created a shift in me to a place of healing and finding meaning in my experiences of mental distress which led to me training in peer support. Discussion Peer-led services can be a transformative experience which redefines the relationship and shifts the person from being a passive recipient of help to an active participant in their recovery. Choice and increased options for peer services as an integral aspect of services available for individuals on their mental health journey is critical., (© 2021 John Wiley & Sons Ltd.)

Objective: To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. Methods: A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12‐month course of IPSRT with CR (IPSRT‐CR), or without CR (IPSRT). In IPSRT‐CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months). Results: Sixty‐eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT‐CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment‐end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT‐CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41–0.60). At 18 months, small to moderate, non‐significant benefits (0.26–0.47) of IPSRT vs IPSRT‐CR were found on functioning and mood outcomes. Conclusions: Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders. [ABSTRACT FROM AUTHOR]

Background: Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders. Methods: This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation – New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis. Discussion: This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures. Trial registration: Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112. Registered on 6 August 2019. [ABSTRACT FROM AUTHOR]

Questioning a diagnosis of bipolar disorder is not surprising given the chronic and fluctuating nature of the illness. Qualitative research using thematic analysis was used to derive an understanding of the process patients used to make sense of their diagnosis of bipolar disorder. The findings suggested that receiving a diagnosis was an active process. Factors such as fluctuating moods, changing diagnoses or misdiagnosis, difficulties patients have differentiating self from illness, mistrust in mental health services, and experiences of negative side effects of medication can contribute to ambivalence about the diagnosis and lead to relapse. These findings highlight the need for clinicians to focus on patients’ perceptions of bipolar disorder and work with the ambivalence in the process of facilitating greater acceptance. This has the potential for reducing relapses through increased adherence with treatment. [ABSTRACT FROM AUTHOR]