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IntroductionThe benefits of physical activity for mental health and well-being and the associations between parental mental health and children’s mental health have been well established. These important issues tend to be examined separately however, and there is limited research on the associations between parent and child physical activity and mental health when all considered together. While family focused practice is recommended to provide support for parents who have mental health problems and their families and includes various components (such as psychoeducation, support for mental health and parenting), promoting physical activity for parents and children is not usually a core component of these interventions.MethodsThe Northern Ireland Youth Wellbeing Survey aimed to provide estimates of the prevalence of mental health problems among children and young people. The survey also included questions about parental physical activity, parental mental health, and children’s physical activity (for those aged 11–19 years). The main aim of the analysis reported in this article was to explore possible bivariate associations between parent and child physical activity and mental health and also explore these associations when all considered together. Participants were included in the analysis where there were completed interviews for the young person and one of their parents, and both young person and parent provided responses in relation to questions on weekly physical activity (n = 882).ResultsThe findings highlight the positive associations between parental physical activity and parental mental health, and between children’s physical activity and children’s mental health. They also explore some of the more complex interactions between these four variables, which suggest that gender may also be an important consideration. There were significant associations between father’s physical activity and son’s mental health, and son’s physical activity and father’s mental health.DiscussionsThese findings suggest that including support for parental physical activity and children’s physical activity should be a routine component of family focused mental health interventions. It is important to acknowledge that there may be additional barriers to engaging in physical activity for families where a parent is experiencing mental health problems, and these should also be explored and addressed.

Abstract Background The World Health Organisation declared the novel Coronavirus disease (COVID-19) a global pandemic on 11th March 2020. Since then, the world has been firmly in its grip. At the time of writing, there were more than 767,972,961 million confirmed cases and over 6,950,655 million deaths. While the main policy focus has been on controlling the virus and ensuring vaccine roll-out and uptake, the population mental health impacts of the pandemic are expected to be long-term, with certain population groups affected more than others. Methods The overall objectives of our ‘Coronavirus: Mental Health and the Pandemic’ study were to explore UK adults’ experiences of the Coronavirus pandemic and to gain insights into the mental health impacts, population-level changes over time, current and future mental health needs, and how these can best be addressed. The wider mixed-methods study consisted of repeated cross-sectional surveys and embedded qualitative sub-studies including in-depth interviews and focus group discussions with the wider UK adult population. For this particular inequalities and mental health sub-study, we used mixed methods data from our cross-sectional surveys and we carried out three Focus Group Discussions with a maximum variation sample from across the UK adult population. The discussions covered the broader topic of 'Inequalities and mental health during the Coronavirus pandemic in the UK’ and took place online between April and August 2020. Focus Groups transcripts were analysed using thematic analysis in NVIVO. Cross-sectional survey data were analysed using STATA for descriptive statistics. Results Three broad main themes emerged, each supporting a number of sub-themes: (1) Impacts of the pandemic; (2) Moving forward: needs and recommendations; (3) Coping mechanisms and resilience. Findings showed that participants described their experiences of the pandemic in relation to its impact on themselves and on different groups of people. Their experiences illustrated how the pandemic and subsequent measures had exacerbated existing inequalities and created new ones, and triggered various emotional responses. Participants also described their coping strategies and what worked and did not work for them, as well as support needs and recommendations for moving forward through, and out of, the pandemic; all of which are valuable learnings to be considered in policy making for improving mental health and for ensuring future preparedness. Conclusions The pandemic is taking a long-term toll on the nations’ mental health which will continue to have impacts for years to come. It is therefore crucial to learn the vital lessons learned from this pandemic. Specific as well as whole-government policies need to respond to this, address inequalities and the different needs across the life-course and across society, and take a holistic approach to mental health improvement across the UK.

Abstract Introduction Mental health problems are a considerable public health issue and spending time in nature has been promoted as a way to access a range of psychological benefits leading to the development of nature‐based interventions for people with severe and enduring mental health problems. Less, however, is understood about the potential benefits and efficacy of day‐to‐day routine access to outdoor green and blue spaces for mental health service users. Methods Using a mixed‐methods design between April and October 2021, we explored the benefits and barriers to spending time outdoors with a purposive sample of mental health service users (N = 11) using qualitative interviews and an online general population survey (N = 1791). Qualitative evidence highlighted the restorative benefits of nature and identified a number of barriers associated with fears around personal safety, social anxiety, fatigue and lack of motivation. COVID‐19 had also restricted access to green and blue spaces. Having social contact and support encouraged people to spend time outdoors. In the quantitative survey, self‐report and standardised measures (the Patient Health Questionnaire and the Warwick–Edinburgh Wellbeing Scale) were used to assess past and current mental wellbeing. Findings Statistically significant differences were found between wellbeing and the use of green and blue spaces. Those with mental health problems spent time outdoors because they: felt guilty; wanted to reduce their anxiety; or rely on someone for encouragement. Those without mental health problems endorsed more positively framed reasons including relaxation, improving physical health or getting exercise. Barriers for people with mental health problems involved safety concerns, feeling anxious and having a poor self‐image. These findings give insight into motivations for an outdoor activity to help inform the design of public mental health interventions. Conclusion Further work is required to improve access and safety to promote the benefits of green and blue spaces for everyone. Patient or Public Contribution The research team included expert experienced researchers with a mental health service provider (Praxis Care) and they were involved in the development of the research idea, funding application, design, data collection, analysis, writing up and dissemination activities.

Abstract Background Previous research suggests that auditory hallucinations are prevalent within both the clinical and general populations. Yet, we know little about how these phenomena are associated with other psychopathology symptoms and experiences. The current study aids investigations towards preventing, predicting and more effectively responding to such distressing occurrences. There have been substantial efforts in the literature to propose models of auditory hallucination and attempts to verify them. However, many of these studies used survey methods that restrict the person’s responses to a set of pre-defined criteria or experiences and do not allow exploration of potential important other symptoms beyond them. This is the first study to explore the correlates of auditory hallucination using a qualitative dataset consisting of unrestricted responses of patients about their lived experiences with mental illness. Method The study used a dataset consisting of 10,933 narratives from patients diagnosed with mental illnesses. For analysis, the study used correlation on the text-based data. This approach is an alternative to the knowledge-based approach where experts manually read the narratives and infer the rules and relationships from the dataset. Result This study found at least 8 correlates of auditory hallucination (small correlation coefficients), with the unusual ones being “pain.” The study also found that auditory hallucinations were independent of obsessive thoughts and compulsive behaviours, and dissociation, in contrast with the literature. Conclusion This study presents an innovative approach to explore the possible associations between symptoms without the restrictions of (or outside the confines of) traditional diagnostic categories. The study exemplified this by finding the correlates of auditory hallucination. However, any other symptom or experience of interest can be studied similarly. Potential future directions of these findings are discussed in the context of mental healthcare screening and treatment.

Abstract Background The limited health and social care infrastructure that existed in the 1970s in Cambodia was destroyed due to the Khmer Rouge. Mental Health service infrastructures have developed in Cambodia in the last twenty five years, however, they have been shaped significantly by very limited funding being made available for human resources, support services and research. The lack of research on Cambodia’s mental health systems and services is a significant barrier to the development of evidence-based mental health policies and practice. In order to address this barrier, effective research and development strategies are needed in Cambodia, which are based on locally well-informed research priorities. There are many possibilities for mental health research in LMIC countries such as Cambodia, therefore focused research priorities in these areas are needed to guide future research investment. This paper is the result of the development of international collaborative workshops, which focused on service mapping and research priority setting in the field of mental health in Cambodia. Methods A nominal group technique was used to gather ideas and insights from a range of key mental health service stakeholders in Cambodia. Results: The key issues in service provisions for people with mental health issues and disorders, the interventions and programmes of support available, and currently needed, were identified. This paper also identifies five key mental health research priority areas which could form the basis for effective mental health research and development strategies in Cambodia. Conclusion There is a clear need for the Cambodian government to devise a clear policy framework for health research. This framework could focus on the five research domains identified in this paper and could be incorporated within its National Health Strategic plans. The implementation of this approach would likely lead to the development of an evidence base which would allow the development of effective and sustainable strategies for mental health problem prevention and intervention. This would also contribute to promote the Cambodian government’s capacity to take the deliberate, concrete, and targeted steps necessary to address the complex mental health needs of its population.

Plain English summary Making your own decisions is important. There are disabled people who need support to make some decisions. Supporting disabled people to make decisions is needed so that they are not excluded from society. However, the evidence is limited on disabled people’s experiences of how best to support decision-making. This article will explore the experiences of four researchers with mental health problems or an intellectual disability who worked with other researchers to conduct a project on how people have, or have not been, supported to make their own decisions. These researchers are called peer researchers. The peer researchers interviewed 21 people with mental health problems and 20 people with an intellectual disability. These interviews were conducted in order to gain a detailed understanding of the experiences and preferences for how decision-making should be supported. Blogs written by the peer researchers, discussions in team meetings and a workshop at the end of the study enabled the peer researchers to reflect on their experiences. The peer researchers reported a number of positive effects of being involved in the research project which included improvements in skills and self-confidence. The peer researchers’ involvement challenged assumptions about the inability of people with an intellectual disability and/or mental health problems to participate in a research project whilst also highlighting the importance of training for all team members.

Plain English summary Since the 1970’s, there has been a shift from research on disabled people to research with disabled people. This is often referred to as co-produced research. Co-production has a wide definition but includes disabled people working with academics to produce research and outcomes which neither group could achieve by working in isolation. This paper presents the co-production methodology used to conduct a research project called ‘Getting our Voices Heard’. This project, sought to find the best way to get the voices of people with a learning disability heard inpolicy development in the UK. We explain how this research was carried out, using a co-produced participatory design. We established a research team with professional researchers from a university, who worked with peer researchers. Peer researchers are people who have lived experience of the issue being studied. In this project, we worked with six peer researchers who all had a learning disability. The experiences of the peer researchers, and ways in which the peer researchers were involved at each stage of the project are discussed. The peer researchers described feeling positive about their role and felt involved. We show that working together is important and recommend that additional time and resources are essential for this joint working.

Abstract Background To deliver appropriate mental healthcare interventions and support, it is imperative to be able to distinguish one person from the other. The current classification of mental illness (e.g., DSM) is unable to do that well, indicating the problem of diagnostic heterogeneity between disorders (i.e., the disorder categories have many common symptoms). As a result, the same person might be diagnosed with two different disorders by two independent clinicians. We argue that this problem might have resulted because these disorders were created by a group of humans (APA taskforce members) who relied on more intuition and consensus than data. Literature suggests that human-led decisions are prone to biases, group-thinking, and other factors (such as financial conflict of interest) that can enormously influence creating diagnostic and treatment guidelines. Therefore, in this study, we inquire that if we prevent such human intervention (and thereby their associated biases) and use Artificial Intelligence (A.I.) to form those disorder structures from the data (patient-reported symptoms) directly, then can we come up with homogenous clusters or categories (representing disorders/syndromes: a group of co-occurring symptoms) that are adequately distinguishable from each other for them to be clinically useful. Additionally, we inquired how these A.I.-created categories differ (or are similar) from human-created categories. Finally, to the best of our knowledge, this is the first study, that demonstrated how to use narrative qualitative data from patients with psychopathology and group their experiences using an A.I. Therefore, the current study also attempts to serve as a proof-of-concept. Method We used secondary data scraped from online communities and consisting of 10,933 patients’ narratives about their lived experiences. These patients were diagnosed with one or more DSM diagnoses for mental illness. Using Natural Language Processing techniques, we converted the text data into a numeric form. We then used an Unsupervised Machine Learning algorithm called K-Means Clustering to group/cluster the symptoms. Results Using the data mining approach, the A.I. found four categories/clusters formed from the data. We presented ten symptoms or experiences under each cluster to demonstrate the practicality of application and understanding. We also identified the transdiagnostic factors and symptoms that were unique to each of these four clusters. We explored the extent of similarities between these clusters and studied the difference in data density in them. Finally, we reported the silhouette score of + 0.046, indicating that the clusters are poorly distinguishable from each other (i.e., they have high overlapping symptoms). Discussion We infer that whether humans attempt to categorise mental illnesses or an A.I., the result is that the categories of mental disorders will not be unique enough to be able to distinguish one service seeker from another. Therefore, the categorical approach of diagnosing mental disorders can be argued to fall short of its purpose. We need to search for a classification system beyond the categorical approaches even if there are secondary merits (such as ease of communication and black-and-white (binary) decision making). However, using our A.I. based data mining approach had several meritorious findings. For example, we found that some symptoms are more exclusive or unique to one cluster. In contrast, others are shared by most other clusters (i.e., identification of transdiagnostic experiences). Such differences are interesting objects of inquiry for future studies. For example, in clear contrast to the traditional diagnostic systems, while some experiences, such as auditory hallucinations, are present in all four clusters, others, such as trouble with eating, are exclusive to one cluster (representing a syndrome: a group of co-occurring symptoms). We argue that trans-diagnostic conditions (e.g., auditory hallucinations) might be prime targets for symptom-level interventions. For syndrome-level grouping and intervention, however, we argue that exclusive symptoms are the main targets. Conclusion Categorical approach to mental disorders is not a way forward because the categories are not unique enough and have several shared symptoms. We argue that the same symptoms can be present in more than one syndrome, although dimensionally different. However, we need additional studies to test this hypothesis. Future directions and implications were discussed.

Plain English summary The aim of this study was to gather information to help us understand the experience of participants’ undertaking a research course called ‘Getting Involved in Research’. A group of individuals including those with lived experience of health and social care services, academics, community and voluntary sector workers and a representative from the Department of Health in Northern Ireland worked together to develop a course to encourage and support people to engage with research. The ‘Getting Involved in Research’, course was designed to provide an understandable introduction to research for those people with lived experience of health and social care. We did this because research in health and social care sector should involve the patients and public who it is intended to help. The evaluation of the course had two distinct phases; we asked course participants to complete a survey before and after the course (pre- and post-course survey) and also asked them to complete a journal reflecting on their experiences after each lecture. This paper gives an overview of the profile of course participants and their responses to the survey questions. The survey answers were analysed using an approach to analysing information which encourages involvement from people with a range of experience of research methods, (known as Participatory Theme Elicitation). Thirty-five participants in total participated in ‘Getting Involved in Research’. Age ranges varied from 19 to 73 years old. Participants were predominately female (n = 24), five males participated (n = 5) and there was one participant who identified as non-binary (n = 1). Participants in ‘Getting Involved in Research’ reported that the content of the course was relevant, encouraged awareness of research methods and encourage their future involvement in research.

BackgroundParental mental illness is a major public health issue and there is growing evidence that family focused practice can improve outcomes for parents and their families. However, few reliable and valid instruments measure mental health and social care professionals' family focused practice.ObjectivesTo explore the psychometric properties of the Family Focused Mental Health Practice Questionnaire in a population of health and social care professionals.MethodsHealth and Social Care Professionals (n = 836) in Northern Ireland completed an adapted version of the Family Focused Mental Health Practice Questionnaire. Exploratory factor analysis was used to test the structure of the underlying dimensions in the questionnaire. The results, and theoretical considerations, guided construction of a model that could explain variation in respondents' items. This model was then validated using confirmatory factor analysis.ResultsExploratory factor analysis revealed that solutions including 12 to 16 factors provided a good fit to the data and indicated underlying factors that could be meaningfully interpreted in line with existing literature. From these exploratory analyses, we derived a model that included 14 factors and tested this model with Confirmatory Factor Analysis. The results suggested 12 factors that summarized 46 items that were most optimal in reflecting family focused behaviours and professional and organizational factors. The 12 dimensions identified were meaningful and consistent with substantive theories: furthermore, their inter-correlations were consistent with known professional and organizational processes known to promote or hinder family focused practice.ConclusionThis psychometric evaluation reveals that the scale provides a meaningful measure of professionals' family focused practice within adult mental health and children's services, and the factors that hinder and enable practice in this area. The findings, therefore, support the use of this measure to benchmark and further develop family focused practice in both adult mental health and children's services.

Background: GPs are often faced with deciding whether or not a patient may require detention for assessment in hospital under mental health legislation. This can be a complex and daunting process. Despite this, GPs and most other professionals receive limited formal training. Aim: To map and review the current literature on training in mental health detention processes. These insights are vital to inform the further development of meaningful educational approaches. Design & setting: A systematic scoping literature review was conducted to identify what is known about how best to develop training in this area. Method: Arksey and O’Malley’s framework was used to select, chart, and analyse articles from across six electronic databases. A total of 1136 articles were included in the initial screening phase and 183 articles were included in the full-text screening phase. Key themes were derived using an iterative and thematic approach. A personal and public involvement (PPI) group was set up for this project and other stakeholders in the mental health detention process were consulted about the findings. Results: Fifty-two articles were included in the final review. Professionals consistently highlighted unmet training needs and difficulties with the process. There were identified needs for practical, interdisciplinary training, including discussion of complex cases, and opportunities to learn from those with direct experience. Conclusion: This work is foundational for the development of meaningful educational approaches around mental health detention processes. A strong research base will inform and strengthen training with the ultimate aim of improving patient care.

BackgroundWorldwide, the Coronavirus pandemic has had a major impact on people's health, lives, and livelihoods. However, this impact has not been felt equally across various population groups. People from ethnic minority backgrounds in the UK have been more adversely affected by the pandemic, especially in terms of their physical health. Their mental health, on the other hand, has received less attention. This study aimed to explore the mental health experiences of UK adults from ethnic minorities during the Coronavirus pandemic. This work forms part of our wider long-term UK population study “Mental Health in the Pandemic.”MethodsWe conducted an exploratory qualitative study with people from ethnic minority communities across the UK. A series of in-depth interviews were conducted with 15 women, 14 men and 1 non-binary person from ethnic minority backgrounds, aged between 18 and 65 years old (mean age = 40). We utilized purposefully selected maximum variation sampling in order to capture as wide a variety of views, perceptions and experiences as possible. Inclusion criteria: adults (18+) from ethnic minorities across the UK; able to provide full consent to participate; able to participate in a video- or phone-call interview. All interviews took place via MS Teams or Zoom. The gathered data were transcribed verbatim and underwent thematic analysis following Braun and Clarke carried out using NVivo 12 software.ResultsThe qualitative data analysis yielded seven overarching themes: (1) pandemic-specific mental health and wellbeing experiences; (2) issues relating to the media; (3) coping mechanisms; (4) worries around and attitudes toward vaccination; (5) suggestions for support in moving forward; (6) best and worst experiences during pandemic and lockdowns; (7) biggest areas of change in personal life. Generally, participants' mental health experiences varied with some not being affected by the pandemic in a way related to their ethnicity, some sharing positive experiences and coping strategies (exercising more, spending more time with family, community cohesion), and some expressing negative experiences (eating or drinking more, feeling more isolated, or even racism and abuse, especially toward Asian communities). Concerns were raised around trust issues in relation to the media, the inadequate representation of ethnic minorities, and the spread of fake news especially on social media. Attitudes toward vaccinations varied too, with some people more willing to have the vaccine than others.ConclusionThis study's findings highlight the diversity in the pandemic mental health experiences of ethnic minorities in the UK and has implications for policy, practice and further research. To enable moving forward beyond the pandemic, our study surfaced the need for culturally appropriate mental health support, financial support (as a key mental health determinant), accurate media representation, and clear communication messaging from the Governments of the UK.

Abstract This is the protocol for a Campbell systematic review. The objectives are as follows: To review existing qualitative research on the experiences of families living with parental mental illness from the perspective of (i) children, (ii) parents who have a mental illness) and (ii) the well parent. To synthesise qualitative evidence on the experience of living with parental mental illness and the experience of and attitude towards services from the perspective of (i) children, (ii) parents who have a mental illness and (ii) the well parent in order to develop the understanding of the needs of families and the implications for service provision.

Abstract The COVID-19 pandemic has affected people’s physical and mental health. Quarantine and other lockdown measures have altered people’s daily lives; levels of anxiety, depression, substance use, self-harm and suicide ideation have increased. This commentary assesses how international governments, agencies and organisations are responding to the challenge of the mental health impact of COVID-19 with the aim of informing the ongoing policy and service responses needed in the immediate and longer term. It identifies some of the key themes emerging from the literature, recognises at-risk populations and highlights opportunities for innovation within mental health services, focusing on the published academic literature, international health ministry websites and other relevant international organisations beyond the United Kingdom and Ireland. COVID-19 has challenged, and may have permanently changed, mental health services. It has highlighted and exacerbated pre-existing pressures and inequities. Many decision-makers consider this an opportunity to transform mental health care, and tackling the social determinants of mental health and engaging in prevention will be a necessary part of such transformation. Better data collection, modelling and sharing will enhance policy and service development. The crisis provides opportunities to build on positive innovations: the adaptability and flexibility of community-based care; drawing on lived experience in the design, development and monitoring of services; interagency collaboration; accelerating digital healthcare; and connecting physical and mental health.

Abstract Background The diagnostic system is fundamental to any health discipline, including mental health, as it defines mental illness and helps inform possible treatment and prognosis. Thus, the procedure to estimate the reliability of such a system is of utmost importance. The current ways of measuring the reliability of the diagnostic system have limitations. In this study, we propose an alternative approach for verifying and measuring the reliability of the existing system. Methods We perform Jaccard’s similarity index analysis between first person accounts of patients with the same disorder (in this case Major Depressive Disorder) and between those who received a diagnosis of a different disorder (in this case Bulimia Nervosa) to demonstrate that narratives, when suitably processed, are a rich source of data for this purpose. We then analyse 228 narratives of lived experiences from patients with mental disorders, using Python code script, to demonstrate that patients with the same diagnosis have very different illness experiences. Results The results demonstrate that narratives are a statistically viable data resource which can distinguish between patients who receive different diagnostic labels. However, the similarity coefficients between 99.98% of narrative pairs, including for those with similar diagnoses, are low (

Abstract Background Accessing support services for depression has been historically difficult given the societal stigma that exists regarding the condition. Recent advances in digital technologies continue to be postulated as a potential panacea yet the results from research trials have been mixed with a range of effect sizes. Methods This article offers a different perspective by presenting a panel of end users (co-researchers) with qualitative interview data (n = 8) taken from a feasibility RCT of a group based video-conferencing service for depressed adults. The co-researcher panel were introduced to a new method of participatory data analysis known as Participatory Theme Elicitation (PTE). This method involves using network analysis techniques to create groupings and visual diagrams in order to support the generation of themes and minimise scientific researcher input/influence. Results Co-researchers reported that while VC based interventions appeared convenient, accessible and relatively low cost - additional training and support should be offered to improve uptake and retention. In addition, co-researchers suggested that further exploration is needed regarding the level of self-awareness one feels in a group based VC environment and whether this facilitates disclosure (through disinhibition) or increases anxiety. Conclusion The findings presented here appear to support existing (researcher and academic-led) literature in the field as well as suggest new areas for investigation. By presenting data generated solely by co-researchers, this article also adds to the evidence surrounding participatory analysis methods - particularly the growing need for robust approaches that are accessible and less time-consuming than those currently available. Trial registration number NCT03288506 (Clinicaltrials.gov) 20th Sept 2017 https://clinicaltrials.gov/ct2/show/NCT03288506

The COVID-19 emergency has affected us all, but not equally. Families where parents have mental illness (PMI) are potentially at increased risk, but little is known about how they or their support services managed under lockdown/restrictions. We harnessed our existing partnerships with adult and child mental health services in the Republic of Ireland (RoI) and Northern Ireland (NI) to investigate the qualitative experiences of service users and families in coping during the first COVID-19 lockdown (March–May 2020), and how services were supporting them. Semi-structured phone/online interviews were conducted with 22 clinicians/managers (12 from RoI; 10 from NI) who provided information from their caseloads (~155 families with PMI). Sixteen family members (10 from RoI, 6 from NI) were also interviewed. Data were analysed using standard thematic analysis. Sixty percent of families reported improved mental health, primarily due to respite from daily stresses and the “normalisation” of mental distress in the general population. Approximately 30%, typically with more severe/enduring mental illness, reported additional challenges, and mental distress including: unmanageable child behaviours; fear of relapse/hospitalisation; financial difficulties; absence of child care; and a lack of routines. Service provision varied considerably across regions. The experiences within this case study highlight unique opportunities to address the multiple stresses of pre-emergency daily living. We also highlight how mental health services and governments might become more “pandemic ready” to more effectively support vulnerable families, including addressing service overload issues, optimising the use of digital technologies, and providing in-person contact and social supports where required.

Sharing a prison cell can be a difficult experience and yet levels of overcrowding mean that staff must often decide which individuals should be placed in a cell together. Little is known about how staff make such decisions or what factors prisoners believe should be considered to minimize the potential stressors associated with cell-sharing. This study addresses this gap in knowledge by examining what factors staff consider when allocating cells and what factors matter to prisoners. Fifty-two staff and adult male prisoners in Northern Ireland were interviewed about their experiences of cell-sharing and cell allocation decision-making. The findings reveal that current policy does not cover many factors staff consider in practice when allocating cells and identifies additional factors staff and prisoners regard as important. How the disempowerment prisoners feel when they lack an opportunity to contribute to cell allocation decision-making processes can contribute to violence, disorder and distress is also highlighted. These findings point to a need to develop cell allocation decision-making processes to incorporate opportunities for prisoners to have a voice in this process, in accordance with the principles of procedural justice. Additionally, staff training and guidance on weighing up a more varied range of factors than is currently considered in policy is required.

Plain English summary Co-producing research with members of the public is increasingly recognised as a valuable process. Yet, despite these good intentions, the literature on coproduction has struggled to keep pace with the coproduction ‘movement’. There is a lack of clarity regarding acceptable levels of involvement and attempts at standardising approaches appear generic and lack detail. Moreover, relatively little research has captured the views of all the parties involved (academics, service providers and service users). We conducted interviews with all those involved in developing a new online service for depression in Northern Ireland. Our main questions related to how these three very different groups of people worked together over a two-year period to design, develop and deliver the service (e.g. what were the benefits? What would they do differently?) We found that early involvement was a key factor as this promoted equal ownership. There was also a need to be flexible and recognise other workload pressures. Interestingly, service providers and service users were keen to become more involved in data analysis – this is one of the most under-researched and reported areas within the coproduction literature. Finally, we considered how user involvement worked within complex research designs and how this could be improved. Based on this learning, the paper concludes with a simple 3-step framework that others may wish to follow in order to improve coproduction outcomes within interventions. Abstract Background Co-production, involving members of the public in research, is increasingly encouraged by research funders. However, reports detailing involvement of the public in the entire research process from design, delivery, analysis and dissemination of findings are lacking. Furthermore, little is known about the lessons learnt from the perspective of the public and researchers; or more specifically lessons learnt when coproducing specific types of research projects, such as feasibility/pilot studies incorporating a randomised controlled trial (RCT) design. This paper aims to provide a more rounded picture of co-production based on the learning outcomes of researchers, their community partners and service users involved in a feasibility/pilot RCT study developing and evaluating an E-health Service for adults with depression. Methods Qualitative research incorporating 11 semi-structured interviews with academic team members (n = 4), community partners (n = 3) and service users with depression (n = 4) Data were analysed using thematic analysis. Results Key factors for successful coproduction include - (1) early involvement at the pre-development stage, including contributing to the scientific grant application; (2) early identification of team strengths and expertise from the outset; (3) regular team meetings and contact (formal or informal) among coproduction partners; (4) a flexible and pragmatic approach to research design (particularly within RCTs); (5) shared decision making and responsibility and (6) recognition of ‘other’ pressures and providing support to each other. Findings also suggested further scope for involving community partners in data analysis and dissemination through co-authored papers. Those seeking to coproduce interventions or utilise RCT designs should consider tensions between data quality and intervention implementation and ethical issues regarding control groups. Conclusion This paper confirms previous research confirming the benefits of coproduction. However, it also highlights a number of barriers, particularly when using complex research design, such as RCTs. Learning points are summarised in an implementation model for coproducing research. This model may provide a useful guide for considering activities associated with meaningful coproduction. We urge others to test this proposed model more widely in different areas of coproduced research.

The relationship between deprivation and health and educational inequalities has been well evidenced in the literature. Recent UK research has now established a similar social gradient in child welfare interventions (Bywaters et al. 2018) with children living in the most deprived areas in the UK facing a much higher chance of being placed on the child protection register or in out-of-home care. There is an emerging narrative that poverty has become the wallpaper of practice, “too big to tackle and too familiar to notice” (Morris et al. 2018) and invisible amid lack of public support and political will to increase welfare spending. This paper will examine poverty-related inequalities and how these affect families. It will discuss the importance of recognising that poverty is a social justice issue and a core task for social work and outline the range of supports that may be available for families to help lift them out of poverty. Finally, it will describe the development of a new practice framework for social work in Northern Ireland that challenges social workers to embed anti-poverty approaches in their practice. The framework emphasises that poverty is a social justice issue, seeks to provide practical support and guidance to re-focus attention, debate, and action on poverty in times of global economic uncertainty and give social workers the tools to make it central to their practice once again. It reinforces the need for social workers to understand and acknowledge the impact of poverty, and to advocate for and support those most in need. It aims to challenge and empower professionals to tackle poverty and inequality as an aspect of ethical and effective practice.