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Aims and method: There are numerous challenges in the recruitment and retention of the medical workforce in psychiatry. This mixed-methods study examined the role of psychiatry clinical attachments for international medical graduates (IMGs) to enhance recruitment and retention. An online survey was launched to capture views and perceptions of IMGs about clinical attachments. The quantitative and qualitative responses were analysed to elicit findings. Results: In total, 92 responses were received, with respondents commonly from India, Pakistan and Egypt. Respondents were mostly aged 25–34, with ≥3 years of psychiatry experience. Over 80% expressed strong interest in completing a psychiatry clinical attachment and believed it would support career progression. Qualitative data indicated that IMGs hoped to gain clinical experience and understanding of the National Health Service (NHS). They wished for a clearer, simpler process for clinical attachments. Clinical implications: Clinical attachment can be mutually beneficial, providing IMGs with opportunity to confidently start their psychiatry career in the UK and enhance medical recruitment in mental health services across the NHS. [ABSTRACT FROM AUTHOR]

Background: The clinical profile of depressive disorder in children and young people in Child Adolescent and Family Services (CAFS), Northampton was studied. Methods: Twenty-five patients who had attended the CAFS over a period of 2 years were analysed retrospectively. Results: The age range of subjects was 8 to 19 years. Majority of patients were in their GCSE (secondary) or A level (higher secondary) courses. In 44% of cases the biological parents of the patients were not living together. Family conflict could be detected in more than half of the subjects. Alcohol related problems were present in one fourth of subjects. Bullying was the most common pattern of child abuse. Physical and sexual abuse was more common in the females than in the males. Almost half of the patients had history of one or more episodes of self-harm. Family history of mental illness, mostly depression, was present in 48% of patients. Most commonly used non-pharmacological interventions were individual psychotherapy and counselling. However in one fourth of patients no psychological intervention was used. Fluoxetine was the most commonly used medication. Frequency of follow-ups ranged from once weekly to once every three monthly. Conclusions: This study suggests that cumulative adverse experiences like high stress level of the GCSE and A level examinations, marital disharmony between parents, stressful family environment etc. singly or together increase the risk of depression in children and young people. It also suggests that parental depression is one of the risk factors associated with depression in this age group. This study also indicates that prescribing antidepressants without any psychological intervention is still a common practice and also that the patients on medication should be followed up more frequently than what is commonly done. (Contains 3 tables.)

This article presents three case studies of patients that a child and adolescent mental health service (CAMHS) have supported and its purpose is to encourage discussion of two key learning points. The first of these is the utility of developmental trauma as an approach for children with mental health presentations. The second centres on the importance of multi-agency working when working with young people, principally those within the UK's local authority care system ('looked after children'), who have had traumatic experiences in order to enhance positive outcomes. We also want to encourage consideration of the implications of developmental trauma for current core CAMHS therapeutic models in an attempt to reach beyond the often held narrative that the trauma formulation implies there is 'just trauma, no mental illness'. [ABSTRACT FROM AUTHOR]

Instability in the lives of young people in care is a public health concern. Placement moves and loss of relationships can have serious implications for young people's overall functioning, as well as their future life outcomes. Despite this, research often lacks the perspective and voice of young people in care. In this qualitative research, Interpretative Phenomenological Analysis was used to provide a deeper insight into young people's perceptions and beliefs about their care experiences to explore the impact of these on their ability to achieve a sense of stability and permanency across time. Semi-structured interviews were conducted with six males from UK foster, residential and semi-independent care homes. The main themes highlighted young people's perceptions of their care environment, relationships with others, sense of self and future under the overarching issue of permanence. Policy and practice implications propose strategies to target instability at the micro-level and how that may facilitate positive outcomes. The study revealed insights that may be helpful for frontline professionals and highlight to policy makers the importance of ensuring environmental and relational stability. An awareness of attachment theory to implement effective caregiving, should be a priority for training parents, caregivers, professionals and policy makers. [ABSTRACT FROM AUTHOR]

Background: The mental health of the population has been negatively affected due to the pandemic. Frontline healthcare workers with increased exposure to COVID diagnosis, treatment and care were especially likely to report psychological burden, fear, anxiety and depression. Aim: To elicit how working as a health professional during the pandemic is impacting on the psychological wellbeing of frontline staff. Method: United Kingdom population of healthcare workers were approached by advertising the survey via social media, NHS trusts and other organisations. Open-ended survey answers were qualitatively explored using content analysis. Results: Survey collected data from 395 NHS staff was developed into three themes; (1) Despair and uncertainty: feeling overwhelmed trying to protect everyone, (2) Behavioural and psychological impact: affecting wellbeing and functioning and (3) Coping and employer support: getting the right help. Conclusion: NHS staff felt enormous burden to adequately complete their professional, personal and civil responsibility to keep everyone safe leading to negative psychological and behavioural consequences and desire for NHS employers to offer better support. As the pandemic progresses, the results of this study may inform NHS employers on how optimum support can be offered to help them cope with negative psychological consequences of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited. Aims: To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions. Methods: Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population. Results: Seventeen papers met eligibility criteria with a total of N = 1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM. Conclusions: The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed. [ABSTRACT FROM AUTHOR]

Background: Unaccompanied refugee minors present with disproportionately high prevalence of emotional and psychological morbidities. However, their utilization of mental health services has been shown to be significantly poorer than the indigenous population of the country they seek asylum in. Despite this, there is limited research exploring their perspectives on the barriers they face. Aims: This research aims to understand unaccompanied refugee minors' and their carers' perceptions of the barriers to utilize mental health services and to explore issues perceived to be related to poor engagement with services. Methods: Semi-structured interviews with 15 unaccompanied refugee minors and their carers were conducted. This was to elicit their views, perceptions and beliefs based on their experience of receiving treatment from a specialist mental health service in the UK. Results: Thematic analysis was used and the findings were categorised into two broad themes; the participants' perceptions of the intervention and perceptions of the professionals. Salient aspects of these are discussed. Conclusions: The findings have potential to stimulate further research into gaining a better understanding of the barriers these young people face in accessing help, and may contribute to developing services that are more efficient in engaging this vulnerable group and meeting their specific needs. [ABSTRACT FROM AUTHOR]

Six young adults (aged 19–21 years) with repeat self-harm for over 5 years were interviewed about their self-harm, why they continued and what factors might help them to stop. Interpretative phenomenological analysis identified six themes: keeping self-harm private and hidden; self-harm as self-punishment; self-harm provides relief and comfort; habituation and escalation of self-harm; emotional gains and practical costs of cutting, and not believing they will stop completely. Young adults presented self-harm as an ingrained and purposeful behaviour which they could not stop, despite the costs and risks in early adulthood. Support strategies focused on coping skills, not just eradicating self-harm, are required. [ABSTRACT FROM AUTHOR]

Self-harm in young people is a common presentation to mental health services. There is little literature, however, on how professionals view their role and the role of others within the assessment of these young people, and the relative accountability. This study explored Child and Adolescent Mental Health Services (CAMHS) professionals’ views of these roles utilising a qualitative framework. The interviews of 18 CAMHS professionals from different disciplines were analysed using a thematic approach. Findings showed participants to be clear regarding the remit of their own role and the purpose of the assessment process, but were less confident in the abilities of those outside their service. They commented on the ongoing problems of stigma in this area and the difficulties with multi-agency working. Findings suggested possible ways to ameliorate these problems; however, the current economic climate may not be conducive to this. [ABSTRACT FROM PUBLISHER]

Purpose -- The purpose of this audit cycle was to compare the clinical practice of treating children and adolescents with moderate to severe depression with the NICE guidelines. The second aim was to recommend changes in practice to improve compliance to the guidelines and reinvestigate the degree of change two years after the initial recommendations. Design/methodology/approach -- A total of 40 patients within Secondary Care with moderate or severe depression were selected. Data were collected, analyzed and recommendations were made. The second phase of the audit cycle was completed after two years, following similar methods. Findings -- On most of the parameters the clinical practice improved in the re-audit, indicating better compliance with the NICE guidelines. However, on a few areas the compliance did not improve or even deteriorated. Research limitations/implications -- The implications of the results were discussed and final recommendations were made based on the findings and the perceived change in practice. Originality/value -- Literature searches revealed no previous audit cycles to have been conducted on CAMHS compliance to NICE guidelines with regards to treating depression. [ABSTRACT FROM AUTHOR]