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There is a significantly higher number of people experiencing severe levels of suicidal thoughts compared to that of suicidal deaths and suicide attempts. In suicide prevention research, there is a shift towards greater emphasis on people's experiences of living with suicidal thoughts. This can expand the existing evidence base, which is dominated by a biomedical approach. The aim of this review was to summarise and disseminate existing research on the lived experiences of living with suicidal thoughts.A scoping review by ArkseyO'Malley consisting of six stages: (1) formulating the research question, (2) identifying relevant studies, (3) selecting studies, (4) mapping data, (5) summarising the results and (6) consulting stakeholders. PubMed, PsycINFO and CINAHL were searched for studies in English, Danish, Swedish and Norwegian. Peer-reviewed articles examining people's experiences of living with suicidal thoughts using qualitative methods were included. The search was supplemented with a citation pearl search in the Web of Science database. Twenty-eight studies were included.The findings were organised under two thematic headings: (a) the significance of social connections and (b) a loss of the personal self.There is a need for further qualitative research of people's experiences of living with suicidal thoughts from an everyday life perspective. Awareness about social connections and attachment in mental health prevention and governance is crucial. Trauma-informed care could be a useful approach to prevent suicidal thoughts as the review found that many participants had traumatic experiences in both childhood and adulthood. As part of the treatment of suicidal thoughts, it might be useful to have a focus on narrative and communicative methods and their clinical application.

Disadvantaged groups in general, and people who use illicit drugs in particular, have consistently been found to mistrust welfare services and service providers. Therefore, knowledge is needed on the relational aspects of service design that facilitate engagement and supportive relationships with disadvantaged consumers.We draw on qualitative interviews investigating the experiences of adults with histories of problematic drug use participating in a health justice partnership, to identify facilitators of engagement from the perspective of the consumers.Common relational facilitators of engagement were identified. These included embedding the service into the local community, foregrounding proximity and relationships in the service encounters, giving consumers' agency, priorities, and concerns primacy over program aims, and safe services acting as gateways to accessing a wider range of resources, services, and programs.The findings suggest that the centrality of relationships may be further heightened in services seeking to assist people in positions of severe disadvantage, including the drug and alcohol arena. In addition, the findings highlight the importance of services paying greater attention to how social and community embeddedness shapes experiences of inclusion and exclusion and designing services best able to accommodate this. This research contributes to the broader understanding of consumer engagement with services by developing a more nuanced understanding of consumer refusal and resistance to service engagement. These findings are important in the development of justice programs for disadvantaged people and people who use illicit substances specifically.

Through conversation analysis, we explore how open dialogue practitioners in a Danish mental health hospital articulate their own experiences as indicative of a client's inner states, an interactional practice defined here broadly as empathic ‘my side tellings’. We argue that there are three types of my side tellings employed by the practitioners for proving an understanding of the clients’ experiences. These are either based on one's bodily sensation; on one's imagination of the other person's experience; or on one's personal experience or role. They all function to support how a practitioner can understand. We suggest that empathic my side tellings are interactional strategies that claim empathy through laying out one's personal source or arguments for understanding. It is proposed that communication of empathy can be at odds with the clients’ own assessment of their situation and feelings, while nevertheless being an integral part of doing psychotherapy.

Aims: To explore how consultation exercises were described in a convenience sample of recent scoping reviews. Design: Critical literature review. Data sources: We searched PsycINFO, Embase, CINAHL and PubMed in July 2020. Our inclusion criterion was a peer-reviewed journal article reporting a scoping review in Danish, English, Norwegian or Swedish. Review methods: We identified a convenience sample of articles (n = 66) reporting a consultation exercise as part of a scoping review. The descriptions of the consultation were charted, summarized and critically discussed. Results: The current analysis showed no widely accepted consensus on how to approach and report a consultation exercise in the sample of scoping reviews. The reports of stakeholder consultation processes were often brief and general, and often there were no reports of the effects of the stakeholder consultation processes. Further, there was no discussion of the principal theoretical problems mixing stakeholder voices and review findings. Conclusion: The finding that conventional research ethics and research methods often were suspended could indicate that the stakeholder consultants were in a precarious position because of power imbalances between researchers and stakeholder consultants. We suggest that a consultation exercise should only be included when it genuinely invites participation and reports on the effect of alternative voices. Impact: Scoping reviews are common across a range of disciplines, but they often lack definitional and methodological clarity. In their influential approach to scoping studies, Arksey and OʼMalley introduced an optional ‘consultation exercise’, which has been heralded as a valuable tool that can be used to strengthen the process and outcome of a scoping study and to support the dissemination of the studyʼs findings and its implications. However, there is no clear outline on about how to operationalize consultations of stakeholders in scoping studies/reviews. This article includes recommendations for consultation exercises, including encouraging an aspirational move from ‘consultation’ to ‘participation’.

The aim of this prospective case study was to explore clients’ and social network members’ responses to participating in a newly implemented Open Dialogue approach in an Australian early intervention in psychosis treatment context. We followed four clients’ trajectories through treatment by drawing on data from electronic medical record entries, observed or audio-recorded network meetings, and client and family interviews. Data were analysed thematically. Clients and families generally appreciated the Open Dialogue approach, even though it created hard practical and psychosocial work for them before, during and in between meetings. We discuss the increased workload as responsibilization of families.

Open Dialogue is an approach to working with mental health problems that emphasises promoting dialogue between multiple perspectives within an individual person and between all the people present, including the therapists. Therapists’ own perspectives are often introduced during conversations called reflections, which present a potential source of different perspectives. Using conversation analysis we analysed 14 hours of video-recorded Open Dialogue sessions with a focus on therapists’ reflections. We noticed that therapists did not display explicit agreement with each other’s reflections. This absence of explicit agreement was displayed through a variety of verbal and non-verbal forms. Eliding agreement facilitated deference to the epistemic authority of the client, assertion of epistemic rights from second position, emphasis of a positive perspective or to voice multiple perspectives. Therapists avoided consensus and thus presented multiple perspectives to the family while also attending to issues of contingency. The implications of epistemic primacy and asymmetry connected to sequential structures in talk pose a challenge to the generation of collaborative reflective dialogues.

Despite their similarities, Scandinavian countries have adopted starkly different automobile tax regimes. The Danish system entails very high and convex tax rates with moderate CO2 differentiation....

Open Dialogue is a collaborative approach to mental health care emphasizing integrated services and a dialogical psychotherapy approach. Open Dialogue training programs eschew traditional didactic teaching of technical therapeutic skills in favor of more experiential learning processes. It is unclear how these training programs affect trainees and shape their perspectives on Open Dialogue. Our aim was to follow up a group of Australian Open Dialogue trainees and explore their perspectives on learning processes and psychotherapeutic practice. We utilized a prospective focus group design with data from audio-recorded focus groups convened before (n = 2) and after (n = 3) participants completing an advanced Open Dialogue training program. Data were subjected to reflective thematic analysis. We identified the theme "Extending possibilities by holding ideas lightly," which represented a universal principle that participants applied to multiple aspects of their practice, for example, favoring multiple perspectives and approaches to therapy, including those other than Open Dialogue. This theme had two sub-themes: (1) "Allowing intimacy by being aware of personal biographies" and (2) "Learning by joining others," which reflected an increased willingness by participants to reflect on and share their inner experiences and an emphasis on joint experiential exercises in the training program. "Extending possibilities by holding ideas lightly" facilitated a means of incorporating a dialogical perspective into existing practices thus avoiding the potential barriers to a wholesale implementation of Open Dialogue. Findings indicated that the participants were not learning how to practice a therapeutic technique or propositional knowledge, but were socialized into a dialogical way of being.

Background: Non-suicidal self-injury (NSSI) is a growing healthcare problem. Individuals with NSSI have an increased risk of suicidality. Because of stigma, they may self-injure in secret, which means they often seek help when events have escalated to suicidal ideation or a mental disorder. Previous studies have shown that interventions delivered via mobile phone applications have the potential to reduce self-injury. This protocol outlines a trial, which examines whether the Zero Self Harm-intervention, which is based on an app created for people with NSSI, can reduce the number of NSSI-episodes, suicide ideation, and depressive symptoms. Methods: The trial will be conducted as a 6-month 2-arm, parallel-group, multicentre, pragmatic, randomized clinical superiority trial. The intervention group will receive the app and instructions on how to use it, while the control group will be allocated to a waitlist and allowed to download the app after 6 months. Participants will be asked to complete questionnaires at 3- and 6 months after date of inclusion and the primary outcome is the number of NSSI-episodes during the last month, as measured at the 3 months follow-up with the Deliberate Self-Harm Inventory. A total of 280 participants, 140 in each arm, will be included.Discussion: This trial will assess the effectiveness of the Zero Self Harm-intervention to reduce the number of NSSI episodes. If effective, the app will have the potential to support to large group of people with NSSI. NSSI is stigmatised and often done in secret. Being both discreet and anonymous, the app might be an appealing option for support. In addition, people with current or former NSSI were involved in the development of the app. The app was developed with a focus on minimizing harm, not to end NSSI, which might also make the app appealing for a broader group of users.Trial registration: ClinicalTrials.gov, NCT04463654. Registered on 7 June 2020

Research has shown that people bereaved by suicide have an increased risk of mental health problems, suicidality and associated stigma, as well as higher rates of sick leave and increased rates of receiving disability pensions. Peer-led suicide bereavement support groups are perceived to enhance people’s recovery by enabling shared experiences with others who are bereaved in similar circumstances. The aim of the research was to explore the viewpoints of participants living in Denmark and the Republic of Ireland on these peer-led support groups. This study focused on how the participants experienced being part of the peer-led support and how the participation affected them. We conducted four focus groups, two in Denmark and two in the Republic of Ireland, and two individual interviews, involving a total of 27 people bereaved by suicide. Data were analyzed thematically. The participants’ experiences in the peer-led support groups were in contrast to what they had experienced in their daily lives. They felt alienated in daily living, as they believed that people could not comprehend their situation, which in turn led participants to search for people with similar experiences and join the peer-led support groups. While peer-led support groups may not be helpful for everyone, they created ‘supportive spaces’ that potentially affected the participants’ recovery processes, from which we generated three key themes: (i) ‘A transformative space’, describing how the peer-led support group created a place to embrace change, learning and knowledge about suicide and suicide bereavement and the making of new connections; (ii) ‘An alternative space for belonging and grieving’, describing how the participants felt allowed to and could give themselves permission to grieve; and (iii) ‘A conflicted space’ describing how it was troublesome to belong to and participate in the peer-led support groups. In conclusion, despite the two cultural settings and different organizational approaches, the experiences were comparable. Peer-led support groups can, despite being a conflicted space for some, provide supportive spaces aiding the participants’ recovery process.

Open Dialogue is a need-adapted approach to mental health care that was originally developed in Finland. Like other need-adapted approaches, Open Dialogue aims to meet consumer’s needs and promote collaborative person-centred dialogue to support recovery. Need-adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need-adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need-adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need-adapted mental health care to ensure they deliver these interventions as intended and in an evidence-based fashion.

The Open Dialogue approach promotes collaboration with clients and families in decisions about the direction of therapy. This creates potential problems for Open Dialogue therapists who seek collaboration but also have responsibility for managing the session. Using conversation analysis, we examined 14 hours of video recordings of Open Dialogue sessions, and specifically how therapists proposed the transition to a reflecting conversation. We found that, when making proposals to reflect, therapists routinely downgrade their deontic authority (i.e., adopt a less powerful, more collaborative position). They did this through framing proposals as interrogatives, providing accounts, and by prefacing their proposals with "I'm wondering". More heavily downgraded proposals made acceptance less salient, potentially risking transition to the reflection. These findings provide more detail on how theoretical concepts such as "collaboration" and "power" are actually displayed and negotiated in practice and can contribute to a more nuanced understanding of what constitutes Open Dialogue.El método de diálogo abierto promueve la colaboración con los pacientes y las familias en las decisiones acerca del rumbo de la terapia. Esto genera posibles problemas para los terapeutas que implementan el diálogo abierto y que buscan colaboración, pero que también tienen la responsabilidad de manejar la sesión. Utilizando el análisis de la conversación, analizamos 14 horas de videograbaciones de sesiones de diálogo abierto y, específicamente, cómo los terapeutas propusieron la transición a una conversación reflexiva. Descubrimos que, cuando los terapeutas hacen una propuesta de reflexionar, habitualmente rebajan su autoridad deóntica (p. ej.: adoptan una postura menos poderosa y más colaborativa). Para esto, los terapeutas plantearon las propuestas como interrogaciones, ofrecieron explicaciones e introdujeron sus propuestas con la frase: “Me pregunto”. Las propuestas más rebajadas hicieron que la aceptación se destacara menos, arriesgando potencialmente la transición a la reflexión. Estos hallazgos ofrecen mas detalles sobre cómo los conceptos teóricos, como la “colaboración” y el “poder”, en realidad se muestran y se negocian en la práctica, y pueden contribuir a una comprensión más matizada de lo que constituye el diálogo abierto.开放性对话的方法促进了在与病人和家庭在有关治疗方向上做出决策时的合作。开放对话治疗师寻求合作但又有责任管理会话，此方法给这一类治疗师带来了潜在的问题。使用会话分析，我们调查了14个小时的公开对话的视频记录，特别是治疗师是如何建议过渡到反思对话的。我们发现，在提出反思建议时，治疗师通常会降低他们的行为权威(即采取一种不那么强势、更具协作性的立场)。这样做的方式是将建议框定为质问句，提供解释，并以 "我在想 "作为建议的前言。更加严重的降级建议使接受不那么突出，可能会有过渡到反思的风险。这些发现提供了更多关于 "协作 "和 "权力 "等理论概念如何在实践中实际呈现和协商的细节，并有助于更细致地理解什么是 "开放式对话"。.

Despite the policy and academic interest in helping disadvantaged young people into employment and education, and towards a more positive future, little is known about the process of supporting positive transitions for young people. In Australia and internationally, youth work is increasingly considering alternatives to the traditional deficit-oriented and risk-averse approach to supporting young people experiencing social or material disadvantage. With an outset in youth practitioners’ perspectives on their work and underpinned by key concepts drawn from the Positive Youth Development approach, this paper seeks to improve understandings of how best to support disadvantaged young people’s ability to thrive, facilitate practitioner dialogue and strengthen practice. Qualitative interviews were conducted with twelve youth practitioners and a focus group run with an additional eight. The paper explores three concepts emerging from the analysis that were identified as key to understanding the unique potential youth work practitioners have to support positive transitions with and for disadvantaged young people: having an ecological focus, encouraging personal agency and fostering alternative possibilities. The findings propose new possibilities for working with young people with whom mainstream services struggle to engage. The paper concludes by discussing the practical implications and limitations of this approach.

Youth peer-support is an increasingly established approach to youth work. Drawing on Wenger's theory of a 'community of practice', this study explored social learning processes in an Australian community-based and peer-led youth program for young people from disadvantaged backgrounds. Social learning was conceptualised as arising from processes of 'negotiated meaning', which Wenger described as a duality of 'participation' and 'reification'. The study was designed as a qualitative field study drawing on participant observation data from weekend workshops and 16 semi-structured interviews with young program participants. Results indicate that the program was highly conventionalised with repeated practices reifying the meaning negotiated by the participants. However, it was also open for participatory negotiation of meaning through which participants learned to recognise and share their own and others' vulnerabilities, which created a strong sense of belonging to a community of equals. The study's conception of social learning offers a novel explanation of how the youth program created and sustained alternative transformative spaces. This was done through simple, repetitive and highly conventionalised practices, brokered by peers, that allowed participants to recognise and address their own and others' vulnerabilities in new ways.

Conventional mental health services are frequently criticized for failing to support people and communities in their care. Open Dialogue is a non-conventional humanistic approach to mental health care, which has been implemented in many different settings globally. At two Australian public health care services, implementation of the approach led to positive client outcomes and sustained organizational and clinical change. The aim of the study was to identify and explore the organizational, management, leadership and cultural factors that contributed to sustained implementation in these complex systems. We conducted nine individual semi-structured interviews of health care leaders and managers from the two sites. Transcriptions of the interviews were analyzed thematically. Leaders facilitated a gradual development of clinical and organizational legitimacy for the non-standardized Open Dialogue approach by holding the anxiety and frustration of practitioners and parts of the administration, cultivating cultural change and adaptation and by continually removing organizational obstacles.

Open Dialogue is a family/social network-centered psychotherapeutic approach to responding to people in crisis and distress. In 2017, Open Dialogue network meetings were implemented in an Australian inner-city shelter for disadvantaged women. The aim of this study was to explore the experience of participating in these meetings from the perspective of service users and Open Dialogue practitioners. Qualitative interviews were completed with thirteen participants (six service users and seven practitioners) and analyzed thematically. The findings suggested that dialogical processes created safety by attending to multiple voices in nonviolent ways that reduced perceived hierarchies. Notions of expertise were renegotiated, which allowed the women to feel heard in significant ways that were different from their previous experiences with other social and healthcare services. Open Dialogue is an approach that can meaningfully attend to some of the power relations within which women live and within which social and health care services are provided.

OBJECTIVE Uremic myopathy is a condition seen in end-stage renal disease (ESRD), characterized by muscle weakness and muscle fatigue, in which the pathophysiology is uncertain. The aim of this study was to assess the role of abnormal serum constituents in ESRD patients by relating them to the excitability properties of the tibialis anterior muscle, at rest and during electrically induced muscle activation, by recording muscle velocity recovery cycles (MVRC) and frequency ramp responses. METHODS Eighteen ESRD patients undergoing hemodialysis were evaluated by blood sample, MVRC, and frequency ramp (before and near the end of dialysis treatment), quantitative electromyography, and nerve conduction studies. Patients were compared to 24 control subjects. RESULTS In patients, muscle relative refractory period, early supernormality, late supernormality after 5 conditioning stimuli, and latency of the last of 15 and 30 frequency ramp pulses were strongly associated with potassium levels (p��

Purpose: Hypertension is common in kidney transplant recipients (KTRs). For the evaluation of blood pressure (BP), 24-h ambulatory BP measurements (ABPM) are considered superior to usual office measurements but are also resource demanding and troublesome to many patients. We therefore evaluated the use of unattended automated office BP (AOBP) during the first year following living donor kidney transplantation and compared AOBP with ABPM as obtained 12 months after transplantation. Materials and methods: Data were retrieved from a cohort of 57 KTRs (mean age 45 ± 14 years, 75% males) who all received kidneys from living donors and had a good graft function (estimated glomerular filtration rate (eGFR) 52 ± 16 ml/min/1.73 m2 at 12 months). Unattended AOBP was measured at each visit to the outpatient clinic using the BpTru® device, while ABPM was obtained by Spacelabs® equipment before and 12 months after transplantation. Results: AOBP remained stable from month 2 (130.2 ± 10.8/82.2 ± 7.8 mmHg) to month 12 (129.0 ± 12.8/83.1 ± 9.6 mmHg) post-transplantation. At 12 months follow-up, ambulatory daytime systolic BP was slightly higher than AOBP (132.7 ± 10.7 vs. 129.4 ± 12.2 mmHg, p = 0.04), while diastolic BP was similar (82.7 ± 7.7 vs. 82.0 ± 10.2 mmHg). Using Bland–Altman plots, 95% limits of agreements were −17.9 to 24.5 mmHg for systolic and −16.5 to 15.1 mmHg for diastolic BP. When considering a target BP of ≤130/

A prevalent critique of Alcoholics Anonymous (AA) is that members must adopt an inflexible illness narrative, taking on an "alcoholic" identity and performing a set of practices to address this condition. Conversely, a small body of research suggests that, rather than comprising the uniform adoption of a rigid narrative, integration into AA is achieved by negotiating individual beliefs, values, and preferences with the AA model. To investigate such processes of negotiation, the current study aimed to explore the politics of belonging in AA. The study involved semi-structured interviews with 15 AA members recruited from meetings across Sydney, Australia, and data were analyzed thematically. Findings illustrated how participants navigated the politics of inclusion/exclusion within AA. While some aspects of AA were found to be negotiable by participants, a non-negotiable aspect of AA ideology that emerged was the axiom that "alcoholics" have no control over alcohol and therefore should maintain abstinence. Findings raise questions about how the politics of belonging in AA may shift over time following broader patterns of societal change.