Dependence and resistance in community mental health care-Negotiations of user participation between staff and users

Developing groups in a paediatric psychology service: Centring the voices of children and young people

There is growing evidence for the benefits of therapeutic groups for children and young people living with chronic health conditions. As a paediatric health service, we regularly run 12 different groups, most of which are informed by a Narrative Therapy approach, with new groups routinely created to respond to the changing needs of children and young people. In this paper, we describe how we have stayed connected to our vision and values in developing and delivering group interventions, sharing our process which integrates different methods of participation and involvement to ensure young people's voices are centred. We use three of our recently introduced groups to illustrate these ideas.

Diagnosis and dilemma: Clinician experiences of the use of 'borderline personality disorder' diagnosis in children and adolescents

Borderline personality disorder (BPD) diagnosis in adolescents is a relatively recent concept and a fast-emerging research area. Regarded by some as controversial, it is important for research to provide greater understanding of differing perspectives and their impact on the use of this diagnosis. Perspectives of 13 clinicians (therapists, psychiatrists and mental health nurses) were explored, to provide a contemporary understanding of perceptions and use of BPD diagnosis within child and adolescent mental health services in England. A particular focus was to explore dilemmas faced by clinicians and how these dilemmas were negotiated. This research took a qualitative, social constructionist approach to explore the in-depth views and experiences of each participant. Interviews were analysed using thematic analysis, to seek out patterns and commonalities across these clinical perspectives. Three overarching themes were generated: 'Who holds the power?', 'Dilemmas within the multidisciplinary team (MDT)' and 'The weightiness of making this decision'. Professional opinions of an adolescent BPD diagnosis are influenced by dominant and less dominant mental health discourses, including the impact of power, and availability of resources within the service context. The role of meaningful collaboration with young people, clinical implications and directions for future research are discussed.

Homelessness, crack use, and length of stay as predictors of planned discharge from night care in a Psychosocial Care Center

Objective: identify predictors of planned discharge to night care embracement in a Psychosocial Care Center Alcohol and Drugs (CAPS AD III). Methods: Quantitative, retrospective, and documentary study of 560 medical records of people with problems resulting from the use of alcohol and other drugs who were admitted to the hospital at night in a CAPS AD III in São Paulo, over five years. As a dependent variable, the type of discharge was used (planned or not). As independent variables, the profile of the subjects related to substance use and time in hospital. Results: 1,097 admissions were identified with 50.4% of unplanned discharge associated with homelessness (p = 0.007), problematic use crack (p = 0.015), length of reception proposed by the team (p = 0.029) and length of stay of the user (p < 0.001). Conclusion: Being homeless, problematic use of crack, and lack of user participation on the decisions regarding length of stay in CAPS AD III were associated with unplanned discharge.

The value of doing philosophy in mental health contexts

People experiencing mental distress and illness are frequently on the receiving end of stigma, epistemic injustice, and social isolation. A range of strategies are required to alleviate the subsequent marginalisation. We ran a series 'philosophy of mind' workshops, in partnership with a third-sector mental health organisation with the aim of using philosophical techniques to challenge mental health stigma and build resources for self-understanding and advocacy. Participants were those with lived experience of mental distress, or unusual beliefs and experiences; mental health advocates; and mental health service providers (such as counsellors, psychologists and psychiatrists). We draw on a shared perspective as a participant and facilitator of the workshop series to assess their impact. We discuss the following benefits: (i) the opportunity for structured discussion of experiences and models; (ii) dialogue across different mental health backgrounds; (iii) the potential to reduce self-stigma and to increase self-understanding and advocacy; and (iv) the potential to alleviate (some) epistemic injustice. We invite researchers and mental health practitioners to consider further opportunities to investigate the potential benefits of philosophy groups in mental health settings to establish whether they generalise.

Mental health patients' experiences of softer coercion and its effects on their interactions with practitioners: A qualitative evidence synthesis

AIMS

To synthesize qualitative evidence of mental health patients' treatment-related experiences of softer coercion and its effect on their interactions with practitioners.

BACKGROUND

Coercion is controversial but global in mental health care. It ranges from softer to harder forms, but less attention is given in the literature to softer coercion.

DESIGN

Qualitative thematic synthesis examining patients' experiences of softer coercion.

DATA SOURCES

Electronic databases searched from inception to September 2015 and further updated January 2018.

REVIEW METHODS

Thematic synthesis of 11 UK/Irish articles, quality appraised using the Critical Appraisal Skills Programme tool.

RESULTS

Three analytic themes were developed: Losing a sense of self, Less than therapeutic relationship, and Journey through treatment.

CONCLUSION

Softer coercion is experienced across mental health care in a context of broader coercion.

The right place? Users and professionals' constructions of the place's influence on personal recovery in community mental health services

Background

Current mental health policy emphasizes the importance of community-based service delivery for people with mental health problems to encompass personal recovery. The aim of this study is to explore how users and professionals construct the place’s influence on personal recovery in community mental health services.

Methods

This is a qualitative, interpretive study based on ten individual, semi-structured interviews with users and professionals, respectively. A discourse analysis inspired by the work of Foucault was used to analyze the interviews.

Results

The findings show how place can be constructed as a potential for and as a barrier against recovery. Constructions of the aim of the services matter when choosing a place for the services. Further, constructions of user–professional relationships and flexibility are important in the constructions of an appropriate place for the services.

Conclusions

The aim of the service, the user–professional relationship, and flexibility in choosing place were essential in the participants’ constructions. To find “the right place” for mental health services was constructed as context-sensitive and complex processes of assessment and co-determination.

Trial registration The study is approved by the Regional Committee for Medical Research Ethics, Norway (REK-Midt 2011/2057)