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Chakravarty D, Mishtal J, Grimes L, Reeves K, Stifani B, Duffy D, Murphy M, Favier M, Horgan P, Chavkin W, Lavelanet A. Restrictive points of entry into abortion care in Ireland: a qualitative study of expectations and experiences with the service. Sex Reprod Health Matters 2023; 31:2215567. [PMID: 37326515 PMCID: PMC10281397 DOI: 10.1080/26410397.2023.2215567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
This article focuses on access to early medical abortion care under Section 12 of the Health (Regulation of Termination of Pregnancy) Act 2018, in Ireland and identifies existing barriers resulting from gaps in current policy design. The article draws primarily on qualitative interviews with 24 service users, 20 primary healthcare providers in the community and 27 key informants, including from grassroots groups that work with women from different migrant communities, to examine service users' experiences accessing early medical abortions on request up to 12 weeks gestation. The interviews were part of a wider mixed-methods study from 2020-2021 examining the barriers and facilitators to the implementation of abortion policy in Ireland. Our findings highlight care seekers' experiences with the GP-led service provision, including delays, facing non-providers, the mandatory three-day waiting period, and oversubscribed women's health and family planning clinics. Our findings also highlight the compounding challenges for migrants and additional barriers posed by the geographical distribution of the service and the 12-week gestational limit. Finally, it focuses on the remaining challenges for racialised and other marginalised groups. In order to provide a "thick description" of women's lives and the complexity of their experiences with abortion services in Ireland, we also present two narrative vignettes of service users, and their experiences with delays and navigating the healthcare system as migrants. To this effect, this article applies a reproductive justice framework to the results to highlight the compounding effects of these barriers on people located along multiple axes of social inequality.
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Affiliation(s)
- Dyuti Chakravarty
- Postdoctoral Researcher, School of Sociology, University College Cork, Cork, Republic of Ireland
| | - Joanna Mishtal
- Professor, Department of Anthropology, University of Central Florida, Orlando, FL, USA
| | - Lorraine Grimes
- Postdoctoral Researcher, Social Sciences Institute, Maynooth University, Maynooth, Republic of Ireland
| | - Karli Reeves
- Research Specialist, Department of Population Health Sciences, University of Central Florida, Orlando, FL, USA
| | - Bianca Stifani
- Complex Family Planning Specialist, Westchester Medical Center / Clinical Assistant Professor, New York Medical College, New York, NY, USA
| | - Deirdre Duffy
- Senior Lecturer in Global Inequalities, Department of Sociology, Lancaster University, Lancaster, UK
| | - Mark Murphy
- General Practitioner, Eldon Family Practice, Dublin, Republic of Ireland
| | - Mary Favier
- General Practitioner, Parklands Surgery, Cork, Republic of Ireland
| | - Patricia Horgan
- General Practitioner, Broad Lane Family Practice, Cork, Republic of Ireland
| | - Wendy Chavkin
- Co-Founder, Global Doctors for Choice, New York, NY, USA
| | - Antonella Lavelanet
- Medical Officer, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Evans BA, Khanom A, Edwards A, Edwards B, Farr A, Foster T, Fothergill R, Gripper P, Gunson I, Porter A, Rees N, Scott J, Snooks H, Watkins A. Experiences and views of people who frequently call emergency ambulance services: A qualitative study of UK service users. Health Expect 2023; 27:e13856. [PMID: 37578195 PMCID: PMC10726061 DOI: 10.1111/hex.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment. METHODS We used a two-stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third-sector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results. RESULTS People said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers. CONCLUSION People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services. PATIENT OR PUBLIC CONTRIBUTION People with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee.
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Affiliation(s)
- Bridie A. Evans
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
| | - Ashra Khanom
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
| | - Adrian Edwards
- School of Medicine, PRIME Centre Wales, Division of Population MedicineCardiff UniversityCardiffUK
| | - Bethan Edwards
- Public Contributor, c/o Swansea University Medical SchoolSwanseaUK
| | - Angela Farr
- Swansea Centre for Health EconomicsSwansea UniversitySwanseaUK
| | | | | | - Penny Gripper
- Public Contributor, c/o Swansea University Medical SchoolSwanseaUK
| | - Imogen Gunson
- West Midlands Ambulance Service University NHS Foundation TrustWest MidlandsUK
| | - Alison Porter
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
| | - Nigel Rees
- Welsh Ambulance Services NHS TrustCwmbranUK
| | | | - Helen Snooks
- Swansea University Medical SchoolSwanseaUK
- PRIME Centre Wales, Institute of Life ScienceSwansea University Medical SchoolSwanseaUK
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Allan J, Thompson A. Experiences of Young People and Their Carers with a Rural Mobile Mental Health Support Service: A Qualitative Study. Int J Environ Res Public Health 2023; 20:1774. [PMID: 36767141 PMCID: PMC9914613 DOI: 10.3390/ijerph20031774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Mental health difficulties during teenage years are common. They are also a risk factor for later mental and physical health problems. Rural young people are at a greater risk for mental health difficulties and have less access to services than their urban counterparts. The purpose of this study was to explore the experiences of young people and their carers with mental health support provided by a rural mobile service, and to identify access enablers from the perspective of the service users. A qualitative descriptive approach was used to analyse twelve interviews with current service users and eight interviews with family members of young people who had accessed the service. Three main themes were identified: (a) access and flexibility, (b) the qualities and strategies of the clinicians, and (c) experiences of change. The mobile service was perceived to be effective in producing a positive change in mental health, relationships, and the attainment of life goals. Key enablers to access included the flexibility of the mobile service, the variety of service delivery modes and therapeutic methods offered, the ease of access facilitated by the location in schools, and the autonomy of young people in how they chose to utilise the service. This study provides information about what is important to rural young people and their families in the provision of mental health services. The findings have implications for changing the way services are organized and operated. Healthcare policies and services could support a user-led model design that incorporates access and use-enablers and removes barriers to rural mental health support.
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Affiliation(s)
- Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, NSW 2800, Australia
| | - Anna Thompson
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, Orange, NSW 2800, Australia
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Greenwood KE, Gurnani M, Ward T, Vogel E, Vella C, McGourty A, Robertson S, Sacadura C, Hardy A, Rus‐Calafell M, Collett N, Emsley R, Freeman D, Fowler D, Kuipers E, Bebbington P, Dunn G, Michelson D, Garety P. The service user experience of SlowMo therapy: A co-produced thematic analysis of service users' subjective experience. Psychol Psychother 2022; 95:680-700. [PMID: 35445520 PMCID: PMC9873386 DOI: 10.1111/papt.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/18/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention. DESIGN Qualitative co-produced sub-study of an RCT. METHODS Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure. RESULTS Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being. CONCLUSIONS For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.
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Affiliation(s)
- Kathryn E. Greenwood
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | | | - Tom Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Evelin Vogel
- Sussex Partnership NHS Foundation TrustWorthingUK
| | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK
| | | | | | | | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Daniel Freeman
- Oxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryOxford UniversityOxfordUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Graham Dunn
- Centre for BiostatisticsSchool of Health SciencesManchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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Patel P, Kennedy A, Carr S, Gillard S, Harris P, Sweeney A. Service user experiences of mental health assessments: a systematic review and thematic synthesis of qualitative literature. J Ment Health 2022:1-14. [PMID: 35965480 DOI: 10.1080/09638237.2022.2069691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Successive governments have placed service users' experiences at the heart of mental health services delivery and development. However, little is known about service users' experiences of assessments and there is some evidence that assessments can cause harm. AIMS To synthesise the qualitative literature on service users' experiences of undergoing mental health service assessments. METHODS Literature was systematically searched, screened and extracted, following PRISMA guidelines. Several search strategies were employed, including electronic database searches, handsearching, and forward and backward citation tracking, to identify literature which contained data on service users' experiences of mental health assessments. Thematic synthesis was used to derive a set of themes underpinning these experiences. RESULTS Of the 10,137 references screened, 47 were identified as relevant to the review. Two main themes were identified: the importance of humanising assessment processes and experiences of service user agency, with each theme containing four sub-themes. CONCLUSIONS Findings highlight key factors determining service user experience. We identify key practice implications, contextualised within the literature on trauma-informed approaches and conclude that trauma-informed approaches may aid understanding and improvement of people's assessment experiences. Further research into the experiences of people from Black and minority ethnic communities is indicated.
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Affiliation(s)
- Paras Patel
- Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Angela Kennedy
- Cumbria, Northumberland and Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Sarah Carr
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, England
| | - Steve Gillard
- Centre for Mental Health Research, City, University of London, London, UK
| | - Poppy Harris
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Angela Sweeney
- Service User Research Enterprise, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, England
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Watts M, Murphy E, Keogh B, Downes C, Doyle L, Higgins A. Deciding to discontinue prescribed psychotropic medication: A qualitative study of service users' experiences. Int J Ment Health Nurs 2021; 30 Suppl 1:1395-1406. [PMID: 34101332 DOI: 10.1111/inm.12894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
Many mental health service users decide to discontinue their psychotropic medication at some stage in the treatment process; however, few studies have captured these experiences. This study aimed to explore people's experiences of coming off medication. A qualitative descriptive design and individual interviews with 23 people who experienced coming off medication were employed. COREQ checklist was used. Data were analysed using inductive and deductive approaches and six major themes were developed. Findings suggest that while medication was useful for many in the short-term, the adverse effects had significant impact and contributed to the decision to come off medication. Participants also reported being driven by a questioning of the biomedical model of treatment and the belief that there were other strategies to manage their distress. Mixed experiences of support from healthcare professionals for the medication cessation process were reported. The discontinuation process was often difficult resulting in changes in mood and behaviour which for many culminated in relapse of distress, rehospitalization and return to medication. To support the process of coming off and staying off medication, participants identified a range of useful strategies but particularly highlighted the importance of peer support. Findings from this study demonstrate the importance of mental health nurses having a collaborative discussion with service users which may support safer decision-making and lessen the risk of people discontinuing medication abruptly. Finding also indicates a need for robust studies that develop and test interventions to support people who wish to discontinue psychotropic medications.
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Affiliation(s)
- Mike Watts
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Esther Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Weir B, Struthers R, Reid L, Wild C, Robinson L. Psychological recovery in a step 4 service: a qualitative study exploring the views of service users and clinicians. J Ment Health 2021; 31:220-226. [PMID: 33978537 DOI: 10.1080/09638237.2021.1922640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psychological recovery is typically measured in improving access to psychological therapies (IAPT) services as the reduction of symptoms on routine outcome measures (ROMs). However, conceptualisations of psychological recovery vary, and there are concerns that ROMs may not be suitable for measuring recovery from complex mental health difficulties. AIM To gain insight into psychological recovery and measurement in clinical practice. METHOD A qualitative study at a step-4 IAPT service in the North of England. Eight clinicians contributed to focus groups, and 10 service users were later interviewed individually. RESULTS Factors that informed four congruent and interacting themes of recovery were identified among participants as an ongoing personal process, of intra-therapeutic and extra-therapeutic factors impacting on recovery in helpful and unhelpful ways, and the need for idiographic long-term recovery measures. The functional and long-term nature of recovery and the socio-economic context for recovery were considered particularly crucial. CONCLUSIONS The need for idiographic long-term recovery measures to support the ongoing process of recovery was reported in the majority of instances. Study findings mirrored existing recovery and outcome measurement literature, provided new evidence in relation to recovery from complex mental health difficulties, and made recommendations for future research and clinical practice.
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Affiliation(s)
- Bronagh Weir
- North Tyneside Talking Therapies, Wallsend Health Centre, Newcastle Upon Tyne, UK
| | - Ruth Struthers
- North Glasgow Child and Adolescent Mental Health Service, Glasgow, UK
| | - Lucy Reid
- North Tyneside Talking Therapies, Wallsend Health Centre, Newcastle Upon Tyne, UK
| | - Celia Wild
- North Tyneside Talking Therapies, Wallsend Health Centre, Newcastle Upon Tyne, UK
| | - Lucy Robinson
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK
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Even D, Shvarts S, Segal-Engelchin D. Medical social workers as mediators between patients, physicians, and the court: the case of former ringworm patients. Soc Work Health Care 2020; 59:575-587. [PMID: 32942962 DOI: 10.1080/00981389.2020.1822488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/06/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
Facilitating benefit and resource acquisition to assist clients is a major responsibility of medical social workers, requiring them to have a thorough knowledge of community resources, legislation, and regulations. The aim of the current study was to examine knowledge of the Law for Compensation of Scalp Ringworm Victims and ringworm-related irradiation damage among 101 social workers employed in diverse healthcare settings in Israel. We found that 65.3% of the social workers were aware of the law, but only 40.6% were aware of the health effects of scalp ringworm irradiation. Media coverage and clients who underwent scalp ringworm irradiation were social workers' major sources of knowledge. Working with former ringworm patients had the strongest association with knowledge of the law and of ringworm-related irradiation damage. Results highlight the important contribution of exposure to clients' experiences and knowledge to expand social workers' knowledge of health issues.
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Affiliation(s)
- Dan Even
- Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Shifra Shvarts
- Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva, Israel
| | - Dorit Segal-Engelchin
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev , Beer-Sheva, Israel
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Hagan RJ. What next? Experiences of social support and signposting after a diagnosis of dementia. Health Soc Care Community 2020; 28:1170-1179. [PMID: 31997478 DOI: 10.1111/hsc.12949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/17/2019] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
The experience of being diagnosed with dementia can be shocking. This may be compounded if individuals feel that there is a lack of signposting onto further avenues of support following diagnosis. This study, then, examines how social support is promoted in the diagnostic process. Using purposive sampling and a grounded theory approach, semi-structured interviews were conducted with 13 members of a dementia empowerment group in Northern Ireland, discussing both their experience of diagnosis and also their subsequent group membership. Respondents reported both positive and negative experiences of diagnosis. Feelings of shock and bewilderment accompanied this process. Only one was able to identify a direct link between a medical professional and referral to the empowerment group, others being referred by other health professionals or dementia navigators. The study indicates that, due to disorienting feelings, one diagnostic consultation is insufficient to explain both the diagnosis and offer follow-up support. Therefore, more explicit links to navigators or other services need to be made at the point of diagnosis to prioritise information regarding opportunities for social engagement for those being diagnosed.
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Affiliation(s)
- Robert J Hagan
- School of Social Care and Social Work, Manchester Metropolitan University, Manchester, UK
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Beattie D, Murphy S, Jamieson S, Lee A. Running a mentalization-based treatment (MBT) programme within a public community adult mental health service setting: a feasibility study. Ir J Psychol Med 2022; 39:28-38. [PMID: 31043180 DOI: 10.1017/ipm.2019.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This article aimed to address the feasibility of mentalization-based treatment (MBT) for patients with personality disorder in a non-specialist setting. The development and implementation of an MBT Programme is described. METHODS A multidisciplinary Consult Group met to plan the implementation of the programme. Participants attended a psychoeducation group (MBT Introductory Group), then weekly individual and group therapy. Fourteen participants started the full programme with eight completing at least 9 months, complete data are available for five participants who completed 27 months (first cohort) and 21 months (second cohort). Data include quantitative measures and qualitative questionnaires/interviews. All had a diagnosis of personality dysfunction with co-morbid disorder including anxiety/depressive disorder, post-traumatic stress disorder and eating disorder. RESULTS Data on five participants revealed reductions in global level of distress, improvements in psychological well-being, less interpersonal difficulties and better work and social functioning. Qualitative data from feedback questionnaires (n = 18) and in-depth interview (n = 2) are discussed under the themes of mentalizing, treatment feedback/outcomes and group factors. Therapist reflections on the process identify the challenges involved in implementing a specialist psychotherapy programme within a general service and learning points from this are discussed. CONCLUSIONS MBT is an acceptable treatment for patients with personality dysfunction. Prior to the implementation of a programme, factors at the therapist, team and organizational level, as well as the wider context, need to be examined. This is to ensure that conditions are in place for proper adherence to the model to achieve the positive outcomes demonstrated in the RCT studies.
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Sweeney A, Clement S, Gribble K, Jackson E, Carr S, Catty J, Gillard S. A systematic review of qualitative studies of adults' experiences of being assessed for psychological therapies. Health Expect 2019; 22:133-148. [PMID: 30618105 PMCID: PMC6433316 DOI: 10.1111/hex.12844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/08/2018] [Accepted: 10/03/2018] [Indexed: 12/03/2022] Open
Abstract
Objective To synthesize the qualitative literature on adults’ experiences of psychological therapy assessments. The review was led by people with experience of undergoing assessments, with high levels of client involvement throughout. Search strategy A comprehensive search of electronic databases was undertaken, with additional search strategies employed to locate further literature. Inclusion criteria Studies were included that qualitatively explored the experiences of people aged 16+ who had been assessed for psychological therapy services. Assessments could be structured or unstructured. Qualitative was defined as any analysed account of people's experiences, including qualitative survey data. Data extraction and synthesis Literature quality was appraised using the Critical Appraisal Skills Program checklist, modified to include client involvement and intersectionalities. Following data extraction, thematic synthesis was used to synthesize findings across studies. Results Of 12 743 titles were screened, with 13 studies relevant to the review. Themes and subthemes were identified at three stages of the assessment process: the journey to the assessment, at the assessment, and after the assessment. Findings highlighted the emotional impact of assessments, collaboration, intersectionalities, rights, pathologization, socioeconomic restrictions, and information and support needs. Implications and limitations were indicated. Discussion and conclusions Findings were situated within the trauma‐informed (TIA) literature. Trauma‐informed assessment principles, including collaborative assessments, may be fruitful means of improving people's experiences. Whilst the benefits of collaboration appear self‐evident, explicitly collaborative approaches were not the norm, nor were studies conducted independently. Further service user research is needed. A greater understanding of the experience of minority groups is also needed.
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Affiliation(s)
- Angela Sweeney
- Population Health Research Institute, St Georges, University of London, London, UK
| | | | - Kate Gribble
- Child, Community and Educational Psychology, Exeter University, Exeter, UK
| | | | - Sarah Carr
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Jocelyn Catty
- Department of Education and Training, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Steve Gillard
- Population Health Research Institute, St Georges, University of London, London, UK
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Krotofil J, McPherson P, Killaspy H. Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis. Health Soc Care Community 2018; 26:787-800. [PMID: 29609195 DOI: 10.1111/hsc.12570] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
Specialist supported accommodation services have become a key component of most community-based mental healthcare systems. While mental health policies highlight the importance of service user involvement in service development and care planning, there are no comprehensive literature reviews synthesising services users' perspectives on, or experiences of, supported accommodation services. This systematic review was undertaken to fill this gap. We searched electronic databases (January 2015, updated June 2017), conducted hand searches and used forward-backward snowballing to identify 13,678 papers. We inspected the full-text of 110 papers and included 50 of these in the final review. Data extraction and quality assessments were conducted. We used narrative synthesis to develop a conceptual model of service users' experiences that included structural, process, relational and contextual factors, such as the characteristics of the service, relationships with staff and other service users, the intensity and nature of support, the physical environment, and social and community integration. The review highlights the complex interplay of individual, service-level and community factors in shaping the lived experience of service users and their impact on personal identity and recovery. Our approach addressed some of the widely reported limitations of the quantitative research in this field, providing a conceptual model relevant to service user experiences across supported accommodation service types, population groups and countries.
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Affiliation(s)
- Joanna Krotofil
- Division of Psychiatry, Faculty of Brain Sciences, UCL, London, UK
| | - Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, UCL, London, UK
| | - Helen Killaspy
- Division of Psychiatry, Faculty of Brain Sciences, UCL, London, UK
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Abstract
BACKGROUND The concept of recovery is contested throughout the existing literature and in mental health services. Little research exists that gives voice to service user perspectives of recovery. AIM This paper explores how service users in two recovery oriented services run by the National Health Service in North West England talked about recovery and what it meant to them. METHOD 14 service users accessing these services took part in semi-structured qualitative interviews focusing on the concept of recovery. Data were analysed using an interpretive phenomenological analysis approach. RESULTS Service users talked about recovery as a dynamic, day to day process as well as an outcome; specifically related to being discharged from inpatient settings. A number of factors including relationships and medication were cited to have the potential to make or break recovery. CONCLUSIONS The study highlights the continued dominance of the biomedical model in mental health services. Service users appear to have internalised staff and services' understanding of recovery perhaps unsurprisingly given the power differential in these relationships. Implications for clinical practice are explored.
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Affiliation(s)
- Rhiannah McCabe
- a Northumberland, Tyne and Wear NHS Foundation Trust , Newcastle Upon Tyne , UK.,b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and
| | - Richard Whittington
- b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and
| | - Laura Cramond
- b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and.,c Pennine Care NHS Foundation Trust , Ashton-Under-Lyne , UK
| | - Elizabeth Perkins
- b Health Services Research, Institute of Psychology, Health and Society, University of Liverpool , Liverpool , UK , and
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14
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Abstract
Introduction: Older people with chronic conditions often receive poor care because of the fragmented way in which their services are delivered from multiple sources. Providers have limited tools to directly capture the views of older people about their experiences of care co-ordination. The study aim was to design and test a survey tool to capture the experiences of older people with chronic conditions regarding how well their health and (where applicable) social care was co-ordinated. Method: To inform the questionnaire development, we reviewed the literature on existing surveys and care co-ordination theory, and on the health status of our target audience (people aged 65 or over with one or more chronic conditions and not in hospital or residential institutions). We also consulted stakeholders including those working in health and social care services and those with expertise in the subject area. We grouped questions around experiences of care in three dimensions: care in the home environment, planned transitions in care and unplanned situations. We also designed the questions so they could be mapped onto three recognised dimensions of continuity of care – management continuity, information continuity and relational continuity – as articulated in the international literature. The questionnaire was tested using focus groups and cognitive interviews and piloted with people aged 65 and over with at least one chronic condition, using a postal survey. We used service user records in 32 general practices located in four areas and a population database held by one local authority in England as the sampling frame. Results: The pilot achieved an overall response rate of 27.6% (n = 562 responses). Ninety five percent of respondents answered 30 or more of the 46 questions and three respondents answered fewer than 10 questions. Twenty four items achieved one or more positive correlations greater than 0.5 with other survey items and four instances of positive associations greater than 0.7 were found. Discussion/conclusion: The growing focus on care co-ordination demonstrates the need for a tool that can capture the experiences of patients accessing care across organisational and professional boundaries, to inform the improvement of care co-ordination activities from a patient perspective. Early results suggest that our tool may have a contribution to make in these areas. However, more work is required to test the efficacy of the tool on a larger scale and in different settings, and to find ways of improving response rates.
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15
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Abstract
OBJECTIVE Emergency mental health admissions (EA) for children under 13 years are not routinely offered in the UK, which may be related to preconceptions about their safety, appropriateness and acceptability. Our aim was to evaluate routinely offered EA of children in a national unit over a three-year period. METHOD A retrospective, naturalistic study was conducted, comparing EA with planned admissions (PA) in terms of children's functioning on admission and discharge, clinical characteristics, significant risk-related incidents and parental and children satisfaction. RESULTS EA children (N=47) did not differ from PA children (N=35) in age, length of admission, medication treatment, significant risk-related incidents, functioning at discharge, access to education at discharge and satisfaction. EA children had lower functioning and were less likely to have been out of education on admission. Parental satisfaction in EA was higher compared to PA. CONCLUSIONS EA for children are an appropriate, clinically indicated and safe alternative to PA, associated with higher parental satisfaction.
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Affiliation(s)
- Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, King's College London, London, UK
| | - Dennis Ougrin
- Institute of Psychiatry, King's College London, London, UK National and Specialist Supported Discharge Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Carmel Fraser
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gillene Thomas
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel McMahon
- National and Specialist Acorn Lodge Inpatient Children's Unit, South London and Maudsley NHS Foundation Trust, London, UK Pediatric BRAIN Center, University of Illinois at Chicago, USA
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