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Winsper C, Bhattacharya R, Bhui K, Currie G, Edge D, Ellard D, Franklin D, Gill P, Gilbert S, Khan N, Miller R, Motala Z, Pinfold V, Sandhu H, Singh SP, Weich S, Giacco D. The impact of reduced routine community mental healthcare on people from minority ethnic groups during the COVID-19 pandemic: qualitative study of stakeholder perspectives. Br J Psychiatry 2024; 224:150-156. [PMID: 38344814 PMCID: PMC7615860 DOI: 10.1192/bjp.2024.11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/24/2023] [Accepted: 12/20/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Enduring ethnic inequalities exist in mental healthcare. The COVID-19 pandemic has widened these. AIMS To explore stakeholder perspectives on how the COVID-19 pandemic has increased ethnic inequalities in mental healthcare. METHOD A qualitative interview study of four areas in England with 34 patients, 15 carers and 39 mental health professionals from National Health Service (NHS) and community organisations (July 2021 to July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and COVID-19 impacts. RESULTS Impacts were largely similar across sites, with some small variations (e.g. positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level included the dominance of a monocultural model, leading to poor communication, disengagement and alienation. During the pandemic remote service delivery, closure of community organisations and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fuelling prejudice and division, and increasing mistrust in services. Some minority ethnic patients reported positive developments, experiencing empowerment through self-determination and creative activities. CONCLUSIONS During the COVID-19 pandemic some patients showed resilience and developed adaptations that could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third-sector services in the community, exacerbating pre-existing barriers. As these developments are likely to have long-term consequences for minority ethnic groups' engagement with mental healthcare, they need to be addressed as a priority by the NHS and its partners.
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Affiliation(s)
- Catherine Winsper
- Department of Research and Innovation, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Kamaldeep Bhui
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - David Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Donna Franklin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Paramjit Gill
- Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Noreen Khan
- Department of Research and Innovation, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Robin Miller
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Zahra Motala
- Department of Sociology, University of Manchester, Manchester, UK
| | | | - Harbinder Sandhu
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran P. Singh
- Department of Research and Innovation, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK; and Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Scott Weich
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Domenico Giacco
- Department of Research and Innovation, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK; and Department of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Davis S, Pinfold V, Catchpole J, Lovelock C, Senthi B, Kenny A. Reporting lived experience work. Lancet Psychiatry 2024; 11:8-9. [PMID: 38101876 DOI: 10.1016/s2215-0366(23)00402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
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Wykes T, Bell A, Carr S, Coldham T, Gilbody S, Hotopf M, Johnson S, Kabir T, Pinfold V, Sweeney A, Jones PB, Creswell C. Shared goals for mental health research: what, why and when for the 2020s. J Ment Health 2023; 32:997-1005. [PMID: 33966543 DOI: 10.1080/09638237.2021.1898552] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 02/08/2023]
Abstract
Mental health problems bring substantial individual, community and societal costs and the need for innovation to promote good mental health and to prevent and treat mental health problems has never been greater. However, we know that research findings can take up to 20 years to implement. One way to push the pace is to focus researchers and funders on shared, specific goals and targets. We describe a consultation process organised by the Department of Health and Social Care and convened by the Chief Medical Officer to consider high level goals for future research efforts and to begin to identify UK-specific targets to measure research impact. The process took account of new scientific methods and evidence, the UK context with a universal health care system (the NHS) and the embedded research support from the National Institute for Health Research Clinical Research Network, as well as the views of individual service users and service user organisations. The result of the consultation is a set of four overarching goals with the potential to be measured at intervals of three, five or ten years.
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Affiliation(s)
- Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andy Bell
- Centre for Mental Health, London, UK
| | - Sarah Carr
- School of Social Policy/Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Tina Coldham
- Participation, Involvement and Engagement Advisor to the NIHR Centre for Engagement and Dissemination, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK
| | | | | | - Angela Sweeney
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Cathy Creswell
- Department of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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Moncrieff J, Crellin N, Stansfeld J, Cooper R, Marston L, Freemantle N, Lewis G, Hunter R, Johnson S, Barnes T, Morant N, Pinfold V, Smith R, Kent L, Darton K, Long M, Horowitz M, Horne R, Vickerstaff V, Jha M, Priebe S. Antipsychotic dose reduction and discontinuation versus maintenance treatment in people with schizophrenia and other recurrent psychotic disorders in England (the RADAR trial): an open, parallel-group, randomised controlled trial. Lancet Psychiatry 2023; 10:848-859. [PMID: 37778356 DOI: 10.1016/s2215-0366(23)00258-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Maintenance antipsychotic medication is recommended for people with schizophrenia or recurrent psychosis, but the adverse effects are burdensome, and evidence on long-term outcomes is sparse. We aimed to assess the benefits and harms of a gradual process of antipsychotic reduction compared with maintenance treatment. Our hypothesis was that antipsychotic reduction would improve social functioning with a short-term increase in relapse. METHODS RADAR was an open, parallel-group, randomised trial done in 19 National Health Service Trusts in England. Participants were aged 18 years and older, had a diagnosis of recurrent, non-affective psychotic disorder, and were prescribed an antipsychotic. Exclusion criteria included people who had a mental health crisis or hospital admission in the past month, were considered to pose a serious risk to themselves or others by a treating clinician, or were mandated to take antipsychotic medication under the Mental Health Act. Through an independent, internet-based system, participants were randomly assigned (1:1) to gradual, flexible antipsychotic reduction, overseen by treating clinicians, or to maintenance. Participants and clinicians were aware of treatment allocations, but assessors were masked to them. Follow-up was for 2 years. Social functioning, assessed by the Social Functioning Scale, was the primary outcome. The principal secondary outcome was severe relapse, defined as requiring admission to hospital. Analysis was done blind to group identity using intention-to-treat data. The trial is completed and has been registered with ISRCTN registry (ISRCTN90298520) and with ClinicalTrials.gov (NCT03559426). FINDINGS 4157 people were screened, of whom 253 were randomly allocated, including 168 (66%) men, 82 (32%) women, and 3 (1%) transgender people, with a mean age of 46 years (SD 12, range 22-79). 171 (67%) participants were White, 52 (21%) were Black, 16 (6%) were Asian, and 12 (5%) were of other ethnicity. The median dose reduction at any point during the trial was 67% in the reduction group and zero in the maintenance group; at 24 months it was 33% versus zero. At the 24-month follow-up, we assessed 90 of 126 people assigned to the antipsychotic dose reduction group and 94 of 127 assigned to the maintenance group, finding no difference in the Social Functioning Scale (β 0·19, 95% CI -1·94 to 2·33; p=0·86). There were 93 serious adverse events in the reduction group affecting 49 individuals, mainly comprising admission for a mental health relapse, and 64 in the maintenance group, relating to 29 individuals. INTERPRETATION At 2-year follow-up, a gradual, supported process of antipsychotic dose reduction had no effect on social functioning. Our data can help to inform decisions about the use of long-term antipsychotic medication. FUNDING National Institute for Health Research.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK.
| | | | - Jacki Stansfeld
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK
| | - Ruth Cooper
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; East London NHS Foundation Trust, Newham Centre for Mental Health, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Thomas Barnes
- Division of Psychiatry, Imperial College, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | | | | | | | - Maria Long
- Division of Psychiatry, University College London, London, UK; Department of Health Services Research and Management, City University, London, UK
| | - Mark Horowitz
- Division of Psychiatry, University College London, London, UK; North East London Foundation NHS Trust, London, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Victoria Vickerstaff
- Research Department of Primary Care and Population Health, University College London, London, UK; PRIMENT Clinical trials unit, University College London, London, UK
| | - Mithilesh Jha
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Stefanidou T, Ambler G, Bartl G, Barber N, Billings J, Bogatsu T, Carroll R, Chipp B, Conneely M, Downey AM, Evlat G, Hunter R, Le Novere M, Lewis G, Mackay T, Marwaha S, Matin Z, Naughton G, Nekitsing C, O'Sullivan M, Pinfold V, Pan S, Sobers A, Thompson KJ, Vasikaran J, Webber M, Johnson S, Lloyd-Evans B. Randomised controlled trial of the Community Navigator programme to reduce loneliness and depression for adults with treatment-resistant depression in secondary community mental health services: trial protocol. Trials 2023; 24:652. [PMID: 37803385 PMCID: PMC10559405 DOI: 10.1186/s13063-023-07684-4] [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] [Received: 07/29/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND New treatments are needed for people with treatment-resistant depression (TRD), who do not benefit from anti-depressants and many of whom do not recover fully with psychological treatments. The Community Navigator programme was co-produced with service users and practitioners. It is a novel social intervention which aims to reduce loneliness and thus improve health outcomes for people with TRD. Participants receive up to 10 individual meetings with a Community Navigator, who helps them to map their social world and set and enact goals to enhance their social connections and reduce loneliness. Participants may also access group meet-ups with others in the programme every 2 months, and may be offered modest financial support to enable activities to support social connections. METHODS A researcher-blind, multi-site, 1:1 randomised controlled trial with N = 306 participants will test the effectiveness of the Community Navigator programme for people with TRD in secondary community mental health teams (CMHTs). Our primary hypothesis is that people who are offered the Community Navigator programme as an addition to usual CMHT care will be less depressed, assessed using the PHQ-9 self-report measure, at 8-month, end-of-treatment follow-up, compared to a control group receiving usual CMHT care and a booklet with information about local social groups and activities. We will follow participants up at end-of-treatment and at 14 months, 6 months after end-of-treatment follow-up. Secondary outcomes include the following: loneliness, anxiety, personal recovery, self-efficacy, social network, social identities. We will collect data about health-related quality of life and service use to investigate the cost-effectiveness of the Community Navigator programme. DISCUSSION This trial will provide definitive evidence about the effectiveness and cost-effectiveness of the Community Navigator programme and whether it can be recommended for use in practice. The trial is due to finish in August 2025. TRIAL REGISTRATION Prospectively registered on 8th July 2022 at: ISRCTN13205972.
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Affiliation(s)
- Theodora Stefanidou
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gareth Ambler
- Department of Statistical Sciences, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| | - Gergely Bartl
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nick Barber
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- The McPin Foundation, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Tumelo Bogatsu
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Beverley Chipp
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- The McPin Foundation, London, UK
| | - Maev Conneely
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | - Gamze Evlat
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Rachael Hunter
- Priment Clinical Trials Unit, University College London, London, UK
- Department of Primary Care and Population Health, University College London, London, UK
| | - Marie Le Novere
- Priment Clinical Trials Unit, University College London, London, UK
- Department of Primary Care and Population Health, University College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Priment Clinical Trials Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Zubair Matin
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | | | - Millie O'Sullivan
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - Shengning Pan
- Department of Statistical Sciences, University College London, London, UK
- Priment Clinical Trials Unit, University College London, London, UK
| | - Angela Sobers
- Barnet, Enfield and Haringey, NHS Mental Health Trust, London, UK
| | - Keith J Thompson
- The McPin Foundation, London, UK
- Tees, Esk and Wear Valley, NHS Foundation Trust, Durham, UK
| | - Jerusaa Vasikaran
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Martin Webber
- School for Business and Society, University of York, York, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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Pinfold V, Thompson R, Lewington A, Samuel G, Jayacodi S, Jones O, Vadgama A, Crawford A, Fischer LE, Dykxhoorn J, Kidger J, Oliver EJ, Duncan F. Public perspectives on inequality and mental health: A peer research study. Health Expect 2023; 27:e13868. [PMID: 37786331 PMCID: PMC10768865 DOI: 10.1111/hex.13868] [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: 06/09/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Associations between structural inequalities and health are well established. However, there is limited work examining this link in relation to mental health, or that centres public perspectives. This study explores people's experience and sense-making of inequality in their daily lives, with particular consideration of impacts on mental health. METHODS We conducted a peer research study. Participants had to live in one of two London Boroughs and have an interest in inequalities and mental health. Using social media, newsletters, local organisations and our peer researchers' contacts, we recruited 30 participants who took photos representing their experience of inequality and discussed them during semi-structured interviews. Data were analysed using reflexive thematic analysis. RESULTS Three themes were identified in this study: (1) inequalities are unjust, multilayered and intertwined with mental health. Accounts demonstrated a deep understanding of inequalities and their link to mental health outcomes, describing inequalities as 'suffering' and 'not good for anyone'. Financial, housing, immigration and healthcare problems exacerbated poor mental health, with racism, gender-based violence and job loss also contributing factors for both poor mental health and experiences of inequality; (2) inequalities exclude and have far-reaching mental health consequences, impacting personal sense of belonging and perceived societal value and (3) moving forwards-addressing long-standing inequality and poor public mental health necessitated coping and resilience strategies that are often unacknowledged and undervalued by support systems. CONCLUSION Lived experience expertise was central in this study, creating an innovative methodological approach. To improve public mental health, we must address the everyday, painful structural inequalities experienced by many as commonplace and unfair. New policies and strategies must be found that involve communities, redistributing resources and power, building on a collective knowledge base, to coproduce actions combatting inequalities and improving population mental health. PATIENT OR PUBLIC CONTRIBUTION This study was peer-led, designed and carried out by researchers who had experiences of poor mental health. Six authors of the paper worked as peer researchers on this study.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Judi Kidger
- Population Health SciencesUniversity of BristolBristolUK
| | - Emily J. Oliver
- Population Health SciencesUniversity of NewcastleNewcastleUnited Kingdom
| | - Fiona Duncan
- Population Health SciencesUniversity of NewcastleNewcastleUnited Kingdom
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Nicholls H, Lamb D, Johnson S, Higgs P, Pinfold V, Billings J. "Fix the system … the people who are in it are not the ones that are broken" A qualitative study exploring UK academic researchers' views on support at work. Heliyon 2023; 9:e20454. [PMID: 37860508 PMCID: PMC10582291 DOI: 10.1016/j.heliyon.2023.e20454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
Recent evidence suggests that it remains difficult for academic researchers to preserve global well-being when working in the UK higher education sector. Our study aimed to explore academic researchers' perspectives on how they feel their mental health and well-being could be better supported within the UK higher education system. Using a combination of semi-structured and narrative interviewing techniques, we gathered the perspectives of 26 researchers. Narrative and reflexive thematic analysis were then used on the data collected. Our findings highlight the need to tackle systemic issues such job insecurity and unrealistically high workloads, given the risk they can pose to researchers' mental health and well-being. Our findings also highlight the key influence of managers and supervisors in creating a supportive environment, and the importance of going beyond what support is offered. That is, it is vital to effectively promote any existing or emerging support systems, and to be proactive in offering this support. Given the diversity identified in researchers' individual situations, it is important that support is flexible and takes into consideration individual requirements and preferences. Higher education authorities and institutions need to determine how they can foster a healthy, caring environment for researchers working in this sector going forwards.
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Affiliation(s)
- Helen Nicholls
- Division of Psychiatry, University College London, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, United Kingdom
| | - Paul Higgs
- Division of Psychiatry, University College London, London, United Kingdom
| | | | - Jo Billings
- Division of Psychiatry, University College London, London, United Kingdom
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Winsper C, Bhattacharya R, Bhui K, Currie G, Edge D, Ellard DR, Franklin D, Gill PS, Gilbert S, Miller R, Motala Z, Pinfold V, Sandhu H, Singh SP, Weich S, Giacco D. Improving mental healthcare access and experience for people from minority ethnic groups: an England-wide multisite experience-based codesign (EBCD) study. BMJ Ment Health 2023; 26:e300709. [PMID: 37463794 PMCID: PMC10357761 DOI: 10.1136/bmjment-2023-300709] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/27/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Long-standing ethnic inequalities in access and mental healthcare were worsened by the COVID-19 pandemic. OBJECTIVES Stakeholders coproduced local and national implementation plans to improve mental healthcare for people from minority ethnic groups. METHODS Experience-based codesign conducted in four areas covered by National Health Service (NHS) mental health trusts: Coventry and Warwickshire, Greater Manchester, East London and Sheffield. Data were analysed using an interpretivist-constructivist approach, seeking validation from participants on their priority actions and implementation plans. Service users (n=29), carers (n=9) and health professionals (n=33) took part in interviews; focus groups (service users, n=15; carers, n=8; health professionals, n=24); and codesign workshops (service users, n=15; carers, n=5; health professionals, n=21) from July 2021 to July 2022. FINDINGS Each study site identified 2-3 local priority actions. Three were consistent across areas: (1) reaching out to communities and collaborating with third sector organisations; (2) diversifying the mental healthcare offer to provide culturally appropriate therapeutic approaches and (3) enabling open discussions about ethnicity, culture and racism. National priority actions included: (1) co-ordination of a national hub to bring about system level change and (2) recognition of the centrality of service users and communities in the design and provision of services. CONCLUSIONS Stakeholder-led implementation plans highlight that substantial change is needed to increase equity in mental healthcare in England. CLINICAL IMPLICATIONS Working with people with lived experience in leadership roles, and collaborations between NHS and community organisations will be essential. Future research avenues include comparison of the benefits of culturally specific versus generic therapeutic interventions.
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Affiliation(s)
- Catherine Winsper
- Research and Innovation, Caludon Centre, Coventry and Warwickshire Partnership Trust, Clifford Bridge Road, Coventry, UK
| | - Rahul Bhattacharya
- Tower Hamlets Home Treatment Team, East London NHS Foundation Trust, Robert Dolan House, Trust Headquarters, 9 Alie Street, London, UK
| | - Kamaldeep Bhui
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Dawn Edge
- Division of Psychology & Mental Health, G6 Coupland 1 Building, The University of Manchester, Manchester, UK
| | - David R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Donna Franklin
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Paramjit S Gill
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Steve Gilbert
- Steve Gilbert Consulting, Suite 2A, Blackthorn House, St Pauls Square, Birmingham, UK
| | - Robin Miller
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Zahra Motala
- Department of Sociology, University of Manchester, Manchester, UK
| | | | - Harbinder Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran P Singh
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Scott Weich
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Domenico Giacco
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Byng R, Creanor S, Jones B, Hosking J, Plappert H, Bevan S, Britten N, Clark M, Davies L, Frost J, Gask L, Gibbons B, Gibson J, Hardy P, Hobson-Merrett C, Huxley P, Jeffery A, Marwaha S, Rawcliffe T, Reilly S, Richards D, Sayers R, Williams L, Pinfold V, Birchwood M. The effectiveness of a primary care-based collaborative care model to improve quality of life in people with severe mental illness: PARTNERS2 cluster randomised controlled trial. Br J Psychiatry 2023; 222:246-256. [PMID: 37078520 DOI: 10.1192/bjp.2023.28] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative care combines clinical and organisational components. AIMS We tested whether a primary care-based collaborative care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses, compared with usual care. METHOD We conducted a general practice-based, cluster randomised controlled superiority trial. Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person-centred coaching support and liaison work. The primary outcome was quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA). RESULTS We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices, 116 participants) or control (19 practices, 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (intervention: 0.25, s.d. 0.73; control: 0.21, s.d. 0.86; estimated fully adjusted between-group difference 0.03, 95% CI -0.25 to 0.31; P = 0.819). Acute mental health episodes (safety outcome) included three crises in the intervention group and four in the control group. CONCLUSIONS There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomes.
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Affiliation(s)
- Richard Byng
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Siobhan Creanor
- Department of Health and Community Sciences, University of Exeter, UK
| | - Benjamin Jones
- Department of Health and Community Sciences, University of Exeter, UK
| | - Joanne Hosking
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | - Sheriden Bevan
- Birmingham Clinical Trials Unit, University of Birmingham, UK
| | - Nicky Britten
- Department of Health and Community Sciences, University of Exeter, UK
| | - Michael Clark
- Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | - Linda Davies
- Division of Population Health, University of Manchester, UK
| | - Julia Frost
- Department of Health and Community Sciences, University of Exeter, UK
| | - Linda Gask
- Division of Population Health, University of Manchester, UK
| | - Bliss Gibbons
- Institute for Mental Health, Coventry and Warwickshire Partnership NHS Trust, UK
| | | | - Pollyanna Hardy
- National Perinatal Epidemiology Unit, Oxford Population Health, Nuffield Department of Population Health, University of Oxford, UK
| | | | - Peter Huxley
- School of Medical and Health Sciences, University of Bangor, UK
| | - Alison Jeffery
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, UK; and Institute for Mental Health, Birmingham and Solihull Mental Health NHS Foundation Trust, UK
| | | | - Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, UK
| | - Debra Richards
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | - Lynsey Williams
- Community and Primary Care Research Group, University of Plymouth, UK
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10
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Zary N, Kenny A, Pinfold V, Couperthwaite L, Kabir T, Larkin M, Beckley A, Rosebrock L, Lambe S, Freeman D, Waite F, Robotham D. A Safe Place to Learn: Peer Research Qualitative Investigation of gameChange Virtual Reality Therapy. JMIR Serious Games 2023; 11:e38065. [PMID: 36645707 PMCID: PMC9947847 DOI: 10.2196/38065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/18/2022] [Revised: 06/24/2022] [Accepted: 10/11/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Automated virtual reality (VR) therapy has the potential to substantially increase access to evidence-based psychological treatments. The results of a multicenter randomized controlled trial showed that gameChange VR cognitive therapy reduces the agoraphobic avoidance of people diagnosed with psychosis, especially for those with severe avoidance. OBJECTIVE We set out to use a peer research approach to explore participants' experiences with gameChange VR therapy. This in-depth experiential exploration of user experience may inform the implementation in clinical services and future VR therapy development. METHODS Peer-led semistructured remote interviews were conducted with 20 people with a diagnosis of psychosis who had received gameChange as part of the clinical trial (ISRCTN17308399). Data were analyzed using interpretative phenomenological analysis and template analyses. A multiperspectival approach was taken to explore subgroups. Credibility checks were conducted with the study Lived Experience Advisory Panel. RESULTS Participants reported the substantial impact of anxious avoidance on their lives before the VR intervention, leaving some of them housebound and isolated. Those who were struggling the most with agoraphobic avoidance expressed the most appreciation for, and gains from, the gameChange therapy. The VR scenarios provided "a place to practise." Immersion within the VR scenarios triggered anxiety, yet participants were able to observe this and respond in different ways than usual. The "security of knowing the VR scenarios are not real" created a safe place to learn about fears. The "balance of safety and anxiety" could be calibrated to the individual. The new learning made in VR was "taken into the real world" through practice and distilling key messages with support from the delivery staff member. CONCLUSIONS Automated VR can provide a therapeutic simulation that allows people diagnosed with psychosis to learn and embed new ways of responding to the situations that challenge them. An important process in anxiety reduction is enabling the presentation of stimuli that induce the original anxious fears yet allow for learning of safety. In gameChange, the interaction of anxiety and safety could be calibrated to provide a safe place to learn about fears and build confidence. This navigation of therapeutic learning can be successfully managed by patients themselves in an automated therapy, with staff support, that provides users with personalized control. The clinical improvements for people with severe anxious avoidance, the positive experience of VR, and the maintenance of a sense of control are likely to facilitate implementation.
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Affiliation(s)
| | | | | | | | -
- McPin Foundation, London, United Kingdom
| | | | - Michael Larkin
- School of Psychology, Aston University, Birmingham, United Kingdom
| | - Ariane Beckley
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom
| | - Laina Rosebrock
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Sinéad Lambe
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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11
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Okoroji C, Mackay T, Robotham D, Beckford D, Pinfold V. Epistemic injustice and mental health research: A pragmatic approach to working with lived experience expertise. Front Psychiatry 2023; 14:1114725. [PMID: 37056406 PMCID: PMC10086175 DOI: 10.3389/fpsyt.2023.1114725] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 12/02/2022] [Accepted: 03/01/2023] [Indexed: 04/15/2023] Open
Abstract
"Epistemic injustice" refers to how people from marginalized groups are denied opportunities to create knowledge and derive meaning from their experiences. In the mental health field, epistemic injustice occurs in both research and service delivery systems and particularly impacts people from racialized communities. Lived experience involvement and leadership are often proposed as methods of combatting epistemic injustice, a tool for ensuring the views of people at the center of an issue are heard and can inform decision-making. However, this approach is not without challenges. In this paper, we draw on our work as intermediary organizations that center lived experience perspectives to challenge epistemic injustice. We highlight two problems we have identified in working in the mental health research field: "elite capture" and "epistemic exploitation". We believe that these problems are barriers to the radical and structural change required for epistemic justice to occur. We propose a pragmatic approach to addressing these issues. Based on our work we suggest three considerations for researchers and our own organizations to consider when involving people with lived experience. These include reflecting on the purpose of creating knowledge, with a focus on impact. Embedding lived experience roles, with appropriate employment, support and remuneration, and acknowledging that it may be necessary to work alongside existing systems as a "critical friend" while developing new spaces and structures for alternative forms of knowledge. Finally, the mental health research system needs to change. We believe these three considerations will help us better move toward epistemic justice in mental health research.
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Affiliation(s)
- Celestin Okoroji
- Black Thrive Global, London, United Kingdom
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, United Kingdom
| | - Tanya Mackay
- The McPin Foundation, London, United Kingdom
- *Correspondence: Tanya Mackay,
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12
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Bond J, Kenny A, Mesaric A, Wilson N, Pinfold V, Kabir T, Freeman D, Waite F, Larkin M, Robotham DJ. A life more ordinary: A peer research method qualitative study of the Feeling Safe Programme for persecutory delusions. Psychol Psychother 2022; 95:1108-1125. [PMID: 35942540 PMCID: PMC9805019 DOI: 10.1111/papt.12421] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Feeling Safe Programme is a cognitive therapy developed to improve outcomes for individuals with persecutory delusions. It is theoretically driven, modular and personalised, with differences in therapeutic style and content compared with first-generation cognitive behavioural therapy for psychosis. OBJECTIVES We set out to understand the participant experience of the Feeling Safe Programme. DESIGN A qualitative study employing interpretative phenomenological analysis. METHODS Using a peer research approach, semi-structured face-to-face interviews were conducted with six people who had received the Feeling Safe Programme as part of the outcome clinical trial. RESULTS Participants spoke of feeling 'unsafe' in their daily lives before the intervention. Openness to the intervention, facilitated by identification with the programme name, and willingness to take an active role were considered important participant attributes for successful outcomes. The therapist was viewed as a professional friend who cared about the individual, which enabled trust to form and the opportunity to consider new knowledge and alternative perspectives. Doing difficult tasks gradually and repeatedly to become comfortable with them was important for change to occur. The intervention helped people to do ordinary things that others take for granted and was perceived to produce lasting changes. CONCLUSIONS The Feeling Safe Programme was subjectively experienced very positively by interview participants, which is consistent with the results of the clinical trial. The successful interaction of the participant and therapist enabled trust to form, which meant that repeated practice of difficult tasks could lead to re-engagement with valued everyday activities.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Freeman
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - Felicity Waite
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
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13
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Simblett SK, Jilka S, Vitoratou S, Hayes C, Morris D, Wilson E, Odoi C, Mutepua M, Evans J, Negbenose E, Jansli SM, Hudson G, Adanijo A, Dawe-Lane E, Pinfold V, Wykes T. Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2491-2501. [PMID: 35727333 PMCID: PMC9211778 DOI: 10.1007/s00127-022-02316-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems. METHODS We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model. RESULTS A model significantly fit our data (rel χ2 = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction. CONCLUSIONS Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.
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Affiliation(s)
- S K Simblett
- Psychology Department, King's College London, London, UK.
| | - S Jilka
- Psychology Department, King's College London, London, UK
| | - S Vitoratou
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - C Hayes
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - D Morris
- Psychology Department, King's College London, London, UK
| | - E Wilson
- Psychology Department, King's College London, London, UK
| | - C Odoi
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Mutepua
- Psychology Department, King's College London, London, UK
| | - J Evans
- Psychology Department, King's College London, London, UK
| | - E Negbenose
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - S M Jansli
- Psychology Department, King's College London, London, UK
| | - G Hudson
- Psychology Department, King's College London, London, UK
| | - A Adanijo
- Psychology Department, King's College London, London, UK
| | - E Dawe-Lane
- Psychology Department, King's College London, London, UK
| | | | - T Wykes
- Psychology Department, King's College London, London, UK
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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14
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Dawe-Lane E, Mutepua M, Morris D, Odoi CM, Wilson E, Evans J, Pinfold V, Wykes T, Jilka S, Simblett S. Factors Influencing Increased Use of Technology to Communicate With Others During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study. JMIR Ment Health 2022; 9:e31251. [PMID: 35435852 PMCID: PMC9644246 DOI: 10.2196/31251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/15/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Communication via technology is regarded as an effective way of maintaining social connection and helping individuals to cope with the psychological impact of social distancing measures during a pandemic. However, there is little information about which factors have influenced increased use of technology to communicate with others during lockdowns and whether this has changed over time. OBJECTIVE The aim of this study is to explore which psychosocial factors (eg, mental health and employment) and pandemic-related factors (eg, shielding and time) influenced an increase in communication via technology during the first lockdown in the United Kingdom. METHODS A cross-sectional, web-based survey was conducted between April and July 2020, examining thoughts, feelings, and behaviors associated with the pandemic, including communicating more using technology (eg, via messaging, phone, or video). We collected sociodemographic information, employment status, mental health service user status, and depression symptoms. We used hierarchical logistic regression to test which factors were associated with communicating more using technology during the lockdown. RESULTS Participants (N=1464) were on average 41.07 (SD 14.61) years old, and mostly women (n=1141; 77.9%), White (n=1265; 86.4%), and employed (n=1030; 70.4%). Participants reported a mild level of depression (mean 9.43, SD 7.02), and were communicating more using technology (n=1164; 79.5%). The hierarchical regression indicated that people who were employed and experiencing lower levels of depression were more likely to report increased communication using technology during a lockdown period of the COVID-19 pandemic, and over time, men communicated more using technology. Increased use of technology to communicate was related to greater communication and the inability to see others due to the social distancing measures enacted during the lockdown. It was not related to a general increase in technology use during the lockdown. CONCLUSIONS Although most participants reported increased use of technology to communicate during a lockdown period of the COVID-19 pandemic, this was more apparent in the employed and those experiencing low levels of depression. Moving forward, we should continue to monitor groups who may have been excluded from the benefits of support and communication using technology.
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Affiliation(s)
- Erin Dawe-Lane
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Magano Mutepua
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Daniel Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Clarissa M Odoi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emma Wilson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Joanne Evans
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sagar Jilka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sara Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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15
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Knowles G, Gayer-Anderson C, Blakey R, Davis S, Lowis K, Stanyon D, Ofori A, Turner A, Dorn L, Beards S, Pinfold V, Reininghaus U, Harding S, Morgan C. Cohort Profile: Resilience, Ethnicity and AdolesCent mental Health (REACH). Int J Epidemiol 2022; 51:e303-e313. [PMID: 35348706 PMCID: PMC9557858 DOI: 10.1093/ije/dyac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Gemma Knowles
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Charlotte Gayer-Anderson
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Rachel Blakey
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Samantha Davis
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Katie Lowis
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Daniel Stanyon
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Aisha Ofori
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Alice Turner
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | - Lynsey Dorn
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College
London, London, UK
| | | | | | - Stephanie Beards
- Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
- National Children’s Bureau, London, UK
| | | | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health,
Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Seeromanie Harding
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty
of Life Sciences & Medicine, King’s College London, London, UK
| | - Craig Morgan
- Corresponding author. ESRC Centre for Society and Mental Health,
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5
8AF, UK. E-mail:
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16
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Wood L, Williams C, Pinfold V, Nolan F, Morrison AP, Morant N, Lloyd-Evans B, Lewis G, Lay B, Jones R, Greenwood K, Johnson S. Crisis-focused Cognitive Behavioural Therapy for psychosis (CBTp) in acute mental health inpatient settings (the CRISIS study): protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2022; 8:205. [PMID: 36088373 PMCID: PMC9463503 DOI: 10.1186/s40814-022-01160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cognitive Behavioural Therapy for psychosis (CBTp) has an established evidence base and is recommended by clinical guidelines to be offered during the acute phases of psychosis. However, few research studies have examined the efficacy of CBTp interventions specifically adapted for the acute mental health inpatient context with most research trials being conducted with white European community populations.
Aims
The aim of this study is to conduct a pilot randomised controlled trial (RCT), which incorporates the examination of feasibility markers, of a crisis-focused CBTp intervention adapted for an ethnically diverse acute mental health inpatient population, in preparation for a large-scale randomised controlled trial. The study will examine the feasibility of undertaking the trial, the acceptability and safety of the intervention and the suitability of chosen outcome measures. This will inform the planning of a future, fully powered RCT.
Methods
A single-site, parallel-group, pilot RCT will be conducted examining the intervention. Drawing on principles of coproduction, the intervention has been adapted in partnership with key stakeholders: service users with lived experience of psychosis and of inpatient care (including those from ethnic minority backgrounds), carers, multi-disciplinary inpatient clinicians and researchers. Sixty participants with experience of psychosis and in current receipt of acute mental health inpatient care will be recruited. Participants will be randomly allocated to either the crisis-focused CBTp intervention or treatment as usual (TAU).
Discussion
Findings of this pilot RCT will indicate whether a larger multi-site RCT is needed to investigate the efficacy of the intervention. If the initial results demonstrate that this trial is feasible and the intervention is acceptable, it will provide evidence that a full-scale effectiveness trial may be warranted.
Trial registration
This trial has been prospectively registered on the ISRCTN registry (ISRCTN59055607) on the 18th of February 2021.
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17
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Crellin NE, Priebe S, Morant N, Lewis G, Freemantle N, Johnson S, Horne R, Pinfold V, Kent L, Smith R, Darton K, Cooper RE, Long M, Thompson J, Gruenwald L, Freudenthal R, Stansfeld JL, Moncrieff J. An analysis of views about supported reduction or discontinuation of antipsychotic treatment among people with schizophrenia and other psychotic disorders. BMC Psychiatry 2022; 22:185. [PMID: 35291964 PMCID: PMC8925064 DOI: 10.1186/s12888-022-03822-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antipsychotic medication can reduce psychotic symptoms and risk of relapse in people with schizophrenia and related disorders, but it is not always effective and adverse effects can be significant. We know little of patients' views about continuing or discontinuing antipsychotic treatment. AIMS To explore the views of people with schizophrenia and other psychotic disorders about continuing their antipsychotic medication or attempting to reduce or discontinue this medication with clinical support. METHODS We collected quantitative and qualitative data by conducting semi-structured interviews in London, UK. Factors predicting a desire to discontinue medication were explored. Content analysis of qualitative data was undertaken. RESULTS We interviewed 269 participants. 33% (95% CI, 27 to 39%) were content with taking long-term antipsychotic medication. Others reported they took it reluctantly (19%), accepted it on a temporary basis (24%) or actively disliked it (18%). 31% (95% CI, 25 to 37%) said they would like to try to stop medication with professional support, and 45% (95% CI, 39 to 51%) wanted the opportunity to reduce medication. People who wanted to discontinue had more negative attitudes towards the medication but were otherwise similar to other participants. Wanting to stop or reduce medication was motivated mainly by adverse effects and health concerns. Professional support was identified as potentially helpful to achieve reduction. CONCLUSIONS This large study reveals that patients are commonly unhappy about the idea of taking antipsychotics on a continuing or life-long basis. Professional support for people who want to try to reduce or stop medication is valued.
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Affiliation(s)
- Nadia E. Crellin
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Stefan Priebe
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK
| | - Nicola Morant
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Glyn Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Nick Freemantle
- grid.83440.3b0000000121901201Institute of Clinical Trials and Methodology, University College London, London, WC1V 6LJ UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Rob Horne
- grid.83440.3b0000000121901201School of Pharmacy, University College London, London, WC1N 1AX UK
| | | | - Lyn Kent
- Independent consultant, London, UK
| | | | | | - Ruth E. Cooper
- grid.4868.20000 0001 2171 1133Unit for Social and Community Psychiatry, Queen Mary University of London, London, E1 4NS UK ,grid.36316.310000 0001 0806 5472University of Greenwich, Faculty of Education, Health and Human Sciences, London, SE10 9LS UK ,grid.450709.f0000 0004 0426 7183East London NHS Foundation Trust, Newham Centre for Mental Health, London, E13 8SP UK
| | - Maria Long
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Jemima Thompson
- grid.83440.3b0000000121901201Faculty of Medical Sciences, University College London, London, UK
| | - Lisa Gruenwald
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Robert Freudenthal
- grid.451052.70000 0004 0581 2008Barnet Enfield Haringey Mental Health NHS Trust, London, UK
| | - Jacki L. Stansfeld
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
| | - Joanna Moncrieff
- grid.439781.00000 0000 8541 7374Research & Development Department, Goodmayes Hospital, North East London NHS Foundation Trust, Essex, IG3 8XJ UK ,grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, W1T 7NF UK
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18
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Liberati E, Richards N, Parker J, Willars J, Scott D, Boydell N, Pinfold V, Martin G, Jones PB, Dixon-Woods M. Qualitative study of candidacy and access to secondary mental health services during the COVID-19 pandemic. Soc Sci Med 2022; 296:114711. [PMID: 35063916 PMCID: PMC8744250 DOI: 10.1016/j.socscimed.2022.114711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 12/21/2021] [Accepted: 01/08/2022] [Indexed: 12/03/2022]
Abstract
Candidacy, a construct describing how people's eligibility for care is negotiated between themselves and services, has received limited attention in the context of mental health care. In addition, candidacy research has only rarely studied the views of carers and health professionals. In this article, we use concepts relating to candidacy to enable a theoretically informed examination of experiences of access to secondary mental health services during the first wave of the COVID-19 pandemic in England. We report a qualitative study of the views and experiences of service users, carers, and healthcare professionals. Analysis of 65 in-depth interviews was based on the constant comparative method. We found that wide-ranging service changes designed to address the imperatives of the pandemic were highly consequential for people's candidacy. Macro-level changes, including increased emphasis on crisis and risk management and adapted risk assessment systems, produced effects that went far beyond restrictions in the availability of services: they profoundly re-structured service users' identification of their own candidacy, including perceptions of what counted as a problem worthy of attention and whether they as individuals needed, deserved, and were entitled to care. Services became less permeable, such that finding a point of entry to those services that remained open required more work of service users and carers. Healthcare professionals were routinely confronted by complex decisions and ethical dilemmas about provision of care, and their implicit judgements about access may have important implications for equity. Many of the challenges of access exposed by the pandemic related to pre-existing resource deficits and institutional weaknesses in care for people living with mental health difficulties. Overall, these findings affirm the value of the construct of candidacy for explaining access to mental healthcare, but also enable deepened understanding of the specific features of candidacy, offering enduring learning and implications for policy and practice. Candidacy is a framework for understanding influences on access to healthcare. We studied access to mental healthcare services during the COVID-19 pandemic. Candidacy was profoundly affected by service changes. Understandings of entitlement and thresholds for access were reconfigured. The value of the candidacy framework for mental health contexts is affirmed.
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19
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Knowles G, Gayer‐Anderson C, Turner A, Dorn L, Lam J, Davis S, Blakey R, Lowis K, Pinfold V, Creary N, Dyer J, Hatch SL, Ploubidis G, Bhui K, Harding S, Morgan C. Covid-19, social restrictions, and mental distress among young people: a UK longitudinal, population-based study. J Child Psychol Psychiatry 2022; 63:1392-1404. [PMID: 35199336 PMCID: PMC9114888 DOI: 10.1111/jcpp.13586] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Adolescence is a critical period for social and emotional development. We sought to examine the impacts of Covid-19 and related social restrictions and school closures on adolescent mental health, particularly among disadvantaged, marginalised, and vulnerable groups. METHODS We analysed four waves of data - 3 pre-Covid-19 (2016-2019) and 1 mid-Covid-19 (May-Aug 2020; n, 1074; 12-18 years old, >80% minority ethnic groups, 25% free school meals) from REACH (Resilience, Ethnicity, and AdolesCent Mental Health), an adolescent cohort based in inner-London, United Kingdom. Mental health was assessed using validated measures at each time point. We estimated temporal trends in mental distress and examined variations in changes in distress, pre- to mid-Covid-19, by social group, and by pre- and mid-pandemic risks. RESULTS We found no evidence of an overall increase in mental distress midpandemic (15.9%, 95% CI: 13.0, 19.4) compared with prepandemic (around 18%). However, there were variations in changes in mental distress by subgroups. There were modest variations by social group and by pre-Covid risks (e.g., a small increase in distress among girls (b [unstandardised beta coefficient] 0.42 [-0.19, 1.03]); a small decrease among boys (b - 0.59 [-1.37, 0.19]); p for interaction .007). The most notable variations were by midpandemic risks: that is, broadly, increases in distress among those reporting negative circumstances and impacts (e.g., in finances, housing, social support and relationships, and daily routines) and decreases in distress among those reporting positive impacts. CONCLUSIONS We found strong evidence that mental distress increased among young people who were most negatively impacted by Covid-19 and by related social restrictions during the first lockdown in the United Kingdom.
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Affiliation(s)
- Gemma Knowles
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Charlotte Gayer‐Anderson
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Alice Turner
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Lynsey Dorn
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Joseph Lam
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Samantha Davis
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Rachel Blakey
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | - Katie Lowis
- ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
| | | | | | | | | | | | - Stephani L. Hatch
- ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK,Psychological MedicineInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - George Ploubidis
- Centre for Longitudinal StudiesUniversity College LondonLondonUK
| | | | - Seeromanie Harding
- Department of Nutritional SciencesSchool of Life Course SciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Craig Morgan
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,ESRC Centre for Society and Mental HealthKing’s College LondonLondonUK
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20
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Pavarini G, Reardon T, Hollowell A, Bennett V, Lawrance E, Pinfold V, Singh I. Online peer support training to promote adolescents' emotional support skills, mental health and agency during COVID-19: Randomised controlled trial and qualitative evaluation. Eur Child Adolesc Psychiatry 2022; 32:1119-1130. [PMID: 35174419 PMCID: PMC8853257 DOI: 10.1007/s00787-021-01933-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022]
Abstract
Adolescents often look to their peers for emotional support, so it is critical that they are prepared to take on a supportive role, especially during a health crisis. Using a randomised controlled trial (ISRCTN99248812, 28/05/2020), we tested the short-term efficacy of an online training programme to equip young people with skills to support to their peers' mental wellbeing during the COVID-19 pandemic. In June 2020, one-hundred UK adolescents (aged 16-18) recruited through social media were randomly allocated (1:1) to immediate 5-day peer support training or a wait-list, via an independently generated allocation sequence. Primary outcomes were indicators of ability to help others (motivation, perceived skills, frequency of help provided, compassion to others and connectedness to peers). Secondary outcomes included emotional symptoms, mental wellbeing, and indicators of agency (civic engagement and self-efficacy). We also collected qualitative reports of participants' experience. Assessments were completed at baseline and 1 week post randomisation (primary endpoint), and up to 4 weeks post randomisation (training group only). The training increased support-giving skills, frequency of providing support, compassion and peer connectedness (medium-large-effect sizes), but not motivation to provide support, 1 week post randomisation, compared to controls. Gains in the training group were maintained 4 weeks post randomisation. Training also improved adolescents' mental health and agency, and qualitative reports revealed further positive outcomes including increased self-care and empowerment. Leveraging digital platforms that are familiar to young people, peer support training has the potential to enable adolescents to support their own and their peers' mental wellbeing during a health crisis.
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Affiliation(s)
- Gabriela Pavarini
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
| | - Tessa Reardon
- Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Vanessa Bennett
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Emma Lawrance
- Imperial College London and Mental Health Innovations, London, UK
| | | | | | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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21
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Vera San Juan N, Oram S, Pinfold V, Temple R, Foye U, Simpson A, Johnson S, Hardt S, Abdinasir K, Edbrooke-Childs J. Priorities for Future Research About Screen Use and Adolescent Mental Health: A Participatory Prioritization Study. Front Psychiatry 2022; 13:697346. [PMID: 35599756 PMCID: PMC9120839 DOI: 10.3389/fpsyt.2022.697346] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This study aimed to identify research priorities for future research on screen use and adolescent mental health, from the perspectives of young people, parents/carers, and teachers. METHODS The study design was informed by the James Lind Alliance Priority Setting Partnership approach. A three-stage consensus-based process of consultation to identify research priorities using qualitative and quantitative methods. Research was guided by a steering group comprising researchers, third sector partners, clinicians, parents/carers and young people. A Young People's Advisory Group contributed at each stage. RESULTS Initial steps generated 26 research questions of importance to children and young people; these were ranked by 357 participants (229 children and young people and 128 adults). Consensus was reached for the prioritization of four topics for future research: (i) the impact of exposure to adult content on young people's mental health and relationships; (ii) the relationship between screen use and the well-being of young people from vulnerable groups; (iii) the impact of screen use on brain development; and (iv) the relationship between screen use and sleep.Additionally, young participants prioritized questions about online bullying, advertisements targeting young people, and the relationship between social media and specific mental health conditions. Research topics of interest arising specifically during the pandemic included the effects on adolescent mental health of exposure to constant news updates and online racial bias, and how young people take part in activism online. CONCLUSION These findings will enable researchers and funders to conduct research that is needs-oriented and relevant to the target audience.
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Affiliation(s)
- Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, London, United Kingdom
| | - Sian Oram
- Health Service and Population Research Department, King's College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, London, United Kingdom
| | | | | | - Una Foye
- Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Alan Simpson
- Health Service and Population Research Department, King's College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, London, United Kingdom.,Division of Psychiatry, University College London, London, United Kingdom
| | - Selina Hardt
- Health Service and Population Research Department, King's College London, London, United Kingdom
| | | | - Julian Edbrooke-Childs
- NIHR Mental Health Policy Research Unit, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
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22
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Blakey R, Morgan C, Gayer-Anderson C, Davis S, Beards S, Harding S, Pinfold V, Bhui K, Knowles G, Viding E. Correction to: Prevalence of conduct problems and social risk factors in ethnically diverse inner-city schools. BMC Public Health 2021; 21:2184. [PMID: 34844598 PMCID: PMC8628402 DOI: 10.1186/s12889-021-12258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Rachel Blakey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Charlotte Gayer-Anderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sam Davis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Stephanie Beards
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Seeromanie Harding
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, Stand, WC2R 2LS, UK
| | - Vanessa Pinfold
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London, Blakey et al. BMC Public Health (2021) 21:849 Page 12 of 13 Queen Mary University of London, Charterhouse Square Campus, Old Anatomy Building, London, EC1M 6BQ, UK
| | - Gemma Knowles
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Essi Viding
- Developmental Risk and Resilience Unit, University College London, 26 Bedford Way, London, WC1H 0AP, UK
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23
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Bond J, Robotham D, Kenny A, Pinfold V, Kabir T, Andleeb H, Larkin M, Martin JL, Brown S, Bergin AD, Petit A, Rosebrock L, Lambe S, Freeman D, Waite F. Automated Virtual Reality Cognitive Therapy for People With Psychosis: Protocol for a Qualitative Investigation Using Peer Research Methods. JMIR Res Protoc 2021; 10:e31742. [PMID: 34694236 PMCID: PMC8576557 DOI: 10.2196/31742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/02/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Many people with psychosis experience difficulties in everyday social situations. Anxiety can make life challenging, leading to withdrawal. Cognitive therapy, using active in vivo learning, enables people to overcome fears. These treatments are not readily available to people with psychosis. Automated virtual reality (VR) therapy is a potential route to increase accessibility. The gameChange automated VR cognitive therapy is designed to help people overcome anxious avoidance and build confidence in everyday social situations. A virtual coach guides the person through the treatment. Understanding user experience is key to facilitating future implementation. Peer research methods, in which people with lived experience of the issues being studied are involved in collecting and analyzing data, may be useful in developing this understanding. This encourages researchers to draw on their lived experience to explore participant perspectives and co-create knowledge. Objective The primary objective is to use a peer research approach to explore the participant experience of a novel automated VR therapy for anxious social avoidance. This includes understanding (1) the experience of anxious social avoidance in people with psychosis, (2) the experience of the gameChange automated VR cognitive therapy, and (3) any potential impact of the therapy in people’s lives. This will inform future implementation strategies. The secondary objective is to explore how peer research can be used to co-create knowledge. Methods Semistructured interviews will be conducted with approximately 25 people with psychosis participating in the gameChange trial (ISRCTN17308399). Participants will be recruited from the five trial centers based in National Health Service mental health trusts across England. Interviews will be conducted by two researchers. One is a peer researcher with similar lived experience to the trial participants. The other has lived experiences of mental health issues that do not directly overlap with those of the trial participants. Interview questions will focus on an individual’s experience of anxious social avoidance, experiences of participating in the gameChange VR therapy, and any changes or impact following therapy. The interview schedule was developed in collaboration with the gameChange Lived Experience Advisory Panel (LEAP), comprising 10 project advisors with lived experience of psychosis. Interpretative phenomenological analysis and template analysis will be used to explore individual accounts. The LEAP will contribute to the analysis. Results Data collection will be conducted from April to September 2021, and analysis will be conducted from June to October 2021. As of September 28, 2021, 20 participants had been interviewed, and coding is underway. Conclusions The study, employing a peer research approach, may provide a unique insight into the experiences of anxious social avoidance in people with psychosis and its treatment using automated VR therapy. This will inform potential future implementation of VR automated therapies in mental health services. International Registered Report Identifier (IRRID) DERR1-10.2196/31742
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Affiliation(s)
| | | | | | | | | | - Humma Andleeb
- Research Department of Clinical, Educational and Health Psychology, Psychology and Language Sciences, Faculty of Brain Sciences, UCL, London, United Kingdom
| | - Michael Larkin
- School of Psychology, Aston University, Birmingham, United Kingdom
| | - Jennifer L Martin
- School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,National Institute for Health Research Mindtech Co-operative, Nottingham, United Kingdom
| | - Susan Brown
- School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,National Institute for Health Research Mindtech Co-operative, Nottingham, United Kingdom
| | - Aislinn D Bergin
- School of Medicine, University of Nottingham, Nottingham, United Kingdom.,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, United Kingdom.,National Institute for Health Research Mindtech Co-operative, Nottingham, United Kingdom
| | - Ariane Petit
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Laina Rosebrock
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Sinéad Lambe
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Oxford Health National Health Service Foundation Trust, Oxford, United Kingdom.,National Institute for Health Research Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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24
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Osborn D, Lamb D, Canaway A, Davidson M, Favarato G, Pinfold V, Harper T, Johnson S, Khan H, Kirkbride J, Lloyd-Evans B, Madan J, Mann F, Marston L, McKay A, Morant N, Smith D, Steare T, Wackett J, Weich S. Acute day units in non-residential settings for people in mental health crisis: the AD-CARE mixed-methods study. Health Serv Deliv Res 2021. [DOI: 10.3310/hsdr09180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
For people in mental health crisis, acute day units provide daily structured sessions and peer support in non-residential settings as an alternative to crisis resolution teams.
Objectives
To investigate the provision, effectiveness, intervention acceptability and re-admission rates of acute day units.
Design
Work package 1 – mapping and national questionnaire survey of acute day units. Work package 2.1 – cohort study comparing outcomes during a 6-month period between acute day unit and crisis resolution team participants. Work package 2.2 – qualitative interviews with staff and service users of acute day units. Work package 3 – a cohort study within the Mental Health Minimum Data Set exploring re-admissions to acute care over 6 months. A patient and public involvement group supported the study throughout.
Setting and participants
Work package 1 – all non-residential acute day units (NHS and voluntary sector) in England. Work packages 2.1 and 2.2 – four NHS trusts with staff, service users and carers in acute day units and crisis resolution teams. Work package 3 – all individuals using mental health NHS trusts in England.
Results
Work package 1 – we identified 27 acute day units in 17 out of 58 trusts. Acute day units are typically available on weekdays from 10 a.m. to 4 p.m., providing a wide range of interventions and a multidisciplinary team, including clinicians, and having an average attendance of 5 weeks. Work package 2.1 – we recruited 744 participants (acute day units, n = 431; crisis resolution teams, n = 312). In the primary analysis, 21% of acute day unit participants (vs. 23% of crisis resolution team participants) were re-admitted to acute mental health services over 6 months. There was no statistically significant difference in the fully adjusted model (acute day unit hazard ratio 0.78, 95% confidence interval 0.54 to 1.14; p = 0.20), with highly heterogeneous results between trusts. Acute day unit participants had higher satisfaction and well-being scores and lower depression scores than crisis resolution team participants. The health economics analysis found no difference in resource use or cost between the acute day unit and crisis resolution team groups in the fully adjusted analysis. Work package 2.2 – 36 people were interviewed (acute day unit staff, n = 12; service users, n = 21; carers, n = 3). There was an overwhelming consensus that acute day units are highly valued. Service users found the high amount of contact time and staff continuity, peer support and structure provided by acute day units particularly beneficial. Staff also valued providing continuity, building strong therapeutic relationships and providing a variety of flexible, personalised support. Work package 3 – of 231,998 individuals discharged from acute care (crisis resolution team, acute day unit or inpatient ward), 21.4% were re-admitted for acute treatment within 6 months, with women, single people, people of mixed or black ethnicity, those living in more deprived areas and those in the severe psychosis care cluster being more likely to be re-admitted. Little variation in re-admissions was explained at the trust level, or between trusts with and trusts without acute day units (adjusted odds ratio 0.96, 95% confidence interval 0.80 to 1.15).
Limitations
In work package 1, some of the information is likely to be incomplete as a result of trusts’ self-reporting. There may have been recruitment bias in work packages 2.1 and 2.2. Part of the health economics analysis relied on clinical Health of the Nations Outcome Scale ratings. The Mental Health Minimum Data Set did not contain a variable identifying acute day units, and some covariates had a considerable number of missing data.
Conclusions
Acute day units are not provided routinely in the NHS but are highly valued by staff and service users, giving better outcomes in terms of satisfaction, well-being and depression than, and no significant differences in risk of re-admission or increased costs from, crisis resolution teams. Future work should investigate wider health and care system structures and the place of acute day units within them; the development of a model of best practice for acute day units; and staff turnover and well-being (including the impacts of these on care).
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 18. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, University College London, London, UK
| | - Danielle Lamb
- Division of Psychiatry, University College London, London, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | | | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - James Kirkbride
- Division of Psychiatry, University College London, London, UK
| | | | - Jason Madan
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Farhana Mann
- Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Division of Psychiatry, University College London, London, UK
| | - Adele McKay
- Camden and Islington NHS Foundation Trust, London, UK
| | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Thomas Steare
- Division of Psychiatry, University College London, London, UK
| | | | - Scott Weich
- Mental Health Research Unit, University of Sheffield, Sheffield, UK
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25
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Osborn DPJ, Favarato G, Lamb D, Harper T, Johnson S, Lloyd-Evans B, Marston L, Pinfold V, Smith D, Kirkbride JB, Weich S. Readmission after discharge from acute mental healthcare among 231 988 people in England: cohort study exploring predictors of readmission including availability of acute day units in local areas. BJPsych Open 2021; 7:e136. [PMID: 34275509 PMCID: PMC8329766 DOI: 10.1192/bjo.2021.961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the UK, acute mental healthcare is provided by in-patient wards and crisis resolution teams. Readmission to acute care following discharge is common. Acute day units (ADUs) are also provided in some areas. AIMS To assess predictors of readmission to acute mental healthcare following discharge in England, including availability of ADUs. METHOD We enrolled a national cohort of adults discharged from acute mental healthcare in the English National Health Service (NHS) between 2013 and 2015, determined the risk of readmission to either in-patient or crisis teams, and used multivariable, multilevel logistic models to evaluate predictors of readmission. RESULTS Of a total of 231 998 eligible individuals discharged from acute mental healthcare, 49 547 (21.4%) were readmitted within 6 months, with a median time to readmission of 34 days (interquartile range 10-88 days). Most variation in readmission (98%) was attributable to individual patient-level rather than provider (trust)-level effects (2.0%). Risk of readmission was not associated with local availability of ADUs (adjusted odds ratio 0.96, 95% CI 0.80-1.15). Statistically significant elevated risks were identified for participants who were female, older, single, from Black or mixed ethnic groups, or from more deprived areas. Clinical predictors included shorter index admission, psychosis and being an in-patient at baseline. CONCLUSIONS Relapse and readmission to acute mental healthcare are common following discharge and occur early. Readmission was not influenced significantly by trust-level variables including availability of ADUs. More support for relapse prevention and symptom management may be required following discharge from acute mental healthcare.
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Affiliation(s)
- David P J Osborn
- Division of Psychiatry, University College London, and Camden and Islington NHS Foundation Trust, UK
| | | | - Danielle Lamb
- Division of Psychiatry, University College London, UK
| | - Terri Harper
- Department of Primary Care and Population Health, University College London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, and Camden and Islington NHS Foundation Trust, UK
| | | | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | | | | | | | - Scott Weich
- Mental Health Research Unit, Sheffield University, UK
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Liberati E, Richards N, Willars J, Scott D, Boydell N, Parker J, Pinfold V, Martin G, Dixon-Woods M, Jones PB. A qualitative study of experiences of NHS mental healthcare workers during the Covid-19 pandemic. BMC Psychiatry 2021; 21:250. [PMID: 33980215 PMCID: PMC8113793 DOI: 10.1186/s12888-021-03261-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. METHODS The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. RESULTS Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be "non-essential", deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants' working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. CONCLUSIONS Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.
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Affiliation(s)
- Elisa Liberati
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Natalie Richards
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Scott
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Nicola Boydell
- Centre for Biomedicine Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | - Graham Martin
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- Department of Public Health and Primary Care, THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, Cambridgeshire & Peterborough NHS Foundation Trust, University of Cambridge, Cambridge, CB2 0SZ, UK.
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Blakey R, Morgan C, Gayer-Anderson C, Davis S, Beards S, Harding S, Pinfold V, Bhui K, Knowles G, Viding E. Prevalence of conduct problems and social risk factors in ethnically diverse inner-city schools. BMC Public Health 2021; 21:849. [PMID: 33941137 PMCID: PMC8091508 DOI: 10.1186/s12889-021-10834-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/29/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background In the UK, around 5% of 11–16-year olds experience conduct problems of clinical importance. However, there are limited data on prevalence of conduct problems by ethnic group, and how putative social risk factors may explain any variations in prevalence. This study has two main aims: (1) to estimate the prevalence and nature of conduct problems overall, and by ethnic group and gender, among adolescents in diverse inner-city London schools; (2) to assess the extent to which putative risk factors - racial discrimination, socioeconomic status, parental control, and troublesome friends - explain any observed differences in prevalence of conduct problems between ethnic groups. Methods This study uses baseline data from REACH, an accelerated cohort study of adolescent mental health in inner-city London. Self-report questionnaire data were collected on conduct problems and a range of distinct putative social risk factors (including racial discrimination, free school meals, troublesome friends, and parental care and control). A total of 4353 pupils, 51% girls, aged 11–14 participated. We estimated prevalence of conduct problems and used multilevel logistic regression to examine differences by ethnicity and gender and associations with putative risk factors. Results Prevalence of conduct problems in inner-city schools was around three times higher than reported in national studies (i.e., 16% [95%CI: 15·2–17·5] vs. 5% [95%CI 4·6–5·9]). Compared with overall prevalence, conduct problems were lower among Indian/Pakistani/Bangladeshi (RR: 0.53 [95% CI:0.31–0.87]) and white British (RR: 0.65 [0.51–0.82]) groups, and higher among black Caribbean (RR: 1.39 [95%CI:1.19–1.62]) and mixed white and black (RR: 1.29 [95% CI: 1.02–1.60]) groups. Risk of conduct problems was higher among those who were exposed to racial discrimination compared with those who were not (RR: 1.95 [95% CI: 1.59–2.31]). Conclusions Conduct problems are markedly more common in inner-city schools, and variations in the prevalence of conduct problems are, to some extent, rooted in modifiable social contexts and experiences, such as experiences of racial discrimination. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10834-5.
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Affiliation(s)
- Rachel Blakey
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Craig Morgan
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
| | - Charlotte Gayer-Anderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Sam Davis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Stephanie Beards
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Seeromanie Harding
- Department of Nutritional Sciences, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, Stand, WC2R 2LS, UK
| | - Vanessa Pinfold
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London, Queen Mary University of London, Charterhouse Square Campus, Old Anatomy Building, London, EC1M 6BQ, UK
| | - Gemma Knowles
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,ESRC Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
| | - Essi Viding
- Developmental Risk and Resilience Unit, University College London, 26 Bedford Way, London, WC1H 0AP, UK
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Liberati E, Richards N, Parker J, Willars J, Scott D, Boydell N, Pinfold V, Martin G, Dixon-Woods M, Jones P. Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic. BMJ Open 2021; 11:e049210. [PMID: 33888531 PMCID: PMC8068948 DOI: 10.1136/bmjopen-2021-049210] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/16/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic. DESIGN Qualitative interview study, codesigned with mental health service users and carers. METHODS We conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method. SETTING National Health Service (NHS) secondary mental health services in England between June and August 2020. PARTICIPANTS Of 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic. RESULTS Experiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic 'safe space' challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost. CONCLUSIONS Though remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.
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Affiliation(s)
- Elisa Liberati
- Department of Public Health and Primary Care, University of Cambridge, THIS Institute, Cambridge, UK
| | - Natalie Richards
- Department of Public Health and Primary Care, University of Cambridge, THIS Institute, Cambridge, UK
| | | | - Janet Willars
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - David Scott
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Nicola Boydell
- Centre for Biomedicine Self and Society, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Graham Martin
- Department of Public Health and Primary Care, University of Cambridge, THIS Institute, Cambridge, UK
| | - Mary Dixon-Woods
- Department of Public Health and Primary Care, University of Cambridge, THIS Institute, Cambridge, UK
| | - Peter Jones
- Department of Psychiatry, Cambridge University, Cambridge, UK
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29
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Lamb D, Steare T, Marston L, Canaway A, Johnson S, Kirkbride JB, Lloyd-Evans B, Morant N, Pinfold V, Smith D, Weich S, Osborn DP. A comparison of clinical outcomes, service satisfaction and well-being in people using acute day units and crisis resolution teams: cohort study in England. BJPsych Open 2021; 7:e68. [PMID: 33736743 PMCID: PMC8058818 DOI: 10.1192/bjo.2021.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For people in mental health crisis, acute day units (ADUs) provide daily structured sessions and peer support in non-residential settings, often as an addition or alternative to crisis resolution teams (CRTs). There is little recent evidence about outcomes for those using ADUs, particularly compared with those receiving CRT care alone. AIMS We aimed to investigate readmission rates, satisfaction and well-being outcomes for people using ADUs and CRTs. METHOD We conducted a cohort study comparing readmission to acute mental healthcare during a 6-month period for ADU and CRT participants. Secondary outcomes included satisfaction (Client Satisfaction Questionnaire), well-being (Short Warwick-Edinburgh Mental Well-being Scale) and depression (Center for Epidemiologic Studies Depression Scale). RESULTS We recruited 744 participants (ADU: n = 431, 58%; CRT: n = 312, 42%) across four National Health Service trusts/health regions. There was no statistically significant overall difference in readmissions: 21% of ADU participants and 23% of CRT participants were readmitted over 6 months (adjusted hazard ratio 0.78, 95% CI 0.54-1.14). However, readmission results varied substantially by setting. At follow-up, ADU participants had significantly higher Client Satisfaction Questionnaire scores (2.5, 95% CI 1.4-3.5, P < 0.001) and well-being scores (1.3, 95% CI 0.4-2.1, P = 0.004), and lower depression scores (-1.7, 95% CI -2.7 to -0.8, P < 0.001), than CRT participants. CONCLUSIONS Patients who accessed ADUs demonstrated better outcomes for satisfaction, well-being and depression, and no significant differences in risk of readmission, compared with those who only used CRTs. Given the positive outcomes for patients, and the fact that ADUs are inconsistently provided in the National Health Service, their value and place in the acute care pathway needs further consideration and research.
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Affiliation(s)
- Danielle Lamb
- NIHR ARC North Thames, Department of Applied Health Research, University College London, UK
| | - Thomas Steare
- Division of Psychiatry, University College London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, UK
| | | | - Sonia Johnson
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
| | | | | | - Nicola Morant
- Division of Psychiatry, University College London, UK
| | | | | | - Scott Weich
- School of Health and Related Research, University of Sheffield, UK
| | - David P Osborn
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, UK
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30
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Morant N, Davidson M, Wackett J, Lamb D, Pinfold V, Smith D, Johnson S, Lloyd-Evans B, Osborn DPJ. Acute day units for mental health crises: a qualitative study of service user and staff views and experiences. BMC Psychiatry 2021; 21:146. [PMID: 33691668 PMCID: PMC7944597 DOI: 10.1186/s12888-021-03140-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs. METHODS We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project. RESULTS Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems. CONCLUSIONS Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.
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Affiliation(s)
- Nicola Morant
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Michael Davidson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Wackett
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Danielle Lamb
- Department of Applied Health Research, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | | | - Deb Smith
- McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Sonia Johnson
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - David P J Osborn
- Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Reilly S, McCabe C, Marchevsky N, Green M, Davies L, Ives N, Plappert H, Allard J, Rawcliffe T, Gibson J, Clark M, Pinfold V, Gask L, Huxley P, Byng R, Birchwood M. Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme. BJPsych Open 2021; 7:e53. [PMID: 33583478 PMCID: PMC8058911 DOI: 10.1192/bjo.2021.10] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. AIMS This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. METHOD We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012-2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. RESULTS The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14-68) and 24% were from primary care (median, 10; IQR, 5-20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. CONCLUSIONS The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.
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Affiliation(s)
- Siobhan Reilly
- Division of Health Research, Lancaster University, UK; and Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, UK
| | | | | | - Maria Green
- Division of Health Research, Lancaster University, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Birmingham University, UK
| | - Humera Plappert
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Jon Allard
- Cornwall Partnership NHS Foundation Trust, UK; and Community and Primary Care Research Group, Faculty of Medicine, University of Plymouth, UK
| | - Tim Rawcliffe
- Division of Health Research, Lancaster University, UK
| | - John Gibson
- Institute for Mental Health, School of Psychology, University of Birmingham, UK
| | - Michael Clark
- London School of Economics and Political Science, UK
| | | | - Linda Gask
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Peter Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, UK
| | - Richard Byng
- Community and Primary Care Research Group, Faculty of Medicine, University of Plymouth, UK
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Knowles G, Gayer-Anderson C, Beards S, Blakey R, Davis S, Lowis K, Stanyon D, Ofori A, Turner A, Working Group S, Pinfold V, Bakolis I, Reininghaus U, Harding S, Morgan C. Mental distress among young people in inner cities: the Resilience, Ethnicity and AdolesCent Mental Health (REACH) study. J Epidemiol Community Health 2021; 75:jech-2020-214315. [PMID: 33558428 PMCID: PMC8142438 DOI: 10.1136/jech-2020-214315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent estimates suggest around 14% of 11-16 years in England have a mental health problem. However, we know very little about the extent and nature of mental health problems among diverse groups in densely populated inner cities, where contexts and experiences may differ from the national average. AIMS To estimate the extent and nature of mental health problems in inner city London, overall and by social group, using data from our school-based accelerated cohort study of adolescent mental health, Resilience, Ethnicity and AdolesCent Mental Health. METHODS Self-report data on mental health (general mental health, depression, anxiety, self-harm) were analysed (n, 4353; 11-14 years, 85% minority ethnic groups). Mixed models were used to estimate weighted prevalences and adjusted risks of each type of problem, overall and by gender, cohort, ethnic group and free school meals (FSM) status. RESULTS The weighted prevalence of mental health problems was 18.6% (95% CI 16.4% to 20.8%). Each type of mental health problem was more common among girls compared with boys (adjusted risk ratios: mental health problems, 1.33, 95% CI 1.18 to 1.48; depression, 1.52, 1.30 to 1.73; anxiety, 2.09, 1.58 to 2.59, self-harm, 1.40, 1.06 to 1.75). Gender differences were more pronounced in older cohorts compared with the youngest. Mental health problems (1.28, 1.05 to 1.51) and self-harm (1.29, 1.02 to 1.56)-but not depression or anxiety-were more common among those receiving (vs not receiving) FSM. There were many similarities, with some variations, by ethnic group. CONCLUSIONS Adolescent mental health problems and self-harm are common in inner city London. Gender differences in mental health problems may emerge during early adolescence.
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Affiliation(s)
- Gemma Knowles
- Health Service and Population Research, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Charlotte Gayer-Anderson
- Health Service and Population Research, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Stephanie Beards
- Health Service and Population Research, King's College London, London, UK
- National Childrens Bureau, London, UK
| | - Rachel Blakey
- Health Service and Population Research, King's College London, London, UK
- Centre for Society and Mental Health, King's College London, London, UK
| | - Samantha Davis
- Health Service and Population Research, King's College London, London, UK
- Centre for Society and Mental Health, King's College London, London, UK
| | - Katie Lowis
- Centre for Society and Mental Health, King's College London, London, UK
| | - Daniel Stanyon
- Health Service and Population Research, King's College London, London, UK
| | - Aisha Ofori
- Health Service and Population Research, King's College London, London, UK
| | - Alice Turner
- Health Service and Population Research, King's College London, London, UK
| | | | | | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, London, UK
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Craig Morgan
- Health Service and Population Research, King's College London, London, UK
- Centre for Society and Mental Health, King's College London, London, UK
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Simblett SK, Wilson E, Morris D, Evans J, Odoi C, Mutepua M, Dawe-Lane E, Jilka S, Pinfold V, Wykes T. Keeping well in a COVID-19 crisis: a qualitative study formulating the perspectives of mental health service users and carers. J Ment Health 2021; 30:138-147. [PMID: 33502941 DOI: 10.1080/09638237.2021.1875424] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with existing mental health conditions may be particularly vulnerable to the psychological effect of the COVID-19 pandemic. But their positive and negative appraisals, and coping behaviour could prevent or ameliorate future problems. OBJECTIVE To explore the emotional experiences, thought processes and coping behaviours of people with existing mental health problems and carers living through the pandemic. METHODS UK participants who identified as a mental health service user (N18), a carer (N5) or both (N8) participated in 30-minute semi-structured remote interviews (31 March 2020 to 9 April 2020). The interviews investigated the effects of social distancing and self-isolation on mental health and the ways in which people were coping. Data were analysed using a framework analysis. Three service user researchers charted data into a framework matrix (consisting of three broad categories: "emotional responses", "thoughts" and "behaviours") and then used an inductive process to capture other contextual themes. RESULTS Common emotional responses were fear, sadness and anger but despite negative emotions and uncertainty appraisals, participants described efforts to cope and maintain their mental wellbeing. This emphasised an increased reliance on technology, which enabled social contact and occupational or leisure activities. Participants also spoke about the importance of continued and adapted mental health service provision, and the advantages and disadvantages associated with changes in their living environment, life schedule and social interactions. CONCLUSION This study builds on a growing number of qualitative accounts of how mental health service users and carers experienced and coped with extreme social distancing measures early in the COVID-19 pandemic. Rather than a state of helplessness this study contains a clear message of resourcefulness and resilience in the context of fear and uncertainty.
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Affiliation(s)
- Sara K Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Wilson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanne Evans
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clarissa Odoi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Magano Mutepua
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Erin Dawe-Lane
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sagar Jilka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Frerichs J, Billings J, Barber N, Chhapia A, Chipp B, Shah P, Shorten A, Stefanidou T, Johnson S, Evans BL, Pinfold V. Influences on participation in a programme addressing loneliness among people with depression and anxiety: findings from the Community Navigator Study. BMC Psychiatry 2020; 20:565. [PMID: 33243222 PMCID: PMC7689977 DOI: 10.1186/s12888-020-02961-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions. METHODS Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study's working group, which included experts by experience, clinicians and researchers. RESULTS The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant's relationship with the Community Navigator. CONCLUSIONS We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual's participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.
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Affiliation(s)
- Johanna Frerichs
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Jo Billings
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Nick Barber
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Anjie Chhapia
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Beverley Chipp
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Prisha Shah
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Anna Shorten
- grid.439468.4Complex Depression, Anxiety & Trauma Team, St Pancras Hospital, London, NW1 0PE UK
| | - Theodora Stefanidou
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Brynmor Lloyd Evans
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Vanessa Pinfold
- McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK.
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Retzer A, Sayers R, Pinfold V, Gibson J, Keeley T, Taylor G, Plappert H, Gibbons B, Huxley P, Mathers J, Birchwood M, Calvert M. Development of a core outcome set for use in community-based bipolar trials-A qualitative study and modified Delphi. PLoS One 2020; 15:e0240518. [PMID: 33112874 PMCID: PMC7592842 DOI: 10.1371/journal.pone.0240518] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/28/2020] [Indexed: 01/24/2023] Open
Abstract
Background A core outcome set (COS) is a standardised collection of outcomes to be collected and reported in all trials within a research area. A COS can reduce reporting bias and facilitate evidence synthesis. This is currently unavailable for use in community-based bipolar trials. This research aimed to develop such a COS, with input from a full range of stakeholders. Methods A co-production approach was used throughout. A longlist of outcomes was derived from focus groups with people with a bipolar diagnosis and carers, interviews with healthcare professionals and a rapid review of outcomes listed in bipolar trials on the Cochrane database. An expert panel with personal and/or professional experience of bipolar participated in a modified Delphi process and the COS was finalised at a consensus meeting. Results Fifty participants rated the importance of each outcome. Sixty-six outcomes were included in Round 1 of the questionnaire; 13 outcomes were added by Round 1 participants and were rated in Round 2. Seventy-six percent of participants (n = 38) returned to Round 2 and 60 outcomes, including 4 outcomes added by participants in Round 1, received a rating of 7–9 by >70% and 1–3 by <25% of the sample. Fourteen participants finalised a COS containing 11 outcomes at the consensus meeting: personal recovery; connectedness; clinical recovery of bipolar symptoms; mental health and wellbeing; physical health; self-monitoring and management; medication effects; quality of life; service outcomes; experience of care; and use of coercion. Conclusions This COS is recommended for use in community-based bipolar trials to ensure stakeholder-relevant outcomes, facilitate data synthesis, and transparent reporting. The COS includes guidance notes for each outcome to allow the identification of suitable measurement instruments. Further validation is recommended for use with a wide range of communities and to achieve standardised measurement.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
| | - Ruth Sayers
- The McPin Foundation, London, United Kingdom
| | | | - John Gibson
- The McPin Foundation, London, United Kingdom
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Thomas Keeley
- GlaxoSmithKline (formerly of CPROR, University of Birmingham), London, United Kingdom
| | - Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of Psychology, University of Bath, Bath, United Kingdom
| | - Humera Plappert
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Bliss Gibbons
- Coventry and Warwickshire Partnership NHS Trust and Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Peter Huxley
- Centre for Mental Health and Society, Bangor University, Bangor, United Kingdom
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Maximillian Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research (CPROR), Institute of Applied Health Research, and Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, United Kingdom
- NIHR Birmingham Biomedical Research Centre, NIHR Surgical Reconstruction and Microbiology Research Centre and NIHR Applied Research Collaboration West Midlands, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
- * E-mail:
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36
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Allen D, Cree L, Dawson P, El Naggar S, Gibbons B, Gibson J, Gill L, Gwernan-Jones R, Hobson-Merrett C, Jones B, Khan H, McCabe C, Mancini M, McLellan D, Nettle M, Pinfold V, Rawcliffe T, Sanders A, Sayers R, Smith D, Wright D. Exploring patient and public involvement (PPI) and co-production approaches in mental health research: learning from the PARTNERS2 research programme. Res Involv Engagem 2020; 6:56. [PMID: 32974052 PMCID: PMC7507647 DOI: 10.1186/s40900-020-00224-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/27/2020] [Indexed: 05/26/2023]
Abstract
BACKGROUND Patient and Public Involvement (PPI) in research is a growing field of work, incorporating experiential knowledge within research processes. Co-production is a more recent PPI approach that emphasises the importance of power-sharing to promote inclusive research practices, valuing and respecting knowledge from different sources, and relationship building. Applying co-production principles in research trials can be difficult, and there are few detailed worked examples or toolkits. This paper explores the successes and challenges encountered by one research team. METHODS Our paper is written by a team of 21 people working on PARTNERS2, led by a smaller co-ordinating group. Using a co-operative style inquiry, the authors have reflected on and written about their experiences; analysis of the resulting 15 accounts provided examples of how PPI and co-production were delivered in practice. RESULTS We reveal varied and complicated experiences as we developed our collaborative approach across the entire research programme. Four main themes emerge from reflective accounts which describe aspects of this process: (1) recognising the importance of 'emotional work'; (2) developing safe spaces to create and share knowledge; (3) some challenges of using our personal identities in research work; and (4) acknowledging power-sharing within the research hierarchy. We also found continual relationship building, how different forms of expertise were valued, and stigma were central to shaping what work was possible together. Other important practices were transparency, particularly over decision making, and clear communication. CONCLUSIONS Our work provides one example of the 'messy' nature of collaborative research in practice. The learning we surface was contextual, generated within a large-scale research programme, but applicable to other studies. We found for success there needs to be an acknowledgement of the importance of emotional work, creating safe spaces to co-produce, transparency in decision making and reflection on the difficulties of using personal identities in research work including for service user researchers. These elements are more important than existing guidelines suggest. Implementation of actions to support emotional work, will require changes within individual teams as well as institutions. Introducing reflective practice in teams may be helpful in identifying further improvements to inclusive research practice.
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Lobban F, Appelbe D, Appleton V, Aref-Adib G, Barraclough J, Billsborough J, Fisher NR, Foster S, Gill B, Glentworth D, Harrop C, Johnson S, Jones SH, Kovacs TZ, Lewis E, Mezes B, Morton C, Murray E, O’Hanlon P, Pinfold V, Rycroft-Malone J, Siddle R, Smith J, Sutton CJ, Viglienghi P, Walker A, Wintermeyer C. An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08370] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Digital health interventions have the potential to improve the delivery of psychoeducation to people with mental health problems and their relatives. Despite substantial investment in the development of digital health interventions, successful implementation into routine clinical practice is rare.
Objectives
Use the implementation of the Relatives’ Education And Coping Toolkit (REACT) for psychosis/bipolar disorder to identify critical factors affecting uptake and use, and develop an implementation plan to support the delivery of REACT.
Design
This was an implementation study using a mixed-methods, theory-driven, multiple case study approach. A study-specific implementation theory for REACT based on normalisation process theory was developed and tested, and iterations of an implementation plan to address the key factors affecting implementation were developed.
Setting
Early-intervention teams in six NHS mental health trusts in England (three in the north and three in the south).
Participants
In total, 281 staff accounts and 159 relatives’ accounts were created, 129 staff and 23 relatives took part in qualitative interviews about their experiences, and 132 relatives provided demographic data, 56 provided baseline data, 21 provided data at 12 weeks’ follow-up and 20 provided data at 24 weeks’ follow-up.
Interventions
REACT is an online supported self-management toolkit, offering 12 evidence-based psychoeducation modules and support via a forum, and a confidential direct messaging service for relatives of people with psychosis or bipolar disorder. The implementation intervention was developed with staff and iteratively adapted to address identified barriers. Adaptations included modifications to the toolkit and how it was delivered by teams.
Main outcome measures
The main outcome was factors affecting implementation of REACT, assessed primarily through in-depth interviews with staff and relatives. We also assessed quantitative measures of delivery (staff accounts and relatives’ invitations), use of REACT (relatives’ logins and time spent on the website) and the impact of REACT [relatives’ distress (General Health Questionnaire-28), and carer well-being and support (Carer Well-being and Support Scale questionnaire)].
Results
Staff and relatives were generally positive about the content of REACT, seeing it as a valuable resource that could help services improve support and meet clinical targets, but only within a comprehensive service that included face-to-face support, and with some additional content. Barriers to implementation included high staff caseloads and difficulties with prioritising supporting relatives; technical difficulties of using REACT; poor interoperability with trust information technology systems and care pathways; lack of access to mobile technology and information technology training; restricted forum populations leading to low levels of use; staff fears of managing risk, online trolling, or replacement by technology; and uncertainty around REACT’s long-term availability. There was no evidence that REACT would reduce staff time supporting relatives (which was already very low), and might increase it by facilitating communication. In all, 281 staff accounts were created, but only 57 staff sent relatives invitations. In total, 355 relatives’ invitations were sent to 310 unique relatives, leading to the creation of 159 relatives’ accounts. The mean number of logins for relatives was 3.78 (standard deviation 4.43), but with wide variation from 0 to 31 (median 2, interquartile range 1–8). The mean total time spent on the website was 40.6 minutes (standard deviation 54.54 minutes), with a range of 0–298 minutes (median 20.1 minutes, interquartile range 4.9–57.5 minutes). There was a pattern of declining mean scores for distress, social dysfunction, depression, anxiety and insomnia, and increases in relatives’ well-being and eHealth literacy, but no changes were statistically significant.
Conclusions
Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, with staff and service user input, as part of a long-term strategy to develop integrated technology-enabled services. Implementation strategies must instil a sense of ownership for staff and ensure that they have adequate training, risk protocols and resources to deliver the technology. Cost-effectiveness and impact on workload and inequalities in accessing health care need further testing, along with the generalisability of our findings to other digital health interventions.
Limitations
REACT was offered by the same team running the IMPlementation of A Relatives’ Toolkit (IMPART) study, and was perceived by staff and relatives as a time-limited research study rather than ongoing clinical service, which affected engagement. Access to observational data was limited.
Trial registration
Current Controlled Trials ISRCTN16267685.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Fiona Lobban
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Duncan Appelbe
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | | | | | | | | | - Naomi R Fisher
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Bethany Gill
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | | | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | - Steven H Jones
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Elizabeth Lewis
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Barbara Mezes
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Puffin O’Hanlon
- Division of Psychiatry, University College London, London, UK
| | | | | | | | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Chris J Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | | | - Andrew Walker
- Division of Health Research, Lancaster University, Lancaster, UK
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Duncan FH, McGrath M, Baskin C, Osborn D, Dykxhoorn J, Kaner EFS, Gnani S, LaFortune L, Lee C, Walters KR, Kirkbride J, Fischer L, Jones O, Pinfold V, Stansfield J, Oliver EJ. Delivery of community-centred public mental health interventions in diverse areas in England: a mapping study protocol. BMJ Open 2020; 10:e037631. [PMID: 32665349 PMCID: PMC7359052 DOI: 10.1136/bmjopen-2020-037631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Public mental health (PMH) is a global challenge and a UK priority area for action. However, to progress, practitioners require a stronger evidence base regarding the effectiveness of approaches, particularly regarding promotion and prevention through community-centred interventions. In addition, policy-makers need to understand what is being delivered, particularly in areas of high need, to identify promising practices or gaps in PMH provision. Finally, and importantly, the public need better information regarding what approaches and services are available to them. We report a protocol designed to (1) identify the types of community-centred interventions used in purposively selected diverse geographical areas of England to improve PMH outcomes and (2) describe the type, target population, content and outcome measures of each intervention. METHODS AND ANALYSIS Five local authority areas of England were selected based on either high social deprivation or differing ethnic population statistics and geographical locations. Community-centred interventions in each area will be identified through: (1) desk-based data capture from standardised searches of publicly-available information (eg, policy, strategy and intervention advertising), (2) established professional networks and service contacts, (3) chain-referral sampling of individuals involved in local mental health promotion and prevention and (4) peer researchers, who will use their personal experience and local knowledge to help identify potentially relevant organisations. Data on the key features of the interventions will be extracted from individuals either by structured interviews or by electronic questionnaires with information regarding the intervention(s) of which they have knowledge. Initial data analysis will involve tabulating descriptive information and grouping interventions according to intervention type, target population, risk/protective factor and intended primary outcome. A descriptive comparison will be made between selected geographical areas. ETHICS AND DISSEMINATION Ethical approval was obtained from Durham University's Department of Sport and Exercise Sciences Research Ethics Committee. We plan to disseminate our findings at relevant conferences, meetings and through peer-reviewed journals. We also plan to disseminate to the public and intervention providers through social media and/or newsletters.
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Affiliation(s)
- Fiona H Duncan
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Mike McGrath
- Division of Psychiatry, UCL, London, UK
- Department of Primary Care and Population Health, UCL, London, UK
| | - Cleo Baskin
- Department of Primary Care and Public Health, Imperial College, London, UK
| | | | - Jen Dykxhoorn
- Division of Psychiatry, UCL, London, UK
- Department of Primary Care and Population Health, UCL, London, UK
| | - Eileen F S Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Louise LaFortune
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Caroline Lee
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Kate R Walters
- Department of Primary Care and Population Health, UCL, London, UK
| | | | | | | | | | - Jude Stansfield
- Health Improvement Directorate, Public Health England, London, UK
| | - Emily J Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Hazell CM, Hayward M, Lobban F, Pandey A, Pinfold V, Smith HE, Jones CJ. Demographic predictors of wellbeing in Carers of people with psychosis: secondary analysis of trial data. BMC Psychiatry 2020; 20:269. [PMID: 32487127 PMCID: PMC7265638 DOI: 10.1186/s12888-020-02691-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 05/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Carers of people with psychosis are at a greater risk of physical and mental health problems compared to the general population. Yet, not all carers will experience a decline in health. This predicament has provided the rationale for research studies exploring what factors predict poor wellbeing in carers of people with psychosis. Our study builds on previous research by testing the predictive value of demographic variables on carer wellbeing within a single regression model. METHODS To achieve this aim, we conducted secondary analysis on two trial data sets that were merged and recoded for the purposes of this study. RESULTS Contrary to our hypotheses, only carer gender and age predicted carer wellbeing; with lower levels of carer wellbeing being associated with being female or younger (aged under 50). However, the final regression model explained only 11% of the total variance. CONCLUSIONS Suggestions for future research are discussed in light of the limitations inherent in secondary analysis studies. Further research is needed where sample sizes are sufficient to explore the interactive and additive impact of other predictor variables.
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Affiliation(s)
- Cassie M. Hazell
- grid.12896.340000 0000 9046 8598School of Social Sciences, University of Westminster, London, W1W 6UW UK ,grid.414601.60000 0000 8853 076XResearch and Development Department, Sussex Education Centre, Brighton and Sussex Medical School, Nevill Avenue, Hove, BN3 7HZ UK ,grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK
| | - Mark Hayward
- grid.12082.390000 0004 1936 7590University of Sussex, Brighton, UK ,grid.451317.50000 0004 0489 3918Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ UK
| | - Fiona Lobban
- grid.9835.70000 0000 8190 6402Health & Medicine, Lancaster University, Furness Building, Lancaster, LA1 4YX UK
| | - Aparajita Pandey
- grid.451317.50000 0004 0489 3918Research and Development Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ UK
| | - Vanessa Pinfold
- grid.490917.2The McPin Foundation, 32-36 Loman Street, London, SE1 0EH UK
| | - Helen E. Smith
- grid.414601.60000 0000 8853 076XResearch and Development Department, Sussex Education Centre, Brighton and Sussex Medical School, Nevill Avenue, Hove, BN3 7HZ UK ,grid.59025.3b0000 0001 2224 0361Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, 308232 Singapore
| | - Christina J. Jones
- grid.414601.60000 0000 8853 076XResearch and Development Department, Sussex Education Centre, Brighton and Sussex Medical School, Nevill Avenue, Hove, BN3 7HZ UK ,grid.5475.30000 0004 0407 4824School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
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Moncrieff J, Lewis G, Freemantle N, Johnson S, Barnes TRE, Morant N, Pinfold V, Hunter R, Kent LJ, Smith R, Darton K, Horne R, Crellin NE, Cooper RE, Marston L, Priebe S. Randomised controlled trial of gradual antipsychotic reduction and discontinuation in people with schizophrenia and related disorders: the RADAR trial (Research into Antipsychotic Discontinuation and Reduction). BMJ Open 2019; 9:e030912. [PMID: 31780589 PMCID: PMC6887002 DOI: 10.1136/bmjopen-2019-030912] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Antipsychotic medication is effective in reducing acute symptoms of psychosis, but it has a range of potentially serious and debilitating adverse effects and is often disliked by patients. It is therefore essential it is only used when benefits outweigh harms. Although multiple trials conducted with people with schizophrenia indicate an increased risk of relapse in the short-term following abrupt antipsychotic discontinuation, there is little evidence about the long-term outcome of a gradual process of reduction and discontinuation on social functioning, relapse and other outcomes. METHODS AND ANALYSIS This is a multicentre, randomised controlled trial involving people with schizophrenia and related disorders who have had more than one episode. Participants are randomised to have a clinically-supervised, gradual reduction of antipsychotic medication, leading to discontinuation when possible, or to continue with maintenance treatment. Blinded follow-up assessments are conducted at 6, 12 and 24 months and the primary outcome is social functioning, measured by the Social Functioning Scale at 24 months. A minimum of 134 evaluable participants provides 90% power to detect a five-point difference, and 206 to detect a four-point difference. Secondary outcomes include severe relapse (admission to hospital) and the study is also intended to detect a minimum 10% difference in severe relapse, which requires 402 participants, assuming a 15% loss to follow-up. Other secondary outcomes include all relapses, as identified by an independent and blinded endpoint committee, symptoms measured by the Positive and Negative Syndrome Scale, quality of life, adverse effects, self-rated recovery and neuropsychological measures. Enrolment started in 2016. The trial is scheduled to finish in June 2022. ETHICS AND DISSEMINATION Ethical approval was initially obtained on 27 October 2016 (UK Research Ethics Committee reference 16/LO/1507). Results will be published in peer-reviewed journals and disseminated to the public. TRIAL REGISTRATION NUMBER ISRCTN90298520. EudraCT: 2016-000709-36. Pre-results.
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Affiliation(s)
- Joanna Moncrieff
- Division of Psychiatry, University College London and North East London NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Nick Freemantle
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
| | | | - Nicola Morant
- Division of Psychiatry, University College London, London, UK
| | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | | | | | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | - Nadia E Crellin
- Division of Psychiatry, University College London, London, UK
| | - Ruth E Cooper
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | | | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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Lamb D, Davidson M, Lloyd-Evans B, Johnson S, Heinkel S, Steare T, Pinfold V, Weich S, Morant N, Kirkbride J, Marston L, Canaway A, Madan J, Osborn D. Adult mental health provision in England: a national survey of acute day units. BMC Health Serv Res 2019; 19:866. [PMID: 31752861 PMCID: PMC6868849 DOI: 10.1186/s12913-019-4687-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/06/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acute Day Units (ADUs) exist in some English NHS Trusts as an alternative to psychiatric inpatient admission. However, there is a lack of information about the number, configuration, and functioning of such units, and about the extent to which additional units might reduce admissions. This cross-sectional survey and cluster analysis of ADUs aimed to identify, categorise, and describe Acute Day Units (ADUs) in England. Methods English NHS Mental Health Trusts with ADUs were identified in a mapping exercise, and a questionnaire was distributed to ADU managers. Cluster analysis was used to identify distinct models of service, and descriptive statistics are given to summarise the results of the survey questions. Results Two types of service were identified by the cluster analysis: NHS (n = 27; and voluntary sector services (n = 18). Under a third of NHS Trusts have access to ADUs. NHS services typically have multi-disciplinary staff teams, operate during office hours, offer a range of interventions (medication, physical checks, psychological interventions, group sessions, peer support), and had a median treatment period of 30 days. Voluntary sector services had mostly non-clinically qualified staff, and typically offered supportive listening on a one-off, drop-in basis. Nearly all services aim to prevent or reduce inpatient admissions. Voluntary sector services had more involvement by service users and carers in management and running of the service than NHS services. Conclusions The majority of NHS Trusts do not provide ADUs, despite their potential to reduce inpatient admissions. Further research of ADUs is required to establish their effectiveness and acceptability to service users, carers, and staff.
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Rennick-Egglestone S, Morgan K, Llewellyn-Beardsley J, Ramsay A, McGranahan R, Gillard S, Hui A, Ng F, Schneider J, Booth S, Pinfold V, Davidson L, Franklin D, Bradstreet S, Arbour S, Slade M. Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis. Can J Psychiatry 2019; 64:669-679. [PMID: 31046432 PMCID: PMC6783672 DOI: 10.1177/0706743719846108] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health recovery narratives are often shared in peer support work and antistigma campaigns. Internet technology provides access to an almost unlimited number of narratives, and yet little is known about how they affect recipients. The aim of this study was to develop a conceptual framework characterizing the impact of recovery narratives on recipients. METHOD A systematic review of evidence about the impact of mental health recovery narratives was conducted. Searches used electronic databases (n = 9), reference tracking, hand-searching of selected journals (n = 2), grey literature searching, and expert consultation (n = 7). A conceptual framework was generated through a thematic analysis of included articles, augmented by consultation with a Lived Experience Advisory Panel. RESULTS In total, 8137 articles were screened. Five articles were included. Forms of impact were connectedness, understanding of recovery, reduction in stigma, validation of personal experience, affective responses, and behavioural responses. Impact was moderated by characteristics of the recipient, context, and narrative. Increases in eating disorder behaviours were identified as a harmful response specific to recipients with eating disorders. CONCLUSIONS Mental health recovery narratives can promote recovery. Recovery narratives might be useful for clients with limited access to peers and in online interventions targeted at reducing social isolation in rural or remote locations, but support is needed for the processing of the strong emotions that can arise. Caution is needed for use with specific clinical populations. Protocol registration: Prospero-CRD42018090923.
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Affiliation(s)
| | - Kate Morgan
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Joy Llewellyn-Beardsley
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Amy Ramsay
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rose McGranahan
- Unit of Social and Community Psychiatry, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Steve Gillard
- Population Health Research Institute, St. George's University of London, London, UK
| | - Ada Hui
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Ng
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Susie Booth
- NEON Lived Experience Advisory Panel, Nottingham, UK
| | | | - Larry Davidson
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | | | - Simon Bradstreet
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Simone Arbour
- Ontario Shores Centre for Mental Health Science, Ontario
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Collom JRD, Davidson J, Sweet D, Gillard S, Pinfold V, Henderson C. Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study. BMJ Open 2019; 9:e023768. [PMID: 31256018 PMCID: PMC6609054 DOI: 10.1136/bmjopen-2018-023768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs. METHODS AND ANALYSIS Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping. ETHICS AND DISSEMINATION This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences.
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Affiliation(s)
| | - Jonathan Davidson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Steve Gillard
- Division of Population Health Sciences and Education, St George's University of London, London, UK
| | | | - Claire Henderson
- King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Osborn D, Burton A, Walters K, Atkins L, Barnes T, Blackburn R, Craig T, Gilbert H, Gray B, Hardoon S, Heinkel S, Holt R, Hunter R, Johnston C, King M, Leibowitz J, Marston L, Michie S, Morris R, Morris S, Nazareth I, Omar R, Petersen I, Peveler R, Pinfold V, Stevenson F, Zomer E. Primary care management of cardiovascular risk for people with severe mental illnesses: the Primrose research programme including cluster RCT. Programme Grants Appl Res 2019. [DOI: 10.3310/pgfar07020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Effective interventions are needed to prevent cardiovascular disease (CVD) in people with severe mental illnesses (SMI) because their risk of CVD is higher than that of the general population.
Objectives
(1) Develop and validate risk models for predicting CVD events in people with SMI and evaluate their cost-effectiveness, (2) develop an intervention to reduce levels of cholesterol and CVD risk in SMI and (3) test the clinical effectiveness and cost-effectiveness of this new intervention in primary care.
Design
Mixed methods with patient and public involvement throughout. The mixed methods were (1) a prospective cohort and risk score validation study and cost-effectiveness modelling, (2) development work (focus groups, updated systematic review of interventions, primary care database studies investigating statin prescribing and effectiveness) and (3) cluster randomised controlled trial (RCT) assessing the clinical effectiveness and cost-effectiveness of a new practitioner-led intervention, and fidelity assessment of audio-recorded appointments.
Setting
General practices across England.
Participants
All studies included adults with SMI (schizophrenia, bipolar disorder or other non-organic psychosis). The RCT included adults with SMI and two or more CVD risk factors.
Interventions
The intervention consisted of 8–12 appointments with a practice nurse/health-care assistant over 6 months, involving collaborative behavioural approaches to CVD risk factors. The intervention was compared with routine practice with a general practitioner (GP).
Main outcome measures
The primary outcome for the risk score work was CVD events, in the cost-effectiveness modelling it was quality-adjusted life-years (QALYs) and in the RCT it was level of total cholesterol.
Data sources
Databases studies used The Health Improvement Network (THIN). Intervention development work included focus groups and systematic reviews. The RCT collected patient self-reported and routine NHS GP data. Intervention appointments were audio-recorded.
Results
Two CVD risk score models were developed and validated in 38,824 people with SMI in THIN: the Primrose lipid model requiring cholesterol levels, and the Primrose body mass index (BMI) model with no blood test. These models performed better than published Cox Framingham models. In health economic modelling, the Primrose BMI model was most cost-effective when used as an algorithm to drive statin prescriptions. Focus groups identified barriers to, and facilitators of, reducing CVD risk in SMI including patient engagement and motivation, staff confidence, involving supportive others, goal-setting and continuity of care. Findings were synthesised with evidence from updated systematic reviews to create the Primrose intervention and training programme. THIN cohort studies in 16,854 people with SMI demonstrated that statins effectively reduced levels of cholesterol, with similar effect sizes to those in general population studies over 12–24 months (mean decrease 1.2 mmol/l). Cluster RCT: 76 GP practices were randomised to the Primrose intervention (n = 38) or treatment as usual (TAU) (n = 38). The primary outcome (level of cholesterol) was analysed for 137 out of 155 participants in Primrose and 152 out of 172 in TAU. There was no difference in levels of cholesterol at 12 months [5.4 mmol/l Primrose vs. 5.5 mmol/l TAU; coefficient 0.03; 95% confidence interval (CI) –0.22 to 0.29], nor in secondary outcomes related to cardiometabolic parameters, well-being or medication adherence. Mean cholesterol levels decreased over 12 months in both arms (–0.22 mmol/l Primrose vs. –0.39 mmol/l TAU). There was a significant reduction in the cost of inpatient mental health attendances (–£799, 95% CI –£1480 to –£117) and total health-care costs (–£895, 95% CI –£1631 to –£160; p = 0.012) in the intervention group, but no significant difference in QALYs (–0.011, 95% CI –0.034 to 0.011). A total of 69% of patients attended two or more Primrose appointments. Audiotapes revealed moderate fidelity to intervention delivery (67.7%). Statin prescribing and adherence was rarely addressed.
Limitations
RCT participants and practices may not represent all UK practices. CVD care in the TAU arm may have been enhanced by trial procedures involving CVD risk screening and feedback.
Conclusions
SMI-specific CVD risk scores better predict new CVD if used to guide statin prescribing in SMI. Statins are effective in reducing levels of cholesterol in people with SMI in UK clinical practice. This primary care RCT evaluated an evidence-based practitioner-led intervention that was well attended by patients and intervention components were delivered. No superiority was shown for the new intervention over TAU for level of cholesterol, but cholesterol levels decreased over 12 months in both arms and the intervention showed fewer inpatient admissions. There was no difference in cholesterol levels between the intervention and TAU arms, which might reflect better than standard general practice care in TAU, heterogeneity in intervention delivery or suboptimal emphasis on statins.
Future work
The new risk score should be updated, deployed and tested in different settings and compared with the latest versions of CVD risk scores in different countries. Future research on CVD risk interventions should emphasise statin prescriptions more. The mechanism behind lower costs with the Primrose intervention needs exploring, including SMI-related training and offering frequent support to people with SMI in primary care.
Trial registration
Current Controlled Trials ISRCTN13762819.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 2. See the NIHR Journals Library website for further project information. Professor David Osborn is supported by the University College London Hospital NIHR Biomedical Research Centre and he was also in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Alexandra Burton
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lou Atkins
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Barnes
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Ruth Blackburn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Craig
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hazel Gilbert
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ben Gray
- The McPin Foundation, London, UK
| | - Sarah Hardoon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Samira Heinkel
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Johnston
- School of Health and Education, Faculty of Professional and Social Sciences, Middlesex University, London, UK
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Judy Leibowitz
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - Susan Michie
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Morris
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Morris
- Department of Allied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Robert Peveler
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ella Zomer
- Department of Primary Care and Population Health, University College London, London, UK
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Baker E, Gwernan-Jones R, Britten N, Cox M, McCabe C, Retzer A, Gill L, Plappert H, Reilly S, Pinfold V, Gask L, Byng R, Birchwood M. Refining a model of collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses in England: a qualitative formative evaluation. BMC Psychiatry 2019; 19:7. [PMID: 30616552 PMCID: PMC6323712 DOI: 10.1186/s12888-018-1997-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. Primary care practitioners may not be well equipped to meet their needs and there is often poor communication with secondary care. Collaborative care is a promising alternative model but has not been trialled specifically with this service user group in England. Collaborative care for other mental health conditions has not been widely implemented despite evidence of its effectiveness. We carried out a formative evaluation of the PARTNERS model of collaborative care, with the aim of establishing barriers and facilitators to delivery, identifying implementation support requirements and testing the initial programme theory. METHODS The PARTNERS intervention was delivered on a small scale in three sites. Qualitative data was collected from primary and secondary care practitioners, service users and family carers, using semi-structured interviews, session recordings and tape-assisted recall. Deductive and inductive thematic analysis was carried out; themes were compared to the programme theory and used to inform an implementation support strategy. RESULTS Key components of the intervention that were not consistently delivered as intended were: interaction with primary care teams, the use of coaching, and supervision. Barriers and facilitators identified were related to service commitment, care partner skills, supervisor understanding and service user motivation. An implementation support strategy was developed, with researcher facilitation of communication and supervision and additional training for practitioners. Some components of the intervention were not experienced as intended; this appeared to reflect difficulties with operationalising the intervention. Analysis of data relating to the intended outcomes of the intervention indicated that the mechanisms proposed in the programme theory had operated as expected. CONCLUSIONS Additional implementation support is likely to be required for the PARTNERS model to be delivered; the effectiveness of such support may be affected by practitioner and service user readiness to change. There is also a need to test the programme theory more fully. These issues will be addressed in the process evaluation of our full trial. TRIAL REGISTRATION ISRCTN95702682 , 26 October 2017.
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Affiliation(s)
- Elina Baker
- Institute of Health Research, University of Exeter Medical School, St Luke's Campus, Exeter, UK.
| | - Ruth Gwernan-Jones
- 0000 0004 1936 8024grid.8391.3Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Nicky Britten
- 0000 0004 1936 8024grid.8391.3Institute of Health Research, University of Exeter Medical School, St Luke’s Campus, Exeter, UK
| | - Maria Cox
- 0000 0000 8190 6402grid.9835.7Health Research, Lancaster University, Furness Building, Lancaster, UK
| | - Catherine McCabe
- 0000 0001 2219 0747grid.11201.33Community and Primary Care Research Group, University of Plymouth, Faculty of Medicine and Dentistry, Plymouth Science Park, Plymouth, UK
| | - Ameeta Retzer
- 0000 0004 1936 7486grid.6572.6Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Laura Gill
- 0000 0001 2219 0747grid.11201.33Community and Primary Care Research Group, University of Plymouth, Faculty of Medicine and Dentistry, Plymouth Science Park, Plymouth, UK
| | - Humera Plappert
- 0000 0004 1936 7486grid.6572.6Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Siobhan Reilly
- 0000 0000 8190 6402grid.9835.7Health Research, Lancaster University, Furness Building, Lancaster, UK
| | - Vanessa Pinfold
- grid.490917.2The McPin Foundation, 32-36 Loman Street, London, UK
| | - Linda Gask
- 0000000121662407grid.5379.8Centre for Primary Care research, University of Manchester, Oxford Road, Williamson Building, Manchester, UK
| | - Richard Byng
- 0000 0001 2219 0747grid.11201.33Community and Primary Care Research Group, University of Plymouth, Faculty of Medicine and Dentistry, Plymouth Science Park, Plymouth, UK
| | - Max Birchwood
- 0000 0000 8809 1613grid.7372.1Warwick Medical School, University of Warwick, Coventry, UK
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46
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Boyce N, Marsh J, Wayman C, Pinfold V, Kabir T. Service user reviewers: extending peer review in The Lancet Psychiatry. Lancet Psychiatry 2018; 5:780-781. [PMID: 30220515 DOI: 10.1016/s2215-0366(18)30353-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
| | - Joan Marsh
- The Lancet Psychiatry, London EC2Y 5AS, UK
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Sweet D, Byng R, Webber M, Enki DG, Porter I, Larsen J, Huxley P, Pinfold V. Personal well-being networks, social capital and severe mental illness: exploratory study. Br J Psychiatry 2018; 212:308-317. [PMID: 28982657 DOI: 10.1192/bjp.bp.117.203950] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Connectedness is a central dimension of personal recovery from severe mental illness (SMI). Research reports that people with SMI have lower social capital and poorer-quality social networks compared to the general population.AimsTo identify personal well-being network (PWN) types and explore additional insights from mapping connections to places and activities alongside social ties. METHOD We carried out 150 interviews with individuals with SMI and mapped social ties, places and activities and their impact on well-being. PWN types were developed using social network analysis and hierarchical k-means clustering of this data. RESULTS Three PWN types were identified: formal and sparse; family and stable; and diverse and active. Well-being and social capital varied within and among types. Place and activity data indicated important contextual differences within social connections that were not found by mapping social networks alone. CONCLUSIONS Place locations and meaningful activities are important aspects of people's social worlds. Mapped alongside social networks, PWNs have important implications for person-centred recovery approaches through providing a broader understanding of individual's lives and resources.Declaration of interestNone.
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Affiliation(s)
| | - Richard Byng
- Peninsula Schools of Medicine and Dentistry,Plymouth University,Plymouth
| | | | | | - Ian Porter
- Primary Care Research,Peninsula Schools of Medicine and Dentistry,Plymouth University,Plymouth
| | | | - Peter Huxley
- Centre for Mental Health and Society,School of Social Sciences,Bangor
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Haddad M, Pinfold V, Ford T, Walsh B, Tylee A. The effect of a training programme on school nurses' knowledge, attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial. Int J Nurs Stud 2018; 83:1-10. [PMID: 29684829 DOI: 10.1016/j.ijnurstu.2018.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 09/12/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mental health problems in children and young people are a vital public health issue. Only 25% of British school children with diagnosed mental health problems have specialist mental health services contact; front-line staff such as school nurses play a vital role in identifying and managing these problems, and accessing additional services for children, but there appears limited specific training and support for this aspect of their role. OBJECTIVES To evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources. Hypothesized outcomes were improvements in school nurses' knowledge, attitudes, and recognition skills for depression. DESIGN A cluster-randomised controlled trial. PARTICIPANTS AND SETTING 146 school nurses from 13 Primary Care Trusts (PCTs) in London were randomly allocated to receive the training programme. METHODS School nurses from 7 PCTs (n = 81) were randomly allocated to receive the training intervention and from 6 PCTs (n = 65) for waiting list control. Depression detection was measured by response to vignettes, attitudes measured with the Depression Attitude Questionnaire, and knowledge by the QUEST knowledge measure. These outcomes were measured at baseline and (following training) 3 months and nine months later, after which nurses in the control group received the training programme. RESULTS At 3 months, 115 nurses completed outcome measures. Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses' knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased. There was also a significant change in optimism about depression outcomes, but no change in tendency to defer depression management to specialists. At 9-month follow-up, improved specificity in depression identification and improved knowledge were maintained. CONCLUSIONS This school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.
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Affiliation(s)
- Mark Haddad
- School of Health Sciences, City University of London, London, UK.
| | | | | | - Brendan Walsh
- Economic and Social Research Institute, Dublin, Ireland.
| | - Andre Tylee
- Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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49
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Osborn D, Burton A, Hunter R, Marston L, Atkins L, Barnes T, Blackburn R, Craig T, Gilbert H, Heinkel S, Holt R, King M, Michie S, Morris R, Morris S, Nazareth I, Omar R, Petersen I, Peveler R, Pinfold V, Walters K. Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial. Lancet Psychiatry 2018; 5:145-154. [PMID: 29396118 DOI: 10.1016/s2215-0366(18)30007-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND People with severe mental illnesses, including psychosis, have an increased risk of cardiovascular disease. We aimed to evaluate the effects of a primary care intervention on decreasing total cholesterol concentrations and cardiovascular disease risk in people with severe mental illnesses. METHODS We did this cluster randomised trial in general practices across England, with general practices as the cluster unit. We randomly assigned general practices (1:1) with 40 or more patients with severe mental illnesses using a computer-generated random sequence with a block size of four. Researchers were masked to allocation, but patients and general practice staff were not. We included participants aged 30-75 years with severe mental illnesses (schizophrenia, bipolar disorder, or psychosis), who had raised cholesterol concentrations (5·0 mmol/L) or a total:HDL cholesterol ratio of 4·0 mmol/L or more and one or more modifiable cardiovascular disease risk factors. Eligible participants were recruited within each practice before randomisation. The Primrose intervention consisted of appointments (≤12) with a trained primary care professional involving manualised interventions for cardiovascular disease prevention (ie, adhering to statins, improving diet or physical activity levels, reducing alcohol, or quitting smoking). Treatment as usual involved feedback of screening results only. The primary outcome was total cholesterol at 12 months and the primary economic analysis outcome was health-care costs. We used intention-to-treat analysis. The trial is registered with Current Controlled Trials, number ISRCTN13762819. FINDINGS Between Dec 10, 2013, and Sept 30, 2015, we recruited general practices and between May 9, 2014, and Feb 10, 2016, we recruited participants and randomly assigned 76 general practices with 327 participants to the Primrose intervention (n=38 with 155 patients) or treatment as usual (n=38 with 172 patients). Total cholesterol concentration data were available at 12 months for 137 (88%) participants in the Primrose intervention group and 152 (88%) participants in the treatment-as-usual group. The mean total cholesterol concentration did not differ at 12 months between the two groups (5·4 mmol/L [SD 1·1] for Primrose vs 5·5 mmol/L [1·1] for treatment as usual; mean difference estimate 0·03, 95% CI -0·22 to 0·29; p=0·788). This result was unchanged by pre-agreed supportive analyses. Mean cholesterol decreased over 12 months (-0·22 mmol/L [1·1] for Primrose vs -0·36 mmol/L [1·1] for treatment as usual). Total health-care costs (£1286 [SE 178] in the Primrose intervention group vs £2182 [328] in the treatment-as-usual group; mean difference -£895, 95% CI -1631 to -160; p=0·012) and psychiatric inpatient costs (£157 [135] vs £956 [313]; -£799, -1480 to -117; p=0·018) were lower in the Primrose intervention group than the treatment-as-usual group. Six serious adverse events of hospital admission and one death occurred in the Primrose group (n=7) and 23, including three deaths, occurred in the treatment-as-usual group (n=18). INTERPRETATION Total cholesterol concentration at 12 months did not differ between the Primrose and treatment-as-usual groups, possibly because of the cluster design, good care in the treatment-as-usual group, short duration of the intervention, or suboptimal focus on statin prescribing. The association between the Primrose intervention and fewer psychiatric admissions, with potential cost-effectiveness, might be important. FUNDING National Institute of Health Research Programme Grants for Applied Research.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK.
| | - Alexandra Burton
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lou Atkins
- Centre for Behaviour Change, Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Barnes
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Ruth Blackburn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Craig
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Hazel Gilbert
- Department of Primary Care and Population Health, University College London, London, UK
| | - Samira Heinkel
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK
| | - Susan Michie
- Centre for Behaviour Change, Department of Clinical, Educational, and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK; Camden and Islington National Health Service Foundation Trust, St Pancras Hospital, London, UK
| | - Richard Morris
- Department of Allied Health Research, University College London, London, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Steve Morris
- Department of Allied Health Research, University College London, London, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Robert Peveler
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
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Franklin D, Pinfold V, Bindman J, Thornicroft G. Consultant psychiatrists' experiences of using supervised discharge Results of a national survey. Psychiatr bull 2018. [DOI: 10.1192/pb.24.11.412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodSupervised discharge orders (SDOs) enable a degree of compulsion to be exerted over patients in the community. We aimed to establish the level of, and reasons for, their use and consultants' perceptions of their effectiveness. All mental health provider NHS trusts in England were surveyed, and a random sample cohort of cases was identified. Community responsible medical officers (CRMOs) were surveyed using a semi-structured questionnaire.ResultsWe identified 596 cases subject to SDOs in 170 mental health provider trusts (100%) in England, involving 18% of consultant psychiatrists. Responses were obtained from the CRMOs of 185 patients (84%) from a sample of 221 cases. The SDO was described as helpful or very helpful in 77% of cases in which it had been in place for over 2 months. In 58% of cases the SDO was intended to improve medication compliance, and in 46% of these cases it was perceived to be effective in doing so.Clinical ImplicationsSDOs are not widely used in England. However, for those patients who are made subject to supervised discharge, the order appears to be effective and may improve medication compliance, despite the absence of the legal power to enforce treatment.
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