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Purpose: Engaging with heritage to support mental health and wellbeing has become a focus of research and policy, more recently moving towards social prescription of heritage interventions. While there are benefits to active participation, there are potential risks to those taking part and to the non-renewable historic remains and landscape that form the core of these projects. The purpose of the current research paper was to develop best practice guidelines for organisations offering heritage projects as interventions for people who live with mental health issues to protect both participants and heritage. Design/methodology/approach: There were two research phases; a Sandpit with World Café discussions to produce a set of research priorities, and a Delphi Consultation, using three questionnaires distributed over six months, to develop best practice guidelines. The panel in both phases comprised experts through lived experience, policy, practice and research. Findings: The Authentic and Meaningful Participation in Heritage or Related Activities (AMPHORA) guidelines cover three stages: project development, project delivery and project follow-up, with a set of action points for each stage. Of particular importance was authentic participation and expertise to ensure appropriate management of heritage/ historic environment assets and support for participants. Social implications: The AMPHORA guidelines can assist all organisations in the delivery of safe projects that support the mental health of those involved, as well as enhancing and protecting the historic environment. Originality/value: To the best of the authors' knowledge, these are the first research-led guidelines that help heritage organisations support those living with mental health issues. [ABSTRACT FROM AUTHOR]

Purpose: This service evaluation aims to understand the experiences of service users (SUs) who accessed an early intervention in psychosis (EIP) service during the Coronavirus pandemic using qualitative and quantitative methodologies and compare these to a previous pre-pandemic study conducted within the same service (Watkins et al., 2018). Design/methodology/approach: This paper collated experiences of individuals accessing an EIP service to inform service development. Questionnaires and individual interviews were conducted to provide quantitative and qualitative data. Descriptive statistics and T-test confidence intervals were created from the results and compared to findings of Watkins et al. (2018). Interviews were transcribed verbatim and analysed using Braun and Clarke's (2006) thematic analysis. Findings: Data showed participants were largely satisfied with all areas of the service with "work or education", "living skills", and "addictions" scoring highest. Though participants reported no overall dissatisfaction, satisfaction levels dropped in "social activities" compared to the findings of Watkins et al. (2018), perhaps due to the national restrictions put in place to manage the spread of Coronavirus during this time. Interview analysis identified three themes of importance consistent with prior literature, highlighting the importance of relationships and validation during recovery. Research limitations/implications: This evaluation did not consider whether participants had accessed the service prior to the pandemic or only during, meaning that some participants could have a point of comparison with the service pre-pandemic, whereas others might not. Similarly, the participants were not the same as those of the Watkins et al.'s (2018) evaluation, meaning that direct comparisons of pre- and post-pandemic experiences were not possible. In addition, this evaluation collected data at only one time point early in the pandemic; therefore, it is unknown if client experiences of services differed as the pandemic and restrictions continued over time. Originality/value: The Covid-19 pandemic has been an unprecedented challenge for health services, and the effects of this are becoming widely reported. This evaluation of clinical services offers a valuable perspective of service user experience of receiving mental health services during a global health crisis further offering a comparison to pre-pandemic services and the experiences of those who used them. [ABSTRACT FROM AUTHOR]

Purpose: By older adulthood, the majority of individuals will have experienced at least one traumatic event. Trauma-informed care (TIC) is proposed to improve effectivity of health-care provision and to reduce likelihood of services causing retraumatisation. This study aims to assess the effectiveness of staff training in TIC in older adult services. Design/methodology/approach: TIC training was delivered across eight Older Adult Community Mental Health Teams in the same UK organisation. Questionnaires were administered before and after training: a psychometrically robust measure, the Attitudes Related to Trauma-Informed Care, was used to assess TIC-related attitudes, and a service-developed scale was used to measure changes in TIC competence. Data was analysed using linear mixed effects modelling (LMM). Qualitative data regarding the impact of training was gathered one month after training through a free-text questionnaire. Findings: There were 45 participants, all of whom were white British. LMM on pre- and post-data revealed that staff training significantly increased competencies across all measured TIC domains. Overall, staff attitudes were also significantly more trauma-informed after training. Qualitatively, staff identified time as the only additional resource required to deliver the skills and knowledge gained from training. Practical implications: Training was found to be effective in increasing TIC-related skills and attitudes. Organisations aiming to become trauma-informed should consider staff training as one aspect of a wider development plan. Originality/value: To the best of the authors' knowledge, this paper is the first to examine TIC training for staff working in Older Adults Mental Health Services. Recommendations for services aiming to develop a trauma-informed culture have been provided. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the roles of psychologists in seclusion in adult mental health services in Ireland, their perspectives on seclusion and its use in recovery-oriented practice and related professional practice issues. Design/methodology/approach: A qualitative hermeneutic phenomenological study was conducted from a social constructivist perspective. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis. Findings: Twenty-four themes were identified, which were clustered into four overarching themes. Participants viewed themselves and psychology in Ireland more broadly as peripheral to seclusion. They believed that seclusion possessed no inherent therapeutic value but viewed it as an uncomfortable and multi-faceted reality. Participants regarded seclusion and recovery as largely inconsistent and difficult to reconcile, and they perceived systemic factors, which had a pervasive negative impact on seclusion and recovery in practice. Practical implications: The findings highlight the perceived complexity of seclusion and its interface with recovery, and the need to conscientiously balance conflicting priorities that cannot be easily reconciled to ensure ethical practice. The findings suggest psychologists are well-suited to participate in local and national discussions on using seclusion in recovery-oriented practice. Originality/value: This study offers a unique insight into psychologists' perceptions of seclusion and considers the implications of these views. Participants' nuanced views suggest that psychologists can make valuable contributions to local and national discussions on these topics. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the use and content of written guidance produced by mental health services in England and Wales describing hospital leave for informally admitted patients. Design/methodology/approach: Guidance on leave was requested from National Health Service (NHS) mental health trusts in England and health boards in Wales (n = 61) using a Freedom of Information submission. Data were analysed using content analysis. Findings: In total, 32 organisations had a leave policy for informal patients. Policies varied considerably in content and quality. The content of policies was not supported by research evidence. Organisations appeared to have developed their policies by either adapting or copying the guidance on section 17 leave outlined in the Mental Health Act Codes of Practice for England and Wales (Department of Health, 2016; Welsh Government, 2016). Definitions of important terms, for example, leave and hospital premises, were either absent or poorly defined. Finally, some organisations appeared to be operating pseudo-legal coercive contracts to prevent informal patients from leaving hospital wards. Research limitations/implications: Research should be undertaken to explore the impact of local policies on the informal patient's right to life and liberty. Practical implications: All NHS organisations need to develop an evidence-based policy to facilitate the informal patient's right to take leave. A set of national standards that organisations are required to comply with would help to standardise the content of leave policies. Originality/value: To the best of the author's knowledge, this is the first study to examine the use and content of local policies describing how informal patients can take leave from hospital. [ABSTRACT FROM AUTHOR]

Purpose: Studies have shown positive housing retention and quality of life outcomes in moving on initiatives (MOIs). However, less is known about how movers' health service use changes post-move. This paper aims to explore physical and mental health service use over time for participants in New York City's MOI program. Design/methodology/approach: This paper uses data collected at baseline, 12-months post move and 24-months post move to explore patterns in mental and physical health service use and their association with mental and physical health status for participants (N = 41). Health status was measured with the Medical Outcomes Study Short Form Survey Instrument. Findings: Three mental health service use patterns emerged: service use at all time points, inconsistent service use across time points and no service use at any time point. Significant group differences in mental health were found at baseline and 12 months. Two physical health service use patterns emerged: service use at all three time points and inconsistent service use across time points. Significant group differences were found in mental health at 12 and 24 months. Originality/value: This study showed that physical and mental health service use varied slightly over time for participants, with the majority of service use being for outpatient/non-acute care. The findings also point to possible relationships between service use and mental health status. Positive and negative implications of these findings are framed within the broader context of PSH and MOI goals. [ABSTRACT FROM AUTHOR]

Purpose: Bipolar disorder is associated with poor mental and physical health outcomes, and therefore, it is crucial to research and develop effective interventions for this population (Grande et al., 2016). Unfortunately, research on the efficacy of current interventions shows only small improvements in symptoms and quality of life (Oud et al., 2016). Additionally, individuals with bipolar disorder face barriers to accessing care like social stigma, isolation and financial constraints (Blixen et al., 2016). This paper aims to introduce and examine the effectiveness of an accessible, peer-led group program, Mood Lifters (Votta and Deldin, 2022), in those who completed the program and also self-reported a diagnosis of bipolar disorder. Design/methodology/approach: Mood Lifters is a 15-week, peer-led group program that approaches mental wellness from a biopsychosocial framework using strategies from a variety of evidence-based treatment methods (e.g. cognitive-behavioral therapy, dialectical behavior therapy, interpersonal psychotherapy, etc.). Participants meet once a week for 1 hour to review various mental health topics, including behavioral changes and insight into mood patterns. Individuals who participated in nonacademic groups in a company setting and self-reported a bipolar diagnosis were surveyed at the beginning and end of their program to measure various aspects of psychological functioning. Findings: Results suggest that these individuals experienced significant improvements in depression, anxiety, social functioning and perceived stress, along with flourishing and positive and negative affect. Originality/value: These findings are promising, given that bipolar disorder is historically difficult to treat (Grande et al., 2016). Based on this preliminary evidence, the authors have developed a Mood Lifters program specifically for individuals with bipolar disorder and are launching a randomized control clinical trial. [ABSTRACT FROM AUTHOR]

Purpose: "Social recovery" is a long-cited aim within the UK early intervention in psychosis (EIP) services; however, there is a lack of evidence regarding existing social recovery provisions and how these can be improved. This paper aims to evaluate an existing social drop-in facility within an EIP team, ran within the Birmingham and Solihull Mental Health NHS Foundation Trust, and highlight the potential benefits of delivering such services for people diagnosed with first episode psychosis. Design/methodology/approach: Attendance and basic demographic statistics (age, gender and ethnicity of attendees) were collected over a period of 13 weeks. In addition, two semi-structured focus groups were conducted: one with EIP staff members (community psychiatric nurses and support workers) and the other with current service users, with both groups describing their satisfaction and experience of the drop-in facility and how it can be improved. Findings: Inductive thematic analysis was used to analyse data from both focus groups, with six overarching meta-themes being identified: reflection, environment, emotional experience, recovery, activities and interactions. Service users and staff reflected that the drop-in facility was an asset to the service, although work could be done to improve overall attendance. Originality/value: This paper explores how a social drop-in facility can provide a supportive, positive environment that aids recovery from psychosis for service users and improves working conditions for the EIP staff. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review the development of mental health service policy in Hong Kong. After the return of Hong Kong's sovereignty to China, mental health services in Hong Kong transformed from an institution-based care model supplemented by community care to a staging model covering primary prevention, early identification, treatment and integration. However, the staging model is subject to cultural barriers, including collectivist values and medical dominance. Therefore, the development of a community-based inclusive development model that follows a rights-based strategy and addresses the regression of the staging model (due to cultural barriers) should be considered. Design/methodology/approach: It is a comprehensive literature review which covered the journal articles, policy review papers and service reports. The foundation of this review was laid upon the development of traditional Chinese culture and values. As brought by the influence of the Western world, the mental health service policy was cling towards a medically oriented system. Following the worldwide change in the definition of disability, the ideology of the mental health service system has been developing into a community-based and person-centred model which emphasised on equal participation and human rights. This review serves to evaluate and discuss how a community-based inclusive development can be further developed in Hong Kong. Findings: A formal support system for providing personal assistance to people with mental health issues through supported decision-making and certified peer specialists forms the principal foundation of a community-based inclusive development model. A review and reconsideration of laws governing guardianship, compulsory treatment and detention should be conducted to enable the local implementation of supported decision-making. Originality/value: The paper addressed and integrated the theoretical, historical and practical issues in developing a community-based inclusive mental health service policy in Hong Kong. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe a novel community development and how the synergies arising from the interaction of diverse perspectives (including arts and health, person centredness, co-production and shared leadership) have led to a transformative initiative for individuals and a local community in the Republic of Ireland. Design/methodology/approach: This is a descriptive case study. It includes the personal narrative of an expert by experience who is one of the co-authors. Links to short digital films are also included along with references to internal evaluation documents and published literature. Reflections from the nurses who contributed to the initiative and a university academic are also incorporated. Findings: A space in the community built around the principles of relational practice has evolved into an alchemical space, enabling creativity, recovery and well-being. The benefits arising out of this network of social relationships have contributed to personal recovery, integration with the local community and generated social capital. This has enhanced mental health and well-being locally. Practical implications: Statutory Irish health policy is reflective of developments in health care internationally, with an emphasis on greater delivery of care in the community. This views citizens as active partners in the maintenance of their health and well-being. This case study illustrates how this has unfolded in practice in a rural mental health community context. Originality/value: This paper adds to the evidence base that demonstrates the potential benefits of participation in the arts to individual recovery journeys. In addition, it shows that when arts and health perspectives coalesce with the wider domain of relational practice, the synergies arising contribute positively to the health and well-being of local communities. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them. Design/methodology/approach: IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned. Findings: There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning. Practical implications: This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research. Originality/value: To the best of the authors' knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally. [ABSTRACT FROM AUTHOR]

Purpose: The rate of female committals to prison has grown rapidly in recent years. Women in prison are likely to have trauma histories and difficulties with their mental health. This paper aims to synthesise the findings of qualitative literature to gain a deeper understanding of the experiences of women in the context of prison-based mental health care. Design/methodology/approach: A systematic search of five academic databases, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, Psychological Information Database (PsycINFO), Excerpta Medica DataBASE (EMBASE) and Medline, was completed in December 2020. This study's search strategy identified 4,615 citations, and seven studies were included for review. Thomas and Harden's (2008) framework for thematic synthesis was used to analyse data. Quality appraisal was conducted using the Joanna Briggs Institute Checklist for Qualitative Research (Lockwood et al., 2015). Findings: Four analytic themes were identified that detail women's experiences of prison-based mental health care: the type of services accessed and challenges encountered; a reduction in capacity to self-manage mental well-being; the erosion of privacy and dignity; and strained relationships with prison staff. There is a paucity of research conducted with women in the context of prison-based mental health care. The findings suggest there is a need for greater mental health support, including the need to enhance relationships between women and prison staff to promote positive mental health. Originality/value: To the best of the authors' knowledge, this is the first systematic review conducted on the experiences of women in the context of prison-based mental health care. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services. Design/methodology/approach: A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having "major" relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes. Findings: There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery. Research limitations/implications: This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English. Originality/value: This review makes a unique contribution, highlighting that, to the best of the authors' knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary. [ABSTRACT FROM AUTHOR]

Purpose: This research aims to explore the nature of Chinese students' mental health information needs and to identify the online resources they use to meet those needs. Design/methodology/approach: Data was collected from three Chinese research-oriented universities using semi-structured interviews and a survey. Twenty-five university students with varied backgrounds were selected for semi-structured interviews to explore the triggers and nature of their needs. Then, printed and online questionnaires were distributed to undergraduate and postgraduate students and 541 valid responses were processed for descriptive statistical analysis and variance analysis. Findings: The following findings were incurred. First, the triggers of university students' mental health information needs mainly are mental health being in the news, personal interest in gaining mental health knowledge, mental health issues, required formal learning and preparation for mental health counselling. Second, eleven types of information are used, with an emphasis on employment pressure, study stress and self-understanding. Third, mental health information needs differ with mental health status and some social-demographic factors (including gender, urban or rural origin and educational stage). Fourth, information needs can be characterized as dynamic; complex and diverse but concentrated on a few types; ambiguous and hard for participants to define; private; stigmatized; self-dependent and substitutable. Fifth, Internet sources used to meet such needs are mainly search engines, Question and Answer platforms, public social media platforms. Finally, a model of mental health information needs was built based on the above findings to map the whole process from what triggers a need, to the content and characteristics of information need, and online resources used to meet those needs. Practical implications: The paper provides suggestions for university mental health services in developing more tailored knowledge contents via effective delivery methods to meet diverse needs of student groups. Originality/value: This research is novel in using empirical data to build a holistic model that captures the context and the nature of mental health information needs of university students. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to draw together what is known regarding the characteristics and context of adult family violence, and to consider what practitioners and organisations in the UK might learn from the literature. Design/methodology/approach: This study reviews literature on adult family violence and parricide and includes illustrative cases from a study of domestic homicide review reports involving older adults. Findings: Adult family violence most often involves mothers killed by their adult sons. Mental health issues, alcohol/substance misuse and criminality are common themes for perpetrators. Caregiving responsibilities is a theme for both victims and perpetrators. Previous research identified two main categories of adult family homicide: perpetrators with major psychotic illness, and victims-perpetrators in complex relational contexts. Practical implications: This study considers how practitioners respond to situations of adult family violence and learning for policymakers, agencies and practitioners. Originality/value: This paper summarises what is known, argues that more research is needed and suggests practical ways forward for policymakers, relevant agencies and practitioners. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe the COVID-19 risk mitigation strategies implemented in California prisons and the impact of these policies on the mental health of incarcerated women. Design/methodology/approach: The authors conducted semi-structured qualitative interviews with ten women who were over the age of 50 and/or had a chronic illness and had been incarcerated in California prisons during the COVID-19 pandemic. The authors also interviewed ten health-care providers working in California jails or prisons during the pandemic. Interviews were analyzed using a grounded theory coding framework and triangulated with fieldnotes from ethnographic observations of medical and legal advocacy efforts during the pandemic. Findings: Participants described being locked in their cells for 23 hours per day or more, often for days, weeks or even months at a time in an effort to reduce the spread of COVID-19. For many participants, these lockdowns and the resulting isolation from loved ones both inside and outside of the prison were detrimental to both their physical and mental health. Participants reported that access to mental health care for those in the general population was limited prior to the pandemic, and that COVID-19 risk mitigation strategies, including the cessation of group programs and shift to cell-front mental health services, created further barriers. Originality/value: There has been little qualitative research on the mental health effects of the COVID-19 pandemic on incarcerated populations. This paper provides insight into the mental health effects of both the COVID-19 pandemic and COVID-19 risk mitigation strategies for the structurally vulnerable older women incarcerated in California prisons. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to evaluate service user (SU) and clinician acceptability of video care, including future preferences to inform mental health practice during COVID-19, and beyond. Design/methodology/approach: Structured questionnaires were co-developed with SUs and clinicians. The SU online experience questionnaire was built into video consultations (VCs) via the Attend Anywhere platform, completed between July 2020 and March 2021. A Trust-wide clinician experience survey was conducted between July and October 2020. Chi-squared test was performed for any differences in clinician VC rating by mental health difficulties, with the content analysis used for free-text data. Findings: Of 1,275 SUs completing the questionnaire following VC, most felt supported (93.4%), and their needs were met (90%). For future appointments, 51.8% of SUs preferred video, followed by face-to-face (33%), with COVID-related and practical reasons given. Of 249 clinicians, 161 (64.7%) had used VCs. Most felt the therapeutic relationship (76.4%) and privacy (78.7%) were maintained. Clinicians felt confident about clinical assessment and management using video. However, they were less confident in assessing psychotic symptoms and initiating psychotropic medications. There were no significant differences in clinician VC rating by mental health difficulties. For future, more SUs preferred using video, with a quarter providing practical reasons. Originality/value: The study provides a real-world example of video care implementation. In addition to highlighting clinician needs, support at the wider system/policy level, with a focus on addressing inequalities, can inform mental health care beyond COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: Health policies in England highlight the need for child and adolescent mental health services (CAMHS) to embed new knowledge in practice, yet evidence remains scarce about the services' ability to learn from the external environment. This paper aims to present a critical analysis of the CAMHS' ability to implement new knowledge through the lens of absorptive capacity, an organisation's ability to identify, assimilate and use new valuable knowledge. Design/methodology/approach: Sixteen semi-structured interviews were conducted with staff from the CAMHS department of a mental health organisation in England to explore the services' absorptive capacity. Findings: Professionals were identified having an impact on the main absorptive capacity components in the following ways: professional background and perceived reliability of knowledge sources appeared to affect knowledge identification; informal communication was found to facilitate knowledge assimilation and exploitation; trust was found to enable knowledge exploitation, particularly between senior management and frontline professionals. At an organisational level, team meetings and internal reporting were identified as enablers to knowledge assimilation and exploitation, while organisational hierarchy and patient data management systems were identified as barriers to knowledge assimilation. No organisational processes were found regarding knowledge identification, indicating an imbalanced investment in the main components of absorptive capacity. Practical implications: Investing in these underpinning factors of absorptive capacity can assist CAMHS with capitalising on new knowledge that is valuable to service provision. Originality/value: This study offers novel insights into the learning ability of CAMHS through the lens of absorptive capacity. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children's services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach: Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings: Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers' accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children's birth families there were more mixed and negative impressions. Originality/value: Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised. [ABSTRACT FROM AUTHOR]

Purpose: Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors' knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach: This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings: There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications: Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a "healthy" level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people's functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value: This paper evaluates a young person's functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England. [ABSTRACT FROM AUTHOR]

Purpose: Primary care psychological interventions for people with common mental health problems in England are primarily delivered through Improving Access to Psychological Therapies (IAPT) services. People with learning disabilities within IAPT have poorer key clinical outcomes than people who do not identify as having a learning disability. During the global COVID-19 pandemic remote consultations have accounted for nearly 90% of all contacts in IAPT services; this paper aims to report the effects of these on outcomes for people with learning disabilities. Design/methodology/approach: Publicly available national data from the COVID-affected period are compared to the most recent available comparison periods that are not during the COVID pandemic. Data are presented graphically. Findings: People with learning disabilities differ little from those with no disabilities on several key process and outcome variables, although their clinical recovery is very much lower than those without disabilities. People with learning disabilities appear to have been affected by the changes in service delivery in a similar way to those without learning disabilities. Originality/value: Despite the shift to predominantly remote therapy delivery, outcomes for people with learning disabilities have not been differentially affected compared to those who have no recorded disability. The potential to learn what has worked and not worked in the delivery of remote interventions for people with learning disabilities is highlighted. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the barriers to accessing mental health support for people experiencing multiple disadvantage along with some potential solutions for attempting to overcome these. It draws on evidence and learning from 12 voluntary sector-led partnerships in England funded by the National Lottery Community Fund's Fulfilling Lives programme. Design/methodology/approach: Qualitative research was undertaken with frontline staff, senior leaders, volunteers, beneficiaries and stakeholders from Fulfilling Lives partnerships. This comprised focus groups (21 participants) and individual face-to-face interviews (41 participants), both of which explored barriers and local solutions to accessing statutory mental health services. Following a thematic analysis of transcripts, research participants and stakeholders were invited to a face-to-face workshop to review and validate emerging findings (34 participants). Findings: People experiencing multiple disadvantage face significant barriers in accessing support for their mental health. These include a complex system that is difficult to navigate, long waiting lists, high eligibility thresholds and models of support that lack flexibility. Fulfilling Lives partnerships have had the funding and the flexibility to trial different approaches. Promising solutions to barriers include the use of navigators, person-centred support and multi-agency networks and training. However, overcoming systemic barriers remains the most difficult challenge. Originality/value: Fulfilling Lives was a rare example of substantial and long-term (eight years) funding to work with people experiencing multiple disadvantage. This provided a unique opportunity to try different approaches and gather learning. The programme evaluation provides insights into the experiences of people facing multiple disadvantage and those who support them and offers evidence-based suggestions for policy and practice. [ABSTRACT FROM AUTHOR]

Purpose: Without effective support and intervention, young people with learning disabilities and severe challenging behaviour are at risk of placement in out-of-area residential settings or highly specialist child and adolescent mental health service (CAMHS) units. Such placements may be inappropriate and result in significant reductions to the quality of life of young people and their families. This paper aims to evaluate the effectiveness of the Bradford positive behaviour support (PBS) service model in terms of its aims to improve quality of life, develop skills and maintain children living with their families in their own homes. Design/methodology/approach: A service evaluation using quantitative and qualitative data from a range of sources to review the effectiveness of the PBS model being applied in Bradford and Calderdale was the methodology used. Findings: When consistently implemented, the Bradford positive behaviour support–in reach service may improve quality of life, facilitate skill development in young people and their carers and reduce placements in residential and CAMHS inpatient units. Avoidance of such placements is likely to reduce the overall costs of service commissioning in Bradford. Originality/value: This paper evaluates a novel approach being applied by a third sector agency to implement effective PBS with a small group of children, their families and networks. There is scope for this model to be successfully implemented in other areas. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article "A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service". Design/methodology/approach: The author's reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings: The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value: The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed. [ABSTRACT FROM AUTHOR]

Purpose: Exposure to trauma in childhood can have lasting impacts upon development and psychological well-being. Services can be sought to help young people heal from their experiences; however, literature suggests that their care may not always be trauma-informed. This paper aims to generate a theory to explain caregivers' experiences of accessing mental health and therapeutic services for young people exposed to developmental trauma. Design/methodology/approach: A constructivist grounded theory approach was used, using an iterative process of data collection and analysis. Nine individuals including foster carers, adoptive parents and a special guardian were interviewed following purposive and theoretical sampling. Techniques of initial, focused and theoretical coding, alongside constant comparative analysis were used to develop the end theory. Findings: The theory demonstrates that multiple factors can impact upon caregivers' experiences when accessing support for young people exposed to trauma. Six themes emerged documenting caregivers' journeys from the decision to seek support to the ending of service involvement. Barriers, challenges and positive experiences are described. Results are contextualised through consideration of wider organisations and systems. Originality/value: The theory highlights challenges caregivers face when accessing mental health and therapeutic support for young people exposed to developmental trauma. It provides new insights into what caregivers consider to be trauma-informed experiences of care in these settings. Tentative recommendations are provided in the hope of improving future care. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a pilot site in a London borough and the progress made in establishing a randomised controlled trial (RCT). Design/methodology/approach: This paper describes an evaluation of a new intervention and the learning that followed in terms of its implementation and future evaluation. Qualitative data were collected from a range of stakeholders and practitioners through interviews and small group discussions. These interviews focussed on both of these issues, with particular reference to the proposal to conduct an RCT. Findings: The findings of this evaluation add to the evidence on how best to support new initiatives that have been introduced from other settings and countries to embed in a receiving site and the optimal timing and feasibility of conducting an RCT. At the end of the feasibility study, which took place within the year of the service being introduced and which was only open to clients for six months of this year the conclusion was that an RCT at that point was neither possible nor desirable. Over the following years, the commitment of the judiciary to examine if there was a way to make an RCT study in respect of this intervention meant that a template was established that may well have broader application. Research limitations/implications: At a time when there is an increasing demand for evidence on effective interventions this paper makes a valuable contribution to the development of RCTs in general and specifically in the family court arena. It also recommends that attention must also be paid to the time, which is needed to implement and establish interventions and then to test them. Practical implications: This paper highlights the need to establish realistic timescales not only around the implementation of initiatives but also for their evaluation. Originality/value: This study breaks new ground in considering implementation challenges in the court and children's services' context. It brings to the fore the important role of the judiciary in approving new processes. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review a case of a man with intellectual disability, autism and challenging behaviour who presented with vomiting, regurgitations and significant weight loss. Design/methodology/approach: The paper examines the case history and identifies challenges contributing to symptom classification and management of a patient with intractable vomiting, regurgitations and significant weight loss. Findings: This case illustrates the importance of the multidisciplinary team working required to reduce morbidity and risk of mortality, as well as highlighting some of the challenges associated with coordinating different approaches from different agencies. Pharmacological management did not result in lasting symptom resolution in this case. Difficulties in establishing diagnostic certainty and consideration of whether symptoms could be consistent with rumination syndrome are also discussed. The value of consistent implementation of positive behavioural support is also demonstrated. Originality/value: The rapid and dangerous weight loss described in this case is associated with adverse physical health outcomes and has generated significant anxiety resulting in extensive liaison between primary and secondary mental and physical health services. Additionally, it considers whether the symptoms could be attributed to the relatively rare diagnosis of rumination syndrome which is historically underdiagnosed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to show that Acceptance and Commitment Therapy (ACT) may have utility with this client group in routine clinical practice. Design/methodology/approach: This uncontrolled double case study describes the targeting of ACT processes with people referred to a mental health service for people with intellectual disabilities because of distressing intrusive thoughts. It includes qualitative data to illustrate the opinions of the participants eight weeks after the end of therapy. Findings: Both clients described rapid relief from distress, with some additional untargeted benefits emerging too. The participants provided follow-up qualitative data in which they described how the therapy had helped them as well as areas where it had not. Research limitations/implications: This paper presents uncontrolled case studies selected from routine clinical practice. They were selected due to their similarity of outcome and will not represent the experience of every client treated this way. Practical implications: The practical implications are that a therapy often considered to rely on the use of metaphors and the manipulation of complex metacognitions may be useful for people with more limited verbal and cognitive ability if the therapy is adapted to meet their level of ability. Originality/value: There has been very little published on using ACT with an intellectual disabilities population. This paper has originality value in that it illustrates the application of the approach in routine clinical practice. Additionally, the qualitative follow-up allows the participants' voices to be heard about their experience of this approach. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore the views of NHS England (NHSE) and Her Majesty's Prison and Probation Service (HMPPS) commissioners about the Offender Personality Disorder (OPD) pathway. Design/methodology/approach: A thematic analysis of four semi-structured interviews with NHSE and HMPPS commissioners is conducted. Findings: Commissioners offered a cautious but confident assessment of the potential effectiveness of the OPD pathway, drawing particular attention to its potential to enhance the confidence and competency of staff, offer better value for money and provide enhanced progression routes for offenders with personality disorders. Additionally, commissioners identified a number of potential risks for the pathway including wider system flux, funding availability, multi-agency working, offender engagement and the need to evidence effectiveness. Research limitations/implications: The analysis is based on a small number of interviews. However, there are only a limited number of commissioners involved with the OPD pathway. Practical implications: While the stronger focus on progression in the OPD pathway is a welcome departure from a narrow focus on high security Dangerous and Severe Personality Disorder (DSPD) services, the foundations of the OPD pathway ultimately lie with the DSPD programme and similar challenges are likely to follow. The system within which the pathway operates is subject to a great deal of flux and this inevitably poses significant challenges for pathway services, staff and offenders, as well as for those of us charged with its evaluation. Originality/value: There has been limited empirical work with commissioners in the mental health field. The paper offers a unique insight into the perspectives of those responsible for commissioning the OPD pathway. [ABSTRACT FROM AUTHOR]

Purpose: This paper considers how the quality of wound care delivered to people experiencing mental ill health can be improved at the system level in line with the global focus on improving population health. The purpose of this paper is to identify how the quality of wound care delivered to mental health care service users can be improved at a population level through system thinking informed by boundary theory. Design/methodology/approach: This paper is a critical analysis of practice underpinned by systems thinking and boundary theory. Findings: Tissue viability care and mental health care have different professional cultures and identities that are manifest in the way that they are organised and deliver care. If improvements in wound care-related outcomes at a population level are to be achieved, then it is important that the wound care needs of people experiencing mental ill health are addressed. Systems thinking and boundary theory provide a useful conceptual framework for informing quality improvement for people experiencing mental ill health at a population level. Integrated care plans are a useful mechanism for delivering comprehensive care that brings about wound healing and recovery from mental ill health. Social implications: Integrated wound and mental health care plans transcend the professional boundaries that exist between tissue viability and mental health care services. Improvements in the quality and safety of care delivered to people with wounds who also utilise mental health services can be achieved through the use of integrated care plans. Health care policy and organisation need to meet the wound-related needs of people using mental health services. Originality/value: There has been a focus on improving many aspects of wound care in line with the global focus on grand convergence in population health, but there has been very little emphasis on improving the wound-related outcomes of people that use mental health services. Systems thinking and boundary theory provide a useful framework for understanding how wound care for people experiencing mental ill health can be improved at a population level. Integrated care plans are a useful way of ensuring that safe high-quality wound care is consistently delivered to people experiencing mental ill health. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to report on the findings of a qualitative study that explored the views and experiences of young people leaving care during the first phase of the Covid-19 pandemic in Northern Ireland. Design/methodology/approach: A qualitative approach was adopted involving semi-structured interviews with 24 care leavers 18–25 years old from across the region. Interviews were conducted remotely online or by telephone and explored young people's lived experiences during the pandemic including their views on the formal support services and how best to provide ongoing for support care leavers during the pandemic. Findings: Study findings highlight how known adversities for care leavers are exacerbated during the pandemic, having a detrimental impact, particularly on their emotional well-being. The response of the state as a corporate parent in mitigating the impact of the pandemic was found to be inadequate; with a need for much clearer communication, transparent and prompt decision-making and targeted specialist mental health services. The account given by the young people also highlighted the importance of participation and relationship-based practice to build on the young people's resilience in the context of high levels of social isolation and limited access to informal support systems. Originality/value: This research, based on the views of care experienced young people themselves, is the first study in Northern Ireland to report on the impact of the Covid 19 pandemic on care leaving. As such it makes a contribution to this emerging international field of study and, given the persistence of the pandemic, provides empirical findings and a social justice perspective of ongoing relevance to policy and practice with young people leaving care. [ABSTRACT FROM AUTHOR]

Purpose: Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored. Design/methodology/approach: Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service. Findings: Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services. Practical implications: The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users. Originality/value: This study offers novel insight into levels of access to support for staff working with people with DDs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to outline a service evaluation that gathered feedback from people with a learning disability on their experience of lockdown in Jersey and Guernsey. This feedback was intended to guide planning for service provision during any future lockdown and for life as we exit lockdown. Design/methodology/approach: An accessible survey was sent to everyone accessing learning disability services across the two islands and Mencap in Jersey. Data was analysed quantitatively and qualitatively to identify patterns in the data and key themes. Findings: Most respondents felt safe, calm and happy and valued support from services. Key themes emerging from the data included the importance of relationships, messages of safety, keeping busy and communication. Originality/value: This survey has been undertaken at a time where there is a paucity of research and consultation with individuals with a learning disability self-reporting on their experiences of lockdown, during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: The over-reliance on psychotropic medication for the management of patients with learning disabilities with behaviour that challenges is well documented.This paper aims to discuss the application of the methodology of clinical audit within community learning disability mental health services to adapt interventions including optimising prescribing practice and behavioural interventions aiming to reduce behaviour that challenges in people with learning disabilities. Design/methodology/approach: Questionnaire-based review of documentation in electronic patient records, covering relevant audit standards in line with NICE and Royal College of Psychiatrists, was carried out in the North Essex Community Learning Disability Service, Hertfordshire Partnership NHS Foundation Trust. The audit included patients on the caseload of consultant psychiatrists. Findings: The audit demonstrated that the prescribing of psychotropic medication was within BNF maximum limits for all patients, evidence of "consent" procedures was being followed in the majority, and there was some evidence of deprescribing attempts.Improvement was required in several areas e.g. undocumented off label prescribing in a significant proportion of patients. Objective measures to record the severity of behaviours and the effects of the medication were being used by clinicians in only a small proportion of patients. A significant proportion of patients have prescribed medication in the absence of appropriate psychological or environmental interventions. Originality/value: As a result of the audit findings, the action plan made recommendations such as the development of a database for tracking the prescribing of psychotropic medicines and routine use of standardised measures. This action has been supported by the pharmacy team. Positive developments include a clinical psychologist taking on the role of leading the development of behavioural intervention strategies. [ABSTRACT FROM AUTHOR]

Purpose: Brain Injury Case Managers (BICMs) work closely with individuals with Acquired Brain Injury (ABI), assessing needs, structuring rehabilitation interventions and providing support, and have significant experience of clients with impairments to decision making. The purpose of this paper is to explore the application of the Mental Capacity Act (MCA) and its guidance when applied to ABI survivors. This research aimed to: first, highlight potential conflicts or tensions that application of the MCA might pose, and second, identify approaches to mitigate the problems of the MCA and capacity assessments with ABI survivors. It is hoped that this will support improvements in the services offered. Design/methodology/approach: Using a mixed method approach, 93 BICMs responded to an online questionnaire about decision making following ABI. Of these, 12 BICMs agreed to take part in a follow-up semi-structured telephone interview. Findings: The data revealed four main themes: disagreements with other professionals, hidden disabilities, vulnerability in the community and implementation of the MCA and capacity assessments. Practical implications: The findings highlight the need for changes to the way mental capacity assessments are conducted and the need for training for professionals in the hidden effects of ABI. Originality/value: Limited research exists on potential limitations of the application of the MCA for individuals with an ABI. This paper provides much needed research on the difficulties surrounding mental capacity and ABI. [ABSTRACT FROM AUTHOR]

Purpose: Direct care staff may be resistant to the use of behavioural interventions. Whilst some research suggests that resistance to the cost of behavioural interventions is one factor of influence, there is lack of research exploring why staff are influenced by the cost. The purpose of this paper is to explore this issue. Design/methodology/approach: In this paper, the phenomenon of resistance is analysed with the help of behavioural economics and of the behavioural perspective model (BPM). Findings: The resistance to the cost of behavioural interventions is correlated with the low quality of the working environment and ways in which staff might attend to factors which protect their own well-being. Practical implications: Services might need to focus on the ways in which behavioural interventions protect staff's well-being. Originality/value: This paper explores the use of the BPM and of behavioural economics as conceptual tools for the analysis of the factors leading to non-adoption of behavioural interventions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present the service model and evaluation of Southwark Enhanced Intervention Service (EIS). EIS is an intensive community service for adults with intellectual disabilities whose behaviours challenge in the context of the Transforming Care agenda. Design/methodology/approach: The service model is described and the following evaluation data over four years are presented: key performance indicators, descriptive data, clinical outcomes, financial outcomes and qualitative feedback on users' experience. Findings: The EIS has demonstrated good outcomes for a small number of adults with complex needs by supporting them at crisis point locally and preventing hospital admission or a move to a restrictive environment out of area. EIS has also supported the successful transition back to area of a small number of adults with complex needs. The evaluation has shown improvements in behaviour, wellbeing and quality of life as well as demonstrating financial savings. Families' and providers' qualitative feedback indicates that the service has been highly valued and in particular the access to timely multidisciplinary coordination of input. Originality/value: The service was developed around the same time as the start of the Transforming Care agenda. It presents findings of a four-year evaluation at a time when there is limited evaluation of such service models focusing on the Transforming Care aims. The paper presents significant findings in support of guidance and recommendations published more recently as well as reflections on components of effective service delivery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to introduce and explore stuckness as a felt phenomenon in psychiatric practice in order to stimulate clinicians in mental health settings to be on the lookout for stuckness and on the lookout for unexpected solutions to difficult clinical scenarios. Design/methodology/approach: Signs of stuckness are looked at and then proposed causal factors of stuckness in clinical practice are reviewed. These are divided conceptually into four main groupings: patient factors, clinician factors, service factors and societal factors. Findings: Although clinicians are encouraged to acknowledge when stuckness is present and to try to address possible causes with their patients, clinicians are also advised to work on understanding stuckness as a natural part of creative processes. It is suggested that services should draw on a psychoanalytic ethos to support staff to tolerate and respond to stuckness better. Originality/value: Feeling stuck with patients' partial recoveries or "revolving door" cycles is uncomfortable. In stretched psychiatric services in particular stuckness may go unnoticed, and instead the difficulty of the work with patients may inadvertently drive therapeutic mania or rejection of the patients, which can lead to harm. This paper offers a simple scheme to use when thinking about stuck patients in the psychiatric setting with the hope that this can stimulate clinicians to search for new creative solutions for patients. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King's Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy's and St Thomas' (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding.Design/methodology/approach This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust's management structures.Findings Innovations including the transitional arrangements for patients' post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care.Originality/value The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts. [ABSTRACT FROM AUTHOR]

Purpose Team formulation, used to understand patient problems and plan care, is a growing practice in adult mental health and learning disability services. The purpose of this paper is to explore definitions applied to team formulation (as distinct to therapy formulation), its underpinning theories, and the inter-relationship between the team and the process of formulation.Design/methodology/approach A database search (main search term of team formulation) of peer-reviewed studies was conducted using PRISMA guidelines. A main and second reviewer conducted quality appraisals and thematic analysis. Data were analysed by convergent qualitative synthesis design using thematic analysis to transform evidence from quantitative and qualitative studies into qualitative findings.Findings Initial searching produced 4,532 papers, 10 of which were eligible for inclusion. Team formulation has no distinct definition. Theories underpinning the practice of therapy formulation emanating from general psychological theory underpin team formulation. Seven studies applied psychological theories to the examination of team formulation. No studies examined the impact of the team on the formulation. Six themes were generated regarding the impact of team formulation on the team; "increased knowledge and understanding", "altered perceptions, leading to altered relationships, feelings and behaviours", "space to reflect", "useful when stuck or challenged", "perceived increase in effectiveness" and "improved team working".Research limitations/implications Limited evidence and variable quality compromised the availability of review evidence.Originality/value This is the first review to examine team formulation through the context of the team. The authors argue that a conceptual framework to encompass team inputs, processes and outputs in team formulation practice should guide future research. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine two competing pharmacological models that have been used to understand how psychiatric drugs work: the disease-centred model and the drug-centred model. In addition, it explores the implications of these two models for mental health service users and the degree to which they are meaningfully involved in decisions about the use of psychiatric drugs.Design/methodology/approach The approach is a conceptual review and critical comparison of two pharmacological models used to understand the mode of action of psychiatric drugs. On the basis of this analysis, the paper also provides a critical examination, supported by the available literature, of the implications of these two models for service user involvement in mental health care.Findings The disease-centred model is associated with a tendency to view the use of psychiatric drugs as a technical matter that is to be determined by mental health professionals. In contrast, the drug-centred model emphasises the centrality of the individual experience of taking a psychiatric drug and implies a more equitable relationship between practitioners and mental health service users.Originality/value Although infrequently articulated, assumptions about how psychiatric drugs work have important consequences for service user involvement in mental health care. Critical consideration of these assumptions is an important aspect of seeking to maximise service user involvement in decisions about the use of psychiatric drugs as a response to their experience of mental distress. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine whether the popular policy assumption of co-production is feasible in secure psychiatric settings.Design/methodology/approach The assumptions of co-production are listed and then used as a basis for an immanent critique to test the feasibility described in the purpose of the paper. An explanatory critique exploring consumerism in the welfare state then follows. These forms of critique are derived from the philosophy of critical realism.Findings A distinction is made between the co-production of knowledge about mental health services and the actual co-production of those services. It is concluded that the former has emerged but the latter is not feasible, given the limitations on citizenship imposed by psychiatric detention.Research limitations/implications Evidence for the co-production of mental health services (rather than the co-production of knowledge about those services) remains sparse.Practical implications The contradictions about citizenship created by the existence of mental health legislation and the social control role of mental health services requires ongoing honest reflects by mental health professionals and those responsible for the development of mental health services.Social implications As described above, mental health legislation pre-empts confidence in the co-production of mental health services.Originality/value Whilst there is a small literature on co-production and mental health services, alluded to at the outset, this paper uses immanent and explanatory critiques to deepen our understanding of the topic. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to focus on how mental health professionals involved in the therapeutic treatment of children in public mental health facilities in Greece experience and talk about the impact of the socioeconomic crises on the psychotherapeutic process.Design/methodology/approach In all, 21 semi-structured interviews were conducted and phenomenologically informed thematic analysis was used in analysing the data.Findings The results coalesced into two all-encompassing thematic structures articulating the following: first, the socioeconomic crises have permeated society and therapeutic praxis like a torrential and chronic rain storm. This has resulted in a deluge in demand for therapeutic services within the public mental health sector; second, mental health professionals describe their positioning and work as “a constant tug-of-war” where they are inundated and often overwhelmed with work, find themselves identifying with service users and taking on several roles simultaneously, and being challenged to find solutions often in dire and complex situations. They describe how creativity and flexibility are in demand in their day-to-day interactions and if they are to intervene in place of a health and welfare system that is faltering. Doing therapeutic work under such circumstances appears to be both emotionally onerous and stimulating with regard to conceptualising new ways of intervening in such complex psychosocial situations.Research limitations/implications The study is limited in that only mental health professionals presented their experiences and service users were not included. The findings do highlight how severe austerity policies impact mental health services and peoples’ lives.Practical implications The study has implications for policy regarding the provision and organisation of mental health services in contexts where crises and economic turmoil prevail.Social implications The results associate severe austerity with major changes in family and community life.Originality/value The paper provides insights and implications on how mental health services are impacted by socioeconomic conditions. [ABSTRACT FROM AUTHOR]

Purpose: Mental health literacy (MHL) is the ability to understand health information originating from different sources. Little is known about ethnic differences in sources for health information, and the effect these differences has on elderly MHL. In this paper, we focus on the social networks (i.e. social connections) of elderly people from different ethnic groups, and investigate the effect these networks have on MHL. Specifically, we focus on the ethnic diversity of one's peers (ethnic diversity) as a network characteristic that can interplay with his\her MHL. Design/methodology/approach: The data used in this study were gathered using a survey among elderly (over the age of 60) Native Israeli Jews (N = 147) and Immigrant Jews from the Former Soviet Union (FSU, N = 131). The survey was used to assess our participants MHL, online and offline sources of mental health information and mental health service utilization. Interviews were also conducted with each participant. The interview purpose was to map the participants' social network (using a sociogram), while indicating the attributes of the participant's peers (age, gender, ethnicity, etc.) and the nature of the interaction (online vs. offline, strength of the tie, etc.). A set of hierarchal regression analyses were then used to examine which social network attributes are correlated with MHL levels. Findings: Our findings shows that ethnic diversity within the social networks of Immigrants from the FSU contributed to their MHL more so than for native-born Jews. Specifically, face to face maintained connections with individuals from diverse ethnic groups lead to increased knowledge about how to search for mental health information. Online maintained connections with individuals from diverse ethnic groups, lead to increase attitudes that promote recognition of mental health related issues and appropriate help-seeking. Originality/value: Understanding the interplay between the ethnic diversity among one's peers and his/her MHL offers an important additional prism of examining MHL; moving beyond the individual's characteristics and examining his/her social connections as well. The relevancy of these findings for reducing MHL inequalities between native-born and elderly migrants, as well as for ethnic minorities is discussed. [ABSTRACT FROM AUTHOR]

Purpose Services for people with intellectual disabilities in the UK have evolved over the years from hospital-based care to more community provision. There are multiple reasons for these changes, however, often it was due to changes in social policy or following a scandal in provision. The paper aims to discuss these issues.Design/methodology/approach Providing services to meet the health and social care needs of people with intellectual disabilities is well-established in the four countries of the UK with support from legislation. There are often specialist mental health and social care teams. Dedicated professionals work with people with intellectual disabilities who experience mental health problems with a focus on support in the community. A range of services for children and adults and for offenders exist across the UK that often vary in composition and structure.Findings The challenges in providing mental health services for children and adults with intellectual disabilities in the future include recruitment and training of the workforce with the remit of enhancing community support and reduced in-patient care.Practical implications This paper helps the reader to understand how ID mental health services are organised in the UK.Originality/value This paper gives a summary of the ID mental health services in the UK. Even though there are various papers looking at different aspects of mental health services for people with ID in the UK, this paper brings all that information together to help reader get a better understanding of the mental health services for people with ID. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to outline the historical background and policy context of mental health services for people with intellectual disability (ID) in Ireland. It then considers recent implementation and lessons from the Irish experience.Design/methodology/approach The policy background and research literature relevant to the development of mental health services for people with ID in Ireland was reviewed and discussed.Findings Mental health services in Ireland remain in a state of change, moving towards the implementation of specialist multi-disciplinary teams in the community, alongside previous models of care and service.Research limitations/implications This paper summarises recent advances and research regarding mental health services for people with ID in Ireland.Practical implications The paper illustrates the process of delivering changes to mental health services with practical implications for mental health services internationally.Originality/value This is the first paper in many years to summarise the development of mental health services for people with ID in Ireland. There has been considerable recent change and it is therefore important to provide a useful reference for the current status of services. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present information on the health care system in Germany with the focus on mental health care in people with intellectual disabilities (ID).Design/methodology/approach The paper is descriptive providing an overview of the general structure of the German health care system with historical and economic background. The paper also provides further information on the general social and health care in Germany for people with ID and medical education in the field of ID is used.Findings There is a highly developed health care infrastructure in Germany but health care for people with ID is not co-ordinated or universal. Mental health care for people with ID is predominantly in in-patient services. Only in recent years, out-patient services for people with ID have been developed. There is a little emphasis in medical education on the health care needs of people with ID.Originality/value The value of this paper is its description of health care in Germany and services for people with ID. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present and discuss mental health services for people with intellectual disability (ID) in Norway.Design/methodology/approach A literature review and a survey were conducted to map services for people with ID and mental health problems in Norway.Findings The results were sparse and confirmed what is already known among clinicians working with these patients. The Norwegian services are fragmented and there are geographical differences.Research limitations/implications There are no special services for children with ID developing mental illness. For offenders with ID, a national unit assesses and follows up, also when the person is sentenced to compulsory care and services are provided in their home municipality.Practical implications More data about both the patients and the services are needed in order to improve mental health services for people with ID in Norway.Originality/value This paper describes mental health services for people with ID in Norway. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe the barriers and facilitators to an effective transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). It also presents a new entry into considering how the transition can be improved.Design/methodology/approach Insights into the transition from CAMHS to AMHS were gathered through eight semi-structured interviews with mental health professionals. Two methods of data analysis were employed to explore the emerging themes in the data and the observed deficit approach to organisational development.Findings The findings identified a vast volume of barriers in comparison to facilitators to the transition. Adolescents who transition from CAMHS to AMHS initially experience difficulty adapting to the differences in the services due to the short duration of the transition period. However, despite the established barriers to the transition, adolescents tend to adapt to the differences between the services. Findings also showed a negative framing towards the transition amongst the mental health professionals which resembles a deficit approach to organisational development.Originality/value This paper explores mental health professionals’ perspectives regarding the transition in Dumfries and Galloway, Scotland. The transition is increasingly recognised as an area in health care that requires improvement. This research provides a new way to consider the transition by exploring the perceived deficit approach to organisational development in the services. [ABSTRACT FROM AUTHOR]