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Purpose: The purpose of this paper was to determine the attachment strategies of prospective adoptive parents and any correlation between attachment and the defensive strategies they used when talking about loss of fertility. The study also examined whether attachment strategy of the applicants had a bearing on the decision by the local authority to place a child. Design/methodology/approach: The sample was comprised of 48 respondents (21 couples) representing 84 per cent of all people who applied to one UK Social Services Department in a 12-month period. Placement of a child was reviewed two years following the assessment. The study used the dynamic maturational model version of the adult attachment interview (DMM-AAI), together with added questions on loss of fertility to assess the applicants' attachment strategies together with unresolved loss and trauma and the DMM modifiers. Findings: Unlike adoption studies using the Main and Goldwyn system, this study rated very few of the applicants' AAIs as secure (13 per cent), 48 per cent were in the normative low-risk range and 52 per cent of the AAIs were coded in the more complex DMM insecure strategies. There was a significant bias towards marriages where the partners deployed opposite low-risk/DMM strategies (13 (62 per cent) of couples). Compared with data on non-clinical populations the AAIs showed a high level of unresolved loss or trauma (58 per cent). Using a six-way distribution (A1-2, C1-2, B, A3-4, C3-6 and A/C) there was an 87 per cent correspondence between discourse about loss of fertility and that about attachment, thereby supporting the established proposition that reproduction is part of the attachment system. Twenty one per cent of the AAIs were coded as "disorientated" and this is discussed in terms of conflict for adoptive of parents concerning the raising of a child who carries their own genes or those of strangers. A case is made to conceptualise negative impact of infertility in terms of unresolved trauma rather than loss. Research - limitations/implications: This study adds to research showing that the DMM approach is more finely calibrated than the ABC+disorganised model with the latter likely over coding for security. The results emphasise that fertility and reproduction are legitimate subjects for attachment studies and that AAI discourse analysis is a valid methodology for future research. However coder agreement as to whether or not loss of fertility was resolved was only fair (64 per cent) κ. 0.25 (po0.33). More work is required in order to determine what constitutes unresolved loss of fertility and what impact, if any, this has on parenting an adopted child. Practical implications: The practice implications are considered in a separate paper. Social implications: The findings are contentious in that they suggest a significant number (48 per cent) of adoptive parents have needs not dissimilar to other clients of psychological services. Originality/value: This is the first DMM-AAI study with prospective adoptive parents and the findings show significant differences when compared with previous studies using the Main and Goldwyn AAI. It is also the first study to establish fertility as a legitimate area for attachment studies by using AAI discourse analysis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe and discuss the variables which have contributed to the adoption of positive behaviour support (PBS) and applied behaviour analysis (ABA). Differences and similarities are highlighted, applications to contemporary issues in the UK and Australia are emphasised, and considerations posed for their improved adoption. Design/methodology/approach: A conceptual framework for diffusion of innovations theory is used to guide the analysis of three sets of articles, and application of the framework is guided by narrative analysis. Findings: Eight variables from the conceptual framework were identified, and the communication networks for PBS and ABA are argued to be distinct. There has been a positive change in the perception of PBS by the ABA field, but PBS has leveraged diffusion more successfully. ABA appears to have been separated from PBS in the UK while Australia is yet to fully benefit from the contributions of ABA. Those working in the fields of PBS and ABA should further collaborate for their mutual benefit. Practical implications: Greater attention to the factors which promote diffusion can assist PBS and ABA to improve their adoption. Originality/value: This is the first paper to use diffusion of innovations theory to analyse the adoption of PBS and ABA. [ABSTRACT FROM AUTHOR]

Purpose The 2017 Naylor Review has been the subject of some controversy, with some of the press, social media and other critics portraying its recommendations as a "fire sale" or privatisation of the NHS. The purpose of this paper is to examine preceding reports into efficiency and best value of the NHS, the evidence behind the review recommendations, and analyse data into housing affordability for the capital's NHS staff. It concludes by advocating for partnerships with housing associations to deliver social and financial value by utilising redundant NHS land to deliver the affordable housing that London and the rest of the UK so urgently needs.Design/methodology/approach The paper was developed using the content analysis of preceding independent reviews of NHS efficiency, published critiques of the Naylor Review and analysis of NHS produced data to consider the potential savings and opportunities for reinvestment in capital projects.Findings The paper identifies existing partnership models and examples of good practice and advocates the adoption of joint ventures and other forms of partnership to ensure that both best value is achieved from the sale of NHS assets, and publicly owned assets are reused for social purpose.Originality/value The paper uses existing data, analysis and context to map a route for achieving best value in managing the publicly owned asset base and reinvesting the proceeds of the sale of redundant properties into UK public services. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a supply-side review of policies and practices that impact on the shortage of supply in the contemporary specialist housing market for older people in the UK.Design/methodology/approach The review is based on a review of academic literature, policy documents, reports and other sources.Findings There is a critical conflict between the key social purpose of specialist housing (i.e. living independent of socially provided care) and the values that underpin and ultimately limit the quantity of units in both the social and private sector. In the social sector, government policies prohibit rather than encourage local authorities and housing associations from increasing specialist housing stock. The nature of leasehold tenures in the private sector tends to commodify not only housing stock but also those who use it and therefore acts to instrumentalise housing supply in favour of the profit motive and the focus on the person and her or his needs is largely ignored.Originality/value While the shortage of specialist housing is well known, this paper is unique in that it provides a comprehensive and critical supply-side review of the factors that have created such conditions. [ABSTRACT FROM AUTHOR]

Purpose There are often calls for more focus on outcomes in Children’s Social Care yet there is little consensus on what these outcomes should be. Key challenges include who should decide what outcomes should be measured and the sheer range of issues that social workers deal with. The purpose of this paper is to provide a reflective account of approaches to measuring outcomes that the author has used in recent studies in order to illustrate the complexity involved in understanding what the purpose of Children’s Social Care is and therefore how outcomes might be measured.Design/methodology/approach A review of and reflection on lessons from recent research studies carried out by the author and colleagues.Findings The results are used to illustrate and support an argument that Children’s Social Care performs multiple functions and that this has implications for thinking about outcomes. Helping children and parents is one element of the work, but assessing risk across large numbers of referrals and identifying those that require involvement is equally important. Furthermore, the social work role requires complex considerations around liberty and the rights of parents and children. One consequence of this is that the quality of the service provided is important in its own right.Research limitations/implications It is suggested that the evaluation of Children’s Social Care involves four types of outcomes: measures of the quality of the service provided; assessment of whether the “right” families are being worked with; client-defined measures of change; and the development of appropriate standardised instruments. Examples of approaches in each area are discussed.Practical implications The theoretical considerations suggest that we need to have a multi-dimensional approach to evaluating, inspecting and leading Children’s Social Care services. In particular, the importance of the quality of delivery and appropriate targeting of the service are emphasised, as well as considering various approaches to measuring outcomes.Originality/value The paper proposes a combination of qualitative and quantitative measures of process, assessment and outcomes for evaluating outcomes in Children’s Social Care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to reflect on development in children’s social work over 35 years from the perspective of someone who has worked in the field as a practitioner and director.Design/methodology/approach Interview.Findings The paper provides insights into implementing the Reclaiming Social Work model and how systems can better support social work practice with children and families.Originality/value The paper offers a unique perspective on developments in the field and implications for the future of children’s social work. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore the aspects of social work for children, primarily in England.Design/methodology/approach It is based on reflections on research undertaken by the author prior to 1995 and after 2015.Findings The paper explores the interaction between people – effective leaders and practitioners – and systems.Research limitations/implications It is an opinion piece, and does not present findings from a single study.Practical implications It urges systems that do not restrict the capability of practitioners.Social implications The value of social work services at times of significant social disadvantage demands strong public policy attention.Originality/value The study draws on several research and case studies in over 20 English local authorities [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to expose and dispel some outdated dilemmas and straw men that have drawn attention away from debates of substance in social work. The paper presents what Frontline believes to be the substantive dilemmas facing the social work profession, as it looks into the future.Design/methodology/approach The paper draws on the insights and experiences of the past four years during which Frontline has been innovating in the field of social work education and leadership development.Findings Building a better social work system requires addressing several important questions, namely, whether social work; first, is a practical or intellectual task; second, is a generic or specialist profession; third, focuses on social or therapeutic change; fourth, requires bureaucrats or change agents; and fifth, involves measuring inspections or measuring outcomes.Originality/value The paper sets out the key dilemmas facing the social work profession, which must be debated and addressed in order to build a better social work system. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide an exploratory account of the links between devolution, homelessness and health in the UK. Specifically, it focusses on the policy context and governance structures that shape the systems of healthcare for homeless people in London, Scotland, Wales and Northern Ireland.Design/methodology/approach Empirically the paper draws on semi-structured interviews with a small sample of policy and practice actors from the devolved territories. Qualitative interviews were supplemented by a comparative policy analysis of the homelessness and health agenda within the devolved regions. Theoretically, it takes inspiration from Chaney’s concept of the “issue salience of homelessness” and explores the comparative character of healthcare as pertains to homeless people across the devolved territories.Findings The paper provides clear evidence of areas of divergence and convergence in policy and practice between the devolved regions. These features are shown to be strongly mediated by the interplay of two factors: first, the scope and scale of national and local homelessness prevention strategies; and second, intra-national variation in public health responses to homelessness.Originality/value The paper offers considerable insight from a comparative policy perspective into the nature of healthcare provision for homeless people in the devolved regions. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability --- those with offending behaviour being treated in forensic hospitals. Design/methodology/approach -- The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions -- containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings -- Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not fall within the law. Originality/value -- This paper makes practical suggestions for the future on how to best integrate hospital and community care for people with intellectual disability, mental health and offending behaviours. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate perceptions towards a career in psychiatry among medical students and psychiatrists and identify how recruitment into the specialty may be improved.Design/methodology/approach This study locally compares medical student and psychiatric doctor responses to a structured online survey and structured interviews with key managerial figures in the Humber NHS Foundation Trust.Findings Comparison across two main areas (pre-decision exposure to psychiatry and reasons for considering a psychiatric career) found that both students and doctors were influenced to make a choice about a career in psychiatry during medical school. Medical students found compatibility with family life to be more important when considering psychiatry, whereas doctors cited content-based reasons as significant pull factors. Stigma and fear of being harmed deterred some students from choosing a career in psychiatry. Structured interview responses reiterated the importance of pre-medical school and undergraduate mentorship in bolstering future recruitment to psychiatry.Practical implications Medical students perceive certain career issues differently to their postgraduate counterparts. Widening the content-based appeal of psychiatry and optimising the medical school experience of the specialty via varied and high-quality placements may be a key step towards tackling the national shortfall in qualified psychiatrists.Originality/value This is the first published study comparing medical student and psychiatric doctor perceptions of a career in psychiatry. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to present an overview of the current state of evidence on the effect of housing circumstances, and housing-related interventions, on adult mental health and well-being. It covers the entire range of health from chronic illness to positive thriving, and both individual and community-level/public health. Design/methodology/approach – The paper is based upon a purposive review, commissioned originally for the UK Department of Health; and therefore is selective in giving priority to research relevant to public policy considerations, and to the UK context. Research with a variety of methodological foundations is considered, where robust enough by its own standards. Findings – The available evidence gives conditional support to policies accentuating empowerment at individual and community levels; early intervention; locality or place-based interventions; and integrated working practice. The complexity of methodological issues emerges as a key challenge for research in this field, and for the prospect of evidence-based national policy. Meanwhile local knowledge and interpretation of data in context may be more reliable than context-blind studies. Research limitations/implications – Where "hard evidence" is unavailable, reports of the lived experience of individuals and in communities remain a legitimate basis for policy and commissioning. Originality/value – This appears to be the first attempt in print to cover such a wide canvas in one overview. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to chart the history of personal social services for children and families in the UK and examine the factors that have influenced it. Special attention is given to changing perceptions of rights, the impact of scandals and the contribution of child development research.Design/methodology/approach Analysis of historical documents and research reports using four methods: a timeline of milestones, demarcation of distinct developmental periods, trends in policy and practice and comparisons of children’s needs and experiences at different times.Findings The evolution of services has not been linear. In policy, there have been reform and retrenchment, amalgamation and differentiation. Practice has been shaped by the emergence of new problems and the disappearance of old ones as well as by legislation, extreme events, research and finance, all occurring in specific political, moral and economic contexts.Originality/value An analysis of developments in children’s services in their political, economic, moral and research contexts. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to offer a view about the future of children’s social work from the perspective of a frontline practitioner.Design/methodology/approach Reflections of a frontline practitioner are based on his experience of practising social work with children and families.Findings The professional task of assessment and intervention in order to protect the nation’s children from significant harm is probably one of the most complex in modern society. However, a focus on gathering too much information and the need for certainty can be detrimental to analysis and judgement. Further, the most complex and challenging part of the social work task, namely, direct work in the family home, is rarely subject to formally structured analysis or feedback. There is insufficient analysis of good practice, and the organisational conditions that will promote and sustain it, but there are alternative models, including outside local government and including from other countries, that appear promising.Originality/value The study offers the perspective of a frontline children and families social worker on issues facing the profession. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to argue for the need to move away from a sole focus on assessing and dealing with individualised risk factors in order to more fully engage with and understand the social determinants of many of the harms that are manifest in families.Design/methodology/approach It draws from a number of research studies being conducted by the authors and a literature on psycho-social approaches to social suffering.Findings It highlights the evidence on the contribution of poverty and inequality to many of the problems encountered within families. It explores how hurt, shame and loss are experienced by those who are marginalised and struggling to live well and care safely for themselves and others.Practical implications It highlights the practice implications of adopting an approach that engages with both the social and the psychological and understands their inter-relationship. It offers some thoughts on how the social in psycho-social might receive the attention it deserves, a situation which does not pertain currently.Originality/value It offers an original contribution to thinking in the area of child protection where the focus is primarily on individualised risk factors. It highlights the importance of understanding the social determinants of many of the harms experienced in families and offers some pointers towards thinking and practising differently. [ABSTRACT FROM AUTHOR]

Purpose The 2015 Modern Slavery Act focusses attention forms of modern slavery (human trafficking and forced labour), within the UK. The contemporaneous 2014 Care Act, identifies modern slavery as a new form of risk within adult social care, listing forms of abuse and vulnerability. However, it does not consider whether those providing care may themselves be vulnerable to forms of modern slavery. The paper aims to discuss these issues.Design/methodology/approach The authors describe the history of the development of modern slavery legislation in the UK, outline key provisions of the Care Act, illustrated with real-life cases. The analysis suggests that adult social care – characterised by informality, fragmentation and vulnerability – is one where instances of modern slavery may be more common than considered to date.Findings The data collected, though relatively modest, suggests that a thorough investigation should be undertaken into the possibility of modern slavery taking place within the realm of adult social care.Research limitations/implications Data have been collected through a snowball process, rolling out a survey to relevant groups of individual and organisations. A more rigorous investigation is required to examine the extent of modern slavery within adult social care.Practical implications The training of those responsible for the regulation/management of adult social care needs to ensure that they are fully equipped to understand the nature of modern slavery and how to identify its symptoms and victims.Social implications There is also a need for heightened awareness of those close to people being cared for that they may also identify the symptoms of modern slavery.Originality/value This area has not been explored to date. [ABSTRACT FROM AUTHOR]

Purpose Many homeless people have significant levels of early adverse experiences and consequent mental health difficulties. The purpose of this paper is to examine the experiences of residents and staff living and working in a psychologically informed environment (PIE), a new model of hostel for homeless people which aims to update and make more flexible the principles of the therapeutic community, thereby meeting the psychological and emotional needs of residents.Design/methodology/approach Semi-structured interviews were carried out with nine residents, ten staff and five psychotherapists at two PIE hostels in London. The data were analysed using thematic analysis with a phenomenological epistemological approach.Findings Analysis generated 18 themes for residents and staff combined, organised into five domains: what makes a home, resident needs, managing relationships, reflective practice and theory vs practice of PIEs. The study suggests that PIEs broadly meet their aim in providing a different type of environment from standard hostels. Efforts to build relationships with residents are particularly prioritised. This work can be challenging for staff and reflective practice groups provide a supportive forum. There are limits to the extent to which the theoretical PIE can be put into practice in the current political and economic climate.Originality/value This is one of the first qualitative studies of PIEs. It provides perspectives on their theoretical background as well as how they operate and are experienced in practice. It may be informative to services intending to establish a PIE and to commissioners in assessing appropriate resources. [ABSTRACT FROM AUTHOR]

Purpose -- This paper aims to offer a commentary on Psychologically Informed Services: A Good Practice Guide, a recently published operational guidance document on developing psychologically informed environments (PiEs) in services for homeless people. Design/methodology/approach -- The paper is an invited opinion piece and comment based on the author's specialist knowledge gained from undertaking research addressing the experiences and needs of young runaways. Findings -- The new operational guidance is welcomed but should be extended so that psychologically informed environments are provided in services for young runaways under the age of 16, who often encounter abuse, mental health issues and problematic substance misuse and experience homelessness post 16 and into adulthood. Originality/value -- Commissioners and practitioners should encourage the development of psychologically informed environments for young runaways to meet their needs, aid recovery and reduce the likelihood of experiencing homelessness as they move into adulthood. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to highlight the challenges in evaluating psychological input into acute wards using more traditional methods; and also to provide an example of how it is possible to evaluate such services capturing outcomes at multiple levels. Design/methodology/approach – Data were gathered from multiple levels including staff, patients and the wider organisation mainly using self report questionnaires. The paper looks at the impact on satisfaction, service utilisation, development of recovery principles, quality of therapeutic environment and alliance with treatment teams following the introduction of a dedicated psychology team. Findings – The results show positive trends in patient experiences of the ward environment, alliance with treating teams and staff recovery principles, along with reduced readmission rates and length of stay in hospital. Qualitative data demonstrate the value of the service to both staff and patients. Research limitations/implications – Much of the data do not meet the criteria for more sophisticated statistical analysis. Originality/value – The paper provides an example of evaluation of a contemporary model of service delivery for which there is currently a limited evidence base and looks to stimulate current thinking on the practice of mental health service delivery. [ABSTRACT FROM AUTHOR]

Purpose - This review of the decision-making literature aims to challenge the rational model of decision-making upon which the Mental Capacity Act (MCA) 2005 is premised.Design/methodology/approach - The paper forms part of a larger study commissioned by the Office of the Public Guardian looking into complex cases.Findings - The literature supported the study findings that decisions are not made in a linear way and identified the importance of history and memory, motivation and drive, mood and stability, and openness to influence when assessing the mental capacity of vulnerable people, especially in the context of self-neglect.Practical implications - This paper will inform workers in health and social care about the emotional factors that influence decision-making and increase their ability to make nuanced assessments.Social implications - Taken together, with other publications from this project, this paper alerts practitioners to situations where vulnerable people are out of their depth; when the role of depression and anxiety may be at least as salient as their understanding of possible consequences and when the past may exert more control over their actions than their understanding of future options.Originality/value - The paper's added value is that it uses ideas that are current within academic psychology to make explicit some of the factors that lead to complexity when assessing mental capacity under the MCA, especially in the context of self-neglect. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to describe an example of a practical evidence-based approach to improvement in the current climate of funding cuts.Design/methodology/approach - The paper describes synthesizing insights from leadership, change management and psychodynamic theory to inform a practical change programme to develop services that meet the needs of clients more efficiently.Findings - The paper finds that rather than simply doing less - cutting staff or reducing services to meet the constraints of funding cuts - it is worth taking a long term and strategic review approach and doing something quite differently.Practical implications - New ways of working can improve client outcomes and deliver better services and the funding cuts can provide an opportunity to thoroughly re-examine existing provision; but, significant changes will only be accomplished by change processes that pervade the whole organisation - they cannot just be add-ons/afterthoughts. The implications of the new way of working are that: even when funding increases, old ways of practice will not be restored; that the use of theoretical approaches from a variety of disciplines can deliver innovative responses that are likely to be sustainable in the medium term; and to improve service standards and outcomes into the future.Originality/value - This paper finds value by looking to neurobiology, clinical psychotherapy, recovery-oriented practice, change management theory and practice, and client involvement to try to resolve the current housing crisis. [ABSTRACT FROM AUTHOR]

Purpose Evidence in the UK tells us that risky drinking is high amongst those in contact with the criminal justice system. The purpose of this paper is to explore the reasons why carrying out research around risky drinking in this setting is so difficult. Design/methodology/approach A commentary on the issues of carrying out research in the criminal justice setting. Findings There are issues of carrying out research in the criminal justice setting. The authors argue, that as academics we can be more proactive in working with practitioners in the design and carrying out of studies. By examining what the primary outcome of interest is to those that work in the field rather than what funding agencies tell us academics must use, academics may engage in a more co-productive way that enables everyone to achieve what they need. Moreover more work is needed to show how this approach can be achieved both in the UK and internationally. Originality/value This editorial explores some of the difficulties of carrying out alcohol research in the criminal justice system and postulates ways that this could be made easier. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to investigate the effectiveness of a day treatment programme (DTP) in reducing psychosocial impairment, changing attitudes, restoring body-weight and decreasing binge/vomit symptoms among 52 individuals (aged 16+) with eating disorders. It was hypothesized that day treatment would result in improvements across all variables measured. Design/methodology/approach – In a within-participants design, demographic, physiological and psychological measures were taken on admission to and at discharge from a DTP in the UK. Quantitative outcomes were analysed. Findings – In total, 40 participants were considered to have received an adequate dose of the DTP, having completed at least four weeks on the programme. Analyses supported all hypotheses, with all improvements being statistically significant. Large effect sizes were evident for all outcomes across the whole sample other than shape concern attitudes and weight concern attitudes, which reduced with moderate and moderate-to-large effect sizes, respectively. Originality/value – This study provides new evidence of the effectiveness of day treatment in reducing psychosocial impairment resulting from eating disorder psychopathology. It remains for future research to determine whether these outcomes can be sustained over the longer term. [ABSTRACT FROM AUTHOR]

Purpose – The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice. Design/methodology/approach – Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts. Findings – Three main themes were identified: participants identified their normative task as the promotion of “moving on” (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults. Originality/value – Staff working in a inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood. [ABSTRACT FROM AUTHOR]

Purpose – There is growing interest in self-management support for people living with mental health problems. The purpose of this paper is to describe the evaluation of a co-designed and co-delivered self-management programme (SMP) for people living with depression delivered as part of large scale National Health Service quality improvement programme, which was grounded in the principles of co-production. The authors investigated whether participants became more activated, were less psychologically distressed enjoyed better health status, and quality of life, and improved their self-management skills after attending the seven-week SMP. Design/methodology/approach – The authors conducted a longitudinal study of 114 people living with depression who attended the SMP. Participants completed self-reported measures before attending the SMP and at six months follow up. Findings – Patient activation significantly improved six months after the SMP (baseline M=49.6, SD=12.3, follow up M=57.2, SD=15.0, t(113)=4.83, p < 0.001; d=0.61). Participants’ experience of depression symptoms as measured by the Patient Health Questionnaire-9 significantly reduced (baseline M=15.5, SD=6.8, follow up M=10.6, SD=6.9, t(106)=7.22, p < 0.001, d=−0.72). Participants’ anxiety and depression as measured by the Hospital Anxiety Depression Scale also decreased significantly (baseline anxiety: M=13.1, SD=4.2, follow up M=10.2, SD=4.4, t(79)=6.29, p < 0.001, d=−0.69); (baseline depression: M=10.3, SD=4.6, follow up M=7.7, SD=4.5, t(79)=5.32, p < 0.001, d=−0.56). The authors also observed significant improvement in participants’ health status (baseline M=0.5, SD=0.3, follow up M=0.6, SD=0.3, t(97)=−3.86, p < 0.001, d=0.33), and health-related quality of life (baseline M=45.4, SD=20.5, follow up M=60.8, SD=22.8, t(91)=−2.71, p=0.008, d=0.75). About 35 per cent of participant showed substantial improvements of self-management skills. Originality/value – The co-produced depression SMP is innovative in a UK mental health setting. Improvements in activation, depression, anxiety, quality of life and self-management skills suggest that the SMP could make a useful contribution to the recovery services in mental health. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore how staff attend to their well-being when working in an inpatient mental health setting with older adults with dementia and complex mental health needs; how staff understand the link between their well-being and the well-being of patients. Design/methodology/approach – A semi-structured group interview was held with 11 members of two multidisciplinary teams. The discussion was audio-recorded and analysed using thematic analysis. Findings – Staff reported managing their well-being by both connecting with and avoiding the difficult emotions of the work. The team avoided the gravity of the work through humour, a task-focus, an absence of thinking and the displacement of workplace frustrations onto an outgroup. Connecting with emotions was done in tolerable ways: in contained reflective spaces, in the presence of supportive others, through genuine connections with patients as people and when the organisation demonstrated care for the staff. Practical implications – Avoidant strategies appeared to represent short-term ways of maintaining staff well-being, while connecting with the gravity of the work appeared to represent what we hope is a more sustainable approach to managing well-being. A crucial premise for staff well-being is teams embedded within organisations that care for their employees. Originality/value – Poor staff well-being can have serious consequences for an organisation, particularly in the existentially challenging environment of dementia care. This study offers a unique opportunity to explore staff well-being in a UK inpatient mental health setting with older adults with dementia and complex mental health needs. [ABSTRACT FROM AUTHOR]

Purpose - People with a learning disability remain at increased risk of abuse and neglect due to a number of factors associated with learning disability per se and the culture in which they live. Understanding the prevalence of abuse within this population allows for appropriate planning and service development. Understanding more about the type and frequency of abuse (and the perpetrators) facilitates prevention of abuse. The paper aims to discuss these issues. Design/methodology/approach - All clients allocated to a psychologist between 2009 and 2011 were included in this survey. The psychologist reported whether the client had experienced any abuse over their lifetime. Information regarding the type of abuse experienced, the relationship to the abuser, and the number of different episodes of abuse was recorded. Findings - Of the 695 clients in the survey 25 per cent had experienced abuse. Of this 25 per cent, 46 per cent were men and 54 per cent were women. In all, 23 per cent of the group who had experienced abuse were referred to the service as a direct result of abuse, whilst 77 per cent were referred for another reason. The most prevalent types of abuse were emotional (27 per cent), sexual (24 per cent), physical (20 per cent), and neglect (12 per cent). Originality/value - Prevalence rates within this study are broadly in line with the existing literature. However, differences included high levels of emotional abuse, and high frequency of abuse perpetrated by women, and by family members. Psychology services should routinely screen for abuse experiences and be alert to the possibility of abuse from female caregivers. [ABSTRACT FROM AUTHOR]

Purpose – The protection of vulnerable adults from abuse is paramount for those working in adult protection. However, staff supporting vulnerable adults who are alleged to have abused them can feel very vulnerable and their needs must also be taken into account. The purpose of this paper is to consider the impact of adult protection investigations from the experiences of people who have been identified as alleged perpetrators in adult protection cases in order to identify improvements in practice. Design/methodology/approach – This limited study used qualitative semi-structured interviews to collect data that reflected views of the issues and experiences of participants. Findings – This study shows that expectations set out in the Wales Interim Policy and Procedures document under “support for alleged perpetrators” do not match with the experience of those who took part in this study. The experience of some alleged perpetrators is that the investigation process can be protracted, they may be left isolated with little or no information and feel very vulnerable. Research limitations/implications – A limitation of this study was the small number of participants who were interviewed and the selection and bias. Participation was on a voluntary basis and the participants were self-selecting. The participants were all paid staff. Vulnerable adults who had been identified as alleged abusers were excluded from the study on the premise that their experiences were likely to be quite different. Practical implications – It is vital that alleged perpetrators are not themselves abused by the process. The findings from this study should be used to develop recommendations to improve practice. Originality/value – The effects on staff who have been investigated as alleged abusers under adult protection policy and procedures has been under-researched. This study will make a contribution to addressing this. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of the paper is to discuss how adult support and protection (ASP) work might support or further damage an adult's strengths, skills and sense of self. There is a particular focus on adults who require some support with decision-making. Design/methodology/approach – Forum theatre and other creative techniques were used to discuss ASP with 42 people who access support. A range of advice for practitioners was generated, a portion of which is reported here. The research design was participatory, with ten people who access support being members of the research team. Findings – ASP work can support or undermine an adult's strengths, skills and sense of self, depending on the way it is performed. Three inter-locking themes are presented to illustrate this finding. First, participants thought it might be intimidating to be "singled out", and wished to be understood in the context of their relationships. Second, ASP was thought likely to be experienced as a judgement on the person and their problem-solving skills. Third, people wanted to be "really listened to" and acknowledged as a person with preferences and strengths. Practical implications – It is important for practitioners to be mindful of the process of ASP work, as well as of its outcomes. Ways must be found to keep the person central, and to maintain and develop their strengths and sense of self. Originality/value – The perspectives of adults actually or potentially affected by ASP have been under-researched. This study adds substantially to the available evidence. [ABSTRACT FROM AUTHOR]

Purpose - This paper seeks to report upon psychiatric trainees' experience of providing psychodynamic therapy for the first time and their experience of group supervision.Design/methodology/approach - A total of five trainees, undertaking training in psychodynamic therapies, were interviewed on multiple occasions over an 18-month period - before, during, and after undertaking their first case of psychodynamic therapy. A semi-structured, qualitative interview approach was used to explore providing psychodynamic psychotherapy and participating in psychodynamic supervision groups. Interviews were transcribed in full and data analysed following the conventions of thematic analysis.Findings - Trainees' anxieties about working psychodynamically and their concerns for developing new competencies are recognised. Personal and professional challenges associated with this therapeutic approach are identified and the importance of "looking after" trainees is stressed; the role of trainee supervision groups in this is advocated. The potential challenges of integrating psychodynamic thinking into general psychiatric practice are discussed and suggestions to address these difficulties are proposed.Research limitations/implications - The small sample size reflects the total number of trainees participating in training at the time of the study; for future work, a larger sample drawn from multiple training centres would be recommended.Originality/value - Training in psychotherapy is now mandatory for all trainee psychiatrists and this is something which many trainees find daunting; training in psychodynamic techniques is particularly challenging. A fuller awareness and understanding of trainees' experiences is important in nurturing clinicians who are competent in psychodynamic thinking, and who might consequently apply these skills clinically. [ABSTRACT FROM AUTHOR]