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The proposed revision to mental health legislation of England and Wales has been long in gestation. In 1998 the government asked Professor Genevra Richardson to chair an expert committee to review the legislation and report (Department of Health, 1999a). By and large the committee’s recommendations were not accepted by government but were followed by a Green Paper in 1999 (Department of Health, 1999b), a White Paper in 2000 (Department of Health, 2000), and a draft Bill in 2002 (Department of Health, 2002). Organisations and individuals submitted over 2,000 commentaries on the draft Bill, many sharply critical of one or more aspects of the proposed legislation. Following further consideration by the Department of Health, including a series of stakeholder seminars during 2003 and early 2004, the revised draft Bill with guidance notes was published on 13 September 2004 accompanied by a composite response to the commentaries received in 2002 (Department of Health, 2004c; 2004a). As well as the more controversial aspects that have generated most debate, the Bill contains some positive developments. For example, the proposals for advocacy are to be welcomed, as is the drive towards more community treatment and, subject to some important caveats, the availability of a tribunal soon after initial admission to hospital is a step towards meeting UN recommendations for ‘speedy’ access to a court or similar body. Although this article will focus on the matters that have created most argument, it should not be assumed that everything about the Bill is contentious, or that there are not valuable aspects of the proposals that should be retained. At 307 clauses and 14 schedules the Bill is, on that measure, over twice as long as the Mental Health Act 1983 and, by common consent, is complex and difficult for the lay person to understand readily. This is a pity as one objective for the Bill was to create a new legal framework for the 21st century, recognising the trend towards community provision of mental health care over the last 20 years or so. Indeed, the Joint Committee on the Draft Bill suggested that any Bill presented to Parliament must be clearer and easier to read than the current draft. Whether the Bill achieves another objective of creating a radically new approach to compulsory care is open to question. Many important issues have caused controversy during preparation of the Bill but three particular changes introduced in the Bill raise significant concerns and deserve most attention. They are: (i) to amend (and widen) the conditions for compulsion in the 1983 Act; (ii) to place a Mental Health Tribunal on ‘entry’ to compulsion as well as ‘exit’; and (iii) to introduce non-resident orders – a form of community treatment provision. The last of these, although ostensibly one of the main reasons for new legislation, will be dealt with in this article in the context of decisions of the tribunal. Early in the preparation of the Bill the Department of Health came to the view that amending the Mental Health Act 1983 was not an option as it would require such fundamental change that a wholly new piece of legislation was needed. In the event, and without debating the many differences of view expressed by interested parties such as the Mental Health Alliance, the Bill itself has now been amended and modified to the point where revisions to the Mental Health Act 1983 could have conceivably provided an easier, more

Purpose This integrative review aimed to identify and synthesis literature on analysis techniques and methodological approaches used to analyse consumer measures in mental health research. Design/methodology/approach The review included papers published up to January 2020 across seven databases: CINAHL, Web of Science, Medline, PsycINFO, EMBASE, Scopus and Google Scholar. Data search and extraction was conducted according to the recommended guidelines for conducting review by Cochrane and Joanna Briggs Institute. Mixed method synthesis was used to integrate both qualitative and quantitative data into a single synthesis. Findings The initial search yielded a total of 2,282 papers. A total of 32 papers were included in the synthesis. Most of the included papers (25/32; 78.12%) focused on psychometric properties, whereas 14% (5/32) targeted analysis techniques, and 6.3% (2/32) addressed methodological justification. The measurement models (e.g. psychometric properties) were analysed through validity and reliability testing as part of instrument development and adaptation. The structural models were analysed using techniques such as structural equation modelling, multivariable regression models, intraclass correlation coefficient and partial least squares–structural equation modelling. Practical implications Although consumer-reported instruments are analysed using techniques involving linear, hierarchical and longitudinal effects, no attempt has been given to procedures that applied complex data mining or machine learning. Consumer researchers, clinicians and quality management are encouraged to apply rigorous analysis techniques to critically evaluate consumer outcome measures. Originality/value This review provides evidence on the analysis techniques in mental health research to inform the training of mental health professionals, students and quality assessment practitioners.

Purpose This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital. Design/methodology/approach This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis. Findings The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome. Practical implications Participants’ feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings. Originality/value This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting.

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 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.

Purpose The purpose of this paper is to describe and compare the attributes of community dwelling adults with serious mental health illnesses in the USA and Singapore in terms of perception of mental health recovery and its correlates, namely, strengths self-efficacy, resourcefulness and stigma experience. Design/methodology/approach A convenience sample of 100 participants from each country participated in the study by completing self-administered questionnaires. Findings The results showed high overall scores in mental health recovery, strengths self-efficacy and resourcefulness in both countries with only a statistically significant difference between both countries in mental health recovery. Participants in both countries also experienced stigma. Research limitations/implications The study not only enhanced the focus on mental health and its correlates but also suggested the need for efforts to de-stigmatize mental health conditions which could impact on mental health recovery. Originality/value This paper is original and adds on to the knowledge base on mental health recovery and its correlates through the unique opportunity to review information from both countries.

Purpose This paper aims to describe a service evaluation study of “Balance” – a National Health Service Tier 2 pilot weight management course delivered in a primary care mental health service. The 12 weekly sessions included dietetic, psychological and behavioural elements underpinned by cognitive behavioural theory and “third-wave” approaches, including acceptance and commitment therapy, compassion-focused therapy and mindfulness. Design/methodology/approach A mixed-methods design was used in this service evaluation study that included analysis of outcome measures (weight, eating choices, weight-related self-efficacy and mental health) and focus group data (n = 6) analysed using thematic analysis. Eleven clients with a body mass index of 25–40 kg/m2 enrolled, and nine clients completed the course. Outcome data were collected weekly with follow-up at three and six months. Findings Quantitative data analysis using non-parametric Wilcoxon signed-rank tests showed that the group mean weight decreased significantly (p = 0.030) by the end of Balance, but the group mean weight loss was not statistically significant at the three-month (p = 0.345) or six-month (p = 0.086) follow-up. The qualitative results showed that participants valued the course ethos of choice and also welcomed learning new tools and techniques. Balance was very well-received by participants who reported benefitting from improved well-being, group support and developing new weight management skills. Research limitations/implications Only one client attended all sessions of the group, and it is possible that missed sessions impacted effectiveness. Some of the weight change data collected at the six-month follow-up was self-reported (n = 4), which could reduce data reliability. Focus group participants were aware that Balance was a pilot with a risk that the group would not be continued. As the group wanted the pilot to be extended, the feedback may have been positively skewed. A small sample size limits interpretation of the results. A group weight management intervention, including dietetic, psychological and behavioural elements, underpinned by cognitive behavioural theory was well-received by service users and effective for some. Commissioners and service users may have different definitions of successful outcomes in weight management interventions. Practical implications Longer-term support and follow-up after Tier 2 weight management interventions may benefit service users and improve outcomes. Originality/value The paper contributes to a small but growing evidence base concerned with the design and delivery of weight management interventions. Areas of particular interest include: a gap analysis between the course content and National Institute for Health and Care Excellence clinical guidelines, participants’ views on the most impactful course features and recommendations for course development. The results also show a disconnect between evidence-based guidelines (mandatory weight monitoring), participants’ preferences and clinicians' experience. The difference between client and commissioner priorities is also discussed.

Purpose The purpose of the paper is to examine the likely impact of the COVID-19 pandemic on health with particular attention to the mental health of children, adolescents, and adults in the most populous country in Africa – Nigeria. Presently, the Coronavirus Disease-2019 (COVID-19) is well-established in Nigeria with increasing community transmission. While a significant response has been initiated by the Federal Government of Nigeria through a multidisciplinary task force, there are challenges for the country’s already weak health sector and invariably the mental health systems. For example, the testing capacity is inadequate because of limited technical, infrastructural, financial and logistical capacity to rapidly scale-up testing which could be a reflection of the health system. Design/methodology/approach In this paper, the authors examined and explored the impact of the COVID-19 pandemic on the prevalent public mental health challenges in Nigeria, the most populous country in sub-Saharan Africa. Findings The authors argued for sustained investments in digitally enhanced health-care delivery and medical surveillance system that incorporate public mental health in a way that accommodates equity in Nigeria. Originality/value The authors have examined the likely impact of the COVID-19 pandemic on health with particular attention to the mental health of children, adolescents and adults in the most populous country in Africa – Nigeria. Furthermore, they discussed emerging frameworks and strategies to build a clinical practice and research capacities for these populations

Purpose User involvement in research is entering the mainstream of traditional mental health research. In practice, there are diverse ways in which the process of involvement is experienced by mental health service user researchers. This paper aims to explore two diverse experiences of involvement by the researcher. Design/methodology/approach Auto-ethnography is the research methodology used in this study; it combines a process of reflective writing and critical analysis which enables the author to explore experiences of being both a service user and academic researcher. Two accounts of the author’s involvement in mental health research are presented: one which builds on a consultation model and the other based on co-production principles. Findings Experiences of power-sharing and collaborative decision-making, alongside disempowerment, are discussed, leading to exploration of the theoretical and practical processes for promoting participation of users in research. Research limitations/implications The research is limited because it is undertaken by one individual in a local setting, and is therefore is not generalisable; however, it provides useful insights into the diverse processes of involvement that many service users experience. Practical implications Recommendations are presented to support the involvement of service users in research, with final remarks offered considering the possible future implementation of this still emerging tradition. Originality/value This paper reflects on the experiences of one service user academic involved in research and highlights diverse experiences of both empowering and disempowering involvement, providing recommendations for best practice.

Purpose Refugee and asylum-seeking women are particularly vulnerable to experiencing mental health difficulties during the perinatal period, with social factors compounding these experiences. Research is limited into the mental health needs of perinatal women who are refugees or seeking asylum. The purpose of this paper is to examine the best available international evidence on this topic and to discuss the findings with relevance to the UK context. Design/methodology/approach A modified population, intervention, comparison, outcome was used to formulate the research question and search strategy. Databases searched were: cumulative index of nursing and allied health literature, Medline, PsychINFO, Web of Science and Scopus. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework, results were screened against an inclusion and exclusion criteria. Each study underwent a quality assessment in which they were appraised using the mixed methods appraisal tool. Findings Eight papers were retrieved, and a thematic analysis was conducted. Two major themes were identified: mental health needs and social influences. Refugees and asylum seekers are likely to have experienced trauma as reasons for migration. Post-migration stressors, including hostility and dispersal from social networks, lead to cumulative trauma. These each add to the mental health needs of perinatal refugee and asylum-seeking women that cannot be ignored by policymakers, health and social care services or professionals. Originality/value Refugee and asylum-seeking women are particularly vulnerable to mental health difficulties in the perinatal period. Stressors accumulated pre-, during and post-migration to the host country exacerbate mental distress. In the UK, the treatment of this population may be detrimental to their mental health, prompting the need for greater critical awareness of the socioecological environment that refugee or asylum-seeking women experience.

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.

Purpose Studies show that experiences of repeated or complex trauma are very common in patients with severe mental health problems. Unfortunately, many professionals do not routinely ask about abuse, due to concerns about how to ask and respond. There is also a need for frontline staff to be trained in trauma-informed care. The purpose of this paper is to identify the needs of inpatient staff and developed a tailor-made training package. Design/methodology/approach A training programme was developed from focus-group discussion and delivered to the team. Questionnaires were administered pre-, post-training and at three-month follow-up, to assess changes in knowledge, confidence and worries in the assessment and treatment of complex trauma. Findings There was an increase in self-reported staff confidence (p=0.001) and knowledge (p=0.028) about working with complex trauma and their worries decreased (p=0.026) between pre- and post-training. Practical implications In order to sustain the benefits of training for longer, recommendations were made to the service for on-going training, supervision and evaluation. Originality/value Given the recent interest in complex trauma within the literature (Diagnostic and Statistical Manual of Mental Disorders – Fifth Version (DSM-V); International Statistical Classification of Diseases – 11th Version (ICD-11)), the piloting and development of complex trauma training packages is timely. To the author’s knowledge, this is the first published account of complex trauma training for inpatient staff. This paper offers clinical and research implications to services who may want to develop as trauma-informed services within the NHS.

Purpose The purpose of this paper is to identify barriers for people with psychotic spectrum disorders accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be explored and if completion of this training effects referral behaviours and attitudes to CBTp. Design/methodology/approach This study is a quantitative service evaluation project which uses a questionnaire design to explore the factors that influence a clinician’s decision to refer a patient for CBTp. Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental health in NHS Lothian were invited to participate in the study. Findings CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates. Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and knowledge in CBTp. Originality/value This is the first paper of its kind to investigate the potential barriers to access to CBTp in Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers identified will be discussed.

Purpose The spread of novel coronavirus 2019 (COVID-19) has infected millions of people worldwide. Public health emergencies caused by COVID-19 affect not only people’s physical health but also mental health. This paper aims to summarize recent research findings on the mental health impact of COVID-19 experienced by the general adult population. Design/methodology/approach This paper used a systematic approach and aimed to review the literature on mental health problems faced by general adults during the COVID-19 pandemic. The PubMed database has been selected randomly from the Google Scholar, Cochrane Library, Embase and PubMed databases. Ten journal articles published between January and July 2020 were selected from the PubMed database for the final review. Findings There is growing evidence that COVID-19 may be an objective risk factor for mental distress among the general adult population. More psychological and social support should be provided to protect adult people’s mental health. Practical implications This review will help policymakers develop mental health interventions for the general adult population vulnerable to psychological distress because of COVID-19 pandemic. Originality/value This paper is original and contributes to the existing knowledge that the mental health challenges of COVID-19 are widespread. There is, therefore, a need for more psychological interventions for adults, older adults, in particular, to promote mental health and reduce the distress associated with public health emergencies caused by COVID-19.

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.

Purpose The purpose of this paper is to address a knowledge gap on advocacy outcomes from mental health service users’ perspective, and the implications for evaluating advocacy impact. The studies discussed highlight challenges for measuring the outcomes of advocacy, but underline the importance of doing so, and of involving service users alongside other stakeholders in co-designing evaluation systems. Design/methodology/approach The paper uses findings from three qualitative studies of independent advocacy involving focus groups and interviews with: 30 African and African Caribbean men who were mental health service users; 90 “qualifying patients” in a study of Independent Mental Health Advocate services; and nine young women in children and adolescent mental health services (CAMHS). Findings A comparative analysis and synthesis of findings from three studies identifies four common dimensions: how mental health advocacy is conceptualised and understood; how service users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacy outcomes. Advocacy outcomes were conceptualised as increasing involvement, changing care and treatment and supporting personal development. There was evidence of advocacy acting to empower mental health service users, and of broader impacts on service regimes and policies. However, there was limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen as important. Originality/value Few researchers have focused primarily on the perspectives of people using independent mental health advocacy, or on the experience of “advocacy as empowerment”, and none have done so across diverse groups. This analysis adds insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems.

Purpose Adolescent mental health issues are on the increase, in particular depression, which is now a major public health concern globally. Mental health education is important and young people’s awareness of mental health is potentially limited. This is one factor that creates barriers to seeking support. School nurses and educational professionals recognise that they do not necessarily have the required skill base to support emotional health concerns with young people. The purpose of this paper is to synthesise qualitative evidence related to the nurse’s role in supporting adolescents. Design/methodology/approach A literature review using a systematic approach was undertaken, predominantly through collection of primary qualitative research studies. In total, 22 published studies are included in this review, extracted from four databases – CINAHL, Embase, Medline and Scopus. Findings This review shows that awareness of mental health is needed early in adolescence, while at school, to encourage young people to access support and have knowledge of their own emotional health. The need for further mental health education and provision is asserted. Practical implications Young people benefit from someone who is accessible and familiar to them in schools so that they can access emotional support as and when needed. Careful involvement of families (including extended families) is noted. It is proposed that this role should be a mental health nurse role, who should be accessible within the school environment. Originality/value This paper is original and adds to existing knowledge that mental health challenges are increasing, and more needs to be done in schools to promote mental health and reduce the stigma associated with seeking support.

PurposeThe purpose of this paper is to delineate the overall theoretical framework on the topic of internet addiction through the comprehensive narrative review to make readers aware of the conceptual growth and development in the respective field. The paper evolves theoretically from the historical foundation, phenomenology, clinical feature, etiological model to the treatment outcome of internet addiction. Multiple studies have been done in the field of mental health but dearth of work given head to toe theoretical overview for understanding of this trendsetter research area in mental health.Design/methodology/approachExtensive review of literature has been carried out to make a systematic layout for conceptual paper.FindingsThe internet has been a source of gratification for several behavioral addictions as well as psychiatric disorders. Mainly because of the lack of established diagnostic criteria and a dearth of large sample surveys, the prevalence of problematic internet use (PIU) in general population has not been established. Still, from all the consolidated data, PIU seems to have a male preponderance and manifests itself in late adulthood. Symptoms of PIU can easily be masked with signs of dependence, tolerance and withdrawal which is quite similar to the phenomenology of substance addiction. Psychiatric co-morbidities are more of a norm than the exception in case of PIU. Even though the clinical status of PIU is doubtful, still there is a significant demand for its treatment all over the world. Overall, the excessive use of internet has been strongly debated in literature from PIU to a positive addiction. Only time will tell how it affects our civilization as a phenomenon of evolutionary significance.Originality/valueThe paper is providing a general conceptual framework for internet addiction/PIU to enable readers to know about the topic in depth from the evolution of the concept to the recent developments in the area.

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.

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.

Purpose The purpose of this paper is to critique Spandler and McKeown’s recent advocacy of a truth and reconciliation (T&R) process in psychiatry. Design/methodology/approach A critique of a recent paper in Mental Health Review Journal. Findings That Spandler and McKeown’s advocacy of a T&R process in psychiatry can be criticised from a number of inter-related practical, political and ethical perspectives. Originality/value The present critique contributes to the ongoing debate about the desirability of a T&R process in psychiatry.

Purpose The purpose of this paper is to provide qualitative evidence from the experience of Chinese service users in the UK to expand the literature on the use of intersectionality analysis in research on the mental health of ethnic minority groups. Design/methodology/approach Repeated in-depth life-history interviews were carried out with 22 participants. Interviews were analysed using the constant comparative method. Findings Four areas of life are identified for their possible negative impact on mental health for this minority group: labour market and work conditions, marriage and family, education, and ageing. The findings illustrate how these intersecting variables may shape the social conditions this ethnic minority group face. For this ethnic minority group in the UK, inequalities can intersect at national as well as transnational level. Originality/value This paper highlights how power relations and structural inequalities including class, gender, age and ethnicity could be drawn upon to understand the interplay of determinants of mental health for ethnic minority groups. As the multi-factorial social forces are closely related to the emergence of poor mental health, it is suggested that interventions to reduce mental health problems in ethnic minority communities should be multi-level and not limited to individualised service responses.

Purpose Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health. Design/methodology/approach The authors conducted a systematic literature search using the Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors included studies of participants with a mental illness facing a mental health care decision, their caregivers, and providers. Findings A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting. Originality/value The review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.

Purpose The purpose of this paper is to identify and describe, in a systematic way, the various academic discourses on the rationale for shared decision making (SDM) in mental health care, and so provide a comprehensive account of the ways in which this emerging field is being conceptualised in the research literature. Design/methodology/approach This study is a systematic review of peer-reviewed papers presenting a rationale for SDM in mental health. Relevant databases were searched from inception to July 2016. Data were analysed using a thematic analysis which aimed to identify and describe different discourses on the rationale for SDM in mental health care. Data were extracted into a standardised data extraction form which contained fields representing the developing thematic framework, study information and research methodology. Findings An initial search returned returned 1,616 papers, of which 175 were eligible for inclusion in this review. The authors developed ten distinct but interrelated themes which capture the various academic discourses on the rationale for SDM and represent some compelling arguments for SDM from a range of different perspectives including ethical, clinical, “user” focussed, economic and political. Dominant narratives in the literature linked SDM to the recovery moment and person-centred care, and adherence and engagement with mental health services. Research limitations/implications The authors are unable to make any conclusions about the strength of evidence for these rationales. The review was restricted to peer-reviewed publications, published in English. Practical implications The findings could be a useful framework to support the selection of outcome measures for SDM evaluations. Originality/value There have been no systematic reviews published in this area previously.

Purpose The purpose of this paper is to consider the role of shared decision making (SDM) as one component of recovery-oriented care. Design/methodology/approach This paper is conceptual and reviews the literature relevant to recovery-oriented care, person-centered recovery planning (PCRP), and SDM. Findings To the degree to which SDM offers tools for sharing useful information about treatment options with service users and family members or other loved ones, it can be considered a valuable addition to the recovery-oriented armamentarium. It is important to emphasize, though, that recovery-oriented practice has a broader focus on the person’s overall life in the community and is not limited to formal treatments or other professionally delivered interventions. Within the more holistic context of recovery, SDM regarding such interventions is only one tool among many, which needs to be integrated within an overall PCRP process. More emphasis is given within the recovery-oriented care to activating and equipping persons for exercising self-care and for pursuing a life they have reason to value, and the nature of the relationships required to promote such processes will be identified. In describing the nature of these relationships, it will become evident that decision making is only one of many processes that need to be shared between persons in recovery and those who accept responsibility for promoting and supporting that person’s recovery. Originality/value By viewing SDM within the context of recovery, this paper provides a framework that can assist in the implementation of SDM in routine mental health care.

Purpose While shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. The purpose of this paper to review existing developments, contemporary challenges, and evidence regarding SDM in mental health with a particular focus on the perspectives of service users. Design/methodology/approach This is a review of international papers analysed using narrative synthesis of relevant data bases. Findings The review shows significant barriers to the utilisation of SDM including ethical and legal frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance of power and feel they lack choices, being “done to” rather than “worked with”. Practical implications The paper also presents perspectives about how barriers can be overcome, and service users enabled to take back power and acknowledge their own expertise. Originality/value This review is the first with a particular focus on the perspectives of service users and SDM.

Purpose The purpose of this paper is to explore the case for a truth and reconciliation (T&R) process in the context of mental health services. Design/methodology/approach The approach is a conceptual review of T&R approaches; a consideration of why they are important; and how they might be applied in the context of mental health services and psychiatry. First, the paper sets out a case for T&R in psychiatry, giving some recent examples of how this might work in practice. Then it outlines potential objections which complicate any simplistic adoption of T&R in this context. Findings In the absence of an officially sanctioned T&R process a grassroots reparative initiative in mental health services may be an innovative bottom-up approach to transitional justice. This would bring together service users, survivors and refusers of services, with staff who work/ed in them, to begin the work of healing the hurtful effects of experiences in the system. Originality/value This is the first paper in a peer-reviewed journal to explore the case for T&R in mental health services. The authors describe an innovative T&R process as an important transitional step towards accomplishing reparation and justice by acknowledging the breadth and depth of service user and survivor grievances. This may be a precondition for effective alliances between workers and service users/survivors. As a result, new forms of dialogic communication and horizontal democracy might emerge that could sustain future alliances and prefigure the social relations necessary for more humane mental health services.

Purpose: To conduct a systematic search of the peer-reviewed qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties, to appraise the quality of the existing literature and synthesise findings.\ud \ud Background: Seclusion is a controversial intervention for the short-term management of unsafe behaviours in inpatient mental health services. There has been some sporadic interest in the service-users' experiences of this.\ud \ud Design: Systematic literature review and meta-synthesis.\ud \ud Data Sources: Databases MEDLINE, EMBASE, CINAHL and PSYCHINFO were searched in July 2015.\ud \ud Review Methods: The JBI QARI tools for critical appraisal and data extraction were used to review papers and synthesise findings.\ud \ud Findings: A small number of papers was found, which were of mixed quality.\ud \ud Value: The existing research is limited in both quantity and quality. Although most participants from the existing research described seclusion as mostly negative with the potential for causing iatrogenic harm, some described more positive experiences, often in the context of compassionate interactions with staff.\ud \ud Summary Statement: \ud \ud Why is this research or review needed? \ud • The use of seclusion is common within mental health services but there is an absence of evidence for the purported theoretical rationale for its use. \ud • Studies of the experiences of individuals placed in seclusion are small in number, of mixed quality and with mixed findings. \ud • A systematic literature review and meta-synthesis of the existing qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties was conducted, to synthesize the existing evidence base and make suggestions for future developments in research and practice. \ud \ud What are the key findings? \ud • The existing research is limited both in quantity and quality.\ud • Despite the limitations of existing research, the evidence does not support the purported theoretical rationale for the therapeutic use of seclusion. This poses a significant challenge to a common practice within mental health settings. \ud • Seclusion has the potential to cause iatrogenic harm, particularly where interactions with nursing staff are not experienced as compassionate.\ud • The actions of nursing staff in implementing seclusion procedures may mitigate iatrogenic harm. \ud • Individuals who have experienced seclusion have suggestions for how to improve its use.\ud \ud How should the findings be used to influence policy/practice/research/education? \ud • There is clearly scope for further, high quality research into people’s experiences of seclusion, particularly within the UK.\ud • The findings include concrete ways in which the practice of seclusion can be improved.\ud • Action research methods may offer a useful way of implementing and evaluating changes in practice.

Purpose – Multidisciplinary team (MDT) clinical supervision is being used in many mental health services but at present has not received adequate attention by researchers in order to generate evidence-based approaches. The purpose of this paper is to explore the utility and staff perspectives of an MDT model of clinical supervision in the form of a “Clinical Discussion Group” (CDG) on an acute inpatient mental health ward within the context of the current literature on the components of effective supervision in order to make recommendations for practice. Design/methodology/approach – In total, 12 members of staff working on the ward were interviewed to gather their perspective on attendance, helpful aspects, outcomes, unhelpful aspects, and changes. Interview transcripts were analysed using thematic analysis. Findings – In total, 11 themes were identified, three within “The Group and how it operates” (attendance, discussion topics and facilitation), five within “Impact and Usefulness” (valued by staff, understanding a case, emotional benefit, learning and working together as a team) and three within “Changes to the Group” (organisation, discussion topic and group outcomes). Originality/value – This paper explores the benefits and challenges of a CDG from the perspective of the staff who attend. It presents some recommendations for good practice which should be of use to managers and supervisors who wish to use team supervision to improve patient outcomes and also makes suggestions for future research in this field.

Purpose – Co-production is becoming a more widely used term in mental health care in England, but it is not always clear what this means nor what the evidence base is behind particular uses of the concept. The purpose of this paper is to set some of this discussion into a historical context and examine some of the relevant evidence base to begin to highlight the challenges with operationalising more co-production. This is by way of setting the scene for the other articles in this special edition of the journal. The paper then provides an overview of the other articles on co-production in this edition. Design/methodology/approach – The paper is a short review and discussion of some key issues and evidence relevant to co-production in mental health. Findings – Some key historical insights from other moves to transform mental health care are discussed, recognising that these developments can take a long time to reach maturity in services and practice across the whole country. The discussion of some pertinent research and of the other articles in this special edition helps to highlight what foundations the author have in place for greater co-production in mental health care, and what remains as some of the challenges and gaps in the knowledge. Originality/value – The paper provides a historical overview of some key issues, evidence and lessons pertaining to moves to develop more co-production in mental health.

Purpose – The purpose of this paper is to reflect on the process of co-producing mental health research where work was shared between university academics, charity-based researchers and a Lived Experience Advisory Panel. Design/methodology/approach – The authors express the opinions of a research team made up of people with experience of using mental health services, being carers and being academically trained researchers from a range of health and social science disciplines. Some had experience in several areas. The paper is co-produced to provide collective reflection and recommendations. Findings – Co-production of research is not well documented in published literature. The authors believe there is scope to develop co-production approaches, but further conceptual and theoretical work is needed alongside empirical studies. A socially situated complex research project, possibly involving multi-stakeholder groups, demands flexibility in approach. Similarly to user-controlled and other emancipatory methodologies, co-production makes the democratisation of research a primary objective in order to produce better quality and more relevant studies. Co-production also addresses inequalities in power and control within research projects; this way of working does provide a healthy challenge to traditional research hierarchies. Practical implications – Lessons learned should be honestly shared to develop co-production research methods. Projects need to have a strategy for how to value different contributions and facilitate constructive relationships if discord emerges. Establishing clear project roles, expectations and process for payment are essential in developing genuine collaborative partnerships. Originality/value – It is a viewpoint paper.

Purpose– The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration.Design/methodology/approach– The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice.Findings– Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care.Research limitations/implications– Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic.Practical implications– Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors.Social implications– The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Roseet al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise.Originality/value– This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.

Purpose – The purpose of this paper is to explore the issues surrounding a long planned expansion of Payment by Results (PbR) into mental health services and to highlight the factors responsible for the delay. Design/methodology/approach – PbR relies upon “standardisation” of conditions and treatments. This depends upon a scheme of classification that can realistically predict resources required to execute treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this way have been delayed, and a key reason is the lack of high-quality data. This would require effective “standardisation-to the-average” of both a system of classification and a repertoire of costed treatment pathways. This paper investigated the delay implementation by exploring the difficulties in applying standardisation principles to service provision and tariff calculation. Findings – The paper identified the fundamental difficulty with PbR’s implementation in applying “standardisation” to practice. This is defining the mental disorder that the patient is suffering and designing care pathways at clinical level considering the balance between practical applicability and conceptual/constructional validity. This is necessary to enable the calculation of a national tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional shortcomings which compromised the credibility and validity of Mental Health Clustering Tool regarding making accurate classification in a standardised way. The validity and credibility of calculating a national tariff thus became contentious on the basis of this inaccurate clinical classification system. Originality/value – This paper explored the driving factors of delay in implementing PbR in mental health through connecting the recent reform with the fundamental assumptions of “standardisation-to the-average”, which provided another perspective to illustrate the current obstacles.

Purpose – As well as working with people who have serious mental health problems, mental health nurses have to maintain a values-based approach to their interactions with mental health service users. However, some have suggested that students and newly qualified nurses are unprepared for this role. The purpose of this paper is to explore perceptions of practising mental health nurses, third year mental health nurse students and lecturers about how well students are being prepared for practice. Design/methodology/approach – A two-phase phenomenological study within a mental health nurse training institution and with staff from a Mental Health Trust in England. The study collected questionnaire responses from 87 participants (42 third year mental health nurse students, 39 practising mental health nurses and six nurse lecturers). A Likert scale questionnaire with written feedback produced data that formed the schedule for ten subsequent focus groups with 41 participants from the above categories. Focus group data were analysed using a process of interpretive phenomenological analysis. This led to the development of three main study themes. The transition from student to registered nurse is difficult, the importance of learning from experience, violence and aggression is difficult to manage, working effectively with victims of sexual abuse or those who have a diagnosis of personality disorder is difficult. Findings – Whilst the study found some evidence to suggest the development of positive values there is a perception that newly qualified mental health nurses lack confidence in other important areas. Participants also expressed doubt about whether it was possible to prepare someone for practice completely. Another finding was that the relationship between student and the mentor is critical to the quality of practice learning. Research limitations/implications – Study limitations are that this is a small selection of participants from one particular area. The researcher attempted to ensure that this study has internal validity. However, it is possible to question the extent to which findings may apply to other areas. Therefore, this study may be most useful to others as a basis for the discussion and comparison of these issues within mental health nurse educators. Practical implications – The need to encourage proactive learning approaches in students is emphasised. Universities should facilitate the sharing of clinical learning experiences as well as developing realistic training in the management of violence and aggression. It is possible to question how well nurses are prepared to work with the physical health needs of service users. Originality/value – This paper gives information about mental health nurse preparation for practice, which will be of value to training organisations as well as to employers of newly qualified mental health nursing staff.

Purpose – The purpose of this paper is to systematically appraise the effect of use of interpreters for mental health problems in old age. The primary objective of the review is to assess the impact of a language barrier for assessment and management in relation to mental health problems in the old age. The secondary objectives are to assess the effect of the use of interpreters on patient satisfaction and quality of care, identify good practice and make recommendations for research and practice in the old age mental health. Design/methodology/approach – The following data sources were searched for publications between 1966 and 2011: PubMed, PsycINFO, CINAHL and Cochrane Library. The authors found in previous reviews that a substantial number of papers from developing and non-English speaking countries are published in journals not indexed in mainstream databases, and devised a search strategy using Google which identified a number of papers, which could not be found when the search was limited to scientific data bases only (Farooq et al., 2009). The strategy was considered especially important for this review which focuses on communication across many different languages. Thus, the authors conducted a search of the World Wide Web using Google Scholar, employing the search term Medical Interpreters and Mental Health. The search included literature in all languages. The authors also searched the reference lists of included and excluded studies for additional relevant papers. Bibliographies of systematic review articles published in the last five years were also examined to identify pertinent studies. Findings – Only four publications related specifically to “old age” and 33 addressed “interpreting” and “psychiatry” generally. Four articles presented original research (Parnes and Westfall, 2003; Hasset and George, 2002; Sadavoy et al., 2004; Van de Mieroop et al., 2012). One article (Shah, 1997) reports an “anecdotal descriptive account” of interviewing elderly people from ethnic backgrounds in a psychogeriatric service in Melbourne and does not report any data. Therefore, only four papers met the inclusion and exclusion criteria and present original research in the field of “old age”, “psychiatry” and “interpreting”. None of these papers present UK-based research. One is a quantitative study from Australia (Hasset and George, 2002), the second is a qualitative study from Canada (Sadavoy et al., 2004), in the third paper Van de Mieroop et al. (2012) describe community interpreting in a Belgian old home and the final paper is an American case study (Parnes and Westfall, 2003). Practical implications – Interviewing older patients for constructs like cognitive function and decision-making capacity through interpreters can pose significant clinical and legal problems. There is urgent need for training mental health professionals for developing skills to overcome the language barrier and for interpreters to be trained for work in psychogeriatrics. Social implications – The literature on working through interpreters is limited to a few empirical studies. This has serious consequences for service users such as lack of trust in services, clinical errors and neglect of human rights. Further studies are needed to understand the extent of problem and how effective interpreting and translating services can be provided in the routine clinical practice. It is also essential to develop a standard of translation services in mental health that can be measured for their quality and also efficiency. At present such a quality standard is not available in the UK, unlike Sweden (see www.regeringen.se/sb/d/3288/a/19564). This omission is disturbing – especially when decisions on human rights are being considered as part of the Mental Health Act. Such a standard can best be achieved by collaboration between medical profession and linguists’ professional associations (Cambridge et al., 2012). Originality/value – Whilst translation/interpretation has been addressed more generally in mental health: specific considerations related to old age psychiatry are almost absent. This needs urgent rectification given that a large proportion of older people from BME communities will require translation and interpretation services.

Purpose – The purpose of this paper is to explore physical and mental health patients’ experience of multidisciplinary team (MDT) care and decision making in order to highlight factors underlying effective care and to identify areas in which patient experience could be improved. Design/methodology/approach – Totally, 12 MDTs within the North Thames area participated; the authors recruited 13 patients from physical health MDTs and seven patients from mental health MDTs. The authors conducted semi-structured interviews with each participant and thematically analysed the transcripts. Findings – The study found a marked contrast in patient experience: physical health patients emphasised their faith in the judgement of MDT clinicians, described experiencing high quality care and expressed a strong preference not to attend MDT meetings; mental health patients highlighted a range of negative experiences, were frequently sceptical about their diagnosis, and expressed a desire to have greater involvement in the decisions directing their care. Research limitations/implications – It was necessary to revise the initial target of interviewing six patients per MDT due to recruitment difficulties. Practical implications – In order to improve care, mental health MDTs should focus on promoting a shared understanding of illness by increasing the transparency of the diagnostic process. Key factors underlying effective MDT care in physical health services include enabling patients to determine their level of involvement in decision making and ensuring patients have a clear understanding of their care plan. Originality/value – The paper highlights the importance of mental health MDTs focusing on developing a shared understanding of illness with their patients.

Purpose – The purpose of this paper is to present findings from the Trans Mental Health Study (McNeil et al., 2012) – the largest survey of the UK trans population to date and the first to explore trans mental health and well-being within a UK context. Findings around suicidal ideation and suicide attempt are presented and the impact of gender dysphoria, minority stress and medical delay, in particular, are highlighted. Design/methodology/approach – This represents a narrative analysis of qualitative sections of a survey that utilised both open and closed questions. The study drew on a non-random sample (n=889), obtained via a range of UK-based support organisations and services. Findings – The study revealed high rates of suicidal ideation (84 per cent lifetime prevalence) and attempted suicide (48 per cent lifetime prevalence) within this sample. A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors. Subsequently, gender dysphoria, confusion/denial about gender, fears around transitioning, gender reassignment treatment delays and refusals, and social stigma increased suicide risk within this sample. Research limitations/implications – Due to the limitations of undertaking research with this population, the research is not demographically representative. Practical implications – The study found that trans people are most at risk prior to social and/or medical transition and that, in many cases, trans people who require access to hormones and surgery can be left unsupported for dangerously long periods of time. The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritise timely intervention and support. Originality/value – The first exploration of suicidal ideation and suicide attempt within the UK trans population revealing key findings pertaining to social and medical transition, crucial for policy makers, commissioners and practitioners working across gender identity services, mental health services and suicide prevention.

Purpose – The purpose of this paper is to highlight the findings of a service evaluation project assessing the impact of team consultation to criminal justice staff working with personality disordered offenders. Design/methodology/approach – A qualitative design using content analysis of focus groups and individual semi-structured interviews. Findings – Criminal justice staff report increased awareness and understanding, use of a person-centred approach, development of formulation skills and defensible practice following team consultation. Practical implications – This paper will be of interest to practitioners who offer and/or receive consultation for work with offenders with personality disorder. Suggested changes to team consultation formats may be of interest to services involved with the Offender Personality Disorder Pathway. Originality/value – This paper contributes towards the emerging literature on the role of consultation and formulation on workforce development for individuals with personality disorder. It also contributes to the evaluation of the services offered by this specialist team as they support probation Trusts across Yorkshire/Humber to support the community specification of the national Offender Personality Disorder Pathway.

Purpose– The purpose of this paper is to critically discuss how the psy-sciences have been, and continue to be, typified by some critics, as colonizers and are credited with Imperialistic motivations. However, rarely are these critiques developed beyond a pejorative characterisation.Design/methodology/approach– This paper reviews the criticisms of psychiatry as colonial and outlines the tensions in taking different frames of reference in the mental health field, before going on to suggest theoretical and research perspectives arising from postcolonial theory that might advance these critical positions more coherently and the implications of doing so.Findings– This study suggests an engagement with humanities-based methods and fields such as postcolonial scholarship.Social implications– This argument is timely, especially given recent controversies over the publication of DSM5, the scaling up agenda for mental health in the Global South and increased attention to the agenda of Big Pharma.Originality/value– Postcolonial intersections with psy-science remains a relatively undeveloped area in the critical literature.

Purpose – The concept of recovery is well accepted internationally as a guiding vision for mental health services. The purpose of this paper is to highlight the challenges faced by in-home psychiatric support workers in implementing this vision in their work with clients with severe psychiatric disability. Design/methodology/approach – The findings reported here are based on interviews with 27 support workers and ten managers of organisations providing support services. These were collected as part of evaluations of two supported housing programmes carried out between 2010 and 2011. Findings – Challenges faced by support workers coalesced around two areas: first, balancing the need to provide care with the need to promote autonomy and second, developing an effective working relationship while working mainly within a clients’ home. Practical implications – These challenges for support workers highlight tensions within the recovery vision that are not easily resolved. To ensure high quality, recovery-oriented care services are provided, support workers need access to training courses that focus on challenging areas of this work and should be provided with regular professional supervision. Originality/value – Existing literature on support workers has generally focused on the nature of the role and support worker interactions with other health workers. In this paper, the authors highlight difficulties faced by support workers in implementing the vision of recovery in their work. The paper provides important information for policy makers and managers who are designing service delivery systems that aim to promote recovery.

Purpose – A public health approach for promoting mental health has become a major health policy agenda of many governments. Despite this worldwide attention on research addressing population mental health and general wellbeing, very little is heard on positive mental health from the low-and middle-income countries. This paper aims to present an attempt to develop a model of positive mental health among young people. This could be used for integrating the concept of positive mental health (PMH) into public health interventions. Design/methodology/approach – The study was conducted in the state of Kerala, India. The paper administered the “Achutha Menon Centre Positive Mental health Scale” to a sample of 453 (230 men and 223 women) in the age group 18-24, along with an interview schedule exploring the relationship of PMH with many explanatory variables such as sex, beliefs, religion, education, employment and social capital. The paper developed an input path model through a series of multiple regressions explaining the levels of PMH in the community, which was then tested statistically (using AMOS version 7.0). The input model was created by identifying the determinants and correlates of PMH based on their predictive power on the outcome variable, the PMH score. The input diagram was used to test the model fit of the data. Findings – The path model (Figure 1) clearly specified the determinants of PMH. Among them, the variables that have a direct determinant effect on PMH are: quality of home learning environment, employment status, education status, marital status, self-perception on possession of skills, happiness with life, membership in social organizations and socializing capability. Research limitations/implications – In this study, path model is used to confirm relationships among observed and latent variables. The path diagram assesses the comparative strength of the correlations between the variables and does not test the directionality. Or, the model itself cannot prove causation. Practical implications – Determinants of PMH those are amenable to interventions as well as those which help in recognizing characteristic groups for intervention could help to plan future intervention programs. Originality/value – Original paper based on primary data collected through a cross-sectional survey.

Purpose– There is growing evidence that health behaviour change interventions are associated with mental health and wellbeing improvements. This paper aims to examine the effect of healthy lifestyle interventions on mental wellbeing.Design/methodology/approach– Six databases (Medline, Evidence Based Medicine Cochrane Registered Controlled Trials, Evidence Based Medicine Full Text Reviews, British Nursing Index, Embase, PsycINFO) were searched from database commencement up to April 2013. A broad focus on lifestyle interventions and mental health and wellbeing outcomes was chosen. Papers were systematically extracted by title then abstract according to predefined inclusion and exclusion criteria. Inclusion criteria: any individual population (non-couple/family); any health behaviour change interventions; mental health and wellbeing outcomes; and a one-two level of evidence. Interventions aimed at workers were excluded, as were articles assessing cognitive functioning rather than mental health or wellbeing, or those using medications in interventions.Findings– Two authors reviewed 95 full papers. In total, 29 papers met inclusion criteria, representing a range of interventions spanning physical activity, diet, alcohol intake, drug use and smoking. A range of measures were used. The majority (n=25) of studies demonstrated improvements on at least one indicator of mental health and wellbeing. Limitations include the broad range of outcome measures used, varied follow-up times and the lack of detail in reporting interventions.Originality/value– Health behaviour change interventions targeting physical outcomes appear to have benefits to mental health and wellbeing spanning healthy populations and those with physical or mental health problems. Evidence is strongest for interventions targeting exercise and diet, particularly in combination and the actual lifestyle changes made and adherence appear to be important. However, it is not clear from this review which specific components are necessary or essential for improvements in mental health and wellbeing.

Purpose – The internet plays an important role in the lives of self-harming and suicidal young people yet little is known about how internet use influences this behaviour. The purpose of this paper is to examine the evidence base with a view to determining directions for future research and practice. Design/methodology/approach – Literature relating to self-harming and suicidal behaviour, young people, and the internet is reviewed with a focus on content and methodology. Findings – The internet provides access to: “how-to” descriptions of suicide; unregulated/illegal online pharmacies; forums to spread this information; access to others seeking to end their own lives. Such sites are believed to elevate risk amongst vulnerable individuals. Conversely, the internet provides access to intervention and prevention activity, online support groups, advice, and personal chat. These can be a key resource in helping young people. There is a lack of consensus on what constitutes harmful and helpful online exchange, often evidenced in disparity between the perceptions of professionals and users. Research limitations/implications – Research is needed to map out a more accurate picture of suicide and self-harm resources on the internet and to establish a consensus about what constitutes harmful and helpful exchange. This needs to be based on: a comprehensive and informed range of search terms; a clear distinction between types of resource; a clear and consistent rationale for distinguishing and categorizing sites; a systematic replicable methodology for plotting the scope, content, accessibility, and popularity of web resources at a given point in time; the views of young people who use these sites, as well as practitioners and professionals. Practical implications – Practitioners need to: regularly assess the quantity, quality, and nature of self-harm/suicide focused internet use amongst service users; be aware of which sites are most appropriate for particular individuals; promote sites directed at young people that enhance effective coping. Professional mental health organizations need to find ways of ensuring that: they are consistently well represented amongst search results online; sites are readily accessible; more practitioners are trained in text-based communications. Originality/value – This paper offers a framework and rationale for future research and for those involved in service provision, policy, and practice.

Purpose – The number of gardening-based mental health interventions is increasing, yet when the literature was last reviewed in 2003, limited evidence of their effectiveness was identified. The purpose of this paper is to evaluate the current evidence-base for gardening-based mental health interventions and projects through examining their reported benefits and the quality of research in this field. Design/methodology/approach – Studies evaluating the benefits of gardening-based interventions for adults experiencing mental health difficulties were identified through an electronic database search. Information on the content and theoretical foundations of the interventions, the identified benefits of the interventions and the study methodology was extracted and synthesised. Findings – Ten papers published since 2003 met the inclusion criteria. All reported positive effects of gardening as a mental health intervention for service users, including reduced symptoms of depression and anxiety. Participants described a range of benefits across emotional, social, vocational, physical and spiritual domains. Overall the research was of a considerably higher quality than that reviewed in 2003, providing more convincing evidence in support of gardening-based interventions. However, none of the studies employed a randomised-controlled trial design. Research limitations/implications – There is a need for further high-quality research in this field. It is important that adequate outcome measures are in place to evaluate existing gardening-based mental health interventions/projects effectively. Originality/value – This paper provides an up-to-date critique of the evidence for gardening-based mental health interventions, highlighting their potential clinical value.

Purpose – The purpose of this paper is to establish that social determinants are vital contributing factors to mental health difficulties and that, similar to physical health, mental health follows a social gradient. Despite this acknowledgement, there is a rhetoric/reality gap found in social determinants of mental health (SDMH). It will be argued in this paper that this rhetoric/reality gap is located on a number of levels, including theoretical, methodological, practical, political and policy based, which are proposed here to be interrelated. Design/methodology/approach – The approach is a conceptual analysis of the rhetoric/reality gap found in SDMH using a critical perspective. It draws on a wide variety of theories in order to provide an analysis of the issues outlined. Findings – The paper's central finding is that there is a dissonance between the dominant ontological, epistemological and methodological, or axiomatic, focus in contemporary mental health theory and practice and SDMH. This dissonance has led to a form of “analysis paralysis” on all levels, and the initiatives required to tackle SDMH have been marginalised in favour of a narrow interpretation of evidence-based research and its accompanying ideology centring on the individual, which has established itself as a primary position on what constitutes valid knowledge to the detriment of other views. Originality/value – The paper offers a critical perspective on an area of SDMH which is often alluded to but never explicitly explored, and questions the underlying assumptions inherent to mental health theory and practice. The paper's value is that it draws attention to this particular dilemma on a wider scale, including on a political and policy-based level, which is often neglected in mental health theory, and it makes some recommendations on how to move forward.

Purpose– The Mental Health Recovery Star (MHRS) has received focus at a national policy level in consideration of outcome measurement within mental health services. The purpose of this paper is to seek the views of mental health professionals about its use within clinical practice.Design/methodology/approach– The paper employed a qualitative, exploratory design to interview 12 participants. Thematic analysis was used.Findings– Four main themes were identified: “the utility of the Recovery Star”; “not for everybody”; “service user involvement”; and “the status of the Recovery Star within the Trust”. A range of factors was found to influence participants’ use of the tool with service users.Research limitations/implications– The paper involved a small number of participants due to a low response rate. Future research could include larger studies and more detailed exploration of factors identified as limiting the use of the MHRS.Practical implications– The MHRS is a potentially useful tool but its limitations and the influence of organisational context must be considered as part of any plan to systematically implement its use within services.Originality/value– To the authors’ knowledge, this is the first study of the views of mental health professionals about the MHRS. As it is professionals who are likely to determine whether and how the tool is used, the paper is seen as a valuable initial investigation.

Purpose – This paper adds to growing research of psychiatric intensive care units (PICU) by recounting descriptions of psychiatric intensive care settings and discusses the perceptions held by nurses of the organisational interfaces, arrangements and provisions of care in these settings. Design/methodology/approach – Data gathered from focus groups held with nurses from two PICUs was used to establish terminology, defining attributes, related concepts, antecedents, values, processes and concepts related to current practices. A literature search was conducted to permit a review of the conceptual arrangements and contemporary understanding of intensive care for people experiencing acute psychiatric illness based on the perspectives held by the nurses from the focus groups. Findings – Dissonance between service needs and the needs and management of individual patients overshadow strategies to implement comprehensive recovery-oriented approaches. Three factors are reported in this paper that influence standards and procedural practice in PICU; organisational structures; physical structures; and subtype nomenclature. Practical implications – Acute inpatient care is an important part of a comprehensive approach to mental health services. Commonly intensive acute care is delivered in specialised wards or units co-located with acute mental health inpatient units mostly known as PICU. Evidence of the most effective treatment and approaches in intensive care settings that support comprehensive recovery for improved outcomes is nascent. Originality/value – Current descriptions from nurses substantiate wide variations in the provisions, design and classifications of psychiatric intensive care. Idiosyncratic and localised conceptions of psychiatric intensive care are not adequately entailing effective treatment and methods in support of recovery principles for improved and comprehensive outcomes. The authors suggest that more concrete descriptions, guidelines, training and policies for provision of intensive psychiatric health care encompassing the perspective of nursing professionals, would reinforce conceptual construction and thus optimum treatments within a comprehensive, recovery-oriented approach to mental health services.

PurposeThe purpose of this paper is to reflect on the novel use of the compassion focused formulation framework, to give thought to the ways that staff can be distracted from their primary task. It aims to examine systemic ideas for supporting staff to be effective and compassionate in their mental health care.Design/methodology/approachThis paper is a reflective piece using qualitative data and experience to frame the information.FindingsStaff have a variety of ways of coping with the stress of their work and some of these ways are more helpful than others. The formulation framework creates a helpful structure for understanding these strategies in a non‐blaming way. This facilitates reflective practice and the model points to ways that compassionate organisations can help staff in their primary task.Originality/valueThe CFT formulation has not been applied systemically in the literature to organisations or groups of staff.

PurposeThere is a large and increasing evidence base for cognitive behavioural therapy (CBT) for the amelioration of common mental health difficulties. In children and young people with autism, there is some evidence that CBT can be effective; however, it is unclear whether this also applies to adults with autistic spectrum disorders (ASDs). This review aimed to evaluate the evidence for the use of CBT with adults with ASDs in relation to reducing comorbid psychiatric symptoms and increasing social and communication skills.Design/methodology/approachA systematic search was conducted to identify best evidence. Comparison to predetermined inclusion and exclusion criteria identified seven relevant studies; these were subsequently critically appraised.FindingsThe results of the appraisal were mixed with no definitive evidence supporting the review question.Practical implicationsBasing assumptions on best evidence, it is suggested that CBT can help adults with ASDs decrease comorbid psychiatric symptomatology. However, there is little evidence that CBT can increase social and communicative functioning. The review concludes that there is a need for increased quantitative research in this area so that more substantial conclusions can be made.Originality/valueThis paper summarises the available evidence in relation to CBT for adults with ASD; most previous review papers have focused on children and young people. Future research directions are suggested.

PurposeMental health reform needs to engage leaders across jurisdictions and governments/communities. This paper aims to describe the history leading to the establishment of the Australian National Mental Commission (the Commission) in 2012 and to identify opportunities/challenges in cross jurisdictional/sectoral reform of mental health services.Design/methodology/approachThis case study is based on the observations of the author who has held lead state and national roles prior to leading the Commission. It sets the establishment of the Commission in the broader context of changing community attitudes, strong consumer/carer advocacy, increased financial support for mental health and establishment of state commissions.FindingsCross sectoral/jurisdictional reform needs leadership from government heads and central agencies. Risks relate to the need to effectively articulate state and national commissions and challenges accompanying multilateral stakeholders with high and often conflicting expectations, and tensions with other high priority issues that also require alignment between Federal and State leaders and agencies.Research limitations/implicationsThere may be potential bias based on the perspective of the narrator, and the benefits of direct experience in multiple jurisdictions.Practical implicationsThe paper identifies critical success factors in the establishment/operation of the first national Commission and the establishment of relationships with state commissions, relevant to other cross jurisdictional bodies.Originality/valueThe paper provides an insight into the factors leading to the establishment of the first national Commission and its articulation with state commissions and the early operational challenges facing cross jurisdictional reforms in changing political climates.

PurposeThis paper aims to describe the establishment and evolution of Ireland's Mental Health Commission including its functions, strategic objectives and the challenges encountered.Design/methodology/approachThis case study is based on an analysis of the outputs of the organisation to date, legislative reviews, and available evidence on the contributions of the organisation to the development of services.FindingsThe organisation has a breadth of responsibilities. It has administered reviews of 9,896 involuntary admissions to inpatient units to date since its inception. It has regulatory and enforcement powers in terms of the licensing of inpatient mental health facilities in Ireland. It has issued numerous codes of practice and rules for the guidance of those working across services. It also has an independent Inspectorate arm that inspects the quality of mental health services annually.Research limitations/implicationsThere is a risk of potential bias given the authors work for the organisation, however, attempts have been made to support observations with evidence from external sources.Practical implicationsThe organisation's work has been seminal in enhancing the protection of the human rights of persons accessing mental health services. Regulatory measures have also led to changes in the behaviour of service providers, but it has proven to be more challenging to change attitudes and culture within services.Social implicationsThe Commission has contributed to the reform agenda by focusing greater attention on rights‐based, participatory and recovery‐oriented models of care provision.Originality/valueThis paper documents the work of the Mental Health Commission and highlights the impact changes have had both for those using services and those providing them.