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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose Interactions between individuals experiencing mental health (MH) problems and the police are complex and may affect the way in which both parties react to and experience the interactions. The purpose of this paper is to examine three commonly used interventions to improve these interactions.Design/methodology/approach Mixed methods were used to examine embedded MH professionals in command and control rooms, Liaison and Diversion Teams and Street Triage. The authors also reviewed the use of Section 136 (s136) of the Mental Health Act 1983 (2007) during the period these interventions were deployed.Findings There was strong support for these interventions but also gaps, resource and operational issues that need to be addressed if they are to have optimal effect on delivering appropriate diversion from the justice system, reduce reoffending and improve MH outcomes for individuals. The use of s136 remained relatively constant.Originality/value Despite a recent increase in the level of investment related to these interventions the evidence base remains limited. This study provides baseline of research evidence for those who commission and provide services for individuals experiencing mental ill health and who are in contact with the justice system. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present a qualitative analysis of the role of self-harm self-help groups from the perspective of group members.Design/methodology/approach A qualitative case study approach guided the research, which involved working with two self-harm self-help groups and all regularly attending members.Findings A thematic approach to the analysis of the findings indicates that self-harm self-help groups can provide a safe, non-judgemental space where those who self-harm can meet, listen and talk to others who share similar experiences for reciprocal peer support. Offering a different approach to that experienced in statutory services, the groups reduced members’ isolation and offered opportunities for learning and findings ways to lessen and better manage their self-harm.Research limitations/implications This was a small-scale qualitative study, hence it is not possible to generalise the findings to all self-harm self-help groups.Practical implications The value of peers supporting one another, as a means of aiding recovery and improving well-being, has gained credence in recent years, but remains limited for those who self-harm. The findings from this research highlight the value of self-help groups in providing opportunities for peer support and the facilitative role practitioners can play in the development of self-harm self-help groups.Originality/value Self-harm self-help groups remain an underexplored area, despite such groups being identified as a valuable source of support by its members. This research provides empirical evidence, at an individual and group level, into the unique role of self-harm self-help groups. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report an analysis of arrangements in English mental health trusts to meet the needs of adult service users who are homeless. Homelessness is associated with various forms of mental ill-health, yet homeless people are not always well-served by statutory mental health services. In recent years, practice guidance seeking to improve health outcomes for the homeless has emphasised the need for NHS services to improve care pathways and professional provision for this service user group, in part by collaborating more closely with homelessness organisations.Design/methodology/approach Responses to freedom of information requests sent to trusts were analysed. The requests asked trusts for information concerning partnerships with external agencies, particular projects/staff, training available to trust professionals, referral pathways, and intervention models/approaches informing work with homeless service users.Findings In total, 49 trusts provided information that could be used in the analysis. Just under half of these had dedicated arrangements or resources, including outreach teams and clinical staff co-located in accommodation and support services for the homeless. The remaining trusts indicated that they either had some limited specific arrangements, such as links between local agencies working with the homeless and existing services, or no dedicated arrangements in place. Training to help trust professionals address issues associated with homelessness tended to be minimal if provided at all.Originality/value This analysis adds further evidence to concerns that homeless people’s mental health needs are not being adequately considered by services at a local level and that there is a lack of appropriate pathways through which they can access care and treatment. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the ways in which "mental health" difficulties are approached in low-income countries, using a case study of Uganda focus down upon the issues. Design/methodology/approach – The study involved two phases. The first was the collection and analysis of documentary evidence and interviews with policy makers in Uganda. The second involved interviews with health staff, traditional healers and the public in the Buganda Kingdom of Uganda. Interviews were conducted in English or Luganda and translated as necessary. No external sources of funding to declare. Findings – There are differing perceptions of mental health and illness in Uganda and there exists culturally accepted sources of support for distress. This highlights the important role of traditional healers and the paper argues that they should be recognised for their work in mental health care. Research limitations/implications – The paper is a small-scale study of one area of Uganda (Buganda Kingdom), the extent to which it can be generalised is therefore very limited. However, the research is sufficient to indicate the benefits of traditional healers in mental health care and supports an argument towards a public mental health model. Practical implications – The paper argues for a move in priority away from a focus upon a biomedical model of mental health support towards a public health model and the meaningful engagement of traditional healers. This would also necessitate a refocus of spending in the wider society. Originality/value – The paper poses a challenge to the Global Public Health movement and questions the relevance of expanding biomedical psychiatry in low-income countries. The paper also adds weight to emerging literature on the value of a public health approach to mental health and illness, especially in the developing world. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore how those engaged in service user involvement (SUI) initiatives perceive involvement and recovery; whether involvement is related to their recovery process and, if so, how.Design/methodology/approach An exploratory qualitative method, social constructionist grounded theory, was adopted throughout the research process. Nine semi-structured interviews were undertaken with participants who self-defined as having current or previous mental health problems and who were engaged in SUI initiatives.Findings Most participants identified explicit links between their own experiences of SUI and recovery. These links represented a connection between the characteristics they perceived to be inherent to involvement and their personal definitions of recovery. In contrast, experiences of consultation and involvement as patient service users was limited and identified as an area for improvement. The core of the tentative grounded theory constructed suggests that individuals found in involvement elements which were concordant with and supported their own definitions of recovery and which were not apparent in their experiences as patients.Research limitations/implications The small sample and narrow constituency of participants limit the nature of the claims made by the study.Practical implications This study highlights the value of involvement in promoting recovery and indicates the merit of promoting meaningful involvement across the spectrum of the service user experience.Originality/value This study offers a unique contribution to the current literature, highlighting the links made between involvement and personal recovery. [ABSTRACT FROM AUTHOR]

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

Purpose – Mental health difficulties are often stigmatised because of situated ways of talking that become taken-for-granted “truths”. Against this backdrop, identities of those affected are constructed. The purpose of this paper is to explore identities of former inpatients at an Irish Child and Adolescent Mental Health Service. Design/methodology/approach – Ten young people (aged 18-22) participated in discussions and their discourse was analysed using a critical discursive perspective. Findings – Three key identities emerged: a hidden identity, a misunderstood identity and the struggle for a re-claimed identity. Research limitations/implications – Findings indicate the power of discourse in creating stigma and the need for mental health professionals to draw on empowering discourses to help service-users construct positive identities. The importance of involving service-users in research is also implicated. Originality/value – This research involves service-users who are increasingly, although not traditionally, involved in research. Use of qualitative methodology allows their voices to be heard and gives meaning to their experiences. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to systematically identify, appraise and synthesise qualitative research into how working as a peer support worker (PSW) affects personal recovery. Design/methodology/approach -- Ten articles were identified through a systematic search of seven databases, grey literature, reference lists, citations and contact with authors in the field. Identified articles were critically appraised and their results synthesised using metaethnography. Findings -- There is potential to significantly improve the quality of the research in this field. Four categories were constructed to synthesise the findings of the reviewed studies, which demonstrated that being a PSW has the potential to be both facilitative of and detrimental to personal recovery. Research limitations/implications -- The quality of existing studies varies widely. Further, high-quality research is required to specifically investigate the effects of employment as a PSW on personal recovery. Practical implications -- The findings are tentative in light of the quality of the studies, but should be considered in the employment, training and ongoing support of PSWs and the services they join. Originality/value -- Through its systematic methodology and appraisal of the quality of the studies reviewed, this review adds value to the literature about the effect of working as a PSW on personal recovery. It offers an original synthesis and criteria for measuring the quality of research in this field. [ABSTRACT FROM AUTHOR]

Purpose -- Recovery is a key organising principle underlying mental health services, but remains under-researched in primary care. The purpose of this paper is to explore what recovery from psychosis means from multiple perspectives, the role of primary care in fostering recovery, and interventions that might enhance its promotion in primary care. Design/methodology/approach -- A total of 20 patients who had experienced psychosis and 24 General Practitioners (GPs) with varying expressed interest in mental health participated in semi-structured interviews, and were invited to two subsequent mixed focus groups. Data were analysed using Framework Analysis. Findings -- Recovery was conceptualised by GPs without a specialist clinical interest in mental health as improvements in symptomatic outcomes, by GPs with a special interest as improvements in social or functional outcomes, and by patients as a process involving a "whole person" approach. Both GPs and patients highlighted benefits of primary care including continuity, accessibility, and the role primary care professionals can play in supporting patients' families, and helping patients expand social support networks. Despite feeling "fobbed off' at times, patients desired a shift in responsibility for psychosis from secondary to primary care. Practical implications -- Reflective peer supervision meetings for GPs and patient-led training might improve primary care's ability to provide a more recovery-focused environment. Originality/value -- This study provided original and valuable findings regarding how GPs viewed their own role in promoting recovery from psychosis. This study also provided original findings regarding how patients viewed the role of primary care in promoting recovery from psychosis. [ABSTRACT FROM AUTHOR]

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