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Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training. [ABSTRACT FROM AUTHOR]

Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment. A total of 646 participants were included, with 43% scoring above the clinical threshold on at least one of the measures on admission. A subset of 272 participants also completed discharge measures and 42% remained above the threshold on discharge, demonstrating sustained psychological need. This paper provides support for services to move to a screen-and-assessment model supplemented by referral options for those with changing needs or who present with difficulties outside the remit of screening. The findings also support the efficacy of universal screening across the system and consideration of screening and standards for psychological care by the wider psychology community. [ABSTRACT FROM AUTHOR]

An editorial is presented on the Editorial Advisory Group for the British Psychological Society (BPS) journals has delighted to present this special issue of landmark papers. Topics include the many different spheres of influence of psychological knowledge, the opportunity to delve outside of your immediate area of interest and read the whole spectrum of papers, and the emphasis on theoretical enhancement and of presenting theoretical interpretations of empirical findings.

In the West, in the post-war and post-industrial period, urban regeneration has undergone a critical shift, from focusing primarily on the built environment (1.0) to focusing also on activity within it (2.0). Predicated upon a more holistic 'place-based' approach, building culture, health, human capital, learning and other capabilities has informed or led regeneration programmes, often improving outcomes. Yet even with this shift, regeneration and renewal interventions have not always succeeded fully in their aims; they have missed opportunities, and in some cases have been detrimental to communities. The reasons for this are complex, but it is our contention that included in their ranks is a fundamental lack of understanding of the emotional and psychological impacts of city living as a whole, and the deeper existential impacts of regeneration programmes which literally reshape the urban landscape, displacing or blending communities at great speed. It is astonishing that psychology, the discipline most concerned with human behaviour and emotional well-being, has been almost absent from urban regeneration thinking, policy and practice. In response to this, a second potential shift is emerging, birthing 'regeneration 3.0', which is seeking to understand the intimate links and symbiotic effects which exist between place and person, taking a psychologically informed approach. Informed by their pioneering book Psychology and the City and their innovative 'Urban Psyche' test, since 2016 the authors have sought to make a case for the development of a new generation of urban psychology scholarship and praxis. This paper introduces readers to their thinking on why place matters to mental health and why mental health matters to place; the evolution of regeneration policy and why ways of reading the city open and foreclose opportunities to engage psychological concerns; the potential of psychology for regeneration policy and practice; and examples of tools from psychology that might be adopted. The paper focuses mainly on UK-based regeneration, although the conclusions are potentially applicable internationally. [ABSTRACT FROM AUTHOR]

Clinical governance has been acknowledged as the driving force behind National Health Service (NHS) reform since the government white paper outlined a new style of NHS in the UK in 1997. The framework of clinical governance ensures that NHS organizations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will develop. A major component of a clinical governance framework requires utilizing audit procedures, which assess the effectiveness of current systems and ultimately direct continual quality improvement. This paper describes the audit component of a local clinical governance framework designed for a unit based within an NHS trust, which has utilized a multidisciplinary approach to assess the effectiveness of a newly commissioned service and its impact on the residents and staff. The unit is a 12-bedded, low-secure-intensive rehabilitation unit for clients with severe and enduring mental illness. Using recognized and standardized psychometric outcome measures, information was collected on clinical symptoms, social functioning, social behaviour, quality of life, relationship quality with named nurses and medication side-effects. Additionally, confidential staff measures were included to assess levels of burnout, identify expressed emotion and assess staff perception of models of illness. The paper includes a comprehensive account of how managerial commitment, teaching processes and application of technology ensured prompt data collection and maintained the momentum through the audit timescale. Data analysis and presentation of data in both clinical reviews and in senior management meetings within the unit are discussed. Findings highlight the full integration of the audit system into the processes of the unit. Clinically, the paper highlights the enhancement of the knowledge base of the client group and the influence on clinical decision-making processes and care delivery as a result of the audit. Brief clinical examples are given. In conclusion, the impact of the audit on unit strategy and organizational efficiency are discussed to highlight the importance of closing the audit loop and completing the cycle of clinical governance. The audit system has positive implications for replication in other services. [ABSTRACT FROM AUTHOR]

Purpose: High-fidelity simulation has well-established educational value. However, its use in psychiatry remains underexplored. This study explores medical students' experiences of high-fidelity simulation teaching during their psychiatry placements. A session was delivered on "psychiatric emergencies", set in a simulated emergency department, with equal emphasis on the management of physical and psychiatric aspects of patient care. This paper aims to report on student attitudes to high-fidelity simulation teaching in psychiatry, as well as student attitudes to "integrated" teaching (i.e. covering both physical and psychiatric knowledge). Design/methodology/approach: Semi-structured focus groups were conducted with medical students at a UK university. This exploratory approach generated rich qualitative data. Thematic analysis was used. Findings: High-fidelity simulation teaching in psychiatry is well regarded by medical students, and helps students recognise that psychiatric problems can present in any clinical setting. This study has demonstrated that students value this type of "integrated" teaching, and there is potential for this approach to be more widely adopted in undergraduate health-care professional education. High-fidelity simulation could also be considered for incorporation in undergraduate examinations. Originality/value: To the best of their knowledge, the authors are the first to conduct an in-depth exploration of attitudes to simulation teaching specifically in psychiatry. The authors are also the first to directly explore student attitudes to "integrated" teaching of psychiatry and physical health topics. The results will support the effective planning and delivery of simulation teaching in psychiatry, the planning of undergraduate summative assessments and will likely be of interest to health-care professionals, educational leads, simulation practitioners and students. [ABSTRACT FROM AUTHOR]

During World War I, civilians became a target of the war machine. Air raids transformed the lives of those not involved in active combat and blurred the lines between the home front and the war front. This paper argues that the experience of air raids in World War I was comparable to the combat stress at the Western Front. The author bases her argument on contemporary publications in medical journals, measures taken by British authorities to prevent air-raid shock, and contemporary case records. The narratives of air-raid shock – similarly to those of shell-shocked soldiers – reflect the feelings of terror and loss of control, and demonstrate the profound effect these experiences could have on individuals' mental health. [ABSTRACT FROM AUTHOR]

Background: This paper is concerned with the issue of service user involvement in education and training within psychological therapy training within the UK. Aims: In particular this paper reflects on the literature on user involvement to gain a deep understanding of its status in the education and training of psychological therapists. Method: A systematic search of the literature indicates minimal involvement from service users in the education and training of psychological therapists. Results: The possible reasons for this are discussed, along with what service users might want from such involvement, what it might add to psychological therapies training, the models of involvement that might be adopted, how service users may be recruited and how they may be involved in the various stages of the educational process, from commissioning, through delivery, to evaluation of programmes. Conclusion: If service user involvement in psychological therapy training is carefully planned, supported and evaluated, it could improve the trainees' practice, so that it reflected the priorities and wishes of those receiving the service. Nevertheless, it is currently an underdeveloped area within contemporary psychological educational practice. Declaration of interests: None. [ABSTRACT FROM AUTHOR]

The government green paper, 'Reform of the Mental Health Act 1983', was published in November 1999, for consultation by end of March 2000. This article offers comment on the operation of the Mental Health Act 1983 and the proposals for change, from an approved social worker perspective. Under the Mental Health Act 1983, approved social workers undertake social assessments of mental health crises, deciding upon the need for compulsory admission and treatment. To the debate on legislative change they bring a detailed social perspective on the processes and outcomes of statutory mental health intervention. Approved social workers' main concerns relate to the social context of mental health need, the availability of social resources, civil liberties, protections for people subject to statutory mental health interventions and the effective regulation of practice and services. Current proposals include options that would significantly reduce approved social worker involvement in decisions about compulsory admission and treatment; the implications of this are discussed. [ABSTRACT FROM AUTHOR]

Purpose -- The failings of "community care" in the late 1980s and early 1990s led to a number of inquiries. The purpose of this paper is to examine one of these key issues that is rarely if ever at the forefront of the inquiry process -- the experiences of young black men of African-Caribbean origin within mental health services and the Criminal Justice System (CJS). Design/methodology/approach -- It sets out to do this by exploring the way in which two inquiries, both from the early 1990s, approached the issues of race, racism and psychiatry. The two inquiries are the Ritchie Inquiry (1994) into the Care and Treatment of Christopher Clunis and Report of the Committee of Inquiry into the death of Orville Blackwood and a Review of the Deaths of Two Other African-Caribbean Patients (Prins, 1994). The Ritchie Inquiry was established following the murder of Jonathan Zito by Christopher Clunis. The Prins Inquiry examined the circumstances of the death of Orville Blackwood at Broadmoor Special Hospital. Findings -- These two inquiries are used as contrasting case studies as a means of examining the approaches to the questions of race and racism. However, the attitudes and approaches that the inquiries took to the issue of race are startlingly different. The Prins Inquiry takes a very clear position that racism was a feature of service provision whilst the Ritchie Inquiry is much more equivocal. Originality/value -- These issues remain relevant for current practice across mental health and CJS systems where young black men are still over-represented. The deaths of black men in mental health and CJS systems continue to scar these institutions and family continue to struggle for answers and justice. [ABSTRACT FROM AUTHOR]

In the United States, the National Institute of Mental Health (NIMH) is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders (the DSM). A key mechanism for this is the "Research Domain Criteria" (RDoC) initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US (and UK) psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty is constituted through discourse. In this paper, I explore and analyze these actors' accounts of what is new, important, or (un)desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary (US) psychiatry and to contribute to science and technology studies (STS) debates about "the new" in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty. [ABSTRACT FROM AUTHOR]

There is emerging evidence that Domestic Violence and Abuse (DVA) has the potential to pose a real threat to the Sikh community as it seeks to ensure that gender equality is embraced within its religious practice. Nevertheless, the interface of domestic abuse and the distress it causes to Sikh female victims in relation to their mental health is barely explored within UK academic literature. From the existing literature on DVA and South Asian women, what we do know is that there may be a denial of the issue within communities due to shame and family exposure. We are aware of the high rates of suicide and self-harm that is prevalent within the South Asian culture, something often attributed to inter-familiar conflict. The pioneering community-led British Sikh Report or BSR (British Sikh Report 2017) surveyed 2000 Sikhs and found that seventy-two percent of Sikh-identifying males and females considered that violence and sexism affected British Sikh women's lives. Notably, the type of violence was not particularised enough to be able to gain a full understanding and extent of the issue. A further eighty-three percent of male and female participants felt that women should be provided mental health support in Gurdwaras (temples). This grassroot report has been presented to Parliament and was pioneered by local MP's and is clearly topical in terms of study. To date, we are aware of no UK-based academic study that focuses on the experiences of Sikh victims of abuse. This paper aims to extrapolate key generic studies on domestic abuse in the South Asian culture, in order to help formulate an initial understanding of issues involving domestic violence and mental health as it impacts Sikh women in Britain. Further recommendations for research within this community are presented. [ABSTRACT FROM AUTHOR]

A commentary on the Mental Health Research Goals paper, emphasising the importance of the involvement of young people at all stages of mental health research pertaining to their demographic. Examples are highlighted from the UKRI Emerging Minds Network's research challenge on the impact of racism on young people's mental health in the UK, which has implications for research on racism and youth mental health specifically but also mental health research generally. [ABSTRACT FROM AUTHOR]

This paper examines the philosophical substructure to the theoretical conflicts that permeate contemporary mental health care in the UK. Theoretical conflicts are treated here as those that arise among practitioners holding divergent theoretical orientations towards the phenomena being treated. Such conflicts, although steeped in history, have become revitalized by recent attempts at integrating mental health services that have forced diversely trained practitioners to work collaboratively together, often under one roof. Part I of this paper examines how the history of these conflicts can be understood as a tension between, on the one hand, the medical model and its use by the dominant profession of psychiatry, and on the other, those alternative models and practitioners in some way differentiated from the medical model camp. Examples will be given from recent policy and research to highlight the prevalence of this tension in contemporary practice. Part II of this paper explores the deeper commonalities that lay beneath the theoretical conflict outlined in Part I. These commonalities will be shown to be apart of a captivating framework that has continued to grip the conflict since its inception. By exposing this underlying framework-and the motivations inherent therein-the topic of integration appears in wholly different light, allowing a renewed philosophical basis for integration to emerge. [ABSTRACT FROM AUTHOR]

Children and young people frequently experience emotional and mental health problems, and the promotion of mental health is a high priority for those working with this client group. This paper describes the educational and supportive role of the principal author, a recent recipient of the CPHVA Education and Development Trust MacQueen Award, working as a registered mental health nurse within the children's services team of a primary care trust. It describes how the emotional and mental health advisor (EMHA) role has developed, and discusses the initiatives that have been implemented through working closely with an extremely skilled and creative team of school nurses and health visitors. It also highlights development in practitioners' abilities in promoting the mental and emotional wellbeing of young people. The initiatives are discussed together with the EMHA's personal reflections on the role. A comprehensive and systematic evaluation is in progress and will be reported on at a later date. [ABSTRACT FROM AUTHOR]

The Model of Human Occupation Screening Tool (MOHOST) plays a key role in the occupational therapy assessment protocol at an acute psychiatric unit in Britain. This paper incorporates a case study and discussions with the occupational therapists to explore how the assessment influences practice from initial assessment to final outcome measure and how single observation forms and prototype self-assessment forms based on the MOHOST have contributed to the assessment process. [ABSTRACT FROM AUTHOR]

Mental ill health is a universal phenomenon: that is, it is seen across all cultures and societies, even though the presentation may be culture-specific and affected by cultural norms and more. Governments have a moral and ethical duty to develop mental health services which are accessible, appropriate, and non-discriminatory. Equity in funding mental health services is critical. As globally services and their quality vary dramatically, one should be proposing and agreeing on minimum standards of care. In this paper the basic components and minimum standards of care are described. It is imperative that services are non-discriminatory. It is important that governments work with psychiatrists, other mental health professionals, and individuals with mental illness, their families, and carers to plan, develop, and deliver services with adequate funding. Employers and psychological first aid must also be remembered. Services must be geographically accessible. In this endeavour primary care services have a major role to play. Training and clinical decision-making must be part of the change in service delivery. It is imperative that every effort is made to keep the population mentally as well as physically healthy, and people who develop mental illness must have access to evidence-based treatment at the earliest possible opportunity. [ABSTRACT FROM PUBLISHER]

Purpose – A Psychiatric Intensive Care Unit (PICU) and or High Dependency Unit (HDU) is a locked, intensive treatment facility available to people experiencing acute psychiatric distress. For many people who access public mental health services in Australia, the PICU/HDU is the primary point of admission, and should represent and facilitate timely assessment and an optimum treatment plan under a recovery framework. Nurses are the largest health discipline working in this specialty area of care. The paper aims to discuss these issues. Design/methodology/approach – A qualitative study aimed to investigate the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. Identifying how nurses provide care in the PICU/HDU will inform a clinical practice guideline to further support this specialty area of care. Four focus groups were facilitated with 52 registered nurses attending. Findings – The nurse participants identified specific skills under four distinct themes; Storytelling, Treatment and recovery, Taking responsibility, and Safeguarding. The skills highlight the expertise and clinical standard required to support a recovery model of care in the PICU. Research limitations/implications – The research findings highlight urgency for a National PICU/HDU clinical practice guideline. Practical implications – A PICU/HDU practice guideline will promote the standard of nursing care required in the PICU/HDU. The PICU/HDU needs to be recognised as a patient centred, therapeutic opportunity as opposed to a restrictive and custodial clinical area. Social implications – Providing transparency of practice in the PICU/HDU and educating nurses to this specialty area of care will improve client outcome and recovery. Originality/value – Very few studies have explored the skills, experience, and practice, of nurses working in the PICU/HDU in relation to a recovery model of care. A dearth of research exists on what is required to work in this specialty area of care. [ABSTRACT FROM AUTHOR]

Until around 1979, ‘confused’ or mentally unwell people over 65 years of age tended to be labelled as having ‘senile dementia’. Senile dementia was usually regarded as a single, inevitably hopeless condition, despite gradually accumulating clinical and pathological evidence to the contrary. Specific psychiatric services for mental illness in older people began to emerge in the 1950s, but by 1969 there were fewer than 10 dedicated services nationally. During the 1970s, ‘old age psychiatrists’ established local services and campaigned nationally for them. By 1979, about 100 old age psychiatrists were leading multi-disciplinary teams in half the health districts in England. This paper explores the tortuous development of these new services, focusing on provision for people with dementia. [ABSTRACT FROM PUBLISHER]

Cultural psychiatry research in the UK comprises a broad range of diverse methodologies, academic disciplines, and subject areas. Methodologies range from epidemiological to anthropological/ethnographic to health services research; mixed methods research is becoming increasingly popular, as are public health and health promotional topics. After briefly outlining the history of cultural psychiatry in the UK we will discuss contemporary research. Prominent themes include: the epidemiology of schizophrenia among Africans/Afro-Caribbeans, migration and mental health, racism and mental health, cultural identity, pathways to care, explanatory models of mental illness, cultural competence, and the subjective experiences of healthcare provision among specific ethnic groups such as Bangladeshis and Pakistanis. Another strand of research that is attracting increasing academic attention focuses upon the relationship between religion, spirituality, and mental health, in particular, the phenomenology of religious experience and its mental health ramifications, as well as recent work examining the complex links between theology and psychiatry. The paper ends by appraising the contributions of British cultural psychiatrists to the discipline of cultural psychiatry and suggesting promising areas for future research. [ABSTRACT FROM AUTHOR]

Survivor-controlled research in the field of mental health can be perceived as the most extended development of participatory research. This is not only because it does away with the role of research subjects, but because the experiential knowledge (as opposed to clinical) acquires a central role throughout the whole research process-from the design to the analysis and the interpretation of outcomes stages. The first part of this article provides some background information about the context and development of user/survivor-controlled research in the UK. In the second part, the discussion focuses on the first two German studies which apply this research methodology in the field of psychiatry. Both studies are used as examples of the approach, which favors closeness to the subject as opposed to "scientific distance." The overall objective of this paper is to outline the general achievements and challenges of survivor-controlled research. Arguing for the value of this research approach I hope to demonstrate the ways in which it raises fundamental issues related to conventional knowledge production and challenges the nature of what counts as psychiatric evidence. [ABSTRACT FROM AUTHOR]

Following the 1991 Gulf War, a number of soldiers who fought there began to complain of various symptoms and disorders, the collection of which came to be known as Gulf War syndrome (GWS). A debate has raged about the nature and cause of this illness, with many suggesting that it is a psychiatric condition. GWS continues to be a contested illness, yet there is no disputing that many Gulf veterans are ill. This article considers the way in which GWS sufferers understand their illness to be physical in nature and the way in which they negotiate and resist psychological theories of their illness. Based on 14 months of ethnographic fieldwork in the United Kingdom, data for this article were collected mainly by in-depth, semistructured interviews with GWS sufferers, their family members, doctors, and scientists, as well as healthy Gulf veterans. A total of 93 informants were interviewed, including 67 UK Gulf veterans, most of whom were ill. The paper argues that despite the increasing presence of psychiatry in military discourse, GWS reveals the way that people are able to transform, negotiate and even negate its power and assumptions. [ABSTRACT FROM AUTHOR]

With the current emphasis upon evidence-based medicine in statutory healthcare provision in the UK, mental health nursing is challenged to justify its approaches. Psychological theories, once taken for granted in mental health nursing, are now being challenged by new definitions of evidence. In this paper the authors focus upon the use of individual case study. The discussion questions the validity of applying the hierarchies of evidence proposed by evidence-based medicine to mental health nursing theory and practice. The role of case study as the prime source of evidence is argued and is justified in mental health nursing research and practice. [ABSTRACT FROM AUTHOR]

Focuses on the transformation of mental health services from the dismantling of the overflowing institutions to the development of community-based care in Great Britain. Anticipation for the reaction of many mental health nurses currently providing services in the country; Challenges encountered by mental health services; Development of a network of community-based services.

This paper reports findings from a qualitative investigation into the relationship between physical activity and mental health from the experiences of participants on exercise referral schemes. A grounded theory methodology was adopted which used focus groups and semi-structured interviews with participants from three exercise referral schemes in England. Schemes were representative of different types within the UK, and included a local authority leisure centre, a private health club and a local authority leisure centre scheme with organized countryside hikes. Pre- and post-exercise referral intervention focus groups, and interviews with purposively sampled individuals, were undertaken. Eighteen people participated and interviews were audio-taped, transcribed and analyzed. A conceptual framework emerged, and provides a psycho-social explanation for the physical activity and mental health relationship from the perspectives of the participants' who experienced it. The explanation of the relationship from this perspective identifies the core category 'self-acceptance', and the importance and interrelationship of context-related factors (such as social support and the physical environment), for the elicitation of positive experiences for people on exercise referral schemes. Investigating participant's experiences within the social contexts of exercise referral schemes provides an understanding about whether schemes have the potential to influence the mental health of referred patients. [ABSTRACT FROM AUTHOR]

Drawing primarily on examples from the UK, this paper argues that an under­standing of the history of psychiatry can be of practical use to clinicians, service users and carers. It can provide a window on the present and an explanation of some aspects of current practice. In addition, a study of the past can provide a vision of how things might be done differently in the present and in the future. Moreover, knowledge of the past can also serve to remind us of psychiatry's potential for misuse and the dangers inherent in a view of the world in which psychiatry is simply seen as a benevolent science destined to find an answer to mental illness. [ABSTRACT FROM AUTHOR]

This paper seeks to advance our understanding of the processes whereby particular techniques of protest are selected from societal 'repertoires of contention'. Empirically, it focuses upon data which have been gathered on activists within mental health movements in the UK. Theoretically, it seeks to make a case for use of the work of Pierre Bourdieu, specifically his concepts of 'habitus', 'capital' and 'field'. The paper is exploratory, and acknowledged to be such. It is argued, however, that the evidence from the mental health movements is sufficiently persuasive to merit further investigation of the usefulness of Bourdieu's approach for analysing processes of repertoire selection. [ABSTRACT FROM AUTHOR]

Introduction: It is increasingly accepted that young people need to be centrally involved in research on issues that affect them. The aim of this study was to explore young people's perceptions of the benefits for them of being involved in mental health research and the processes that enabled these benefits. Methods: Qualitative interviews were conducted by co‐researchers (young people with lived experience and/or interest in mental health) with 13 young people (aged 13–24 years) who had experience of being involved in mental health research when they were between 11 and 16 years of age. Reflective thematic analysis was used to identify important aspects of young people's experiences. Results: Four main themes were identified: (1) opportunity to have a meaningful impact, (2) opportunity to be part of a supportive community, (3) opportunity to learn and grow and (4) increasing opportunities for young people. Conclusion: This study highlights young people's experiences of being involved in mental health research and identifies ways in which researchers can ensure that involvement opportunities bring benefits to both the young people and the research. Patient or Public Contribution: This research was a response to issues raised by young people involved in research. The project was supported by co‐researchers throughout, including design, data collection, analysis and write‐up. [ABSTRACT FROM AUTHOR]

Medical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power, Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services - a medicoeclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments - are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and paraprofessionals. This paper draws primarily upon two sources of data; an ethnography and in-depth interview study of 40 psychiatrists and managers in the Bristol area in 1989-90 and an analysis of the writings of psychiatrists in the professional press. [ABSTRACT FROM AUTHOR]

Background: Patient involvement in psychiatry education is required by policy and has many benefits for students. Little research has focused on the impact on expert patients (EPs). Objective: This study aimed to explore the impact of involvement in psychiatry education on mental health patients. Design: A qualitative descriptive study using semistructured interviews was conducted in a psychiatry teaching unit in the East Midlands, UK. A purposive sample of 20 EPs involved in teaching was interviewed about the social and psychological impacts of involvement. Transcripts were analysed thematically and a coding scheme was developed. Results: Five themes were identified: shaping the doctors of the future—something worthwhile, challenging assumptions about mental health, recovery and transformation, vulnerability and support and expertise and power. Conclusion: These EPs benefitted from their experience of teaching. Involvement in psychiatry teaching may require putting oneself in a vulnerable position, but a supportive and open faculty team may mitigate this challenge. The Expert Patient Programme was seen as a way of helping to reduce the power difference between patients and doctors in the future. There is a need to examine the language that we use to talk about patient involvement as this may have implications for this power dynamic. The context and mechanisms that lead to the benefits described by participants should be studied so that these benefits may be generalized to other contexts. Patient Contribution: An EP was involved in the planning and ethical approval application process of the project and the drafting and approval of this manuscript. [ABSTRACT FROM AUTHOR]

In recent years, personality disorders – psychiatric constructs understood as enduring dysfunctions of personality – have come into ever-greater focus for British policymakers, mental health professionals and service-users. Disputes have focussed largely on highly controversial attempts by the UK Department of Health to introduce mental health law and policy (now enshrined within the 2007 Mental Health Act of England and Wales). At the same time, clinical framings of personality disorder have dramatically shifted: once regarded as untreatable conditions, severe personality disorders are today thought of by many clinicians to be responsive to psychiatric and psychological intervention. In this article, I chart this transformation by means of a diachronic analysis of debates and institutional shifts pertaining to both attempts to change the law, and understandings of personality disorder. In so doing, I show how mental health policy and practice have mutually constituted one another, such that the aims of clinicians and policymakers have come to be closely aligned. I argue that it is precisely through these reciprocally constitutive processes that the profound reconfiguration of personality disorder from being an obdurate to a plastic condition has occurred; this demonstrates the significance of interactions between law and the health professions in shaping not only the State’s management of pathology, but also perceptions of its very nature. [ABSTRACT FROM PUBLISHER]

Background: Severe mental illness is a serious and potentially life changing set of conditions. This paper describes and analyses patient characteristics and service usage over one year of a representative cohort of people with a diagnosis of severe mental illness across England, including contacts with primary and secondary care and continuity of care. Methods and Findings: Data were collected from primary care patient notes (n = 1150) by trained nurses from 64 practices in England, covering all service contacts from 1st April 2008 to 31st March 2009. The estimated national rate of patients seen only in primary care in the period was 31.1% (95% C.I. 27.2% to 35.3%) and the rates of schizophrenia and bipolar disorder were 56.8% (95% C.I. 52.3% to 61.2%) and 37.9% (95% C.I. 33.7% to 42.2%). In total, patients had 7,961 consultations within primary care and 1,993 contacts with mental health services (20% of the total). Unemployed individuals diagnosed more recently were more likely to have contact with secondary care. Of those seen in secondary care, 61% had at most two secondary care contacts in the period. Median annual consultation rates with GPs were lower than have been reported for previous years and were only slightly above the general population. Relational continuity in primary care was poor for 21% of patients (Modified Modified Continuity Index =<0.5), and for almost a third of new referrals to mental health services the primary care record contained no information on the referral outcome. Conclusions: Primary care is centrally involved in the care of people with serious mental illness, but primary care and crossboundary continuity is poor for a substantial proportion. Research is needed to determine the impact of poor continuity on patient outcomes, and above all, the impact of new collaborative ways of working at the primary/secondary care interface. [ABSTRACT FROM AUTHOR]

Background: Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods: A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results: Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health. Conclusions: Service delivery components - e.g. peer support groups, personal planning - advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings. [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the experiences and perspectives of ex-military servicemen in the UK. It focuses specifically on the complex links between emotional distress and various constructions of ‘masculinity’ in a military context. Aspects of military culture that exacerbate vulnerability and also those that are protective to mental health are identified and discussed with reference to the theoretical constructs relating to hegemonic masculinity. A qualitative research design using semi-structured interviews provided in-depth accounts of the experiences of 20 ex-servicemen aged 23–44, all but one of whom were in the Army. We found that in a military setting hegemonic masculinity is embedded in the construction of a soldier identity and expression of emotion may be seen as inappropriate. As a result soldiers often lack a language with which to express distress (in a context in which they may witness extremely distressing events), which may result in delays in recognising and treating mental health problems. However, constructions of masculinity in this setting to some degree also promote a caring, sharing ethos based on strong inter-dependent bonds. A young soldier who can cope with the stresses of military life ‘becomes a man’, adopts a masculine/soldier identity and is well-placed to benefit from these protective factors, notably the camaraderie that is part of service life. In this manner a caring ethos in which some admissions of weakness may be permissible is situated within hegemonic masculinity. This seeming paradox between hyper masculinity and caring masculinities appears to be embedded within military culture, perhaps reflecting the flexibility and ambiguity inherent in constructions of hegemonic masculinity. [ABSTRACT FROM AUTHOR]

Background The role of journals in disseminating research to clinicians is increasingly debated. Current measures of esteem for journals (e.g. impact factors) may not indicate clinical penetration. Aims To assess the perceived importance of different mental health journals to psychiatrists clinical practice and compare this with impact factors. Method Random samples of psychiatrists providing child and adolescent, adults of working age and old age services chose up to ten journals read or consulted with regard to their clinical work, ranking the top three. For these journals, comparisons were made with impact factors and importance as outlets for UK psychiatry research. Results A total of 560 questionnaires were completed (47%). Two membership journals (the British Journal of Psychiatry and the BMJ) were most read and highest ranked. Associations between impact factors, clinicians' ratings and importance as outlets for psychiatry papers varied. Conclusions The results could lead to reconsideration of the importance of some journals. Academic assessments of the status of journals should not be assumed to reflect their influence on clinicians. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown. Method: A retrospective case-note review study with an exploratory mixedmethods design to examine factors for psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018. Results:Themes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6.19 (s. d. = 2.43), with a mean number of categories per case of 3.73, (s. d. = 0.98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (X2(1, N = 98) = 20.80, p < 0.00001) and older adults (X2(1, N = 98) = 8.61, p = 0.0033) in the study group than the control. Single people, compared to those in a relationship (X2(1, N = 45) = 4.46, p = 0.035), and people with affective disorders compared to psychotic disorders ((X2(1, N = 28) = 5.19, p = 0.023), were more likely to have a COVID-19 related admission factor. Conclusions: Early stages of the COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, older adults and those with affective disorders. [ABSTRACT FROM AUTHOR]

Background: Loneliness is a frequent and distressing experience among people with mental health problems. However, few longitudinal studies have so far investigated the trajectories of loneliness and objective social isolation, and the extent to which both issues may impact mental health outcomes among mental health service users. Therefore, this study aims to describe the trajectories of loneliness and objective social isolation and their associations with self-rated personal recovery among people leaving crisis resolution teams (CRTs). Methods: A total of 224 participants receiving care from CRTs (recruited for a large multi-site randomised controlled trial) were included in this longitudinal cohort study. They completed the eight-item University of California at Los Angeles Loneliness Scale (ULS-8), Lubben-Social Network Scale (LNSN-6), and the Questionnaire about the Process of Recovery (QPR) (primary outcome) at baseline, 4- and 18-month follow-up, as well as baseline sociodemographic and clinical variables. Results: We compared groups who were persistently lonely (at all time points), intermittently lonely (at one or two time points) and never lonely. After adjusting for all potential confounders and baseline predictive variables, persistent severe loneliness was associated with worse personal recovery at 18-month follow-up compared with the never lonely (reference group) (coef. = − 12.8, 95% CI -11.8, − 3.8, p <.001), as was being intermittently lonely (coef. = − 7.8, 95% CI -18.8, − 6.8, p <.001). The persistently objectively social isolated group (coef. = − 9.8, 95% CI -15.7, − 3.8, p =.001) also had poorer self-rated recovery at 18-month follow-up than those who were not socially isolated at any timepoint (i.e., reference category). Conclusion: Results suggest that both persistent loneliness and objective social isolation are associated with poorer self-rated recovery following a crisis, compatible with a causal relationship. These findings suggest a potential role for interventions aimed at alleviating loneliness and objective social isolation in improving recovery outcomes for people with mental health symptoms. Increased awareness of both issues among health practitioners is also warranted. [ABSTRACT FROM AUTHOR]

Objectives: The quality of therapeutic relationships in psychiatric services has a significant impact upon the therapeutic outcomes for people diagnosed with a severe mental illness. As previous work has not explicitly explored service users' in‐depth views about the emotional impact of these relationships, the objective of this work was to bring this perspective to the fore and to gain a greater understanding about which relational components can lead to psychological change. Design: The project was conducted alongside a service user organization. An interview design was used to qualitatively explore service users' experiences and perceptions of their relationships with mental health practitioners. Methods: Eight individuals who had experience of the mental health system in the United Kingdom were interviewed. Interpretative phenomenological analysis was used to analyse the data. Findings: Three superordinate themes emerged from the analysis. These were (1) Trying to survive: am I a person or just an object in the system?; (2) Traumatic experiences within relationships; and (3) Helpful and transformative relationships. Further, the key transformative components of these relationships were power, safety, and identity. Conclusions: Mental health services should be more focused upon care, rather than control. The Power Safety Identity (PSI) model, a reflexive model based upon key relational components highlighted by participants, is proposed for services and professionals to consider their work. The components of this model are managed by mental health practitioners and can determine whether these relationships maintain, increase, or alleviate psychological distress. Practitioner points: Awareness of the relational components of power, safety, and identity has the potential to help practitioners reflect upon the tensions they experience in their relationships with service users.Mental health services and professionals that are sensitive to issues related to power, safety, and identity when responding to the needs of the service users can improve how individuals perceive the quality of care provided by them.Relationships between service users and mental health practitioners can encourage recovery if they are consistent, safe, trusting, provide protective power, and mirror a positive sense of self. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the editor discusses various topics within the issue, including college student mental health, mental health research, depression, and social support.

Aims Treatment of patients with comorbidity of mental health problems and alcohol use disorder (AUD) constitutes a challenge in many countries. The article aimed at exploration of personal experiences of clinicians and patients with the comorbidity regarding its assessment, treatment and organization of care in Poland and the UK. Methods Data were collected via in-depth, semi-structured interviews with clinicians (N = 28) and patients (N = 81) in both countries, according to a unified study protocol. Maximum variation sampling was applied to both study groups. All interviews' transcripts were coded (CAQDA) and the consistency of coding across centres was assessed. Data analysis was performed according to the principles of thematic analysis. Results Our data show that most patients with AUD admitted at the psychiatric wards—apart from assessment which is a standard procedure during admission—receive only minimal support during their hospital stay. This is the consequence of two factors: lack of trained staff prepared to help those patients and a priority given to self-referrals by AUD units. At the same time, it is recognized by clinicians and patients that more support is needed to encourage the utilization of AUD services and to prevent the drop-out. Conclusions In order to improve the system response, the use of screening instruments in the process of the assessment of AUD and establishment of special procedures supporting motivation and adherence to treatment and preventing drop-out merits consideration. Moreover, the psychiatric wards and the AUD services could possibly profit from formalization of the collaboration between services. [ABSTRACT FROM AUTHOR]

The number of people claiming for personal injury after being involved in a road traffic accident (RTA) in the UK continues to soar. In April 2015, the UK Government intervened to implement measures aimed at reducing the prevalence of fraud within such personal injury claims. However, these reforms did not include claims for mental disorder that arise because of a RTA despite being responsible for substantially larger payouts in comparison with claims for whiplash. The present study examines the assessment practice for detecting fraudulent claims of this nature using a mixed methods survey analysing UK medico-legal professionals' assessment methodologies (N = 37). The findings suggest comprehensively that assessment practices in this field are idiosyncratic. The findings evidence limitations in all aspects of the assessment process from medico-legal assessors being asked to undertake examinations without the presence of medical records to 44% of examiners being unaware of the three types of malingering. The article concludes with recommendations for improving both assessments and the assessment process for assessing RTA claimants in the UK. [ABSTRACT FROM AUTHOR]

Purpose Of the Study: To examine the use of alcohol and other substances among medical and law students at a UK university.Study Design: Anonymous cross-sectional questionnaire survey of first, second and final year medical and law students at a single UK university.Results: 1242 of 1577 (78.8%) eligible students completed the questionnaire. Over half of first and second year medical students (first year 53.1%, second year 59.7%, final year 35.9%) had an Alcohol Use Disorders Identification Test (AUDIT) score suggestive of an alcohol use disorder (AUDIT≥8), compared with over two-thirds of first and second year law students (first year 67.2%, second year 69.5%, final year 47.3%). Approximately one-quarter of medical students (first year 26.4%, second year 28.4%, final year 23.7%) and over one-third of first and second year law students (first year 39.1%, second year 42.4%, final year 18.9%) reported other substance use within the past year. Over one-third of medical students (first year 34.4%, second year 35.6%, final year 46.3%) and approximately half or more of law students (first year 47.2%, second year 52.7%, final year 59.5%) had a Hospital Anxiety and Depression Scale anxiety score suggestive of a possible anxiety disorder.Conclusions: Study participants had high levels of substance misuse and anxiety. Some students' fitness to practice may be impaired as a result of their substance misuse or symptoms of psychological distress. Further efforts are needed to reduce substance misuse and to improve the mental well-being of students. [ABSTRACT FROM AUTHOR]

Background: In 2008, the Mental Health Act (MHA) 2007 amendments to the MHA 1983 were implemented in England and Wales. The amendments were intended to remove perceived obstacles to the detention of high risk patients with personality disorders (PDs), sexual deviance and learning disabilities (LDs). The AMEND study aimed to test the hypothesis that the implementation of these changes would lead to an increase in numbers or proportions of patients with these conditions who would be assessed and detained under the MHA 2007. Method: A prospective, quantitative study of MHA assessments undertaken between July-October 2008-11 at three English sites. Data were collected from local forms used for MHA assessment documentation and patient electronic databases. Results: The total number of assessments in each four month period of data collection varied: 1034 in 2008, 1042 in 2009, 1242 in 2010 and 1010 in 2011 (n = 4415). Of the assessments 65.6% resulted in detention in 2008, 71.3% in 2009, 64.7% in 2010 and 63.5% in 2011. There was no significant change in the odds ratio of detention when comparing the 2008 assessments against the combined 2009, 2010 and 2011 data (OR = 1.025, Fisher's exact χ² p = 0.735). Only patients with LD and 'any other disorder or disability of the mind' were significantly more likely to be assessed under the MHA post implementation (χ² = 5.485, P = 0.018; χ² = 24.962, P > 0.001 respectively). There was no significant change post implementation in terms of the diagnostic category of detained patients. Conclusions: In the first three years post implementation, the 2007 Act did not facilitate the compulsory care of patients with PDs, sexual deviance and LDs. [ABSTRACT FROM AUTHOR]

The primary aims are to consider whether a range of paternalistic medical interventions can be justified in the treatment of factitious disorder ( FD) and to show that the particularities of FD and its management make it an ideal phenomenon to highlight the difficulties of balancing respect for self-determination, responsibility and duty of care in psychiatry. FD is usually classified as a mental disorder involving deliberate and hidden feigning or inducement of illness, in order to achieve patient status. Both the nature of the disorder and the approach to treatment are controversial and under-researched. It is argued that FD should be classified as a mental disorder; may well expose the patient to extreme risk; can warrant paternalistic interventions, in order to fulfil duty of care. Moreover, treatment of FD is inherently paternalistic and therefore raises interesting questions about justifications and type of paternalistic interventions in psychiatry both for FD and in general. A brief account of key questions concerning psychiatry and paternalism is followed by some case histories of FD, the clinical dilemmas posed and the question of how this disorder might warrant paternalistic interventions. In order to answer this question, two things are considered: the legitimacy and character of FD as a mental disorder; possible frameworks for and types of paternalistic interventions. To conclude, it is argued that there are no compelling reasons for rejecting the use of paternalistic interventions for FD, but that further investigation of FD and type and frameworks for psychiatric paternalism, in relation to FD and other mental disorders, are urgently needed. [ABSTRACT FROM AUTHOR]

The International Health Partnership ('the Link') between the East London NHS Foundation Trust and Butabika Hospital in Uganda was set up in 2005. It has facilitated staff exchanges and set up many workstreams (e.g. in child and adolescent psychiatry, nursing and psychology) and projects (e.g. a peer support worker project and a violence reduction programme). The Link has been collaborative and mutually beneficial. The authors describe benefits and challenges at individual and organisational levels. Notably, the Link has achieved a commitment to service user involvement and an increasingly central involvement of the Ugandan diaspora working in mental health in the UK. [ABSTRACT FROM AUTHOR]

This article examines the experiences of mentally ill Nigerian migrants during the colonial era. Migrant Nigerian ‘lunatics’ faced different circumstances depending on what type of migrant they were and where they fell ill. Those in the UK tended to be repatriated for medical reasons, while those within the West African region rarely returned home because of financial considerations. Nigerian pilgrims to Mecca are noticeably absent from the discourse as are procedures associated with the relationship between migration and mental illness, despite the fact that they made up a large and constant flow of migrants from Nigeria during the colonial period. By putting these transnational individuals at the centre of analysis, this article provides a comparative perspective that reveals contingencies of psychiatric biopower that are often subsumed in narratives that focus on the activities of specific colonial asylums within individual colonial states. [ABSTRACT FROM PUBLISHER]

Objective: To evaluate whether multisystemic therapy (MST) is more cost-effective than statutory interventions that are currently available for young offenders in England. Method: A cost-offset evaluation of MST based on data from a randomised controlled trial conducted in North London, England, comparing MST with usual services provided by two youth offending teams (YOT). Service costs were compared to cost savings in terms of rates of criminal re-offending. Results: 108 adolescents, aged 11–17 years, were randomly allocated to MST+YOT (n = 56) or YOT alone (n = 52). Reductions in offending were evident in both groups, but were higher in the MST+YOT group. At 18-month follow-up, the MST+YOT group cost less in terms of criminal activity (£9,425 versus £11,715, p = 0.456). The MST+YOT group were significantly cheaper in terms of YOT services than the YOT group (£3,402 versus £4,619, p = 0.006), but more expensive including the cost of MST, although not significantly so (£5,687 versus £4,619, p = 0.195). The net benefit per young person for the 18-month follow-up was estimated to be £1,222 (95% CI −£5,838 to £8,283). Conclusions: The results reported in this study support the finding that MST+YOT has scope for cost-savings when compared to YOT alone. However, the limitations of the study in terms of method of economic evaluation, outcome measures used and data quality support the need for further research. [ABSTRACT FROM AUTHOR]

Aims Although smoking prevalence among people with severe mental illness is high, it remains largely unaddressed. This pragmatic pilot project aimed to develop and implement a tailored tobacco dependence service in mental health settings and to assess its impact, as well as barriers and facilitators to implementation. Design An integrative service model, spanning acute, rehabilitation and community services, including the design of tailored instruments and referral pathways, delivered by two mental health professionals. Setting and participants Four adult acute and two rehabilitation wards (129 beds), and the community recovery team (2038 cases) of the United Kingdom's largest Mental Health Trust. Measurements Audit of smoking information in patient notes; service uptake; quit attempts; smoking cessation and reduction; qualitative data on implementation barriers/facilitators. Findings A total of 110 patients attended at least one support session: 53 inpatients (23% of inpatient smokers) and 57 community (of unknown number of community smokers, as recording of smoking status is not mandatory). Thirty-four of these (31%) made a quit attempt; 17 (15%) stopped smoking and 29 (26%) reduced cigarette consumption by up to 50% at the final contact. Barriers to service implementation related to: (i) trust policy, systems and procedures, (ii) staff knowledge and attitudes and (iii) illness-related factors. Conclusions Despite the strong anti-smoking climate in the United Kingdom, including a law requiring smoke-free policies in mental health settings, establishing a smoking cessation treatment service for people with mental illness proved difficult, due to complex systemic barriers. However, there is clearly a demand, by patients, for such a service. [ABSTRACT FROM AUTHOR]

Involvement of people who use health services as researchers is increasingly widely practised internationally, but methodological enquiry into how involvement impacts on research findings is lacking. A qualitative study of the experiences of people detained under the UK Mental Health Act (1983) used secondary analysis to explore the extent to which mental health service user researchers produced different interpretive narratives to conventional university researchers working on the same research team, and the potential to coproduce integrated analytical narrative to inform service improvement. We found we were able to articulate a range of situated analytical narratives on the detained patient experience and, through negotiating what each narrative meant in relation to the others, to coproduce an integrated analytical narrative that moved beyond what was already known about the detained patient experience. We concluded that research involving mental health service user researchers can coproduce new knowledge that might usefully inform service improvement. [ABSTRACT FROM PUBLISHER]