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Introduction: Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions., Methods: A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24., Results: 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found., Conclusions: Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics., Competing Interests: Competing interests: NJ is a full-time reserve member of the British Army currently seconded to King’s College London. AS is a full-time member of the British Army similarly seconded. NG is the Royal College of Psychiatrists Lead for Military and Veterans Health and trustee with two military charities; however, he was not directed by these organisations in any way in relation to his contribution to this paper. He is affiliated to the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response at King’s College London in partnership with Public Health England, in collaboration with the University of East Anglia and Newcastle University. AP, CW and LH received funding from the Ministry of Defence for the duration of the study but were not instructed in any way in the production of this manuscript., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Stigmatised attitudes are known to be associated with negative outcomes in schizophrenia, yet there is little focus on the role of stigma in the recovery process. Attempts to develop interventions to reduce self-stigma in schizophrenia have not been found effective. This paper presents a theoretical integration based on a narrative review of the literature. PsycINFO, Medline and Embase databases were searched up to the 11th December 2023. Studies were included if they were: i) empirical studies using qualitative, quantitative or mixed methods studies investigating mental health stigma; ii) included participants based in the United Kingdom, fluent in English, between the ages of 16 and 70, meeting criteria for a schizophrenia spectrum diagnosis. Fourteen studies were included. In Part 1, we propose a novel theoretical model derived from a synthesis of service-user perspectives on the relationship between stigma and schizophrenia. Stigmatised attitudes were commonly perceived to be caused by a lack of education and further exacerbated by disinformation primarily through the media and cultural communities. Stigma led to negative self-perceptions, negative emotional responses, social isolation and increased symptom severity, ultimately acting as a barrier to recovery. In Part 2, we identify several factors that ameliorate the impact of stigma and promote clinical and subjective recovery among service-users: education, empowerment, self-efficacy, self-acceptance, hope and social support. We argue that the notion of stigma resistance may be helpful in developing new interventions aimed at promoting recovery in individuals with schizophrenia. Wider implications are discussed and recommendations for future research and practice are explored. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to explore how supervision is applied in the context of National Health Service services for older adults, with particular regard to the profession of clinical psychology and psychotherapy. Design/methodology/approach: The clinical supervision theories that are considered in this exploration are the Seven-Eyed Model (Hawkins and Shohet, 2012) and the Cyclical Model (Page and Wosket, 2015). The discussion also integrates an overview of psychological dynamics as presented by the existing literature with the author's reflections on the influence of ageing stereotypes in the therapeutic work with older adults. Findings: The theoretical models of clinical supervision considered can offer a robust framework and pathway for supervisory work in psychology and psychotherapy for older people. However, this alone seems insufficient and needs to be combined with the supervisor's knowledge on psychology of ageing as well as their own self-reflection on internalised ageing stereotypes. Practical implications: The paper suggests a need for health care professionals, providing clinical supervision on older adult therapeutic work, to be familiar with the aspects analysed. Originality/value: Clinical supervision handbooks overlook aspects related to age as an issue of difference. This paper adds value to the clinical work with older people through a novel attempt to link implications of ageing stereotypes with the therapeutic and supervisory practice. [ABSTRACT FROM AUTHOR]

Hope is considered crucial to mental health recovery. However, the manner in which social inequalities shape individuals' meaning of hope has received little attention. Based on a close analysis of the recovery journeys of six Chinese service users in the UK, this paper explores the diverse meanings of hope among service users from non-dominant cultures. Illustrative stories are selected from in-depth life history interviews conducted with twenty-two participants. Based on the capabilities approach and intersectionality analysis, the findings reveal a paradox of hope and show how hope can be embraced, cautiously pursued or held at bay by individuals. Whilst hope is one expression of human agency, service users with reservations about hope maintain agency in other ways, despite their diminished life chances. This paper argues for an increased focus on individuals' agency development to support recovery and advocates for the challenging of inequalities to achieve this. [ABSTRACT FROM AUTHOR]

This paper analyses the first significant change to Special Educational Needs (SEN) legislation in England for over a decade, a change that promises new approaches to identification and assessment, increased parental choice and enhanced pupil outcomes. The paper aims to examine to what extent this new framework can live up to its claims in the field of emotional and behavioural difficulties. It analyses the policy context and some key details of this legislation by focussing on approaches such as person-centred planning, multi-professional collaborations and recent mental health initiatives in schools. It also explores what can be expected from the legislative requirements for collaboration between health, social care and education agencies to improve outcomes for children and young people. The paper concludes by addressing tensions between medical and social model assumptions by proposing a systemic approach to multi-agency working and an educationally oriented and integrated functional framework for identifying and assessing emotional and behavioural difficulties. [ABSTRACT FROM AUTHOR]

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

Purpose – The aim of this paper is to provide a conceptual framework for understanding how, even in the absence of identifiable racist behaviours by white people and predominantly white institutions, African Caribbean people can suffer detriment to their mental health due to toxicity in interactions. Design/methodology/approach – This paper was developed through a desktop review of literature that analyses the factors that cause the sustained variation in experience and outcome in mental health for people from African Caribbean backgrounds. Findings – Prior experiences of personalised racism (interpersonal and institutional) and an awareness of non-personalised racism in society creates conditions which mean that African Caribbean people experience toxicity in their dealings with white people and white institutions, including mental health services. This is detrimental to service user outcomes. Originality/value – The paper provides a language for the process that leads to negative outcomes for African Caribbean people in mental health services resulting from interactions with white people or white institutions even in the absence of racism or racist events directed at them. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the similarities and differences in the development of psychological therapies in three European Union countries (the United Kingdom, the Netherlands and France) in the context of national policies about health services and public mental health. Design/methodology/approach – Three case studies are utilised for this purpose as historical descriptions. The latter are then discussed in the light of traditional approaches to the sociology of the professions. Findings – Whilst some similarities are identified across the three countries (for example the recent convergence of policy interest in "evidence-based practice") it is also clear that the particular national cultures have shaped developments and their different forms of healthcare organisation have been reflected in national legislative and regulatory arrangements. Research limitations/implications – These case studies draw attention to the need to explore national variations in policy formation about the same matter (in this case the professionalization of psychological therapies) and to extend discussions within the sociology of the professions to ones of healthcare organizational contexts. In addition, the contested nature of applied psychology may require special attention relative to other forms of health work practice. Originality/value – This paper provides a particular form of understanding about psychological practices within modern healthcare and public health policies, in the light of the peculiar and contextualised aspects of the case studies provided. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by hyperactivity, inattention and impulsivity. Up to two thirds of young people with ADHD may experience symptoms into adulthood, yet the limited literature available suggests that many young people with ongoing needs do not transfer from child to adult healthcare services. Although worldwide and NICE guidelines recognise the importance of supported transition, evidence suggests for ADHD that this is poorly managed and variable. Little is known about how transition is experienced by those involved. We aimed to synthesise existing peer‐reviewed literature to understand views and experiences of young people, carers and clinicians on transitioning between child and adult ADHD services. Method: Five databases were searched and all articles published between 2000 and up until January 2017 considered. Four key search areas were targeted; ADHD, Transition, Age and Qualitative Research. Quality appraisal was conducted using Wallace criteria. Findings from included studies were synthesised using thematic analysis. Results: Eight papers, six from the UK and one each from Hong Kong and Italy, were included. Emerging themes centred on difficulties transitioning; hurdles that had to be negotiated, limitations of adult mental health services, inadequate care and the impact of transition difficulties. Conclusions: Healthcare transition for this group is difficult in the United Kingdom because of multiple challenges in service provision. In addition to recommendations in NICE guidelines, respondents identified a need for better provision of information to young people about adult services and what to expect, greater flexibility around age boundaries and the value of support from specialist adult ADHD services. More research is needed into ADHD healthcare transition experiences, especially in countries outside the United Kingdom, including accounts from carers and clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Team psychological formulation is an organisational intervention aimed at developing a shared understanding of a person's mental health difficulties. There is a lack of evidence regarding the therapeutic value of this approach for older people. The purpose of this paper is to explore how older people and their carers experience a cognitive-behavioural approach to team psychological formulation, within a mental health inpatient service in the UK. Design/methodology/approach: A qualitative study using interpretative phenomenological analysis was undertaken. In total, 13 participants were interviewed: five older people/carer dyads, two lone older people and one lone carer. Findings: Three overarching themes emerged: "Emotional impact of formulation" captured the mixed emotions that the process evoked in participants. "Making sense?" reflected the therapeutic value that participants experienced and what held them back from making gains in their recovery. "Disempowered people trapped in a biomedical world" illustrated the negative aspects of ward care, which hindered recovery. Research limitations/implications: The findings provide insights into the therapeutic value of team psychological formulation and the difficulties in facilitating the process effectively. More consistency is required to ensure that team formulation is standardised. Further research into the outcomes of the approach for older people is recommended. Practical implications: Recommendations are proposed for how team psychological formulation can be conducted effectively, using the mnemonic "SETUP". Originality/value: This study focussed on older people's and their carers' own perspectives regarding the team psychological formulation approach. [ABSTRACT FROM AUTHOR]

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman, or degrading treatment, and having the right to liberty, security, respect, and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature, findings revealed that restraint can be a form of abuse, it's inappropriate use often being a consequence of fear, neglect, and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike. [ABSTRACT FROM AUTHOR]

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

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

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

This paper describes a mindfulness group and illustrates the benefits of mindfulness groups for people who access NHS/Local Authority mental health services in terms of learning mindfulness skills, becoming more mindful in daily life and in terms of improvements in psychological well-being. [ABSTRACT FROM AUTHOR]

This paper describes a systematic approach to generating practice-based evidence in a United Kingdom adult psychological therapies service. Routine clinical outcomes using standardized measures at referral, assessment, the beginning of therapy, discharge and 6-month follow-up are reported. The system is integrated into the clinical service in many ways including contributing to risk assessment and feeding back clinical outcome data to the therapists. A number of issues related to such an approach are discussed in the light of the clinical governance and clinical effectiveness agendas in the UK NHS. These include practical constraints, the costs, getting staff on board, attrition from such services and service user involvement. Such an approach provides a framework for routine, systematic and integrated service evaluation that can be fed back to therapists. It contributes to the evidence for the effectiveness of psychological therapies in routine clinical settings and also provides opportunities to link evidence with practice in more creative ways to enhance therapists' reflection on their practice. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract Outcome measurement in the NHS remains more an aspiration than a practical reality. reviews the key features required of a modern outcome system and describes the CORE outcomes initiative, designed to evaluate health, social and quality of life outcomes of mental health services, from both clinician and user perspectives. This paper. [ABSTRACT FROM AUTHOR]

Over the past 10 years, researchers and employers have shown an increased interest in the psychological problems that can be experienced by first-line disaster workers. This article briefly reviews available research in the area, and then illustrates the increased management concern over these problems by describing recent developments in the UK Police Service. Disaster contingency planning in this Service has come to place particular emphasis upon the provision of crisis intervention after potentially traumatic disaster work experiences: early, brief, problem-focused treatment, which aims to restore distressed individuals to a precrisis level of functioning. The possible benefits of such early intervention are considered, and then attention is turned to the types of information required for guiding intervention in specific cases. Beyond basic information relating to current symptoms and coping activities, it will be useful to determine what experiences from before, during and after the disaster work are implicated in the person's current disturbance, and how the person is modeling these experiences. It will also be important to identify those contemporaneous, psychological appraisal processes that are sustaining the disturbance: individuals who are left to adjust ‘naturally’ typically pay little or no attention to these powerfully disturbing, but in principle modifiable appraisal processes. [ABSTRACT FROM AUTHOR]