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• Many mental health disorders first emerge during early childhood or adolescence. • Wait times for children's mental health services have been an international and widespread problem. • Long wait times prolong the emotional distress of children and/or adolescents and their caregivers which can exacerbate mental health difficulties. • The majority of research in this area has been conducted in the United Kingdom and Canada and focus on one waitlist strategy. • Common strategies include alternative service delivery models, increasing system capacity, and improving intake and assessment processes. Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level. Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children's mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed. [ABSTRACT FROM AUTHOR]

The first Transplant Games took place in 1978 in Portsmouth, England. Since then, numerous Olympic-style sporting 'Games' have been established, each aiming to increase public awareness of organ donation, demonstrate the benefits of transplantation, and encourage patient fitness. Despite this, there is limited research exploring the psycho-social and health impacts of the Games. Drawing on qualitative research conducted at the 2022 British Transplant Games and the 2022 European Transplant and Dialysis Games, this paper explores the Games through a therapeutic landscapes framework, a concept that examines the ways in which environments contribute to health and wellbeing. Building upon work that acknowledges the relational and contingent nature of health-in-place, I argue that the Games are a therapeutic landscape of social relations for transplant recipients in three ways: providing a landscape of belonging , a landscape of hope , and a landscape of motivation. Through this therapeutic landscapes perspective, the Transplant Games are presented as a peer-to-peer clinic – a care space where individuals are more actively involved in their health on a reciprocal level than in the traditional hospital clinic. In turn, this paper emphasises the crucial role of affective peer support in producing health-promoting environments. This research seeks to make a practical contribution to the wider transplant community by promoting the Games as an environment which may positively contribute to both physical and mental wellbeing. • The Transplant Games function as a therapeutic landscape for organ recipients. • They provide a peer-to-peer clinic where participants are active in their health. • The Games provide a landscape of belonging, acceptance, understanding and family. • In showing you can still lead a healthy life, the Games become a landscape of hope. • As a landscape of motivation, the Games improve both physical and mental health. [ABSTRACT FROM AUTHOR]

National guidance in the UK advises that psychosocial screening is completed for all inpatients admitted to burns services for over 24 h. Acceptable methods of psychosocial screening have been nationally agreed. However, little is known about how different services conduct psychosocial screening. Moreover, data related to validity and reliability are lacking. This paper describes a tiered approach to inpatient psychosocial screening in a UK adult burns service and considers implications for services. Data collected over a seven-year period was analysed retrospectively. Of 891 patients, almost half (48%; n = 431) were screened face-to-face by a graduate level assistant psychologist. Almost one quarter (23%, n = 205) were screened face-to-face by a qualified clinical psychologist. Around a fifth (22%, n = 193) were screened indirectly through psychological discussions at multi-disciplinary team meetings with a member of the burns clinical psychology team present. A minority of patients were screened face-to-face by liaison psychiatry, or by both liaison psychiatry and a clinical psychologist. Screening and delivery of low-level psychological interventions by a graduate level assistant psychologist appeared to protect resources of qualified clinical psychologists for the most distressed patients. Results highlight the value and cost-effectiveness of a tiered approach to psychosocial screening and in guiding subsequent intervention. Future study is needed in relation to inpatient psychosocial screening and its validity and reliability. Investigating the predictive value of screening methods in identifying those with longer-term psychological difficulties would also be important clinically. [ABSTRACT FROM AUTHOR]

In this multi-study paper, we adopted a mixed methods approach to examine the motivational profiles of sub-elite student footballers participating in UK university sport, in relation to their wellbeing, burnout, and drop-out intentions. In Study 1 we used a cross-sectional survey design to collect quantitative measures of motivational regulations, wellbeing, burnout, and drop-out intentions in 260 (n = 129 female) and (n = 131 male) sub-elite university footballers from UK universities (M age = 20.7 y, SD = 1.5 y). Latent profile analysis revealed five distinct motivational regulation profiles that we deemed ranged from less to more motivationally adaptive in the following order: High-controlled, Amotivated (n = 27), Very-low Motivation (n = 32), Average Motivation (n = 104), High-autonomous, High-controlled (n = 38), and High-autonomous, Low-controlled (n = 59). Wald chi-square tests revealed between-profile differences in wellbeing (χ2 = 115, p <.001), burnout (reduced accomplishment: χ2 = 74, p <.001, exhaustion: χ2 = 34, p <.001, devaluation: χ2 = 121, p <.001), and drop-out intentions (university football: χ2 = 40, p <.001, football in general: χ2 = 91, p <.001). Pairwise comparisons suggested more adaptive motivational profiles had higher wellbeing, and lower burnout and drop-out intentions, than less adaptive profiles. Subsequently, in Study 2 we qualitatively explored the experiences of footballers from the different motivational profiles. We purposefully sampled 2–4 participants from each of the five motivational profiles to take part in focus groups, resulting in a total of 15 participants (M age = 21.6 y, SD = 1.41 y; n = 8 female, n = 7 male). Results revealed commonalities across the motivational profiles, including that while motivation was complex, individualized, dynamic and interactive in nature; a central, underlying motivator for all players was their passion for football. However, results also suggested that compared to those from less motivationally adaptive profiles, those from more adaptive profiles tended to perceive the environment more positively and tended to feel more valued by those around them. Thus, protecting players' passion for football and helping them feel more valued within their university-sport environment may support players in remaining in, or moving towards, more adaptive motivational regulation profiles and experiencing associated positive outcomes. • The motivational profiles of sub-elite student footballers participating in UK university sport were examined. • Underpinned by critical realism, a multi-study mixed methods approach was adopted. • Adaptive motivational regulation profiles were associated with positive outcomes (Study 1). • A passion for football and feeling valued within the university sport environment were key themes (Study 2). [ABSTRACT FROM AUTHOR]

In the UK mental health and associated NHS services face considerable challenges. This paper aims to form an understanding both of the complexity of context in which services operate and the means by which services have sought to meet these challenges. Systemic principles as have been applied to public service organisations with reference to interpersonal relations, the wider social culture and its manifestation in service provision. The analysis suggests that the wider culture has shaped service demand and the approaches adopted by services resulting in a number of unintended consequences, reinforcing loops, increased workload demands and the limited value of services. The systemic modelling of this situation provides a necessary overview prior to future policy development. The paper concludes that mental health and attendant services requires a systemic understanding and a whole system approach to reform. [ABSTRACT FROM AUTHOR]

• This study reviewed the prevalence of mental health disorders among Looked After Children in the UK. • Prevalence rates varied across studies. • The Strengths and Difficulties Questionnaire (SDQ) was the most frequently used tool to assess mental health. • There is still uncertainty about the scale and nature of mental health difficulties in this group. Care-experienced children and young people are more likely to experience poorer mental health relative to the general population. Some of the most highly cited literature in this area is becoming increasingly outdated, however, and as the gap between mental health service availability and provision is steadily growing, it is imperative that we understand the scale and nature of the mental health needs of this group. A systematic review of all literature published from the UK was conducted in March 2022 using APA PsycINFO, ASSIA, Cochrane Library, Medline, PubMed, Scopus, Social Policy and Practice, Social Services Abstracts, and Web of Science. Papers were included if they 1) sampled young people (aged 0 to 18 years) with care experience and, 2) used either a standard or non-standardised measurement tool, or health records to assess mental health prevalence rates (reported as a percentage). Risk of bias assessed used the QuADS tool (Harrison et al., 2021) and data was extracted. Thirty-nine studies were included and summarised. The estimated prevalence of mental health disorders of young people in care ranged from 1 to 82 %. The most frequently used tool to assess mental health was the Strengths and Difficulties Questionnaire (Goodman, 1997) and, while over half of studies utilised prevalence information from a comparator group, this was most commonly young people in the general population. The results of the systematic review demonstrate that estimates of mental health disorders among care-experienced young people in the UK vary considerably. Further consideration should be given toward what measures are used to assess mental health in this population and how we can optimally assess and characterise their support needs. [ABSTRACT FROM AUTHOR]

This paper examines the mental health impacts of poor quality private-rented housing in the north of England during the UK's first COVID-19 lockdown. The paper draws on data collected from semi-structured telephone interviews with 40 renters in the private-rented sector. We use the Power Threat Meaning Framework to highlight how substandard housing was a social and material vulnerability which, underpinned by powerlessness, resulted in threats that created and exacerbated the mental-ill health of precarious private renters. The paper suggests the pandemic and increased time spent in unhealthy places of residence can create stresses at a time of broader structural fragility, and calls for the greater engagement and integration of health practitioners in the future development of housing policy at all levels. [ABSTRACT FROM AUTHOR]

Muslims constitute the largest, fastest growing religious minority in the UK. Globally, nurses are legally, morally and ethically obliged to provide non-discriminatory, person-centred, culturally sensitive care. This obligation includes supporting people with their religious needs where appropriate, but there is evidence this is not always happening, particularly for Muslims in mental health care. This paper reviewed primary research to address the question: Can mental healthcare for Muslims be person-centred without consideration of religious identity? Narrative synthesis and concurrent analysis. Searches were conducted post 2000 in MEDLINE, CINAHL, SAGE, PsychINFO and ASA with terms: 'Muslim', 'Islam* ', 'mental health', 'nurs* ', 'person-cent* ', 'religio* '. Narrative data were analysed for commonalities and themes. Seven studies of sufficient quality were analysed. Unconscious religious bias was the overarching theme linking the findings that healthcare staff felt ill-prepared and lacked necessary knowledge and experience to work with diverse patient groups. Unconscious racial bias contributed to limited cultural/ religious competence in treatment and care. Religious identity is core for Muslim patients, so this group may not be receiving the person-centred care they deserve. Nurses need cultural and religious competence to deliver person-centred, holistic care to diverse patient populations, yet the importance of religious practice can be overlooked by staff, with harmful consequences for patient's mental and spiritual welfare. This paper introduces a welcome pack that could help staff support the religious observance of those Muslim patients/service-users wishing to practice their faith during their stay in health services. [ABSTRACT FROM AUTHOR]

Background: There is a large literature suggesting that noise can be detrimental to health and numerous policy documents have promoted noise abatement in clinical settings. Objectives: This paper documents the role of noise in clinical environments and its deleterious effects with a particular focus on mental health care. Our intention however, is to go beyond the notion that noise is simply undesirable and examine the extent to which researchers have explored the meaning of sound in hospital settings and identify new opportunities for research and practice. Data sources and review methods: This is a narrative review which has grouped the literature and issues in the field into themes concerning the general issues of noise in health care; sleep noise and hospital environments; noise in intensive care units; implications for service users and staff; and suggestions for new ways of conceptualising and researching clinical soundscapes. Data sources comprised relevant UK policy documents and the results of a literature search of Pubmed, Scopus and Web of Knowledge using terms such as noise, health, hospital, soundscape and relevant additional terms derived from the papers retrieved. In addition the references of retrieved articles were scanned for additional relevant material and historical items significant in shaping the field. Results: Excess unwanted noise can clearly be detrimental to health and impede recovery, and this is clearly recognised by policymakers especially in the UK context. We use the literature surveyed to argue that it is important also to see the noise in clinical environments in terms of the meaning it conveys and rather than merely containing unwanted sound, clinical environments have a 'soundscape'. This comprises noises which convey meaning, for example about the activities of other people, the rhythms of the day and the nature of the auditory community of the hospital. Unwanted sound may have unwanted effects, especially on those who are most vulnerable, yet this does not necessarily mean that silence is the better option. Therefore it is our contention that it is important to begin thinking about the social functions of sound in the mental health environment. Conclusions: Whilst it can be stressful, sound can also be soothing, reassuring and a rich source of information about the environment as well. It may be used to secure a degree of privacy for oneself, to exclude others or as a source of solidarity among friends and colleagues. The challenge then is to understand the work that sound does in its ecological context in health care settings. [ABSTRACT FROM AUTHOR]

There is ongoing debate regarding the shape of life-course trajectories in mental health. Many argue the relationship is U-shaped, with mental health declining with age to mid-life, then improving. However, I argue that these models are beset by the age–period–cohort (APC) identification problem, whereby age, cohort and year of measurement are exactly collinear and their effects cannot be meaningfully separated. This means an apparent life-course effect could be explained by cohorts. This paper critiques two sets of literature: the substantive literature regarding life-course trajectories in mental health, and the methodological literature that claims erroneously to have ‘solved’ the APC identification problem statistically (e.g. using Yang and Land's Hierarchical APC–HAPC-model). I then use a variant of the HAPC model, making strong but justified assumptions that allow the modelling of life-course trajectories in mental health (measured by the General Health Questionnaire) net of any cohort effects, using data from the British Household Panel Survey, 1991–2008. The model additionally employs a complex multilevel structure that allows the relative importance of spatial (households, local authority districts) and temporal (periods, cohorts) levels to be assessed. Mental health is found to increase throughout the life-course; this slows at mid-life before worsening again into old age, but there is no evidence of a U-shape – I argue that such findings result from confounding with cohort processes (whereby more recent cohorts have generally worse mental health). Other covariates were also evaluated; income, smoking, education, social class, urbanity, ethnicity, gender and marriage were all related to mental health, with the latter two in particular affecting life-course and cohort trajectories. The paper shows the importance of understanding APC in life-course research generally, and mental health research in particular. [ABSTRACT FROM AUTHOR]

Background Poor mental health is the largest single source of disability in the UK, and co-morbid health problems, particularly with cancer, raise total health care costs significantly. Methods This study examined what research is being conducted into the intersection between cancer and mental health. Research papers captured by the intersection of sub-field filters—‘mental disorder’ and ‘cancer’—were studied from the Web of Science over a 10-year period (2002–2011). Results There were 1463 papers dealing with the dual presence of cancer and mental disorder. They amounted to 0.26% of cancer research and 0.51% of mental health research over the 10-year period, indicating that their intersection receives little research attention. Eighty per cent of papers were concerned with the effects of cancer on mental health rather than the reverse; a few (5%) looked at the post-traumatic stress suffered by carers of cancer patients. Of cancer types, breast dominated (21%), followed by prostate (5%), lung (3%), oral (2%) and colorectal (2%) cancer. The area of mental health most studied in cancer was unipolar depression. Conclusions The paucity of research that exists at the intersection of cancer and mental health requires attention from policymakers and funders in order to address an important trans-disciplinary gap in health care research. [ABSTRACT FROM PUBLISHER]

Abstract: Drawing from 81 interviews with practitioners in social care and housing with care services in the United Kingdom, this paper explores practice issues in rural areas when supporting the mental health and well-being of older people from Black and minority ethnic groups. The paper begins with a review of the literature which provides evidence that BME older people are likely to be increasingly part of the populations of rural areas. Next it presents interview data revealing that while practitioners are aware of such demographic changes in general terms; some feel that they lack training and skills in adapting their professional practice to support all older people. Others express feelings of professional isolation in seeking to support older people from minority groups and are concerned that older people from minority groups may be at risk of isolation and loneliness. The paper concludes with a discussion of the study''s implications for rural practice, policy and research. [Copyright &y& Elsevier]

Abstract Current political rhetoric and some media commentaries suggest there is a yawning gap of understanding between policymakers and the reality of families living in poverty in 21st century Britain. A key reason identified for the disconnect between policymakers and families is the absence of the voices of the families in public discourse. In this paper accounts of the lived experiences of parents in poverty are examined in four UK qualitative studies published in the period 1998–2016. Their accounts highlight how problems of disadvantage can be cumulative, compounding and enduring. The struggle to provide the basics of family life and the role of supportive communities and relationships are explored. The impact on parents of financial stress, the sense of shame and stigma often experienced and the consequences for their physical and mental health are highlighted. Under the government's austerity policy, there is an increase in poverty even in working families, an increase in homelessness and considerable evidence emerging on the damaging consequences of food and fuel poverty on the health of children and parents. Listening to the lived realities of individual families provides a much greater understanding of family poverty and its causes and consequences, provides a corrective to the critical pejorative rhetoric and lays the foundation for the provision of appropriate government support. Highlights • A significant gap exists between the understanding of policymakers and the reality of families living in poverty in 21st Century Britain. • A key reason for this disconnect is the absence of the voices of the families in public discourse. • Accounts of the lived experiences of parents in poverty highlight how problems of disadvantage can be cumulative, compounding and enduring. • The impact on parents of financial stress, sense of shame and stigma as well as physical/mental health consequences are highlighted. • Under the government's austerity policy, there is an increase in poverty even in working families and an increase in homelessness. • Considerable evidence is emerging on the damaging consequences of food and fuel poverty on the health of children and parents. [ABSTRACT FROM AUTHOR]

Abstract This paper focuses on the long-term impacts of attending a high school with inadequate sports facilities. We use prospective data from the British National Child Development Study, a continuing panel of a cohort of 17,634 children born in Great Britain during a single week of March 1958. Our empirical approach exploits the educational system they were exposed to: children were sorted by educational ability at age 11, but conditional on educational ability, attended their closest school. This produces quasi-random variation in the quality of the school sports facilities across respondents. We use this variation between cohort members residing within the same local authority area, and focus on outcome measures of physical activity, health, health-related lifestyle activities, and socioeconomic status, collected at ages between 33 and 50 years. We control for any potential links between the inadequacy of sports facilities and inadequacy of other facility types, and test that allocation to school type is random with respect to pre-high school observables. We find that attending a school with inadequate sports facilities led to a statistically significant, modest decrease in the likelihood of physical activity participation during adulthood. In contrast, we find no evidence that inadequate sports facilities worsened adulthood measures of physical and mental health, lifestyle or socioeconomic status. Highlights • Inadequate school sports facilities leads to a decrease in adulthood exercise. • The reduction in exercise is modest. • Inadequate school sports facilities has no long-term health effects. • Inadequate school sports facilities has no long-term socioeconomic effects. [ABSTRACT FROM AUTHOR]

Abstract: UK policy interest in the health effects of the outdoors has grown rapidly in recent years. In parallel, the research community''s effort to strengthen the evidence base for the relationships between the outdoors and health has also increased. However, little has been done to explore quantitative secondary public data sets conducted by government departments and agencies to improve the evidence base on understanding such links. This paper aims to provide an overview of potentially valuable secondary public data sets and to assess their relevance for adding to the existing evidence base on the health effects of the natural outdoors. The search identified 41 data sets dealing with the outdoors/outdoor use, health or both. Review results indicated that, due to their large scale, extensive coverage, and continuous or longitudinal nature, knowledge included in secondary public data sets could be a valuable addition to the current evidence base and provide useful baseline information for future studies. This paper also identifies some aspects of secondary public data which could be improved, establishing a stronger knowledge base for the health effects of the natural outdoors. [Copyright &y& Elsevier]

Abstract: This paper examines routine primary care consultations in the UK where smoking is discussed using data from a larger study of the factors influencing discussion of smoking between general practitioners (GPs) and patients. In this study, consultations have been analysed with a focus on the termination of discussion about smoking, using an approach that is informed by the conversation analytic (CA) literature on professional/client interaction. In interviews from the previous larger study, GPs suggested two main reasons for not pursuing discussion of smoking in consultations. One reason was an overarching fear of damaging the GP/patient relationship. The second reason related to clinical judgement, where it was feared that an attempt to stop smoking might exacerbate a patient''s existing condition, particularly their mental health. This paper suggests that, while this latter scenario of clinical judgement is borne out by the consultation data, there are two more subtle patient behaviours which are associated with GPs abandoning further discussion of smoking: patients’ ‘troubles telling’, where the issue of smoking is de-emphasised in the face of other ‘troubles’, and ‘defensive expansion’, where the patient over-emphasises deficiencies to curtail discussion. Greater awareness of the situations in which doctors end discussion of smoking will help GPs to develop ideas for alternative approaches in these circumstances which could result in more meaningful, effective engagement between doctors and their patients who smoke when smoking is discussed. [Copyright &y& Elsevier]

Abstract: In this paper I discuss the question of how we should understand the concept of “social movements”, particularly as applied to health related movements. My argument is that movements should be understood as “fields of contention”. This concept, as I develop it, emphasizes two key aspects of social movement mobilization. Firstly, departing from traditional models of movements, which tend to view them as unified “things”, it draws our attention to the numerous groups and agents who interact within the internal space of a “movement” and to the relations, alliances and conflicts between those various groups/agents as they unfold through time. Secondly, it draws our attention to the embedding of social movement struggles within multiple differentiated contexts of struggle, each of which affords different opportunities for struggle but each of which makes different demands upon activists if struggle is to prove effective. The model of fields of contention is explored within the paper using empirical data on a variety of “social movement organizations” (SMOs) which have formed around the mental health system in the UK over the last forty years. [Copyright &y& Elsevier]

• Digital technologies draw together knowledge, practice and self-care in novel and productive ways. • Digital curation provides young farmers with the agency to connect or disconnect from others. • Digital mediation encourages young farmers to critically reflect on their own practices of digital self-care. This paper explores the geographies of digital curation and self-care among young farmers in the UK, examining how virtual and digital spaces are having a significant impact on how young farmers negotiate their identities, (dis)connection and self-care within their everyday lives. Drawing on interviews with 28 young famers in the UK, we observe how farming identities are (re)produced and practiced online, via carefully curated social media, and how these might constitute practices of self-care in overcoming issues such as disconnection and rural isolation. Our analysis reveals how social media posts are more than simple connections, they are curations of the self that are complexly bound up in the emotional, spatial and temporal contexts of the author's identities. We examine how digital curation is not just an act of the self, but something drawn relationally to others. Attention is given not just to what is posted, but how others are (dis)engaged with, and how posts of others are reacted to, or endorsed, implicitly or explicitly. Through our examination of young farmers' social identities, we therefore argue that digital identities are produced, practiced, managed and understood in very specific ways 'online', in ways that carefully overlap with other geographical identities. [ABSTRACT FROM AUTHOR]

The last two decades have seen a changing profile of young male mental health in Britain, including increased suicidal and parasuicidal behaviours. For mental health professionals to respond effectively and appropriately to meet these changing needs there needs to be further theorising and development of knowledge of young men's psychological processes and, in particular, how they make sense of their experiences within the cultural context of their lives. By drawing upon contemporary theories of subjectivities, this paper attempts to begin to address some of these issues. It looks in detail at two young men's accounts of their experiences of mental health problems. By using narrative, thematic and discourse analyses, the authors consider the cultural concepts the young men draw upon, and the language they use to voice their distress. The paper focuses on how gender and traditional masculinities constrain and influence the young men's narratives within the context of their individual life-histories and how these may become problematic for their mental health. The analyses provide a contemporary language-sensitive and culturally-sensitive reading of the young men's accounts of mental distress. It highlights how young men may talk about their distress in ways that are not immediately recognisable and extends the knowledge of the contemporary discourses used by young men in British society today. The implications for male subjectivities and mental health and therapeutic engagement are discussed. [ABSTRACT FROM AUTHOR]

According to the health selection hypothesis, poor mental health and behavioural problems in adolescence limit socioeconomic attainment. But to what extent is health selection driven by prior social causation? This paper quantifies the extent to which health selection – here, restricted or downward intergenerational social class mobility due to poor mental health or behavioural problems – can be attributed to the influence of modifiable childhood risk factors. The UK National Child Development Study provides measures of socioeconomic deprivation and childhood adversities, as well as multiple-informant ratings of adolescents' mental health and behavioural problems, for which confirmatory factor analysis supports a three-factor model. Decomposition analysis is used to robustly assess the extent of attenuation of selection effects when conditioning on the childhood environment. Conduct problems, hyperactivity, and to a lesser extent emotional symptoms at age 16 are associated with individuals' chances of achieving (un)desirable mobility outcomes. When prior childhood risk factors are taken into account, the association of conduct problems with mobility is attenuated by around 50%, indicating a substantial role for confounding and earlier processes of social causation in the generation of this health selection effect. Further analyses indicate that this attenuation is greater for those from the most disadvantaged backgrounds and is mostly driven by the inclusion of indicators of generalised disadvantage such as crowded housing and low income. On the other hand, the effects of emotional symptoms and hyperactivity on mobility outcomes are not significantly accounted for by childhood risk factors. This study adds to the health inequalities literature by interrogating the empirical validity of the usual interpretation of health selection effects as indicating the causal priority of the onset of poor mental health. [ABSTRACT FROM AUTHOR]

• Risk of maltreatment from combined toxic trio factors a dominant concept in UK child protection. • Systematic review found 20 papers. • Evidence base lacks definition of key measures, intersectionality analysis or theoretical basis. • Other key risk factors, especially family socio-economic circumstances, excluded. • Need to rebuild the evidence base and rethink the focus of policy and practice. The term 'toxic trio' was coined to describe the risk of child abuse and neglect stemming from a combination of domestic violence, parental mental health issues and/or learning disability, and parental alcohol and/or drug misuse (Brandon, 2009). Although concerns about the language have been raised in some quarters, it has become a dominant reference point in children's social care in England and, to an extent, internationally over the past two decades. It has become embedded in the family justice system, child protection assessment processes and national data collection. There is evidence that each factor in isolation can lead to worse child outcomes, although this is of mixed quality and far from comprehensive. This article reports the results of a systematic review of evidence relevant to the relationship between the 'toxic trio' factors in combination and child maltreatment, identifying 20 papers. Despite the term's currency, we found little quality evidence of the incidence of the 'trio' factors in child maltreatment, little consideration of intersectionality and almost no theoretical examination of the supposed relationships. Such studies as have been conducted have too rarely taken into account, or controlled for, contextual factors, such as the socioeconomic circumstances or the ethnicity of the families, or children's ages. The discrepancy between the priority given to the 'toxic trio' and the paucity of the evidence-base makes a case for a shift away from over-simplified attributions of parental risk in policy and practice, and towards greater attention being given to other significant factors for child protection. [ABSTRACT FROM AUTHOR]

This paper explores how middle aged and older asylum applicants in the UK speak about health in relation to migratory experiences. It proposes biocredibility as a novel theoretical concept, through which the narratives of those migrating to the UK to seek asylum can be analysed. The UK government's hostile environments policies, which aim to make life uncomfortable for irregular migrants in the UK in order to drive down migration, have been criticised on legal, material and moral grounds. This paper adds to this critique. Narrative analysis of semi-structured interviews shows that the majority of the asylum applicants interviewed felt their health was poor and told of the difficulties of life in the UK. Stories of homelessness, poverty and exclusion dominated, underpinned by the erosion of their perceived trustworthiness and credibility through encounters with the Home Office. Particular personal experiences of social, political and economic strife in exile were narrated closely against stories of illness. The concept of biocredibility refers to, and provides a way of understanding, participants' propensity for creating narrative enclaves for pathographies as a discursive mechanism to add credibility to narratives of lived experience. In this way, visceral descriptions of biological suffering can function as a narrative resource. It does this firstly by providing material and social context for adverse health, thus allowing participants to attribute a socio-political cause for their illness. Secondly it interjects experiences of illness into life narratives, thus effectively communicating the significance of such experiences. Finally, it provides narrative evidence of individuals' autobiographical testimony. For discredited and marginalised asylum applicants, biocredibility can be understood to represent a strategy used to re-negotiate credibility and urges a critical consideration of the hostile and austere socio-political context in which it is observed. • In the UK hostile environment policies aim to decrease net migration. • Narrative analysis shows how this impacts asylum seekers' health. • Asylum seekers associate life in the UK with biological dysfunction. • This paper conceptualises this through a novel paradigm: Biocredibility. • Biocredibility describes the narrative biologisation of lived experience. [ABSTRACT FROM AUTHOR]

Using data from the British Millennium Cohort Study (MCS), an ongoing longitudinal study of a cohort of 18,827 children born in the UK in 2000–2001, we investigate important correlates of mental health issues during childhood. MCS respondents were sampled at birth, at age 9 months, and then when they were 3, 5, 7 and 11 years old. Each sweep contains detailed information on the family's SES, parenting activities, developmental indicators, parental relationship status, and indicators of parental mental health. The Strengths and Difficulties Questionnaire (SDQ) and the related Rutter scale were used to identify behavioral and emotional problems in children. In this paper, childhood problems are separated into four domains: hyperactivity, emotional symptoms, conduct problems, and peer problems. We focus on two aspects of this relationship at ages 5 and 11–the role of temporary and persistent poverty and the role of temporary and persistent mental health problems of mothers and fathers. At ages 11 and 5, without other controls in the model, persistent and transitory poverty have strong estimated associations with all four domains, with somewhat stronger estimated effects for persistent poverty. After a set of controls are added, we document that both persistent levels of poverty and transitions into poverty are strongly associated with levels of and transitions into childhood mental health problems. Similarly, sustained levels and transitions into mothers' mental health problems are strongly associated with levels and transitions into children's mental health problems. This is much less so for fathers. [ABSTRACT FROM AUTHOR]

Evidence points towards the key role that networks of both formal and informal relationships play in musicians' careers. Alongside this, these careers have in recent decades become increasingly understood as engendering emotional stressors around mental health and wellbeing. However, what is the relationship between these two phenomena? In other words, what is the affective impact on musicians' mental health of maintaining, understanding and negotiating the most proximate relationships in their lives? This paper seeks to answer this by employing the conceptual architecture of relational work, focusing in particular on the experiences of 'mismatches', to interpret insights from semi-structured interviews with twenty-eight musicians working in the United Kingdom. The findings suggest that the relational work of 'matching' relationships to appropriate understandings and methods of transactional exchange is enormously complex for musicians given that their economic relationships often are intimate personal relationships, and vice versa, leading to frequent 'mismatches' in musicians' methods of relationship management which can be upsetting or emotionally destabilising. This is revealed by exploring the overlapping and interconnected forms of relational work employed by musicians amongst both their family and their musical colleagues. The findings contribute towards scholars adopting an affective frame of analysis towards practices of relational work, an emerging body of work primarily from Eastern Europe applying relational work analysis towards musicians, and more broadly researchers interested in understanding the psychosocial causes of mental ill-health amongst musicians. [ABSTRACT FROM AUTHOR]

Recent housing welfare reform in Britain has left many younger welfare claimants with no choice but to move into a shared rental property with strangers. In this paper we take an intersectional approach to analyzing the impact of housing welfare reform, by examining how certain protected equalities groups may be particularly at risk from the potential harms of shared living with strangers. Drawing upon in-depth biographical interview data, we outline how young people often spoke of their share houses as places that were detrimental to their health and wellbeing. Our analysis focuses on two key themes: physical safety and violence, followed by mental health and isolation. Ultimately the paper examines whether housing welfare reform in Britain has resulted in placing already vulnerable people into potentially dangerous and unhealthy housing situations. [ABSTRACT FROM AUTHOR]

Urban centres in the US, Britain and Canada have responded to identified visible 'social problems' such addiction, mental health and homelessness by providing some supportive housing for the urban poor and marginalized. While some critics have questioned what supportive housing specifically entails in terms of the built environment, what remains under explored, though a growing area of concern, is the relationship between surveillance and supportive housing for urban residents identified as having addiction and mental health problems - a gap addressed in this paper. Drawing upon qualitative ethnographic observational data we examine some of the measures of control and coercion that are encroaching into social housing primarily established for poor and marginalized people with addiction and mental health problems in the urban centre of Vancouver, Canada. We witnessed three modes of regulation and control, that vary widely, among the residencies observed: physical surveillance technologies; site-specific modes of coercion; police presence and staff surveillance, which all together impact the everyday lives of residents living in low-income and supportive housing. We argue that supportive housing has the potential to provide its intended commitment - safe and secure affordable housing. However, owing to an (over)emphasis on 'security', the supportive housing we observed were also sites of social control. [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]

Since the closure of the UK asylums, ‘the community’ has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action. [ABSTRACT FROM AUTHOR]

Studies in the UK demonstrate evidence that ethnic minorities living in communities with a higher proportion of co-ethnics report better mental health: co-ethnic density effects. This paper aims to address three gaps in this literature. Firstly, most UK research has focused on acute mental disorders (e.g., psychosis), with little work examining co-ethnic density effects for more common mental disorders. Secondly, there is a paucity of research exploring the role that residential segregation may play alongside co-ethnic density in minority mental health. Thirdly, little systematic testing has examined at what geographic-scale co-ethnic density effects are most salient for minority-group mental health. To address these potential gaps, we apply multi-level linear regression modelling to a large-scale, nationally-representative UK panel dataset, containing an ethnic minority booster-sample, to study the community-level drivers of mental health-related quality-of-life (SF-12 Mental Component Summary Score). The results demonstrate mixed support for the protective-effects of co-ethnic density on mental well-being. However, they demonstrate broadly consistent support for the impact of residential segregation on mental well-being. In particular, that segregation exerts a non-linear effect: mental well-being is at its most positive at medium-levels of segregation, somewhat more negative at low-levels of segregation, and much more negative at higher-levels of segregation. These patterns are present for the 'all ethnic minority' sample, and stronger for Black sub-groups compared to Asian sub-groups. These relationships appear most consistent at meso-local geographic scales (Middle Super Output Areas). These findings have important implications for theorising our understanding of the nexus between the community and mental health among minority-groups. [ABSTRACT FROM AUTHOR]

Abstract: Guided by theoretical perspectives of relational social science, this paper draws on reanalyses of multiple qualitative datasets related to a multi-ethnic, economically disadvantaged area in Liverpool, UK, with the aim to advance general understanding of access to primary mental health care while using local Somali minority as an instrumental focus. The findings generate a novel concept: the space of access. The shape and dynamics of the space of access are determined by at least four fields of tensions: understandings of area and community; cognitive mapping of mental well-being, illness and care; positioning of primary care services; and dynamics of resources beyond the ‘medical zone’ of care. The conclusions indicate a need for de-centring and re-connecting the role of medical professionals within primary care which itself needs to be transformed by endorsement of multiple avenues of access to diverse support and intrepid communication among all involved actors. [Copyright &y& Elsevier]

Abstract: In 2009, two seminal documents were published by the United Kingdom (UK) government concerning healthcare services for offenders. The Bradley review into diversion for people with mental health problems and learning disabilities emphasised a need to improve offender health, not least because of the high economic costs to society as a whole resulting from unresolved mental illness, physical ill-health and substance abuse problems commonly experienced by offenders. The Bradley review made wide-reaching recommendations for change, requiring strong partnership between health and justice agencies at both central government and local levels. A framework for the delivery of Bradley''s recommendations has been set out in Improving health, supporting justice, the Department of Health''s offender health strategy which sets out the direction of travel for the next 10years. This paper discusses the reality of working toward improving health services for this marginalised group in the context of the influence of the current straitened financial climate on the allocation of resources to publically funded healthcare in the UK; it examines the historically based, and widely held, belief in the principle of “less eligibility” within our society, whereby there is much public and media resistance to allocating resources to improving care for offenders when other, more “deserving”, groups are perceived to be in continuing need. [Copyright &y& Elsevier]

Abstract: Historically, war trauma research has concentrated on the relationship between level of exposure and development of post-traumatic symptoms. More recently, it has been recognized that intra- and interpersonal differences can mediate how service personnel are affected by their experiences. This paper is a qualitative study exploring moral evaluations of 30 British male veterans towards their deployment in conflicts from WWII to the most recent Iraq War (2003–2009). Retrospective thematic analysis is used to explore moral evaluation and societal support. Four categories emerged based on veterans’ moral evaluation of deployment: justifiable, implicitly justifiable, unclear, and unjustifiable. Analysis revealed broad differences between these groups. Veterans able to justify their experiences reported more positive aspects of both deployment and societal support than those unable to justify their deployment. These findings make clear the importance of future research exploring the interactions between civilians and service personnel, and the impact this has on mental health. [Copyright &y& Elsevier]

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]

Abstract: Remote psychotherapy services such as telephone-administered cognitive behavioural therapy (T-CBT) have the potential to provide effective psychological treatment whilst simultaneously maximising efficiency, lowering costs and improving access to care. However, a lack of research examining the acceptability of non face-to-face psychotherapy means that little is known about users’ perceptions of these delivery models. This paper reports data from two qualitative evaluations of T-CBT delivered in the voluntary and occupational health sectors in the UK. It explores users’ acceptance of T-CBT, contrasting initial socially-construed expectations with more positive regard derived from experiential norms. User satisfaction with T-CBT was mixed. However, the relative ease with which most participants adapted to telephone-based care was suggestive of a shared construct of mental health service provision that prioritised the accessibility and availability of services over the social, professional and medico-legal perspectives that conventionally promote the co-location of practitioner and client. [Copyright &y& Elsevier]

Abstract: In this paper we consider the potential of autobiographical narratives for accessing ‘storied knowledge’ in research around geographies of health voluntarism. We firstly consider what is meant by elicited autobiography and how the narrative approach has been used in research more broadly. Drawing on fieldwork undertaken in Manchester, UK and Auckland, New Zealand we then demonstrate how this approach has helped us to map out and unpack the career journeys of mental health activists working within and across the voluntary and statutory sectors. Through our autobiographical narratives we illustrate how this approach has enabled us to elicit important insights into the triggers and trajectories underpinning mental health activism and how events and moments in time have provided critical junctures in these trajectories. We consider places as sites of significance in activist career paths; and as central to the researcher-participant gestalt within which the autobiography is elicited and recounted. The autobiographical process, we suggest, offers reflective insights into mental health activism that might not otherwise be gained using more conventional methodologies. [Copyright &y& Elsevier]

Abstract: Care pathways are multidisciplinary care management technologies which map out chronologically activities in a healthcare process. In the UK, they are advanced as a mechanism for enacting the changes called for under clinical governance. The terminological imprecision of care pathway methodology has enabled it to align clinical, management and service user interests and helps to explain the growing popularity of care pathways as quality improvement tools. Whilst it is possible to identify a ‘zone of agreement’ between these social worlds, there exists a fuzzy periphery characterised by conflicting agendas, which presents challenges for those charged with inscribing these interests into the pathway artefact. Drawing on a qualitative case study of a mental health safety care pathway in the UK, this paper examines the processes by which originators negotiated and settled upon a given design. The data reveal inherent tensions within pathway technology and the knowledge developers draw upon in devising strategies to overcome these challenges. [Copyright &y& Elsevier]

• We explore young Black males' understandings of mental health, alongside informal and formal support systems in the UK. • Mental health is constructed through notions of masculinity, culture, weakness and control. • Formal support systems represent an unfamiliar and discriminatory environment for Black males and whilst informal support feels more accessible, speaking to family and friends is hindered by their constructs of mental health. • It is necessary to continue discursive investigations into unique experiences of young Black males in the UK, particularly with regards to statutory services which remains a huge barrier for helpseeking. Black males within Western society, who navigate recurrent racism and discrimination, have frequently been constructed as "high risk" for mental health difficulties. Research, particularly in the USA, has identified the barriers that Black males face in relation to seeking help, with research outlining the underutilisation of mental health services and overrepresentation of acute mental health diagnoses such as psychosis. Research within the UK has explored barriers to help-seeking amongst males in general, or adult Black males who are within the mental health or prison systems, yet to date little is known about the ways in which Black male adolescent youth outside of formal services understand mental health. Therefore, this paper offers a contribution to knowledge by examining the way in which young Black males in the UK make sense of mental health and associated systems of support. Data from ten interviews with males aged 16–18 from a South London school was collected and analysed using thematic analysis (TA). The young Black males' understandings of mental health were embedded with notions of masculinity, being in control and strong, and they understood mental health as something that is experienced by other people. Formal support for mental health difficulties was constructed as an unfamiliar and unapproachable system, that is often unkind and discriminatory towards Black males. Speaking to family and friends about mental health difficulties felt more accessible for these young males, however their construct of mental health and constructs within the community provided further silencing on using this support. This study suggests important implications for understanding the experiences of mental health and seeking support amongst Black male adolescents in the UK. [ABSTRACT FROM AUTHOR]

Abstract: Irish geographical and cultural propinquity to the UK might be considered as an advantage to migrants. However, research over 40 years shows Irish migrants to have consistent high vulnerability to mental disorders. Only recently have researchers begun to explore the reasons for this morbidity. Taking a previous epidemiological study on depression and Irish migrants as a point of departure, we explored the reasons for this morbidity—we hypothesised that depression may be related to unprepared or spontaneous migration. We report on a qualitative study in order to clarify how, from the migrant''s perspective, migration might be related to depression. These perspectives were obtained through in-depth interviews with Irish-born migrants aged 18 and over living in London in order to explore psychological distress through a contextualised ‘insiders’ account. The interviews were completed with men and women who experienced depression and others who had not. We found that previous theories on Irish migrant psychiatric disorder such as racial discrimination were not supported by the narratives of Irish migrant experience. For many participants, the origins of distress are located in Ireland or in difficult life events and circumstances without a direct relationship to migration. This paper examines the causal attributes to depression among Irish migrants in the UK in the context of pre- and post-migration experiences with particular focus on gender and age. [Copyright &y& Elsevier]

User or patient involvement (UI) in the planning and delivery of health services is an aspiration of many industrialized economies, and has been promoted by United Kingdom (UK) governments for over two decades. This paper reports the findings of qualitative case studies of UI in two mental health provider Trusts in London. Semi-structured interviews were conducted with a variety of stakeholders, including Trust staff at all levels and user group members, to compare the expectations of diverse stakeholders and the extent to which these were achieved. We found that UI remained in the gift of provider managers: providers retained control over decision making, and expected users to address Trust agendas and conform to Trust management practices. Users wanted to achieve concrete changes to policies and services, but had broader aspirations to improve the status and condition of people with mental health problems. Suggestions are made about the direction of future strategies to improve UI. [Copyright &y& Elsevier]

Background: The aim was to examine the correlates of increased alcohol consumption during the COVID-19 pandemic-related restrictions that were implemented in a sample of UK adults.Methods: This paper presents analyses of data from a cross-sectional study. Adults aged 18 years and over, residing in the UK and self-isolating from others outside their own household were eligible to participate. Participants reported increase or no increase in their level of alcohol consumption from before to during lockdown, as well as symptoms of anxiety, depression and mental wellbeing. Socio-demographic characteristics were compared between adults with and without reported increased alcohol consumption. The associations between reported increased alcohol consumption and mental health outcomes were investigated using logistic and linear regression analyses.Results: 691 adults (61.1 % women; 48.8 % aged 35-64 years) were included in the analysis. Of these, 17 % reported increased alcohol consumption after lockdown. A higher proportion of 18-34-year olds reported increased alcohol consumption compared to older groups. The prevalence of poor overall mental health was significantly higher in individuals with increased alcohol consumption (vs. no increase) (45.4 % versus 32.7 %; p-value = 0.01). There was a significant association between increased alcohol consumption and poor overall mental health (OR = 1.64; 95 % CI = 1.01, 2.66), depressive symptoms (unstandardized beta = 2.93; 95 % CI = 0.91, 4.95) and mental wellbeing (unstandardized beta=-1.38; 95 % CI=-2.38, -0.39).Conclusions: More than one in six UK adults increased their alcohol consumption during lockdown and a higher proportion of these were younger adults. Increased alcohol consumption was independently associated with poor overall mental health, increased depressive symptoms and lower mental wellbeing. These findings highlight the importance of planning targeted support as we emerge from lockdown and plan for potential second and subsequent waves. [ABSTRACT FROM AUTHOR]

Liew et al. (2020) recently published a paper in this journal that analyzed antidepressant prescription trends in the context of the 2016 Brexit referendum and the sociopolitical discord that followed. They present a novel finding that Leave-majority constituencies in England seemed more adversely affected by that discord than Remain-majority constituencies. I offer criticism of their findings and methodology. Using the complete set of available NHS prescription data shows that the trend the authors detect dates from at least mid-2010 and is not associated with the referendum. In terms of methodology, I critique the potential ecological fallacy and issues of false equivalence in their study design. The former stems from the inability to adequately control for demographic heterogeneity within constituencies, and the latter stems from the fact that the populations from which they draw their data are not equivalent in potentially important ways. Finally, I conclude that the key trend the authors detect seems to merely be a geographic artifact. The set of Remain-majority constituencies unintentionally oversamples the areas of England with the lowest rates of antidepressant prevalence, Greater London and the Southeast. Remain-majority constituencies outside of those two regions have roughly the same antidepressant prescription levels as Leave-majority constituencies in all of England. In itself, that is a troubling fact of social epidemiology, but Brexit is associated with it neither spatially nor temporally. [ABSTRACT FROM AUTHOR]

This paper presents the lived experiences of individuals with mental illness as they navigate the benefits landscape in an age of welfare reform in the UK. We focus on the impacts upon their well-being and daily geographies. We articulate the relationship between welfare reform and mental health using the concept of poverty management and its 'missing geographies', in which everyday well-being and routines are dismissed by the restructuring welfare system. We liken this dismissal to a shift towards a narrower and more unforgiving mode of poverty management, where even the smallest misstep can unravel the entire edifice of everyday survival and well-being. [ABSTRACT FROM AUTHOR]

Reviewed research reveals a lack of young people's voices articulating if and how urban nature supports their mental health and wellbeing. This paper presents qualitative research with young multi-ethnic urban residents living in a northern UK city and offers an important counter-narrative to the pervasive notion of childhood nature-deficit disorder. Using interviews and creative arts workshops, we explored the value of urban nature for the mental health and wellbeing of 24 young people aged 17-27 years, 9 of whom had lived experience of mental health difficulties. Trees, water, open spaces and views were frequently experienced nature typologies offering benefits. Deteriorating landscapes, young people's shifting identities and perceived time pressures disrupted support. Young people expressed how urban nature encounters were experienced as accepting and relational, offering a: stronger sense of self; feelings of escape; connection and care with the human and non-human world. [ABSTRACT FROM AUTHOR]

Abstract: This updates a contribution published in 2003 that aimed to give clinicians a framework for understanding the medico-legal aspects of treatment refusal in general hospital practice with respect to adults in England and Wales. The update discusses recent advice from the Mental Health Act Commission, the NICE guideline on self-harm, the Bournewood ruling by the European Court of Human Rights, and a brief consideration of some relevant changes to be brought in with the new Mental Capacity Act 2005. Issues covered by the previous paper are not repeated. [Copyright &y& Elsevier]

Health and care services for patients may improve or harm the wellbeing of their family carers. Formal consideration of these effects (also known as spillovers) in decision-making is advocated, but, to date, little is known about how they occur. This paper presents the first empirical study to determine the mechanisms by which health and care services affect family carers' wellbeing. The study focused on three major health conditions: dementia, stroke, and mental health. Focus groups and interviews were conducted with 49 purposefully sampled care professionals and family carers in the UK between December 2016 and September 2017. Transcripts were coded and analysed thematically, using descriptive accounts and an explanatory account. The analysis generated six over-arching mechanisms by which health and care services affect family carers' wellbeing, through: (i) information (degree to which service delivery informs and trains family carers); (ii) management of care (shifts of responsibility for care between formal and family sectors); (iii) patient outcomes (services changing patient outcomes); (iv) alienation (feelings of alienation or inclusion created by service delivery); (v) compliance (barriers to patients complying and engaging with services); and (vi) timing or location (changes in the timing or location of services). Each mechanism was associated with sub-themes relating to both positive and negative spillovers on the family carers. The six mechanisms can be summarised with the mnemonic 'IMPACT'. The IMPACT mechanisms may be useful in designing and evaluating services to optimise the wellbeing of carers as well as patients. • Identified mechanisms linking patient services and carer wellbeing. • Mechanisms were 'information', 'management', 'patient', 'alienation', 'compliance', 'timing'. • Summarised by mnemonic IMPACT and relevant across conditions. • Each mechanism generated positive and negative spillover. [ABSTRACT FROM AUTHOR]