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This paper engages with the notion of 'embodied belonging' through an ethnography of the social and material aspects of accessing mental health care in the UK. I focus on moments of access and transition in a voluntary sector organisation in London: an intercultural psychotherapy centre, serving a range of im/migrant communities. Whilst both 'belonging' and 'place' are often invoked to imply stability, I explore how material contexts of access and inclusion can paradoxically be implicated in the ongoing production of precarity-of unstable, uncertain, and vulnerable ways of being. A sociomaterial analysis of ethnographic material and visual data from two creative mapping interviews attends to material and spatial aspects of the centre and its transitory place in the urban environment. It demonstrates how these aspects of place became entangled in client experiences of access: uncertainties of waiting, ambivalence towards belonging to a particular client group, and questions around deservingness of care. This engendered an embodied and situated experience of 'precarious belonging'. I therefore argue that precarity should be 'placed', both within the concept of embodied belonging, and ethnographically, within the material constraints, impermanence, and spatial politics of projects to include the excluded in UK mental health care. [ABSTRACT FROM AUTHOR]

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed. [ABSTRACT FROM AUTHOR]

This review outlines a migraine-specific specialist patient program developed by the UK Migraine Action Association (MAA) for delivery to groups of patients with migraine throughout England and Wales. The program, which began in 2004, will deliver courses to 36 groups of 20 patients over 3 years. This paper reports the development of the program and the evaluation of the first six courses. The program enables participants to manage their migraine more effectively and educates them to provide information and support to other patients with migraine. Each course is open to 20 migraine patients aged between 18 and 70 years who fulfill the International Headache Society definition of migraine with or without aura. To develop the specialist migraine program, MAA staff researched the literature regarding the term 'expert/specialist patients,' which patients are invited to become after completing the program. MAA staff also consulted with experts in the field and organizations involved in delivering expert patient programs. Each course is delivered by a health professional, usually a general practitioner who is a local member of Migraine in Primary Care Advisors, and two lay trainers from the MAA. Results to date have shown that the majority of participants in the program now feel that they understand their condition better and are able to control it more effectively. Thirty-four percent of participants have agreed to become specialist patients within their own community. The program has succeeded in raising awareness of migraine in the areas visited, educating patients, and creating local networks of support for patients with migraine in these areas, which will complement and be supported by the services already provided by the MAA. [ABSTRACT FROM AUTHOR]

Purpose: To examine factors associated with being re-admitted in the year after discharge from acute postpartum psychiatric treatment. Methods: Secondary data analysis of information collected from mothers who were admitted to acute psychiatric services in the year after childbirth between 2013 and 2017. We carried out univariable analyses and multivariable hierarchical logistic regression to examine risk factors for women's re-admission to acute psychiatric care (inpatient or community crisis care) in the year following discharge. Results: Sixty-seven (24.1%) of 278 women were re-admitted in the year after discharge from acute care; the median number of days to re-admission was 86 (IQR 35–214), and women who were re-admitted accessed a median of two further acute services (IQR 1–3). In adjusted analyses, reporting a history of childhood trauma (aOR 1.02; 95% CI 1.00- 1.03, p = 0.036), a higher level of difficulties in the mother–infant bond (aOR 1.03; 95% CI 1.01–1.06, p = 0.009) and younger age (aOR 0.95; 95% CI 0.90–1.00, p = 0.066) were associated with re-admission. Conclusion: This study confirms that the role of childhood adverse experiences on mental health is relevant for outcomes in women experiencing acute postpartum psychiatric episodes. Ongoing parent–infant bonding difficulties are also independently associated with re-admission. Perinatal mental health services therefore need to offer evidence-based interventions to address histories of trauma and to support parent–infant bonding to optimise mental health in women following discharge from acute psychiatric services. However, further research is needed to explore what other factors, not measured in our study, are also influential to re-admission. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders (CMD), such as depression and anxiety, are an important cause of morbidity, economic burden and public mental health need. The UK Improving Access to Psychological Therapies (IAPT) programme is a national effort to reduce the burden and impact of CMD, available since 2008. Aims: To examine ethnic and migration-related differences in use of IAPT-based psychological treatment using a novel epidemiological dataset with linkage to de-identified IAPT records. Method: Data from a psychiatric morbidity survey of two South East London boroughs (2008–2010) were individually-linked to data on IAPT services serving those boroughs. We used Poisson regression to estimate association between ethnicity and migration status (including years of UK residence), with rate of subsequent use of psychological treatment. Results: The rate of psychological treatment use was 14.4 cases per thousand person years [cases/1000 pyrs, 95% confidence intervals (95% CI) 12.4, 16.7]. There was strong statistical evidence that compared to non-migrants, migrants residing in the UK for less than 10 years were less likely to use psychological treatment after adjustment for probable sociodemographic predictors of need, life adversity, and physical/psychiatric morbidity at baseline [rate ratio (RR) 0.4 (95% CI 0.20, 0.75]. This difference was not explained by migration for asylum/political reasons, or English language proficiency, and was evident for both self- and GP referrals. Conclusions: Lower use of IAPT among recent migrants is unexplained by sociodemographics, adversity, and baseline morbidity. Further research should focus on other individual-level and societal barriers to psychological treatment use among recent migrants to the UK, including in categories of intersecting migration and ethnicity. [ABSTRACT FROM AUTHOR]

There is a limited amount of empirical data available regarding the cultural and religious variation in perceptions about the age when young people should be regarded as competent to make decisions in health settings. A public survey of 400 adults from diverse religious and ethnic backgrounds was conducted in the UK and Spain. Attitudes were assessed using case vignettes. It was found that high religious practice was associated with recommending a higher age of consent for medical interventions. White British adults were more likely than Spanish adults to agree that younger adolescents should be allowed to consent to medical interventions. The study suggests that there is social, cultural and religious variation in adults' attitudes regarding the age when youngsters should consent to health interventions. [ABSTRACT FROM AUTHOR]

Objectives: Postnatal depression (PND) can have negative consequences for mother and infant. Current psychological therapies are effective in treating depression but improvements in mother-infant outcomes have not yet been established. We aimed to capture mothers' experiences of therapy for PND with a focus on parenting-related outcomes. We also sought their views on including parenting support within interventions. Methods: Fourteen mothers who received psychological therapy in the United Kingdom's National Health Service (NHS) participated in semi-structured interviews. Data were audio-recorded, transcribed, coded and analysed using Framework Analysis. Results: Three main themes were identified: 'The experience of therapy', 'Therapy outcomes' and 'Views about parenting interventions for postnatal depression'. The main themes were underpinned by other themes. Overall the findings revealed that mothers perceived therapy as helpful in improving mood, confidence as a parent and relationship with their infant. Mothers valued the process of normalising their experiences within group therapy and by their therapists because it reduced any shame and stigma associated with PND. Mothers thought parenting support within therapy would be acceptable if delivered collaboratively. Conclusions: Primary care-based psychological therapy for PND was perceived as helpful and acceptable. It clearly met some of the mothers' goals, especially if their beliefs about being a 'bad mother' was challenged and modified. Barriers to engagement, such as childcare issues and therapist's knowledge about perinatal mental health, would also need to be overcome. Finally, mother-infant interventions should be further explored as an adjunct treatment option. [ABSTRACT FROM AUTHOR]

In sketching the position of couples and family therapy and systemic practice in the United Kingdom of Great Britain and Northern Ireland (the UK) we have provided what we can of the development of the contexts of training and practice; the content of some of the theories and their applications; and the external realities within which we currently operate. The UK has a well developed structure for training and practice in systemic couples and family therapy. The history is of enthusiastic adoption of therapies from international sources which are generally then incorporated into an overarching systemic framework. Family therapy in the UK is currently subjected to a variety of pressures but is well regulated and is in a strong position to continue making its contribution to the welfare of families. [ABSTRACT FROM AUTHOR]

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Objective: To estimate the annual direct cost of managing erectile dysfunction (ED) to the UK National Health Service (NHS) and to examine the impact of the introduction of sildenafil in 1998 and Schedule 11 restrictions in 1999.Design: A prevalence-based cost-of-illness approach was used. The period 1997 to 2000 was covered. The numbers of ED prescriptions, prosthesis implantations and general practitioner (GP) consultations were retrieved retrospectively from UK resource utilisation databases. The number of specialist consultations and psychosexual therapy sessions were estimated from NHS clinic data. National resource unit costs were applied.Main Outcomes and Results: Between 1997 and 2000 the number of men presenting with ED increased from 79,800 to 257,984. The cost to the NHS increased from pounds sterling 29.4 million to pounds sterling 73.8 million (2000 estimates). The cost per patient fell from pounds sterling 368 to pounds sterling 286. In 1997, most NHS costs came from psychosexual therapy (30.7%), specialist consultations (20.2%) and intracavernosal injections (26.6%). By 2000, NHS costs came primarily from specialist consultations (32.0%), sildenafil prescriptions (26.2%), psychosexual therapy (13.6%) and GP consultations (12.0%). The annual cost was most sensitive to the number of drug prescriptions and specialist consultations.Conclusions: The increased NHS cost of managing ED was due mainly to a three-fold increase in the number of men presenting to GPs, substantial numbers of whom were then referred for specialist consultations under Schedule 11 restrictions. This naturally resulted in the increased use of all resources including sildenafil. The cost effectiveness of transferring prescribing responsibility in cases of severe distress from specialists to GPs in primary care remains to be determined. [ABSTRACT FROM AUTHOR]