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Using data from eight waves of the English Longitudinal Study of Aging, we study the cross-domain and cross-spouse spillover of health among married adults aged 50 and above in England. We apply the system generalized method of moments to linear dynamic panel models for physical, mental, and cognitive health, controlling for individual heterogeneity and the influence of marriage market matching and shared environments. Our findings reveal bidirectional spillovers between memory abilities and mobility difficulty among men, as well as between depressive symptoms and mobility difficulty among women. Worsening mobility increases the risk of depression in men, but not vice versa. Additionally, gender-specific cross-spouse effects are observed. Women's mental health is significantly influenced by their spouse's mental health, while this effect is weaker for men. Conversely, men's mental health is notably affected by their spouse's physical health. These results highlight the importance of considering spillovers within families and across health domains when developing policies to promote health and reduce health disparities among the elderly population., (© 2024 John Wiley & Sons Ltd.)

The dual-factor approach to mental health was employed to explore levels and interrelations of protective factors associated with resilience in a dataset of 30,841 schoolchildren aged 11-14 in England. ANOVA was used to contrast levels of protective factors between groups (combinations of higher/lower psychopathology and higher/lower wellbeing) and network analysis to explore protective factor interrelations. Levels of protective factors tended to be highest for those who had higher wellbeing and lower psychopathology (termed 'complete mental health'). Those with lower levels of protective factors were split between two subpopulations: having lower wellbeing and higher psychopathology (termed 'troubled'), and having lower wellbeing and lower psychopathology (termed 'vulnerable'). Analysis of the protective factor networks revealed that the four subpopulations of the model were distinguished by both their overall structure and individual node connectivity (the 'complete mental health' subpopulation demonstrated the greatest connectivity), though two were similar: those with higher wellbeing and higher psychopathology (termed 'symptomatic but content') and lower wellbeing and higher psychopathology ('troubled'). The results indicate that while 'vulnerable' and 'symptomatic but content' may be hard to discriminate conceptually, the former may reflect a lower capacity to cope during periods of adversity (i.e., show resilience). Overall, the results encourage a holistic approach to mental health screening, particularly as children with lower wellbeing had lower levels of the protective factors, regardless of their level of psychopathology. Moreover, interventions to improve protective factors associated with positive development in stressed environments may therefore have a greater impact on improving wellbeing than decreasing symptoms of psychopathology., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Associations between structural inequalities and health are well established. However, there is limited work examining this link in relation to mental health, or that centres public perspectives. This study explores people's experience and sense‐making of inequality in their daily lives, with particular consideration of impacts on mental health. Methods: We conducted a peer research study. Participants had to live in one of two London Boroughs and have an interest in inequalities and mental health. Using social media, newsletters, local organisations and our peer researchers' contacts, we recruited 30 participants who took photos representing their experience of inequality and discussed them during semi‐structured interviews. Data were analysed using reflexive thematic analysis. Results: Three themes were identified in this study: (1) inequalities are unjust, multilayered and intertwined with mental health. Accounts demonstrated a deep understanding of inequalities and their link to mental health outcomes, describing inequalities as 'suffering' and 'not good for anyone'. Financial, housing, immigration and healthcare problems exacerbated poor mental health, with racism, gender‐based violence and job loss also contributing factors for both poor mental health and experiences of inequality; (2) inequalities exclude and have far‐reaching mental health consequences, impacting personal sense of belonging and perceived societal value and (3) moving forwards—addressing long‐standing inequality and poor public mental health necessitated coping and resilience strategies that are often unacknowledged and undervalued by support systems. Conclusion: Lived experience expertise was central in this study, creating an innovative methodological approach. To improve public mental health, we must address the everyday, painful structural inequalities experienced by many as commonplace and unfair. New policies and strategies must be found that involve communities, redistributing resources and power, building on a collective knowledge base, to coproduce actions combatting inequalities and improving population mental health. Patient or Public Contribution: This study was peer‐led, designed and carried out by researchers who had experiences of poor mental health. Six authors of the paper worked as peer researchers on this study. [ABSTRACT FROM AUTHOR]

Purpose – During 2011, the Making Every Adult Matter (MEAM) coalition supported three pilots to better coordinate existing local services for people facing multiple needs and exclusions. These individuals experience a combination of problems such as homelessness, substance misuse, mental health problems and offending. Many face difficulties consistent with dual diagnosis in its broadest sense. The purpose of this paper is to summarise the evaluation of the pilots, undertaken by FTI Consulting/Compass Lexecon in partnership with Pro Bono Economics. Design/methodology/approach – The evaluation examined the three pilots, which took place in Cambridgeshire, Derby and Somerset in England. The study looked at two main effects as individuals engaged with better coordinated services: changes in wellbeing and, changes in the use and cost of wider local services. Primary wellbeing data were collected from clients and primary service use data were collected directly from relevant local agencies (police, health, housing etc). The study followed 39 individuals across the pilot sites. The average period between initial and final measurements was nine months.Findings – The findings show significant improvements in wellbeing for nearly all clients across three quantitative measures. The evaluation also recorded changes in the use and cost of local services. Some costs decreased in the first year of the pilot, for example, criminal justice costs in the Cambridgeshire and Somerset pilot areas. Other costs increased in the first year as people accessed the help they needed. In Cambridgeshire, the reduction in crime costs (£100,000 or 31 percent) was large enough to lead to an overall cost reduction. The total cost of service use in the first year increased in the other two areas. Originality/value – Collecting primary data on clients' actual service use directly from local agencies provides a strong methodological base. The evaluation will continue for a further year to examine the longitudinal impact of the pilots. The evaluation findings are of relevance to service providers, commissioners and policy makers interested in improving services for people facing multiple needs and exclusions. [ABSTRACT FROM AUTHOR]

This is a perspective from an Independent Advocate in England, United Kingdom on the importance of equality in the involuntary treatment of children and young people (CYP). The article highlights the need for safeguards when CYP require detention as part of their mental health care. The paper raises concern that CYP and their families who are less empowered to advocate for optimal care plans may be at risk of less satisfactory outcomes from mental health detention. It notes that CYP in the care system may be particularly vulnerable to such outcomes due to their lower levels empowerment. To mitigate this risk, services need to be proactive in reducing inequity arising from differential levels of empowerment among service users. This could be achieved by adopting strong participation and coproduction activities and ensuring access to Advocacy services for all CYP., (© 2024 Association for Child and Adolescent Mental Health.)

This paper explores the explanatory models of mental challenges among Black Africans in England. It argues that understanding these models is critical for providing culturally appropriate care to this population. The study employed qualitative methodology, and interpretative phenomenological analysis (IPA). Twelve mental health service users who are living in England and self-identified as first or second-generation Black Africans were purposively selected. The data were gathered using face-to-face semistructured interviews. Data were manually analysed in accordance with IPA concepts of searching for common, unique and idiosyncratic themes across transcripts. The findings revealed three themes Black Africans associated to their explanatory model of mental health challenges: complexities of migration, African-centred worldview and negative life experiences. To help alleviate the Eurocentric nature of mental health practice in England, it is hoped that this explanatory model will become an integral part of mental health practice in England and around the world., (© 2023 The Authors. Nursing Inquiry published by John Wiley & Sons Ltd.)

Background: Early language delay is exacerbated by social disadvantage. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. Methods used to achieve successful health outcomes in socially disadvantaged clinical populations may need enhancing. Aims: To compare the impact of standard parent‐based intervention (PBI) to enhanced PBI for young children with speech, language and communication needs (SCLN) and their families living in more socially disadvantaged populations. Methods and Procedures: A multicentre clustered blind randomised controlled trial was used to compare the effect of parent‐based group interventions to improve early language development with children (mean age 27.5 months) from more socially disadvantaged populations with an expressive vocabulary of 40 or less single words. Intervention sessions were delivered by a speech and language therapist, over a 20‐week period. Participants received one of two interventions: (1) Standard Care – indirect group PBI – (PBI) (2) Enhanced Care: indirect group enhanced PBI – (EPBI). Both standardised and non‐standardised measures were used as outcomes. Parent engagement in the intervention was captured through analysis of attendance and the Parent Activation Measure – Speech & Language Therapy (PAM‐SLT) (Insignia Health, 2014). The PAM measures a person's knowledge, skills and confidence to manage their own health and well‐being (NHS England, 2018). In this study, activation referred to parents' knowledge, skills and confidence to manage their child's language development. Outcomes and Results: One hundred fifty‐five participants were randomised at baseline. Children in both groups made significant improvements in the outcome on MacArthur‐Bates Communicative Development Inventories Sentence Length, from pre‐intervention to post‐intervention and 6 months post‐intervention (p < 0.05). Changes in vocabulary and expressive language skills were more equivocal, showing wide variation in confidence intervals for both groups. Where parents attended at least one intervention session almost all effect sizes were in favour of the EPBI intervention. Parents' activation levels significantly increased for both groups (EPBI p < 0.001, PBI p = 0.003), with a moderate effect size in favour of EPBI (Hedges' G 0.37, confidence interval –0.02 to 0.76), although wide variation was found. Conclusions and Implications: This trial provides some evidence of facilitating the language development of children with SLCN from more socially disadvantaged areas through supporting caregivers. However, we found variation in outcomes; some children made excellent progress, whilst others did not. Further exploration of parent engagement and its relationship to child language outcomes will be valuable to understanding more about mechanisms of change in interventions that involve parents. WHAT THIS PAPER ADDS: What is already known on the subject: Speech, language and communication needs (SLCN) have a knock‐on effect on emotional well‐being, school readiness, literacy and school attainment, putting children at increased risk of long‐term consequences such as poor literacy, mental health problems and unemployment. In disadvantaged areas, the prevalence of language difficulties is higher than elsewhere. Factors such as parents' low levels of literacy, confidence and self‐perception can affect the capacity to act on advice received, critical to empowerment. What this paper adds to existing knowledge: Children with SLCN from more socially disadvantaged areas can make improvements in their language development through parent intervention, although wide individual variation was found. There was some evidence that children achieve better outcomes with EPBI, which employed an interagency collaborative approach. Parent's engagement (activation levels) increased significantly over time with intervention, with the increase twice as big for EPBI. What are the potential or actual clinical implications of this work?: This trial provides some evidence that it is possible to facilitate the language development of children from more socially disadvantaged areas through supporting their caregivers. Further research would be useful to determine whether increases in parent engagement are related to adherence to intervention and change in child outcomes. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the complexity of the needs of people with delirium superimposed on dementia • To enhance your knowledge of second-generation activity theory • To recognise the consequences of the separation of physical health and mental healthcare. Background: Delirium superimposed on dementia (DSD) affects the physical, mental and cognitive well-being of the person. The separation of physical health and mental health means that the care of people with DSD is at odds with the multifaceted aetiology and presentation of the condition. There is a lack of research on DSD from a mental health perspective. Aim: To explore UK mental health nurses’ experiences of providing care for people with DSD. Method: Individual semi-structured interviews were conducted with seven mental health nurses from one NHS trust in England. Participants’ experiences were considered through the lens of second-generation activity theory. Data were analysed using framework analysis. Findings: Six themes were identified: awareness of guidance and tools; guidance or tools as ‘paper exercises’; knowing the patient; the multidisciplinary team; care burden; and mental health versus physical health. Conclusion: When providing care for people with DSD, mental health nurses use their skills in knowing patients as individuals. However, this aspect of ‘knowing’ cannot be readily translated into the use of a numerical scoring tool. An integrated approach is required to support the care of people with DSD. [ABSTRACT FROM AUTHOR]

This paper examines ideas about mental health, wellbeing and school education to illustrate important issues in the relationship between mental health and education. The Covid crisis has amplified the pre‐existing mental health problems of children and young people in England and recognition of the opportunities in schools to address these. The paper gives an overview of child and adolescent mental health services and how they position the role of schools. It examines prominent concepts of mental health and their relationship to wellbeing, setting this in a discussion of 'mentally healthy' schools, mental health in special educational needs and whole‐school approaches. This analysis shows how the relationship between mental health and wellbeing has not been adequately worked out, using this as the basis for arguing for the dual‐factor mental health model which separates mental illness/disorder from wellbeing as two related dimensions. The paper then translates the dual‐factor model into a two‐dimensional framework that represents the distinctive but related aims of school education (wellbeing promotion) and mental health services (preventing, coping, helping mental health difficulties). This framework involves a complex conception of wellbeing, with schools playing an important role in promoting wellbeing (beyond emotional wellbeing), tiered models and establishing school‐wide social emotional learning. It is about a whole‐school curriculum approach that involves considering what is to be learned and how it is taught. It contributes to a more nuanced concept of wellbeing that has a place for meaningful learning and challenge. [ABSTRACT FROM AUTHOR]

Objective: To explore feasibility of using child/young person patient-reported outcome measures (PROMs) routinely in practice, using vision-specific instruments and paediatric ophthalmology as the exemplar.Methods: Participants comprised patients aged 8-17 years, with visual impairment or low vision (visual acuity of the logarithm of the minimum angle of resolution (logMAR) worse than 0.3 in the better eye), attending the Department of Ophthalmology at Great Ormond Street Hospital, London, UK. All participants completed age-appropriate PROMs before attending their outpatient appointment. Half were randomly assigned to completion at home, with the choice of paper-and-pencil or electronic format. The other half were invited to complete PROMs during their hospital appointment, and randomly assigned to completion format. All participants completed a face-to-face survey exploring their attitudes and preferences. Analysis comprised survival analysis, and direct comparisons of proportions, with complementary qualitative data analysis.Results: 93 patients participated. 48 (98%) completing PROMs at home chose the paper-and-pencil format. Completion at home took longer than at hospital (median=20, vs 14 min, p<0.001). Visual acuity was associated with completion time (p=0.007) and missing data (p=0.03). Overall, 52 (60%) reported a preference for completion at home but there was no clear preference for format (37 (43%) preferred either format).Conclusion: PROM completion at home ahead of hospital appointments may be preferable for collecting complete, high-quality datasets. Despite equipoise on preference for format, the majority of those completing at home chose the traditional paper-and-pencil format, despite impaired sight. These findings should inform implementation of child/young person PROMs into routine practice. [ABSTRACT FROM AUTHOR]

Background: Identifying locally relevant and agreed-upon priorities for improving young people's mental health, aligned with social and environmental factors, is essential for benefiting target communities. This paper describes a participatory approach to engage young people and professionals in identifying such priorities, whilst considering the social determinants related to them. Methods: We utilised a community-based participatory approach to support young people and professionals in identifying, reviewing, refining, and prioritising, locally relevant opportunity areas that are crucial for understanding and addressing social determinants of young people's mental health. We adopted a flexible five-stage process, which enabled greater reflection and adaptation in response to young people's and professionals' feedback and reflections. Results: Over seven months, we engaged with young people and professionals in Northern Devon, (a rural area in southwest England), involving over 290 individuals to identify locally relevant priorities for supporting young people's mental health. Three priorities were identified for subsequent exploration using co-design approaches: (1) identity and belonging; (2) mental health awareness and literacy; and (3) diverse opportunities (for education, employment and leisure). The engagements suggested that designing initiatives and strategies in these areas could contribute to improvements in young people's mental health. Conclusion: Young people in Northern Devon prioritised three themes for the next phase of the Kailo Programme—mental health literacy, access to diverse careers and employment opportunities, and identity and belonging within their communities. Rural communities face unique barriers associated with these issues, related to less diverse populations, lack of access to reliable and affordable transport and local industries, and seasonal working. The perceived neglect by authorities towards rural young people has resulted in a lack of activities and opportunities catering to their specific needs, compared to urban areas. Although the government has recognised the need to address these disparities, community members suggest that there is still more work to be done. Plain English summary: The Kailo project aims to help young people and their communities find local solutions for better mental health in the UK. This paper discusses our findings in Northern Devon, England. Through various conversations and workshops with young people and professionals, we identified three key themes: (1) identity and belonging; (2) mental health knowledge and awareness; and (3) a variety of career, education, and leisure opportunities. These themes will be of focus for Kailo's next phase where ideas and initiatives will be designed and developed with young people and community professionals with the aim to help address important mental health challenges young people are experiencing within Northern Devon. [ABSTRACT FROM AUTHOR]

Since 2010, government policy in England has positioned further education almost exclusively as employment-orientated training for school leavers whilst also imposing severe budget cuts. During this period, values-based pedagogies that foreground social justice for students, many of whom come from low-income households, have been undermined. Following the COVID-19 pandemic, there is evidence that the mental health and well-being of further education students has suffered but little is known about the pandemic's effects on teachers.This paper presents analysis of primary research data drawn from interviews with a small sample of further education teachers and managers in the English West Midlands about their mental health and well-being during the pandemic. The paper frames the research data by acknowledging that both mental health nursing and further education teaching are currently riven by contradictions with an epistemological basis anchored in meritocratic and neoliberal policy. Using Lefebvrian theory, our analysis suggests that for further education staff, the pandemic has sharpened the tensions experienced in an already precarious professional role. Key findings were that the further education funding regime drove a 'business as usual' management attitude during the pandemic, and an intensification of work and the erosion of pedagogical practice negatively affected staff's mental health. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to interrogate and develop the conceptualisation of discriminatory abuse in safeguarding adults policy and practice beyond the current interpersonal definition. The paper draws on Safeguarding Adults Reviews (SARs) that refer to discriminatory abuse or safeguarding practice with adults who have care and support needs and protected characteristics. Design/methodology/approach: A search of the national network repository of SARs identified 27 published reviews for inclusion. The contents were thematically analysed to understand how discrimination was experienced in these cases. Fricker's "Epistemic Injustice" theory was adopted as a conceptual framework, informing the analysis of findings. Findings: Evidence from SARs provides a challenge to the interpersonal emphasis on language and behaviour in national policy. Although the reviews acknowledge that interpersonal abuse occurs, a close reading spotlights practitioner and institutional bias, and inattention to social, structural and contextual factors. The silence on these matters in policy provides a narrow frame for interpreting such abuse. This suggests significant potential for epistemic injustice and signals a need to acknowledge these social, structural and contextual factors in safeguarding practice. Originality/value: Discriminatory abuse is an under-researched and under-utilised category of abuse in safeguarding adults practice. The paper adopts Fricker's theory of "Epistemic Injustice" to highlight the silencing potential of current policy approaches to discriminatory abuse to suggest a more inclusive and structural framing for safeguarding practice with those targeted due to their protected characteristics. [ABSTRACT FROM AUTHOR]

This paper examines gender differences in travel behaviour by people with mental health conditions based on the results of an on-line survey. Responses from 363 people have been weighted by figures from the Adult Psychiatric Morbidity Survey 2014 to make them representative of the population with mental illness in England. The evidence from the surveys presented in this paper shows that more women than men have panic attacks, but that more men than women have communication difficulties. More women than men are prevented by their mental health condition from leaving home, using bus, rail and metro and from buying rail tickets in advance. Significantly more women than men suffered from the following anxieties when travelling: the need for support, wayfinding, interacting with fellow travellers and concerns about the failure of the bus, train or car. For women, the greatest need seems to be policies and actions that will increase their confidence when travelling such as access to staff when assistance is required and clear information when travelling, plus the opportunity to receive travel training. More men than women wanted improvements to the travelling environment, such as less clutter on the street. Summing up, implementing improvements to increase confidence when travelling could help to reduce gender inequalities. [ABSTRACT FROM AUTHOR]

Objectives: To address the lack of individual-level socioeconomic information in electronic healthcare records, we linked the 2011 census of England and Wales to patient records from a large mental healthcare provider. This paper describes the linkage process and methods for mitigating bias due to non-matching., Setting: South London and Maudsley NHS Foundation Trust (SLaM), a mental healthcare provider in Southeast London., Design: Clinical records from SLaM were supplied to the Office of National Statistics for linkage to the census through a deterministic matching algorithm. We examined clinical (International Classification of Disease-10 diagnosis, history of hospitalisation, frequency of service contact) and socio-demographic (age, gender, ethnicity, deprivation) information recorded in Clinical Record Interactive Search (CRIS) as predictors of linkage success with the 2011 census. To assess and adjust for potential biases caused by non-matching, we evaluated inverse probability weighting for mortality associations., Participants: Individuals of all ages in contact with SLaM up until December 2019 (N=459 374)., Outcome Measures: Likelihood of mental health records' linkage to census., Results: 220 864 (50.4%) records from CRIS linked to the 2011 census. Young adults (prevalence ratio (PR) 0.80, 95% CI 0.80 to 0.81), individuals living in more deprived areas (PR 0.78, 95% CI 0.78 to 0.79) and minority ethnic groups (eg, Black African, PR 0.67, 0.66 to 0.68) were less likely to match to census. After implementing inverse probability weighting, we observed little change in the strength of association between clinical/demographic characteristics and mortality (eg, presence of any psychiatric disorder: unweighted PR 2.66, 95% CI 2.52 to 2.80; weighted PR 2.70, 95% CI 2.56 to 2.84)., Conclusions: Lower response rates to the 2011 census among people with psychiatric disorders may have contributed to lower match rates, a potential concern as the census informs service planning and allocation of resources. Due to its size and unique characteristics, the linked data set will enable novel investigations into the relationship between socioeconomic factors and psychiatric disorders., Competing Interests: Competing interests: MH is principal investigator of the RADAR-CNS, a precompetitive public–private collaboration on mobile health funded by the Innovative Medicine Initiative with cash and in-kind contributions paid to the university from Janssen, Lundbeck, UCB, MSD and Biogen. RS declares research support in the last 3 years from Janssen, GSK and Takeda., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access., Methods: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase., Results: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture., Conclusions: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose - often inflexible and untested - specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences., (© 2024. The Author(s).)

Aims: While physical activity (PA) is recommended in the treatment of severe mental illness (SMI), there are no standardized processes for implementing PA in mental healthcare, and the extent to which PA programs have been implemented is unknown. Therefore, we sought to describe usual care in terms of the provision of PA in the National Health Service (NHS) mental health trusts in England for people with SMI., Methods: We invited all NHS Mental Health Trusts across England to participate in a bespoke survey., Results: Fifty-two mental health trusts (96.2%) responded, of which 47 (87%) offered some form of physical activity provision. The provision across these 47 trusts comprised 93 different types of PA programs. The programs that were identified showed vast differences in the types of physical activity offered, the settings in which they were provided, and the providers., Conclusions: Although existing mental healthcare services are demonstrating good practice in some areas, the findings of this survey underline the pressing need for more standardization of PA programs that are delivered to people with SMI, better allocation of resources, staff training, improved monitoring of the delivery of these programs, and better PA support for patients as they transition to community care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. JF is supported by a UK Research and Innovation Future Leaders Fellowship (MR/T021780/1) and has received honoraria / consultancy fees from Atheneum, Informa, Gillian Kenny Associates, Big Health, Hedonia, Wood For Trees, Nutritional Medicine Institute, Angelini, ParachuteBH, Richmond Foundation and Nirakara, independent of this work., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

WHAT IS KNOWN ON THE SUBJECT?: A significant number of people with mental health diagnoses have also experienced some form of trauma. In 2008, it was recommended that MHTs in England provide training to MHPs to support them in how to ask their service users about trauma and abuse. It has been identified that staff are not consistently enquiring about trauma and abuse in mental health services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: A description of how many MHTs in England are providing training for staff to ensure that they enquire about trauma and abuse. The current gaps in the resources available for mental health practitioners and staff. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much more work and development of trauma-informed care and accessibility of training is needed for MHPs working in MHTs. Most MHTs still need to take the first step of implementing training in trauma-informed care. This should involve ways to ask about trauma and abuse and advice on how to respond to any disclosures made., Abstract: INTRODUCTION: Trauma, abuse and adversities are extremely prevalent for those who access secondary mental health services. Health policy guidance recommends that mental health professionals (MHPs) should routinely enquire about trauma and abuse. Staff training is required to adopt trauma-informed approaches, as research has identified a clear gap in practice. This study provides a baseline measure of the current provision of trauma-informed training in English mental health trusts (MHTs)., Question: What trauma-informed training is currently available for MHPs in England?, Method: A freedom of information request was submitted to 52 MHTs in England to explore the current training available for MHPs in trauma-informed care, routine enquiry into abuse and responding to disclosures., Results: The results showed 70% of respondents reported no available training in trauma-informed care., Discussion: Many MHTs in England do not provide any trauma-informed training (despite existing recommendations from 2008). Does this contribute to the re-traumatisation of patients?, Implications for Practice: MHTs in England require a responsible and active approach to training MHPs in sensitive routine enquiry into trauma and abuse as a first step to becoming trauma responsive., (© 2023 John Wiley & Sons Ltd.)

Background: The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16–18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants. Method: We enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation. Results: Schools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward. Conclusion: The BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected. Trial registration: ISRCTN registry ISRCTN90912799. Registered on 28 May 2020. [ABSTRACT FROM AUTHOR]

Despite a history of critique, concentrated discussion and improved assessment processes, neglect continues to be a major challenge for child protection services. This paper draws on findings from a government‐commissioned analysis of 'serious case reviews' (SCRs) in England, arising from incidents of serious child abuse in 2017–2019. There were 235 cases, for which 166 final reports were available. Alongside a quantitative analysis of the whole cohort, we undertook an in‐depth qualitative analysis of 12 cases involving neglect. A key challenge in responding to neglect in its different forms is that it can be so widespread amongst families that practitioners no longer notice its severity or chronicity – it becomes normalised. In this paper we explore two dimensions of the 'paradox of neglect' where it seems to be everywhere and nowhere simultaneously. The first is that neglect is so closely bound up with the prevalence of poverty that little action is taken to address it. The second is that the overwhelming nature of neglect can blind practitioners to other forms of maltreatment that may also be present within a family. Practitioners, now more than ever, need to recognise the dimensions of this paradox to protect children from neglect. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the experiences of living through the COVID-19 pandemic for people who faced homelessness and dealt with mental health and/or substance use challenges. Design/methodology/approach: This qualitative study was comprised of 26 1:1 interviews (16 men and 10 women), conducted between February and May 2021 with people who experienced homelessness in North East England during the COVID-19 pandemic. An inductive reflexive thematic analysis was undertaken, with input from individuals with lived experience who were involved throughout the study. Findings: Four themes were developed. The first theme, lack of support and exacerbation of mental health and substance use difficulties, highlighted how the lack of in-person support and increased isolation and loneliness led to relapses or new challenges for many people's mental health and substance use. The second theme, uncertainty and fear during the pandemic, explored how the "surreal" experience of the pandemic led to many people feeling uncertain about the future and when things would return to normal. The third theme, isolation and impacts on social networks, discussed how isolation and changes to relationships also played a role in mental health and substance use. Finally, opportunity for reflection and self-improvement for mental health and substance use, explored how some people used the isolated time to re-evaluate their recovery journey and focus on self-improvement. Practical implications: The experiences shared within this study have important implications for planning the future delivery and commissioning of health and social care services for people facing homelessness, such as sharing information accessibly through clear, consistent and simple language. Originality/value: As one of the few papers to involve people with lived experience as part of the research, the findings reflect the unique narratives of this population with a focus on improving services. [ABSTRACT FROM AUTHOR]

The pressure on mental health services has not gone unremarked and is of widespread concern in England and Wales. This can have implications when a bed is being sought for a patient who has undergone a Mental Health Act assessment and is deemed to meet the criteria for being formally admitted to hospital. Once the 24 h period for assessment under section 136 of the Act has lapsed, the ongoing detention of the patient can lead to a legal grey area. Through a fictional example this paper examines the relevant case law and statute that may be used to continue the detention and explores the ethical problems that this may cause. [ABSTRACT FROM AUTHOR]

Avoidable harm—that is, harm to service users caused by unsafe or improper interventions, practices or services and which could have been mitigated or prevented—is embedded in social care legislation and inspections. However, the concept of avoidable harm has largely been defined by policymakers, academics, practitioners, regulators and services, with little known about service users' experiences of avoidable harm in practice. This survivor-controlled review maps and synthesises peer-reviewed literature on service users experience of social and psychological avoidable harm in mental health social care (MHSC) in England. The review was guided by an Advisory Group of practitioners and service users. Six databases were systematically searched between January 2008 and June 2020 to identify relevant literature. Following de-duplication, 3,529 records were screened using inclusion and exclusion criteria. This led to full-text screening of eighty-four records and a final corpus of twenty-two papers. Following data extraction, thematic analysis was used to synthesise data. Six key themes were identified relating to relationships and communication, information, involvement and decision-making, poor support, fragmented systems and power-over and discriminatory cultures. Impacts on MHSC service users included stress, distress, disempowerment and deterioration in mental health. We discuss our findings and indicate future research priorities. [ABSTRACT FROM AUTHOR]

In England, failing to achieve a 'good pass' (C/4 grade) in key subjects is thought to have serious negative implications. Yet evidence on this issue remains relatively sparse. This paper therefore presents new evidence on the link between meeting a key threshold on high-stakes examination and a wide array of future outcomes. Using Next Steps survey data collected from around 4,000 young people in England, we explore the short-to-medium term benefits of achieving a 'good pass' (grade C/4) in English Language, double science and mathematics. Results from our regression analyses point towards a sizable association with future educational attainment; those who achieve a good pass in GCSE mathematics are around 5 percentage points more likely to hold a university degree by age 26 than observationally similar individuals who fail to meet this threshold. No link is found with future wellbeing and mental health, while results for labour market outcomes are somewhat mixed. The findings potentially motivate the need for GCSEs to move away from awarding a set of discrete grades and towards a continuous measurement scale. Alternatively, if discrete grades are to be retained, computer adaptive testing should be introduced for GCSEs to increase measurement precision around high-stakes grade boundaries. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to use systems mapping as a tool to develop an organisation-wide approach to public mental health to inform strategic direction within a national public health agency. Design/methodology/approach: Two workshops were facilitated with internal staff from a wide range of public health policy teams working in small groups to produce paper-based maps. These were collated and refined by the project team and digitised. Findings: The approach engaged a range of teams in forming a shared understanding and producing a complex system map of the influences on population mental health and well-being, where current policy initiatives were addressing them and what the gaps and priorities were. Participants valued the approach which led to further study and organisational commitment to the whole system working as part of national public mental health strategy. Research limitations/implications: The approach was limited to internal stakeholders and wider engagement with other sectors and community members would help further the application of complex system approaches to public mental health. Originality/value: It was a valuable process for developing a whole-organisation approach and stimulating thinking and practice in complex system approaches. The paper provides a practical example of how to apply systems mapping and its benefits for organising public mental health practice. [ABSTRACT FROM AUTHOR]

The findings presented here derive from a wider study that sought to establish a baseline understanding of mental health and wellbeing among the agricultural community in England and Wales. This paper focuses on selected questions that investigated levels of anxiety and associated stress factors among farm women, a group which has been relatively neglected within previous research on farming mental health in the United Kingdom. A questionnaire survey was widely distributed to members of the agricultural community in England and Wales (n = 15,296) in both paper and online formats. The survey included a number of standardised instruments to assess mental health and wellbeing, including the Generalised Anxiety Disorder-7 scale (GAD-7). Focusing on a sub-sample of female respondents (n = 3487), this paper details the findings from the GAD-7, alongside those from a selection of other questions investigating sources of stress, loneliness and perceived business viability. A significant proportion of female respondents were experiencing anxiety at the time of survey completion, with 23.3% reaching the threshold for clinically relevant anxiety based on their GAD-7 scores (medium or severe anxiety, scores≥10). A further 34.6% were classified as experiencing mild anxiety (scores 5–9) whilst 42.1% were not suffering from anxiety (scores 0–4). Medium/severe anxiety was identified as being associated with a number of stress factors, feelings of loneliness and pessimistic perceptions of farm business viability. There were important age-based differences, with working-aged women identified as more likely to suffer from anxiety, loneliness and certain stressors than older women. The findings reported here indicate concerning levels of anxiety among farming women and this should be seen as a call to action. There are clear associations between anxiety and a range of stressors and, although we cannot ascertain causality, these point to issues that demand attention in efforts to improve mental health within this social group. The factors contributing to anxiety are, however, multiple and complex and farm women may be affected by particular gender-based challenges that have not yet been explicitly explored in relation to mental health. Further research is needed to investigate and understand these issues in greater depth. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the nature and scope of dog-based programmes in prisons, assessing critically the potential opportunities, benefits, challenges and risks of developing innovative dog-based programmes for older prisoners in England and Wales. This paper outlines the potential benefits and challenges of developing dog-based programmes for older prisoners and sets out next steps for future research and practice. Design/methodology/approach: This study is based on a scoping review of published research literature on prison dog programmes (PDPs) in the USA, the UK and other countries, with particular reference to older people in prison, followed by semi-structured interviews with six members of an expert advisory group. The literature review and data from the qualitative interviews were analysed thematically. Findings: There is a substantial body of published research literature which supports PDPs as having identifiable positive impacts for people and also dogs, and also published research which highlights the benefits to older people of dog ownership or participation in dog-based activities. However, much of this research is small-scale and qualitative, and it has been argued that there is a lack of a quantitative evidence base. This research concludes that findings from the literature review and the semi-structured interviews support further research and the creation of pilot projects to develop dog-based projects for older people in prison. Research limitations/implications: This study was small-scale, and the findings need to be approached with caution. The literature review searched a small number of databases and filtered out articles published in languages other than English, and the review of the grey literature focused on reports from the UK. The number of experts interviewed was small and there was no direct consultation with older people in prison nor with older people with recent personal lived experience of imprisonment and community resettlement. A more extensive future study would benefit from a more extensive literature review, a larger group of participants and the inclusion of service users, prison managers and government policymakers, subject to the appropriate ethical and security approvals. At the time the research took place, ongoing COVID-19 restrictions on prison research meant that research with current prisoners and prison managers would not have been approved by the HMPPS NRC. Practical implications: This research provides a research-based justification for future dog projects for older prisoners, leading potentially to improved well-being for older people in prison. Originality/value: This study brings together the published research literature on PDPs with the research literature on the needs and experiences of older people in prison for the first time, and identifies potential directions for future research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider the role of the Mental Health Act (MHA) 1983 in safeguarding adults at risk of abuse and neglect. The author has undertaken a thematic review of Safeguarding Adults Reviews (SARs) commissioned in England and Adult Practice Reviews (APRs) commissioned in Wales where the MHA 1983 was a central aspect to the review. Design/methodology/approach: Reviews were included based on specific determinants, following analysis of SARs, APRs and executive summaries. This should not affect the credibility of the research, as themes were identified in conjunction with analysis of literature regarding use of the MHA in the context of adult safeguarding. Consequently, this review has been underpinned by evidence-based research in the area of study. Findings: The interaction between statutes, such as the MHA 1983 and Care Act 2014, signify challenges to professionals, with variable application of mental health legislation in practice. Research limitations/implications: Lack of a complete national repository for review reports means that it is likely that the data set analysis is incomplete. It was noted that limitations to this research include the fact that Safeguarding Adults Boards in England may not publish SAR reports or may choose to publish an executive summary or practice brief instead of the full SAR report, therefore limiting the scope of disseminating learning from SARs, as this is difficult to achieve where the full report has not been published. The author aimed to mitigate this by undertaking comprehensive searches of Local Authority and SAB websites, in addition to submitting Information requests to ensure that this research encompassed as many relevant review reports as possible. Originality/value: This is an important and timely topic for debate, given that the UK Government is proposing reform of the MHA 1983. In addition, existing thematic reviews of SARS tend to be generalised, rather than specifically focused on the MHA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to offer a viewpoint on the impact that the COVID-19 pandemic has had on people's engagement with an online alcohol service in the UK. This paper examines whether self-reported mental health concerns increased during the pandemic compared to pre-pandemic times. Design/methodology/approach: A comparison was made between service data captured in one contract area – West Sussex, England – pre-pandemic (April 2019 to March 2020) and during pandemic (April 2020 to March 2021). Findings: Self-reported mental health treatment needs increased during the pandemic period (71.2% of presentations compared to 50% pre-pandemic) via the online coaching service. Male referrals increased by 74% during the pandemic period compared to the previous year. Female referrals decreased by 4% in the same time period. Feelings of shame and guilt as well as loss of a confidential space to engage in online interventions were common concerns reported by service users. Research limitations/implications: Research limitations include the relatively small sample size, the sample comprised of self-referred treatment seeking clients, and there was no control group. All data collected is self-report therefore subjective and not necessarily meeting diagnostic criteria. Practical implications: Of note was the impact of the pandemic on women and their reduced access to the online service during the pandemic. Commissioners and services must adapt their service design and delivery alongside the new "normal" way of living and working. Routine screening of mental health and alcohol use are recommended. Originality/value: This paper offers insight from an established online/digital service and the impact of the pandemic on people's engagement with the service. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine how faculty staff on health and social care programmes support students with mental health issues. Design/methodology/approach: The study used a qualitative survey design to gain in-depth information on faculty staff experiences. Seventy-one faculty staff at two universities in the South East of England out of an eligible population of 115 staff responded to an anonymous online questionnaire which were thematically analysed. Findings: The findings indicated that faculty staff faced uncertainties in providing support to students with mental health needs. They reported tensions between their academic, professional and pastoral roles. There was a wide recognition that supporting students was physically and emotionally demanding for faculty staff and especially challenging when their roles and expectations were unclear. This was compounded by lack of explicit guidelines and an apparent severed connection between faculty staff and student support services. Practical implications: A need for clearly defined roles and responsibilities for faculty staff in supporting students with mental health needs including a review of their pastoral role were identified. The study reinforces the need for effective collaborative arrangements and collective decision making and clearer procedures in the planning and implementation of students' personal support plans. A concerted effort into adopting a transpersonal approach which incorporates mental health staff awareness training, restorative spaces for reflection and supportive pathways for faculty staff are recommended. Originality/value: This paper provides rare empirical evidence of faculty staff views on their role in supporting students with mental health needs on health and social care programmes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' experience challenges of managing risk, boundaries and emotional responses when working with people who self‐harm.Adolescent self‐harm is a growing problem, with rates increasing in the UK.Existing research has failed to differentiate and specifically explore nurses' experiences of working with adolescents who self‐harm. What the paper adds to existing knowledge?: This paper provides an understanding of the impact of working with adolescents who self‐harm in the community on nurses, and highlights recommendations to improve staff and patient experiences and care.Community CAMHS nurses experience personal and professional conflicts when working with adolescents who self‐harm. They experience interpersonal conflicts balancing the needs of adolescents with the needs of the systems around them, and intrapersonal conflicts regarding experiencing mixed emotions, and balancing the care they want to provide with service pressures.Community CAMHS nurses experience feelings of self‐doubt and shame due to their emotional responses, self‐care behaviours, personal and professional boundaries. They use their feelings of pride, honour and enjoyment to manage these experiences. What are the implications for practice?: Nurses working in CAMHS should be provided with more opportunities for reflective practice and self‐care, to enable reflection and learning regarding the emotional impacts and working with systems. Managerial investment is required to facilitate this.Nurses working with adolescents who self‐harm in CAMHS could benefit from training regarding understanding and managing self‐harm (such as dialectical behavioural therapy), and effectively working with families and people who support these adolescents (such as attachment‐based family therapy). Introduction: Nurses often work in the community with adolescents who self‐harm. There is a lack of qualitative research exploring nurses' experiences of working with adolescents who self‐harm. Aim: This study aimed to gain an understanding of community nurses' experiences of working with adolescents who self‐harm. Method: Ten semi‐structured interviews were conducted with registered nurses working in Child and Adolescent Mental Health Services (CAMHS) in the United Kingdom (UK). Results: Data were analysed using interpretative phenomenological analysis (IPA). Two superordinate themes were identified, each consisting of two subordinate themes: personal and professional conflicts, describing interpersonal and intrapersonal conflicts the nurses experienced working with adolescents who self‐harm and the systems around them, and personal and professional development, outlining processes of management of conflicts and development. Discussion: Nurses feel conflicted about working with adolescents who self‐harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self‐care behaviours and personal and professional boundaries. Implications for Practice: Nurses working with adolescents who self‐harm would benefit from training, reflective practice and self‐care. CAMHS managers should encourage and invest in these areas. [ABSTRACT FROM AUTHOR]

This paper will explore the ways in which behaviour features in the accounts of 'off rolling' processes in schools in England volunteered by participants – senior school leaders, SENCos and parents, in an ongoing multi-stranded research project. In addition to analysing these accounts, this paper draws on contextual features and concepts such as parrhesia and authenticity in a probing of methodological considerations. The status of such accounts as data will also be considered given the high stakes accountability environment in which school principals strive to fulfil their legal remit in the field of inclusion. The trustworthiness of findings in qualitative research is more usually the focus of attention; however, our studies to date imply that some professionals carefully manage the image of their school and visibility of exclusionary practices to the detriment of students with mental health and behavioural issues. The methodological implications of conducting research in politicised and highly sensitive areas will be discussed. [ABSTRACT FROM AUTHOR]

This paper presents findings from a photovoice project that was aimed at engaging with a diverse range of black men in a London Borough. The key objectives were to find a different way to get men to talk about their concerns and to raise awareness about mental health. Photovoice is a participatory research action technique that was developed to enable communities to document their concerns and experiences of community life that is meaningful to them. Nineteen men participated in the project. It has been suggested that men, in particular, black men do not find it easy to talk about mental health issues. This study found that through the use of photovoice methods, black men were able to talk about a range of emotions when they were offered the right medium and safe spaces to share their experiences. It found that they can and want to take control of their lives, but at times may require life skills training. Another finding was that black men have to balance expectations about being strong whilst 'containing' vulnerabilities in racialised contexts – being hard on the outside and human on the inside, and that their experiences are characterised by journeys of significant struggle and resilience in the face of adversity. The paper concludes that mental health services should find ways of engaging with black men differently, i.e. reaching out rather than the traditional mantra of 'outreach'. [ABSTRACT FROM AUTHOR]

As a result of a changing legal and policy context, statutory social work with adults in the UK has undergone a series of radical reforms. Underpinning these changes has been an ideological shift in the way adult social care should be provided. A clear 'direction' including a focus on autonomy, self-determination and personal responsibility is being promoted. These represent changes for both social workers and people receiving services. However, it has been suggested that policy may not fully acknowledge the factors that may undermine the ability of some individuals to take control of and manage their own needs. This paper draws on findings from two research projects, undertaken with social work practitioners located in statutory adult social care teams in the North East of England. The first explored the involvement of older people in adult safeguarding and the second considered capacity assessments and best interest decision making by social workers under the Mental Capacity Act [2005. Retrieved from ]. This paper presents key findings regarding how social workers attempt to reconcile the gap between the profile of the service user in policy and the reality of the people that social workers are supporting in practice. Key recommendations for policy, practice, and further research are also discussed. [ABSTRACT FROM AUTHOR]

This article presents a speech by Barbara Wootton delivered at the Quarterly Meeting of the Royal College of Psychiatrists in London, England on November 18, 1976. She discusses the contributions of Aubrey Lewis to psychiatry and in particular she examines Lewis' research on health as a social concept in the light of recent developments in psychiatry. She praises Lewis for making a sensible and measurable definition of health and its application in understanding mental illness.

Accessible summary: What is already known about the topic?: MHST represents transformation at the forefront of policing and mental health to people in crisis with the aim of providing a better and more efficient response.Current knowledge has largely focused on service development, informed by narratives of risk, and this study applies an alternative focus by considering the interplay in practice. What the paper adds to existing knowledge?: This paper adds to emerging work on mental health street triage, offering original insights into the interplay of police officers and mental health nurses in practice.The evidence presented shows how the dynamics between officers and nurses were informed by perceptions of trust, belonging and legitimacy which shaped decision‐making and outcomes.This study also reveals the impacts of leadership continuity and staff turnover to service efficacy and the potential of strategic "drift." What are the implications for practice?: Nurses who work in MHST operations should be prepared to share knowledge, learning and insight into how different mental health conditions present in practice and support the assessment of risk posed to officers.Alternative pathways available to detainment by police under the Mental Health Act should be identified and communicated to officers, both in the control room and in situ, to avoid unnecessary detentions.Strategies should be developed to extend the communication of mental health education and knowledge beyond those immediately involved in MHST to support the police to better respond to mental health. Introduction: The limited evidence on mental health street triage (MHST) is largely focused on service development and is overly police‐centric dominated by narratives of risk. This paper considers the interplay between officers and CPNs in practice situated within strategic and operational contexts, illustrating the importance of place to service developments and trust within practice. Aim: This study was conducted to compare the processes, experiences and perceptions of MHST in three sites in England. Method: Semi‐structured interviews were completed with 27 police and health service staff in strategic and operational roles over a three‐month period in three sites in England. Results: Four themes were identified: "Reducing and improving the use of mental health detainments," "Importance of local contexts and partnerships," "Enhancing officer confidence" and "Developing street triage." Discussion: Mental health street triage decision‐making and outcomes were influenced by issues of trust, belonging and legitimacy within the interplay between officers and nurses. Continuity and staff turnover influenced strategic and operational development. However, MHST was perceived to be an effective and cost‐saving model. Implications for practice: Mental health nurses are well positioned to lead awareness and education of officers in relation to mental health crisis response. Staff need to develop communication strategies that extend beyond those immediately involved in MHST. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: 'Leave' is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge.Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective.While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. What the paper adds to existing knowledge?: The leave policies of NHS mental health services in England and Wales are highly inconsistent.The extent to which policies are consistent with guidance differs depending on which service is providing care. What are the implications for practice?: It is very likely that, because of inconsistencies between services and policies, practice also differs.Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey.Policymakers need to revisit leave policies in light of evidence from this study. Introduction: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies. Aim: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation. Method: A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave‐related terms were extracted and analysed. Results: Fifty‐seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain‐level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance. Discussion: Mental health professionals are inconsistently supported by the policy in their leave‐related practice. This could potentially contribute to inconsistent practice and leave‐related patient outcomes. Implications for Practice: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs. [ABSTRACT FROM AUTHOR]

In this paper, we use a UK case study to explore how the COVID-19 pandemic affected the mental health (emotional, psychological, social wellbeing) of farmers. We outline the drivers of poor farming mental health, the manifold impacts of the pandemic at a time of policy and environmental change, and identify lessons that can be learned to develop resilience in farming communities against future shocks. We undertook a survey answered by 207 farmers across the UK, focusing on drivers of poor mental health and the effect of the COVID-19 pandemic. We also conducted 22 in-depth interviews with individuals in England, Scotland and Wales who provide mental health support to farmers. These explored how and why the COVID-19 pandemic affected the mental health of farmers. These interviews were supplemented by 93 survey responses from a similar group of support providers (UK-wide). We found that the pandemic exacerbated underlying drivers of poor mental health and wellbeing in farming communities. 67% of farmers surveyed reported feeling more stressed, 63% felt more anxious, 38% felt more depressed, and 12% felt more suicidal. The primary drivers of poor mental health identified by farmers during the pandemic included decreased social contact and loneliness, issues with the general public on private land, and moving online for social events. Support providers also highlighted relationship and financial issues, illness, and government inspections as drivers of poor mental health. Some farmers, conversely, outlined positive impacts of the pandemic. The COVID-19 pandemic is just one of many potential stressors associated with poor farming mental health and its impacts are likely to be long-lasting and delayed. Multiple stressors affecting farmers at the same time can create a tipping point. Therefore, there is a need for long-term support and ongoing evaluation of the drivers of poor mental health in farming families. [ABSTRACT FROM AUTHOR]

Background: Mental health acute crisis episodes are associated with high inpatient costs. Self-management interventions may reduce readmission by enabling individuals to manage their condition. Delivery of such interventions by Peer Support Workers (PSWs) may be cost-effective. CORE, a randomized control trial of a PSW self-management intervention compared to usual care, found a significant reduction in admissions to acute mental healthcare for participants receiving the intervention. This paper aims to evaluate the cost-effectiveness of the intervention over 12 months from a mental health service perspective. Analysis methods of increasing complexity were used to account for data missingness and distribution. Methods: Participants were recruited from six crisis resolution teams in England from 12 March 2014 to 3 July 2015 (trial registration ISRCTN: 01027104). Resource use was collected from patient records at baseline and 12 months. The EQ-5D-3L was collected at baseline and 4 and 18 months, and linear interpolation was used to calculate 12-month values for quality-adjusted life-years (QALYs). The primary analysis of adjusted mean incremental costs and QALYs for complete cases are calculated separately using OLS regression. Secondly, a complete-case non-parametric two-stage bootstrap (TSB) was performed. The impacts of missing data and skewed cost data were explored using multiple imputation using chained equations and general linear models, respectively. Results: Four hundred and forty-one participants were recruited to CORE; 221 randomized to the PSW intervention and 220 to usual care plus workbook. The probability that the PSW intervention was cost-effective compared with the workbook plus usual care control at 12 months varied with the method used, and ranged from 57% to 96% at a cost-effectiveness threshold of £20,000 per QALY gained. Discussion: There was a minimum 57% chance that the intervention was cost-effective compared to the control using 12-month costs and QALYs. The probability varied by 40% when methods were employed to account for the relationship between costs and QALYs, but which restricted the sample to those who provided both complete cost and utility data. Caution should therefore be applied when selecting methods for the evaluation of healthcare interventions that aim to increase precision but may introduce bias if missing data are heavily unbalanced between costs and outcomes. [ABSTRACT FROM AUTHOR]

This paper examines the role of the police in mental health work. It explores whether the calls to 'defund the police' can be the basis for fundamental reforms of mental health services and the police role. The paper outlines the roots of the calls to ' defund the police' situating the perspective in the wider Black Lives Matter movement (BLM). The wider BLM movement seeks to overturn long standing racial and social injustices, including the disproportionate use of force against black citizens and racial biases within the Criminal Justice System. It goes further in that BLM calls for a shift in funding from policing towards an investment in welfare and community services. These calls are captured in the phrase 'defund the police'. These calls have highlighted the police role in mental health, particularly, the police response to citizens in mental health crisis. The paper examines the police role in mental health work, highlighting the historic impact of policies of deinstutionalisation and more recently austerity and welfare retrenchment. In calling for this policy shift, campaigners have highlighted the need to significant investment in mental health services. The police role in mental health services increased because of the failings of community care (Cummins, 2020a). Police officers have increasingly become first responders in mental health crises. The paper, focusing on England and Wales, uses 'defund the police' perspective as a lens to examine long standing areas of concern. Police involvement in mental health emergencies is inevitably stigmatizing. There are also concerns from the police. This is an area of police demand that has grown of austerity and the wider retrenchment in public services. Police officers often feel that they lack the skills and knowledge required to undertake their role in mental health work. In addition, there is frustration generated by poor interprofessional working. Police officers on an organizational and individual level feel that they are often left ' picking up the pieces '. There is a wide recognition that mental health services are failing to provide appropriate responses to those in crisis (Wessley, 2018). As well as being an issue of human rights and social justice, these failures place vulnerable people at increased risk. All aspects of police work involve contact with people experiencing mental health problems. People with mental health problems are first and foremost human beings who should be treated with dignity and respect. They are also citizens, family members, carers and work colleagues. Having acknowledged that core value perspective, if we accept that police officers will be involved in mental health work, we should seek to limit their role as far as is possible. The paper concludes that it is likely that there will be always be some form of police involvement in mental health–related work. However, there is a need to limit this as far as possible. [ABSTRACT FROM AUTHOR]

Children who spend time in the care of their local authority, usually due to neglect or abuse within the birth family, tend to experience significant educational disruption and have lower educational outcomes, on average, than other young people. However, little is known about those subsequently participating in higher education, who comprise just under one percent of the student body in England. The paper synthesises three contrasting datasets to map participation patterns among care-experienced young people for the first time. Considerably more enter higher education than previously thought, but they remain significantly less likely to participate than other young people. Furthermore, they tend to enter later, with less prestigious qualifications and to lower status institutions. The paper concludes by discussing key differences between the datasets, reflecting on difficulties with identifying and recording care-experienced students which may account for an apparent lack of progress in encouraging their participation despite concerted policy efforts. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: People with mental health problems have higher rates of physical health concerns and hospital admissions than those without mental health problems. These patients have poorer outcomes from surgery and have worse experiences of care when admitted for medical or surgical procedures. What the paper adds to existing knowledge?: This paper looks to understand why care may be poorer for patients with mental health problems by speaking to staff providing care in these settings. We spoke to 30 general hospital staff about mental health on the wards and found that a lack of leadership and ownership for prioritising mental health led to people not seeing it as their job, and that it was somebody else's business to manage that side of care. We also found that the emotional effect of caring for people who had attempted suicide or had self‐harm injuries was difficult for staff, impacting on staff well‐being and leading them to distance themselves from providing care in those cases. What are the implications for practice?: There is a need for staff to be supported from the top‐down, with management providing clear leadership around issues and pathways for mental health needs so they know the best way to provide care and encourage collaborative working. In addition, bottom‐up support is needed to help staff personally manage their own well‐being and mental health, including supervision and debriefing from mental health specialists to improve understanding from the patient's perspective and to provide emotional support to manage difficulties. Relevance Statement: This paper places focus on the care of patients with mental health problems in medical and surgical care settings highlighting the interplay between mental and physical health from a perspective that is less often explored. This paper provides insights into the multidisciplinary nature of nursing and the need for integrated care. This provides findings that build a picture of how mental health nursing specialism is needed beyond psychiatric wards and within medical and surgical settings. Introduction: Evidence shows that patients with mental health problems have poorer physical health outcomes, increased mortality and experience poorer care during surgery and medical admissions. Issues related to lack of training, stigmatizing attitudes, fear or hopelessness may help understand these poor outcomes. Aim: To explore the experiences of staff in providing care for people with mental health problems. Method: A qualitative service evaluation approach was used. Participants working in an acute care hospital in inner‐city London were recruited across professions and job levels using a self‐selection sampling method. A total of 30 participants took part in semi‐structured interviews (n = 17) and two focus groups (n = 13), and data were thematically analysed. Relevant organizational documents and service use data were utilized to inform the evaluation. Results: Key themes were organized across the macro, meso and micro levels to understand the levels of disconnection and silence around mental health in acute care. Themes include systemic factors surrounding the institutional culture, ward cultures and collaborative working, and individuals' sense‐making of mental health and personal well‐being. Implications for practice: These findings signpost the growing need for greater mental health nursing input on medical and surgical wards and within these teams to provide informed knowledge, support and supervision. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to discuss the recent National Appropriate Adult Network (NAAN) report on the role of the appropriate adult. Design/methodology/approach: This paper is based on the NAAN report and a review of relevant policy and research literature. Findings: There to Help 2 highlights that there are still significant gaps in the provision of appropriate adult schemes across England and Wales. These gaps potentially place vulnerable adults at increased risk. Originality/value: This paper is a review of recent research. [ABSTRACT FROM AUTHOR]

Background: Children and young people's (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP's, parents' and service providers' perceptions of the effectiveness, acceptability and accessibility of services. Methods: Case studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis. Results: Four key themes defined participants' perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner's personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child's mental health problems. Conclusions: This study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services. [ABSTRACT FROM AUTHOR]

Women experiencing three or more co-occurring issues (homelessness, substance misuse, mental health) are a highly vulnerable population associated with multimorbidity. Taking women's life stories of trajectories into social exclusion in the north of England as its focus, this paper aims to explore the complexity of social contexts in which women navigate extreme health inequalities. Of the few studies that have examined women's experiences of homelessness through the lens of social capital, most have focused on network size, rather than the quality and influence of the relationships which precipitate or contextualise experiences of social exclusion. We utilise case studies to offer a theoretically-grounded analysis which illustrates the relationship between social capital and homelessness within this population. Our results illustrate how structural contexts, and specifically social capital accrual and social bonding processes particularly pertinent to women can act to both ameliorate and perpetuate social exclusion. We conclude by arguing that health inequalities cannot be tackled as single-issue processes but instead are multi-layered and complex. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England. Design/methodology/approach: The MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed. Findings: Results showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions. Originality/value: This project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments. [ABSTRACT FROM AUTHOR]

Purpose: Public mental health training can effectively support well-being at a population level. The application of this type of training is increasingly prevalent, however, training evaluation is currently limited and inconsistent. This paper aims to summarise the characteristics of public mental health training available in England, presents key quality criteria for this training and identifies gaps in training provision. Design/methodology/approach: This paper uses a pragmatic mixed-methods approach including database and Google Searches, focus groups and survey methods. The data analysis included a structured data extraction template for the training availability scoping and thematic analysis of the survey and focus groups. Findings: This paper identifies a total of 74 training courses targeting workplace employees, young people and the general population. Most courses were delivered face-to-face (54), followed by e-learning (16) and blended modalities (4). This paper derives four core quality principles, focussing on the training approach, key features of training, trainer attributes and evaluation. There were no significant gaps in training provision, although areas for future development included consistency in public mental health terminology, systems and populations requiring additional training and the logistics of training delivery, etc. Originality/value: The results contribute to the evidence base of interventions that are currently available, supporting the efforts to evaluate the impact of training provision in this area. This paper provides a novel approach to assessing training quality and discuss areas for development and innovation in this field. [ABSTRACT FROM AUTHOR]

In seventeenth-century England, many religiously devout people believed they had an obligation to immediately stifle any sinful thought that entered their minds. As some prominent clerics during the time period recognised, however, the effort to subdue unwelcome thoughts often can increase the thoughts. Indeed, recent cognitive science research bears out the counterintuitive phenomenon that trying to suppress an undesired thought can boomerang. With this in mind, just how effective was the endeavour in seventeenth-century England to purify thoughts? The paper argues that it was frequently counterproductive. The paper also explores a disagreement among mental health professionals, historians, and literary scholars regarding how to interpret the numerous seventeenth-century English autobiographical descriptions of tormenting, uncontrollable sinful thoughts. For instance, were the ungovernable blasphemous thoughts that Pilgrim's Progress author John Bunyan (1628-1688) recounted experiencing the product of a bodily illness equivalent to obsessive-compulsive disorder? The question presents methodological challenges. [ABSTRACT FROM AUTHOR]