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Research on patient safety in mental health settings is limited compared to physical healthcare settings. Recent qualitative studies have highlighted that patient safety is more than just physical safety but includes psychological safety. Traditionally, psychological safety has been defined as the belief that it is safe to take interpersonal risks, such as speaking up, without a fear of negative consequences. However, to date, it is not clear what constitutes psychological safety for service users of inpatient mental health settings. To understand this, we conducted 12 interviews with former inpatient mental health service users. Interviews were analysed with Reflexive Thematic Analysis, and five themes were developed. All themes had subthemes. Overall, we found that participants were more readily able to draw on situations where they felt psychologically unsafe, rather than safe. Psychological safety in service users was influenced by (1) healthcare staff attitudes and behaviours towards them, (2) their relationships with other service users, (3) whether they felt they had any control over their environment and medical decision‐making regarding their care, (4) their experiences of physically safety, feeling listened to and believed and (5) access to meaningful occupation on the wards. These findings suggest that changes are needed to enhance inpatient mental health service users' general experiences of psychological safety. Further research will need to (1) further develop understanding of the concept of psychological safety for service users and (2) identify interventions, and such interventions should be co‐designed with service users. [ABSTRACT FROM AUTHOR]

This article uses data from a doctoral thesis concerning service users' views on what works for them in relation to their mental health wellness following a suicidal ideation/attempt in Aotearoa New Zealand. In particular, it focuses on the experiences of service users regarding mental health crisis team responses and what they wanted from their crisis teams specifically. Participants indicated that what they wanted was to feel heard, respected and not judged, consistent with the core conditions of therapeutic alliance within such professions as social work, counselling and psychology. Social work has a valuable role to play in emphasising and advocating for social, contextual and non-medical responses within crisis teams and service delivery. [ABSTRACT FROM AUTHOR]

Cognitive behaviour therapy for psychosis (CBTp) should be offered to patients receiving psychiatric inpatient care, yet very little is known about patients' perspectives on this. The aim of this study was to examine patients' experiences of a CBTp‐informed intervention delivered in inpatient settings. We recruited 10 participants from the intervention arm of a randomised controlled trial examining the feasibility and acceptability of a CBTp‐informed intervention for psychiatric inpatient settings. We undertook semistructured interviews examining their experiences of the intervention and analysed them using thematic analysis. The study was conducted in partnership with a coproduction group of key stakeholders (people with lived experience, family and carers, and clinicians). The intervention was found helpful by almost all participants, and all participants would recommend it to others in similar situations to themselves. The results demonstrated that participants valued the therapist's professionalism and emphasised the importance of the therapeutic relationship. Participants highlighted the importance of the therapy focusing on navigating admission and developing skills to manage the crisis experience so they could return to their normal lives. Participants described challenges to having psychological therapy in the acute crisis context including therapy interruptions and ongoing distressing experiences of psychosis. The study demonstrated the importance of prioritising the therapeutic relationship, that therapy was a valued process to navigate admission and discharge, but that some environmental and patient‐level challenges were present. Further research is needed to explore inpatients' experiences of psychological interventions in this setting. Trial Registration: ISRCTN trial registry: ISRCTN59055607 [ABSTRACT FROM AUTHOR]

Background: While healthcare policy has fostered implementation strategies to improve inclusion and access of under-served groups to clinical care, systemic and structural elements still disproportionately prevent service users from accessing research opportunities embedded within clinical settings. This contributes to the widening of health inequalities, as the absence of representativeness prevents the applicability and effectiveness of evidence-based interventions in under-served clinical populations. The present study aims to identify the individual (micro), organisational (meso) and structural (macro) barriers to clinical research access in patients with comorbid alcohol use disorder and alcohol-related liver disease. Methods: A focused ethnography approach was employed to explore the challenges experienced by patients in the access to and implementation of research processes within clinical settings. Data were collected through an iterative-inductive approach, using field notes and patient interview transcripts. The framework method was utilised for data analysis, and themes were identified at the micro, meso and macro levels. Results: At the micro-level, alcohol-related barriers included encephalopathy and acute withdrawal symptoms. Alcohol-unrelated barriers also shaped the engagement of service users in research. At the meso-level, staff and resource pressures, as well as familiarity with clinical and research facilities were noted as influencing intervention delivery and study retention. At the wider, macro-level, circumstances including the 'cost of living crisis' and national industrial action within healthcare settings had an impact on research processes. The findings emphasise a 'domino effect' across all levels, demonstrating an interplay between individual, organisational and structural elements influencing access to clinical research. Conclusions: A combination of individual, organisational and structural barriers, exacerbated by the COVID-19 pandemic, and the socioeconomic landscape in which the study was conducted further contributed to the unequal access of under-served groups to clinical research participation. For patients with comorbid alcohol use disorder and alcohol-related liver disease, limited access to research further contributes towards a gap in effective evidence-based treatment, exacerbating health inequalities in this clinical population. [ABSTRACT FROM AUTHOR]

Background: There is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards. Objectives: This study aimed to consider what outcomes service users think are important to measure. Methods: This qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding. Results: The 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like. Conclusions: Our results highlight the need for patient‐reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy. Patient or Public Contribution: The wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study. [ABSTRACT FROM AUTHOR]

Quality of life (QoL) is a widely recognized and valuable social outcome measure in drug treatment and rehabilitation services, but the discrepancies in QoL perceptions between service users and providers remain under-explored. In this study, semi-structured interviews were conducted with service users (n = 22) and providers (n = 29) to capture their perceptions of QoL and explore the similarities and discrepancies between their views. A thematic analysis and contrast exploration revealed a shared understanding of QoL that extends beyond health to six dimensions and prioritizes empowerment and connection. However, divergent views emerged regarding the priorities of material conditions, emotional well-being, and physical health. Findings underscore the importance of using shared decision-making as a strategy to effectively address these discrepancies and promote a more patient-centered approach in treatment and rehabilitation services. [ABSTRACT FROM AUTHOR]

Objective: To understand how materiality affects patient and public involvement (PPI) for commissioning and leading health and care services in the English National Health Service (NHS) context. Context: From April 2013 groups of general practitioners (GPs) became members of NHS clinical commissioning groups (CCGs) to assess needs and procure core health services for and with local communities. Since July 2022, integrated care systems (ICSs) have subsumed this responsibility. NHS reorganisations have been driven by the promise of more effective and efficient health care and have led to a long history of PPI on economic, political, and moral grounds. Few studies researching PPI in clinical commissioning exist and fewer still have explored a more agentic understanding of materiality and its impact on PPI. Study Design: A focused ethnography was used to examine PPI for clinical commissioning within two CCG case study sites in England. Three CCG Governing Body lay representatives, nine GP commissioners and seven service user representatives took part in focus groups and/or were interviewed. Fifteen nonparticipant observations were also carried out at CCG meetings and the associated materiality was examined. Findings: The materiality of activities involved in clinical commissioning influences and shapes the nature of PPI. These forms of materiality may dilute and subvert meaningful engagement and involvement that relies on trust, leadership, learning, and partnership working. Conclusion: System leaders in ICSs should consider the significance of materiality in centrally driven processes involved in PPI commissioning to reduce barriers and ensure meaningful partnerships within local communities. Patient and Public Contribution: The study design ensured PPI throughout the research process in keeping with contemporary research practice guidance. The project steering committee included service users with current or recent PPI clinical commissioning experience outside of the study sites. There was PPI involvement in the original study proposal and its development including the bid for doctoral funds on which this study is based. All were involved in assessing the rigour of the data collection, interpretation of the findings and ensuring the project remained true to the aims of the study. Two members have also participated in presentation of the study findings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Anti‐, peri‐ and post‐natal depression negatively affect the relationship between mothers and their children.At least half of cases of anti‐, peri‐ and post‐natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives.Previous qualitative studies considered women's experiences relating to anti‐, peri‐ and post‐natal depression separately from studies looking at the views of HCPs.There is a lack of research in Middle Eastern countries, despite the high prevalence of anti‐, peri‐ and post‐natal depression. What does this paper add to existing knowledge?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti‐, peri‐ and post‐natal depression from the Middle East perspective, particularly in Oman.This study revealed that anti‐, peri‐ and post‐natal depression has been neglected in primary healthcare systems in Oman.The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti‐, peri‐ and post‐natal depression in the primary healthcare system. What are the implications for practice?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help‐seeking behaviours with their patients.Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti‐, peri‐ and post‐natal depression. Introduction: Anti‐, peri‐ and post‐natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti‐, peri‐ and post‐natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti‐, peri‐ and post‐natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti‐, peri‐ and post‐natal depression globally. Aim: This study aimed to explore the views and experiences of HCPs and service users relating to anti‐, peri‐ and post‐natal depression from the Middle East perspective. Method: A qualitative descriptive study using semi‐structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2–20 years of clinical experience in anti‐, peri‐ and post‐natal primary care and 13 pregnant patients plus 2 post‐birth patients were interviewed. Audio‐recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12. Results: A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti‐, peri‐ and post‐natal depression; (2) how to deal with anti‐, peri‐ and post‐natal depression; (3) barriers to addressing anti‐, peri‐ and post‐natal depression in primary anti‐, peri‐ and post‐natal care settings and (4) bridging the gap: facilitators in detecting and managing anti‐, peri‐ and post‐natal depression. Conclusions: Improving the identification and management of anti‐, peri‐ and post‐natal depression in primary healthcare systems will require a whole‐system approach with interventions at the patient, practice and comprehensive primary care team levels. Implications for Practice: The findings suggest implications for improving the identification and management of anti‐, peri‐ and post‐natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti‐, peri‐ and post‐natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills. [ABSTRACT FROM AUTHOR]

Human rights abuses in mental health care are a global concern. Addressing the problem requires input from key stakeholders, particularly from people using mental health services. This study explored the experiences of persons with mental illness receiving care in a faith-based setting in Ghana. The study employed a qualitative design, with in-depth interviews (n = 23) and focus groups (n = 18 participants in 3 groups). The constant comparative method of analysis was used to identify themes in participants' descriptions of their experiences. The first three themes identified are consistent with human rights and coercion, and the last two themes related to service users' views on participation in spiritual practices. Themes included: decision-making around care; consent and efficacy of religious healing; experiences with chaining; views around biomedical treatment; participation in religious activities as part of healing and recognition of the need for spiritual healing. It was observed that participants with prior experience of psychiatric treatment were happy about the absence of chaining in psychiatric facilities but strongly disliked the side effects of medications. These findings underscore the need for faith-based institutions to provide care that is consistent with patient preferences, thereby helping to address the resultant human rights abuses. [ABSTRACT FROM AUTHOR]

Purpose: Integrated service models aim to simplify access, enable effective delivery, remove duplication and provide a holistic and person-centred approach. This project explored the development of integrated well-being services in two local authorities in North-East England. The purpose of this paper is to address this issue. Design/methodology/approach: Underpinned by public health and co-production approaches, the project utilised a mixed-methods approach. Data were collected via online surveys (n = 95), virtual interviews with members of the local population (n = 8) and practitioners and commissioners (n = 8) to explore needs for a new service. Thematic analysis was used to identify key themes and issues. Findings: Several benefits of an integrated service were highlighted by both staff and service users, with a central anticipated benefit being the provision of holistic care. Improvement in information sharing was also seen to increase the efficiency of services and communication barriers between services. Beneficial aspects and barriers related to the COVID-19 pandemic on current service provision were reported that have informed our future recommendations. Originality/value: The authors' findings provide a much deeper insight into function, care, social inclusion and ongoing support needs, from both the perspectives of staff and service users. Service users and staff saw value in an integrated model for themselves, as well as the wider community. The authors' findings indicate that the integrated service model is a promising one for the development of services within local authorities. [ABSTRACT FROM AUTHOR]

When dealing with vulnerable populations, the first impression can have far-reaching implications due to socio-cultural dynamics. This has proved true in clinical social work practice where a fiduciary relationship is critical for the restoration of social functioning. The study discovered that service users in Zimbabwe generally have differing opinions regarding how clinical social workers should dress. This was attributed to age, personal preferences, and socio-cultural orientations. Furthermore, service users suggested the prevalence of a perceived connection between dress and the competence of the practitioner. The possibility of service user resistance and inability to build a good rapport if the practitioner's dress is unacceptable to the service user was also noted. The study thus advocates for the need to have social work organizational training on the issue of dress to orient social workers on the sensitivity of dress in practice. By so doing, a social worker will be intentional in their choice of a dress, being cognisant of the fact that their dress is a language that has the potential to either catalyze or hinder the effectiveness of the helping process. [ABSTRACT FROM AUTHOR]

Research suggests that the COVID-19 pandemic has had a significant impact on those already living with mental health problems, though there is also evidence of resilience. However, to date there has been limited in-depth qualitative investigation. We interviewed 15 people living with long-term mental health problems who, before the pandemic, were being supported by third sector organisations, to explore how they experienced lockdowns and accessing services remotely. Template analysis was informed by the Power Threat Meaning Framework and suggested that participants experienced significant threats to their mental wellbeing and recovery which were exacerbated by current or previous powerlessness and inequality. Although participants described positive coping strategies, several described a return of unhelpful behaviours that had contributed to the original difficulties. The findings illustrate the wider contributions of social and economic context to mental health problems and the importance of ensuring that people do not feel abandoned and are proactively supported. [ABSTRACT FROM AUTHOR]

In the digital age, traditional approaches to accessing information are disrupted by the 'public' nature of social media. The notion of accessing service users' social media in social work practice is fraught with ethical issues around privacy and boundaries, yet lacks clear guidance from existing law and policy. This qualitative study sought to identify how mental health social workers were navigating these issues and how they thought practice could be developed. Ten mental health social workers, from one NHS Trust in England, were interviewed about their views and experiences around accessing service users' social media without express permission. Semi-structured interviews were analysed using thematic analysis. Practitioners shared a variety of justifications for utilising social media, based upon statutory responsibility and professional values, but felt direct guidance/legislation and training would be helpful. A process of 'digital reflexivity' was outlined, which balanced reasons to access social media against considerations of privacy and the potential effects on the therapeutic relationship. Implications include the need for definitive guidance and training around if, when and how to access service users' social media; inclusion of digital reflexivity in supervision and multidisciplinary meetings; educating service users about privacy controls; and a potential reconfiguration of theoretical boundaries to include the 'public' domain. [ABSTRACT FROM AUTHOR]

In Southeast Asia, services for survivors of human trafficking have historically been centralized within shelter programs. Minimal research has, however, been conducted regarding trafficking-specific shelters, particularly research that highlights the perspectives of survivors themselves. This manuscript presents the perspectives of survivors of human trafficking and sexual exploitation on their own experiences pertaining to trafficking-specific shelter services. We analyzed data from the Butterfly longitudinal research (BLR) study, a 10-year longitudinal study exploring the lives, trajectories, and viewpoints of survivors of human trafficking and sexual exploitation in Cambodia. We analyzed 236 in-depth interviews and narrative summaries of interviews conducted between 2011 and 2016 using an interpretive phenomenological approach (n = 79). Four themes were identified: feeling privileged to live in a shelter; lacking freedom and feeling imprisoned by rules; limited engagement with family; and mixed experiences with counseling. Findings inform critical recommendations for implementing trauma-informed care and strengthening mental health services for survivors, including services provided within shelter programs and within the anti-human trafficking movement more broadly. [ABSTRACT FROM AUTHOR]

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users. [ABSTRACT FROM AUTHOR]

Experts by Experience (EBE) in mental health are increasingly becoming involved in the education of health professionals. In response, research findings suggest positive attitudinal change towards people who experience mental distress and enhanced appreciation of recovery and person‐centred approaches to practice. However, this growing body of evidence has not resulted in the broad adoption of these roles in academia. The perspectives of academics instrumental in implementing academic positions for EBE (referred to as allies) have not yet been articulated. Acknowledging this gap, the aim of this research was to explore experiences of allies involved in implementing EBE positions in academia regarding the impact of EBE led education on students. Qualitative exploratory methods were used involving in‐depth interviews with allies. Data were analysed thematically. Participants observed significant positive impacts on students, as evidenced through four themes: contextualized learning, enhancing reflection, feedback from the clinical field, and students' own lived experience. The fifth sub‐theme, Challenging experiences were observed to potentially detract from the student experience in some instances. Overall, participants were very supportive of EBE involvement and were confident this approach produced more person‐centred and recovery‐oriented clinicians, with the skills, knowledge and attitudes needed to work as practitioners. These findings support previous research and suggest positive implications for clinical practice and for students with their own mental health challenges. [ABSTRACT FROM AUTHOR]

Negative attitudes towards people with mental health disorders have been widely studied and identified in the general population, and even within health care professionals. Moreover, studies focused on service users have also identified mental health professionals, including psychiatrists, as a source of stigma. However, in Mexico and Latin America few studies have been conducted addressing this issue. To explore mental health service users' perceptions of stigma by members of the general population and by psychiatrists in Mexico, service users at a psychiatric hospital in Mexico were invited to participate in either focus groups or individual interviews, which were audio recorded, transcribed and analysed using thematic analysis. A total of 47 service users participated in this study. The results suggested that participants were not only aware of the possible consequences of mental health related stigma, but they have also experienced stigmatisation for having a mental illness. Participants also considered psychiatrists can hold negative attitudes towards people with mental illness, something that can represent a barrier for them to have optimal quality of care. Therefore, participants agreed that these attitudes should be addressed to improve the care they received from these professionals. This study suggests that, like members of the general population, psychiatrists are also considered as a source of stigma by people with mental illness in Mexico. These findings not only add to previous work conducted in Mexico and other countries, they also confirm the importance of addressing negative attitudes in this group of health professionals. [ABSTRACT FROM AUTHOR]

Introduction: The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. The aim of this research was to investigate the use of 24-hour postural management by occupational therapists and to explore its impact on service users with neurodisability and their carers. Methods: Quantitative and qualitative methods were employed in two phases: (a) online survey with 96 occupational therapists across one UK region, with data analysed by descriptive statistics and correlations; (b) focus groups with service users and/or carers (n = 9), with data analysed by thematic analysis. Results: Findings showed moderate positive correlation between frequency of use and (a) all key intervention skills and (b) knowledge of night-time positioning (p < 0.001). Moderate positive correlations were found between level of training and (a) assessment skills and (b) knowledge of night-time positioning (p < 0.001). The overarching theme from focus groups was 'reliance on individualised equipment', with overwhelming frustration from lack of support, loss of identity, equipment cost, insufficient focus on preventative strategies and accessibility issues. Conclusion: A clinical practice guideline, including training, is crucial to direct practice. Providers must engage with service users and carers to address their frustrations. [ABSTRACT FROM AUTHOR]

Objective: Understanding factors that promote and hinder the recovery process for people living with serious mental illness remains of critical importance. We examine factors, including limited literacy, associated with mental health recovery among public mental health service users. Method: This study uses data from a mixed-methods, service-user informed project focused on the impact of limited literacy in the lives of people with serious mental illness. Data from structured interviews evaluate perceptions of recovery as assessed with the Recovery Assessment Scale (RAS). Regression models examine factors related to recovery controlling for sociodemographic factors, literacy, neurocognition, mental health status, perceived social support, and stigma. Results: Despite bivariate relationships between RAS and limited literacy, the full models suggest that other factors account for this relationship. These include mental health status, higher social support, higher self-reported community status, and higher stigma consciousness, as well as race for some models. Conclusions and Implications for Practice: Our findings that social support and perceptions of community status are associated with higher scores on the RAS echo prior work demonstrating the importance of social connection and context in mental health recovery. Though literacy was not a predictor of recovery, further research should examine the relationship between literacy and recovery given the deep literature on literacy on health outcomes. In order to better support people in the recovery process it is important that more research is done to examine the complex relationship between stigma consciousness and recovery as well as understand the racial disparities that exist within the recovery subscales. Impact and Implications: Limited literacy was not significantly associated with recovery attitudes; however, individual and social level factors, mental health status, social support, perception of community status, and stigma consciousness were found to positively impact one's recovery attitudes. These factors need to be understood so they can be leveraged to help people move toward recovery. [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]

The proportion of older adults using secure forensic psychiatric services is rising. Research is needed to examine the experience of older service users and evidence how adult services can adapt to meet their needs. To explore user experiences of being an older adult in secure forensic services. Thematic analysis of interviews and observations of weekly routines conducted with fifteen service users aged 50 and over residing in a low and medium secure NHS unit in England. User experiences of ageing and age-related needs are reported using five themes: age-related identities; ward environments; participation in activities; management of physical health; and ageing futures. Older adults living with people their own age reported more social integration than those on wards dominated by younger adults. Most wished to self-manage their physical health needs with the support of primary care staff. Older adults were reluctant to identify as "old" or "vulnerable". Some older adults downplayed their changing care needs. Placement of older people in adult secure services requires awareness of the age balance of the ward. A culture of inclusivity, sensitivity and respect for older persons' agency is key to collaboratively meeting additional care needs and discharge planning. [ABSTRACT FROM AUTHOR]

Whilst the evidence for the efficacy of treatment interventions for individuals with dual diagnosis has been developing in recent decades, little is known about individual perceptions and the personal benefits of attending integrated treatment programmes within this population group. A qualitative methodology, Interpretive phenomenological analysis, was used to investigate the experiences of individuals with a range of complex mental health and coexisting substance misuse problems who took part in a psychoeducational group (PEG) programme. This comprised of social support and therapeutic peer group relationship facilitation. Semi‐structured interviews were undertaken with 15 service users who successfully participated in this treatment programme. Findings identify the complexity of the therapeutic process and understanding of the treatment from the service users perspective. This included the importance of forming meaningful therapeutic relationships as an influential factor in countering a range of distressing and incompatible environmental and situational stressors, such as self‐regulatory control, self‐awareness of a need for change and the importance of integrated treatment in reducing the sense of stigma and exclusion linked with using mental health services. The study findings support the use of integrated treatment programmes in mental health services with a dual diagnosis population group. [ABSTRACT FROM AUTHOR]

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

Background: There is no consensus on how to best define recovery in gambling disorder. This minimizes clinicians' abilities to apply optimal treatment goals and contributes to inconsistency in the use of outcome variables to evaluate interventions. Current understanding of recovery is largely based on professional opinion and theoretical models of gambling disorder. This study aimed to examine core features of recovery identified by service users with lived experiences. Methods: Thematic analysis was applied to qualitative data from 32 face-to-face interviews. Interviewees were at various stages of help-seeking for gambling problems mostly related to electronic gaming machines via self-exclusion and/or specialized gambling counseling. Results: Recovery was perceived by the participants as a continuous process that encompasses periods of improvement and decline. Several key themes of recovery emerged; participants highlighted the importance of developing insight into the psychological and environmental processes that contribute to their gambling problem. Insight helped participants feel empowered to successfully manage their gambling urges and behavior. Recovery extended to building a meaningful life beyond gambling, which involved engagement in alternative activities and fostering strong social relationships. It included stabilization of personal finances and achieving general psychological health and wellbeing. Conclusions: Findings challenge acute symptom-focused models of recovery by broadening the definitional boundaries to include sustained improvements across multiple psychosocial dimensions. Greater emphasis should be given to service user-defined elements of recovery in treatment and research. The long-term perspective of the recovery process has implications for extending standard follow-up assessment intervals in gambling treatment studies. [ABSTRACT FROM AUTHOR]

Six social care professionals were recruited to take part in in-depth interviews that sought to explore their phenomenological experiences of humour within their place of work. Using an Interpretative Phenomenological Analysis (IPA) approach, the results suggest that humour serves various important functions within social care. Humour can allow social care professionals to relieve themselves of negative emotions, to avoid stress and cynicism, to achieve a sense of normality and perspective and to engage with service users. The positive impact humour appears to have upon these professionals is in keeping with the humour–health hypothesis, which posits that humour enhances well-being. However, results from this study also suggest that humour may be capable of negatively impacting well-being. Arguably, these findings highlight the need to extend the humour–health hypothesis and incorporate the negative effects humour can have upon well-being. Results also indicate that, if used appropriately, humour can be utilised to benefit work performance and service user outcomes. The findings of this research hold important implications for how humour may be understood and fostered in social care training, practice and policy. [ABSTRACT FROM AUTHOR]

Continuity of mental health care is central to improve the treatment and rehabilitation of people with mental disorders. While most studies on continuity of care fail to take the perspectives of service users into account, the aim of this study was to explore the perceived meanings of continuity of care among people with long-term mental disorders. Fifteen service users participated in semi-structured in-depth interviews. We used template analysis to guide the analysis. The main transversal themes of continuity were "Navigating the system" and "Connecting to people and everyday life." While the first theme related to the participants' experiences of their interaction with the mental health care system, the latter related to their hopes and perceived opportunities for a good life as desired outcomes of mental health care. We conclude that efforts to improve continuity of mental health care should be tailored to the priorities of service users. [ABSTRACT FROM AUTHOR]

The Common Assessment Framework provides a model of early intervention, which is familiar in local authorities throughout England, and asserts a participatory framework of child and family engagement. This paper is based on a qualitative study of parents and children who were subject to a multi‐agency process of early intervention in children's social care in a local authority in the Midlands of England. I advance the concept of assemblage to consider the basis of an active service user participation as rather more a struggle to achieve than something that has been granted by practitioner agencies. Interview extracts are used to show the enrolment and assembly of participation as a process of service users developing their active human agency in a multi‐agency setting. The article explores the assembling of skills in administration and management of meetings and plans, accessing knowledge and expertise through service user networks, and challenging professional expertise and institutional space while developing personal qualities of confidence and voice as a means of marshalling an effective participation in a multi‐agency setting. [ABSTRACT FROM AUTHOR]

Making sense of service users' accounts of their mental health problems requires a method able to deal with complexity. Yet the different underlying epistemological and ontological positions of the methods researchers use, based, for example, on biomedicine or social constructionism, produce highly partial analyses. Addressing this problem, this article offers a method of Critical Realist Discourse Analysis (CRDA) that employs a synthesized discourse analysis, informed by critical realism, to examine the discursive, material, embodied, and institutional factors that might inform how mental health service users make sense of their mental health problems and associated service use. The article describes the epistemological/ontological underpinnings of CRDA and its three-phase methodology, before showcasing the method using, as examples, two data sets from care leavers and mothers. With our CRDA, we demonstrate a method for analyzing the complexity of interacting factors informing service users' understanding of their mental health problems. [ABSTRACT FROM AUTHOR]

The inclusion imperative in community care means that disabled people are now increasingly being employed as peer workers in the service systems that manage them. This article offers a timely inquiry into the role of the peer worker in mental health and homeless service sectors. Drawing on a four-year ethnography and in-depth qualitative interviews with fellow peer workers, I explore the paradoxical nature of new expectations for peer 'authenticity,' and the ways in which peer workers learn to manage the requirement to perform identity in our work roles. This analysis thus denaturalizes peer identity, and works to develop possibilities for doing disability identity-based work differently. [ABSTRACT FROM AUTHOR]

'This paper reports on findings from a qualitative study of practitioner–service user relationships in social work. The research aimed to identify social workers' personal constructs of their relationships with service users and explore how these constructs differed across roles and settings. A qualitative methodology employing a variation on role repertory grid techniques was used to carry out semi-structured interviews with social workers. Twenty-five social workers from seven different practice settings were interviewed and altogether identified over 200 personal constructs. The research team undertook a thematic analysis of these constructs along with their explanation and discussion in interview transcripts. The results identified twenty-five superordinate constructs within ten core themes, which reflected practitioners' experience of relationships, their systemic context, along with dynamics of power and collaboration. The constructs were often found to contrast a positive or preferred attribute of relationships with a more negative or challenging attribute, although the reality of relationships was often found to be complex and ambiguous. Some implications are explored for current theories of relationship-based practice in social work. [ABSTRACT FROM AUTHOR]

This paper offers an original examination of the interrelationship between organisational arrangements, supervisory practices and outcomes from supervision in a study funded by the Social Care Institute for Excellence. The study aimed to capture examples of good supervision. Researchers used systems theory to develop a supervision model, which informed the research design and evaluation. Good supervision was identified by 136 online survey participants, and all emerging themes were examined in nineteen interviews, within four case study settings. Social workers within an 'integrated' case-study setting and health workers in a 'partnership' setting said that 'good' supervision was supported by organisational policies, supervisor training and devolved management and professional practice. In the care-home and social-enterprise settings, supervision was similarly supported, but its delivery was a management performance target. In all four case-study settings, good supervision could be negatively transformed by a supervisor's action (e.g. rigid responses to performance issues) or supervisor's inaction (e.g. cancelled supervision sessions). Service-user feedback on supervision is an underdeveloped area that needs further research. This paper concludes by considering the implications of the research findings for the study of supervision. [ABSTRACT FROM AUTHOR]

The theoretical framework of citizenship is increasingly being used in mental health settings to inform practice. This exploratory qualitative study describes in more detail the acts of citizenship embedded in the everyday practices of mental health workers that promote the social inclusion of people in their care. Acts make a claim for justice when one's rights and responsibilities of citizenship are denied. Semistructured interviews were conducted with 12 participants, seven mental health clinicians and five peer support workers, recruited from a mental health facility in Connecticut, USA. Two themes are presented, breaking the rules and the right thing to do, a rights‐based practice that fosters inclusion for service users. Results suggest that staff undertake hidden acts of citizenship to promote inclusion and rights of service users by responsibly subverting the rules and norms of the organization. Changes to organizational practices to make visible such inclusionary acts are required. Implications for practice and considerations of organizational change through the development of a citizenship framework to underpin practice are recommended. [ABSTRACT FROM AUTHOR]

Recovery‐oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in‐depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery‐oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users. [ABSTRACT FROM AUTHOR]

Abstract: In Western nations, the Recovery approach has become a widely accepted philosophy and treatment concept in mental health. Yet, community understanding of the Recovery approach remains largely unexplored. This study aimed to investigate (i) people's awareness of the principles underpinning the Recovery approach in mental health, and (ii) the treatment approaches people consider most important, and whether these align with the Recovery approach. To achieve these aims, a random sample of 1217 Australian adults participated in the National Social Survey (QSS) via telephone interview. People's experience with mental health services, the importance they place on various treatment approaches, and their awareness of principles underpinning the Recovery approach were assessed. Analyses were conducted using descriptive statistics. Most participants (94%) agreed that ‘regardless of the severity of symptoms experienced and/or the mental illness diagnosis, being diagnosed with a mental illness means there is always hope for a meaningful life’. Moreover, most participants considered treatments in line with the Recovery approach as important. However, few participants (35%) agreed with the principle that ‘after diagnosis, the person themselves should direct the long‐term management of their mental illness, rather than a medical professional’. Australian people were to some extent aware of the principles underpinning the Recovery Approach, particularly with regard to hope, ability to live a meaningful life, and the importance of support from family, friends, and others living with mental illness. Nonetheless, autonomy was not highly prioritized, with the prevailing view that management of mental illness should be directed by the medical profession. [ABSTRACT FROM AUTHOR]

Objectives: Research has shown interpersonal relationships influence experiences of inpatient psychiatric services. This study explored inpatient staff and service users’ talk about relating, and consequences on available/limited social actions. Design: A Foucauldian discourse analysis was used to analyse transcribed semi‐structured interviews and focus groups with current inpatient staff members and members of a service‐user involvement group. Method: Two focus groups (service users n = 10; staff n = 6) and five interviews (service users n = 2; staff n = 3) were held, with participants responding to questions regarding the discursive object of ‘experiences of relating on inpatient wards’. Results: A dominant ‘medical–technical–legal’ discourse was seen, alongside a counter discourse of ‘ordinary humane relating’. Through the tensions between these discourses emerged a discourse of ‘collaborative exploration’. Conclusion: The medical–technical–legal discourse perpetuates notions of mental illness as impenetrable to relating. Staff fear of causing harm and positions of legal accountability generate mistrust which obstructs relating, whilst patients expect to be asked their opinions on their experiences and to be involved in deciding what treatment to accept, and experience frustration and alienation when this is not forthcoming. Ordinary humane relating was described as vital for service users in regaining a sense of self, although not considered enough in itself to promote recovery/wellness. ‘Treatment for my problems’ was constructed by service users as emerging through the collaborative exploration discourse, where therapeutic relationships can develop, enabling change and a return to safety. Practitioner points: Discourse analysis of how we talk can help us understand the complexities of being, working, and relating on psychiatric inpatient units. Relating as constructed through the medical–technical–legal discourse is seen as the most legitimized but least fulfilling for staff and service users alike. Both staff and service users want purposefully therapeutic, collaborative relationships however, the environment does not currently appear to support these ways of relating emerging with legitimacy. Some simple steps might be taken to begin the shift towards more fulfilling and therapeutic ways of relating being privileged in psychiatric inpatient environments. [ABSTRACT FROM AUTHOR]

Purpose: Service user involvement in instrument development is increasingly recognised as important, but is often not done and seldom reported. This has adverse implications for the content validity of a measure. The aim of this paper is to identify the types of items that service users felt were important to be included or excluded from a new Recovering Quality of Life measure for people with mental health difficulties.Methods: Potential items were presented to service users in face-to-face structured individual interviews and focus groups. The items were primarily taken or adapted from current measures and covered themes identified from earlier qualitative work as being important to quality of life. Content and thematic analysis was undertaken to identify the types of items which were either important or unacceptable to service users.Results: We identified five key themes of the types of items that service users found acceptable or unacceptable; the items should be relevant and meaningful, unambiguous, easy to answer particularly when distressed, do not cause further upset, and be non-judgemental. Importantly, this was from the perspective of the service user.Conclusions: This research has underlined the importance of service users' views on the acceptability and validity of items for use in developing a new measure. Whether or not service users favoured an item was associated with their ability or intention to respond accurately and honestly to the item which will impact on the validity and sensitivity of the measure. [ABSTRACT FROM AUTHOR]

Largely as a result of early adverse experiences, children and young people in care are more likely to suffer from mental health difficulties than their peers. Despite these difficulties, they tend to find it hard to seek help and engage with professional services to address their needs. In Northern Ireland, the Mind Your Health study collected data for 233 children and young people in care through phone interviews with their carers, and twenty-five of these young people were interviewed. Focus groups with professionals were also carried out. According to their carers, 35 per cent had diagnosed emotional difficulties, and 36 per cent scored in the abnormal range for the Strengths and Difficulties Questionnaire's emotional symptoms scale. Carers described difficulties in accessing mental health services for young people, due to lengthy waiting lists, a lack of information offered and a lack of effort to engage them. Young people found it difficult to engage with these services because of their feelings of stigma, embarrassment, insecurity, guilt and fear. Some felt unable to seek help even from their families and friends. We recommend that mental health services are made more locally accessible and waiting times are reduced, with a greater emphasis on pro-active outreach work. [ABSTRACT FROM AUTHOR]

Background: Few employment programmes exist to support forensic service users with severe mental health problems and a criminal history. Little is known about how best to achieve this. The Employment and Social Inclusion Project (ESIP) was developed and piloted to support forensic service users into employment and vocational activities. Aims: This pilot service evaluation aimed to assess the number of service users who secured employment/vocational activities and explored services users’ and staff experiences. Method: Quantitative data were collected to record the characteristics of participating service users and how many secured employment and engaged in vocational activities. Eighteen qualitative interviews were conducted with service users and staff. Results: Fifty-seven service users engaged with the project, most were men (93.0%) and previously employed (82.5%). Four service users (7.0%) secured paid competitive employment. Eight (14.0%) gained other paid employment. Tailored one-to-one support to increase skills and build confidence was an important feature of the project. Creation of a painting and decorating programme offered training and paid/flexible work. Conclusions: This exploratory project achieved some success in assisting forensic service users into paid employment. Further research to identify what works well for this important group will be of great value. [ABSTRACT FROM AUTHOR]

Background: Shared decision making (SDM) is recognised as a promising strategy to enhance good collaboration between clinicians and service users, yet it is not practised regularly in mental health. Aims: Develop and evaluate a novel training programme to enhance SDM in psychiatric medication management for service users, psychiatrists and care co-ordinators. Methods: The training programme design was informed by existing literature and local stakeholders consultations. Parallel group-based training programmes on SDM process were delivered to community mental health service users and providers. Evaluation consisted of quantitative measures at baseline and 12-month follow-up, post-programme participant feedback and qualitative interviews. Results: Training was provided to 47 service users, 35 care-coordinators and 12 psychiatrists. Participant feedback was generally positive. Statistically significant changes in service users’ decisional conflict and perceptions of practitioners’ interactional style in promoting SDM occurred at the follow-up. Qualitative data suggested positive impacts on service users’ and care co-ordinators confidence to explore medication experience, and group-based training was valued. Conclusions: The programme was generally acceptable to service users and practitioners. This indicates the value of conducting a larger study and exploring application for non-medical decisions. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore mental health service users’ experiences of involvement in a clinical psychology course.Design/methodology/approach Five participants were recruited from a service user and carer group aligned to a university professional clinical psychology course. Data were collected using semi-structured interviews and data were analysed using an interpretative phenomenological analysis (IPA).Findings Four superordinate themes, group processes, advocating, transforming and power, were drawn from the data, with ten subthemes emerging capturing experiences on the personal, professional and group levels.Research limitations/implications The study is not generalisable and has a small number of participants. However, many of the themes have resonance with existing literature.Practical implications Service user initiatives need to consider the personal and contextual issues that service users may have experienced prior to their involvement. The needs of service user initiatives may change over time. Such initiatives must evolve in conjunction with the personal and political journeys of participants.Originality/value Few studies have explored the experiences of mental health service users in clinical psychology training using a robust methodology. The current study suggests that eliciting these experiences highlights factors that facilitate involvement as well as the barriers. [ABSTRACT FROM AUTHOR]

Background People with diabetes and severe mental illness ( SMI) experience poorer outcomes than those with diabetes alone. To improve outcomes, it is necessary to understand the difficulties that people with SMI experience in managing their diabetes. Aims To identify barriers and enablers to effective diabetes self-management experienced by people with SMI and type 2 diabetes. Method Qualitative methodology using semi-structured interviews was employed. Development of the interview topic guide and analysis of the transcripts were informed by the Theoretical Domains Framework for behaviour change, which consists of fourteen theoretical domains that have been found to influence behaviour. Results Fourteen people with SMI and type 2 diabetes took part in the study. Participants considered diabetes self-management to be important, were aware of the risks of poor diabetes control but struggled to follow recommended advice, particularly if their mental health was poor. Support from family and health professionals was considered an important enabler of diabetes self-management. Conclusions New approaches are required to support diabetes self-management in people with SMI. This study identified some of the important domains that may be targeted in new interventions. [ABSTRACT FROM AUTHOR]

Peer-led approaches hold unique and innovative potential as a response to child sexual exploitation (CSE), yet little is known about such approaches in this field. This study aims to increase understanding by listening to young people using one such service. Qualitative methods were adopted in an attempt to understand how young people make sense of peer mentoring, data were collected through self-completion booklets, interviews and a focus group, and analysed using thematic analysis and Gilligan's listening guide (see Kiegelmann, 2009). Given the small and local sample, the findings presented are not representative; rather they provide a snapshot, which enables us to consider the approach with this client group and the broader implications for peer-led practices. Peer mentoring emerges here as a method which may have emotional, practical and inter-personal benefits for young people facing multiple vulnerabilities. It also, importantly, reaches young women from hidden populations, who are often missing from, or missed by, support services. The article concludes by reflecting on the dilemmas associated with peer-led work and by outlining suggestions made by young people themselves, in the hope that inherent strengths in the approach can be recognised and embedded. [ABSTRACT FROM AUTHOR]

In recent years, there has been an increase in scholarly writing on the theory and practice of critical social work with people living in poverty. Yet there is a lack of research on the experiences and perspectives of service users regarding this kind of practice. This paper presents a qualitative study that explored the practice of a special poverty-aware social work programme in Israel, through the experiences of women who took part in it. Using an interpretative interactionist approach, in-depth interviews with nine women were held three times over a 2-year period. Findings reveal a high degree of satisfaction with the programme on the part of the women. The satisfaction was derived from four main experiences: the experience of visibility, the experience of the active partnership in the fight against poverty, the experience of close, hierarchy-challenging relationships, and the experience of responsiveness to material and emotional needs. The findings are discussed in terms of three principles of practice: intervention in a real-life context, relationship-based intervention and the focus on both the material and emotional needs and their fulfilment. [ABSTRACT FROM AUTHOR]

Purpose: To examine the public's views towards their choice of first-contact care and its associated factors in urban China.Methods: A mixed-method study was adopted using individual interviews, focus group interviews and a cross-sectional survey. The study was conducted among the general public between September 2014 and September 2015 in Zhejiang province, China.Results: Six focus groups and 13 individual interviews were conducted. The questionnaire was completed by 1248 respondents with a response rate of 83%. Survey results showed that 70% of the respondents preferred hospital-based services for first-contact care, it is especially the case with paediatric patients (83.3%). The qualitative data revealed that a major cause was the public distrust in the competence of primary care practitioners with lower educational qualifications. In the decision-making process, compared to cost factors like medical expenses and waiting times, participants attached greater emphasis on organizational characteristics. Respondents who rated sophisticated medical equipment, reputation of the facility, average education of doctors as important were significantly more inclined to choose hospital services. Respective adjusted odds ratios (AOR) were 2.14 (P < 0.001), 1.83 (P < 0.001) and 1.40 (P = 0.043) for their own conditions and 2.19 (P = 0.004), 1.94 (P = 0.002) and 1.86 (P = 0.003) for their children's conditions. Availability of medications and perceived severity of illness were also significantly associated with their choice of hospital services for their children.Conclusion: The public's preference for hospital-based services for first-contact care places a huge obstacle to promoting community-based primary care. Addressing the public's concerns about the primary care practitioners' competence is worth more efforts. [ABSTRACT FROM AUTHOR]

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio-metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question 'what do patients experience and expect of mental health services in relation to their physical health?' To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants' accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health-related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self-care, and mental health services to provide or enable access to health-promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Mental health service users ( MHSUs) may experience disruptions in their education. However, education has been shown to have a positive influence on their recovery, potentially offering them broader employment opportunities., The literature suggests that providing support for MHSUs in their educational efforts may be beneficial and is wished for by the service users themselves. However, there is a lack of mental health professionals' views on the topic in the setting of a community mental health centre., What does this paper add to the existing knowledge? In the perception of mental health professionals, the predominance of disease in the life of MHSUs and their marginalization may form barriers to their success in education., Professionals can support MHSUs in their educational efforts by strengthening the MHSUs' internal resources and creating a supportive environment with professional expertise available. A service user-centred education might further help MHSUs to achieve their educational goals., Our findings confirm previous knowledge of a recovery-oriented approach to supporting MHSUs' education. This study explored the topic from the professionals' perspective in the context of community mental health centres, which is a fresh view in the research literature., What are the implications for practice? The findings suggest which types of support professionals perceive to be required for MHSUs to advance their studies. Knowledge of adequate forms of support can be applied in the mental health nursing practice to develop support measures for service users to advance in their studies., All levels of the community mental health centres should be aware of and adopt a recovery-oriented approach. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and the more active involvement of MHSUs in the design of their own rehabilitation process., Abstract Introduction Studies show the importance of providing support for mental health service users' ( MHSUs') education. However, none of these studies explored this support in the community mental health centre setting. The range of MHSUs' educational activities identified in this study varied from participation in courses at the mental health centres to independent studies at different levels of education outside the centres. Aim (1) How do mental health professionals perceive the challenges that may limit service users' potential when they apply for, and complete, their education? (2) How do the professionals describe the methods of rehabilitation aimed at supporting the service users in achieving their educational goals? Method The data were collected from 14 mental health professionals using focus group interviews. Inductive content analysis was then performed. Results Professionals perceive that the predominance of disease and marginalization may be barriers to MHSUs' success in education. Strengthening the MHSUs' internal resources, creating a supportive environment with professional expertise available and service user-centred education appeared to support the MHSUs' educational achievements. Our findings confirm previous knowledge of a recovery-oriented approach to support MHSUs' education. However, professionals' views on this topic in the context of community mental health centres have not been investigated previously. Discussion Professionals perceive that a recovery-oriented approach to rehabilitation may support MHSUs in their educational efforts. Implications for practice A recovery-oriented approach should be adopted by all levels of the community mental health centres. MHSUs and professionals need to have a shared opinion on the definition of recovery orientation. This requires mutual discussion and a more active involvement of MHSUs in the design of their own rehabilitation process. [ABSTRACT FROM AUTHOR]

Background: Despite abundant literature on the different aspects of health care complaint management systems in high-income countries, little is known about this area in less developed health care systems and most research to date has been conducted in hospital settings. This article seeks to address this gap by reporting on research into complaint systems in primary health care (PHC) settings in Nepal.Methods: Using a mixed-methods design, qualitative interviews were conducted with key informants (n = 39) and six community focus groups (n = 56), in the Dang District of Nepal. In addition, interviewer-administered structured questionnaire interviews were held with 400 service users, health facility operation and management committee (HFMC) members and service providers from 22 of the 39 public health facilities. Qualitative data were transcribed, organized and then analyzed using the framework method in QSR NVivo 10, while quantitative data were analyzed using IBM SPSS 22.Results: Despite service users having grievances with the health system, they did not complain frequently: 9% (n = 20) reported ever making complaints about the PHC services. Complaints made were about medicines, health facility opening hours, health facility physical environment, and service providers, and were categorized into environment/equipment, accessibility/availability, level of empathy in the care process and care/safety. Generally, complaints were made verbally to health providers or to HFMC members or female community health volunteers. Use of formal channels such as suggestion boxes or written complaints was almost non-existent. Reasons reported for not complaining included: a lack of complaint channels; lack of knowledge of service entitlements; power asymmetry between service providers and service users; lack of opportunity to choose alternative providers, lack of an established culture of complaining, and a perceived lack of responsiveness to complaints.Conclusion: Very few service users made complaints to PHC services in Nepal. Several contextual factors related to the community and the health system were identified as the reasons for not complaining. We recommend continuing efforts to establish proper complaints mechanisms with an increased emphasis on the existing community health system networks. Furthermore, awareness among service users about service entitlements and complaint mechanisms should be increased. [ABSTRACT FROM AUTHOR]

Purpose Peer support (PS) workers are being employed despite uncertain evidence for clinical and cost-effectiveness. Psychological theories have been proposed to explain the mechanisms of PS but these lack empirical validation and specificity to professional PS. The purpose of this paper is to develop a substantive interpretive grounded theory of service-users’ experience of professional PS work.Design/methodology/approach Constructivist grounded theory was used throughout. Semi-structured interviews were conducted with ten service-users who had engaged with a professional PS worker.Findings Three overarching themes were constructed. “The process of disclosure” describes how disclosure of mental health difficulties, experiences as a service-user and wider disclosure about life experiences, interests and values facilitate the development of a shared identity with the PS worker. “The product of disclosure” highlights the sense of being understood as a result of the disclosure and marks a deepening of the relationship. “Dual roles” describes the tenuous position of holding both a professional relationship and friendship.Research limitations/implications Future research should seek to refine the theory developed and compare the effects of therapist self-disclosure with that found within PS. There were limitations within the study, including limited diversity within the sample as well as difficulties with recruitment.Originality/value This study connects service-users’ accounts of receiving PS with existing psychological theory to move towards an understanding of the relationship between receivers and providers of professional PS. [ABSTRACT FROM AUTHOR]

The study reported in this article examines the associations between service users' hope, the social worker--service user working alliance, and social worker burnout as perceived by service users, on the one hand, and perceived change in the service users' presenting problems, on the other. The study was conducted with 342 service users of a large municipal welfare agency. Consistent with the study hypotheses, the findings show (a) positive associations between the working alliance and service users' hope, on the one hand, and between the working alliance and the perceived effectiveness of the intervention, on the other, and (b) negative associations between perceived social worker burnout and perceived intervention effectiveness. They also show that hope and social worker burnout, as perceived by service users, mediate the association between the working alliance and the perceived effectiveness of the intervention. [ABSTRACT FROM AUTHOR]