Purpose Depression significantly impacts physical health, yet its influence on physical impairments among older adults warrants detailed exploration. This study aims to address the relationship between depression and physical limitations in older adults by analyzing findings from various research studies. Design/methodology/approach The study used specific inclusion and exclusion criteria. Eligible studies were prospective cohort studies where depression served as the exposure variable and physical impairment represented the outcome variable. A systematic review was conducted across two databases, namely, PubMed and Scopus, by the first author, while a third database, Google Scholar, was reviewed by the second author. Duplicate articles were subsequently screened for removal. Only articles written in English and published up to March 2018 were considered for inclusion. To identify potential publication bias, a combination of the Funnel plot, Egger’s test and the trim-and-fill method was used. In addition, a random-effects model was applied to synthesize the findings, and publication bias was thoroughly evaluated during the analysis process. Findings A total of 19 articles were identified following a review of published studies in databases up to March 2018. Findings indicated an association between depressive symptoms and physical impairment. Individuals experiencing depressive symptoms had a risk ratio of 1.54, with a 95% confidence interval (CI) ranging from 1.34 to 1.78. From a subset of studies, the pooled odds ratio across four studies was calculated as 2.21, with a 95% CI of 1.38 to 3.56, while the pooled hazard ratio from other four studies was found to be 1.44, with a 95% CI of 1.31 to 1.59. Evidence of heterogeneity and publication bias was observed. Originality/value This study suggests that depression may contribute to a heightened risk of physical impairment among older adults.
Purpose This pilot project aimed to implement and evaluate the impact on crisis service use of an intervention based on the Crisis Plus model, with High Intensity Users (HIU) to a Mental Health Liaison Team (MHLT) in an Emergency Department in rural East Anglia. Design/methodology/approach This service evaluation applied a case series approach and uncontrolled pre-post analysis. HIUs were offered an intervention, focused on the development of a formulation of distress and help seeking behaviour, followed by co-production of a multi-service support plan. Randomisation tests compared the average number of referrals to the mental health liaison and crisis teams in the six months pre and post intervention. Findings Fourteen service-users engaged in the intervention. The final sample comprised 100% White British females, ranging in age from 18 to 50, with presenting difficulties relating to Complex Emotional and Relational Needs. Following the intervention, 11 out of 14 service-users had fewer referrals to the MHLT and 9 out of 14 had fewer referrals to the crisis team. Randomisation tests revealed that these average reductions were statistically significant, with large effect sizes. Practical implications This data supports continued use of the intervention within the service. Whilst further effectiveness studies are needed, this project provides tentative evidence that this intervention may help reduce crisis service use for HIUs. A further larger-scale pilot project is underway. Originality/value The findings suggest that the Crisis Plus principles could be applicable to HIUs of MHLTs, through potentially reducing reliance on crisis services and improving clinical outcomes.
PurposeThe purpose of this paper is to consider service users who struggle to make changes in spite of often-repeated periods of care under secondary care mental health services – who they are, what may be interfering with change and how they can be best supported. Design/methodology/approachThis paper summarises the authors’ clinical experience and draws on existing theories of therapeutic change and attachment. FindingsThe authors reflect on how (and whether) services should identify which service users are ready to make use of psychotherapy in the context of increased demand and limited resources. The role of the therapist in creating a facilitative environment is considered, with EMDR and internal family systems models offered as helpful approaches in particular. The authors also highlight the importance of acknowledging social, economic and systemic contexts as potential barriers to change. Research limitations/implicationsThis paper discusses NHS services that are available in England and, therefore, does not consider broader global community mental health care provision. Originality/valueTo the best of the authors’ knowledge, there is little written on this issue, and our hope is to stimulate further discussion.
PurposeData from the Office for National Statistics identifies a particularly high risk of suicide amongst middle-aged White men in the United Kingdom (UK). The causal factors for this high-risk group of middle age white men are poorly understood. The aim of this paper was examine why there is such a high rate of suicide among white middle aged men in the UK. Design/methodology/approachNarrative approach analysing policy, research and scholarly literature on suicide and white male identity. Practice initiatives are presented as two case studies that describe how male identity and suicide prevention have been considered in two different organisations. FindingsA conceptual analysis deconstructs the question of suicide and white male identity and finds that essentialist and hegemonic subjectivities in the context of psychocentric approaches to suicide implicate White male narratives stigmatised as toxic. Hegemonic masculinity as a signifier is found to be different to White masculinity and White culture. It is argued that future research needs to consider the challenge of understanding how middle-aged White men in the UK, who are vulnerable to suicide, can be supported in developing life enhancing identities that will prevent suicide. Originality/valueThis paper sets out a unique and sustained interrogation of suicide among white males in the UK.
PurposeThis study aims to explore the experiences of mental health practitioners who were discriminated against due to their perceived race, gender or sexual orientation by service users or carers in the UK, and the support sought and received from their employing organisations.Design/methodology/approachThis mixed-methods study used an explanatory sequential design, with 51 mental health practitioners across the UK completing an online cross-sectional survey and six of those participants then taking part in semi-structured telephone interviews to discuss their views and experiences in greater depth. Data were analysed and reported using descriptive statistics, content analysis and thematic analysis.FindingsExperiencing discrimination had a negative impact on clinical practice with the service user and on general clinical practice. It also impacted negatively on the wellbeing of practitioners, who felt stressed and demoralised. Practitioners believed that most discrimination was a result of prejudiced attitudes. Some practitioners did not seek support from within their organisation due to historic inaction and discrimination from management and peers; and for those who did, support was not always forthcoming.Practical implicationsImplications include the need for clear policies appropriate for mental health settings to address discrimination; organisations providing resources and intervening to support practitioners in their clinical work; and training for all staff to raise awareness and improve support.Originality/valueThis study explored perceived contributing factors towards discrimination and established adverse impacts of discrimination on clinical practice and personal wellbeing.
PurposeIndividuals with complex emotional needs (CEN) can regularly present to mental health services in crisis; however, services are often not able to meet their needs. This study aims to conduct a service evaluation of a new crisis service model, the enhanced crisis pathway (ECP), for individuals with CEN.Design/methodology/approachService data from the ECP were evaluated, which included 78 individuals with CEN. Descriptive statistics, t-tests and linear regression models were used to examine patient demographics, impact of ECP on service use (referrals/admissions to and length of stay in acute services, inpatient and home treatment team [HTT]) and whether patient age, gender or ethnicity impacted service use outcomes.FindingsIn total, 88.46% of individuals who accessed the ECP in the examination period were included in the analysis. There was a significant reduction in referrals to the HTT, admissions to inpatient care, length of stay in HTT and length of stay in inpatient units post-ECP. Gender and ethnicity did not impact on care outcomes when using the ECP service, but age had a small impact on total acute referrals. As this was a service evaluation, these results are tentative and future research needs to be conducted.Originality/valueThis study evaluates a novel service model for people with CEN in crisis and provides tentative evidence for its usefulness and acceptability.
PurposeSecure Children's Homes (SCHs) within the Children and Young Person's Secure Estate (CYPSE) accommodate children and young people (CYP) on either welfare or justice grounds. Effective transition planning for CYP leaving secure settings, managed by Local Authorities, has a crucial role in ensuring positive experiences and outcomes for CYP. However, several barriers to effective transition planning and subsequent transition concerns have been identified. This study aims to investigate transition planning from SCH's specifically, focussing on two SCHs in the North East of England.Design/methodology/approachThe two SCHs circulate a multi-agency "Letter of Concern" (MALoCs) to Local Authorities on behalf of admissions where transition planning concerns are present 6, 4 and 2 weeks prior to discharge. MALoCs circulated on behalf of CYP discharged between 1st December 2022 and 30th November 2023 and admission demographic data were gathered via inspection of clinical records to identify whether transition concerns were present. Transition concerns and number of MALoCs were descriptively and statistically analysed alongside demographic characteristics.FindingsMALoCs were circulated for more than half of all admissions with a frequent need for escalation. Number of MALoCs circulated was significantly higher for welfare admissions. No significant association was found between transition concerns and CYPs' age, sex, neurodiversity diagnostic status, ethnicity or length of admission.Originality/valueThe study provides the first quantitative overview of transition planning concerns from staff teams within SCH's specifically. It is hoped that this will help inform future policy and improve outcomes for CYP.
Purpose The purpose of this study is to understand the clinical and demographic factors of these patients to understand if treatment could be provided earlier and prevent the need for hospital admission. Design/methodology/approach A retrospective cohort analysis was conducted using secondary data in a large multi site National Health Service Trust in the Northwest of England. The sample comprised of 905 patients over a 12-month period. Findings A high proportion of patients (n = 362, 40%) admitted to inpatient wards were not under community services at the time of admission. Nearly half (n =170, 47%) of these had been discharged from community services previously. This cohort of 362 patients were significantly more likely to be male (n = 202, p <0003), younger (p > 0001), have shorter length of stay (n =17, p < 0.001) and be discharged directly to community services (n = 116, p < 0.001). Practical implications The findings call into question critical elements of the current design of secondary mental health services and support the need for further exploration of access to services. A focus on case load management and continuity of care principles is recommended. Originality/value The authors are not aware of other published work examining previous community involvement for patients admitted to hospital.
PurposeThis study aims to conduct an extended evaluation of the emotional resources group (ERG), a brief emotion regulation group intervention routinely delivered in a secondary care adult mental health setting in NHS Scotland.Design/methodology/approachThe service evaluation used a within-subjects repeated measures design to assess change in emotional regulation, self-efficacy, well-being and functioning for those who attended the ERG.FindingsAnalysis of those who completed the programme found highly statistically significant improvements in measures of emotion regulation, self-efficacy, well-being and functioning. Large effect sizes were observed on all measures other than functioning, which was moderate to large. Analysis of a conservative intent to treat sample mirrored these findings with highly significant improvements on all measures. Moderate to large effect sizes were also observed on all measures other than functioning, which was moderate. In addition, good rates of reliable and clinically significant change were found for the primary measure of emotional regulation across both completers and the intent to treat sample. In addition, good rates of reliable and clinically significant change were found for the primary measure of emotional regulation across both completers and the intent to treat sample.Originality/valueThis evaluation builds on previous research by extending the evidence of ERG's effectiveness in an extended real-world NHS clinical setting. It establishes the credibility and acceptability of the intervention in secondary care outpatient adult mental health service settings.
PurposeStaff-patient interactions in mental health wards may involve multiple, sometimes contradictory, stressful interpersonal sequences. National guidelines stress the importance for clinicians to have appropriate training to develop: a good understanding of staff-patient interactions; a capacity to step back and reflect. Mentalizing skills training has been proposed to support staff in these two areas. This approach teaches general clinicians core concepts and skills derived from specialist mentalization-based treatment. Earlier mentalizing skills evaluations have lacked ongoing supervision following initial training and used self-report measures only. This study therefore aims to assess the feasibility of implementing mentalizing skills training for staff followed by ongoing supervision, using a researcher-rated measure of staff metacognition (essentially, reflective capacity).Design/methodology/approachIn three psychiatric wards, the authors examined staff participation in a two-day mentalizing skills course followed by five-months of supervision. To measure outcomes, the authors used a repeated-measures design (baseline, post-training, five months post-training). They undertook semi-structured interviews ("The Caregiving Interview") to explore participants' responses to patients, applying the Metacognitive Assessment Scale (MAS) to assess reflective capacity.FindingsOf 54 staff members approached, 43 completed the two-day course. Thirty-one participants attended at least one supervision session; seven participants undertook the protocol-intended five or more sessions. Wilcoxon signed-ranked tests showed moderate improvements in MAS from baseline to post-training (r = 0.31) and five-months (r = 0.36).Originality/valueA novel semi-structured interview was developed. The findings extend the literature on mentalizing skills, revealing potential difficulties in engaging staff in ongoing supervision. Despite this attrition, participants' gains in metacognition appear to be maintained.
PurposeThis study aims to examine the potential impact of trauma-informed care (TIC) on trauma symptoms by comparing admission and discharge self-report trauma symptomatology in a secure children's home (SCH) in the North East of England where the SECURE STAIRS framework is embedded.Design/methodology/approachThe Trauma Symptom Checklist for Children (TSCC; Briere, 1996) was administered at two time-points during admission to the SCH. Young people completed this measure at admission and pre-discharge. Forty-six young people (29 males and 17 females) completed the TSCC at both admission and pre-discharge, with valid responses.FindingsSignificant improvements in discharge scores were found across four domains: depression [z(45) = -0.49, p = 0.011]; anger [ t(45) = 3.106, p = 0.003]; dissociation [z(45) = 0.45, p = 0.007]; and dissociation (overt) [t(45) = 3.104, p = 0.003].Originality/valueThis research contributes to the literature base by examining the impact of TIC on the Children and Young People's Secure Estate population. There is a dearth of literature on this area particularly in the UK.
PurposeThe number of Experts by Experience (EbE) working in mental health services has grown in recent years. The National Health Service (NHS) five-year plan states EbE should be used across different levels, including service delivery, design and commissioning. While current research explores the role of EbE in service delivery, little is known about their experiences of co-designing services. This study aims to explore EbE experiences of co-designing NHS mental health services.Design/methodology/approachThis research used qualitative semi-structured interviews with ten participants who had worked on projects focused on co-designing NHS mental health services as an EbE. Data were analysed using reflexive thematic analysis.FindingsAnalysis identified four themes and associated subthemes. Themes emphasised the importance of being involved from the start of projects, with late or limited involvement leading to feelings of tokenism. Co-design was described as emotionally demanding but meaningful. Findings suggested that connection both between EbE and with the wider organisation was central to supporting feelings of safety. When organisational support or feedback was lacking, participants questioned if their contributions were listened to. Findings emphasised the need for systemic support to enable meaningful co-design.Originality/valueThis research provides new insight into how EbE experience co-designing NHS mental health services. It highlights how EbE find community and value in co-design work, and stresses the need for systemic support to enable EbE to fully participate. Future research should explore how intersecting, marginalised identities shape experiences of co-design.
Purpose - The primary objective of this study was to investigate the effects of 10-Hz binaural beat synchronization on cognitive flexibility and working memory in patients diagnosed with major depressive disorder (MDD). Cognitive impairments, particularly in working memory and cognitive flexibility, are significant challenges in MDD and affecting daily functioning and quality of life. This study aims to explore whether binaural beats could serve as a noninvasive, cost-effective intervention to address these deficits. Design/methodology/approach - This quasi-experimental study included 60 patients diagnosed with MDD who were randomly assigned to either an intervention group exposed to 10-Hz alpha wave binaural beats or a control group listening to neutral sounds. The intervention consisted of daily 20-min sessions over four weeks. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST), and working memory was evaluated using the N-back test. Data were analyzed using multivariate analysis of covariance with SPSS version 24, controlling for covariates such as age, gender and education level. Findings - The results revealed that exposure to 10-Hz binaural beats significantly improved both cognitive flexibility and working memory in the intervention group compared to the control group (p < 0.05). Specifically, significant enhancements were observed in metrics such as total errors, residual errors and response times in the WCST, as well as in accuracy and processing speed in the N-back test. These findings suggest that binaural beats can effectively enhance executive function in MDD patients. Originality/value - This study introduces a novel application of 10-Hz alpha wave binaural beats as a nonpharmacological intervention for addressing cognitive deficits in MDD. By demonstrating the potential of binaural beats in improving cognitive flexibility and working memory, this research highlights a promising adjunct to traditional treatments, offering practical implications for clinical practice and mental health rehabilitation.
PurposeDespite potential benefits of using social media for participant recruitment in mental health research, there are limited evaluations to guide researchers. This pilot study aims to explore feasibility of using social media in mental health research to recruit a population-representative, heterogeneous sample of adults from the general population.Design/methodology/approachThe global, top 15 most popular social media platforms were evaluated according to researchers' needs to determine use in this study. Recruitment, over three months, used standard, cost-free methods to recruit participants to a survey-based mental health study. In the last month of recruitment, researchers piloted the addition of paid advertising, to reduce sampling bias and aid recruitment. The evaluation aimed to monitor engagement of potential participants with social media.FindingsSurvey participants (n = 2,195) were mostly of white ethnicity, female and aged 18-24 years, indicating limited representation. Over one million individuals interacted with social media posts. Standard use averaged 1,124 people reached, 32 engagements, 6 link clicks per day on tracked social media posts, and on average 24 new participants per day. Paid advertising averaged 36,372 people reached, 5,959 engagements, 338 link clicks per day, and on average 22 new participants per day. Conversion rate differed between phase of recruitment, but sample diversity did not differ significantly. Paid advertising did not appear to make a difference.Originality/valueThis study highlights that social media is an exciting development in research and has potential to increase sample size. This study identifies practical challenges for researchers, such as adequate funding and understanding of social media.
Purpose A long-standing agenda in the field of health is developing practice-based evidence, with research driven by applied research questions and led by practitioner experts. The purpose of this paper is to contribute to a growing literature addressing this type of practice research in mental health by presenting the authors’ experiences embedding practice-based evaluation and research activity in an English NHS context. Design/methodology/approach Efforts in two multidisciplinary settings in a single mental health trust are detailed: a specialist child and adolescent mental health service team and an adult rehabilitation and recovery pathway. This work, developed to inform the meaningful integration of research-based knowledge with care delivery, is described by reference to experiences over a four-year period in which research activity was particularly productive in output compared to other periods. Findings A reflective account is provided in which conditions that animate practice research activity are considered, particularly collaboration with wider professional networks, including academic colleagues, and the involvement of junior and trainee clinicians. Originality/value The reflections presented in the paper provide insights into the “doing” of practice research activity in NHS mental health service provision and virtuous cycles of activity to embed this activity in a local context. Though based on experiences from one specific trust, this paper may have the implication of illustrating a prototype for embedding practice research in other settings across similar provider trusts in the UK.
PurposeThis study aims to document the process of adapting Recovery College (RC) courses into an online format and assess whether online adaptation meets learners' goals. The study describes the challenges encountered, the strategies deployed and the factors influencing implementation from the perspectives of four interested parties: coordination team, partners advisory committee, trainers and learners.Design/methodology/approachThe study adopts a descriptive single-case study design. Several sources of data were collected: focus groups, implementation daybook, meeting minutes, interviews and satisfaction survey. Simple descriptive content analysis was used for all qualitative data, and simple descriptive statistical analyses were used for the online satisfaction survey with learners.FindingsThe results highlight challenges and strategies for adapting content and facilitation, as well as challenges and strategies for respecting RC key principles. Internal, organizational and technological factors have influenced the implementation. Most learners were satisfied with the courses attended and felt that it met their goals. Three overarching aspects of online implementation are discussed based on findings: training and supporting trainers, facilitation and pedagogical methods and ongoing monitoring and feedback to interested parties.Research limitations/implicationsFindings encourage further research to determine the extent to which online RC courses align with recommended strategies for reducing digital inequalities and implementing digital health interventions.Originality/valueFew studies have focused on implementing RC online. This case study offers insights for organizations pursuing similar initiatives.
Purpose This paper aims to explore ethnic variation in the diagnosis of personality disorders across Birmingham and Solihull mental health services. Design/methodology/approach An odds ratio was used to compare diagnostic prevalence rates among ethnic minority groups against the white British majority using service evaluation data. Findings Compared with the white British population, personality disorder was significantly less diagnosed in most ethnic minority groups. A notable exception was the mixed white and black Caribbean group, where prevalence was significantly higher. No significant differences were found in mixed white and Asian and mixed white and black African groups. Practical implications More needs to be done to explore and understand the difference in personality disorder diagnosis rates. It is possible that the differences described in this paper may reflect a true lower prevalence rate, but it is perhaps more likely to reflect difficulties with detection, bias in diagnosis or cultural differences with service use. The findings can help inform more equitable diagnostic practices and highlight the need for culturally competent mental health assessments. Originality/value To the best of the authors’ knowledge, this study is one of few UK-based evaluations exploring ethnic variation in personality disorder diagnosis within a superdiverse urban population. The findings raise important questions about diagnosis, stigma and service accessibility.
Purpose-Prior research suggests that members of a gaming community might have a higher risk for depression. This paper aims to investigate the effect of self-stigma on self-reported depression and its link with rumination in the Pok & eacute;mon Trading Card Game (TCG) community. The purpose is to assess the mental health in this community, raising awareness about mental health issues in under-researched, sub-nerd cultures. Design/methodology/approach-A total of N = 733 Pok & eacute;mon TCG players took part in an online survey in September 2021. The survey collected socio-economic and game-related data, along with responses to the Ruminative Thought Style Questionnaire. A list experiment was conducted to disentangle social desirability bias when self-reporting a depression diagnosis. Findings-The results show that members of the Pok & eacute;mon TCG community underreport if they have received a diagnosis of depression by 4.6% points (z = 2.018, p < 0.05). This underreporting further increases to 7.2% points (z = 2.559, p < 0.01) when considering the sub-sample of respondents who ruminate more. Intersecting those who ruminate more with the respondents residing in North America, more than quadruples the initial underreporting to 20.6% points (z = 5.345, p < 0.01). Research limitations/implications-This study relies on self-reported depression, rather than using a standardized questionnaire. Further research should determine if rumination and depression in the Pok & eacute;mon TCG community predate or result from participation. Originality/value-This study offers a unique insight into a never before studied community. The findings raise awareness about depression, potentially reducing self-stigma that is preventing individuals from accessing mental health care.
Purpose This study aims to explore and investigate the patient-reported outcome and experience measure (DIALOG) with respect to physical health of service users under the care of a Mental Health and Learning Disabilities National Health Service trust. Design/methodology/approach Three exploratory statistical analyses (paired samples t -test, a logistic regression on changing from unsatisfied to satisfied and a logistic regression on improving by at least one DIALOG score) were conducted on physical health DIALOG scores ( n = 3,077). Findings The mean score for the DIALOG physical health question increased from 3.28 to 3.43 whilst under the care of secondary care mental health services. Service users living in deprived areas were 35% (OR 0.65, CI [0.45, 0.95]) less likely to be satisfied with their physical health. Service users recorded as long-term sick or disabled were 60% (OR 0.40, CI [0.25, 0.63]) less likely to be satisfied with their physical health. Service users who had not had a physical health assessment were 57% (OR 0.43, CI [0.23, 0.79]) less likely to be satisfied with their physical health. Originality/value The routine collection of patient-reported outcome measures and patient-reported experience measures in the UK mental health setting is in its infancy with currently little analysis of data taking place; therefore, this exploratory study generates several discussion points.
Purpose Links between trauma and psychosis have been well evidenced. Trauma has been proposed to underlie psychotic experiences, with the trauma model of psychosis suggesting psychotic experiences represent forms of trauma-related distress. As such, traumatic experiences can be seen symbolised in the content of psychosis experiences. Despite this, Community Mental Health Teams (CMHTs) predominantly operate within a medicalised model, where trauma and trauma-informed care are often neglected. Therefore, staff training was delivered on the trauma model of psychosis and trauma-informed care. This study aims to assess whether the training would improve knowledge and attitude in working with trauma and whether the training would improve staff recognition of the connections between the content of psychosis and previous trauma. Design/methodology/approach The training consisted of an online 1-h session, with measures of trauma-informed care (knowledge and attitude) and trauma-psychosis links (symbolism questionnaire) collected pre- and post-training. The training was open to all 115 staff in the CMHTs, 53 attended, however, only 23 completed both pre- and post-measures. Findings Wilcoxon signed-rank tests revealed significant differences in pre- and post-performance on both the trauma-informed care and symbolism questionnaire. Findings showed in this sample that the training improved knowledge and attitude in trauma-informed care and staff ability to recognise connections between trauma and psychotic experiences. Originality/value A novel symbolism questionnaire was designed for this evaluation. The findings extend the literature, as they show that staff were more accurate in recognising the specific underlying trauma to the psychosis content following training.
