Purpose Acute inpatient mental health services operate under systemic pressures that limit staff capacity for reflective, relational work. Reflective practice groups (RPGs) are widely recommended, yet the experiences of healthcare assistants (HCAs) – who deliver much of the day-to-day relational care – remain underexplored. This paper aims to examine HCAs’ experiences of ward-based RPGs on two male acute inpatient wards and how organisational conditions shaped opportunities to attend and participate. Design/methodology/approach Seven HCAs who had attended at least one RPG in the previous six months participated in semi-structured interviews. Data were analysed using Framework Analysis. Routine operational records of RPG delivery (attendance and cancellations) across a 57-week period were also reviewed descriptively to contextualise qualitative insights. Findings HCAs experienced RPGs as a rare, protected space offering emotional decompression, reduced isolation and more empathic understandings of patients. Participants described subtle changes in practice, including reduced reactive responding and greater consistency. Engagement was influenced by confidence, psychological safety and mixed views on leadership presence. RPG delivery was operationally fragile: across 57 weeks, only around one-third of scheduled sessions occurred, with cancellations largely linked to staffing shortages and ward acuity. Originality/value This evaluation provides a focused examination of HCAs’ experiences of RPGs in acute inpatient settings. Findings highlight RPGs as a valued but vulnerable resource that helps restore reflective capacity under operational pressures, underscoring the need for organisational conditions that protect reflective time.
Purpose This paper aims to understand the lived experiences of people with severe mentalillness navigating the benefits system. The UK’s benefit system has undergone considerable changes over the last decade. The current system is associated with psychological distress for claimants, with psychological processes (e.g. stigma) hypothesised as mechanisms underlying distress. Design/methodology/approach Individual interviews were conducted with 10 people who have claimed benefits over at least five years due to their severe mental health difficulties. Transcripts were analysed using Interpretative Phenomenological Analysis. Findings Three superordinate themes “the system has become hostile,” “traumatised by contact with the system,” and “trapped: stuck between a misunderstood and unwanted reality and the longing for change” were generated. Distress associated with the system focused on experiences of powerlessness, stigma, shame and forced disclosure, deception and threat, inaccessible processes and misunderstandings of mental illness. Participants described increased symptoms of mental illness and felt unable to exit the system, despite longing for work and ’normality’. Originality/value The current system is not equipped to support individuals with severe and enduring mental health difficulties. Significant changes within the system are required to reduce the traumatic impact for these people. Both individual and community interventions may help services to become more trauma-informed.
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.
