BACKGROUND:Previous studies show ambiguous results concerning quality of palliative care among patients with severe mental disorders, defined as schizophrenia, moderate to severe depression, and bipolar disorders. AIM:To investigate quality in specialist palliative care among Danish patients with pre-existing severe mental disorders using data from the Danish Palliative Database. DESIGN:Danish cohort study linking data from the Danish Palliative Database and hospital medical files. SETTING/PARTICIPANTS:All adult decedents in 2023 from Central Denmark Region affiliated with specialist palliative care. Hospital records were screened for severe mental disorders. Quality indicators included: Place-of-death, days from referral to death, specialist palliative care waiting time, discussion at multidisciplinary conferences and completion of symptom assessment. RESULTS:Of 1869 patients, 80 (4.3%) had pre-existing severe mental disorders. Compared to patients without mental disorders, these patients died younger and more often from non-cancer conditions. They were less likely to complete symptom assessment (Risk Ratio (RR): 1.49 (95% CI: 1.15;1.95)). Those who also received active psychiatric treatment experienced longer waiting times for specialist palliative care (Mean ratios (MR): 3.48 (95% CI: 1.06;11.39)) and shorter palliative care pathways (MR: 0.44 (95% CI: 0.20;0.96)) than patients without active psychiatric treatment. CONCLUSION:Danish patients with active severe mental disorders were less likely to complete symptom assessment, had longer waiting times and shorter specialist palliative care pathways. Future efforts should focus on timely access to specialist palliative care and health professionals supporting completion of symptom assessments in this population.

Background The Grenfell Tower fire, London, in 2017 caused 72 deaths, and mass evacuations. This evaluative case study examines the disaster response, particularly the mental health and wellbeing programme delivered by statutory services, notably the NHS and local government (RBKC). It explores what they did, and how they worked together and with voluntary sector organisations (VSOs) to identify key lessons for the planning of disaster responses. Methods The study focused on the first two years of the response. Data was gathered from publicly available sources and interviews with key informants. Uncertainties and missing information were clarified with organisations. A timeline of the response was created as well as an overview of key lessons for future responses. Results In national guidance RBKC was responsible for co-ordinating the longer-term recovery response. That was difficult because it had lost the trust of the local community. The NHS had to go beyond its assigned role of treatment and advice, which was too narrowly envisaged in national guidance. Both mental health and wellbeing need to be addressed after a disaster. Wellbeing is poorly defined, inadequately measured and rarely researched. Local and national VSOs played a vital role, but our understanding of the details is incomplete, as for most disaster responses. Conclusions Local communities must be fully involved in decisions about recovery programmes. Mental health and wellbeing are not synonymous but closely linked. Far more people will be injured psychologically than physically in a disaster. Large disasters require multi-agency partnerships sharing expertise and resources, rather than tasks being allocated between organisations through commissioning. There is a need to further develop and disseminate evidence-based mental health interventions delivered by non-experts as part of these partnerships. Training needs to teach practical skills as well as awareness. These lessons are also relevant to mainstream mental health services.

BACKGROUND:Systematic reviews have identified variation and inequity in care provision for people with pre-existing severe mental illnesses who have palliative or end-of-life care needs. AIM:To analyse service use and variation for people with severe mental illness in the last year of life in Wales. METHODS:This is an observational retrospective cohort study between 2018 - 2023 using anonymised linked routinely collected health datasets within a data dashboard. RESULTS:We identified n = 4722 (2.3%) deaths with ICD-10 codes for severe mental illness for the period 2018-2023. As a group, people with severe mental illness die younger, are in receipt of specialist palliative care at lower rates, die more often in institutional settings rather than their own homes and comorbidity indicates more unscheduled care use in the last year of life. CONCLUSIONS:Unscheduled care use in the last year of life is associated with comorbidity, indicating opportunities for upstream intervention to improve treatment, experience, and quality of life for people with severe mental illness. Further investigation, such as mixed methods approaches to examine experiences of those with severe mental illness in the last year of life, and the human and systems factors influencing the nature and effectiveness of unscheduled delivery, is needed.

Abstract Care for people with mental health difficulties is provided by practitioners often working in different teams and organizations. This makes the system of mental health a complex one and places a premium on continuity of care. Care continuity is a cornerstone of modern mental healthcare and one of the principal aims of care coordination. Mental health nurses have important parts to play in these areas. This chapter explores interprofessional and interagency working and introduces evidence and skills useful to nurses in their roles as care coordinators. Key skills must be developed and applied in working across multiple service interfaces with the aim of promoting care continuity. These include facilitating better continuity and connectivity across service boundaries, developing better therapeutic relationships, providing greater flexibility for service users, and supporting better communication and information transfer. The policy context is also important for developing interagency and interprofessional skills to promote better care continuity.

BACKGROUND: The mental health and wellbeing of children and young people is a global concern. Alongside approaches emphasising mental health promotion in schools, communities and in the home, many countries are also investing in crisis services. These aim to meet the needs of young people experiencing acute psychosocial distress. A recent synthesis of the international evidence found a paucity of research in this area. This study sought to address this gap while simultaneously situating the findings within the international context and drawing out implications for policymakers and practitioners. METHODS: A cross-sectional study aiming to describe and map approaches to the implementation and organisation of crisis care for children and young people was conducted across England and Wales. Complexity ideas, systems thinking and normalisation process theory conceptually underpinned the study. A bespoke survey captured service characteristics, service organisation and service user characteristics. It also incorporated the NoMAD tool to gather data on implementation. Usable data were received from 124 services. We used descriptive statistics and thematic analysis to summarise service characteristics and to develop a logic model. Typological analysis was used to develop a typology of service responses. NoMAD data were analysed using frequency analysis, item means and mean scale scores for each construct. RESULTS: The ‘community in-person rapid response’ is the most common approach to provision. However, our analysis captured a patchwork of diverse provision across the system, typified by an absence of consensus regarding definitions of ‘mental health crisis’, lack of common agreement relating to the goals of care, and multiplication of approaches to the organisation and provision of services. Despite this, high levels of within-service coherence, cognitive participation and reflexive monitoring were observed. CONCLUSIONS: There is significant variation in the organisation and provision of crisis services for children and young people. Through situating our findings in a prevailing international policy context, we suggest that the variation we observe reflects an absence of a developed evidence base and a proliferation of strategies and frameworks which fail to provide clear guidance on how crisis care might best be organised and provided. PROJECT REGISTRATION: This project is registered with Research Registry (unique identifier: researchregistry8660).

In this editorial we set out the background to the advent and development of the concept of recovery in mental health care. We follow this with an overview of policy with specific reference to our own locale here in Wales where a recovery-focus is now written into national mental health legislation and policy directions. We briefly summarise our own research in this area and note positive relationships between recovery and social support and quality of life but also limited shared understanding of what recovery might mean alongside gaps in policy aspirations and everyday experiences of using services. The concept of recovery remains contested with concerns it has become a means for neoliberal thinking in services and in effect has been colonised by competing ideas. Despite this (sometimes) conflicting evidence and the polyvalent quality of the concept, recovery retains a sense of vitality and validity as evidenced by contributions to this special issue of the journal. Building on our reading of this growing literature we suggest that recovery necessitates social change, implies an understanding of systems and awareness of complexity and finally must account for and accommodate competing understandings. To achieve its foundational aims, it is imperative that research in this field directly engages and includes people with experience of using mental health services as co-researchers in generating new recovery-focused interventions to address the challenges of severe mental illness experiences.

Background: The COVID-19 pandemic has significantly impacted education, necessitating a massive shift towards digital learning. As a result, healthcare, medical and nursing education have had to swiftly transfer and adapt to online (OL) instruction despite the substantial challenges this has presented, given that healthcare education involves crucial hands-on skills, laboratory practice and clinical experience. Previous research investigated healthcare students' experiences with online learning for various healthcare professions during the COVID-19 pandemic; however, scarce evidence was found for the population of paramedic students. Therefore, this study aimed to explore the paramedic students' experiences with online learning during COVID-19, particularly by examining their facilitators and barriers to this new learning modality. Objectives: This study has two intended outcomes. First, instructors and stakeholders will gain increased insights regarding students' OL experiences and identify the facilitators and barriers to their learning to initiate additional improvements. As a result, the instructional methods, learner competency and patients' safety might be enhanced. Second, the students will be able to examine their strengths and weaknesses using this new learning method and suggest future improvements. Methods: A qualitative descriptive design was adopted to explore paramedic students' experiences with online learning during the COVID-19 pandemic. Purposive sampling was utilized to recruit six students in the eastern region of Saudi Arabia. Data collection employed in-depth, semi-structured virtual interviews, which were audiotaped and transcribed verbatim. Braun and Clarke's reflexive thematic analysis was then used for data analysis. Results: Eight main themes and four sub-themes were explored from the data. The main themes were: unfamiliarity requiring quick adaptation; lack of infrastructure hindering e-learning; troublesome learning clinical skills virtually; problematic communications within the online realm; difficulty maintaining active learning; online learning allows more flexibility and time; using e-tools effectively; and adapting blended learning approach. The analysis explored valuable findings regarding these students' learning facilitators and barriers alongside their suggestions for future improvements. Conclusion: The study's findings provide crucial information for educators and stakeholders to improve online learning and ensure education quality that, in turn, could contribute to safer patient care. These findings may also help authorities understand students' online learning experiences and better prepare them for this mode of learning. [SJEMed 2025; 6(1.000): 084-084]

AimThere is an absence of evidence generated in a UK context to support interventions based on occupational therapists' core skills for people living with early-stage dementia. To inform the development of a programme theory and a future evaluation, this paper aimed to describe real-world (routine) community-based occupational therapy interventions for this population and contextual barriers.MethodOccupational therapy practitioners (n = 21) from five Health Boards in Wales, UK participated in semi-structured interviews (n = 17) which were audio recorded, transcribed, and analysed thematically.FindingsThe availability of, and access to, real-world community-based interventions was variable, and associated with multilevel contextual barriers (resources, understanding of dementia specialist occupational therapy, professional influence, and evidence base). Where available and accessible, contents comprised a pre-intervention component (relational work, assessment, and goal setting) and intervention component (personalised problem-solving and coping strategies, emotional support, and advice and signposting), to meet needs associated with everyday activities and poor wellbeing. Variation in mode, duration, contents, and who received interventions, was associated with contextual barriers.ConclusionFindings indicate that the development of an intervention programme theory and future evaluation design, will need to account for the impact context may have on the variability of real-world intervention characteristics, and how this in turn may influence outcomes.

Introduction: This paper explores the impact that early-stage dementia has on everyday activities from the perspective of people living with dementia, their supporters and occupational therapy practitioners.Method: People living with dementia and their supporters (n = 10), and occupational therapy practitioners (n = 21) took part in semi-structured interviews, with transcripts analysed thematically.Findings: Six primary themes were identified across participants, namely: (1) 'Everybody seems to be different, [but] they are similar'; (2) An awareness of change: 'Something's not quite right'; (3) 'Changes' and 'difficulties' associated with complex and unfamiliar activities; (4) Social withdrawal and exclusion: 'I've felt like I was a leper'; (5) Post-diagnostic mental health: '. . .a dark place'; and (6) A process of adaptation: 'I'm still who I am, I can still do things. . .'Conclusion: Findings indicate that occupational therapy intervention programmes for people living with early-stage dementia should target difficulties associated with a broad range of activity types, and include components that target mental health and motivational needs. The study adds to existing knowledge about the need to personally tailor interventions to ensure that they meet individual needs, experiences, and circumstances. Findings will inform the development of an occupational therapy intervention programme theory (theory of change) for early-stage dementia.

BACKGROUND In England, one in six children aged 5-19 has a probable diagnosable mental health disorder. This is a major public health problem, with multiple agencies adopting varying approaches to care delivery for children and young people (CYP) in crisis. OBJECTIVES To examine the organisation of crisis services across education, health, social care and voluntary sectors; the experiences and perceptions of CYP, families and staff; the effectiveness of current approaches to care and the goals of crisis intervention. METHODS A systematic review of all relevant English language evidence regarding the provision and receipt of crisis support for CYP aged 5-25 (PROSPERO-CRD42019160134). Seventeen databases were searched from 1995 to 2002 and relevant UK-only grey literature was identified. Critical appraisal was conducted using appropriate design specific appraisal tools. A narrative approach to synthesis was conducted. RESULTS In total, 138 reports (48 reports covering 42 primary research studies; 36 reports covering 39 descriptive accounts of the organisation services and 54 UK-only grey literature reports) were included. The evidence suggests that crisis services were organised as follows: triage/assessment-only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, four themes were identified: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) children's, young people's and families' experiences of crisis services; and (d) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of crisis services were identified. DISCUSSION Despite a lack of high-quality international studies, findings suggest that support prior to reaching crisis point is important. From this work, various aspects of crisis care have been identified that can be incorporated into existing services across education, health, social care and the voluntary sector.

Background: Adverse drug reactions (ADRs) can occur due to ecstasy use, and the number of people dying due to drug-related deaths has increased in the past 10 years. Harm reduction strategies could help prevent ADRs or decrease the incidence of life-threatening health consequences due to ecstasy use. However, no reviews have explored the breadth of evidence available on ecstasy harm reduction strategies. Methods: A rapid scoping review was conducted using adapted JBI methodology to identify the prevalence and nature of harm reduction strategies that ecstasy users employ in recreational settings, with both peer-reviewed research and user-oriented drug information websites explored. Five databases (CINAHL, EMBASE, Medline, PsycINFO, CENTRAL) were searched for English language records from database inception to August 2022. User-oriented websites were identified via the project’s stakeholder group and Google searches. Results: Twenty reports representing 19 studies (one randomised control trial, nine quantitative descriptive studies and nine qualitative studies) were included. A wide variety of harm reduction strategies were reported, including drug-specific strategies (for example, limiting the amount of ecstasy consumed, buying from trusted sources, drug checking (pill testing)); behavioural strategies (for example, monitoring fluid (water) consumption, taking a rest break to regulate temperature, avoiding alcohol and mixing with other drugs; preloading and post-loading); and peer-related strategies (for example not using alone, looking out for friends). Ecstasy users obtain information on ecstasy’s effects and/or harm reduction practices from a variety of sources including friends, nightclubs, TV news, drug leaflets, music magazines and user-oriented information websites. Fourteen user-oriented websites providing ecstasy-specific harm reduction information were identified, and strategies focused on dosage and frequency of use, interaction with other substances and prevention of health consequences, such as heatstroke, or dehydration among others. However, only two webpages provided citations to the evidence used for the content. Conclusions: While numerous harm reduction strategies exist, employing them can depend on the users’ overall goal/s which might also encompass avoiding comedown or increasing their high. Moreover, users’ previous experience can influence how and when they adhere to harm reduction. More efficient ways of communicating harms and harm reduction strategies might be needed.

BackgroundMulti-modular motion-assisted memory desensitization and reconsolidation therapy (3MDR) is a new psychological intervention for people with post-traumatic stress disorder (PTSD). 3MDR is immersive, delivered in a virtual reality environment, and emphasises engagement, recollection and reprocessing. ObjectiveThrough a theory-driven examination of data relating to 10 out of 42 UK military veterans taking part in a trial of 3MDR, the principal objective was to explore the complex interrelationships between people, interventions and context and to investigate how factors within these domains interacted in specific outcome typologies. MethodQuantitative and qualitative data relating to 10 trial participants were derived from: researcher-assessed and self-report clinical measures; interviews; physiological recordings; words describing thoughts and feelings during therapy; and subjective unit of distress scores. Using a convergent mixed methods approach, data were tabulated using a person, intervention and context model. Participant summaries were grouped into outcome typologies, followed by an analysis of data convergence and divergence within each and an interpretation of identified patterns. ResultsThree outcome response typologies were identified: dramatic improvement, moderate improvement and minimal improvement. Within the person domain, factors associated with outcomes included walking capacity, commitment and ability to complete therapy, and levels of subjective distress. Within the intervention domain, factors associated with outcomes related to image selection and use, therapeutic alliance and orientations towards the tailoring of sessions. Within the context domain, factors associated with outcomes included reactions to the therapy environment. The patterning of secondary outcomes broadly corresponded with primary outcomes within each typology. Alongside patterned data differentiating aspects of the person, intervention and context domains, within the three response typologies data also existed where no obvious patterning was detected. ConclusionsThe model developed here may have novel value in evaluating a range of personalised interventions, but further work is needed before confident assertions can be made of who is likely to benefit from 3MDR specifically.

Background One in six five 16-year-olds have a probable mental health difficulty. Of these

"Mental Health Nurse Academics can help attain goals for mental health research and influence policy." Journal of Mental Health, ahead-of-print(ahead-of-print), pp. 1–2

Background Mental health care for children and young people is a rising concern, with one in six children aged 5–19 years in England having a probable diagnosable mental disorder. Care for children and young people in crisis is known to be delivered by multiple agencies using a range of approaches. Objectives The review objectives of this study were to critically appraise, synthesise and present the best-available international evidence related to crisis services for children and young people aged 5–25 years, specifically looking at the organisation of crisis services across education, health, social care and the third sector, and the experiences and perceptions of young people, families and staff, to determine the effectiveness of current models and the goals of crisis intervention. Methods All relevant English-language international evidence specifically relating to the provision and receipt of crisis support for children and young people aged 5–25 years, from January 1995 to January 2021, was sought. Comprehensive searches were conducted across 17 databases and supplementary searching was undertaken to identify grey literature. Two team members appraised all the retrieved research reports (except grey literature) using critical appraisal checklists. A separate analysis was conducted for each objective. Confidence in research findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation and the Confidence in the Evidence from Reviews of Qualitative research approaches. Findings One hundred and thirty-eight reports were used to inform this evidence synthesis, including 39 descriptive accounts of the organisation of crisis services (across 36 reports), 42 research studies (across 48 reports) and 54 grey literature documents. The organisation of crisis services has been categorised as follows: triage/assessment only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, the following four themes were identified: (1) barriers to and facilitators of seeking and accessing appropriate support; (2) what children and young people want from crisis services; (3) children’s, young people’s and families’ experiences of crisis services; and (4) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of a crisis service should be to (1) keep children and young people in their home environment as an alternative to admission; (2) assess need and plan; (3) improve children’s and young people’s and/or their families’ engagement with community treatment; (4) link children and young people and/or their families to additional mental health services, as necessary; (5) provide peer support; (6) stabilise and manage the present crisis over the immediate period; and (7) train and/or supervise staff. The key limitation of this review was that much of the literature was drawn from the USA. Owing to the differences between USA and UK in terms of commissioning and delivering services, approaches to crisis care operating in the USA may not be directly applicable to the UK. Future work As only three research studies included in this evidence synthesis had been completed in the UK, a clear case exists for the commissioning of new high-quality studies to generate knowledge about the efficacy and acceptability of crisis care approaches operating in the UK. Future empirical research in this area is planned. Study registration: This study is registered as PROSPERO CRD42019160134. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.

AbstractThis is the protocol for a Campbell review. The objectives are as follows: To carry out a mixed methods review to summarise current evidence relating to the components of case‐management interventions for people experiencing homelessness.

Background One in six five -16-year-olds have a probable mental health difficulty. Of these, almost half of older teenagers and a quarter of 11–16-year-olds report having self-harmed or attempted suicide. Currently, there is little research into mental health crisis services for young people, with little understanding of what services exist, who uses them, or what works best. Question ‘How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services’? Objectives 1. To describe National Health Service (NHS), local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales. 2. To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services. 3. To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families. Methods A sequential mixed methods approach, underpinned by normalisation process theory will be employed. A survey will create a detailed record of how crisis responses across England and Wales are organised, implemented and used. Subsequently, eight contrasting services in relation to geographic and socioeconomic setting, populations served, and service configuration will be identified as case studies. Interviews will be conducted with children, young people and parents/carers who have used the service, as well as commissioners, managers and practitioners. Operational policies and service usage data will also be examined. Analysis of how each service is provided, experienced, implemented and sustained will be conducted both inductively and deductively, reflecting normalisation process theory constructs.