PurposeThis study aims to demonstrate the practical application of a collaborative intervention (DIALOG+) and the outcomes for an individual suffering with schizophrenia.Design/methodology/approachCase study methodology.FindingsUsing DIALOG+ in mental health clinical practice can act as a beneficial therapeutic adjunct to established care-planning processes. Outcomes in this case study demonstrated improvements in a number of life domains, resulting in a significantly improved recovery.Research limitations/implicationsFuture research should evaluate the implementation of DIALOG+ in different service settings and with different diagnoses within the domain of mental health and physical health.Practical implicationsThere is scope for further implementation of DIALOG+ within mental health service practice across a range of service settings and countries. Training in DIALOG+ is brief and inexpensive, with the approach having very good face validity with patients of these services.Social implicationsThe DIALOG scale is a life domains scale with an emphasis on social determinants that are impacted by mental illness. Improvements in social functioning are fundamental for sustained recovery from serious mental illnesses. Planning collaborative interventions within these domains would appear to improve the likelihood of such recovery.Originality/valueThe description of the DIALOG+ approach within this case study will be of value to practicing mental health clinicians across a range of service settings.

Background: Over three-quarters of suicides occur in low- and middle-income countries (LMICs) and a better understanding of this behavior within these settings is crucial. Aim: To investigate stakeholders' knowledge, attitudes, and experiences of self-harm and suicide in LMICs. Method: A systematic search was conducted using British Nursing Index, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE, PsycINFO, and Social Sciences electronic databases from inception to March 2022, combined with hand-searching reference lists. The search was updated using the PubMed Similar Articles function in February 2024. Analysis followed a modified narrative synthesis approach. Results: One hundred and fifty-four articles met the inclusion criteria, of which 60 included relevant quantitative data. Attitudes toward suicide were often contradictory although, overall, were negative and suicide literacy was poor. Healthcare staff reported lacking training in this area. Willingness to seek help was linked to suicide literacy and attitudes toward suicide. Limitations: Heterogeneity of included studies. Conclusion: Tackling stigma and improving awareness of suicide and self-harm in LMICs are needed to facilitate suicide prevention. Training should include people with lived experience of suicide and self-harm. The complex and contradictory influences of age, gender, religious, and cultural beliefs and lived experience must be considered.

Summary In the post-COVID-19 pandemic era, a ‘digital-first’ agenda is being adopted in health/social care services, while digital exclusion has not been fully addressed. People with severe mental illness face profound inequalities at many levels (i.e. social, financial and health). Digital exclusion may further exacerbate some of these inequalities.

BACKGROUND:With a rising prison population, a substantial portion of whom are identified as substance misusers, it is important to understand the availability of treatment pathways, their successes and areas for improvement. Given the likely importance of national factors in criminal justice and substance use service provision, we chose to focus on one country. AIM:To review substance misuse treatment and outcomes for such treatments as implemented in British prisons for men. METHODS:We conducted a mixed-methods systematic review, searching Ovid MEDLINE, Ovid Embase, APA PsycINFO, CINAHL Plus, Sociology Collection, Web of Science Core Collection and Social Science Premium Collection between 1 January 2000 and 5 June 2024. Included were empirical, peer-reviewed studies of processes and outcomes of UK male prison-based substance misuse programmes. Primary outcomes included changes in substance use, withdrawal symptoms and experiences of interventions, whereas secondary outcomes encompassed quality of life, locus of control and mental health. Because of study design heterogeneity, meta-analysis was not possible. Analysis followed JBI methodology with a convergent synthesis. RESULTS:Fourteen studies were included: 8 qualitative, 5 quantitative studies of which 3 were randomised control trials (RCTs) and 1 mixed-methods study, with a combined sample of 4037 participants engaged in opioid substitute treatment (OST) and/or psychosocial interventions. Four key themes emerged: the power of purposeful activity, strengthening support systems, bridging patient needs with treatment plans and, for those in opiate programmes, experiences and engagement with opioid substitution treatments. CONCLUSIONS:Participants articulated diverse treatment needs, highlighting the necessity of individualised and tailored reduction or maintenance plans. Treatment requires a comprehensive approach with the aim of facilitating effective social integration.

Background: Over three-quarters of suicides occur in low- and middle-income countries (LMICs) and a better understanding of this behavior within these settings is crucial. Aim: To investigate stakeholders' knowledge, attitudes, and experiences of self-harm and suicide in LMICs. Method: A systematic search was conducted using British Nursing Index, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE, PsycINFO, and Social Sciences electronic databases from inception to March 2022, combined with hand-searching reference lists. The search was updated using the PubMed Similar Articles function in February 2024. Analysis followed a modified narrative synthesis approach. Results: One hundred and fifty-four articles met the inclusion criteria, of which 60 included relevant quantitative data. Attitudes toward suicide were often contradictory although, overall, were negative and suicide literacy was poor. Healthcare staff reported lacking training in this area. Willingness to seek help was linked to suicide literacy and attitudes toward suicide. Limitations: Heterogeneity of included studies. Conclusion: Tackling stigma and improving awareness of suicide and self-harm in LMICs are needed to facilitate suicide prevention. Training should include people with lived experience of suicide and self-harm. The complex and contradictory influences of age, gender, religious, and cultural beliefs and lived experience must be considered.

BACKGROUND:Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. OBJECTIVES:To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. SEARCH METHODS:We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. SELECTION CRITERIA:Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. DATA COLLECTION AND ANALYSIS:Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. MAIN RESULTS:Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. AUTHORS' CONCLUSIONS:This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.

Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.

The study aimed to culturally adapt and validate the SCOPE scale for Brazil, focusing on measuring social inclusion among adults in community psychosocial centers in São Paulo. Utilizing a cross-sectional sample survey and the adapted SCOPE-B scale, it assessed 255 patients, revealing their low social inclusion levels. Findings highlighted the negative correlation between social inclusion and aspects like race, economic status, and employment, alongside a positive association with physical and mental health. The SCOPE-B scale demonstrated reliability, internal consistency, and construct validity, supporting its application in diverse cultural contexts

Background and aims Individuals living with severe mental illness such as schizophrenia and bipolar can have significant emotional, cognitive, physical and social challenges. Most people with severe mental illness in the United Kingdom do not receive specialist mental health care. Collaborative care is a system of support that combines clinical and organisational components to provide integrated and person-centred care. It has not been tested for severe mental illness in the United Kingdom. We aimed to develop and evaluate a primary care-based collaborative care model (PARTNERS) designed to improve quality of life for people with diagnoses of schizophrenia, bipolar or other psychoses when compared with usual care. Methods Phase 1 included studies to (1) understand context: an observational retrospective study of primary and secondary care medical records and an update of the Cochrane review ‘Collaborative care approaches for people with severe mental illness’; (2) develop and formatively evaluate the PARTNERS intervention: a review of literature on collaborative care and recovery, interviews with key leaders in collaborative care and recovery, focus groups with service users and a formative evaluation of a prototype intervention model; and (3) develop trial science work in this area: a core outcome set for bipolar and recruitment methods. In phase 2 we conducted a cluster randomised controlled trial measuring quality of life using the Manchester Short Assessment of Quality of Life and secondary outcomes including time use, recovery and mental well-being; a cost-effectiveness study; and a mixed-methods process evaluation. Public involvement underpinned all of the workstream activity through the study Lived Experience Advisory Panel and the employment of service user researchers in the project team. Results phase 1 The study of records showed that care for individuals under secondary care is variable and substantial and that people are seen every 2 weeks on average. The updated Cochrane review showed that collaborative care interventions were highly variable, and no reliable conclusions can be drawn about effectiveness. The PARTNERS model incorporated change at organisational, practitioner and individual levels. Coaching was selected as the main form of support for individuals’ personal goals. In the formative evaluation, we showed that more intensive supervision and ‘top-up’ training were needed to achieve the desired shifts in practice. A core outcome set was developed for bipolar, and measures were selected for the trial. We developed a stepped approach to recruitment including initial approach and appointment. Results phase 2 The trial was conducted in four areas. In total, 198 participants were recruited from 39 practices randomised. Participants received either the PARTNERS intervention or usual care. The follow-up rate was 86% at 9–12 months. The mean change in overall Manchester Short Assessment Quality of Life score did not differ between the groups [0.25 (standard deviation 0.73) for intervention vs. 0.21 (standard deviation 0.86) for control]. We also found no difference for any secondary measures. Safety outcomes (e.g. crises) did not differ between those receiving and those not receiving the intervention. Although the costs of intervention and usual care were similar, there is insufficient evidence to draw conclusions about the overall cost-effectiveness of PARTNERS. The mixed-methods process evaluation demonstrated that a significant proportion of individuals did not receive the full intervention. This was partly due to care partner absence and participant choice. The in-depth realist informed case studies showed that participants generally appreciated the support, with some describing having a ‘professional friend’ as very important. For some people there was evidence that delivery of the intervention had led to specific personal changes. Strengths and limitations The phase 1 records study provided insights into usual care that had not been previously documented. The realist informed complex intervention development was both theoretical and pragmatic. The trial continued through the COVID-19 pandemic with high levels of follow-up. The process evaluation had the depth to explore individual changes in participants’ response to the intervention. Weaknesses in the trial methodology included suboptimal implementation, outcome measures that may not have been sensitive to changes patients most appreciated and difficulties collecting some outcomes. Conclusions While PARTNERS was not shown to be superior to usual care, the change to PARTNERS care was not shown to be unsafe. Full intervention implementation was challenging, but this is to be expected in studies of care that include those with psychosis. Some individuals responded well to the intervention when psychological support in the form of individualised goal setting was flexibly deployed, with evidence that having access to a ‘professional friend’ was experienced as particularly helpful for some individuals. Future work Key components of the PARTNERS model could be developed further and tested, along with improved supervision in the context of ongoing community mental health care change. Trial registration This trial is registered as ISRCTN95702682. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: NIHR200625) and is published in full in Programme Grants for Applied Research ; Vol. 12, No. 6. See the NIHR Funding and Awards website for further award information.

ObjectiveSocioeconomic status deprivation is known to be associated with self-harm in Western countries but there is less information about this association in Low and Middle Income Countries (LMIC). One way of investigating this is to assess the prevalence of indicators of financial stress in people who self-harm. We have assessed the prevalence and correlates of day-to-day financial hardships amongst individual presenting with non-fatal self-harm to hospitals in Sri Lanka.MethodsData on non-fatal self-harm presentations were collected from an ongoing surveillance project in 52 hospitals in Sri Lanka. A questionnaire captured data on two forms of financial stress: unmet need (i.e., costs and bills that cannot be paid) and required support (i.e., steps taken to cover costs, such as selling belongings). Additional data on demographic, economic and clinical characteristics were also collected.ResultsThe sample included 2516 individuals. Both forms of financial stress were very common, with pawning/selling items (47%) and asking family or friends for money (46%) in order to pay bills or cover costs being commonly reported. Greater financial stress was associated with being aged 26-55 years, limited education, and low socioeconomic position. Financial stress was greater in women than men after adjusting for other factors.ConclusionThe results indicate that financial stress is commonly reported amongst individuals presenting to hospital with non-fatal self-harm in Sri Lanka, especially women. The research highlights a need to attend to financial stress both within self-harm prevention and aftercare.

Design and intervention: Before-and-after evaluation of web-based mindfulness trainingfor staff caring for people living with dementia in care homes. Stepped-wedge clusterrandomised design.Setting and participants: Random sample of 31 care homes for people living with dementia.Homes started mindfulness training at a random time over 35 weeks. From thesehomes 172 staff volunteered, 151 (88%) started training, and 111 (67%) completedquestionnaires after 20 weeks.Methods: Questionnaires completed at baseline, 8 and 20 weeks included job stress (WSI)and health and well-being (SF-12).Results: There were significant reductions in job stress of 0.07 (95% confidence interval[CI]: 0.02, 0.13) at 8 weeks and 0.06 (95% CI: 0.01, 0.11) at 20 weeks; and improvementsof 2.49 points (95% CI: 0.81, 4.17) in the SF-12 Mental Component Score at 8 weeksand 3.41 (95% CI: 1.88, 4.94) at 20 weeks.Conclusions: Web-based mindfulness training improved the psychological well-beingof care home staff and reduced their stress with small to moderate effects in both shortand medium term

SummaryIn this journal Ikkos examines the work of the American sociologist Owen Whooley, who argues that US psychiatry has gone through five paradigm shifts without defining the object of its own expertise. We look at the substance of Whooley's methods and assumptions and offer our observations on Ikkos's argument and conclusions.

Background: Reports of increasing presentations of new cases of acute psychosis both locally, nationally and internationally during the COVID-19 pandemic, warranted further investigation. International case reports almost exclusively reported only clinical outcome (e.g. remission of psychotic symptoms), and fail to report on social precipitants or social outcomes. This is a common omission when investigating new psychosis cases such as acute and transient psychotic disorder (ATPD). In order to assess social impacts and outcomes, we conducted a rapid review of recent evidence. Aims: To conduct a rapid review of the recent evidence of social outcomes on new cases of psychosis emerging during the COVID-19 pandemic. Method: Four databases (Medline, Embase, Psychinfo and Cochrane COVID-19) were searched for ATPD, psychosis and social outcomes in adults aged 18+. Duplicates were removed. There were no language limitations. Results: There were 24 papers consisting of 18 original data research papers and 6 reviews. Additionally, 33 papers/letters, reporting on 60 individual cases of psychosis emerging during the COVID-19 pandemic. These two sets of papers were reviewed separately. Many original data research papers and reviews were sub optimal in their quality, with 44% online surveys, with the remainder being routinely collected data. Conclusion: There is a consensus that clinical outcomes of ATPD and other brief psychotic disorders (BPD) are good in the short term. The focus only on symptomatic clinical presentation and outcomes, leaves a gap in our understanding regarding social stressors and longer term social outcomes. ATPD and BPD often may not come to the attention of Early Intervention in Psychosis services, and if they do, are discharged following symptomatic remission. Without an understanding of the social stress factors and social outcomes, opportunities may be missed to prevent increased social disability and future relapse with these presentations.

Background Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative care combines clinical and organisational components. Aims We tested whether a primary care-based collaborative care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses, compared with usual care. Method We conducted a general practice-based, cluster randomised controlled superiority trial. Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person-centred coaching support and liaison work. The primary outcome was quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA). Results We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices, 116 participants) or control (19 practices, 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (intervention: 0.25, s.d. 0.73; control: 0.21, s.d. 0.86; estimated fully adjusted between-group difference 0.03, 95% CI −0.25 to 0.31; P = 0.819). Acute mental health episodes (safety outcome) included three crises in the intervention group and four in the control group. Conclusions There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomes.

Background The classification of mental disorders used to be based only on people seen by hospital psychiatrists. In fact, most people with a mental disorder were, and are, not seen by psychiatrists because of decisions made prior to psychiatric consultation. The first description of this ‘pathway’ to care and its levels and filters was published by Goldberg and Huxley in 1980. Aims To conduct a review of papers relevant to the application of the Goldberg–Huxley model in the 21st century. Method Systematic review (PROSPERO registration CRD42021270603) of the pathway to psychiatric care in the 21st century. The review concentrates on community surveys and passage through the first filter (consultation in primary care or its equivalent). Ten databases were searched for papers meeting the defined inclusion criteria published between 2000 and 2019 and completed on 15 February 2020. Results In total, 1824 papers were retrieved, 137 screened fully and 31 included in this review. The results are presented in a table comparing them with previous research. Despite major social, economic and health service changes since 1980, community prevalence and consultation rates remain remarkably consistent and in line with World Health Organization findings. Passage through the first filter is largely unchanged and there is evidence that the same factors operate internationally, especially gender and social parameters. Conclusions The Goldberg–Huxley model remains applicable internationally, but this may change owing to an increasingly mixed mental health economy and reduced access to primary care services.

AbstractObjectiveWe report a review of outcomes in schizophrenia in the twenty‐first century, replicating and extending work undertaken by the late Richard Warner in his seminal book, “Recovery from Schizophrenia: Psychiatry and Political Economy” (1985;2004).MethodWarner's methods were followed as closely as possible. Only observational/naturalistic studies were included. Six scientific databases were searched from 2000 to 2020. 6,640 records were retrieved. 47 met inclusion criteria.ResultsOverall, complete recovery is higher in this study than in Warner's (37.75% cf 20.4%), especially for first episode psychosis (FEP) (57.1% cf 20.7%). Clinical recovery, annualized remission rate (ARR), and employment outcomes were significantly superior for first episode psychosis compared with multiple episode psychosis (MEP). ARR shows a trend toward reduction over time, from 2.2 before the financial crash of 2008 to 1.6 after (t = 1.85 df 40 p = .07). The decline is statistically significant for the MEP group (t = 2.32 df18 p = .03). There were no differences in outcome by region, sample characteristics, outcome measures used, or quality of studies. Heterogeneity of clinical outcome measures across the literature makes evidence synthesis difficult. Weak and inconsistent reporting of functional and employment outcomes mean that findings lack meaning with respect to lived experience.ConclusionFuture research strategies should aim to reduce heterogeneity in clinical outcome measures and to increase the emphasis on capture and reporting of more sophisticated measures of social and functional outcome. Outcome domains should be disaggregated rather than conflated into unitary recovery constructs.

Dyfyniad o'r fersiwn a gyhoeddwyd / Citation for published version (APA): Reilly, S., Marchevsky, N., Green, M., Davies, L., Plappert, H., Allard, J., Rawcliffe, T., Gibson, J., Clark, M., Pinfold, V., Gask, L., Huxley, P., Byng, R., & Birchwood, M. (2021). Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme. British Journal of Psychiatry, 7(2), [e53]. https://doi.org/10.1192/bjo.2021.10

BACKGROUND:Current NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The 'PARTNERS2' complex intervention is designed to support individuals with psychosis in a primary care setting.AIM:The trial will evaluate the clinical and cost-effectiveness of the PARTNERS2 intervention.DESIGN & SETTING:This is a cluster randomised controlled superiority trial comparing collaborative care (PARTNERS2) with usual care, with an internal pilot to assess feasibility. The setting will be primary care within four trial recruitment areas: Birmingham & Solihull, Cornwall, Plymouth, and Somerset. GP practices are randomised 1:1 to either (a) the PARTNERS2 intervention plus modified standard care ('intervention'); or (b) standard care only ('control').METHOD:PARTNERS2 is a flexible, general practice-based, person-centred, coaching-based intervention aimed at addressing mental health, physical health, and social care needs. Two hundred eligible individuals from 39 GP practices are taking part. They were recruited through identification from secondary and primary care databases. The primary hypothesis is quality of life (QOL). Secondary outcomes include: mental wellbeing, time use, recovery, and process of physical care. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action, and look for unintended consequences. An economic evaluation will estimate its cost-effectiveness. Intervention delivery and follow-up have been modified during the COVID-19 pandemic.CONCLUSION:The overarching aim is to establish the clinical and cost-effectiveness of the model for adults with a diagnosis of schizophrenia, bipolar, or other types of psychoses.