Aims and method This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used – the Dissociative Experiences Scale – II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale – and a proforma was used to collect demographic data. Results Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI. Clinical implications The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.

BackgroundThe relationship between dissociation and recovery from psychosis is a new topic, which could attract the interest of the researchers in the field of dissociation due to its relevance to their daily clinical practice. This review brings together a diversity of international research and theoretical views on the phenomenology of dissociation, psychosis and recovery and provides a synthesis by narrative and tabulation of the existing knowledge related to these concepts.AimsThe objective was to make a synthesis by narrative and tabulation about what is known on the topic.MethodsThe systematic search was conducted according to the PRISMA-statement in the databases Medline, PsycInfo, PubMed and Google Scholar. 2110 articles were selected according to the inclusion and exclusion criteria detailed in the methods, and 19 records were included in the review.OutcomesNone of the included publications put together, in the same conceptualisation or hypothesis, dissociation and the recovery from an episode of psychosis, therefore this matter remains unstudied at this time.ConclusionThe process of reviewing the existing scientific literature in the field of dissociation and recovery from psychosis has been very useful for charting the direction that future research will take.

Background:The REFOCUS intervention was a whole team, complex intervention, designed to increase the recovery support off ered by community based, mental health staff .The intervention consisted of two components: Recovery promoting relationships, which focused on how staff work with service users, and Recovery working practices, which focused on what activities and tasks staff and service users could do together. Aim:We aimed to investigate the experiences of community mental health workers using the REFOCUS intervention to support personal recovery. Method:In the context of the REFOCUS Trial (ISRCTN02507940), 28 semi-structured individual interviews and 4 staff focus groups, with 24 participants were conducted and thematically analyzed.Results: Staff valued coaching training and used coaching skills to have tough as well as empowering, motivational conversations with service users.They were positive about the resources within the 'working practices' intervention component.The whole team training and refl ection sessions helped create team cultures, structures and processes which were conducive to supporting recovery practice. Conclusion:We recommend the wider use of coaching skills, strengths-based assessments, and approaches to support clinicians to broaden their understanding of service users' values, treatment preferences and to support striving towards personally-meaningful goals.Staff who used these working practices changed their beliefs about what their service users were capable of, and became more hopeful practitioners.A team-based approach to support recovery creates a learning environment in which staff can support and challenge one another, making sustained practice change more likely.[1-3].Supporting personal recovery involves an emphasis on personalized care so service users can live a satisfying, hopeful and contributing life [4].The literature providing guidance on how to implement recovery practice has been growing, though evidence suggests it remains problematic [5,6].In a recent grounded theory of staff and manager perceptions

Background: Mental health supported accommodation services are implemented across England, usually organised into a ‘step-down’ care pathway that requires the individual to repeatedly move as they gain skills and confidence for more independent living. There have been no trials comparing the effectiveness of different types of supported accommodation, but two widely used models (supported housing and floating outreach) have been found to provide similar support. We aimed to assess the feasibility of conducting a large-scale trial comparing these two models.Methods: Individually randomised, parallel group feasibility trial in three regions of England (North London, East London, and Cheltenham and Gloucestershire). We aimed to recruit 60 participants in 15 months, referred to supported accommodation, randomly allocated on an equal basis to receive either a local supported housing or floating outreach service. We assessed referrals to the trial, participants recruited, attrition, time from recruitment to moving into either type of supported accommodation, and feasibility of masking. We conducted a process evaluation to examine our results further.Results: We screened 1,432 potential participants, of whom 17 consented to participate, with 8 agreeing to randomisation (of whom 1 was lost to attrition) and 9 participating in naturalistic follow-up. Our process evaluation indicated that the main obstacle to recruitment was staff and service user preferences for certain types of supported accommodation or for specific services. Staff also felt that randomisation compromised their professional judgement.Conclusions: Our results do not support investment in a large-scale trial in England at this time.Trial registration: UK CRN Portfolio database, Trial ID: ISRCTN19689576.Trial funding: National Institute of Health Research (RP-PG-0707-10093).

Aims and method To evaluate outcomes for patients during their admission or in the first year of treatment in two in-patient recovery units. Changes in health and social functioning, service use and need (rated by patients and staff) were evaluated. Results In 43 patients treated, there was a large (30%) increase in patients discharged to their own tenancies, rather than supported accommodation. There was minimal change in Health of the Nation Outcome Scales (HoNOS) scores in the course of the admission but staff- and patient-rated unmet needs reduced and met needs increased. Needs changed mainly in domains relating to social functioning. Reductions in risk to self and others were rated by staff but not patients. There were no cases of patients being readmitted to acute hospital during the study period. Clinical implications Although these results offer some support to the treatment approach described in these in-patient recovery units, further research in larger samples is needed to identify how these services can best be deployed to help individuals with severe mental illness and complex needs.

Quality improvement (QI) projects have been shown to positively influence patient care. They provide opportunities for trainees to present and publish their work locally and nationally, and to gain valuable leadership and management experience. We describe a pilot project to engage in QI trainees across a National Health Service trust and a school of psychiatry. After the first year of this programme over half of psychiatry trainees in the school (58% of core trainees and 47% of advanced trainees) are participating in 28 individual QI projects and QI project methodology is to become embedded in the core psychiatry training course. Specialty doctors, consultants, foundation doctors, general practitioner trainees, medical students and the wider multidisciplinary team have all become engaged alongside trainees, working with patients and their families to identify problems to tackle and ideas to test.

Background Current national policy in the UK is to make all psychiatric inpatient areas non-smoking by the end of 2018. Methods A mixed qualitative approach, using a survey with a semi-structured format and a World Café method. Discussion This pilot project explored views and experiences of staff and patients in making an inpatient recovery unit a smoke-free zone. A number of issues that were causing anxiety in patients and staff members were identified. Conclusion The focus group generated a number of possible interventions which may help to achieve a smoke-free environment while supporting inpatients who are giving up smoking.

This paper describes the need for commissioners and service providers to consider the development of a whole-system approach to providing rehabilitation services for patients with complex psychosis, in the context of the current economic pressures and emergence of a competitive market in this area of mental health. The practical and organisational arrangements for the management of risk with such services are described, taking into account the varying provision of rehabilitation services across the UK and considering how these can be developed against the care clustering system and interfaces with other mental health services.

BackgroundThere is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched.AimsTo investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England.MethodIn six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR).ResultsTeam leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31–0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians.ConclusionsCompared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery.

Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships.Interviews (n = 24) and two focus groups (n = 13) were conducted as part of a process evaluation and included a purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data.Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention.Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured.

Sarah Greef and colleagues examine the pros and cons for staff and patients of electronic prescribing with the expectation that its use will become more widespread

Background: Little is known about the empirical relationship between clinical and personal recovery. Aims: To examine whether there are separate constructs of clinical recovery and personal recovery dimensions of outcome, how they change over time and how they can be assessed.Method: Standardised outcome measures were administered at baseline and one-year follow-up to participants in the REFOCUS Trial (ISRCTN02507940). An exploratory factor analysis was conducted and a confirmatory factor analysis assessed change across time.Results: We identified three factors: patient-rated personal recovery, patient-rated clinical recovery and staff-rated clinical recovery. Only the personal recovery factor improved after one year. HHI, CANSAS-P and HoNOS were the best measures for research and practice.Conclusions: The identification of three rather than two factors was unexpected. Our findings support the value of concurrently assessing staff and patient perceptions of outcome. Only the personal recovery factor changed over time, this desynchrony between clinical and recovery outcomes providing empirical evidence that clinical recovery and personal recovery are not the same. We did not find evidence of a trade-off between clinical recovery and personal recovery outcomes. Optimal assessment based on our data would involve assessment of hope, social disability and patient-rated unmet need. (C) 2015 Published by Elsevier B.V.

Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a patient-specific outcome measure to be used for RCTs of complex interventions. IOM was developed using a narrative review, expert consultation and piloting with mental health service users (n = 20). The final version of IOM comprises two components: Goal Attainment (GA) and Personalized Primary Outcome (PPO). For GA, patients identify one relevant goal at baseline and rate its attainment at follow-up. For PPO, patients choose an outcome domain related to their goal from a pre-defined list at baseline, and complete a standardized questionnaire assessing the chosen outcome domain at baseline and follow-up. A feasibility study indicated that IOM had adequate completion (89%) and acceptability (96%) rates in a clinical sample (n = 84). IOM was then evaluated in a RCT (ISRCTN02507940). GA and PPO components were associated with each other and with the trial primary outcome. The use of the PPO component of IOM as the primary outcome could be considered in future RCTs. Copyright (C) 2015 John Wiley & Sons, Ltd.

Background : This project arises from recent literature that has challenged a conventional view of training as being professional-specific or 'silo' based. Various authors have recommended that to train psychiatrists for the future, it will be helpful to provide opportunities for exposure to different medical specialties, including general practice.Methodology : Training Across Boundaries (TAB) started in February 2013, aiming to develop training links between core psychiatry and medical specialties and primary care. The project encouraged the use of up to six sessions in a medical speciality or in primary care during a 6-month core psychiatry placement, and evaluated the benefits gained from this experience. Feedback was obtained from all the participants by means of structured interviews.Results : Results from the structured interviews with the participants are presented. Overall the project seems to have broadly achieved its aims, in the first year of activity.Discussion and conclusions : The pilot programme seems to have opened up opportunities for cooperation and learning between doctors from different disciplines. The experience of TAB has helped trainees to see many of the commonalities of practice, but also the cultural differences that operate in different parts of the health service. The results of the project show us that we need to think more about the potential value of bringing training in psychiatry, primary care and medical specialties closer, to improve the breadth and quality of training and patient care

BACKGROUND:Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations of recovery-orientated practice. METHODS:A systematic review of empirical primary research was conducted. Data sources were online databases (n = 8), journal table of contents (n = 5), internet, expert consultation (n = 13), reference lists of included studies and references to included studies. Narrative synthesis was used to integrate the findings. RESULTS:A total of 10,125 studies were screened, 245 full papers were retrieved, and 22 were included (participants, n = 1163). The following three conceptualisations of recovery-orientated practice were identified: clinical recovery, personal recovery and service-defined recovery. Service-defined recovery is a new conceptualisation which translates recovery into practice according to the goals and financial needs of the organisation. CONCLUSIONS:Organisational priorities influence staff understanding of recovery support. This influence is leading to the emergence of an additional meaning of recovery. The impact of service-led approaches to operationalising recovery-orientated practice has not been evaluated. TRIAL REGISTRATION:The protocol for the review was pre-registered (PROSPERO 2013: CRD42013005942 ).

Background Mental health policy in many countries is oriented around recovery, but the evidence base for service-level recovery-promotion interventions is lacking.Methods We did a cluster, randomised, controlled trial in two National Health Service Trusts in England. REFOCUS is a 1-year team-level intervention targeting staff behaviour to increase focus on values, preferences, strengths, and goals of patients with psychosis, and staff-patient relationships, through coaching and partnership. Between April, 2011, and May, 2012, community-based adult mental health teams were randomly allocated to provide usual treatment plus REFOCUS or usual treatment alone (control). Baseline and 1-year follow-up outcomes were assessed in randomly selected patients. The primary outcome was recovery and was assessed with the Questionnaire about Processes of Recovery (QPR). We also calculated overall service costs. We used multiple imputation to estimate missing data, and the imputation model captured clustering at the team level. Analysis was by intention to treat. This trial is registered, number ISRCTN02507940.Findings 14 teams were included in the REFOCUS group and 13 in the control group. Outcomes were assessed in 403 patients (88% of the target sample) at baseline and in 297 at 1 year. Mean QPR total scores did not differ between the two groups (REFOCUS group 40.6 [SD 10.1] vs control 40.0 [10.2], adjusted difference 0.68, 95% CI -1.7 to 3.1, p=0.58). High team participation was associated with higher staff-rated scores for recovery-promotion behaviour change (adjusted difference -0.4, 95% CI -0.7 to -0.2, p=0.001) and patient-rated QPR interpersonal scores (-1.6, -2.7 to -0.5, p=0.005) at follow-up than low participation. Patients treated in the REFOCUS group incurred 1062 pound (95% CI -1103 to 3017) lower adjusted costs than those in the control group.Interpretation Although the primary endpoint was negative, supporting recovery might, from the staff perspective, improve functioning and reduce needs. Implementation of REFOCUS could increase staff recovery-promotion behaviours and improve patient-rated recovery.

Summary This paper describes a model of training in leadership and project management skills for advanced trainees, using educational projects within the Severn School of Psychiatry. Fellowships lasting 1 year have been developed to enable trainees, working with a senior consultant trainer associated with the School of Psychiatry, to support important new educational initiatives. Linkage with the local university training and learning for health professionals research module has provided academic support for the trainees and the projects. Four examples for the first year of the programme are described and feedback from structured interviews with participants is presented. The development of the fellowships appears to have had wider benefits, in developing educational faculty in the School of Psychiatry and the trainees involved have had opportunities to extend their project management and leadership skills. The fellowship programme is continuing to develop, based on feedback from its first successful year.

Aims and methodTo evaluate outcomes for service users during their first year of treatment in three English assertive outreach teams. Changes in health and social functioning, engagement with services, service use and need (rated by staff and service users) were evaluated.ResultsIn 49 service users we found a significant increase in mean staff-rated met needs up to 6 months of treatment. There were no significant changes in ratings of engagement or Health of the Nation Outcome Scales (HoNOS) scores at 6 and 12 months. Unmet needs rated by service users and staff showed a non-significant trend for improvement across a range of individual health and social domains. Duration of hospital admission reduced significantly between the 12 months before the evaluation and the 12 months of the evaluation. Formal and informal admission and levels of contact with crisis teams reduced over the study period.Clinical implicationsAlthough these results offer some support to the assertive outreach approach, further research in larger samples is needed to identify which changes in health and social functioning are associated with transfer to assertive outreach teams.