This perspective brings together authors from care aesthetics, dementia studies, mental health nursing, and clinical psychology to explore how aesthetics and Polyvagal Theory intersect in dementia care. Across these fields, there is growing recognition that wellbeing is shaped not only by clinical interventions but also by the subtle, embodied cues that create a sense of safety, connection, and belonging for patients. Concepts such as aesthetic care, in-the-moment practices, and everyday aesthetics emphasize how lived experience and wellbeing is grounded in the sensory and relational details of everyday life. In parallel, Polyvagal Theory provides a psychophysiological framework for understanding how people respond to such cues through the process of threat detection, co-regulation, and social engagement. By placing these perspectives side-by-side, we explore the currently untapped benefits of developing a cross disciplinary therapeutic toolkit for clinicians working with people living with dementia. Looking ahead, integrating aesthetics and Polyvagal-informed approaches could reshape dementia care into a practice that values safety, connection, and meaning as core clinical outcomes. Although further research is needed to translate this integrated model into practice, the work of the authorship in both research and clinical practice with people with dementia illustrate that such approaches are already ongoing and can bring tangible benefits for several stakeholders, including people living with dementia.

Background During the COVID-19 pandemic, 40 mental health and well-being hubs were funded in England to support health and social care staff affected by the pandemic.Aims To describe the characteristics of staff accessing four hubs for support and identify characteristics associated with clinically significant mental health difficulties and work and social functioning.Method Routinely collected screening data were analysed from 1973 individuals across 4 hubs, including mental health, demographic and occupational data and pandemic-related stressors. Factors associated with clinically significant mental health difficulties were identified via logistic regression.Results Most hub clients identified as white women who worked for the UK National Health Service; other groups were less well represented. Hub clients reported high levels of clinically significant mental health difficulties: 60% had severe and often co-occurring difficulties (ie, depression, anxiety, post-traumatic stress disorder or alcohol use) and 80% reported significantly impaired functioning. Younger age, disability status, identifying as from a minority ethnic group, and sexual orientations excluding heterosexual were associated with higher likelihood of having clinically significant mental health difficulties. Suffering financial loss during the pandemic, and prepandemic emotional well-being concerns were the most consistent factors associated with higher difficulties.Conclusions The hubs supported health and social care staff with significant mental health difficulties. Outreach and engagement with under-represented groups should be undertaken to address potential barriers to service access. The findings add to the knowledge base on the support needs of the health and social care workforce and the planning of support in response to future crises.

This study explores the practice of healthcare support workers (HCSWs) working with people with dementia on mental health wards for older people within the National Health Service in the United Kingdom. People with dementia in these settings have complex physical and mental health needs with significant behaviors that challenge and therefore require high levels of staff expertise to meet their needs. Underpinned by the theory of care aesthetics, our primary aim was to raise the visibility of HCSWs' everyday practice in this under-researched area of dementia. Working with three mental health wards over two sites, we used an exploratory, participatory action research methodology with qualitative and ethnographic methods to refine and clarify our understanding of care aesthetics in this practice setting. Over the course of the study, and through a series of collaborative learning groups in each site, we developed an explanatory practice model applying constant comparative analysis to the data to ensure that each stage of the model was iteratively developed and refined with the participating HCSWs. The model demonstrates how HCSWs use sensory, embodied, and relational practice to effectively "tune in" to the person with dementia, to the ward and their colleagues, to themselves and their values, to their craft, and to ward visitors. Being co-present was a resulting linking schema that demonstrated high-quality in-the-moment person-centered care. The model illustrates the range of everyday practices delivered by HCSWs and how care aesthetics has the potential to inform and develop the language of person-centered dementia care.

Abstract Key workers are vulnerable to adverse mental health. To ensure service sustainability during COVID-19, Resilience Hubs were established across England offering outreach, screening, and mental health support. This evaluation aimed to describe wider service use, associated costs, and satisfaction among Hub clients (key workers) accessing Hub support. Clients accessing support across four Hubs were invited to complete a service use questionnaire, between 5 and 8 months post referral, collecting satisfaction, wider service use and cost data. Exploratory linear regression assessed the relationship between demographic variables and service use. Most Hub clients reported Hub contact post referral (219/299, 73.2%), with many accessing mental health support (171/299, 57.2%) or on waitlists (34/299, 11.4%). Satisfaction was high, with median helpfulness rated 92 (out of 100), and many stating that Hubs either fully (148/299, 49.5%) or partially (54/299, 18.1%) met their needs. Mental health support accounted for most service use, with higher total service use and costs when including Hub services (£514 versus £213). Key workers have complex needs. Hub services helped clients to access support, with high reported satisfaction indicating that Hubs met clients needs. Further research is required to assess how service use varies according to occupation or demographic characteristics, and whether Hubs are clinically and cost-effective.

Background NHS England funded 40 Mental Health and Wellbeing Hubs to support health and social care staff affected by the COVID-19 pandemic. We aimed to document variations in how national guidance was adapted to the local contexts of four Hubs in the North of England.Methods We used a modified version of Price's (2019) service mapping methodology. Service level data were used to inform the analysis. A mapping template was adapted from a range of tools, including the European Service Mapping Schedule, and reviewed by Hub leads. Key data included service model; staffing; and interventions. Data were collected between March 2021 - March 2022 by site research assistants. Findings were accuracy-checked by Hub leads, and a logic model developed to theorise how the Hubs may effect change.Results Hub goals and service models closely reflected guidance; offering: proactive outreach; team-based support; clinical assessment; onward referral, and rapid access to mental health support (in-house and external). Implementation reflected a service context of a client group with high mental health need, and high waiting times at external mental health services. Hubs were predominantly staffed by experienced clinicians, to manage these mental health presentations and organisational working. Formulation-based psychological assessment and the provision of direct therapy were not core functions of the NHS England model, however all Hubs incorporated these adaptations into their service models in response to local contexts, such as extensive waiting lists within external services, and/or client presentations falling between gaps in existing service provision. Finally, a standalone clinical records system was seen as important to reassure Hub users of confidentiality. Other more nuanced variation depended on localised contexts.Conclusion This study provides a map for setting up services, emphasising early understandings of how new services will integrate within existing systems. Local and regional contexts led to variation in service configuration. Whilst additional Hub functions are supported by available literature, further research is needed to determine whether these functions should comprise essential components of staff wellbeing services moving forward. Future research should also determine the comparative effectiveness of service components, and the limits of permissible variation.Study registration researchregistry6303.

In the United Kingdom, people living with dementia admitted to National Health Service (NHS) psychiatric/mental health inpatient dementia assessment wards (dementia assessment wards) are nearly always compulsorily detained under a section of the Mental Health Act 1983 owing to the risk and complexity of the presenting condition. As such, dementia assessment wards admit some of the most vulnerable patients in society, yet these environments of care are under-researched and under-reported in the literature. Using care aesthetics as an overarching explanatory lens, this article focuses on the care of one patient (Charlotte - not her real name) resident on a dementia assessment ward and uses a range of qualitative methods to illuminate that experience, including ethnographic observations and a care record review. To further develop the reach of the case study, interviews were also conducted with Charlotte's husband as her main family carer and key ward staff involved in Charlotte's care. Data were analysed using a sensory and narrative-based method to provide a sequential, embodied, individually positioned and storied account of Charlotte's care and interpreted experience on the ward. The analysis revealed that Charlotte's presentation of dementia was complex insofar as she resisted any attempt by the ward staff to offer her food or drink or to help with washing and dressing. Charlotte also swore frequently and loudly and spent time actively 'watching' and 'looking' at people and the environment in which she was now living. The findings contribute to the fields of critical dementia studies, dementia education, health-care practice and policy making, and may be used to highlight the value of sensory and embodied approaches to capturing a caring dynamic.

Background Resilience Hubs provide mental health screening, facilitation of access and direct provision of psychosocial support for health and social care keyworkers in England affected by the coronavirus disease 2019 pandemic. Aim To explore implementation of the Hubs, including characteristics of staff using the services, support accessed, costing data and a range of stakeholder perspectives on the barriers and enablers to Hub use and implementation of staff well-being support within the context of the pandemic. Design Mixed-methods evaluation. Setting Four Resilience Hubs. Methods Findings were integrated via mixed-method case studies, including: analyses of Hub mental health screening (N = 1973); follow-up questionnaire data (N = 299) on service use and health status of Hub clients; economic information provided by the Hubs; 63 interviews with Hub staff, wider stakeholders, Hub clients and keyworkers who did not use the Hubs. Results Findings were consistent across Hubs and workstreams. Most Hub clients were NHS staff. Under-represented groups included men, keyworkers from minority ethnic communities, care homes and emergency services staff. Clients reported comorbid mental health needs across multiple domains (anxiety; depression; post-traumatic stress; alcohol use; functioning). Their health status was lower than population norms and relevant pre-pandemic data. Several factors predicted higher needs, but having pre-pandemic emotional well-being concerns was one of the most robust predictors of higher need. Sixty per cent of participants who completed follow-up questionnaires reported receiving mental health support since Hub screening, most of which was directly or indirectly due to Hub support. High levels of satisfaction were reported. As in many services, staffing was the central component of Hub cost. Hubs were predominantly staffed by senior clinicians; this staffing model was consistent with the generally severe difficulties experienced by clients and the need for systemic/team-based working. Costs associated with health and social care use for Hub clients were low, which may be due to barriers to accessing support in general. Enablers to accessing Hubs included: a clear understanding of the Hubs, how to self-refer, and managerial support. Barriers included confusion between Hubs and other support; unhelpful beliefs about job roles, unsupportive managers, negative workplace cultures and difficulties caused by systemic issues. Some keyworkers highlighted a perceived need for further diversity and cultural competency training to improve reach to under-represented communities. Other barriers for these groups included prior negative experiences of services, structural inequalities and stigma. Some wider stakeholders had concerns around growing waiting times for Hub-provided therapy, and insufficient data on Hub usage and outcomes. Feedback was otherwise very positive. Limitations Main limitations included lack of comparative and pre-pandemic/baseline data, small numbers from under-represented groups limiting fine-grained analysis, and participant self-selection. Conclusions Findings highlighted the value of the Hub model of outreach, screening, support navigation and provision of direct support during the coronavirus disease 2019 pandemic, and as a potential model to respond to future crises. The research provided recommendations to improve Hub promotion, equality/diversity/inclusion access issues, management of specialist resources and collection of relevant data on Hub outcomes and activities. Broader recommendations for the primary prevention of mental health difficulties across the health and care system are made, as individual support offers should be an adjunct to, not a replacement for, resolutions to systemic challenges. Research recommendations are made to conduct more robust evaluations of the clinical and cost-effectiveness of the Hubs, using larger data sets and comparative data. Study registration This study is registered as researchregistry6303. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132269) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 29. See the NIHR Funding and Awards website for further award information.

Objectives Evaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic.Design Qualitative interviews informed by normalisation process theory to understand how the Hub model became embedded into normal practice, and factors that disrupted normalisation of this approach.Setting Three Resilience Hubs in the North of England.Participants Hub staff, keyworkers who accessed Hub support (Hub clients), keyworkers who had not accessed a Hub, and wider stakeholders involved in the provision of staff support within the health and care system (N=63).Results Hubs were generally seen as an effective way of supporting keyworkers, and Hub clients typically described very positive experiences. Flexibility and adaptability to local needs were strongly valued. Keyworkers accessed support when they understood the offer, valuing a confidential service that was separate from their organisation. Confusion about how Hubs differed from other support prevented some from enrolling. Beliefs about job roles, unsupportive managers, negative workplace cultures and systemic issues prevented keyworkers from valuing mental health support. Lack of support from managers discouraged keyworker engagement with Hubs. Black, Asian and minority ethnic keyworkers impacted by racism felt that the Hubs did not always meet their needs.Conclusions Hubs were seen as a valuable, responsive and distinct part of the health and care system. Findings highlight the importance of improving promotion and accessibility of Hubs, and continuation of confidential Hub support. Policy implications for the wider health and care sector include the central importance of genuine promotion of and value placed on mental health support by health and social care management, and the creation of psychologically safe work environments. Diversity and cultural competency training is needed to better reach under-represented communities. Findings are consistent with the international literature, therefore, likely to have applicability outside of the current context.

Purpose This study aims to address this need. In the UK, people with dementia admitted to National Health Service mental health in-patient dementia assessment wards [dementia assessment wards] present as complex and experience a number of changed behaviours, such as excessive walking, agitation and aggression. The complexity of the presentation of dementia has been identified as underpinning pre-and post-admission to these care environments, but limited study has so far been conducted to explore the boundaries and meaning of complexity and its relationship to dementia assessment ward practice. Design/methodology/approach An online electronic survey of UK-based national dementia leaders was conducted in 2018. Nineteen completed questionnaires were returned, and mental health nurses comprised the largest sub-sample. Qualitative data of the free-text responses were analysed using manifest content analysis. Findings Four routes to admission to a dementia assessment ward were identified. Multiplicity of needs and interconnectedness were seen as important domains in uncovering the meaning of complexity. The importance of life story and formulation approaches were highlighted. Challenges uncovered included, better understanding changed behaviour and its relationship to complexity, the need for understanding the boundaries of complexity and making visible care practices on these specific wards. Originality/value Findings can be used to produce a heightened awareness about the meaning and function of complexity in dementia assessment wards. Policymakers and researchers need to increase the emphasis on this area of mental health and dementia care. Further training for the multidisciplinary team on formulation approaches could help to improve the evidence-base for practice.

Background In the United Kingdom, the use of the terms ‘complex’ and ‘complexity’ alongside dementia is reflected in a number of policy and practice documents. However, there is a lack of evidence that explores how complexity is perceived, constructed and experienced by people with dementia, family carers and practitioners working in the NHS dementia inpatient assessment wards [dementia assessment wards]. Objective To explore the meaning and concept of complexity in dementia from within the setting of a dementia assessment ward and develop a practice model. Methods The study was conducted over three phases: 1) an online electronic survey of UK national dementia leaders; 2) individual interviews and a focus group with dementia practitioners in two dementia assessment wards; 3) case studies of four patients with dementia resident on a dementia assessment ward which included their identified family carer/consultee, the named clinician on the ward involved in that person’s care and a care records review. Results The findings highlighted that complexity is constructed through a number of interconnected and interrelated domains that vary in acuity. These findings have been developed into the ‘3 Fs Model of Complexity’ and the 3‘Fs’ stand for Fixed, Flexible and Fluctuating. The Fixed domain consists of six components which are always present in complexity. The Flexible domain consists of 14 components and a person with dementia may experience any number of Flexible domain components at any one time. The Fluctuating domain highlights that all components have the ability to vary in their acuity. Conclusion The ‘3 Fs Model of Complexity’ may facilitate a more holistic view of a person with dementia than when ‘symptoms’ are viewed in isolation. Going forward, and subject to further refinement and testing, the ‘3 Fs Model of Complexity’ could help guide the selection of tailored, personalised interventions for people with dementia, including formulation approaches.