Introduction Overcrowding and nursing workload are two major issues within urgent and emergency care (UEC) settings and contribute to incompletion or omission of patient vital signs in initial assessment and patient monitoring. This could potentially have a negative impact on patient health outcomes. Software enabling contactless monitoring of patient vital signs using camera photoplethysmography (PPG) has been developed, where patients can measure their own vital signs by recording a 30-second video on their smartphone on the software platform. This software could prove beneficial within UEC settings to help to reduce nursing workload and allow prioritisation of higher order tasks and could help to reduce long wait times for initial triage assessment. Before any such software can be implemented, it is first necessary to assess the feasibility and acceptability of the software in situ among patients in UEC settings, as well as the acceptability among staff working in triage. Methods and Analysis To assess feasibility of the software, 1500 patients attending three UEC services at St George’s University Hospitals NHS Foundation Trust will be invited to take part in a study where vital signs will be measured manually and using smartphone PPG software. Feasibility will be measured using a survey after data collection. Staff acceptability will be measured using a short survey among 20-40 staff. Patient acceptability of digital health technology in UEC settings will be measured by a questionnaire among 10,000 patients. Ethics and Dissemination   This research has been ethically approved by the NHS London – Surrey Research Ethics Committee and the Human Research Authority (reference: 25/PR/0222; IRAS project ID: 346745). Informed consent will be obtained prior to the participant undergoing any activities that are specifically for the purposes of the study. Findings from this research will be disseminated via journals and conferences and used to inform further research in the field.   Strengths and Limitations       This observational study aims to assess the feasibility of using novel photoplethysmography (PPG) technology to measure vital signs in the Emergency Department Whilst several studies have explored the use of PPG, FacED will ascertain if this can be correctly used by patients in the ED The study includes several outcomes and will generate data on the acceptance of digital technologies in ED care                 The ability to recruit from three urgent and emergency care (UEC) settings within one NHS Trust is a strength of this research as it will enable a wide range of participants to be recruited from across emergency care, making the study target sample sizes more attainable and will provide feasibility assessments in 3 locations.  This feasibility study will test the appropriateness of the methods to answering the study question but at present, the study materials are only accessible to English-understanding patients and data will be collected on participant’s first language ### Competing Interest Statement I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr Gabriel Jones: Unpaid role as medical officer at streamwave.ai. This may translate into shares or a paid position in the future. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study obtained UK NHS ethical approval by the London – Surrey Research Ethics Committee (REC number 25/PR/0222) on 4th April 2025. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.

IntroductionThe aims of this synthesis were to investigate the relationship between IPV severity and mental health outcomes and shed light to gaps and limitations in existing methodologies used to assess IPV severity and its association with mental health outcomes.MethodsWe conducted a two-stage narrative synthesis of 76 studies. First, we identified IPV measures used in at least five studies, focusing on their variations and severity score calculation. Then, we analyzed findings of studies correlating IPV severity with mental health outcomes, identifying features of measures and statistical methods influencing result consistency.ResultsMeasures of intimate partner violence were often modified from their original, potentially impact on the reliability and validity of these measures. The operationalization of violence severity varied across studies, leading to inconsistencies in scoring whereby compromising the consistency of severity levels across studies. We found lack of consistency in applying validated methods for scoring instruments to determine abuse severity. In this review, we consistently found that the severity of IPV and its various subtypes were linked to different mental health outcomes across multiple studies. We discovered evidence suggesting that experiencing more types of IPV was associated with worse mental health outcomes. Generally, higher levels of overall IPV severity and its specific subtypes were correlated with poorer mental health outcomes. However, our analyses did not reveal consistent patterns that would allow for a definitive determination of how individual IPV subtypes differently affect mental health outcomes. Nevertheless, we observed that increasing severity of physical IPV tended to have a notable impact on post-traumatic stress disorder (PTSD). Conversely, increasing severity of psychological IPV was consistently associated with depression. While sexual IPV severity was explored in fewer studies, the evidence regarding its impact on various mental health outcomes was less conclusive.DiscussionTo achieve a comprehensive understanding of the mechanism by which IPV severity is related to mental health it may be time to take an alternative approach to measuring IPV severity. No IPV measures assessed the acceptability of the content to people who have experienced IPV. This is an important omission with significant consequences for the validity of the evidence base.

The aim of this systematic review was to assess the magnitude of the association between types of intimate partner violence (IPV) and mental health outcomes and shed light on the large variation in IPV prevalence rates between low- to middle-income countries and high-income countries. The study is a systematic review and meta-analysis. The following databases were searched for this study: Cochrane, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Applied Social Sciences Index and Abstracts. The inclusion criteria for this study are as follows: quantitative studies published from 2012 to 2020 on IPV exposure in women aged 16+, using validated measures. Random effects meta-analyses and subgroup analysis exploring heterogeneity across population groups in different economic contexts are used in this study. In all, 201 studies were included with 250,599 women, primarily from high-income countries. Higher prevalence rates were reported for women’s lifetime IPV than past year IPV. Lifetime psychological violence was the most prevalent form of IPV. Women in the community reported the highest prevalence for physical, psychological, and sexual violence in the past year compared to clinical groups. Perinatal women were most likely to have experienced lifetime physical IPV. Prevalence rates differed significantly ( p = .037 to <.001) for “any IPV” and all subtypes by income country level. Meta-analysis suggested increased odds for all mental health outcomes associated with IPV including depression (odds ratio [OR] = 2.04–3.14), posttraumatic stress disorder (PTSD) (OR = 2.15–2.66), and suicidality (OR = 2.17–5.52). Clinical and community populations were exposed to high prevalence of IPV and increased likelihood of depression, PTSD, and suicidality. Future research should seek to understand women’s perspectives on service/support responses to IPV to address their mental health needs. Work with IPV survivors should be carried out to develop bespoke services to reduce IPV in groups most at risk such as pregnant and/or help-seeking women.

Purpose Peer support is increasingly being introduced into mainstream mental health services internationally. The distinctiveness of peer support, compared to other mental health support, has been linked to values underpinning peer support. Evidence suggests that there are challenges to maintaining those values in the context of highly standardised organisational environments. The purpose of this paper is to describe a “principles-based” approach to developing and evaluating a new peer worker role in mental health services. Design/methodology/approach A set of peer support values was generated through systematic review of research about one-to-one peer support, and a second set produced by a UK National Expert Panel of people sharing, leading or researching peer support from a lived experience perspective. Value sets were integrated by the research team – including researchers working from a lived experience perspective – to produce a principles framework for developing and evaluating new peer worker roles. Findings Five principles referred in detail to: relationships based on shared lived experience; reciprocity and mutuality; validating experiential knowledge; leadership, choice and control; discovering strengths and making connections. Supporting the diversity of lived experience that people bring to peer support applied across principles. Research limitations/implications The principles framework underpinned development of a handbook for a new peer worker role, and informed a fidelity index designed to measure the extent to which peer support values are maintained in practice. Given the diversity of peer support, the authors caution against prescriptive frameworks that might “codify” peer support and note that lived experience should be central to shaping and leading evaluation of peer support. Originality/value This paper adds to the literature on peer support in mental health by describing a systematic approach to understanding how principles and values underpin peer worker roles in the context of mental health services. This paper informs an innovative, principles-based approach to developing a handbook and fidelity index for a randomised controlled trial. Lived experiences of mental distress brought to the research by members of the research team and the expert advisors shaped the way this research was undertaken.

BACKGROUND:This is the third in a series of papers on patient outcomes and other consequences of the withdrawal of specialist assertive outreach (AO) teams. We previously reported positive outcomes for patients receiving a less intensive service at up to four years, but had not systematically interviewed patients.AIMS:To test the generalizability of earlier findings through replication in another service. To complement the analysis of service utilisation with patient reported experience between the two treatment models.METHODS:Service level evaluation 12 months pre and post service change for 55 eligible AO patients. Thirty three consenting patients answered validated questionnaires.RESULTS:There were no statistically significant changes in hospital bed use comparing the year before and the year after the change (850-712 bed days, median 34-20). No significant change in crisis activity occurred despite a highly significant reduction in face to face contacts from a mean of 90-40. There were no significant changes in patient reported experience.CONCLUSIONS:Results are consistent with earlier studies. Reinforcing community mental health teams can provide an integrated service model that is clinically effective and equally acceptable to patients, making this a viable and affordable alternative to orthodox AO teams.

Background An original cohort study found that over half of the individuals detained under Section 136 (S136) of the Mental Health Act 1983 were discharged home after assessment, and nearly half were intoxicated. Aims To investigate whether the cohort was followed up by psychiatric services, characterise those repeatedly detained and assess whether substance use was related to these outcomes. Method Data were retrospectively collected from the notes of 242 individuals, who presented after S136 detention to a place of safety over a 6-month period, and were followed up for 1 year. Results After 1 year, 48% were in secondary care. Those with psychosis were the most likely to be admitted. Diagnoses of personality disorder or substance use were associated with multiple detentions; however, few were in contact with secondary services. Conclusions Crisis and long-term care pathways for these groups need to be developed to reduce repeated and unnecessary police detention.

BACKGROUND:The introduction of specialist Assertive Outreach (AO) teams has produced only modest differential findings from English studies compared to standard care. Providers have gradually closed AO services over the last 8 years. We previously studied outcomes at 12 months following the dismantling of two AO teams in London. We now report on the longer term outcomes for these patients.AIMS:To evaluate the longer term outcomes, activity and costs for patients receiving a less intensive service.METHODS:Observational service level evaluation of 112 patients comparing baseline of AO care with each year of routine care subsequent to the team closure.RESULTS:Patients transferred to standard teams reinforced with the Flexible Assertive Community Treatment (FACT) approach had significantly fewer admissions and bed days at each of the four subsequent years compared to baseline, offset by a significant rise in missed face-to-face appointments. There was no significant change in the use of crisis services. Predictably patients had significantly fewer contacts under standard care.CONCLUSIONS:AO patients are remarkably resilient to substantial reductions in the intensity of care. Reinforcing multi-disciplinary community mental health teams (CMHTs) with FACT appears to provide an integrated service that is clinically effective and an affordable alternative to orthodox AO teams.

Social functioning is as an important outcome in studies of people with schizophrenia. Most measures of social function include a person's ability to manage everyday activities as well as their abilities to engage in leisure and occupational activities. The Personal Social Performance (PSP) scale assesses functioning across four dimensions (socially useful activities, personal and social relationships, self-care, disturbing and aggressive behaviours) rather than one global score and thus has been reported to be easier to use. In a pan-European study of people with severe mental illness a team of 26 researchers received training in rating the scale, after which the inter-rater reliability (IRR) was assessed and found to be not sufficiently high. A brief survey of the researchers elicited information with which to explore the low IRR and their experience of using the PSP. Clinicians were found to have higher IRR, in particular, psychologists. Patients’ employment status was found to be the most important predictor of PSP. Researchers used multiple sources of information when rating the scale. Sufficient training is required to ensure IRR, particularly for non-clinical researchers, if the PSP is to be established as a reliable research tool.

BACKGROUND:Looked-after children (LAC) are at greater risk of teenage pregnancy than non-LAC, which is associated with adverse health and social consequences. Existing interventions have failed to reduce rates of teenage pregnancy in LAC. Peer mentoring is proposed as a means of addressing many of the factors associated with the increased risk of teenage pregnancy in this group.OBJECTIVE:To develop a peer mentoring intervention to reduce teenage pregnancy in LAC.DESIGN:Phase I and II randomised controlled trial of a peer mentoring intervention for LAC; scoping exercise and literature search; national surveys of social care professionals and LAC; and focus groups and interviews with social care professionals, mentors and mentees.SETTING:Three local authorities (LAs) in England.PARTICIPANTS:LAC aged 14-18 years (mentees/care as usual) and 19-25 years (mentors).INTERVENTION:Recruitment and training of mentors; randomisation and matching of mentors to mentees; and 1-year individual peer mentoring.MAIN OUTCOME MEASURES:PRIMARY OUTCOME:pregnancy in LAC aged 14-18 years.SECONDARY OUTCOMES:sexual attitudes, behaviour and knowledge; psychological health; help-seeking behaviour; locus of control; and attachment style. A health economic evaluation was also carried out.RESULTS:In total, 54% of target recruitment was reached for the exploratory trial and 13 out of 20 mentors (65%) and 19 out of 30 LAC aged 14-18 years (63%) (recruited during Phases I and II) were retained in the research. The training programme was acceptable and could be manualised and replicated. Recruitment and retention difficulties were attributed to systemic problems and LA lack of research infrastructure and lack of additional funding to support and sustain such an intervention. Mentees appeared to value the intervention but had difficulty in meeting weekly as required. Only one in four of the relationships continued for the full year. A future Phase III trial would require the intervention to be modified to include provision of group and individual peer mentoring; internal management of the project, with support from an external agency such as a charity or the voluntary sector; funds to cover LA research costs, including the appointment of a dedicated project co-ordinator; a reduction in the lower age for mentee recruitment and an increase in the mentor recruitment age to 21 years; and the introduction of a more formal recruitment and support structure for mentors.CONCLUSIONS:Given the problems identified and described in mounting this intervention, a new development phase followed by a small-scale exploratory trial incorporating these changes would be necessary before proceeding to a Phase III trial.FUNDING:This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 19, No. 85. See the NIHR Journals Library website for further project information.

OBJECTIVE:To identify the factors that promote and compromise the implementation of reasonably adjusted healthcare services for patients with intellectual disabilities in acute National Health Service (NHS) hospitals. DESIGN:A mixed-methods study involving interviews, questionnaires and participant observation (July 2011-March 2013). SETTING:Six acute NHS hospital trusts in England. METHODS:Reasonable adjustments for people with intellectual disabilities were identified through the literature. Data were collected on implementation and staff understanding of these adjustments. RESULTS:Data collected included staff questionnaires (n=990), staff interviews (n=68), interviews with adults with intellectual disabilities (n=33), questionnaires (n=88) and interviews (n=37) with carers of patients with intellectual disabilities, and expert panel discussions (n=42). Hospital strategies that supported implementation of reasonable adjustments did not reliably translate into consistent provision of such adjustments. Good practice often depended on the knowledge, understanding and flexibility of individual staff and teams, leading to the delivery of reasonable adjustments being haphazard throughout the organisation. Major barriers included: lack of effective systems for identifying and flagging patients with intellectual disabilities, lack of staff understanding of the reasonable adjustments that may be needed, lack of clear lines of responsibility and accountability for implementing reasonable adjustments, and lack of allocation of additional funding and resources. Key enablers were the Intellectual Disability Liaison Nurse and the ward manager. CONCLUSIONS:The evidence suggests that ward culture, staff attitudes and staff knowledge are crucial in ensuring that hospital services are accessible to vulnerable patients. The authors suggest that flagging the need for specific reasonable adjustments, rather than the vulnerable condition itself, may address some of the barriers. Further research is recommended that describes and quantifies the most frequently needed reasonable adjustments within the hospital pathways of vulnerable patient groups, and the most effective organisational infrastructure required to guarantee their use, together with resource implications.