Low vision (LV) services are likely to become more in demand as the prevalence of vision impairment increases. Primary eye care clinicians represent a substantially underutilised resource for LV service provision and increasing their participation could considerably improve service capacity and accessibility. This study aimed to gain a comprehensive in-depth theory-based understanding of factors influencing participation of primary eye care clinicians in LV services to inform the evidence base for future behaviour change intervention design. Semi-structured one-to-one interviews using topic guides based on the capability, opportunity, motivation – behaviour (COM-B) system were conducted with a maximum variation sample of primary eye care clinicians and other relevant stakeholders. Thematic data analysis was undertaken; codes were inductively generated then mapped to domains of the theoretical domains framework (TDF) to generate themes and subthemes, which were mapped back to the COM-B system. A total of 31 individual interviews were conducted. Multiple TDF domain themes and subthemes were found to influence primary eye care clinicians’ participation in LV services, including knowledge (knowledge gaps); memory, attention and decision processes (case identification); social influences (professional support and influences, clinician-patient relationships, interprofessional relationships); environmental context and resources (funding and commissioning, practice resources); intentions (passion); beliefs about consequences (LV outcome expectations); beliefs about capabilities (confidence); goals (profitability); professional role and identity (scope of practice); reinforcement (rewards) and emotion (enjoyment, clinician wellbeing). This is the first study to qualitatively explore factors influencing participation of primary eye care clinicians in LV services and to explicitly apply behaviour change theory to do so. It provides a novel, comprehensive, in-depth and theory-based understanding of influences on primary eye care clinicians’ participation in LV services. This evidence base is fundamental to designing successful theory-informed behaviour change interventions which aim to increase primary eye care clinicians’ participation and facilitate LV service expansion.

Importance:Hospital-based ophthalmology faces increasing demand for long-term monitoring of neovascular age-related macular degeneration (nAMD). Safe redistribution of routine monitoring to community clinicians is relevant to integrated community (primary)-secondary care models. Objective:To examine whether community optometrist-led monitoring of nAMD is noninferior to hospital-based monitoring for detecting disease activity requiring treatment. Design, Setting, and Participants:This multicenter, noninferiority randomized clinical trial was conducted from October 8, 2019, to January 31, 2024, at secondary centers (17 hospitals) and primary centers (60 community optometry practices) with 12-month follow-up. Statisticians were masked to patient grouping. Adults 55 years or older with quiescent AMD in at least 1 eye (and quiescent or nonneovascular disease in the other) were recruited at participating hospitals. Data analysis was performed from October 2024 to March 2025. Interventions:Participants were randomized 1:1 to monitoring sessions once every 2 months in hospitals (control) or community practices (intervention). Trained and accredited optometrists performed optical coherence tomography imaging, clinical examination, patient management, and online reporting at each visit. Main Outcomes and Measures:The primary outcome (participant level) was a binary indicator of whether a false-negative clinical management decision occurred at any visit within 12 months (missed quiescent nAMD reactivation or new fellow-eye nAMD, adjudicated by a central reading-center reference standard). The noninferiority margin was a 10-percentage point absolute risk difference. Secondary outcomes were false-positive clinical management decisions, attendance adherence, visual acuity change, harms, loss to follow-up, suspicious classifications, and confirmation visit outcomes. Results:Of 704 randomized participants, 635 (90.2%) completed at least 1 follow-up visit, including 287 at community practices (mean [SD] age, 80.6 [8.1] years; 236 [67.4%] female) and 348 at hospitals (mean [SD] age, 80.1 [8.5] years; 203 [57.3%] female). False-negative clinical management decisions occurred in 11 of 287 community participants (3.8%) vs 27 of 348 hospital participants (7.8%) (risk difference, -3.9 percentage points; 95% CI, -7.4 to -0.3 percentage points; P = .04; adjusted odds ratio, 0.51; 95% CI, 0.24-1.07; P = .08), meeting noninferiority. False-positive clinical management decisions occurred in 24 of 287 community participants (8.4%) vs 12 of 348 hospital participants (3.5%) (risk difference, 4.9 percentage points; 95% CI, 0.9-9.0 percentage points). Findings were consistent across per-protocol, cluster-adjusted, and relative risk sensitivity analyses. No adverse event-related withdrawals occurred. Conclusions and Relevance:In this randomized clinical trial, community optometrist-led monitoring of quiescent nAMD was noninferior to hospital monitoring for detecting disease activity requiring treatment. These results provide evidence for its use in integrated clinical care models. Trial Registration:ClinicalTrials.gov Identifier: NCT03893474.

QuestionIs community optometrist-led monitoring of quiescent neovascular age-related macular degeneration noninferior to hospital monitoring for identifying disease activity requiring treatment?FindingsIn this randomized clinical trial of 635 adults, false-negative clinical management decisions occurred in 3.8% in the community group and 7.8% in the hospital group for a difference of -3.9 percentage points, meeting the criterion for noninferiority.MeaningThis study's results support the use of community optometrist-led monitoring of quiescent neovascular age-related macular degeneration for detecting disease activity requiring treatment in integrated clinical care models. This randomized clinical trial examines whether community-based monitoring of neovascular age-related macular degeneration is noninferior to hospital monitoring for identifying disease activity requiring treatment. ImportanceHospital-based ophthalmology faces increasing demand for long-term monitoring of neovascular age-related macular degeneration (nAMD). Safe redistribution of routine monitoring to community clinicians is relevant to integrated community (primary)-secondary care models.ObjectiveTo examine whether community optometrist-led monitoring of nAMD is noninferior to hospital-based monitoring for detecting disease activity requiring treatment.Design, Setting, and ParticipantsThis multicenter, noninferiority randomized clinical trial was conducted from October 8, 2019, to January 31, 2024, at secondary centers (17 hospitals) and primary centers (60 community optometry practices) with 12-month follow-up. Statisticians were masked to patient grouping. Adults 55 years or older with quiescent AMD in at least 1 eye (and quiescent or nonneovascular disease in the other) were recruited at participating hospitals. Data analysis was performed from October 2024 to March 2025.InterventionsParticipants were randomized 1:1 to monitoring sessions once every 2 months in hospitals (control) or community practices (intervention). Trained and accredited optometrists performed optical coherence tomography imaging, clinical examination, patient management, and online reporting at each visit.Main Outcomes and MeasuresThe primary outcome (participant level) was a binary indicator of whether a false-negative clinical management decision occurred at any visit within 12 months (missed quiescent nAMD reactivation or new fellow-eye nAMD, adjudicated by a central reading-center reference standard). The noninferiority margin was a 10-percentage point absolute risk difference. Secondary outcomes were false-positive clinical management decisions, attendance adherence, visual acuity change, harms, loss to follow-up, suspicious classifications, and confirmation visit outcomes.ResultsOf 704 randomized participants, 635 (90.2%) completed at least 1 follow-up visit, including 287 at community practices (mean [SD] age, 80.6 [8.1] years; 236 [67.4%] female) and 348 at hospitals (mean [SD] age, 80.1 [8.5] years; 203 [57.3%] female). False-negative clinical management decisions occurred in 11 of 287 community participants (3.8%) vs 27 of 348 hospital participants (7.8%) (risk difference, -3.9 percentage points; 95% CI, -7.4 to -0.3 percentage points; P = .04; adjusted odds ratio, 0.51; 95% CI, 0.24-1.07; P = .08), meeting noninferiority. False-positive clinical management decisions occurred in 24 of 287 community participants (8.4%) vs 12 of 348 hospital participants (3.5%) (risk difference, 4.9 percentage points; 95% CI, 0.9-9.0 percentage points). Findings were consistent across per-protocol, cluster-adjusted, and relative risk sensitivity analyses. No adverse event-related withdrawals occurred.Conclusions and RelevanceIn this randomized clinical trial, community optometrist-led monitoring of quiescent nAMD was noninferior to hospital monitoring for detecting disease activity requiring treatment. These results provide evidence for its use in integrated clinical care models.Trial RegistrationClinicalTrials.gov Identifier: NCT03893474

Prevention is becoming ever more central in UK care policy for older people, though precisely what this entails, and how it works most effectively in social care and support, remains ambiguous. Set against the “newness” of recent social care legislation in Wales, this article explores the perspectives of professionals on prevention and community development, particularly for older people. This draws on qualitative data collected from 11 Welsh local authorities, four NHS Wales health boards, and eight regional third-sector organisations, incorporating 64 interviews with directors, executives, and senior managers. Recent research has highlighted concerns over the slipperiness of prevention as a concept, resulting in multiple interpretations and activities operating under its banner. Consistent with this, our data suggested a kaleidoscopic picture of variously named community-based initiatives working to support the intricate web of connections that sustain older people, as well as provide practical or material help. Similarly, professionals highlighted varied agendas of community resilience, individual independence, and reducing the need for state-funded health and social care, as well as a range of viewpoints on the roles of the state, private sector, and the third sector. Analysis revealed fragments of familiar themes in community development; positive hopes for community initiatives, tensions between the mixed agendas of state-instigated activities, and the practical challenges arising from systems imbued with neo-liberal ideas. Realising the promise of prevention will require deft steering through these challenges.

Recently there has been a chorus of demands to “re‐imagine” social care. Community and faith‐based organisations, policy, and academic communities are engaged in discussions on issues such as human rights for older populations, the future of residential care, how to better support family/community care, and strengthen local place‐based community development. Moreover, the Covid‐19 pandemic has added new urgency to this mission, galvanizing developments for change and collective action and exposing public troubles of endemic system failings, prevailing discourses of ageism, tensions with health systems, and limitations of market models of care and support. Prevention is a central social welfare principle in many countries. It is associated with policy and practices that aim to meet social care needs early and is explored in this thematic issue.

INTRODUCTION:The role of optometrists in glaucoma within primary and secondary care has been well described. Whilst many studies examined safety and clinical effectiveness, there is a paucity of qualitative research evaluating enablers and barriers for optometrists delivering glaucoma care. The aims of this study are to investigate qualitatively, and from a multi-stakeholder perspective whether optometric glaucoma care is accepted as an effective alternative to traditional models and what contextual factors impact upon their success.METHODS:Patients were recruited from clinics at Manchester Royal Eye Hospital and nationally via a Glaucoma UK registrant database. Optometrists, ophthalmologists, and other stakeholders involved in glaucoma services were recruited via direct contact and through an optometry educational event. Interviews and focus groups were recorded and transcribed anonymously, then analysed using the framework method and NVivo 12.RESULTS:Interviews and focus groups were conducted with 38 participants including 14 optometrists and 6 ophthalmologists (from all 4 UK nations), and 15 patients and 3 commissioners/other stakeholders. Themes emerging related to: enablers and drivers; challenges and barriers; training; laser; professional practice; the role of other health professionals; commissioning; COVID-19; and patient experience.CONCLUSION:Success in developing glaucoma services with optometrists and other health professionals is reliant on multi-stakeholder input, investment in technology and training, inter-professional respect and appropriate time and funding to set up and deliver services. The multi-stakeholder perspective affirms there is notable support for developing glaucoma services delivered by optometrists in primary and secondary care, with caveats around training, appropriate case selection and clinical responsibility.

Prevention is a core principle in social care legislation across the UK. However, history shows great variability in how a preventative social care agenda is conceptualised and implemented. We report findings from an independent evaluation of the implementation of the ‘2014 Social Services and Well-being (Wales) Act’ incorporating a document analysis of reports and plans from Wales’ twenty-two local authorities (LAs) and eighty-eight qualitative interviews from social services strategic leaders and operational managers within four Welsh LAs. Analysis highlighted multiple interpretations of national policy, with notable overlapping agendas. In Gramscian terms, there is a constant process of negotiating prevention values and agendas, with consequences for whose interests are served. This was apparent through drives towards cost-saving, financial sustainability and reduced service demand operating alongside values-based principles rooted in well-being and mutualism. Following Kenny’s work in community development, we argue a ‘fusing’ of principles whilst espousing benefits for service users, potentially blurs the aims of the legislation, with implications for practice.

The law is a particular framework that is crucial for shaping the aims and objectives as well as the responsibilities and structure of public services. Legal regulations influencing public services exist at the international, regional, national and subnational levels. This chapter explores the law in relation to public services. Starting with international institutions, such as the United Nations, it provides an introduction to major law-making bodies influencing public services at international and regional levels. Taking the United Kingdom as an example, this chapter furthermore explores the role and interaction of national, subnational and local laws.

Background Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that 'plasticity' of intervention components and 'elasticity' of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. Methods A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention's usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. Results Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components. Conclusions Flexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.

BACKGROUND:The role of glaucoma virtual clinics has developed to help meet demand for capacity within busy glaucoma services. There is limited research of patient and clinician experiences and perceptions of these clinics and the aim of this study is to provide further information to help improve patient experience and guide service delivery.METHODS:A mixed methods research design was employed comprising of a patient satisfaction survey, and patient and clinician interviews. Consultant ophthalmologists were recruited from throughout the UK, and patients and data gathering clinical staff recruited from the Manchester Royal Eye Hospital and Bristol Eye Hospital.RESULTS:We received a total of 148 patient satisfaction questionnaires with an overall response rate of 55.4%. Most respondents were diagnosed with primary open angle glaucoma (33.9%) at Manchester and glaucoma suspect status at Bristol (50.6%). Patients had high levels of confidence in the person conducting the tests (94.8% Manchester, 98.8% Bristol), and most were likely to recommend the service to family or friends (94.8% Manchester, 92.6% Bristol). We interviewed 10 consultant ophthalmologists, 10 data gathering staff and 20 patients. A number of key themes emerged from the transcribed interviews including: patient experience, clinician perception of patient experience, service delivery, staffing and staff experience, and patient safety.CONCLUSIONS:Glaucoma virtual clinics can be acceptable to both clinicians and patients, including those with a varied complexity of glaucoma and glaucoma-related disease. Dissatisfaction seemed to relate to poor communication or processes and systems within the service rather than complexity of disease.

Prevention has become increasingly central in social care policy and commissioning strategies within the United Kingdom (UK). Commonly there is reliance on understandings borrowed from the sphere of public health, leaning on a prevention discourse characterised by the 'upstream and downstream' metaphor. Whilst framing both structural factors and responses to individual circumstances, the public health approach nonetheless suggests linearity in a cause and effect relationship. Social care and illness follow many trajectories and this conceptualisation of prevention may limit its effectiveness and scope in social care. Undertaken as part of a commissioned evaluation of the Social Services and Wellbeing Act (2014) Wales, a systematic integrative review was conducted to establish the key current debates within prevention work, and how prevention is conceptually framed, implemented and evaluated within the social care context. The databases Scopus, ASSIA, CINAHL and Social Care Online were initially searched in September 2019 resulting in 52 documents being incorporated for analysis. A further re-run of searches was run in March 2021, identifying a further 14 documents, thereby creating a total of 66. Predominantly, these were journal articles or research reports (n = 53), with the remainder guidance or strategy documents, briefings or process evaluations (n = 13). These were categorised by their primary theme and focus, as well as document format and research method before undergoing thematic analysis. This highlighted the continued prominence of three-tiered, linear public health narratives in the framing of prevention for social care, with prevention work often categorised and enacted with inconsistency. Common drivers for prevention activity continue to be cost reduction and reduced dependence on the care system in the future. Through exploring prevention for older people and caregivers, we argue for an approach to prevention aligning with the complexities of the social world surrounding it. Building on developments in complexity theory in social science and healthcare, we offer an alternative view of social care prevention guided by principles rooted in the everyday realities of communities, service users and caregivers.

PURPOSE:Describe the development, delivery, acceptability and evaluation of a modular training programme for community-based, non-medical practitioners monitoring patients with quiescent neovascular age related macular degeneration (QnAMD). Also, report on a qualitative process evaluation conducted during the pilot phase of a randomised control trial (the FENETRE Study) exploring patient and practitioner acceptability of community-based QnAMD care relative to hospital-based care. METHODS:Learning outcomes from The College of Optometrists' Medical Retina higher qualifications and the Royal College of Ophthalmologists' Common Clinical Competency Framework were used to develop a competency framework for QnAMD care. Training was delivered online, comprising six asynchronous lectures followed by two synchronous case-based discussion webinars, with an accredited assessment of 24 case vignettes. An anonymous evaluation survey was conducted with the first two FENETRE cohorts (n = 38). Separately, we undertook a qualitative process evaluation, sampling purposively in four hospitals and five community-based practices, interviewing nine patients and eight practitioners. RESULTS:Survey responses (n = 26) showed community optometrists were very satisfied (n = 12; 46%) or satisfied (n = 14; 54%) with the training; feedback reflected by qualitative process evaluation data. Overall, optometrists also felt either confident (n = 15; 58%) or very confident (n = 8; 31%) in conducting AMD monitoring appointments following training, a finding also corroborated by interview data from optometrists participating in the initial pilot phase roll-out. Optometrists identified patient convenience and alleviating pressures in hospital care as the primary reasons for acceptability of community pathways. Data from patients entering community practices suggested they largely found this at least as safe and convenient as hospital care, although some patients randomised to hospital care perceived that as safer. CONCLUSION:This pilot study has shown the development and implementation of a collaborative community monitoring model is feasible, with satisfaction from community optometrists for training and accreditation, and broad acceptance for the pathway by both patients and practitioners.

Background/aims Assess whether a new clinical pathway for glaucoma was acceptable to patients and healthcare professionals and whether it provided useful clinical information on non-responsiveness and non-adherence to the treatment of elevated intraocular pressure with latanoprost eye drops. Methods A single arm non-randomised prospective observational study incorporating new glaucoma/ocular hypertension patients. To assess issues of acceptability, qualitative observation and interviews were conducted with patients and healthcare professionals. To determine clinical responsiveness, intraocular pressures were measured before and 4 hours after a clinician-instilled eye drop over two distinct appointments. Adherence data were collected using a Medicine Event Monitoring System. Economic analyses compared the costs between novel and standard care pathways. Results Of 72 patients approached, 53 entered the study (74.3%) and 50 completed all procedures (94.3%). Intraocular pressure was reduced more than 15% in 83 out of 92 study eyes by final visit (90.2%). The non-response rate was 5.1% once the effect of low adherence was minimised. For the 1376 drop instillation days under observation, eye drops were instilled as prescribed on 1004 days (73.0%), over-instilled on 137 days (9.9%) and not instilled on 235 days (17.1%). The Cardiff Model of Glaucoma Care involved negligible cost, although acceptance for healthcare professionals showed variation. Conclusions The Cardiff Model of Glaucoma Care offers novel clinical and adherence insights at marginal costs while acceptable to patients. Healthcare professionals felt that 4 hour and 4 week follow-up appointments could cause administrative problems. A streamlined version of the pathway has therefore been developed to facilitate clinical adoption. Trial registration number ISRCTNID:ISRCTN75888393

Patient adherence to medication is an ongoing concern for clinicians, obfuscating treatment efficacy and resulting in wastage of medicine, reduced clinical benefit, and increased mortality. Despite this, procedural guidance on how clinicians should best engage patients regarding their medicine-taking is limited in the United Kingdom. Adherence for chronic conditions is notably complex, requiring clear education, communication, and behavioural shifts to initiate and sustain daily regimens successfully. This article explores current clinician guidance on assuring patient adherence to medication within the National Health Service, comparing it to that provided for healthcare workers in the field of behavioural change. Outlining the inertia of the former and the progress of the latter, we consider what steps should be taken to address this deficit, including greater focus on patient concerns, as well as knowledge translation for healthcare professionals in future adherence research. Current United Kingdom clinical guidance for assuring patient adherence is largely outdated based on inconclusive evidence for best practice. However, efforts to encourage behavioural change in the public health setting demonstrate evidence-based success. Integrating knowledge generated around adherence behaviour and the practical application of adherence and behavioural change research, as well as funding for longer-term studies with a focus on clinical outcomes, may help to solidify the NICE guidance on adherence and further progress the field. This would require close involvement from patient groups and networks informing ethical aspects of study design and clinical implementation.

Purpose “She wouldn’t remember. Even when I go through, and she’s decided to go to bed, I’ll say I’ll come and do her drops. If I didn’t say that, they wouldn’t be done.” Dementia is widely considered as a key factor in whether patients take their medication as prescribed. However, few studies have examined the effect of dementia on medication management strategies for glaucoma including how patient and carer needs impact adherence and long-term prognosis. We report findings from a qualitative grounded theory study incorporating the views of patients, carers, and healthcare professionals. Methods Eighty-three semistructured interviews were conducted with 35 patients, 22 lay carers, and nine healthcare professionals across sites in Wales and Scotland. These explored understanding of eye drop regimens, barriers, and facilitators to drop administration, as well as attitudes toward glaucoma, dementia, and other comorbidities. Results Using Pound’s synthesis of adherence behavior, we identified categories of active and passive acceptance of medicines, alongside modification or rejection of eye drop regimens. In relation to dementia, participants highlighted transitions between such categories, with a shift from active to passive acceptance commonly reported. This loss of self-medicating capability was referred to as the precipice of care, where entwinement of multiple conditions (eg, heart disease, glaucoma, and dementia) and sociocultural influences (eg, living alone) contributed to accelerated health declines. That said, numerous factors mitigated this, with a key role being the lay carer. Spouses and family members often acted as the monitor of eye drops for patients, seeking intervention when any behavioral changes influenced their administration. Conclusion Though dementia was associated with progression toward the precipice of care, factors such as communication with healthcare professionals appeared to affect patient adherence. Recommendations for healthcare practice include better recording of dementia diagnoses and integrating eye drops into preexisting routines.

Abstract Research effort into what a ‘good death’ entails has generally concentrated on six themes: pain and symptom management; clear decision-making; preparation for death; completion; contributing to others; and affirmation of the whole person. This review explores these themes, specifically examining their applicability to those who lack mental capacity to make their own decisions. Some appear more relevant than others, with clear decision-making and affirmation of personhood predicating issues related to reduced capacity. Largely, however, the literature on a ‘good death’ builds on an underlying assumption that the dying patient is cognisant and capable of rationalising their death. Those instances where mental capacity is acknowledged within the model have been met by criticism from numerous authors. Factors such as the subjectivity of substitute decision-makers and the complexity associated with medico-legal interpretations of current legislation help to highlight deficiencies in the application of principles of a ‘good death’ in practice. Further specific consideration is required on how to achieve a ‘good death’ for those with reduced capacity.

BACKGROUND:Hate crimes - those perpetrated because of perceived difference, including disability, race, religion, sexual orientation or transgender status - have not been studied at the point of the victim's hospital emergency department (ED) use.AIM:To investigate the frequency, levels of physical harm and circumstances of targeted violence in those seeking treatment at EDs in three UK cities.METHOD:In a multimethods study, face-to-face semi-structured interviews were conducted with 124 adult ED attenders with violent injuries. Victim and perpetrator socio-demographics were recorded. Patient narratives about perceived motives and circumstances were transcribed, uploaded onto NVivo for thematic analysis.RESULTS:Nearly a fifth (23, 18.5%) of the injured patients considered themselves to have been attacked by others motivated by hostility or prejudice to their 'difference' (targeted violence). Thematic analyses suggested these prejudices were to appearance (7 cases), racial tension (5 cases), territorial association (3 cases) and race, religious or sexual orientation (8 cases). According to victims, alcohol intoxication was particularly relevant in targeted violence (estimated reported frequency 90% and 56% for targeted and non-targeted violence, respectively).CONCLUSIONS:Our findings support a broader concept of hate victimisation and suggest that emergency room violence surveys could act as a community tension sensor and early warning system in this regard. Tackling alcohol misuse seems as important in this as in other forms of violence perpetration. Copyright © 2017 John Wiley & Sons, Ltd.

This article examines multidisciplinary public engagement projects that bring together developments in psychiatric research and practice with visual art and its use of metaphor. The article focuses on the art exhibition Translation: From Bench to Brain , which was the basis for further collaborations, illustrating how the learning from the original event influenced subsequent projects. Combining art exhibitions with online documentation and resources, the projects explored not only medical and scientific themes, but also the wider social, cultural and ethical ramifications, specifically aspects of identity, risk and stigma. The activities demonstrate the value of a developmental approach to public engagement as a process, whereby projects build on previous activities and evolving multidisciplinary perspectives, networks and expertise.