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  • 1
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    Online Resource
    ‘Modelling social exclusion in a diagnostically-mixed sample of people with severe mental illness’
    SAGE Publications ; 2022
    In:  International Journal of Social Psychiatry Vol. 68, No. 2 ( 2022-03), p. 420-428
    Details
    In: International Journal of Social Psychiatry, SAGE Publications, Vol. 68, No. 2 ( 2022-03), p. 420-428
    Abstract: Social inclusion is an important indicator of recovery in individuals with severe mental illness. The Social Inclusion Questionnaire User Experience (SInQUE) is a new measure of social inclusion for mental health service users which assesses five domains (consumption, production, access to services, social integration and civil engagement). It has good psychometric properties and is acceptable to service users and mental health professionals. It is not clear whether individuals with different diagnostic conditions experience a similar reduction in social inclusion. Aims: (1) Investigate whether current social inclusion differs between diagnostic groups (people with schizophrenia/other psychotic disorders, common mental disorder or personality disorder); (2) Identify factors associated with lower social inclusion; (3) Examine associations between social inclusion and stigma, quality of life and loneliness. Method: Mental health service users with psychotic disorder, personality disorder or common mental disorder, living in the community, completed the SInQUE, alongside other validated outcome measures. Multiple regression investigated associations. Results: About 192 service users (55% with psychotic disorder; 26% with common mental disorder; 19% with personality disorder). Current social inclusion did not vary according to diagnosis, except for the sub-domain of productivity, where individuals with personality disorder were more socially included than the other two groups. Lower social inclusion was associated with older age ( p = .008), lack of higher education ( p  〈  .001), more previous admissions ( p = .005), severity of current symptoms and greater experienced stigma ( p = .006) and anticipated stigma ( p = .035). Greater social inclusion was associated with better quality of life ( p  〈  .001) and less loneliness ( p  〈  .001). Conclusions: Barriers to social inclusion in individuals with severe mental health problems include factors related to the illness, such as symptom severity and external factors, such as stigma and discrimination. Social inclusion is a recovery goal and should be routinely assessed. Increasing people’s social inclusion benefits service users in terms of improved mental health, better quality of life and reduced loneliness.
    Type of Medium: Online Resource
    ISSN: 0020-7640 , 1741-2854
    URL: Article
    DOI: 10.1177/00207640211001893
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2066492-8
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  • 2
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    Self-management interventions for people with severe mental illness: systematic review and meta-analysis
    Royal College of Psychiatrists ; 2019
    In:  The British Journal of Psychiatry Vol. 214, No. 5 ( 2019-05), p. 260-268
    Details
    In: The British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 214, No. 5 ( 2019-05), p. 260-268
    Abstract: Self-management is intended to empower individuals in their recovery by providing the skills and confidence they need to take active steps in recognising and managing their own health problems. Evidence supports such interventions in a range of long-term physical health conditions, but a recent systematic synthesis is not available for people with severe mental health problems. Aims To evaluate the effectiveness of self-management interventions for adults with severe mental illness (SMI). Method A systematic review of randomised controlled trials was conducted. A meta-analysis of symptomatic, relapse, recovery, functioning and quality of life outcomes was conducted, using RevMan. Results A total of 37 trials were included with 5790 participants. From the meta-analysis, self-management interventions conferred benefits in terms of reducing symptoms and length of admission, and improving functioning and quality of life both at the end of treatment and at follow-up. Overall the effect size was small to medium. The evidence for self-management interventions on readmissions was mixed. However, self-management did have a significant effect compared with control on subjective measures of recovery such as hope and empowerment at follow-up, and self-rated recovery and self-efficacy at both time points. Conclusion There is evidence that the provision of self-management interventions alongside standard care improves outcomes for people with SMI. Self-management interventions should form part of the standard package of care provided to people with SMI and should be prioritised in guidelines: research on best methods of implementing such interventions in routine practice is needed. Declaration of interests None.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.2019.54
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2019
    detail.hit.zdb_id: 2021500-9
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  • 3
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    Authors' reply
    Royal College of Psychiatrists ; 2019
    In:  British Journal of Psychiatry Vol. 215, No. 2 ( 2019-08), p. 503-504
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 215, No. 2 ( 2019-08), p. 503-504
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.2019.145
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2019
    detail.hit.zdb_id: 2021500-9
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  • 4
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    In-patient and residential alternatives to standard acute psychiatric wards in England
    Royal College of Psychiatrists ; 2009
    In:  British Journal of Psychiatry Vol. 194, No. 5 ( 2009-05), p. 456-463
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 194, No. 5 ( 2009-05), p. 456-463
    Abstract: Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years. Aims Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations. Method National cross-sectional survey of alternatives to standard acute in-patient care. Results We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions. Conclusions Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.bp.108.051698
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2009
    detail.hit.zdb_id: 2021500-9
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  • 5
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    Where next with residential alternatives to admission?
    Royal College of Psychiatrists ; 2010
    In:  British Journal of Psychiatry Vol. 197, No. S53 ( 2010-08), p. s52-s54
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 197, No. S53 ( 2010-08), p. s52-s54
    Abstract: The quest for alternatives to traditional psychiatric wards has a long history but methodological difficulties have limited research into their benefits. Two UK studies suggest that community-based residential alternatives are valued by service users and may be cost-effective. Establishing and/or maintaining such services, where they function as an integrated component of local acute care pathways, is a justifiable decision. However, our findings do not provide compelling evidence that they should be seen as essential in every catchment area. Quality of therapeutic relationships appears central to service user experiences, and future research should explore how this may be improved in both hospital and community settings.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.bp.110.081125
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2010
    detail.hit.zdb_id: 2021500-9
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  • 6
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    Service users' experiences of residential alternatives to standard acute wards: qualitative study of similarities and differences
    Royal College of Psychiatrists ; 2010
    In:  British Journal of Psychiatry Vol. 197, No. S53 ( 2010-08), p. s26-s31
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 197, No. S53 ( 2010-08), p. s26-s31
    Abstract: Little is known about the preferences and experiences of people with mental illness in relation to residential alternatives to hospital. Aims To explore patients' subjective experiences of traditional hospital services and residential alternatives to hospital. Method In-depth interviews were conducted with 40 purposively selected patients in residential alternative services who had previously experienced hospital in-patient stays. Transcripts were coded and analysed for thematic content. Results Patients reported an overall preference for residential alternatives. These were identified as treating patients with lower levels of disturbance, being safer, having more freedom and decreased coercion, and having less paternalistic staff compared with traditional in-patient services. However, patients identified no substantial difference between their relationships with staff overall and the care provided between the two types of services. Conclusions For patients who have acute mental illness but lower levels of disturbance, residential alternatives offer a preferable environment to traditional hospital services: they minimise coercion and maximise freedom, safety and opportunities for peer support.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.bp.110.081075
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2010
    detail.hit.zdb_id: 2021500-9
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  • 7
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    A systematic review and meta-analysis of group peer support interventions for people experiencing mental health conditions
    Springer Science and Business Media LLC ; 2021
    In:  BMC Psychiatry Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Psychiatry, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Peer support is being integrated within mental health services to further the development of a recovery approach. However, the most effective models and formats of intervention delivery are unknown. We conducted this systematic review and meta-analysis to determine the effectiveness of peer support for improving outcomes for people with lived experience of mental health conditions, when delivered as group interventions. Methods Studies reporting randomised controlled trials of group peer support interventions for people experiencing mental health conditions were identified by searching MEDLINE, PsycINFO, Embase and Cochrane CENTRAL, from inception until July 12th 2019 and undertaking supplementary searches. Included studies were assessed for risk of bias and meta-analyses were conducted if three or more trials provided usable data. Results Eight trials met eligibility criteria, providing data from 2131 participants. Six trials had either high or unclear risk of bias. Interventions were categorised as mutual support groups, or peer support groups, sub-categorised as anti-stigma or self-management interventions. Meta-analyses were only possible for peer support groups and five outcomes. We found evidence that group peer support may make small improvements to overall recovery but not hope or empowerment individually, or to clinical symptoms. Evidence for effectiveness for outcomes which could not be meta-analysed was mixed. Conclusions Findings from the few eligible trials suggest group peer support interventions may be specifically effective for supporting personal recovery and have a limited impact on other outcomes, though there were some risks of bias to study findings. Interventions were heterogeneous and most social outcomes were absent in the literature, highlighting further limitations to the current evidence-base. There is insufficient evidence available from trials of group peer support torecommend the routine implementation of these interventions across mainstream mental health services at present. More high-quality trials of peer-developed, group peer support interventions are needed in order tomake firm conclusions about intervention effectiveness.
    Type of Medium: Online Resource
    ISSN: 1471-244X
    URL: Article
    DOI: 10.1186/s12888-021-03321-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2050438-X
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  • 8
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    Loneliness as a predictor of outcomes in mental disorders among people who have experienced a mental health crisis: a 4-month prospective study
    Springer Science and Business Media LLC ; 2020
    In:  BMC Psychiatry Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Psychiatry, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Loneliness has not until recently been a prominent focus in research on outcomes of mental illness. The aim of this study was to determine whether loneliness at baseline predicts poor outcomes at 4-month follow-up for individuals who have experienced mental health crises. The outcomes in this study included overall symptom severity, affective symptoms, self-rated recovery and health-related quality of life. Methods Our study reports a secondary analysis of data from a randomised controlled trial. The sample ( n  = 399) was taken from patients who received treatment from community crisis services. Respondents ( n  = 310) completed the follow-up measurement 4 months after baseline. Loneliness at baseline was assessed using an eight-item UCLA Loneliness Scale. The four mental health outcomes were measured at both baseline and follow-up. Two scales (or part thereof) assessed objective social isolation and neighbourhood social capital at baseline. Regression analyses were conducted to investigate longitudinal associations between loneliness at baseline and mental health outcomes at follow-up. Results Loneliness at baseline was associated with all four mental health outcomes at 4-month follow-up, adjusting for psychosocial, socio-demographic and clinical characteristics. A one-point higher loneliness score was associated with 0.74-point (95% CI 0.45, 1.02) and 0.34-point (95% CI 0.21, 0.47) increase in overall symptom severity score and affective symptoms score respectively, and with 1.08-point (95% CI -1.45, − 0.71) and 1.27-point (95% CI -1.79, − 0.75) decrease in self-rated recovery score and health-related quality of life score respectively. Loneliness was a better predictor of clinical outcomes than objective social isolation and social capital, even though the associations with clinical outcomes were reduced and no longer statistically significant following adjustment for their baseline values. A significant association with quality of life persisted after adjustment for its baseline score. Conclusions Greater loneliness at baseline predicted poorer health-related quality of life at follow-up. There were cross-sectional associations between loneliness and clinical outcomes, but their longitudinal relationship cannot be confirmed. Further research is needed to clearly establish their underpinning pathways. Reducing loneliness may be a promising target to improve recovery for mental health community crisis service users.
    Type of Medium: Online Resource
    ISSN: 1471-244X
    URL: Article
    DOI: 10.1186/s12888-020-02665-2
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2050438-X
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  • 9
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    Initiatives to shorten duration of untreated psychosis: systematic review
    Royal College of Psychiatrists ; 2011
    In:  British Journal of Psychiatry Vol. 198, No. 4 ( 2011-04), p. 256-263
    Details
    In: British Journal of Psychiatry, Royal College of Psychiatrists, Vol. 198, No. 4 ( 2011-04), p. 256-263
    Abstract: Long duration of untreated psychosis (DUP) is common and associated with poor outcomes. Strategies to enhance early detection of first-episode psychosis have been advocated. Aims To evaluate initiatives for early detection of psychosis. Method Systematic review of available evidence on the effectiveness of early detection initiatives to reduce the DUP. Results The review included 11 studies which evaluated 8 early detection initiatives. Evidence suggests that general practitioner education campaigns and dedicated early intervention services do not by themselves reduce DUP or generate more treated cases. Evidence for multifocus initiatives is mixed: intensive campaigns targeting the general public as well as relevant professionals may be needed. No studies evaluated initiatives targeting young people or professionals from non-health organisations. Conclusions How early detection can be achieved is not clear. Evidence is most promising for intensive public awareness campaigns: these require organisation and resourcing at a regional or national level. More good-quality studies are needed to address gaps in knowledge.
    Type of Medium: Online Resource
    ISSN: 0007-1250 , 1472-1465
    URL: Article
    DOI: 10.1192/bjp.bp.109.075622
    RVK:
    XA 10000
    Language: English
    Publisher: Royal College of Psychiatrists
    Publication Date: 2011
    detail.hit.zdb_id: 2021500-9
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  • 10
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    ‘Beyond places of safety’ – a qualitative study exploring the implementation of mental health crisis care innovations across England
    Springer Science and Business Media LLC ; 2023
    In:  BMC Health Services Research Vol. 23, No. 1 ( 2023-10-17)
    Details
    In: BMC Health Services Research, Springer Science and Business Media LLC, Vol. 23, No. 1 ( 2023-10-17)
    Abstract: Mental health acute and crisis care consumes a large share of mental health budgets internationally but is often experienced as unsatisfactory and difficult to access. As a result, there is an increasing move towards developing innovative community crisis services, to improve patient experience and relieve pressure on inpatient and emergency services. This study aims to understand what helps and hinders the implementation of innovative mental health crisis care projects in England. Methods Using a qualitative approach, 18 interviews were conducted with crisis care service managers exploring their experiences and views of the development and implementation of their service developed with support from an English national capital funding programme. A framework analysis was conducted informed by implementation science. Results Key facilitators to implementation of innovative crisis services included bottom-up development, service user involvement, strong collaborative working, and leadership and management buy-in. Key barriers that affected the projects implementation included the complexities of crisis care, workforce challenges and resourcing issues. Conclusion There is a recognised need to improve, update, and innovate current crisis care offers. Results from this study suggest that a range of models can help address the heterogenous needs of local populations and that new approaches can be implemented where they utilise a whole-systems approach, involving service users and relevant professional stakeholders beyond mental health services in planning and developing the service.
    Type of Medium: Online Resource
    ISSN: 1472-6963
    URL: Article
    DOI: 10.1186/s12913-023-10058-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2050434-2
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