Impact on staff attitudes of brief personality disorder training for acute psychiatric wards

Purpose Negative attitudes towards “personality disorder” are common among mental health professionals. This study aims to design a psychoeducational training targeting attitudes to “personality disorder” for staff working in a London psychiatric hospital. Its impact on staff attitudes was evaluated. Design/methodology/approach Mental health clinicians were recruited from five acute psychiatric wards. Feasibility of implementing the training was measured. A free-association exercise explored baseline attitudes to “personality disorder” and visual analogue scales assessed staff attitudes pre- and post-training. Content analysis of staff feedback was carried out. Findings Psychoeducational training was found to be feasible, well-attended and highly valued by ward staff (N = 47). Baseline results revealed negative perceptions of “personality disorder”. Post-training, significant improvements in understanding, levels of compassion and attitudes to working with service users with a diagnosis of a “personality disorder” were observed. Staff feedback highlighted desire for further training and support. Research limitations/implications The sample size was relatively small and there was no control group, so findings should be interpreted with caution. Practical implications The findings highlight the need for support for staff working with service users with diagnoses of “personality disorder” on acute psychiatric wards. Providing regular training with interactive components may promote training as a resource for staff well-being. Planning to ensure service users’ and carers’ views are incorporated into the design of future training will be important. Originality/value This study is innovative in that it investigates the impact of a brief psychoeducational training on “personality disorder” designed for mental health staff on acute psychiatric wards.

Emotions in our lives: the evaluation of a user-centered training course »living e-Motions« in the context of recovery of people with mental health challenges

Purpose This paper aims to evaluate the feasibility and effectiveness of a training course »Living e-Motions« for people living with mental health challenges in the context of their recovery. The course was developed in the joint project of partners from Spain, Estonia, Slovenia and the UK. The curriculum of the course is focused on emotional education. It uses a narrative approach as a practical way for participants to explore and regulate their emotions and consequently take charge of their recovery. Design/methodology/approach Seventeen participants were included in the pilot training in Spain and Estonia. Impact of the training was assessed on measures of life satisfaction, emotion regulation, positive and negative affect and recovery at baseline and directly after training. Findings The analysis revealed that participants reported higher life satisfaction, emotion regulation skills, positive affect and recovery after the training. However, because of the small sample size, the mean differences did not reach statistical significance. Further studies on larger samples are needed to test the effectiveness of the training course. Practical implications Pilot study findings are encouraging and show that the developed training course has a potential for improving key competencies and abilities needed in daily life, concretely in emotion regulation, positive and negative affect, life satisfaction and recovery. Originality/value This paper presents a novel training course that uses a narrative approach and focuses on recovery and improvement of key competencies and abilities of individuals with mental health issues.

Predicting treatment outcomes in improving access to psychological therapy (IAPT) services

Purpose Given the considerable variation in treatment effectiveness observed across Improving Access to Psychological Therapy (IAPT) services, the purpose of this study is to explore client- and service-related variables that predict successful treatment outcomes and clients’ dropout. Clinician-rated clients’ motivation to change was also explored as a potential predictor for both outcome variables. Design/methodology/approach A convenience sample of 1,135 (F = 752; Mage = 39.4) was collected from three IAPT services in the North West of England. The study adopts a quasi-experimental, observational design. The analysis involves the description of patients’ socio-demographic and clinical characteristics and the development of three outcome prediction models, using hierarchical logistic regression. Findings After adjusting for confounders, employment status and motivation to change as rated by clinicians were predictive of both recovery and reliable improvement. The higher number of IAPT re-referrals was negatively associated with recovery and positively with dropouts. Clients who indicated low motivation to change and received low intensity treatment at their last session presented a higher likelihood to dropout. Research limitations/implications Given that the evaluation of clients’ motivation to change was solely reliant on clinical judgement, as no validated measure was used, further robust research is recommended to draw sensible conclusions. Originality/value This is the first study evaluating clinician-rated motivation to change as a significant predictor of treatment outcomes and dropouts within the IAPT setting. Further research implications are discussed.

Rewiring practice: community mental health professionals’ attitudes towards and knowledge of electroconvulsive therapy in the context of advance decision-making

Purpose In England, electroconvulsive therapy (ECT) cannot be administered to service users who make an advance decision to refuse the treatment, unless in life-threatening circumstances. In a sector where person-centred practice is revered, no prior research has investigated whether community mental health practitioners (CMHPs) encourage service users to make advance decisions about ECT. This study aims to explore whether CMHPs have supported advance decision-making about ECT and whether their profession, attitudes towards and knowledge of the treatment affect this. Design/methodology/approach A quantitative online survey was completed by n = 120 CMHPs (nurses, social workers and occupational therapists). The validated Questionnaire on Attitudes and Knowledge of ECT was used. Findings In total, 93% of participants knew service users who had undergone ECT, yet only 12% had supported a service user to make an advance decision about ECT. Compared to those who had not supported advance decision-making, those who had shown significantly higher knowledge and a more positive attitude. Nurses and those who had worked in the mental health field for over 10 years had significantly higher knowledge of ECT. Originality/value CMHPs are well placed to support advance decision-making about ECT. Increased knowledge about advance decisions and ECT may bolster the uptake of advance decision-making, thus greater training is recommended.

A qualitative study of the label of personality disorder from the perspectives of people with lived experience and occupational experience

Purpose The label “Personality Disorder” continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by critical practitioners and academics are tempered by acknowledgement of certain positive social consequences of obtaining a diagnosis. This study aims to engage service users and staff in a process of inquiry to better understand the complexities of views on the terminology of Personality Disorder. Design/methodology/approach This study set out to qualitatively explore the views of a range of people with lived, occupational and dual lived experience/occupational expertise, relating to the diagnostic label of Personality Disorder, via participatory and critical group debate. The World Café approach is an innovative methodology for participatory inquiry into subjective views suited to exploring the contested subject matter. Findings This study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words “personality” and “disorder” are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered. Research limitations/implications The findings have the potential to contribute to the ongoing critical debate regarding the value of the Personality Disorder construct in the provision of care and support. Specific emphasis upon the relational framing of care provision offers a means to ameliorate some of the negative impacts of terminology. Perspectives are influenced in the way the label is understood, hence, attention is required to enhance these processes in clinical practice. There is much more study required to overcome stigmatisation, prejudice, and lack of knowledge and understanding. Further research identifying means for challenging stigma and the factors contributing to positive clinical interactions are required. Originality/value This study brings together a wide range of views and experiences of mental health professionals, individuals lived experiences and those who align to both lived and occupational expertise. A safe space was provided via the uniquely co-produced World Café research event to bring together discussion and debates from mixed perspectives makes this a novel study. The focus being on perspectives towards contested language, labelling and social impact adds to scholarship in this field.

Helping with the pressures of the past: service-user perspectives of the sensory approaches within the National High Secure Healthcare Service for Women

Purpose This paper aims to explore service-user perspectives of sensory approaches introduced and promoted by the trauma and self-injury service within the National High Secure Healthcare Service for Women (NHSHSW) at Rampton Hospital. Design/methodology/approach This cross-sectional descriptive study used a semi-structured questionnaire, which was devised for this evaluation and included both open and closed questions. The data collected were then analysed using descriptive statistics and thematic analysis. Findings The paper evaluates the current use of sensory approaches within the NHSHSW. Sensory approaches were widely used across the service, with essential oils being the most commonly used sensory approach. The use of sensory approaches can be understood according to the following three themes: independence, accessibility and self-regulation. The self-regulation theme contained three sub-themes as follows: safety-seeking, relaxation and reducing distress. The evaluation also highlighted barriers to using sensory approaches and sought service-user feedback as to how these may be overcome. Practical implications Participants’ feedback informed changes to practice, such as introducing sensory approaches to service-users earlier in their care pathway and increasing the accessibility of sensory items. These approaches may be of relevance to service provision in other forensic or inpatient settings. Originality/value This paper offers a unique contribution to the current literature with its focus on using sensory approaches to ameliorate trauma symptoms, in the context of a forensic setting.

Preventing unnecessary referrals into specialist mental health services: an interrupted time-series evaluation of a new primary care-linked mental health service

Purpose Many patients referred by their GP for an assessment by secondary mental health services are unlikely to ever meet eligibility thresholds for specialist treatment and support. A new service was developed to support people in primary care. “the authors evaluate” whether the phased introduction of the Lambeth Living Well Network (LWN) Hub to a population in south London led to: a reduction in the overall volume of patients referred from primary care for a secondary mental health care assessment; and an increase in the proportion of patients referred who met specialist service eligibility criteria, as indicated by the likelihood of being accepted in secondary care. Design/methodology/approach The evaluation applied a quasi-experimental interrupted time series design using electronic patient records data for a National Health Service (NHS) provider of secondary mental health services in south London. Findings Scale-up of the Hub to the whole of the population of Lambeth led to an average of 98 fewer secondary care assessments per month (95% CI −118 to −78) compared to an average of 203 assessments per month estimated in the absence of the Hub; and an absolute incremental increase in the probability of acceptance for specialist intervention of 0.20 (95% CI; 0.14 to 0.27) above an average probability of acceptance of 0.57 in the absence of the Hub. Research limitations/implications Mental health outcomes for people using the service and system wide-service impacts were not evaluated preventing a more holistic evaluation of the effectiveness and cost-effectiveness of the LWN Hub. Practical implications Providing general practitioners with access to service infrastructure designed to help people whose needs cannot be managed within specialist mental health services can prevent unnecessary referrals into secondary care assessment teams. Social implications Reducing unnecessary referrals through provision of a primary-care linked mental health service will reduce delay in access to professional support that can address specific mental-health related needs that could not be offered within the secondary care services and could prevent the escalation of problems. Originality/value The authors use NHS data to facilitate the novel application of a quasi-experimental methodology to deliver new evidence on whether an innovative primary care linked mental health service was effective in delivering on one of its key aims.

A feasibility study of a novel work-focused relational group CBT treatment programme for moderate to severe recurrent depression

Purpose No current psychotherapeutic intervention is designed to enhance job retention in employees with moderate–severe recurrent depression. The aim of this study is to test the feasibility of a new, interdisciplinary work-focused relational group cognitive behavioural therapy (CBT) treatment programme for moderate–severe depression. Design/methodology/approach The programme was based on a theoretical integration of occupational stress, psychological, social/interpersonal and bio-medical theories. It consisted of up to four 1:1 psychotherapy sessions; 12 work-focused, full-day, weekly CBT sessions facilitated by a cognitive behavioural therapist and occupational therapist; and up to four optional 1:1 sessions with an occupational therapist. Depression severity (primary outcome) and a range of secondary outcomes were assessed before (first CBT session) and after (twelfth CBT session) therapy using validated instruments. Findings Eight women (26–49 years) with moderate–severe depression participated. Five were on antidepressant medication. While there was no statistically significant change in Hamilton Depression Rating Scale depression scores after therapy (n = 5; p = 0.313), Beck Depression Inventory-II depression scores significantly decreased after therapy (n = 8; –20.0 median change, p = 0.016; 6/8 responses, 7/8 minimal clinically important differences, two remissions). There were significant improvements in the secondary outcomes of overall psychological distress, coping self-efficacy, health-related quality of life and interpersonal difficulties after therapy. All clients in work at the start of therapy remained in work at the end of therapy. The intervention was safe and had 100% retention. Research limitations/implications A major limitation was recruitment shortfall, resulting in a small sample of middle-aged women, which reduces representativeness and increases the possibility of methodological weaknesses in terms of the statistical analysis. A definitive trial would need much larger samples to improve statistical power and increase confidence in the findings. Another major limitation was that two of the authors were involved in delivering the intervention such that its generalisability is uncertain. Practical implications This novel programme was evaluated and implemented in the real world of clinical practice. It showed promising immediate positive outcomes in terms of depressive symptoms, interpersonal difficulties and job retention that warrant further exploration in a longer-term definitive study. Social implications Empirical studies focused on enhancing job retention in employees with moderate–severe recurrent depression are lacking, so this study was highly relevant to a potentially marginalised community. Originality/value While limited by a recruitment shortfall, missing data and client heterogeneity, this study showed promising immediate positive outcomes for the new programme in terms of depressive symptoms, interpersonal difficulties and job retention that warrant exploration in a definitive study.

From prevention to peer support: a systematic review exploring the involvement of lived-experience in eating disorder interventions

Purpose The current policy landscape advocates for the involvement of people with lived experience in the co-production and co-delivery of mental health services. However, evidence on how to do this safely and effectively for people with eating disorders (EDs) is lacking. The purpose of this study was to explore and synthesis the implementation of ED interventions which involved lived-experience and to evaluate the associated benefits and risks to participants. Design/methodology/approach This study will conduct a systematic review of ED interventions which involve people with lived experience of an ED. A total of seven databases and four subject-specific journals were searched using Boolean search terms. Findings The search yielded ten eligible studies. Involvement procedures were extracted which highlighted variation with some roles being continuous and active and others being isolated and passive. Qualitative results were extracted and thematically analysed which demonstrated many benefits from involving people with lived experience, such as normalisation of experiences, inspiration to recover and the sharing of insight, as well as some risks such as disingenuity and exposure to triggering content. Practical implications The implications of this review highlight the need for policy and guidance to minimise variation across procedures and implementation of co-production to ensure positive outcomes and benefits for participants, given the current landscape. More research in the benefits and risks for those involved in the delivery of the interventions is needed to ensure that co-production and peer support is delivered as safely and effectively as possible. Originality/value This was the first systematic review since 2016 (Fogarty et al., 2016) to assess peer-mentorship programmes in ED treatments, whilst expanding the remit to include wider definitions of peer-support and peer-mentorships such as co-production and co-design in research.

An evaluation of the Stratford multiagency, multidisciplinary, assessment clinic

Purpose This study aims to assess a novel clinic whereby new patients were discussed in a multi-agency, multi-disciplinary panel and given feedback on the same day. The objectives were to determine the impacts on time to commencing treatment, need for further assessment, discharges and staff and patient experiences. Design/methodology/approach Outcomes from the new assessment clinic were compared to previous individual assessments. Feedback questionnaires were given to patients, while a focus group was conducted with staff. Findings There was a significant reduction in the time to agreeing a treatment plan (34 days to <1 day), the need for further assessment (61%–23.2%) and a significant increase in the proportion discharged from secondary care (26.9%–49.8%). Clinician and patient feedback on the clinic was positive. Practical implications The model of a multi-agency, multi-disciplinary clinic could be used for assessing new referrals to community mental health teams. Originality/value The use of a multi-agency, multi-disciplinary clinic is a novel approach within community mental health teams which led to improvements in efficiency, while demonstrating positive patient and clinician feedback.