It is increasingly recognised that traditional models of mental health (MH) care, with a service transition at age 18 years, may not reflect best practice. The literature supports a move towards ...youth and young adult focused models of MH care, for young people up to the age of 25, which specifically cater to the unique psychosocial and developmental needs of this population. This service evaluation aimed to explore the facilitators and barriers to the implementation of youth models of MH care across England (UK).
Six services participated in separate focus groups pertaining to their experience of implementing youth models of MH care. The interview guide for the focus groups was informed by the Consolidated Framework for Implementation Research (CFIR) and explored barriers and facilitators to implementation and sustainment. The focus groups were recorded, transcribed verbatim and analysed thematically.
Seven key themes relevant to the implementation of youth models of MH care were identified: a clear rationale for doing things differently, for young people by young people, "building those relationships is key", service identity development, resource and infrastructure, leadership at multiple levels, and valuing and developing staff.
The findings suggest effective communication and leadership, co-production and cross system collaboration contribute to successful implementation of youth models of MH care. The findings will be of interest to those involved in informing and supporting successful implementation and delivery of youth models of mental health care at local and national levels.
Aim
Psychosis spectrum disorders continue to rank highly among causes of disability. This has resulted in efforts to expand the range of treatment targets beyond symptom remission to include other ...recovery markers, including social and occupational function and quality of life. Although the efficacy of psychosocial interventions in early psychosis has been widely reported, the acceptability of these interventions is less well‐known. This study explores the participant perspective on a novel, psychosocial intervention combining cognitive remediation and social recovery therapy.
Methods
We employed a qualitative research design, based on semi‐structured interviews and reflexive thematic analysis. Six participants with early psychosis were recruited from the intervention arm of a randomized pilot study, three women and three men, aged between 22 and 27 years.
Results
Four themes were developed through the analytical process, namely, (1) a solid therapeutic foundation, (2) multi‐directional flow of knowledge, (3) a tailored toolset, and (4) an individual pathway to recovery. Participants also provided pragmatic feedback about how to improve the delivery of the therapy assessments and intervention. Both the themes and pragmatic feedback are described.
Conclusions
People with early psychosis described the intervention as acceptable, engaging, helpful and person‐centred, suggesting its potential role in a multicomponent therapy model of early intervention in psychosis services. Participants in this study also highlight the importance of an individualized approach to therapy, the vital role of the therapeutic relationship and the ecological validity and value of adopting an assertive outreach delivery, providing therapy outside a conventional clinic setting.
Aims and method
In the context of increasing recognition of the role of nature in well-being, but limited evidence for specific patient groups, we describe a mixed-methods evaluation of a 10-week ...green care intervention (a woodland group) for 18- to 30-year-olds who had experienced a first episode of psychosis. Data were collected using the Questionnaire on the Process of Recovery (QPR), semi-structured service evaluation questionnaires, the NHS Friends and Family Test (FFT), and focus group analysis.
Results
All participants present at week 10 (
n
= 5) would recommend this group to others; 4/8 participants showed reliable improvement on QPR outcome measures. Thematic analysis identified themes of connection with nature and others, development of a sense of well-being and ‘peacefulness’ and new perspectives on psychotic experience.
Clinical implications
This small retrospective evaluation describes patient-reported benefits, feasibility and acceptability of green care interventions within early intervention in psychosis services (EIS).
Aims
Recognition of the essential role of nature-based activities for general wellbeing is expanding. Previous evaluation of nature-based activities has shown that those with greater mental health ...needs may benefit proportionally more compared to the general population. Currently, there is limited evidence of the benefits of green care for those with severe and enduring mental illness, including psychosis.
We aim to establish benefits and difficulties encountered during a 10-session green care programme for 18-30 year olds who have experienced first episode of psychosis (FEP) using a mixed methods approach.
Method
This was a service evaluation of the Woodland Group, run by Circle of Life Rediscovery (CLR) and commissioned by Sussex Partnership NHS Foundation Trust in Autumn 2019 for 10 half-day sessions. All participants were aged 18–30 years, referred from Early Intervention in Psychosis service and had experienced FEP. Patients were supported by EIS staff with a ratio of at least 3:1. Sessions consisted of a welcome and agenda setting, ice-breaking activity, core nature-based activity (such as roasting chestnuts, maintaining the woodland area) and a ‘sense meditation’.
Quantitative data for this evaluation were collected through routinely collected 15-item Questionnaire on the Process of Recovery (QPR), and a semi-structured intervention experience questionnaire. Qualitative data were collected via a focus group within the final session of the Woodlands Group. Thematic analysis was performed by the three co-authors.
Result
Session attendance ranged between 3-15. 4/8 patients showed reliable improvement on QPR outcome measures, 1 showed deterioration and 3 showed no change. Mean QPR scores showed modest increase from average 3.4 (week 1) to 3.8 (week 10). 100% of respondents would recommend this group to others. Thematic analysis identified themes of connection with nature and others, development of a sense of wellbeing and ‘peacefulness’ and new perspectives on psychotic experience.
Conclusion
This small, retrospective evaluation is the first to investigate green care interventions for young people experiencing FEP. Our results reflect the positive informal feedback from participants and supporting staff following attendance at the Woodlands Group. Limitations include small sample size, incomplete data, and reliance on patient-reported outcomes. These findings show promise for green care activities within EIS and represents a sustainable intervention in mental health care.
Many individuals with first-episode psychosis experience severe and persistent social disability despite receiving specialist early intervention. The SUPEREDEN3 trial assessed whether augmenting ...early intervention in psychosis services with Social Recovery Therapy (SRT) would lead to better social recovery.
A qualitative process evaluation was conducted to explore implementation and mechanisms of SRT impact from the perspective of SUPEREDEN3 participants.
A subsample of SUPEREDEN3 trial participants (
= 19) took part in semi-structured interviews, which were transcribed verbatim and analysed thematically. Trial participants were early intervention service users aged 16-35 years with severe and persistent social disability. Both SRT plus early intervention and early intervention alone arm participants were interviewed to facilitate better understanding of the context in which SRT was delivered and to aid identification of mechanisms specific to SRT.
The six themes identified were used to generate an explanatory model of SRT's enhancement of social recovery. Participant experiences highlight the importance of the therapist cultivating increased self-understanding and assertively encouraging clients to face feared situations in a way that is perceived as supportive, while managing ongoing symptoms. The sense of achievement generated by reaching targets linked to personally meaningful goals promotes increased self-agency, and generates hope and optimism.
The findings suggest potentially important processes through which social recovery was enhanced in this trial, which will be valuable in ensuring the benefits observed can be replicated. Participant accounts provide hope that, with the right support, even clients who have persistent symptoms and the most severe disability can make a good social recovery.
Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing ...care and providing targeted psychological or psychosocial intervention.
We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone.
A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation.
We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm.
We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
Abstract Background A number of risk and protective factors have been identified in association with the mental health of doctoral researchers (DRs). One consistent factor noted in the limited ...available literature is the role of the supervisor. This literature is largely quantitative though, meaning less is known about how DRs experience supervision and its impact on their mental health. Aim The aim of this study was to explore how DRs experience research supervision and its impact on their mental health and wellbeing using qualitative methods at scale. Materials and Methods We analysed the free‐text responses of 1783 UK‐based DRs collected as part of the nationwide U‐DOC survey. Results Using reflexive thematic analysis, we found two superordinate themes capturing how DRs perceive research supervision and its impact on their mental health: (1) supervision as a conduit and (2) supervision as a mirror. Discussion Broadly, these themes encapsulate how supervisors can directly trigger, exacerbate or protect against mental health problems in DRs, as well as supervision providing an opportunity for DRs to learn more about themselves and their mental health. Conclusion Our findings support the need for compulsory supervisor training on positive supervisory practices as well as understanding and responding compassionately to DRs with mental health difficulties.
High rates of postgraduate researchers (PGRs) terminate their studies early. This attrition can have detrimental personal consequences, and results in a loss of productivity, and research and ...innovation for the higher education sector and society as a whole. PGRs are vulnerable to the experience of mental health problems; a factor that appears to be increasing attrition amongst students in the UK. However, investigation of the determinants of problems with PGRs’ attendance and influencing intention to discontinue their studies is rare. Here, we consider the relative predictive validity of a set of putative predictors (mental health symptoms, demographic, occupational, psychological, social, and relational) of attendance behaviours (absenteeism, presenteeism, mental health-related intermission) and early attrition intention amongst UK PGRs. Depression, anxiety, and suicidality predicted attendance behaviours and greater attrition intention. Individual demographic and occupational factors predicted all outcomes. Psychological, social and relational factors had less predictive validity, although individual variables in these conceptual clusters did significantly predict some outcomes. Our results suggest that interventions to reduce high rates of mental health problems are likely to improve attendance behaviours, and reduce the extent to which PGRs intermit or consider ending their PhD studies for mental health-related reasons. Initiatives designed to improve supervisory relationships and reduce loneliness may also reduce absenteeism, intermission and attrition intention.
Hopefulness is arguably of central importance to the recovery of youth with major or complex youth depression, yet it is unclear how hopefulness can best be enhanced in treatment. A narrative ...synthesis of published and grey literature was combined with new insights from a youth lived-experience panel (N = 15), focusing on to what extent and how specific psychological therapies and standard mental health care scaffold hopefulness as applied to depression among 14–25-year-olds. Thirty-one studies of variable quality were included in this review; thirteen were qualitative, thirteen quantitative, and five used mixed methods. Hopefulness is an important active ingredient of psychotherapies and standard mental health care in youth depression. Evidence suggests talking and activity therapies have moderate to large effects on hopefulness and that hopefulness can be enhanced in standard mental health care. However, varying intervention effects suggest a marked degree of uncertainty. Hopefulness is best scaffolded by a positive relational environment in which there is support for identifying and pursuing personally valued goals and engaging in meaningful activity.
Animated (
https://www.youtube.com/watch?v=o4690PdTGec
) and graphical summaries (
https://doi.org/10.13140/RG.2.2.27024.84487
) are available.
PDF
