Staff views on formulations in community mental health services: a discursive analysis

The aim of this research was to understand staff views and experiences of using psychological formulations in mental health services. A systematic review was conducted utilising a Thematic Synthesis to combine findings from qualitative studies on staff experiences of participating in team formulations. The review also aimed to provide a quality appraisal of the included research using the Critical Appraisal Skills Programme qualitative checklist. The review examined 16 qualitative papers which were of a mixed quality and in some instances there was an insufficient amount of detail to complete an accurate assessment. The review highlighted the importance of team formulation in general practice for enhancing staff understanding of service users but also improving professional confidence and validation. The review also highlighted some barriers to staff practicing team formulation. An empirical study was conducted to further identify discourses of community mental health staff regarding psychological formulation in their everyday practice. Focus groups were completed with staff in three different multidisciplinary community mental health teams, with the discussions subsequently analysed using a critical discourse informed approach. Discourse topics were identified relating to the importance of storytelling, the role of power and hierarchy, trauma and exclusion of the individual and staff struggles, burnout and constraints. Four overlapping major discourses were found in the research, with the study highlighting the positive impacts that formulation can have on staff but emphasising the role of power in mental health settings. The findings from both studies were critically discussed and evaluated

A systematic review of team formulations in multidisciplinary teams: staff views and opinions

Background: Formulation and working psychologically with teams is considered a fundamental part of the role of a clinical psychologist. Quantitative studies have found staff find team formulations a positive, useful experience. Aims: This review aims to utilize a Thematic Synthesis to combine qualitative studies on staff experiences of participating in team formulations and explore what benefits staff perceive from the process. The review also aims to provide a thorough quality appraisal of the included research. Method: A Thematic Synthesis was completed on qualitative studies which met the required inclusion criteria. The Critical Appraisal Skills Programme qualitative checklist was used to appraise the included research. Results: The studies included in the review were of a mixed quality, and in some instances there was an insufficient amount of detail to complete an accurate assessment. Overall, seven themes were identified across the studies. Conclusions: The current review highlights the importance of team formulation in general practice for both enhancing staff understanding of service users but also improving professional confidence and validation. The review also highlighted some of the barriers to staff practicing team formulations

The prevalence of common and stress-related mental health disorders in healthcare workers based in pandemic-affected hospitals: a rapid systematic review and meta-analysis

Background : Healthcare workers (HCWs) are considered at elevated risk of experiencing mental health disorders in working with patients with COVID-19. Objective : To estimate the prevalence of common mental health disorders in HCWs based in hospitals where pandemic-affected patients were treated. Method : Databases were searched for studies published before 30 March 2020. Quantitative synthesis was used to obtain estimates of the prevalence of mental health disorders in four time windows, determined a priori (the acute phase, i.e. during and up to 1.5 months post-pandemic; 1.5–5.9 months; 6–11.9 months; 12 months and later). Results : Nineteen studies met the review criteria. They predominantly addressed the acute phase of the SARS outbreak in Asia. The most studied outcomes were clinically significant post-traumatic stress symptoms (PTSS) and general psychiatric caseness. For clinically significant PTSS in the acute phase, the prevalence estimate was 23.4% (95% CI 16.3, 31.2; N = 4147; I2 = 96.2%); in the 12 months plus window, the estimate was 11.9% (8.4, 15.8; N = 1136; I2 = 74.3%). For general psychiatric caseness, prevalence estimates were acute phase, 34.1% (18.7, 51.4; N = 3971; I2 = 99.1%); 6–12 months, 17.9% (13.1, 23.2; N = 223; I2 = 0.0%); 12 months plus, 29.3% (6.0, 61.0; N = 710; I2 = 97.8%). No differences between doctors and nurses with respective to PTSS and general psychiatric caseness were apparent in the acute phase. Conclusions : Mental health disorders are particularly common in HCWs working with pandemic-afflicted patients immediately following a pandemic, but the course of disorders following this period is poorly understood. There was considerable heterogeneity between studies, likely linked to methodological differences. More extended follow up of HCWs is needed

ECLAIRE third periodic report

The ÉCLAIRE project (Effects of Climate Change on Air Pollution Impacts and Response Strategies for European Ecosystems) is a four year (2011-2015) project funded by the EU's Seventh Framework Programme for Research and Technological Development (FP7)

ECLAIRE: Effects of Climate Change on Air Pollution Impacts and Response Strategies for European Ecosystems. Project final report

The central goal of ECLAIRE is to assess how climate change will alter the extent to which air pollutants threaten terrestrial ecosystems. Particular attention has been given to nitrogen compounds, especially nitrogen oxides (NOx) and ammonia (NH3), as well as Biogenic Volatile Organic Compounds (BVOCs) in relation to tropospheric ozone (O3) formation, including their interactions with aerosol components. ECLAIRE has combined a broad program of field and laboratory experimentation and modelling of pollution fluxes and ecosystem impacts, advancing both mechanistic understanding and providing support to European policy makers. The central finding of ECLAIRE is that future climate change is expected to worsen the threat of air pollutants on Europe’s ecosystems. Firstly, climate warming is expected to increase the emissions of many trace gases, such as agricultural NH3, the soil component of NOx emissions and key BVOCs. Experimental data and numerical models show how these effects will tend to increase atmospheric N deposition in future. By contrast, the net effect on tropospheric O3 is less clear. This is because parallel increases in atmospheric CO2 concentrations will offset the temperature-driven increase for some BVOCs, such as isoprene. By contrast, there is currently insufficient evidence to be confident that CO2 will offset anticipated climate increases in monoterpene emissions. Secondly, climate warming is found to be likely to increase the vulnerability of ecosystems towards air pollutant exposure or atmospheric deposition. Such effects may occur as a consequence of combined perturbation, as well as through specific interactions, such as between drought, O3, N and aerosol exposure. These combined effects of climate change are expected to offset part of the benefit of current emissions control policies. Unless decisive mitigation actions are taken, it is anticipated that ongoing climate warming will increase agricultural and other biogenic emissions, posing a challenge for national emissions ceilings and air quality objectives related to nitrogen and ozone pollution. The O3 effects will be further worsened if progress is not made to curb increases in methane (CH4) emissions in the northern hemisphere. Other key findings of ECLAIRE are that: 1) N deposition and O3 have adverse synergistic effects. Exposure to ambient O3 concentrations was shown to reduce the Nitrogen Use Efficiency of plants, both decreasing agricultural production and posing an increased risk of other forms of nitrogen pollution, such as nitrate leaching (NO3-) and the greenhouse gas nitrous oxide (N2O); 2) within-canopy dynamics for volatile aerosol can increase dry deposition and shorten atmospheric lifetimes; 3) ambient aerosol levels reduce the ability of plants to conserve water under drought conditions; 4) low-resolution mapping studies tend to underestimate the extent of local critical loads exceedance; 5) new dose-response functions can be used to improve the assessment of costs, including estimation of the value of damage due to air pollution effects on ecosystems, 6) scenarios can be constructed that combine technical mitigation measures with dietary change options (reducing livestock products in food down to recommended levels for health criteria), with the balance between the two strategies being a matter for future societal discussion. ECLAIRE has supported the revision process for the National Emissions Ceilings Directive and will continue to deliver scientific underpinning into the future for the UNECE Convention on Long-range Transboundary Air Pollution