Social inclusion for young people with and without psychosis: the importance of internal and external factors

Psychosis most commonly first occurs during adolescence or early adulthood, disrupting the social and occupational transitions characterising this time. Studies on social and occupational outcomes in psychosis have tended to focus on observer-rated, dysfunction-based outcomes. However, mental health services are increasingly adopting a personal recovery model; focusing on facilitating hopeful and individually meaningful lives. Social inclusion is paramount to personal recovery but there is a need for greater awareness of the processes by which mental health services facilitate social inclusion for young people with psychosis. Cognitive models and research with longterm psychosis service users suggests that negative self-beliefs contribute to poorer social outcomes in psychosis, whereas personal recovery models emphasise the role of hopefulness and therapeutic relationships with optimistic mental health professionals. This thesis first investigates a structural model of social inclusion and its association with hope and negative self-beliefs for healthy young people (n= 387). Then the processes by which young service users’ self-beliefs, therapeutic relationships and professionals’ beliefs influence social inclusion are explored using directed path models (n= 51). Directed path models then test how professional characteristics, focusing on attachment styles and job attitudes, facilitate therapeutic relationships (n= 61). Finally, the contributions of self-beliefs, therapeutic relationships, professional beliefs and social inclusion in predicting vocational outcomes are explored (n= 51). Current findings support the relative importance of hopefulness over negative selfbeliefs in social inclusion for young people with and without psychosis. Hope appears particularly important for adolescents compared to young adults. Positive relationships with optimistic professionals predict service users’ hopefulness, social inclusion and vocational activity. Findings suggest that professionals’ own attachment style and job attitudes may aid in positive therapeutic relationship formation. These findings encourage a greater focus on therapeutic relationships and service users’ hopefulness in youth psychosis service provision. Professional training should encourage greater awareness of professionals’ own attachment style and job attitudes, and how these factors impact on positive therapeutic relationship developmen

Is doing a PhD bad for your mental health?

Poor mental health amongst PhD researchers is increasingly being recognised as an issue within higher education institutions. However, there continues to be unanswered questions relating to the propensity and causality of poor mental health amongst PhD researchers. Reporting on a new comparative survey of PhD researchers and their peers from different professions, Dr Cassie M Hazell and Dr Clio Berry find that PhD researchers are particularly vulnerable to poor mental health compared to their peers. Arguing against an inherent and individualised link between PhD research and mental health, they suggest institutions have a significant role to play in reviewing cultures and working environments that contribute to the risk of poor mental health

Working in the woodlands: a mixed methods evaluation of Green Care in first episode psychosis

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

Increasing access to CBT for psychosis patients: a feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2)

Background: The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (clinical psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of assistant psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised controlled trial (RCT). Methods: This is a feasibility study for a pragmatic, three-arm, parallel-group, superiority 1:1:1 RCT comparing a Guided self-help CBT intervention for voices and treatment as usual (GiVE) to Supportive Counselling and treatment as usual (SC) to treatment as usual alone (TAU), recruiting across two sites, with blinded post-treatment and follow-up assessments. A process evaluation will quantitatively and qualitatively explore stakeholder experience. Discussion: Expected outcomes will include an assessment of the feasibility of conducting a definitive RCT, and data to inform the calculation of its sample size. If evidence from a subsequent, fully powered RCT suggests that GiVE is clinically and cost-effective when delivered by briefly trained assistant psychologists, CBTp offered in these less resource-intensive forms has the potential to generate benefits for individual patients (reduced distress, enhanced recovery and enhanced quality of life), service-level patient benefit (increased access to evidence-based psychological therapies) and economic benefits to the NHS (in terms of the reduced use of mental health inpatient services). Trial registration: Current Controlled Trials, ISRCTN registration number: 16166070. Registered on 5 February 2019