A virtual ethnography of the madosphere - exploring a disrupted relationship between users and providers of mental health services

My thesis seeks to answer the question: ‘to what extent is the relationship between users and providers of mental health services being disrupted in the madosphere?’ It arises from curiosity about the extent to which online interactions have the potential to interrupt and complicate boundaries between providers and receivers of care. I consider the interplay between mediations of mental health in mainstream media and a space and set of practices I refer to as the madosphere. Through my research I endeavour to answer questions about the intersection of two discourses that are not obviously connected – the treatment of people with mental health problems by institutions and the existence of social networking sites as spaces to share information and develop common cultures. My research endeavours to understand ways in which people accessing and providing mental health services are interacting in particular online spaces; how participants in those spaces are engaging with current social and political issues relating to mental health; how they are encountering and resisting representations of mental ill-health in mainstream media, with a particular focus on stigma and discrimination. I elucidate themes relating to social practices, cultural norms, identity, power formation and impacts on mental health and wellbeing. My research comprises four sub-questions, which are set out below: 1. Disrupted relationships - who is participating in the madosphere, how do participants experience and understand their engagement, and what meanings does it carry for them? 2. An account of the madosphere - what are the behaviours, practices and social norms in the madosphere? 3. Re-mediation of representation - how do participants engage with and resist mainstream media reporting of mental health issues? 4. Fractured power and expertise - how do participants engage in themes of identity, power, stigma and discrimination? How are participants resisting and subverting institutional paradigms and discourses relating to mental health? I conclude with a series of recommendations for mental health professionals and institutions in relation to their engagement with social networking sites

Identification, recombinant production and partial biochemical characterization of an extracellular cold-active serine-metalloprotease from an Antarctic Pseudomonas isolate

Cold-adapted enzymes are generally derived from psychrophilic microorganisms and have features that make them very attractive for industrial and biotechnological purposes. In this work, we identified a 50 kDa extracellular protease (MP10) from the Antarctic isolate Pseudomonas sp. AU10. The enzyme was produced by recombinant DNA technology, purified using immobilized metal affinity chromatography and partially characterized. MP10 is an alkaline thermosensitive serine-metallo protease with optimal activity at pH 8.0 and 40 ℃, in the presence of 1.5 mM Ca2+. MP10 showed 100% residual activity and stability (up to 60 min) when incubated with 7% of non-ionic surfactants (Triton X-100, Tween-80 and Tween-20) and 1.5% of the oxidizing agent hydrogen peroxide. The 3D MP10 structure was predicted and compared with the crystal structure of mesophilic homologous protease produced by Pseudomonas aeruginosa PA01 (reference strain) and other proteases, showing similarity in surface area and volume of proteins, but a significantly higher surface pocket area and volume of MP10. The observed differences presumably may explain the enhanced activity of MP10 for substrate binding at low temperatures. These results give insight to the potential use of MP10 in developing new biotechnologically processes active at low to moderate temperatures, probably with focus in the detergent industry

Identifying research priorities for digital technology in mental healthcare: results of the James Lind Alliance Priority Setting Partnership

Digital technology, including the use of internet, smartphones and wearables, holds the promise to bridge the mental health treatment gap by offering a more accessible, potentially less stigmatising, flexible and tailored approach to mental healthcare. However, the evidence-base for digital mental health interventions and demonstration of clinical- and cost-effectiveness in real-world settings remains inadequate. The James Lind Alliance (JLA) Priority Setting Partnership (PSP) for digital technology in mental healthcare was established to identify research priorities that reflected the perspectives and unmet needs of people with lived experience of mental health problems, mental health service users, their carers, and healthcare practitioners. 644 participants contributed over 1350 separate questions, which were reduced by qualitative thematic analysis into six overarching themes. Following removal of out of scope questions and a comprehensive search of existing evidence, 134 questions were verified as uncertainties suitable for research. These questions were then ranked online and in workshops by 628 participants to produce a shortlist of 26. The top ten research priorities were identified by consensus at a stakeholder workshop. The top ten priorities should inform research policy and funding in this field. Identified priorities primarily relate to the safety and efficacy of digital technology interventions in comparison with face to face interventions, evidence of population reach, mechanisms of therapeutic change, and how best to optimize the effectiveness of digital interventions in combination with human support

The barriers and facilitators of supporting self care in Mental Health NHS Trusts

Mental health presents challenges to the concept of self care – mental health services have been especially reluctant to share responsibility with service users, and some service users are reluctant to engage with services that they feel are disempowering. This makes mental health a particularly useful case within which to explore the barriers and facilitators of effective implementation of self care policy. This study integrates qualitative and quantitative methodologies in a two-stage service mapping design together with a cohort study in order to investigate the implementation of self care initiatives in mental health care from a range of stakeholder perspectives. The study will address the following aims and objectives: (1) To identify the main barriers/ facilitators-– organisational, team, user & carer expectations, structures and processes of self care - to effective delivery of self care in NHS mental health organisations (in terms of improved outcomes for users of self care initiatives and their carers); (2) To identify learning about the implementation of self care from the mental health service experience that can be applied to other health service areas. Service user researchers and NHS managers will be integral members of the research team at all stages of the research process, and have been fully involved in the development of this proposal. The initial service mapping phase and cohort study will take place in three NHS Trust areas (Hampshire Partnership NHS Trust, Leeds Mental Health NHS Trust, South West London & St George’s Mental Health NHS Trust) selected as offering geographical and demographic contrast, as well as range of socio-economic and rural/ urban mix. The cohort study, with measures at baseline (referral) and 9 month follow-up, will investigate three self care initiatives (one in each trust area) selected as offering three contrasting interpretations and applications of self care. Participants in the cohort study will be 40 consecutive new referrals to each self care initiative, aged 18-65 and meeting the entry criteria of each initiative. Carers and support workers on the self care initiatives - with sampling centred on the service user sample - will also be interviewed as part of the study. As well as semi-structured interviews collecting qualitative data about expectations and experiences of self care, standard measures of clinical status (CORE-OM), satisfaction, empowerment, quality of life, mental health confidence, locus of control and experience of therapeutic relationship will be made of user participants, experience of care giving of carers, and experience of therapeutic relationship of support workers/ professionals. Concrete indicators of service use (9 months prior to and 9 months post referral) and engagement with the self care initiative will also be measured. A final national service mapping design, using an online, web based approach, will be applied to all 77 mental health Trusts in England (including PCTs that provide mental health services directly). The potential to generalise the findings of this study to people in other health service sectors undertaking self care will be explored firstly by triangulating our findings with existing published change management and self care literature, and secondly by comparison with the findings of SDO funded self care teams working in other areas. The potential to generalise findings to different groups of people with a mental health problem will be considered firstly by accurately describing the sample in each study site, and secondly by between site data comparison and a synthesis of data across sites

The role of social media in reducing stigma and discrimination

SummaryThis editorial explores the implications of social media practices whereby people with mental health problems share their experiences in online public spaces and challenge mental health stigma. Social media enable individuals to bring personal experience into the public domain with the potential to affect public attitudes and mainstream media. We draw tentative conclusions regarding the use of social media by campaigning organisations.</jats:p