Understanding the barriers to accessing symptom-specific cognitive behavior therapy (CBT) for distressing voices: reflecting on and extending the lessons learnt from the CBT for psychosis literature

The experience of hearing voices ('auditory hallucinations') can cause significant distress and disruption to quality of life for people with a psychosis diagnosis. Psychological therapy in the form of Cognitive Behavior Therapy for psychosis is recommended for the treatment of positive symptoms, including distressing voices, but is rarely available to patients in the UK. Cognitive Behavior Therapy for psychosis has recently evolved with the development of symptom-specific therapies that focus upon only one symptom of psychosis at a time. Preliminary findings from randomized controlled trials suggest that these symptom-specific therapies can be more effective for distressing voices than the use of broad CBT protocols, and have the potential to target voices trans-diagnostically. Whilst this literature is evolving, consideration must be given to the potential for a symptom-specific approach to overcome some of the barriers to delivery of evidence-based psychological therapies within clinical services. These barriers are discussed in relation to the UK mental health services, and we offer suggestions for future research to enhance our understanding of these barriers

Interventions to support reproductive and mental health among care leavers: A systematic review

Compared to other teenagers, young care leavers tend to have poorer sexual/reproductive and mental health; mental health difficulties may increase risk for poor sexual/reproductive health. This systematic review addresses a gap in knowledge regarding the effectiveness of existing interventions that support care leavers’ sexual/reproductive health (e.g., contraception, pregnancy choices, early parenting). Eight published articles spanning six interventions were eligible. Interventions were associated with improvements in a range of sexual/reproductive health measures (e.g., sexual health knowledge; knowledge of where to get support; attitudes to sexual health practices), with some indicative improvements in self-esteem. However, some studies suggested these improvements may not be sustained. Interventions tended to include a broad age range, with limited programmes specifically aimed at care leavers. While some programmes focused on attitudes toward reproductive health and pregnancy (i.e., contraception), we identified no programme focusing on parenthood choice. We also identified no sexual/reproductive health programme that targeted or assessed associated mental health problems, despite evidence of associations between sexual health and mental health difficulties. Findings suggest that care leavers may benefit from specific sexual/reproductive health supports, but further evidence is needed. Findings also indicate a need for more holistic supports that integrate mental health supports with reproductive/sexual health and consider care leaver decision-making. This research was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Kent, Surrey, Susse

Interventions to support reproductive and mental health among care leavers: A systematic review

Compared to other teenagers, young care leavers tend to have poorer sexual/reproductive and mental health; mental health difficulties may increase risk for poor sexual/reproductive health. This systematic review addresses a gap in knowledge regarding the effectiveness of existing interventions that support care leavers’ sexual/reproductive health (e.g., contraception, pregnancy choices, early parenting). Eight published articles spanning six interventions were eligible. Interventions were associated with improvements in a range of sexual/reproductive health measures (e.g., sexual health knowledge; knowledge of where to get support; attitudes to sexual health practices), with some indicative improvements in self-esteem. However, some studies suggested these improvements may not be sustained. Interventions tended to include a broad age range, with limited programmes specifically aimed at care leavers. While some programmes focused on attitudes toward reproductive health and pregnancy (i.e., contraception), we identified no programme focusing on parenthood choice. We also identified no sexual/reproductive health programme that targeted or assessed associated mental health problems, despite evidence of associations between sexual health and mental health difficulties. Findings suggest that care leavers may benefit from specific sexual/reproductive health supports, but further evidence is needed. Findings also indicate a need for more holistic supports that integrate mental health supports with reproductive/sexual health and consider care leaver decision-making

Engaging 'gay' businesses in HIV prevention 'Everywhere': Findings from a qualitative study in eight European cities

on behalf of the Everywhere ConsortiumObjective: 'Gay' businesses providing physical and virtual sex spaces for men who have sex with men (MSM) have been shown empirically to be useful sites for public health and health promotion interventions. While HIV incidence in Europe has been more or less stable in recent years, the number of infections attributed to MSM has continued to increase with new cases almost doubling in Western and Central Europe between 2000 and 2006. Set within the context of the Everywhere Project, the objective of this study was to explore the feasibility and acceptability to 'gay' businesses of developing and implementing a European model of HIV prevention focusing on MSM that provides common prevention standards across eight European countries. Design: A qualitative study Setting: 'Gay' businesses that bring men together and facilitate sex between them in 'gay' tourist destinations and other European capital cities. Method: Semi-structured qualitative interviews were conducted with 54 'gay' business representatives from different European cities. Interviews were recorded, transcribed, translated, and analyzed using a 'framework' approach. Results: Many representatives of 'gay' businesses reported being willing to provide HIV prevention activities that target MSM in their venues and perceive this as part of improving their corporate image of being a socially responsible enterprise. However, concerns were voiced around issues such as fear of alienating customers, and inciting stigma and discrimination, safe-sex fatigue and lack of knowledge of prevention messages, as well as the need for appropriate condom and lubricant distribution networks. Businesses also reflected on the potential benefits and disadvantages of being involved in a scheme that provides a common and recognizable framework for HIV prevention across multiple European countries. Conclusions: Early conclusions from this exploratory research suggest that a European-wide model of HIV prevention is acceptable and feasible to those working in 'gay' businesses. Further investigations, however, are required to develop solutions in order to overcome identified social, cultural and practical barriers. 2011 The Author(s).sch_iih72pub3091pub