Barriers to accessing psychological treatment for medium to high risk male young offenders

Within the young offender population, rates of personality disorder and mood disorders are considerably higher than both the general and adult offender population. Despite this high level of need and high risk of harm, psychological services within prisons are widely underutilized. Little is known about the barriers to accessing treatment for young offenders. This study investigated barriers to accessing psychological treatment for male young offenders detained in a UK prison. There were 128 participants, aged 18–21. A cross-sectional design compared self-reported barriers and psychological distress for Black and Minority Ethnic (BME) and White young offenders not accessing treatment, as well as those who were. A preference for self-reliance, a lack of trust in the prison system, lengthy waiting times and a general reluctance to talk about emotions were the most commonly cited barriers. BME young offenders not engaged in treatment reported significantly more barriers to accessing treatment than BME young offenders who were engaged in treatment, but both BME groups had equal levels of psychological distress. There was no significant difference between BME and White young offenders in the number of barriers reported, including stigma barriers. Future research should evaluate interventions to increase access for this marginalised population

Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: a national cross-sectional study

Background Patients who undergo psychological treatment can report both negative and positive effects, but evidence of factors influencing the likelihood of negative effects is limited. Aims To identify aspects of the organisation and delivery of secondary care psychological treatment services that are associated with patient experiences of negative effects. Method Cross-sectional survey of people with anxiety and depression who ended psychological treatment delivered by 50 NHS trusts in England. Respondents were asked about how their treatment was organised and delivered and whether they experienced lasting negative effects. Results Of 662 respondents, 90 (14.1%) reported experiencing lasting negative effects. People over the age of 65 were less likely than younger respondents to report negative effects. There was an association between reporting neutral or negative effects and not being referred at what respondents considered to be the right time (OR = 1.712, 95% CI = 1.078–2.726), not receiving the right number of sessions (OR = 3.105, 95% CI = 1.934–4.987), and not discussing progress with their therapist (OR 2.063, 95% CI = 1.290–3.301). Conclusions One in seven patients who took part in this survey reported lasting negative effects from psychological treatment. Steps should be taken to prepare people for the potential for negative experiences of treatment, and progress reviewed during therapy in an effort to identify and prevent negative effects

Re-thinking soil carbon modelling: a stochastic approach to quantify uncertainties

The benefits of sequestering carbon are many, including improved crop productivity, reductions in greenhouse gases, and financial gains through the sale of carbon credits. Achieving better understanding of the sequestration process has motivated many deterministic models of soil carbon dynamics, but none of these models addresses uncertainty in a comprehensive manner. Uncertainty arises in many ways - around the model inputs, parameters, and dynamics, and subsequently model predictions. In this paper, these uncertainties are addressed in concert by incorporating a physical-statistical model for carbon dynamics within a Bayesian hierarchical modelling framework. This comprehensive approach to accounting for uncertainty in soil carbon modelling has not been attempted previously. This paper demonstrates proof-of-concept based on a one-pool model and identifies requirements for extension to multi-pool carbon modelling. Our model is based on the soil carbon dynamics in Tarlee, South Australia. We specify the model conditionally through its parameters, soil carbon input and decay processes, and observations of those processes. We use a particle marginal Metropolis-Hastings approach specified using the LibBi modelling language. We highlight how samples from the posterior distribution can be used to summarise our knowledge about model parameters, to estimate the probabilities of sequestering carbon, and to forecast changes in carbon stocks under crop rotations not represented explicitly in the original field trials

Impact of co‐morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression

Introduction Concerns have been raised about the quality of inpatient care received by patients with a diagnosis of personality disorder. Objectives The aim of this study was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a co‐morbid personality disorder. Method We used a retrospective case‐note review of 3 795 patients admitted to inpatient psychiatric wards in England, utilizing data from the National Clinical Audit of Anxiety and Depression. Data were gathered on all acute admissions with an anxiety or depressive disorder over a 6‐month period, for a number of measures reflecting quality of care derived from national standards. Association of coexisting personality disorder with quality of care was investigated using multivariable regression analyses. Results Four hundred sixteen (11.0%) of the patients had a co‐co‐morbid diagnosis of personality disorder. Patients with personality disorder were less likely to have been asked about prior responses to treatment in their initial assessment (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.50 to 0.89, p = 0.007). They were less likely to receive adequate notice in advance of their discharge (OR = 0.87, 95% CI 0.65 to 0.98, p = 0.046). They were more likely to be prescribed medication at the point of discharge (OR = 1.52, 95% CI 1.02 to 2.09, p = 0.012) and less likely to have been provided with information about the medicines they were taking (OR = 0.86, 95% CI 0.69 to 0.94, p = 0.048). In addition, the carers of patients with co‐morbid personality disorder were less likely to have been provided with information about available support services (OR = 0.73, 95% CI 0.51 to 0.93, p = 0.045). Conclusion We found evidence of poorer quality of care for patients with co‐morbid personality disorder who were admitted to psychiatric hospital for treatment of anxiety or depressive disorders, highlighting the need for improved clinical care in this patient group

Combined growth hormone and insulin-like growth factor 1 rescues growth retardation in glucocorticoid-treated mdx mice but does not prevent osteopenia

Short stature and osteoporosis are common in Duchenne muscular dystrophy (DMD) and its pathophysiology may include an abnormality of the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis, which is further exacerbated by long-term glucocorticoid (GC) treatment. Hence, an agent that has anabolic properties and may improve linear growth would be beneficial in this setting and therefore requires further exploration. A 5-week-old x-linked muscular dystrophy (mdx) mice were used as a model of DMD. They were treated with prednisolone ± GH + IGF-1 for 4 weeks and then compared to control mdx mice to allow the study of both growth and skeletal structure. GC reduced cortical bone area, bone fraction, tissue area and volume and cortical bone volume, as assessed by micro computed tomography (CT) In addition, GC caused somatic and skeletal growth retardation but improved grip strength. The addition of GH + IGF-1 therapy rescued the somatic growth retardation and induced additional improvements in grip strength (16.9% increase, P  < 0.05 compared to control). There was no improvement in bone microarchitecture (assessed by micro-CT and static histomorphometry) or biomechanical properties (assessed by three-point bending). Serum bone turnover markers (Serum procollagen 1 intact N-terminal propeptide (P1NP), alpha C-terminal telopeptide (αCTX)) also remained unaffected. Further work is needed to maximise these gains before proceeding to clinical trials in boys with DMD

Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression

Background Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. Procedures Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England submitted details of between 20 and 100 service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. Findings Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. Conclusions There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality