The alarms should no longer be ignored: survey of the demand, capacity and provision of adult community eating disorder services in England and Scotland before COVID-19.

This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016-2017 and 2019-2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18-25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP

Eimear Galvin - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Critical Review of the Literature Title: Identifying factors which facilitate and impede disclosure or non-disclosure of suicidal ideation: a systematic review. Background: As identifying suicide risk relies on individuals choosing to disclose their suicidal ideation to others, non-disclosure of suicidal ideation acts as a significant barrier to effective suicide risk assessment and management. We aimed to review the predictors of suicidal ideation disclosure as well as the factors which separate disclosers from non-disclosers, to develop a wider understanding of barriers and facilitators to disclosure, and thereby inform risk assessment and management protocols. Methods: For this systematic review, we reviewed Embase, PsycINFO, Ovid, Scopus and Web of Science in November 2021. All studies which explored predictors of suicidal ideation disclosure or non-disclosure in adults, or the factors which separated adult disclosers and non-disclosers were included without date restriction. A narrative synthesis was conducted. This study is registered on Prospero, number: CRD42021262056. Findings: Of 7448 papers, 26 were eligible for synthesis, where risk of bias was low overall. No individual characteristics (i.e. demographics, mental or physical health or suicidality) conclusively predicted suicidal ideation disclosure or non-disclosure. Tentative links were associated with being female, being of younger age, having a history of psychiatric symptoms and having a history of suicide attempt and disclosure of suicidal ideation. In a small number of studies, individuals’ motivations for (non-)disclosure, as well as their relationships with both personal and professional confidants were more consistently identified as being predictive of disclosure. Interpretation: Theoretical conceptualisations of suicidal ideation disclosure, as well as clinical risk assessment and management protocols should consider the inclusion of relationship dynamics between the individual experiencing suicidal ideation and their confidants, in addition to individual characteristics and external contextual factors. Service Improvement Project Title: Developing integrated mental health care for people experiencing homelessness: an exploration of barriers and facilitators. Research highlights the need for integrated mental health provision for people experiencing homelessness. Examples of such services are currently limited in the UK, and the implementation of current services have encountered several obstacles. Utilising interpretative phenomenological analysis, this project aimed to explore staff perspectives on the barriers and facilitators to integrated mental health provision for homeless people in Berkshire. Semi-structured interviews were conducted with 6 participants from a range of professional backgrounds. Super- and subordinate themes about understanding, clarity, service demands vs. individual needs, and the benefits and challenges of working in homelessness emerged. Recommendations for service development based on these findings were outlined. Theory Driven Research Project Title: The roles of cognitive appraisals and self-compassion as predictors of post-traumatic stress symptoms following first episode psychosis. Individuals who experience first episode psychosis (FEP) often develop symptoms of post-psychotic trauma symptoms (PPTS) as a result of their distressing experiences. Although systematic reviews have called for further understanding of the risk factors for PPTS, few studies have examined the psychological underpinnings. This study examined the role of post-traumatic cognitions (negative cognitions about the self and the world, and self-blame) in PPTS, and examined whether self-compassion contributed to this relationship. A quantitative prospective methodology was employed. 34 participants under the care of Early Intervention in Psychosis teams completed measures of post-traumatic cognitions, post-traumatic stress symptoms, depression, symptoms of psychosis, self-compassion and history of trauma. Follow-up measures of post-traumatic stress symptoms, depression and psychosis symptoms were also completed. The study identified that post-traumatic cognitions, and particularly negative cognitions about the self are associated with symptoms of PTSD, and individuals with PPTS experienced significantly greater post-traumatic cognitions than those without. Aside from self-blame, post-traumatic cognitions were not found to be predictive of PPTS over time. No relationship was identified between self-compassion, post-traumatic cognitions and PPTS. Limitations and implications for clinical practice are discussed

COVID-19-related loneliness, social isolation and burden in informal caregivers worldwide

Background: Informal caregivers may experience high levels burden. Prior to COVID-19, loneliness and social isolation, and especially the discordance between them, were recognized for rapid aging-related cognitive decline. The COVID-19 has significantly increased social isolation and loneliness in caregivers. Thus, we aimed to explore the variables that were associated with higher care burden among all caregivers and only among caregivers for people living with dementia, and whether the increased burden could be associated with a discrepancy between loneliness and social isolation. Method: ‘Comparing Loneliness and Isolation in COVID-19’ was an online global survey of over 20,000 respondents, including 5243 caregivers across 50 countries with enduring brain or/and physical health conditions. We first used a multilevel modelling to identify risk factors associated with higher burden. Then, we defined profiles of discrepancy between loneliness and social isolation, based on the differences between standardized score on a scale of loneliness and of social connectedness and estimated the association between the discrepancy and higher burden. Result: In our sample, 74% of caregivers were female, 44% were caring for people with dementia, and 22% for people with multiple conditions, including dementia. The most prevalent age group was 60-69 years old. Factors significantly associated with higher care burden were being female, having poorer financial situation, worse mental health during the pandemic, caring for people with dementia or intellectual disabilities, caring in the same home, being diagnosed with COVID, and changes of care abilities. 40% of caregivers consistently reported high level of loneliness and social isolation, 38% reported consistent lower levels of both, and two groups reported discordance (low levels of loneliness and high social isolation in 13%; high levels of loneliness and mild social isolation in 12%). The latter group was at the highest risk of self-reported increased and intense care burden. Conclusion: This represents the largest, most widespread survey on the impact of the COVID-19 pandemic on caregivers of people with long-term conditions to date and reflects the importance of capturing the nuances in the relationship between loneliness and social isolation in caregivers. It will be an important resource for support agencies and to inform policy

COVID-19-related loneliness and social isolation in caregivers of people with brain health challenges : The CLIC-Caregiver Global Survey

BACKGROUND: Prior to COVID-19, >90% of caregivers of people with brain health challenges (dementia, mental ill health, intellectual disability) experienced high levels of distress, burden, loneliness and social isolation. The COVID-19 pandemic has significantly increased these impacts, particularly since these caregivers are often older and physically vulnerable themselves. The aim of this cross-sectional study is to explore coping and caregiver burden, loneliness and social isolation in caregivers of people with brain health challenges during the COVID-19 pandemic. METHOD: CLIC-Caregiver was a cross-sectional, online, and global survey (June 2nd - November 15th , 2020) using self-administered questionnaires directed at informal caregivers of people with long-term brain health challenges. The study was embedded within a larger survey of loneliness and social isolation for general public ('Comparing Loneliness and Isolation in COVID-19' (CLIC)), including validated loneliness and isolation tools. Translated into ten different languages such as Arabic, French, Romanian, etc, the survey was disseminated over 100 countries. Respondents were included in the CLIC-caregiver sub-study if they answered yes to the question 'Do you provide care and support to a family member or friend with a long-term or life-limiting health problem or disability (including mental health)'. The CLIC project received the initial global ethical approval from Ulster University. The data were fully anonymized. RESULT: From the CLIC main study, 5243 (25%) identified themselves as caregivers. This proportion varied in different countries, from 12 % in Romania to 65% in France. 2323 (44%) had care recipients with dementia, 1761 with physical conditions (disability or long-term illness), 832 with enduring mental health problems, and 404 with intellectual disability. Measures of caregiver burden, loneliness and social isolation will be compared across geographic regions, sociodemographic factors, and risk factors for poor outcomes sought. Findings will be distributed to relevant stakeholders in the form of a project report, with region and country-specific outcomes. This will support recommendations and actions supporting caregivers of people with brain health challenges. CONCLUSION: This represents the largest, most widespread survey on the impact of the COVID-19 pandemic on caregivers of people with long-term conditions to date. It will be an important resource for support agencies and to inform policy

The alarms should no longer be ignored: A Survey of the Demand, Capacity and Provision of Adult Community Eating Disorder Services in England and Scotland before COVID-19

Aims/Methods: This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) to NHSE commissioning guidance. Results: Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016/17 and 2019/20 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% were aged 18–25, 54%>25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for co-morbidities, offer assertive outreach, or provide seamless transitions. For patient volume, ACEDS workforce budget was 15% compared to the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for ACEDS. Clinical Implications: This study highlights the severe pressure in ACEDS, which has increased since the pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance for adults, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP

A randomised controlled trial exploring the impact of a dedicated health and social care professionals team in the emergency department on the quality, safety, clinical and cost-effectiveness of care for older adults: a study protocol

Background: Older people are frequent emergency department (ED) users who present with complex issues that are linked to poorer health outcomes following the index visit, often have increased ED length of stay, and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and an improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCP teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, and clinical- and cost-effectiveness of care of older adults when compared with usual care. Methods: The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30 days, and 4 and 6 months of follow-up; patient functional status and quality of life (at baseline and follow up); patient satisfaction; cost-effectiveness in terms of costs associated with ED-based HSCP compared with usual care; and perceptions on implementation by ED staff members Discussion: This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, and clinical- and cost-effectiveness of care for older patients. The findings of this study will provide important information on the effectiveness of this model of care for future implementatio

Impact of assessment and intervention by a health and social care professional team in the emergency department on the quality, safety, and clinical effectiveness of care for older adults: A randomised controlled trial

Older adults frequently attend the emergency department (ED) and experience high rates of adverse events following ED presentation. This randomised controlled trial evaluated the impact of early assessment and intervention by a dedicated team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical effectiveness of care of older adults in the ED

SARS-CoV-2 infection in general practice in Ireland: a seroprevalence study

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing in community settings may help us better understand the immune response to this virus and, therefore, help guide public health efforts. Aim: To conduct a seroprevalence study of immunoglobulin G (IgG) antibodies in Irish GP clinics. Design & setting: Participants were 172 staff and 799 patients from 15 general practices in the Midwest region of Ireland. Method: This seroprevalence study utilised two manufacturers’ point-of-care (POC) SARS-CoV-2 immunoglobulin M (IgM)—IgG combined antibody tests, which were offered to patients and staff in general practice from 15 June to 10 July 2020. Results: IgG seroprevalence was 12.6% in patients attending general practice and 11.1% in staff working in general practice, with administrative staff having the lowest seroprevalence at 2.5% and nursing staff having the highest at 17.6%. Previous symptoms suggestive of COVID-19 and history of a polymerase chain reaction (PCR) test were associated with higher seroprevalence. IgG antibodies were detected in approximately 80% of participants who had a previous PCR-confirmed infection. Average length of time between participants’ positive PCR test and positive IgG antibody test was 83 days. Conclusion: Patients and healthcare staff in general practice in Ireland had relatively high rates of IgG to SARS-CoV-2 compared with the national average between 15 June and 10 July 2020 (1.7%). Four fifths of participants with a history of confirmed COVID-19 disease still had detectable antibodies an average of 12 weeks post-infection. While not proof of immunity, SARS-CoV-2 POC testing can be used to estimate IgG seroprevalence in general practice settings