Commissioning Liaison Psychiatry services

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A pilot study to support veterans in the criminal justice system

Project Nova is a pilot model in Norfolk and Suffolk of an intervention, to reach veterans at the earliest point of contact following their arrest. This evaluation of Project Nova provides an insight into the needs of veteran offenders at an early stage in the criminal justice pathway. It also helps the reader to understand whether these needs can be met shortly after arrest, and whether this has any impact on offending behaviour. This Report reflects on examples of best practice for working with this challenging and often hard to engage populatio

We Also Served: The Health and Well-being of Female Veterans in the UK

Women have served within the Armed Forces for over 100 years. Their contribution has been extraordinary but the prevailing military culture, together with evolving terms and conditions of Service, have left their mark on the health and well-being of many. Whilst it is right, therefore, to recognise the progress that has been made, there is a pressing need to evidence the impact of past policies and actions. This timely report is the first major step in addressing this. Almost thirty organisations, drawn from across the military charity sector as well as from statutory bodies including NHS England and NHS Improvement and the MOD, have contributed to this report. It is the first research project to consider holistically the full range of female veteran issues, uniquely capturing the lived experiences of women who have served. Perhaps most importantly, it provides an essential start point for a comprehensive evidence base that will enable debate with a level of insight and clarity that has been missing before, and which will ensure statutory and Service Charity provision is targeted accurately to meet the needs of those women who are serving and veterans. The report is clear that for many that is not yet the case, both for those in Service and for those who have transitioned to civilian lives. It is a timely warning that there is still work to do both in improving in-Service conditions to allow our servicewomen to thrive and, once they leave, for us to tailor our veteran support services to meet their specific needs. This will include the requirement to support and improve the needs of serving women, whether as partners, mothers or in different family situations, and its impact on well-being, whilst at the same time enabling military careers. A prioritised action pl an has been produced in order to a chieve real impact and create long-lasting change. Top of the list is a review of the impact on health and well-being outcomes of Service culture an d sexual harassment, issues which have long been discussed but which continue to persist, with a number of the recommendations from the recent Wigston Report yet to be fully implemented. The report also identifies considerable gaps in our understanding of how in-Service experiences impact on health, wealth, and socio-economic outcomes, and explores what further action is required. Overall, this report is unique in its breadth and depth, in the academically robust processes undertaken and in its capture of the lived experiences of female veterans from across the services and the decades. It is not an easy read. It is, however, a necessary read. By compiling the evidence, the report gives voice to our former servicewomen and sets out an irrefutable case for further and necessary cultural and policy change to improve the long-term health and well-being of those women who have served and are serving

Reduced Resting-State Functional Connectivity in Current and Recovered Restrictive Anorexia Nervosa

Functional connectivity studies based on resting-state functional magnetic resonance imaging (rs-fMRI) have shown alterations in brain networks associated with self-referential processing, cognitive control, and somatosensory processing in anorexia nervosa (AN). This study aimed to further investigate the functional connectivity of resting-state networks (RSNs) in homogenous subsamples of individuals with restrictive AN (current and recovered) and the relationship this has with core eating disorder psychopathology. rs-fMRI scans were obtained from 12 female individuals with restrictive AN, 14 females recovered from restrictive AN, and 16 female healthy controls. Independent components analysis revealed a set of functionally relevant RSNs, previously reported in the literature. Dual regression analysis showed decreased temporal coherence within the lateral visual and auditory RSNs in individuals with current AN and those recovered from AN compared to healthy individuals. This decreased connectivity was also found in regions associated with somatosensory processing, and is consistent with reduced interoceptive awareness and body image perception, characteristic of AN. Widespread gray matter (GM) reductions were also found in both the AN groups, and differences in functional connectivity were no longer significant when GM maps were added as a covariate in the dual regression analysis. This raises the possibility that deficits in somatosensory and interoceptive processing observed in AN may be in part underpinned or exacerbated by GM reductions

A preliminary investigation of the well-being of visually impaired ex-service personnel in the UK

Research has shown that visual impairment may impact daily functioning, health, and well-being negatively for adults of all ages. Ex-service personnel (‘veterans’) too may be at risk of poor health and well-being outcomes associated with post-military life, and this may be exacerbated by the presence of visual impairment. Despite this, research considering the experience of blind veterans has been limited and has not yet assessed well-being for these individuals across a broad spectrum of life domains. Rather, it has highlighted poor mental health and psychological well-being in working-age visually impaired veterans. However, the experiences of older visually impaired veterans (who make up the majority of visually impaired veterans in the United Kingdom) have been poorly represented in the literature. This pilot study aimed to provide a preliminary assessment of holistic well-being in an adult sample of 97 UK blind veterans, predominantly composed of older age veterans (majority over 80 years). Cross-sectional well-being data were collected using a validated measure of well-being (the Well-Being Inventory [WBI]). Results suggest that members of Blind Veterans UK are functioning well and are satisfied across four life domains (vocation, finances, health, and social relationships). Lower health satisfaction was identified, particularly in blind veterans with comorbid mental health conditions. Results are discussed in relation to the older age of the sample, the limitations of face-to-face survey administration, and the applicability of the WBI finance domain in this age cohort. Recommendations are made for future research in this population

State Anxiety in People Living with Disability and Visual Impairment during the COVID-19 Pandemic

There has been growing recognition of the impact of COVID-19 and the restrictions implemented to contain the virus on mental health. This study provides a preliminary assessment of the longitudinal impact on state anxiety in individuals with disabilities and a subsample of individuals with visual impairment (VI). Two surveys were conducted in April–May 2020 (T1) and March 2021 (T2) to explore state anxiety (State-Trait Anxiety Inventory). Participants who consented to being re-contacted were invited to take part in T2. A total of 160 participants completed T1 and T2. There were no significant group differences in median anxiety at T1; however, at T2 anxiety was significantly higher in those with disabilities and there was a trend towards being higher in participants with VI compared to those with no disabilities. While not statistically significant within any of the three subgroups, state anxiety decreased slightly in those with no disabilities. The absence of a disability affecting mobility, experiencing loneliness, and poorer sleep quality predicted state anxiety at both timepoints. While anxiety appeared to decrease in individuals with no disabilities, it remained comparatively stable, and higher in those with disabilities. Loneliness and poor sleep may need to be addressed to alleviate feelings of anxiety

The Impact of COVID-19 on Sleep Quality in People Living With Disabilities

Background: Research exploring the impact of the COVID-19 pandemic on sleep in people with disabilities has been scarce. This study provides a preliminary assessment of sleep in people with disabilities, across two timepoints during the pandemic, with a focus on those with visual impairment (VI). Methods: Two online surveys were conducted between April 2020 and March 2021 to explore sleep quality using the Pittsburgh Sleep Quality Index (PSQI). A convenience sample of 602 participants completed the first survey and 160 completed the follow-up survey. Results: Across both timepoints, participants with disabilities reported significantly poorer global sleep quality and higher levels of sleep disturbance, use of sleep medication and daytime dysfunction than those with no disabilities. Participants with VI reported significantly higher levels of sleep disturbance and use of sleep medication at both timepoints, poorer global sleep quality, sleep duration and latency at time 1, and daytime dysfunction at time 2, than those with no disabilities. Global sleep quality, sleep duration, sleep efficiency, and self-rated sleep quality deteriorated significantly in participants with no disabilities, but daytime dysfunction increased in all three groups. Disability and state anxiety were significant predictors of sleep quality across both surveys. Conclusion: While sleep was consistently poorer in people with disabilities such as VI, it appears that the COVID-19 pandemic has had a greater impact on sleep in people with no disabilities. State anxiety and, to a lesser extent, disability, were significant predictors of sleep across both surveys, suggesting the need to address anxiety in interventions targeted toward improving sleep

Fishing Participation, Motivators and Barriers among UK Anglers with Disabilities: Opportunities and Implications for Green Social Prescribing

Green social prescribing, which includes the referral of patients to nature-based activities, could exacerbate inequalities between people with disabilities and people without. Research suggests fishing could be more inclusive relative to other outdoor sports. To understand if fishing is an inclusive sport, and the potential benefits and barriers to prescribing fishing, the present study compared participation, motivators and barriers to fishing, between anglers with and without disabilities. UK adults were invited to participate in an online survey. Chi-square tests examined differences between anglers with and without disabilities regarding the type of fishing anglers engaged in, the frequency of fishing, the length of time spent fishing, motivators for fishing and barriers to fishing. Among 1799 anglers (97.5% male), 292 (16.2%) anglers reported having a disability. Most anglers with disabilities were over 55 years old (56.5%). There was no difference in fishing participation, or motivators for fishing, between anglers with and without disabilities; however, anglers with disabilities were more likely to report ‘costs’, ‘lack of transport’ and ‘having no one to go with them’ as barriers. Overall, there appeared to be no differences in fishing participation between anglers with versus without disabilities, although additional barriers to participation may exist

The Long-Term Impact of the COVID-19 Pandemic on Loneliness in People Living With Disability and Visual Impairment

Background: There has been growing concern about the impact of restrictions put in place to contain the coronavirus pandemic on loneliness, particularly in individuals with disabilities. This study explored the longitudinal impact of the pandemic on loneliness in these individuals, with a focus on those living with visual impairment (VI). Methods: An online survey was conducted in April-2020 and repeated in March 2021 to explore current life circumstances, health-related behaviours, sleep (Pittsburgh Sleep Quality Index) and social well-being, including state anxiety (State-Trait Anxiety Index) and loneliness (UCLA Loneliness scale). A convenience sample of 602 participants completed the first survey. Participants who agreed to be re-contacted were invited to take part in the follow-up survey. Results: Data is presented for the 160 participants who completed both timepoints. At both timepoints, median loneliness was significantly higher in participants with disabilities and those with VI than in participants with no disabilities. While there was no significant change in loneliness in any of the three subgroups, participants with VI experienced the largest increase in median loneliness. Loneliness was associated with having a mental health condition and higher levels of state anxiety at both timepoints. Conclusions: Individuals with disabilities such as VI experienced consistently higher levels of loneliness than those with no disabilities throughout the pandemic. While loneliness remained relatively stable in individuals with no disabilities, it increased, albeit to a non-significant level, in those with disabilities and particularly those with VI. Interventions designed to alleviate loneliness may benefit from addressing state anxiety