How accessible and acceptable are current GP referral mechanisms for IAPT for low-income patients? Lay and primary care perspectives

Background: Improving Access to Psychological Therapies (IAPT) constitutes a key element of England’s national mental health strategy. Accessing IAPT usually requires patients to self-refer on the advice of their GP. Little is known about how GPs perceive and communicate IAPT services with patients from low-income communities, nor how the notion of self-referral is understood and responded to by such patients. Aims: This paper examines how IAPT referrals are made by GPs and how these referrals are perceived and acted on by patients from low-income backgrounds Method: Findings are drawn from in-depth interviews with low-income patients experiencing mental distress (n = 80); interviews with GPs (n = 10); secondary analysis of video-recorded GP-patient consultations for mental health (n = 26). Results: GPs generally supported self-referral, perceiving it an important initial step towards patient recovery. Most patients however, perceived self-referral as an obstacle to accessing IAPT, and felt their mental health needs were being undermined. The way that IAPT was discussed and the pathway for referral appears to affect uptake of these services. Conclusions: A number of factors deter low-income patients from self-referring for IAPT. Understanding these issues is necessary in enabling the development of more effective referral and support mechanisms within primary care

The impact of the Work Capability Assessment on mental health: claimants’ lived experiences and GP perspectives in low-income communities

This is the final version. Available from Policy Press via the DOI in this record.Anonymised focus group and interview transcripts from participants who consented to data sharing, plus additional supporting information, are available from the UK Data Service, subject to registration and permission. Details of how to request access are available from the UK Data Service at: http://doi.org/10.5255/UKDA-SN-853788This paper examines the impact of increased welfare conditionality on people with mental health issues claiming benefits in the UK. Drawing on data from the DeStress study, this paper explores the lived experience of welfare claimants in low-income communities, and the perspectives of GPs seeking to support them. Particular focus is placed on people’s experience of the Work Capability Assessment, the tool used to determine welfare claimants’ entitlement to sickness benefit, and how the narratives and culture surrounding welfare reform and the actual assessment itself can have a negative impact on mental health and wellbeing.Economic and Social Research Council (ESRC

A prototype ASIC for APD array readout of scintillating plastic fibers

We report on the development of custom front-end electronics for use with avalanche photodiode (APD) arrays as part of a NASA technology study for the readout of scintillating plastic fibers. APD arrays featuring 64 1 mm square pixels are used. We demonstrate that a pixel of these APD arrays coupled to relatively thin (0.25 mm) and short (15 cm) scintillating plastic fibers can be used to detect and measure the tracks of even minimum ionizing particles (MIPs). An applicationspecific integrated circuit (ASIC) implementation of the electronics is required to produce a detector sufficiently compact for practical use in a flight experiment featuring many thousands of channels. This paper briefly describes the detector concept and performance and presents the design and performance of a four-channel prototype ASIC fabricated using the 0.35 micron TSMC process

Needs and fears of young people presenting at Accident & Emergency department following an act of self-harm: Secondary analysis of qualitative data

This is the author accepted manuscript. The final version is available from the Royal College of Psychiatrists via the DOI in this record.Background: Presentation at an Accident and Emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood. Aims: To examine young people’s perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter. Method: Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm. Results: Participants reported avoiding A&E whenever possible, based on their own and others’ previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received ‘treatment as usual’, i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle. Conclusions: The clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.National Institute for Health ResearchThanks must again be given to all the primary study participants, who gave so much time and energy and allowed us access to their private worlds. We also acknowledge the other members of the primary study team. C.O. and S.S. were supported for part of the time spent on this paper by the National Institute for Health Research (NIHR) CLAHRC for the South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health

A scintillating plastic fiber tracking detector for neutron and proton imaging and spectroscopy

We report the results of recent calibration data analysis of a prototype scintillating fiber tracking detector system designed to perform imaging, spectroscopy and particle identification on 20 to 250 MeV neutrons and protons. We present the neutron imaging concept and briefly review the detection principle and the prototype description. The prototype detector system records ionization track data on an event-by-event basis allowing event selection criteria to be used in the off-line analysis. Images of acrylic phantoms from the analysis of recent proton beam calibrations (14 to 65 MeV range) are presented as demonstrations of the particle identification, imaging and energy measurement capabilities. The measured position resolution is c 500 pm. The measured energy resolution (AE/E, FWHM) is 14.2% at 35 MeV. An effective technique for track identification and data compression is presented. The detection techniques employed can be applied to measurements in a variety of disciplines including solar and atmospheric physics, radiation therapy and nuclear materials monitoring. These applications are discussed briefly as are alternative detector configurations and future development plans

Supporting mental health in low-income communities: Implications for justice and equity

This is the author accepted manuscript. The final version is available from Routledge via the link in this recordThis chapter examines the paradox between growing equity in mental health diagnosis and treatment and the discontent and injustice experienced by those living with poverty-related distress. The chapter identifies two inter-related ways in which forms of injustice impact upon people in low-income communities: first, examining how experiences of poverty and engagement with the welfare system can engender and exacerbate underlying vulnerabilities to mental distress; and second, focusing on the well-being implications of medicalising poverty-related distress. Particular attention is given to the relevance, effectiveness and ethics of current treatment options and their implications for equitable service provision and support.Economic and Social Research Council (ESRC

Poverty, choice and dying in the UK: a call to examine whether public health approaches to palliative care address the needs of low-income communities

This is the final version. Available on open access from Routledge via the DOI in this record. Data availability statement: The data that support the findings of this study are openly available in the UK Data Service at https://beta.ukdataservice.ac.uk/datacatalogue/studies/study?id=853488 ReShare record 853488People living on a low income are less likely to access palliative care in the UK; however, beyond the statistics, little is known about the impact of poverty on attitudes towards death and experiences of dying and bereavement. Covid-19 has disproportionally affected poorer communities and foregrounded issues of social and health inequalities including experiences of loss and grief. Whilst this might suggest an opportune moment for embracing inclusive health-promoting approaches to palliative care, this paper argues that the centrality of concepts such as choice within such approaches, and assumptions about what constitutes a ‘good death’, disregard the ways in which structural, social and economic aspects of poverty interface with attitudes towards and experiences of dying, and may exacerbate inequalities in death and dying.Wellcome Trus

Reflecting on choices and responsibility in palliative care in the context of social disadvantage

This is the final version. Available on open access from SAGE Publications via the DOI in this recordThere is a need to understand how to improve palliative care provision for people impacted by social inequity. Social inequity, such as that related to socioeconomic circumstances, has profound impacts on experiences of death and dying, posing personal and professional challenges for frontline professionals tasked to ensure that everyone receives the best standard of care at the end of their lives. Recent research has highlighted an urgent need to find ways of supporting healthcare professionals to acknowledge and unpack some of the challenges experienced when trying to deliver equitable palliative care. For example, those involved in patient or person-centred activities within health settings often feel comfortable focusing on individual choice and responsibility. This can become ethically problematic when considering that inequities experienced towards the end of life are produced and constrained by socio-structural forces beyond one individual's control. Ideas and theories originating outside palliative care, including work on structural injustice, cultural safety and capabilities approach, offer an alternative lens through which to consider roles and responsibilities for attending to inequities experienced at the end of life. This paper draws upon these ideas to offer a new way of framing individual responsibility, agency and collective action that may help palliative care professionals to support patients nearing their end of life, and their families, in the context of socioeconomic disadvantage. In this paper, we argue that, ultimately, for action on inequity in palliative care to be effective, it must be coherent with how people understand the production of, and responsibility for, those inequities, something that there is limited understanding of within palliative care

Teaching classroom management – A potential public health intervention?

Author's manuscript version. The final published version is available from the publisher via: http://dx.doi.org/10.1108/HE-03-2014-0030© Emerald Group Publishing LimitedPurpose – The purpose of this paper is to explore the feasibility of a classroom management course as a public health intervention. Improved socio-emotional skills may boost children’s developmental and academic trajectory, while the costs of behaviour problems are enormous for schools with considerable impact on others’ well-being. Design/methodology/approach – In total, 40 teachers attended the Incredible Years (IY) Teacher Classroom Management (TCM) intervention in groups of ten. Afterwards teachers attended focus groups and semi-structured interviews were completed with headteachers to explore whether TCM was feasible, relevant and useful, research processes were acceptable and if it influenced teachers’ practice and pupils. Teachers completed standardised questionnaires about their professional self-efficacy, burnout and well-being before and after attendance. Findings – In all, 37/40 teachers completed the course. Teachers valued sharing experiences, the support of colleagues in the group and time out to reflect on practice and rehearse new techniques. Most teachers reported that they applied the strategies with good effect in their classrooms. Teachers’ questionnaires suggested an improvement in their self-efficacy in relation to classroom management (p=0.03); other scales changed in the predicted direction but did not reach statistical significance. Research limitations/implications – Although preliminary and small, these feasibility study findings suggest that it was worthwhile proceeding to a definitive randomised controlled trial (RCT). Practical implications – Should the RCT demonstrate effectiveness, then the intervention is an obvious candidate for implementation as a whole school approach. Originality/value – Successful intervention with one teacher potentially benefits every child that they subsequently teach and may increase the inclusion of socio-economically deprived children living in challenging circumstances in mainstream education. © Emerald Group Publishing Limited.National Institute for Health Research (NIHR

Possible expansion of Ixodes ricinus in the United Kingdom identified through the Tick Surveillance Scheme between 2013 and 2020

The tick Ixodes ricinus (Ixodida: Ixodidae, Linnaeus) is the main vector of several pathogens including Borrelia burgdorferi s.l. (agent of Lyme borreliosis) and tick-borne encephalitis virus. Its distribution depends on many factors including suitable habitat, climate and presence of hosts. In this study, we present records of I. ricinus bites on humans, dogs (Canis lupus familiaris; Carnivora: Canidae, L.) and cats (Felis catus; Carnivora: Felidiae, L.) in the United Kingdom (UK) obtained through the Tick Surveillance Scheme between 2013 and 2020. We divided the UK into 20 km x 20 km grids and 9.2% (range 1.2%–30%) of grids had at least one record every year since 2013. Most regions reported a yearly increase in the percentage of grids reporting I. ricinus since 2013 and the highest changes occurred in the South and East England with 5%–6.7% of new grids reporting I. ricinus bites each year in areas that never reported ticks before. Spatiotemporal analyses suggested that, while all regions recorded I. ricinus in new areas every year, there was a yearly decline in the percentage of new areas covered, except for Scotland. We discuss potential drivers of tick expansion, including reforestation and increase in deer populations