Admission to psychiatric hospital for mental illnesses 2 years prechildbirth and postchildbirth in Scotland: a health informatics approach to assessing mother and child outcomes

Objective: To identify factors associated with: admission to a specialist mother and baby unit (MBU) and the impact of perinatal mental illness on early childhood development using a data linkage approach in the 2 years prechildbirth and postchildbirth. Methods: Scottish maternity records (SMR02) were linked to psychiatric hospital admissions (SMR04). 3290 pregnancy-related psychiatric admissions for 1730 women were assessed. To investigate factors associated with MBU admission, the group of mothers admitted to an MBU were compared with those admitted to general psychiatric wards. To assess the impact of perinatal mental illness on early child development, a pragmatic indicator for ‘at potential risk of adversity’, defined as a child who was recorded as requiring intensive treatment at any time under the health plan indicators (HPI) and/or who had no record of completing three doses of the 5-in-1 vaccine by 12 months was generated. Logistic regression models were used to describe the association between each variable and the risk of admission between those with a history of prior psychiatric admission and those without. Results Women admitted to an MBU were significantly more likely to be admitted with non-affective psychosis (OR=1.97, 95% CI 1.22 to 3.18), affective psychosis (OR=2.44, 95% CI 1.37 to 4.33) and non-psychotic depressive episodes (OR=1.93, 95% CI 1.42 to 2.63). They were less likely to come from deprived areas (OR=0.68 95% CI 0.49 to 0.93). Women with a previous history of psychiatric admission were significantly more likely to be located in the two most deprived quintiles. Almost one-third (29%) of children born to mothers with a pregnancy-related psychiatric admission were assessed as ‘at potential risk of adversity.’ Conclusions: A health informatics approach has potential for improving understanding of social and clinical factors, which contribute to the outcomes of perinatal mental illness, as well as potential adverse developmental outcomes for offspring

The curious case of blended learning: an evaluation of a curriculum innovation in the global mental health Master’s programme

Background: This study aimed to evaluate students’ satisfaction, perceived utility and engagement with a range of Blended Learning (BL) resources, in the context of the staged introduction of BL within the MSc Global Mental Health Programme. Methods: A descriptive mixed methods design was employed. An electronic questionnaire was completed by 18 (90%) of the enrolled on-campus students. Eight of them opted to participate in a collaborative workshop aiming to corroborate and expand upon the questionnaire findings, and generate ideas for optimising the BL components. Results: Overall, students were satisfied with the quantity and usefulness of the BL materials. Specifically, the easy access to, and diversity of, learning activities were recognised as instrumental in stimulating innovative ways of thinking, in addition to improving subject-specific knowledge. Students starkly diverged according to their reported use of materials as the foundation of independent study as well as perceptions of the difficulty level of the modules. Students reported lacking the confidence and knowledge regarding integrating the breadth of learning resources effectively to support their learning. Collaboratively, the students helped generate actionable programmatic changes aimed at improving the curriculum cohesion and enhancing learner engagement. Conclusion: Systematic evaluation of the initial stages of BL is critical. This study demonstrated the complexities of the staged introduction of BL in terms of ensuring learning efficiency, student satisfaction, learner development and programme cohesion. This study enabled the identification of strategic and feasible high-impact areas for optimising BL, and transforming them into stages of change

Staged Introduction of Blended Learning – To Blend or Not to Blend?

The Master’s Degree in Global Mental Health (GMH) is in its sixth year as an on-campus course and in its second year as an online distance learning (ODL) course. A significant review of ILOs, course content, Moodle resource, the role of graduate attributes and assessment types was undertaken prior to the 2017/18 launch. The optimisation of agility and cohesion between Programmes has provided an opportunity to introduce blended learning materials for the on-campus students as a means of supporting learning. With the introduction of blended learning into the on-campus course we wish to ensure that it is embedded robustly, efficiently and effectively

Using Primary Sources in Content Areas to Increase Disciplinary Literacy Instruction

This paper describes how a three-day summer workshop on using primary sources helped teachers increase the emphasis placed on disciplinary literacy when teaching social studies and history. Two specific issues in teacher education and practice are addressed. First, increasing teachers’ content knowledge of history topics can help them plan lessons that connect local and global events. Second, content area reading requires literacy practices, which are unique to disciplines. Therefore, teachers need to apply historical inquiry and disciplinary literacy methods in the curriculum

Repositioning psychiatry in medical school curricula: a study of medical students’ attitudes

Amidst the ongoing global recruitment crisis in psychiatry there are compelling reasons to rethink the approach to, and the content and structure of, educational and experiential opportunities for medical students and foundation doctors. Medical students’ attitudes to mental illness and psychiatry have been a topic of interest for many decades. The literature identifies the undergraduate years as pivotal in the formation of attitudes towards psychiatry and it has been suggested that medical students’ attitudes towards psychiatry worsen as they progress through undergraduate education. The aim of this study was to explore University of Glasgow medical students’ attitudes towards psychiatry and possible reasons for not choosing psychiatry as a viable career option. An electronic survey was emailed to all medical students in October 2017. A response rate of 24.5% (N=324) was achieved which was representative across year groups one to five. The findings identified generally positive attitudes towards psychiatry as a specialty. However, year group analysis demonstrated a declining level of interest in pursuing psychiatry as a career choice. Negative attitudes towards psychiatry clustered in common themes, namely: stigmatised views about psychiatry and people with mental illness; perceived limited exposure to psychiatry in the curriculum and for experiential learning opportunities. This paper proposes that enhanced coverage of, and exposure to, psychiatry in undergraduate and postgraduate training may provide avenues into reducing negative attitudes towards psychiatry within medicine. This in turn may support national campaigns to 'rebrand' psychiatry and reinvigorate the psychiatry core trainee (CT) supply chain

Identifying health inequalities in individuals with major mental illness (MMI) using routine data

Abstract and Summary of Thesis: Background: Individuals with Major Mental Illness (such as schizophrenia and bipolar disorder) experience increased rates of physical health comorbidity compared to the general population. They also experience inequalities in access to certain aspects of healthcare. This ultimately leads to premature mortality. Studies detailing patterns of physical health comorbidity are limited by their definitions of comorbidity, single disease approach to comorbidity and by the study of heterogeneous groups. To date the investigation of possible sources of healthcare inequalities experienced by individuals with Major Mental Illness (MMI) is relatively limited. Moreover studies detailing the extent of premature mortality experienced by individuals with MMI vary both in terms of the measure of premature mortality reported and age of the cohort investigated, limiting their generalisability to the wider population. Therefore local and national data can be used to describe patterns of physical health comorbidity, investigate possible reasons for health inequalities and describe mortality rates. These findings will extend existing work in this area. Aims and Objectives: To review the relevant literature regarding: patterns of physical health comorbidity, evidence for inequalities in physical healthcare and evidence for premature mortality for individuals with MMI. To examine the rates of physical health comorbidity in a large primary care database and to assess for evidence for inequalities in access to healthcare using both routine primary care prescribing data and incentivised national Quality and Outcome Framework (QOF) data. Finally to examine the rates of premature mortality in a local context with a particular focus on cause of death across the lifespan and effect of International Classification of Disease Version 10 (ICD 10) diagnosis and socioeconomic status on rates and cause of death. Methods: A narrative review of the literature surrounding patterns of physical health comorbidity, the evidence for inequalities in physical healthcare and premature mortality in MMI was undertaken. Rates of physical health comorbidity and multimorbidity in schizophrenia and bipolar disorder were examined using a large primary care dataset (Scottish Programme for Improving Clinical Effectiveness in Primary Care (SPICE)). Possible inequalities in access to healthcare were investigated by comparing patterns of prescribing in individuals with MMI and comorbid physical health conditions with prescribing rates in individuals with physical health conditions without MMI using SPICE data. Potential inequalities in access to health promotion advice (in the form of smoking cessation) and prescribing of Nicotine Replacement Therapy (NRT) were also investigated using SPICE data. Possible inequalities in access to incentivised primary healthcare were investigated using National Quality and Outcome Framework (QOF) data. Finally a pre-existing case register (Glasgow Psychosis Clinical Information System (PsyCIS)) was linked to Scottish Mortality data (available from the Scottish Government Website) to investigate rates and primary cause of death in individuals with MMI. Rate and primary cause of death were compared to the local population and impact of age, socioeconomic status and ICD 10 diagnosis (schizophrenia vs. bipolar disorder) were investigated. Results: Analysis of the SPICE data found that sixteen out of the thirty two common physical comorbidities assessed, occurred significantly more frequently in individuals with schizophrenia. In individuals with bipolar disorder fourteen occurred more frequently. The most prevalent chronic physical health conditions in individuals with schizophrenia and bipolar disorder were: viral hepatitis (Odds Ratios (OR) 3.99 95% Confidence Interval (CI) 2.82-5.64 and OR 5.90 95% CI 3.16-11.03 respectively), constipation (OR 3.24 95% CI 3.01-3.49 and OR 2.84 95% CI 2.47-3.26 respectively) and Parkinson’s disease (OR 3.07 95% CI 2.43-3.89 and OR 2.52 95% CI 1.60-3.97 respectively). Both groups had significantly increased rates of multimorbidity compared to controls: in the schizophrenia group OR for two comorbidities was 1.37 95% CI 1.29-1.45 and in the bipolar disorder group OR was 1.34 95% CI 1.20-1.49. In the studies investigating inequalities in access to healthcare there was evidence of: under-recording of cardiovascular-related conditions for example in individuals with schizophrenia: OR for Atrial Fibrillation (AF) was 0.62 95% CI 0.52 - 0.73, for hypertension 0.71 95% CI 0.67 - 0.76, for Coronary Heart Disease (CHD) 0.76 95% CI 0.69 - 0.83 and for peripheral vascular disease (PVD) 0.83 95% CI 0.72 - 0.97. Similarly in individuals with bipolar disorder OR for AF was 0.56 95% CI 0.41-0.78, for hypertension 0.69 95% CI 0.62 - 0.77 and for CHD 0.77 95% CI 0.66 - 0.91. There was also evidence of less intensive prescribing for individuals with schizophrenia and bipolar disorder who had comorbid hypertension and CHD compared to individuals with hypertension and CHD who did not have schizophrenia or bipolar disorder. Rate of prescribing of statins for individuals with schizophrenia and CHD occurred significantly less frequently than in individuals with CHD without MMI (OR 0.67 95% CI 0.56-0.80). Rates of prescribing of 2 or more anti-hypertensives were lower in individuals with CHD and schizophrenia and CHD and bipolar disorder compared to individuals with CHD without MMI (OR 0.66 95% CI 0.56-0.78 and OR 0.55 95% CI 0.46-0.67, respectively). Smoking was more common in individuals with MMI compared to individuals without MMI (OR 2.53 95% CI 2.44-2.63) and was particularly increased in men (OR 2.83 95% CI 2.68-2.98). Rates of ex-smoking and non-smoking were lower in individuals with MMI (OR 0.79 95% CI 0.75-0.83 and OR 0.50 95% CI 0.48-0.52 respectively). However recorded rates of smoking cessation advice in smokers with MMI were significantly lower than the recorded rates of smoking cessation advice in smokers with diabetes (88.7% vs. 98.0%, p<0.001), smokers with CHD (88.9% vs. 98.7%, p<0.001) and smokers with hypertension (88.3% vs. 98.5%, p<0.001) without MMI. The odds ratio of NRT prescription was also significantly lower in smokers with MMI without diabetes compared to smokers with diabetes without MMI (OR 0.75 95% CI 0.69-0.81). Similar findings were found for smokers with MMI without CHD compared to smokers with CHD without MMI (OR 0.34 95% CI 0.31-0.38) and smokers with MMI without hypertension compared to smokers with hypertension without MMI (OR 0.71 95% CI 0.66-0.76). At a national level, payment and population achievement rates for the recording of body mass index (BMI) in MMI was significantly lower than the payment and population achievement rates for BMI recording in diabetes throughout the whole of the UK combined: payment rate 92.7% (Inter Quartile Range (IQR) 89.3-95.8 vs. 95.5% IQR 93.3-97.2, p<0.001 and population achievement rate 84.0% IQR 76.3-90.0 vs. 92.5% IQR 89.7-94.9, p<0.001 and for each country individually: for example in Scotland payment rate was 94.0% IQR 91.4-97.2 vs. 96.3% IQR 94.3-97.8, p<0.001. Exception rate was significantly higher for the recording of BMI in MMI than the exception rate for BMI recording in diabetes for the UK combined: 7.4% IQR 3.3-15.9 vs. 2.3% IQR 0.9-4.7, p<0.001 and for each country individually. For example in Scotland exception rate in MMI was 11.8% IQR 5.4-19.3 compared to 3.5% IQR 1.9-6.1 in diabetes. Similar findings were found for Blood Pressure (BP) recording: across the whole of the UK payment and population achievement rates for BP recording in MMI were also significantly reduced compared to payment and population achievement rates for the recording of BP in chronic kidney disease (CKD): payment rate: 94.1% IQR 90.9-97.1 vs.97.8% IQR 96.3-98.9 and p<0.001 and population achievement rate 87.0% IQR 81.3-91.7 vs. 97.1% IQR 95.5-98.4, p<0.001. Exception rates again were significantly higher for the recording of BP in MMI compared to CKD (6.4% IQR 3.0-13.1 vs. 0.3% IQR 0.0-1.0, p<0.001). There was also evidence of differences in rates of recording of BMI and BP in MMI across the UK. BMI and BP recording in MMI were significantly lower in Scotland compared to England (BMI:-1.5% 99% CI -2.7 to -0.3%, p<0.001 and BP: -1.8% 99% CI -2.7 to -0.9%, p<0.001). While rates of BMI and BP recording in diabetes and CKD were similar in Scotland compared to England (BMI: -0.5 99% CI -1.0 to 0.05, p=0.004 and BP: 0.02 99% CI -0.2 to 0.3, p=0.797). Data from the PsyCIS cohort showed an increase in Standardised Mortality Ratios (SMR) across the lifespan for individuals with MMI compared to the local Glasgow and wider Scottish populations (Glasgow SMR 1.8 95% CI 1.6-2.0 and Scotland SMR 2.7 95% CI 2.4-3.1). Increasing socioeconomic deprivation was associated with an increased overall rate of death in MMI (350.3 deaths/10,000 population/5 years in the least deprived quintile compared to 794.6 deaths/10,000 population/5 years in the most deprived quintile). No significant difference in rate of death for individuals with schizophrenia compared with bipolar disorder was reported (6.3% vs. 4.9%, p=0.086), but primary cause of death varied: with higher rates of suicide in individuals with bipolar disorder (22.4% vs. 11.7%, p=0.04). Discussion: Local and national datasets can be used for epidemiological study to inform local practice and complement existing national and international studies. While the strengths of this thesis include the large data sets used and therefore their likely representativeness to the wider population, some limitations largely associated with using secondary data sources are acknowledged. While this thesis has confirmed evidence of increased physical health comorbidity and multimorbidity in individuals with MMI, it is likely that these findings represent a significant under reporting and likely under recognition of physical health comorbidity in this population. This is likely due to a combination of patient, health professional and healthcare system factors and requires further investigation. Moreover, evidence of inequality in access to healthcare in terms of: physical health promotion (namely smoking cessation advice), recording of physical health indices (BMI and BP), prescribing of medications for the treatment of physical illness and prescribing of NRT has been found at a national level. While significant premature mortality in individuals with MMI within a Scottish setting has been confirmed, more work is required to further detail and investigate the impact of socioeconomic deprivation on cause and rate of death in this population. It is clear that further education and training is required for all healthcare staff to improve the recognition, diagnosis and treatment of physical health problems in this population with the aim of addressing the significant premature mortality that is seen. Conclusions: Future work lies in the challenge of designing strategies to reduce health inequalities and narrow the gap in premature mortality reported in individuals with MMI. Models of care that allow a much more integrated approach to diagnosing, monitoring and treating both the physical and mental health of individuals with MMI, particularly in areas of social and economic deprivation may be helpful. Strategies to engage this “hard to reach” population also need to be developed. While greater integration of psychiatric services with primary care and with specialist medical services is clearly vital the evidence on how best to achieve this is limited. While the National Health Service (NHS) is currently undergoing major reform, attention needs to be paid to designing better ways to improve the current disconnect between primary and secondary care. This should then help to improve physical, psychological and social outcomes for individuals with MMI

Attitudes and Knowledge of Electroconvulsive Therapy (ECT): An Exploration of Medical Students’ Perspectives

Aims: We aim to explore knowledge and attitudes of medical students, before and after exposure to an online teaching session about ECT. Background: Adequate knowledge of electroconvulsive therapy (ECT) is essential for medical students; however, the effectiveness of the teaching delivered is not frequently studied. Methods: 4th and 5th year medical students at one Scottish University were provided with an online questionnaire before and after the ECT teaching session was delivered. The online teaching session involved going through learning resources which were created by a multi-disciplinary team who specialize in ECT. The questionnaire contained three sections: demographics, knowledge of ECT, and attitudes towards ECT. The knowledge and attitude sections were scored with a Likert questionnaire. Changes in scores were analyzed using descriptive analysis. Results: 67 students attended the online teaching session. Response rate to the pre-course questionnaire was 68.7% (n=46) and the post-course questionnaire was 44.8% (n=30). In the pre-course questionnaire, medical students who had personal experience with mental illness (loved-one or self) tended to have more positive attitudes towards ECT and higher knowledge scores. 9 students had no knowledge of ECT. In the pre-course questionnaire, 32.6% (n=15) thought that ECT did not cause a seizure. A statistically significant increase in knowledge and attitude scores were found in the post-course questionnaire. Conclusions: Medical students should be taught about ECT during their psychiatric placement to improve knowledge and attitudes surrounding ECT. The online teaching session appeared to increased knowledge and improved attitudes towards ECT in this cohort of student

Equality, Diversity and Inclusion in Global Mental Health: a Human Library Reading Event

Stigma, discrimination, and social exclusion across cultural settings are among the greatest barriers to achieving equitable healthcare globally. Students on the Mental Health and Disability: International Law and Policy course explore ways of minimising stigma and discrimination. They also learn about mental health legislation and policies based on core equality and inclusivity principles. Given that the pillars of the MVLS Education Strategy are underpinned by the core values of equality, diversity, inclusion, integrity, and respect, (https://www.gla.ac.uk/media/Media_842672_smxx.pdf ) the Global Mental Health (GMH) Team aimed to introduce a novel and innovative means of embedding these concepts into the curriculum. With funding from the MVLS College Equality Diversity and Inclusion (EDI) Committee we hosted a learning facilitated by the Human Library. The Human Library Organisation (https://humanlibrary.org) provides an international learning platform that enables safe and confidential dialogue between volunteers representing a stigmatised group (i.e. ‘Books’) and learners (i.e. ‘Readers’). Drawing on personal experience Books answer questions put to them by small groups of Readers, helping to challenge stereotypes and stigmatising beliefs. The session aims to encourage those attending to ‘unjudge someone’. The event was held on the 1st of March 2023 and around 20 students attended. Six Books and Three Librarians engaged in the session with diversity areas including: mental illness, religion, physical disability, gang membership, survivor of abuse, transgender and eating disorder. Feedback from students who completed the evaluation questionnaire was very positive. With 94% (15/16) either strongly agreeing or agreeing that the event was informative and made them reflect on their personal views. One student reported: ‘I thoroughly enjoyed this event. I had never heard of this organization before and I think that it is an incredible concept. This was easily one of my favorite class days. I can't think of anything in particular that could've been done better.

Delivering the first internationally accessible Massive Online Open Course (MOOC) on suicide prevention: a case study and insights into best practice

To date, little guidance exists on how to design safe and effective online programming on sensitive and/or controversial topics. Massive online open courses (MOOCs) represent a unique opportunity for delivering inclusive and accessible teaching to international learner audiences. This paper provides an insight into designing and delivering the first internationally accessible MOOC on suicide prevention in the global context in 2019-highlighting insights into best practice as well as pertinent challenges. The results from two runs of this MOOC indicate that there appears to be a global demand for education on suicide prevention. Our practice suggests that new knowledge on extremely sensitive topics such as suicide can be safely and effectively delivered through a MOOC to an international community of learners. Learner safety needs to be carefully considered when developing and delivering online learning. Thorough and careful moderation is essential to ensure that learners engage safely and sensitively with the content and with one another. The involvement of diverse stakeholders, including people with lived experience, in the MOOC design is recommended to enhance the authenticity, inclusiveness and rigour of the curriculum

Designing a Massive Open Online Course (MOOC): Understanding Suicide and Suicide Prevention Strategies in a Global Context. Findings from the March and Sep 2019 runs

Introduction: Suicide prevention is a global public health challenge. Increasing evidence-based knowledge and understanding of suicide needs to be central to suicide prevention efforts worldwide. We aimed to design a 3 week Massive Open Online Course (MOOC) to allow students to gain a broader understanding of suicide as a global issue. Methods: A multidisciplinary team of psychiatrists, psychologists, suicide researchers, people with lived experience and digital learning technologists developed the educational content. To ensure a safe learning environment, the World Health Organisation (WHO) guidelines on safe reporting of suicides was adhered to. Self–care activities were embedded throughout each week of the MOOC and wellbeing resources were signposted at the end of each step. Once the draft MOOC was completed, extensive consultation occurred. External feedback was obtained from a range of key stakeholders and a number of organisations were approached for endorsement or accreditation. Five teaching assistants were employed to aid course moderation. Results/Discussion: The MOOC launched in March and September 2019 with five organisational endorsements and one accreditation. Over 3,000 students engaged in the MOOC with 4,410 discussion comments. Student discussions were monitored by staff. The MOOC appeared to have a global reach with 51% of learners residing in the UK, 5% in Australia, 4% in the United States, 3% in Mexico, 2% in Canada, India and China and 1% in Russia and Saudi Arabia. Completion data from 276 learners reported that 93.5% (n=258) felt the course met or exceeded expectations and 95.7% (n=264) reported new learning. Conclusion: There appears to be a global demand for education on suicide prevention. Early outcome data suggested that new knowledge can be delivered through a MOOC. Learner safety needs to be carefully considered when developing and delivering online learning. Thorough and careful moderation is essential to ensure that learners engage safely with the content