“It’s a matter of building bridges…” – feasibility of a carer involvement intervention for inpatients with severe mental illness

Background Family and friends (carer) involvement in the treatment of people with mental illness is widely recommended. However, the implementation remains poor, especially during hospital treatment, where carers report being excluded from care decisions. Methods We developed structured clinical procedures to maximise carer involvement in inpatient treatment. The aim of this study was to test their feasibility across four inpatient wards in East London and explore experiences of the participants. The intervention was delivered by clinicians (social therapists, nurses and psychiatrists) who were trained by the research team. Thirty patients and thirty carers received the intervention and completed research assessments and qualitative interviews after the intervention. 80% of the patients were followed up after six weeks of admission to complete quantitative questionnaires. Six clinicians were interviewed to explore their views on the intervention. Thematic analysis was used to analyse qualitative data. Results The intervention was found to be feasible to be delivered within the first week of admission in more than a half of the patients (53%) who provided consent. The main reasons why the interventions was not delivered in the remaining 47% of patients included staff or carers not being available, withdrawal of consent from the patient or patient being discharged prior to the intervention. Two themes were identified through thematic analysis. The first captured participant experiences of the intervention as facilitating a three-way collaborative approach to treatment. The second covered how patients’ mental states and practicalities of inpatient care acted as barriers and facilitators to the intervention being implemented. Conclusions Carer involvement in hospital treatment for mental illness is more difficult to implement than is commonly thought. This study has shown that a simple structured approach can facilitate a trialogue and that patients, clinicians and carers appreciate this approach to care. Our intervention provides clear and simple manualised clinical procedures that clinicians can follow. However, even the implementation of such procedures may be challenging in the absence of wider organisational support. The involvement of senior managers and clinical leaders might play a key role in overcoming barriers and support front-line clinicians to prioritise and implement carer involvement

Psychosis or spiritual emergency? A Foucauldian discourse analysis of case reports of extreme mental states in the context of meditation

Meditation is becoming increasingly popular in the West and research on its effects is growing. While studies point to various benefits of meditation on mental and physical health, reports of extreme mental states in the context of meditation have also been published. This study employed Foucauldian discourse analysis to examine how the experience of extreme mental states has been constructed in case reports and what kind of practices were employed to address them. The study analyses how extreme mental states associated with meditation are framed within the scientific literature and how such differential framings may affect the meaning making and help-seeking of persons experiencing these states. A systematic scientific literature search identified 22 case studies of extreme mental states experienced by practitioners of various types of meditation. The analysis suggests a discursive divide between two dominant framings: a biomedical discourse which constructs such experiences as psychiatric symptoms and an alternative discursive, which understands them as spiritual emergencies. Both approaches offered distinct therapeutic avenues. This divide maps onto the disciplinary divides within the mental health field more generally, which may obscure a better understanding of these experiences. However, the two discourses are not necessarily mutually exclusive and authors of three articles chose to blend them for their case reports. A supportive environment could help those experiencing extreme state integrate them into their lives. Our findings encourage collaboration between clinicians, therapists and spiritual teachers in order to make a range of approaches available

“It’s like a charge – either fuses you or burns you out”: an interpretative phenomenological analysis of extreme mental states in meditation context

Meditation, an ancient Eastern spiritual practice, is increasingly being practised in the West where its benefits for mental and physical health have been established. Extreme mental states that can be encountered in the context of meditation have also been reported and often have been labelled as psychosis or spiritual emergency. This study aimed for more nuanced understanding of the phenomena. Interpretative phenomenological analysis was employed to explore the meaning-making of three meditation teachers from different philosophical traditions. The teachers described phenomenology of various extreme mental states, explained their nature according to their traditions and discussed ways of helping persons who experience these. Significance was given to having a spiritual teacher to provide guidance and support. The study highlights the importance of acknowledging the diverse understandings of the phenomena and cultivating a non-judgemental attitude towards it, which could help clinicians and meditation teachers work together to support persons experiencing these

Internet use for social interaction by people with psychosis : a systematic review

People with psychosis (PWP) have difficulties in establishing and maintaining social connections. An earlier systematic review on the use of online social networking (OSN) in psychosis found only 11 studies published before January 2014, but with promising findings. These studies showed no difference in OSN use between PWP and general population. Given the limited number of articles found and the rapid advances in OSN, we carried out an update review to assess evidence on how PWP use OSN. Several electronic databases were searched for the literature published between January 2014 and May 2018. Data from included studies were narratively synthesized. Thirteen additional studies examined the use of OSN in PWP in 2014–2018. Updated evidence confirms that PWP seem to use OSN at least as much as the general population, although only when not acutely unwell. PWP who are younger and have higher education level are more likely to use OSN. There was no evidence of worsening psychological symptoms due to OSN. Some studies showed patient-reported concerns about negative experiences and the inability to identify online social contacts. The use of OSN by PWP is a subject of increasing interest with a rapidly developing evidence base. The frequent use of OSN by PWP and the absence of evidence of symptom worsening are encouraging findings. This would justify the inclusion of OSN among the strategies to reduce social isolation in psychosis. Research methodologies should be improved by developing standardized measures to assess use and associated risks

Additional file 1: of What might affect acceptability of online positive psychology interventions for depression: a qualitative study on patient expectations’

Topic guide. This is the topic guide used in the semi-structured interviews, that includes key questions and suggested probes. (DOCX 60 kb

What might affect acceptability of online positive psychology interventions for depression: a qualitative study on patient expectations'.

BACKGROUND: Positive psychology interventions are brief self-adminstered exercises designed to promote positive emotions, behaviours, or thoughts. They are potentially effective for reducing depression and are considered suitable for online dissemination to people with depression and related conditions, as they are assumed to be more acceptable than traditional symptom-focused approaches. However, there is little investigation into perceived acceptability and potential factors that might affect it. This might limit the development and evaluation of effective interventions. METHODS: Semi-structured interviews with patients with depression and/or anxiety (n = 18) and professionals, including GPs and psychologists (n = 5) were conducted on their perceptions of a proposed online intervention using positive psychology. Thematic analysis, according to Braun and Clarke, was used to identify meaningful patterns in the data. RESULTS: Four key themes were identified. The fit between the positive psychological approach and the patient's context, including their personality, symptoms and other treatments, was important in determining acceptability. Social aspects of interventions were thought to facilitate acceptability, as long as these were balanced. Support was identified as important in facilitating intervention suitability, although it was not without limitations. Finally, participants identified how design features can enhance acceptability. CONCLUSIONS: The findings suggest that positive psychology interventions might not be acceptable to all and that specific exercises might be more or less appropriate to deliver online. Design aspects can help to facilitate acceptability, beyond the psychological content. These findings may inform the design of future online psychology interventions for people with depression and anxiety, which can then be evaluated in future research

How to make carer involvement in mental health inpatient units happen: a focus group study with patients, carers and clinicians

United Kingdom National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust