Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive suboptimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (N=22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data was transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioral therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach

A three-phased model to support the design and development of core competency education for liaison mental health clinicians

Purpose This paper aims to provide an insight into the design, development and delivery proposals for a first of its kind “Liaison Mental Health Training Programme”. In the UK, there has been a significant investment in Liaison Mental Health Services and an expansion of the workforce (NHS England, 2016). However, the complexity and varied presentations of patients who attend to acute physical health services now requires a dedicated strategy to address any skills deficit in the mental health liaison workforce and to support core competency development (DOH, 2016). Design/methodology/approach This paper provides an overview of preparations to develop a regional educational pilot programme using a three-phased model: Phase 1 – Review of policy and best practice guidelines; Phase 2 – Stakeholder Data Collection; and Phase 3 – Synthesis and Development. Findings An insight into the developmental processes undertaken to shape a core competency liaison mental health training programme is presented. Additionally, the authors provide insight into educational theory and an overview of the LMH Core Competency Curricula. Practical implications This paper provides the reader with an insight into our findings and a focussed core competency training model for those working within LMH services. This programme development was reviewed throughout by both those using LMH services and the LMH practitioners working within them, ensuring the curriculum proposed was endorsed by key stakeholders. The three-phased model has transferable benefits to other training development initiatives. Originality/value To the best of the authors’ knowledge, this training is the first of its kind in the UK and addresses the education of essential core competencies of a regional liaison mental health workforce. The collaboration of clinical and academic expertise and model of co-production makes this endeavour unique

Meeting the needs of people with complex emotional needs: what's wrong with genericism in the mental health nursing curriculum?

OBJECTIVES: In this presentation we take a critical stance to the current Nursing & Midwifery Council (NMC) standards underpinning nurse education and consider their potential impact upon the future of mental health nursing care for people with Complex Emotional Needs (CEN) in the UK. BACKGROUND: Over the years, Mental Health Nursing as a profession, has fallen foul of controversy and criticism; and rightly, its most vocal critics are amongst those to whom we deliver care. In 2018, the NMC introduced new standards for nurse education, framed as developing future Mental Health Nurses with a more holistic skillset. Widespread dissatisfaction, however, is felt by Mental Health Nurse Academics who feel mental health nursing content has been diluted and that the preparation of new mental health nurse graduates has shifted from relational understanding and psycho-social skills development, towards a biomedical focus. METHOD: As a collective of Nurse Academics, we acknowledge that changes to mental health nursing care are warranted. This presentation critically examines how the recent changes to the education standards underpinning mental health nurse education in the UK prioritise procedural-based, often redundant, physical health interventions and skills above mental health nursing-specific knowledge / skills needed to work effectively with people who are distressed. We argue that University curricula and practice assessment documents underpinned by the current education standards, undervalue the mental health nursing skills and qualities required to effectively support people with CEN. RESULTS: As a consequence of this foundational shift in the NMC standards, and without any focus of meeting the needs of people with CEN, we predict poorer outcomes and experiences for people with this demographic. LIMITATIONS: Service Users have not been involved in the development or presentation of this conceptual argument, however by bringing this debate to colleagues with Lived and Occupational Experience, we argue for solidarity and collective action. CONCLUSIONS & IMPLICATIONS FOR PRACTICE: This current period marks a critical time for the mental health nurse profession and the people we work with. Collective action and innovations are required to bridge the gaps, especially if we are to better meet the needs of people with CEN

Can an interactive e-learning training package improve the understanding of Personality Disorder within mental health professionals?

Purpose -Personality disorder is reported to elicit strong emotional responses and negative attitudes in mental health staff (Bodner et al., 2015). The purpose of this paper is to provide an overview of the design and development of a co-produced e-learning training package for personality disorder awareness and an evaluation of its effectiveness. This study was carried out to explore if e-learning is an effective mode of training delivery for raising personality disorder awareness. Design/methodology/approach - The e-learning was uniquely developed by subject matter experts working in co-production with people with lived experience. Self-reported measures were completed at three separate intervals to evaluate the effectiveness of the training: at pre-, post- and three-month follow up. Quantitative data were collected via these questionnaires. Findings - The results from this evaluation show that e-learning is an effective mode of delivery for raising the awareness of personality disorder among mental health professionals, achieving similar outcomes to those reported following face-to-ace training. Research limitations/implications - Attrition at follow-up phase was high which was consistent with other similar studies. The evaluation was led by the lead contributors and in the geographical area of its development. The study was relatively small and the participants were self-selected, therefore findings should be treated with caution. Practical implications - E-learning can provide flexible training to compliment and act as an alternative to face-to-face personality disorder training. E-learning may provide an alternative refresher course to knowledge and understanding framework or other face-to-face methods. Co-produced training can be mirrored within an e-learning programme, careful planning to ensure the service user voice is heard and that their lived experience is embraced is required. Originality/value - This is the first evaluation of a co-produced e-learning only personality disorder awareness training

Psychosocial support for healthcare workers during the COVID-19 pandemic

The novel corona virus disease COVID-19 was first diagnosed in humans in Wuhan, China in December 2019. Since then it had become a global pandemic. Such a pandemic leads to short- and long-term mental health burden for healthcare workers. Recent surveys suggest that rates of psychological stress, depression, anxiety, and insomnia and will be high for this group. Numerous organizations have since released guidance on how both healthcare workers and the general public can manage the mental health burden. However, these recommendations focus on specific healthcare workers (e.g., nurses or psychologists), are often not evidence-based, and typically do not situate guidance within a phased model that recognizes countries are at different stages of the COVID-19 pandemic. In this perspective paper we propose a phased model of mental health burden and responses. Building on work by the Intensive Care Society and the Royal College of Psychiatrists in the United Kingdom, we present a model that demonstrates how both staff and organizations might respond to the likely stressors that might occur at preparation-, pre-, initial and core-, and longer-term-phases of the pandemic. Staff within countries at different stages of the COVID-19 pandemic will be able to use this model. We suggest practical tips for both healthcare workers and organizations and embed this within up-to-date scientific literature. The phased model of mental health burden and responses can be a helpful guide for both staff and organizations operating at different stages of the pandemic

A qualitative study of the label of personality disorder from the perspectives of people with lived experience and occupational experience

Purpose: The label ‘Personality Disorder’ continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by critical practitioners and academics are tempered by acknowledgement of certain positive social consequences of obtaining a diagnosis. As such, it is opportune to engage service users and staff in a process of inquiry to better understand the complexities of views on the terminology of Personality Disorder. Design / Methodology / Approach: This study set out to qualitatively explore the views of a range of people with lived, occupational and dual lived experience / occupational expertise, relating to the diagnostic label of Personality Disorder, via participatory and critical group debate. The World Café approach is an innovative methodology for participatory inquiry into subjective views suited to exploring contested subject matter. Findings: This study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words ‘personality’ and ‘disorder’ are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered. Originality: This study brings together a wide range of views and experiences of mental health professionals, individuals lived experience and those who align to both lived and occupational expertise. A safe space was provided via the uniquely co-produced world café research event to bring together discussion and debates from mixed perspectives makes this a novel study. The focus being on perspectives towards contested language, labelling and social impact adds to scholarship in this field Research / Practical / Social Implications: The findings have potential to contribute to ongoing critical debate regarding the value of the Personality Disorder construct in the provision of care and support. Specific emphasis upon the relational framing of care provision offers a means to ameliorate some of the negative impacts of terminology. Perspectives are influenced in the way the label understood hence attention is required to enhance these processes in clinical practice. There is much more work required to overcome stigmatisation, prejudice, and lack of knowledge and understanding. Further research identifying means for challenging stigma and the factors contributing to positive clinical interactions are required

Care giving and receiving for people with complex emotional needs within a crisis resolution/home treatment setting: A qualitative evidence synthesis

Background: A growing body of qualitative evidence focusing upon the experiences of care within Crisis Resolution/Home Treatment (CRHT) is emerging, however, a firm evidence-base regarding both the giving and receiving of care for those with complex emotional needs (CEN) in this context is yet to be established. Objective: A qualitative evidence synthesis was used to develop a comprehensive understanding of how crisis care for people with CEN is experienced by both those giving and receiving care, within the context of CRHT. Method: Findings from 19 research papers considering both clinician and service users’ experiential accounts of CRHT were synthesised using meta-ethnography. Findings: Both the giving and receiving of care within a CRHT context was experienced across four related meta-themes: ‘contextual’, ‘functional’, ‘relational’ and ‘decisional’. Discussion: Service user accounts focused upon relational aspects, highlighting a significance to their experience of care. Meanwhile, clinicians focused more upon contextual issues linked to the management of organisational anxieties and resources. For those with CEN, a clinician’s focus upon risk alone highlighted power differentials in the caring relationship. Conclusions: There is a need for nurses to connect with the experience of the person in crisis, ensuring a better balance between contextual issues and relational working

Can a carer (peer) led psychoeducation programme improve mental health carers well-being, reduce burden and enrich empowerment: a service evaluation study

Purpose: Carers of people with mental health problems present with high levels of burden, poor mental wellbeing and feelings of disempowerment by mental health services. The aim of this study was to establish whether providing a psychoeducation skills programme for carers would lead to an improvement of mental wellbeing, reduce the levels of burden that carers sometimes feel in caring for someone with mental illness, and also to increase empowerment. This paper provides a service evaluation study of an innovative carer led psychoeducational intervention that was undertaken. Design/ Methodology/ Approach: This programme was initiated and led by a carer who had themselves experienced a lack of service provision to support carers and families in understanding and caring for a relative with severe and enduring mental health diagnoses. A model of co-production was adopted with the carer who led this initiative working closely with an occupational therapist and consultant psychologist in its development and delivery. Data was collected to measure the impact of the training at 5 different time points. The measures employed to measure outcomes were the Warwick- Edinburgh Mental Well-Being Scale (WEMWEBS), the Burden Assessment Scale (BAS) and Family Empowerment Scale (FES). Findings: Results indicated improved well-being, reduced burden and increased family empowerment in carers who completed this peer led carer initiative psychoeducational programme. Research Limitations/ Implications: This service evaluation study was conducted in a single site and in the site in which it was developed. The carer consultant who led this evaluation and development of the intervention was also the peer worker who delivered the interventions. Hence, we are unable to ascertain if the results reported are unique to the individual peer worker. The transferability of this programme and generalisability of the result should therefore be treated with caution and further replication of this model and research is required. This would be beneficial to be conducted in an alternative site from where it was developed, delivered by different facilitators and include a control group. Practical Implications: The evidence from this study indicates that carers are able and willing to attend a group psychoeducational programme. The high number of referrals to the programme in a relatively short timeframe, indicates that there is significant demand for such a service. Implementation of the programme is relatively straight forward. The key challenges for practical implementation are to have the of Mental Health Training, Education and Practiceright carer to lead and deliver the programme, and the right support system in place for them (financial and supervision). Co-production also is not without challenges, the peer worker and occupational staff need to ensure mutually valued and respected working relationship develop. Originality Value: This is the first evaluation of the impact of a carer led psychoeducation intervention for carers of people with mental health difficulties in secondary mental health services

Associations between social media use and loneliness in a cross-national population: Do motives for social media use matter?

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http:// creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: We aimed to examine the association between social media use and loneliness two years after the COVID-19 pandemic outbreak. Methods: Participants were 1649 adults who completed a cross-sectional online survey disseminated openly in Norway, United Kingdom, USA, and Australia between November 2021 and January 2022. Linear regressions examined time spent on social media and participants’ characteristics on loneliness, and interactions by motives for social media use. Results: Participants who worried more about their health and were younger, not employed, and without a spouse or partner reported higher levels of loneliness compared to their counterparts. More time spent on social media was associated with more loneliness (β = 0.12, p < 0.001). Three profile groups emerged for social media use motives: 1) social media use motive ratings on avoiding difficult feelings higher or the same as for maintaining contact; 2) slightly higher ratings for maintaining contact; and 3) substantially higher ratings for maintaining contact. Time spent on social media was significant only in motive profile groups 2 and 3 (β = 0.12 and β = 0.14, both p < 0.01). Conclusions: Our findings suggest that people who use social media for the motive of maintaining their relationships feel lonelier than those who spend the same amount of time on social media for other reasons. While social media may facilitate social contact to a degree, they may not facilitate the type of contact sought by those who use social media primarily for this reason.publishedVersio

Self-reported long COVID in the general population: sociodemographic and health correlates in a cross-national sampl

We aimed to gain knowledge of possible sociodemographic predictors of long COVID and whether long COVID was associated with health outcomes almost two years after the pandemic outbreak. There were 1649 adults who participated in the study by completing a cross-sectional online survey disseminated openly in Norway, the UK, the USA, and Australia between November 2021 and January 2022. Participants were defined as having long COVID based on self-reports that they had been infected by COVID-19 and were experiencing long-lasting COVID symptoms. Logistic regression analyses were used to examine possible sociodemographic predictors, and multivariate analysis of variance was used to examine whether long COVID status was associated with health outcomes. None of the sociodemographic variables was significantly associated with reporting long COVID. Having long COVID was associated with higher levels of psychological distress, fatigue, and perceived stress. The effect of long COVID on health outcomes was greater among men than among women. In conclusion, long COVID appeared across sociodemographic groups. People with long COVID reported worsened health outcomes compared to those who had had COVID-19 but without long-term symptoms. Men experiencing long COVID appear to be particularly vulnerable to experiencing poorer health outcomes; health services may pay extra attention to potentially unnoticed needs for support among men experiencing long COVID.publishedVersio