Tackling the inescapable : mental ill health in later life. Report on a series of conversations.

Background to the project Older people with mental health problems (OPMHP) are a sub group of both mental health service users and older people service users. The specific voice OPMHP is therefore diluted within these general groups and there is little evidence to inform our understanding of the experiences of OPMHP. Project aims and objectives This project aimed to engage in conversation with older people who have experienced mental health problems with a view to hearing OPMHP perspectives and identifying priorities for future research. Methodology and methods Twelve people met though contacts with local services and community contacts contributed. Their ages ranged from 52-86 and there were 7 men and 5 women. Six meetings/conversations were held (individually or in small groups) during a three month period April-July 2017. Each conversation built on findings from the previous meeting/conversation. The conversations were shaped by the questions: What does ‘older person’ mean to you? ‘What matters in mental health care for older people’? (Including discussion about what was meant by ‘age appropriate’) and ‘What should be researched’? Conversations about preliminary findings were continued at a feedback event on 3rd July 2017 attended by seven of the contributors. Analysis and Findings The predefined categories ‘older people’, mental health care and age appropriateness’ and ‘research’ shaped the conversations. The older people category found mixed and contradictory ideas about what older person meant. A content analysis of the categories ‘mental health care and age appropriateness’, and ‘research’ was conducted by ‘within’ and ‘across’ analysis of the transcribed notes from the six meetings/conversations and found eight themes: Mutuality, Sensitivity, Carers, Exclusion, Meaning and purpose, Politics, Physical and mental health integration, and Mortality. Discussion Although limitations include: a small number of people, lack of diversity, and took place in only one location, the depth of the discussions was wide ranging. The themes overlapped somewhat but some new insights emerged which are perhaps not well explored in literature or policy. The idea of age appropriateness was confusing and was not defined but was conflated with illness and frailty. There was an emphasis on ageism that is in contrast with mental health policy that does not address the complexity of (indirect) discrimination on the basis of age for OPMH. Conclusion and Next steps Although this report only includes the views of twelve people it raises a number of important issues that are worthy of further exploration. This is particularly important for policy and commissioners who need to progress on the basis of up to date evidence. The consultation will inform development for research proposals and bids following exploratory literature reviews on topics raised

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

Learning the subtle dance: the experience of therapists who deliver mentalisation-based therapy for borderline personality disorder

Objectives: This study aimed to understand therapists’ lived experiences of delivering mentalisation-based therapy (MBT), including their experiences of service user change. / Method: One-to-one semi-structured interviews or focus groups were conducted with 14 MBT therapists and analysed using interpretative phenomenological analysis (IPA). / Results: Four superordinate themes were identified: 1) experiencing the challenges and complexities of being with service users during MBT; 2) being on a journey of discovery and change; 3) being an MBT therapist: a new way of working and developing a new therapeutic identity; and 4) being a therapist in the group: seeing it all come together / Conclusion: Our findings highlight the complexity, challenges and individualised experience of working therapeutically with service users with a diagnosis of BPD. The study provides a perspective of service use change that is enriched by idiosyncrasies within the therapeutic encounter. We conclude with a consideration of implications for MBT research and clinical practice

Self-Reported Long COVID in the General Population: Sociodemographic and Health Correlates in a Cross-National Sample.

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

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

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

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

Motivation and Hesitancies in Obtaining the COVID-19 Vaccine—A Cross-Sectional Study in Norway, USA, UK, and Australia

Background: Vaccinations protect the public against serious diseases or death; however, some individuals are hesitant in obtaining them. We aim to contribute to the understanding of the challenges of vaccination roll-out by examining the motivations, hesitancies, and their associated factors, in obtaining the COVID-19 vaccines two years into the pandemic. Methods: Cross-sectional online surveys were conducted in Norway, the USA, the UK, and Australia (N = 1649). The participants self-reported whether they had obtained one of the COVID-19 vaccines. Those who had obtained a vaccine reported the reason for their motivation, and those who had not obtained a vaccine reported the reason for their hesitancies. Results: More than 80% of the total sample obtained a COVID-19 vaccine because of public health recommendations and trusted that it was safe. Among those who had not obtained one, the most frequent reason was concerns about side effects. Most who obtained the vaccine reported that they believed in science, but many of those who had not obtained one reported distrust. Among those who had not obtained a vaccine, reports of distrust in policies and science were frequent. Concerns about side effects were more common in males and those with lower education, and those living in rural or remote areas. Conclusion: People who endorsed the vaccine believed that the vaccine reduces the risk of illness, protects the health of others, and had trust in scientific vaccination research. Conversely, the most frequent reason for vaccine hesitancy was concerns about side effects, followed by distrust in healthcare and science. These findings could inform public health strategies that aim to increase vaccination rates