Facilitating access to voluntary and community services for patients with psychosocial problems: a before-after evaluation

Background: Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs) facilitating access to voluntary and community sector services for patients with psychosocial problems. Methods: Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated. Results: 108 patients consented to take part in the study. At three-month follow-up, 63 (58%) had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%). Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced. Conclusion: Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems

The barriers, benefits and training needs of clinicians delivering psychological therapy via video

BACKGROUND: Due to the COVID-19 pandemic, mental health services have had to offer psychological therapy via video with little time to prepare or mitigate potential problems. Identifying the barriers, benefits and training needs highlighted by clinicians may support the effective delivery of care. METHOD: Changes in the mode therapy sessions were delivered in during 2020 were assessed in two high-volume psychological therapies services. Sixty-six therapists completed a survey about their experiences of delivering therapy via video. RESULTS: The lockdown in March 2020 precipitated a dramatic shift from face-to-face to telephone and video-delivered sessions. Most clinicians (89%) found video-based sessions acceptable. Barriers to effective delivery included technological issues, problems with online platforms, and feeling more tired after sessions. Benefits included generalised learning from behavioural work, improvements in efficiency and in the therapeutic relationship, particularly in comparison with telephone-based sessions. Tutorials and support guides were recommended to maximise use of sessions via video. CONCLUSIONS: Video-delivered therapy was liked by clinicians and preferred to telephone-based sessions. Issues with platforms, internet connections and access for patients need addressing, local troubleshooting guides, video-based tutorials and greater support for low-intensity therapists to maximise uptake of video sessions where appropriate, may be beneficial

Trends in depression & anxiety symptom severity among mental health service attendees during the COVID-19 pandemic

Background: General population surveys have shown that some groups, particularly young women, experienced increased distress during nationally mandated restrictions to control the spread of COVID-19. However, there has been limited research on such trends among people with pre-existing mental health conditions, leaving mental health services ill equipped to plan for current and future lockdowns. / Methods: Mean weekly scores on the GAD-7 and PHQ-9 between 01/01/2020-22/06/2020 (n=9,538 individuals) for all patients of two psychological treatment services (Improving Access to Psychological Therapies) in London, were compared to mean weekly scores from the same time periods in 2017-2019 (n=37,849). The proportion of scores which were above the clinical thresholds for ‘caseness’ each week were compared, and scores between groups based on gender, age group, and ethnicity, were also compared. / Results: Confirmed community transmission in the UK (26/02/2020-03/03/2020) and the announcement of the national ‘lockdown’ (23/03/2020) were associated with significant increases in anxiety symptom scores. ‘Lockdown’ was associated with a decrease in depression scores. These changes were not maintained during lockdown. Significant increases in depression and anxiety were observed at week 23, as restrictions were eased. / Limitations: This was an exploratory analysis in two services only. Residual confounding and selection biases cannot be ruled out. / Conclusions: Differences in the weekly average symptom scores were short-term; they did not continue throughout ‘lockdown’ as might have been expected, except among older people. Replication of this study in other settings and investigating the potential benefits of more regular reviews or more intensive treatments for at-risk groups, are warranted

A New Interpretation for the Second Peak of T Coronae Borealis Outbursts: A Tilting Disk around a Very Massive White Dwarf

A new interpretation for the second peak of T Coronae Borealis (T CrB) outbursts is proposed based on a thermonuclear runaway (TNR) model. The system consists of a very massive white dwarf (WD) with a tilting accretion disk and a lobe-filling red-giant. The first peak of the visual light curve of T CrB outbursts is well reproduced by the TNR model on a WD close to the Chandrasekhar mass ($M_{\rm WD} \gtrsim 1.35 ~M_\odot$), while the second peak is reproduced by the combination of the irradiated M-giant and the irradiated tilting disk. The derived fitting parameters are the WD mass $M_{\rm WD} \sim 1.35 ~M_\odot$, the M-giant companion mass $M_{\rm RG} \sim 0.7 M_\odot$ ($0.6-1.0 M_\odot$ is acceptable), the inclination angle of the orbit i \sim 70 \arcdeg, and the tilting angle of the disk i_{\rm prec} \sim 35 \arcdeg. These parameters are consistent with the recently derived binary parameters of T CrB.Comment: 6 pages including 2 figures, to be published in ApJ Letter

U Sco 2010 outburst: a new understanding of the binary accretion disk and the secondary star

We present optical and NIR spectroscopic observations of U Sco 2010 outburst. From the analysis of lines profiles we identify a broad and a narrow component and show that the latter originates from the reforming accretion disk. We show that the accretion resumes shortly after the outburst, on day +8, roughly when the super-soft (SSS) X-ray phase starts. Consequently U Sco SSS phase is fueled (in part or fully) by accretion and should not be used to estimate $m_{\mathrm{rem}}$, the mass of accreted material which has not been ejected during the outburst. In addition, most of the He emission lines, and the HeII lies in particular, form in the accretion flow/disk within the binary and are optically thick, thus preventing an accurate abundance determination. A late spectrum taken in quiescence and during eclipse shows CaII H&K, the G-band and MgI b absorption from the secondary star. However, no other significant secondary star features have been observed at longer wavelengths and in the NIR band.Comment: Accepted for publication on A&A. 12 pages and 12 figures (a few are multiple figures