Exploring the experiences of young people with multiplicity

Zarah Eve and Sarah Parry outline the findings of a consultation conducted with young people with multiplicity, a largely misunderstood community. Young people who experience having multiple identities may be diagnosed with Dissociative Identity Disorder (DID) or Other Specified Dissociative Disorder (OSDD) which are treated under mental health services. Eve and Parry argue that the lived experience of young people with multiplicity has been neglected in research and practice, with their voices often unheard and their treatment often unsuitable. They conclude that the voices and experiences of young people with multiplicity need to be carefully considered and centred in further research

Conceptualizing multiplicity spectrum experiences: a systematic review and thematic synthesis

Background: Dissociative identity disorder and depersonalization–derealization have attracted research and clinical interest, facilitating greater understanding. However, little is known about the experience of multiplicity of self outside of traumagenic or illness constructs. Consequently, this systematic review explored how people identifying as having multiple selves conceptualize their experiences and identity. Methods: A comprehensive search of qualitative studies reporting lived experiences of multiplicity was conducted through PsycINFO, PubMed and Scopus (PROSPERO ID: CRD42021258555). Thirteen relevant studies were retrieved (N = 98, 16–64 years, conducted in the United Kingdom, the United States, Hungary and Poland). Results: Using line-by-line thematic synthesis, four analytical themes were developed: multiplicity: disorder versus experience; impact of understanding multiplicity; importance of supporting multiplicity; and continuum of experiences. Discussion: This review highlights heterogeneity within multiplicity-spectrum experiences, emphasizing the need for person-centred, individualized understanding, separate from mental health conceptualizations. Therefore, training in person-centred individualized care to promote self-concept clarity is needed across health, education and social care. This systematic review is the first to synthesize voices of people with lived experience across the multiplicity spectrum, demonstrating how qualitative research can contribute to advancing our understanding of this complex phenomena with the community, acknowledging reciprocal psychosocial impacts of multiplicity and providing valuable recommendations for services

How can teachers support children and young people with unusual sensory experiences at school?

Dr Sarah Parry, Rachel Hughes, Jasmine Lamonby and Zarah Eve explore how teachers can support children and young people who experience 'Unusual Sensory Experiences'. They draw on their research to propose recommendations and signposting for policy and practice

School Employee Sexual Misconduct: Red Flag Grooming Behaviors by Perpetrators

The sexual exploitation of students is a worldwide problem. In the U.S., the problem is three-fold: (1) Ten percent of public school students report being sexually abused by a school employee. (2) There is little in the existing research that identifies and describes the school culture, patterns, and conditions in which educator sexual misconduct occurs. (3) Because no one has systematically documented the school culture and the behaviors and patterns of adults who sexually abuse children in schools, school professionals fail to understand what patterns and behaviors should trigger concern, supervision, investigation, and/or reporting. Stopping sexual misconduct directed toward students means understanding the process that adults use to prepare students to be abused so that they do not tell, do not fight, and acquiesce. This process, called grooming, has the purpose of gaining student trust, as well as the trust of parents and colleagues. This study examines school employee sexual misconduct toward students in school in the United States and is based upon an analysis of 222 cases of school employee sexual misconduct toward a student where a school employee was convicted of student sexual abuse. The findings identify red flag grooming patterns used with students, colleagues, and parents

Take 5 Hub 2021 Report: Service Evaluation of a Community Mental Health Hub for Children and Young People

In 2021, one in ten children require support for mental health challenges. A lack of support for a young person’s mental health can affect educational attainment, and physical and mental health in their future. The case for early intervention in childhood is clear, with up to 75% of adulthood mental health difficulties beginning by 18-years-old and half of adulthood mental health challenges beginning by 14-years-old. However, the recent Future in Mind Report identified that less than 25-35% of young people with a mental health difficulty were engaging with support. Access to help and commissioning inequalities were cited as key barriers. The Take 5 Hub aims to provide improved access to early mental health support with the objective of preventing an escalation of difficulties through evidence-based brief interventions, thus reducing the need for crisis services or specialist statutory services. The Hub has 11 members of staff and supports approximately 600 children and young people (8-18-years-old) to varying degrees of engagement. Over 100 parents/carers are also supported through family support and brief interventions. The Hub adopts an inclusive approach and does not require young people to have a specific diagnosis or meet threshold criteria. Our service evaluation indicates the Hub is benefitting its service users and becoming increasingly embedded in the community, supporting a number of ongoing outreach and collaborative endeavours. The undertakings of the Hub and the lessons they have learnt could inform service design and delivery elsewhere. With their local knowledge and community-centred approach, Hubs can provide an innovative safe space for young people and their families, especially young people who may be less likely to seek help from primary care services. The research team and I have been privileged to conduct this service evaluation, the key themes of which are: The Hub provides a range of support that leads to a reduction in reported psychological distress and improved family function. Waiting times for access to services had also more than halved. As a developing service, the Hub is finding novel ways to become integrated in the community, with further outreach projects in progress to reach ethnic minority groups. Flexible and tailored care for young people and families is being provided through a small cohesive team with anxiety, low mood and anger the most commonly reported challenges. In terms of service audit and evaluation, there are challenges for the Hub in terms of measuring clear ‘problems’ and outcomes, whilst also providing a child-centred, holistic and flexible service. Due to the impact of COVID-19, the Hub has had to adapt its delivery, which has naturally led to setbacks in some areas and rapid developments in others. The importance of staff team ownership, cohesion and collegiate support for creative, responsive service adaptations and delivery are discussed

“Friendly, Local and Welcoming” - Evaluation of a Community Mental Health Early Intervention Service

Purpose: Half of adulthood mental health challenges begin by the age of 14-years-old, making the need for early-intervention clear. This study aims to evaluate a new service model that promotes early-intervention through a community based low-intensity Hub. Design/methodology/approach: Clinical data from 2,384 young people were analysed through within-group, pre- and post-comparisons and qualitative survey, and interview data was analysed through content analysis. Findings: Overall, participants reported that they were highly satisfied with the Hub and the low-intensity brief interventions met their needs. Participants reported that learning new skills, having a place to talk and positive therapeutic relationships were beneficial. The Hub appeared to be less successful for young people with complex mental health difficulties. As a service, the adoption of the Hub model reduced waiting list times by more than half. Research limitations/implications: The quantitative data demonstrated that engaging with the Hub reduced symptoms of psychological distress. Qualitative analyses suggest that access to local, community, welcoming and “less clinical” support was beneficial, and the type of brief interventions offered was less important than therapeutic relationships. Originality/value: This is the first study of a novel “Hub” model for low-intensity brief interventions in a socio-economically deprived area of England. Local knowledge, community integrated support, therapeutic relationships and a welcoming environment were viewed as more beneficial than the type of brief interventions offered. Consequently, community spaces can be created to be therapeutic and beneficial for mental health outside of a traditional conceptualisation of clinical support

Exploring the workplace well-being of staff at a new integrated community mental health service for children and young people

Background There is a lack of research into the workplace well-being of community mental health professionals. Given children and young people’s increasing needs for mental health support in the wake of the coronavirus disease 2019 pandemic, it is timely to explore the workplace well-being of community mental health teams. Aim To explore the workplace well-being of staff working in a new integrated community mental health service for children and young people. Method Eleven mental health professionals from a range of disciplines took part in the study. The 11 participants completed an online questionnaire and the Professional Quality of Life (ProQOL) scale, which measures levels of compassion satisfaction, burnout and secondary traumatic stress. Three of them also took part in an individual semi-structured interview. Findings Participants felt hopeful and optimistic about the future of the service, felt supported by managers and peers, and wanted to enhance their skills to meet children and young people’s increasingly complex needs within the constraints of a service offering brief interventions. Participants displayed high levels of compassion satisfaction, low levels of burnout and particularly low levels of secondary traumatic stress. Conclusion Emotionally supportive leadership, a culture of continuous learning and peer support may reduce the uncertainty felt by community mental health staff about a new service and create optimism about the future, which may in turn contribute to workplace well-being

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Mésusage des antihypertenseurs (étude descriptive dans un service de médecine interne du CHU de Clermont-Ferrand)

CLERMONT FD-BCIU-Santé (631132104) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

Online participatory research: lessons for good practice and inclusivity with marginalized young people

This research project case focuses on the use of multiple participatory research platforms to explore the experience of multiplicity within young adult populations; multiplicity refers to the experience of having more than one person within a single body. The issues and approaches discussed are relevant across a range of participant populations who may find less frequently used participatory methods more accessible. The case study outlines the transferable learnings from one study, including the use of an online consultation model and social media platforms, as well as the researcher’s reflections on the respective strengths and limitations. The importance of using appropriate methodologies when researching traditionally under-represented groups will also be examined, with specific examples used. The process of developing a positive, inclusive project that draws on the expertise of the participants will be outlined