Training in cognitive behavioural interventions on acute psychiatric inpatient wards

There has been a drive towards addressing the types of care and therapeutic interventions available to people with serious mental illness, which is reflected in the latest government mental health policy initiatives. Recent evidence strongly supports the implementation of psychological and social interventions for people with psychosis, and in particular the use of cognitive behavioural techniques. Until now, the main focus has been on people living in the community. This study examines the delivery of psychosocial interventions training to qualified psychiatric nurses and unqualified staff on seven acute psychiatric admission wards in London, UK. The approach had the strength of on-site delivery, follow-up role modelling of the interventions and clinical supervision. Despite this, in some cases the training was less successful, mainly because of staffing and leadership weaknesses. The impact of training in these methods and the implications for mental health education and practice development are discussed

Debt Counselling for Depression in Primary Care: an adaptive randomised controlled pilot trial (DeCoDer study)

Background: Depression and debt are common in the UK. The DeCoDer trial aimed to assess the clinical and cost effectiveness of the addition of Primary Care debt counselling advice service to usual care, for patients with depression and debt. However, the study was terminated early during the internal pilot trial phase because of recruitment delays. This report describes the rationale, methods and findings of the pilot study, and implications for future research. Objectives: The overarching aim of the internal pilot was to identify and resolve problems, thereby assessing the feasibility of the main trial. Specific objectives were to: confirm methods for practice recruitment, ability to recruit patients via the proposed approaches, determine acceptability of the study interventions and outcome measures; assess contamination, confirm the randomisation method for main trial, the level of participant attrition; and check robustness of data collection systems. Design: Adaptive parallel two group multi-centre randomised controlled pilot trial with nested mixed methods process and economic evaluation. Both individual and cluster (General Practice) level allocation were used in the pilot phase to assign participants to intervention or control groups. Setting: General practices in England and Wales.Participants: Individuals age ≥18 years, scoring ≥14 on the Beck Depression Inventory and self-identifying as having debt worries were included. Main exclusion criteria were: actively suicidal or psychotic and/or severely depressed and unresponsive to treatment, severe addiction to alcohol/illicit drugs, unable/unwilling to give written informed consent, currently participating in other research including follow-up phases, received Citizen’s Advice Bureau (CAB) debt advice in past year, and not wanting debt advice via GP practice. Interventions: Intervention: debt advice provided by CAB and shared biopsychosocial assessment in addition to treatment as usual (TAU) and two debt advice leaflets; Control: advice leaflets provided by GP and TAU only. Outcomes of pilot trial: Proportion of eligible patients who consented; number of participants recruited compared to target; assessment of contamination; assessment of patient satisfaction with intervention and outcome measures.Participant outcomes: Primary: Beck Depression Inventory II; Secondary: Psychological wellbeing, health and social care utilisation, service satisfaction, substance misuse, record of priority/non-priority debts, life events and difficulties and explanatory measures. Outcomes were assessed at baseline (pre-randomisation) and 4-months post randomisation. Other data sources: Qualitative interviews were conducted with participants, clinicians and CAB advisors.Results: Of the 238 expressions of interest screened, 61 participants (26%) were recruited and randomised (32 intervention and 29 control). All participants provided baseline outcomes and 52 provided primary outcome at four months follow up (14.7% drop out). 17 participants allocated to intervention saw CAB. Descriptive statistics are reported for participants with complete outcomes at baseline and 4-months’ follow up. Our qualitative findings suggest that the relationship between debt and depression is complex and the impact of each on the other is compounded by other psychological, social and contextual influences. Conclusions, Study Limitations and Future work: Due to low recruitment this trial was terminated at the internal pilot phase, and too small for inferential statistical analysis. We provide implications for conducting future research in this area

A randomised controlled feasibility trial for an educational school-based mental health intervention: study protocol

Background: With the burden of mental illness estimated to be costing the English economy alone around £22.5 billion a year [1], coupled with growing evidence that many mental disorders have their origins in adolescence, there is increasing pressure for schools to address the emotional well-being of their students, alongside the stigma and discrimination of mental illness. A number of prior educational interventions have been developed and evaluated for this purpose, but inconsistency of findings, reporting standards, and methodologies have led the majority of reviewers to conclude that the evidence for the efficacy of these programmes remains inconclusive. Methods/Design: A cluster randomised controlled trial design has been employed to enable a feasibility study of 'SchoolSpace', an intervention in 7 UK secondary schools addressing stigma of mental illness, mental health literacy, and promotion of mental health. A central aspect of the intervention involves students in the experimental condition interacting with a young person with lived experience of mental illness, a stigma reducing technique designed to facilitate students' engagement in the project. The primary outcome is the level of stigma related to mental illness. Secondary outcomes include mental health literacy, resilience to mental illness, and emotional well-being. Outcomes will be measured pre and post intervention, as well as at 6 month follow-up. Discussion: The proposed intervention presents the potential for increased engagement due to its combination of education and contact with a young person with lived experience of mental illness. Contact as a technique to reduce discrimination has been evaluated previously in research with adults, but has been employed in only a minority of research trials investigating the impact on youth. Prior to this study, the effect of contact on mental health literacy, resilience, and emotional well-being has not been evaluated to the authors' knowledge. If efficacious the intervention could provide a reliable and cost-effective method to reduce stigma in young people, whilst increasing mental health literacy, and emotional well-being. Trial registration: ISRCTN: ISRCTN0740602