Women, homelessness and multiple disadvantage in Stoke-on-Trent: the need for safe places in the context of wider health and social inequalities

This article is based on two qualitative studies related to women’s experiences of homelessness and multiple disadvantage in Stoke-on-Trent (one of the 20% most ‘deprived’ districts in England, with higher than average rates of statutory homelessness). This research utilised a participatory approach, with collaboration between researchers from Staffordshire University’s Centre for Health and Development (CHAD) and Expert Citizens C.I.C. Qualitative data collection occurred with 10 women with lived experiences of homelessness and local services (conducted by Expert Citizens) and 20 frontline workers/wider stakeholders (conducted by CHAD). For this article, we conducted thematic analysis to identify patterns across both studies. Three themes are discussed: “So much unmet need” and revolving doors for women; the lack of safe accommodation for women and ‘risky’ alternatives; creating safe spaces for women and the need for longer term investment and opportunities. There was surprise at how many women came forward for accommodation during ‘Everyone In’ and evolving recognition of gendered experiences of homelessness combined with other experiences. Next steps for action are discussed, highlighting the importance of partnerships and collaboration with people with lived experience. We have strong foundations to build on, and far more to be done, to improve women’s experiences within Stoke-on-Trent

Women, Addictions, Mental Health, Dishonesty, and Crime Stigma: Solutions to Reduce the Social Harms of Stigma

British drug policies could underserve women with treatment needs, and this paper provides evidence that communication through the words and actions of professionals across drug and alcohol services, health and mental health, social work and the criminal justice sector can leave women feeling stigmatised and failed. Women live with the stigma of ‘the lying addict’; however, documents and courtroom statements provided by professionals can misrepresent women’s experiences, which exacerbates social harm. Data are drawn from feminist participatory action re-search, where female lived experience experts worked alongside academics to implement a qualitative study using interviews and focus groups with women using treatment services (n = 28) and an online world café with professionals working with these women (n = 9) and further professionals providing support at lived experience data collection events (n = 5). This data set is cross-referenced with one-to-one and small-group interviews with professionals in the field (n = 17) conducted by a third-sector partner. Findings establish that stigma negatively impacts the identification of treatment needs and access to timely and appropriate service delivery. Social harms to women with addictions could be significantly reduced with timely, authentic, honest, gender-informed and trauma-informed practices for girls and women using drugs and alcohol to self-medicate from traumatic experiences

How is suicide risk assessed in healthcare settings in the UK? A systematic scoping review

A high proportion of people contact healthcare services in the 12 months prior to death by suicide. Identifying people at high-risk for suicide is therefore a key concern for healthcare services. Whilst there is extensive research on the validity and reliability of suicide risk assessment tools, there remains a lack of understanding of how suicide risk assessments are conducted by healthcare staff in practice. This scoping review examined the literature on how suicide risk assessments are conducted and experienced by healthcare practitioners, patients, carers, relatives, and friends of people who have died by suicide in the UK. Literature searches were conducted on key databases using a pre-defined search strategy pre-registered with the Open Science Framework and following the PRISMA extension for scoping reviews guidelines. Eligible for inclusion were original research, written in English, exploring how suicide risk is assessed in the UK, related to administering or undergoing risk assessment for suicide, key concepts relating to those experiences, or directly exploring the experiences of administering or undergoing assessment. Eighteen studies were included in the final sample. Information was charted including study setting and design, sampling strategy, sample characteristics, and findings. A narrative account of the literature is provided. There was considerable variation regarding how suicide risk assessments are conducted in practice. There was evidence of a lack of risk assessment training, low awareness of suicide prevention guidance, and a lack of evidence relating to patient perspectives of suicide risk assessments. Increased inclusion of patient perspectives of suicide risk assessment is needed to gain understanding of how the process can be improved. Limited time and difficulty in starting an open discussion about suicide with patients were noted as barriers to successful assessment. Implications for practice are discussed

How is suicide risk assessed in healthcare settings in the UK? A systematic scoping review

A high proportion of people contact healthcare services in the 12 months prior to death by suicide. Identifying people at high-risk for suicide is therefore a key concern for healthcare services. Whilst there is extensive research on the validity and reliability of suicide risk assessment tools, there remains a lack of understanding of how suicide risk assessments are conducted by healthcare staff in practice. This scoping review examined the literature on how suicide risk assessments are conducted and experienced by healthcare practitioners, patients, carers, relatives, and friends of people who have died by suicide in the UK. Literature searches were conducted on key databases using a pre-defined search strategy pre-registered with the Open Science Framework and following the PRISMA extension for scoping reviews guidelines. Eligible for inclusion were original research, written in English, exploring how suicide risk is assessed in the UK, related to administering or undergoing risk assessment for suicide, key concepts relating to those experiences, or directly exploring the experiences of administering or undergoing assessment. Eighteen studies were included in the final sample. Information was charted including study setting and design, sampling strategy, sample characteristics, and findings. A narrative account of the literature is provided. There was considerable variation regarding how suicide risk assessments are conducted in practice. There was evidence of a lack of risk assessment training, low awareness of suicide prevention guidance, and a lack of evidence relating to patient perspectives of suicide risk assessments. Increased inclusion of patient perspectives of suicide risk assessment is needed to gain understanding of how the process can be improved. Limited time and difficulty in starting an open discussion about suicide with patients were noted as barriers to successful assessment. Implications for practice are discussed

A quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England

Objectives: Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information requests made to NHS trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS trusts. Design: A cross-sectional survey of suicide risk assessment tools and training gathered via Freedom of Information requests and subjected to a content analysis. Setting: Freedom of Information requests were submitted to NHS trusts across England. Results: A wide variety of suicide risk assessments tools were identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment whilst 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. Conclusions: There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the numbers of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention

The impact and perception of England’s web-based heart age test of cardiovascular disease risk: A mixed-methods study

Background: It is well documented that individuals struggle to understand cardiovascular disease percentage risk scores which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered before. Objectives: To understand who accesses England’s heart age test and its effect on user perception, knowledge and understanding of CVD risk, future behaviour intentions and potential engagement with primary care services. Methods: There were three sources of data: 1. Routinely gathered data on all those accessing the heart age test (Feb 2015-Jun 2020); 2. Online survey, distributed January-March 2021; 3. Interviews with a sub-sample of survey respondents (February-March 2021). Data were used to describe the test user population, explore knowledge and understanding of CVD risk, confidence in interpreting CVD risk and control of CVD risk, and the effect on future behaviour intentions and potential engagement with primary care. Interviews were analysed using reflexive thematic analysis. Results: Between Feb 2015 and Jun 2020, the heart age test was completed almost 5 million times, with more completions by males (54.8%), those aged 50-59 years (27.2%), from a White ethnic background (81%), and those living in the least deprived 20% of areas (14.4%). The study concluded with 819 survey responses and 33 semi-structured interviews. Participants suggested they understood the meaning of a higher estimated heart age and self-reported at least some improvements to understanding and confidence in understanding and control of CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their prior risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (i.e., blood pressure, cholesterol) led some users to question the credibility of the test. Yet, most suggested they would or had already recommended the test to others, would use it again in the future, would be more likely to take up the offer of a NHS Health Check, and self-reported that they had made or intended to make changes to their health behaviour or felt encouraged to continue to make changes to their health behaviour. Conclusions: England’s web-based heart age test has engaged large numbers of people on their heart health. Improvements to England’s heart age test, noted in this paper, may enhance user satisfaction and prevent confusion. Future work to understand the longer-term benefit of the test on behavioural outcomes is warranted

Social network use, social support and mental health in adolescence: A systematic review

Background: Social network sites (SNS) are a preferred method of communication for many young people. It is therefore of increasing importance to examine the possible benefits and detriments of SNS use to adolescent mental health. One possible benefit to adolescents who engage with SNS is increased access to social support from peers, which may promote positive mental health. Aim: We aimed to systematically review the existing research that has examined relationships between SNS use, social support and mental health in adolescents. Method: The protocol for this review was registered with PROSPERO. A systematic literature search was conducted using PRISMA guidelines for studies published between 2003 and 2021 to identify research that examined the relationships between SNS use, social support, and mental health in adolescents. Study quality was appraised using the Mixed Methods Appraisal Tool. Results: 11 articles met the criteria for inclusion in the current review. Findings show that adolescents use SNS to access social support when experiencing stressful life events and perception of support is important for enabling positive impact on mental health. SNS offer marginalised groups a way to access social support that may be lacking in their offline life. There is a clear difference between males and females in how adolescents use SNS and how active and passive SNS use impacts on mental health. Included studies is mostly cross-sectional in design and investigation into the differences between male and female adolescents experiences of using SNS were limited. Conclusions: Despite widespread publication of the adverse impact of SNS on adolescent wellbeing, access to social support is a clear benefit with positive impacts on adolescent mental health. However, the benefits of perceived social support appear to be context specific

The role of perceived social norms in non-suicidal self-injury and suicidality: a systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes

A quantitative content analysis of Freedom of Information requests examining the extent and variations of tools and training for conducting suicide risk assessments in NHS Trusts across England

Objectives: Determining the risk for suicide is a difficult endeavour. Clinical guidance in the UK explicitly advises against using risk assessment tools and scales to determine suicide risk. Based on Freedom of Information requests made to NHS trusts in England, this study provides an overview of suicide risk assessment tools in use, training provided in how to use such assessments, and explores implementation of suicide risk assessment guidance in practice in English NHS trusts. Design: A cross-sectional survey of suicide risk assessment tools and training gathered via Freedom of Information requests and subjected to a content analysis. Setting: Freedom of Information requests were submitted to NHS trusts across England. Results: A wide variety of suicide risk assessments toolsere identified as being used in practice, with several trusts reported using more than one tool to determine suicide risk. Forty-one trusts reported using locally developed, unvalidated, tools to assess risk of suicide and 18 stated they do not use a tool. Ten trusts stated they do not train their staff in suicide risk assessment whilst 13 reported use of specific suicide risk assessment training. Sixty-two trusts stated they do not centrally record the number of assessments conducted or how many individuals are identified as at risk. Content analysis indicated the frequent wider assessment of risk not restricted to suicide risk. Conclusions: There is wide variation in suicide risk assessment tools being used in practice and some lack of specific training for healthcare staff in determining suicide risk. Few trusts routinely record the number of assessments being conducted or the numbers of individuals identified at high risk. Implementation of specific training is necessary for the suicide risk assessment process to identify patient needs and develop therapeutic engagement. Routinely recording how many assessments are conducted is a crucial step in improving suicide prevention