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Authors:Jennifer Meggs Abstract: This paper aims to present a theoretical framework and underpinning evidence to support researchers and practitioners to systematically design sport and exercise interventions. The framework highlights the theoretical underpinnings and practical feasibility considerations that are important when designing sport and exercise interventions for children and adolescents with attention deficit hyperactivity disorder (ADHD). Future research may wish to apply and evaluate the utility of this framework and research and practice and make recommendations for further refinement. The quality and strength of conclusions from this body of research has been undermined by a lack of methodological quality and clarity in these studies. One criticism has been the lack of an evidence based, transparent and consistent approach to the design of physical activity and sport interventions and selection of outcome measures. This paper will facilitate the transparent and evidence-based decision-making to guide the design of sport/physical activity interventions for children/adolescents with ADHD. Citation: Mental Health Review Journal PubDate: 2024-08-27 DOI: 10.1108/MHRJ-01-2024-0004 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Niamh O’Leary, Christian Ryan, Philip Moore Abstract: Mentalization-based treatment (MBT) is a psychotherapeutic approach that aims to increase mentalizing capacity. The purpose of this meta-ethnography was to synthesize the available qualitative literature on MBT to allow for a more thorough understanding of the lived experience of those who have undergone this therapy. A systematic search of seven databases was carried out. The Critical Appraisal Skills Programme was used to appraise the papers suitable for inclusion. The data were synthesized using a meta-ethnographic approach in which the second-order constructs from each paper were translated and reinterpreted creating a line of argument synthesis. A total of 11 studies were included in the meta-ethnography. Three overarching themes were identified within the included papers which outlined that participant experience of MBT consisted of three different developmental stages. Navigating the therapeutic process describes the participant’s experience of the therapeutic process of MBT. The processes of change in MBT outlined participant reports of mechanisms of change experienced in MBT. Mentalizing self and others described the experience of generalizing new knowledge and skills to the world outside of therapy and unveiled the impact that engaging in MBT had on participants. This meta-ethnography offers new insights into how clients experience MBT as a therapeutic process and offers suggestions for implementation in clinical practice as well as areas of focus for research of this therapeutic approach. Citation: Mental Health Review Journal PubDate: 2024-08-20 DOI: 10.1108/MHRJ-11-2022-0069 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Michael Haslam, Keir Harding Abstract: This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk. Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears. Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges. To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care. The authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve. Citation: Mental Health Review Journal PubDate: 2024-08-15 DOI: 10.1108/MHRJ-11-2023-0065 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Katie Bell, Helen Coulthard, Diane Wildbur, Iain Williamson Abstract: Self-disgust appears to be a prominent feature in anorexia nervosa (AN), which might help explain why AN is often such a persistent disorder. Little is known about how this emotion can impact on recovering from this disorder. This study aims to develop our understanding of how people experience the emotion of self-disgust after physical recovery from AN. Twelve female participants who reported previously having had a clinical diagnosis of AN but had physically recovered according to their EDE-Q scores took part in a semi-structured interview to explore their experiences of recovery and the role self-disgust played within this. Interpretative phenomenological analysis was used to explore the data. Three themes were identified within the data to explain the experiences of self-disgust in those with AN: continued self-disgust following physical “Recovery”, multiple manifestations of self-disgust in recovery and increasing self-disgust in recovery as a driver for relapse. Self-disgust was something each participant appeared to experience often, despite being physically recovered from AN. Disgust-based reactions to the self are enduring and highly resistant to change even whilst other aspects of the disorder become less potent. Self-disgust is multi-faceted and may trigger relapse as the signs of improvement and behaviours inherent in recovering were generally viewed as disgusting to the individuals. Self-disgust is an emotion that continues to affect people with AN despite physical recovery. The recovery process itself is not linear and self-disgust is enduring and may cause those affected to relapse. Considering this emotion within therapeutic intervention may encourage those with AN to accept their recovered self. Citation: Mental Health Review Journal PubDate: 2024-08-13 DOI: 10.1108/MHRJ-06-2022-0039 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Katherine Brown, Laura Jenkinson Abstract: A notable number of young people self-harm, with only a minority receiving professional support. Evidence suggests that therapy can help recovery from self-harm, but little is known about the experiences of those who self-harm and participate in therapy delivered via videoconferencing. Risk assessments were examined for evidence of self-harm and used to identify two groups for analysis: young people who had self-harmed in the past six months and those who had not. A mixed methods analysis was then conducted to examine process and outcome data for these two groups. Data included a number of sessions attended, late-cancelled and missed without notice; and patient-reported outcome measure scores (Young Person-Clinical Outcomes in Routine Evaluation and Revised Children’s Anxiety and Depression Scale). End-of-treatment reports were subsequently analysed using thematic analysis. Those with current self-harm risk appeared to start therapy with lower well-being. No notable differences in progress were found between groups on quantitative outcomes. There was greater reporting of poorer clinical outcomes in the reports of those with current self-harm risk, including two unique types of barriers to effective therapy: “general difficulties” (e.g. poor well-being limiting engagement, specific components of therapy being challenging) and “CBT was not preferred”. Lower baseline well-being could explain the greater ongoing care needs and lower well-being post-therapy among those with current self-harm risk, despite both groups appearing to make similar levels of therapeutic progress quantitatively. Recent self-harm does not appear to reduce the utility of videoconferencing cognitive behavioural therapy; however, clients’ individual needs should be carefully considered. Citation: Mental Health Review Journal PubDate: 2024-08-01 DOI: 10.1108/MHRJ-04-2023-0017 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Robyn Lee, Annette McKeown, Jessica Graham, Yussra Hajaji, Patrick J. Kennedy Abstract: The current study aimed to examine the population of girls in two secure children’s homes (SCHs) in the North East of England to consider the impact of menstruation on girls’ physical, mental and emotional wellbeing within secure settings. Gender-responsive approaches and understanding gender differences are central to trauma-informed provision within the Children and Young People Secure Estate (CYPSE). Whilst trauma-informed approaches are central, it could be argued that basic gender differences, such as the menstrual cycle, are currently being overlooked within research and practice. A case file audit examined documentation of 24 girls who were admitted across both sites between January 2022 and January 2023. Of the sample (n = 24), 50% had information recorded regarding their menstrual cycle during admission assessments. Six girls (25%) disclosed experiencing irregular menstruation. Painful cramping was noted by two girls (8%). One girl (4%) disclosed heavy bleeding, and menorrhagia (abnormal heavy bleeding) was reported for one further girl (4%). One girl (4%) disclosed early onset menarche. Case formulations tended to focus less on girls’ menstrual cycles or the potential impact of this on wellbeing. However, 100% of case formulations considered the potential impact of trauma and/or disrupted attachment on girls’ presentations. The results indicate the impact of menstrual cycles on girls’ physical, mental and emotional wellbeing may benefit from much further consideration. Implications are presented alongside directions for future research. Citation: Mental Health Review Journal PubDate: 2024-07-16 DOI: 10.1108/MHRJ-11-2023-0067 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Ashley Lister, Karen Morris Abstract: The paper aims to gain understanding of perceived benefits and barriers to GAS-light as an occupational therapy outcome measure in community adult mental health. The study explored occupational therapists’ views on the client-centred nature of GAS-light and whether it is an applicable outcome measure for group intervention. It also aimed to understand how occupational therapists use of GAS-light informed their practice and the wider multidisciplinary team perspective. The study used a phenomenological design. This comprising of a focus group of occupational therapists experienced in using the tool, followed by framework analysis. Focus group questions were derived from literature. Three main themes were identified to reflect experiences relating to the GAS-light tool as an outcome measure; value in process, occupational narrative and language and expertise. The paper is indicative of practical implications regarding the use of the GAS-light tool with community mental health clients and therapists, including the perceived value in the process, the language used by the therapist and level of expertise. This paper fulfils an identified need to contribute towards an evidence base for occupational therapy and mental health. Citation: Mental Health Review Journal PubDate: 2024-06-27 DOI: 10.1108/MHRJ-09-2023-0050 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Helen Parr, Gaia Cetrano Abstract: Violence and aggression against mental health professionals is a global concern with well-documented consequences. In the UK, mental health care is increasingly delivered in the community, yet little research has explored practitioner experiences of workplace violence (WPV) outside of inpatient settings. This study aimed to explore how mental health professionals in a UK community mental health team (CMHT) perceive, experience and cope with WPV. Face-to-face semi-structured interviews were conducted with ten multidisciplinary professionals based in a CMHT in a UK city. Data was analysed using interpretative phenomenological analysis. Three interconnected themes emerged. WPV was accepted as inevitable: participants carried on working despite its impact, and feeling unheard by management they gave up on change, perpetuating the perceived inevitability of WPV. Peer support and organisational resources like debriefing, counselling and occupational health improved coping. Stigma and ideas of professional responsibility were barriers to access. To mitigate against the negative consequences of WPV, CMHTs could offer peer support initiatives, improve communication and availability of organisational resources and involve staff in post-incident decision-making. Recommendations are made to shift the attitude of acceptance of WPV and encourage help-seeking. Citation: Mental Health Review Journal PubDate: 2024-06-20 DOI: 10.1108/MHRJ-04-2023-0020 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Claire McDonald, Jessica Townsend, Caitlin Gillespie Abstract: Mental health staff often experience significant levels of stress working in the acute psychiatric inpatient setting. Team-building interventions can mitigate stress in health-care settings, via improvements in team-cohesion, staff interactions and communication skills. The “Tree of Life” (ToL) is a specific narrative therapy approach which uses the metaphor of a tree to facilitate the construction and sharing of strength-based stories. This study aims to describe the development of and evaluate the feasibility, acceptability and staff experiences of the “Team Tree”, an adapted Professional ToL (PToL) intervention. A one-hour, Professional ToL intervention was designed for multidisciplinary acute inpatient staff teams working within a psychiatric hospital in London, UK. A mixed methods approach was used to evaluate the feasibility, acceptability and staff experiences of the session. Participants were 46 multidisciplinary staff (33 women; 13 men) working across four acute psychiatric wards. The intervention was feasible to deliver and was acceptable to participants. Results showed significant improvements in self-reported mental well-being and team-cohesiveness scores post-session. Psychologists face myriad barriers in working with staff teams in the acute inpatient setting. The “Team Tree” intervention was both well received by staff and practical to deliver within the challenging environment of the acute ward. This adaptation of the original PToL emerged from the author’s work with distressed inpatient teams with limited time resources. To the best of the authors’ knowledge, this is the first description of this intervention using a single tree metaphor to facilitate a reflective and creative session with health-care teams. Citation: Mental Health Review Journal PubDate: 2024-06-13 DOI: 10.1108/MHRJ-06-2023-0029 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Mariana Velykodna, Oksana Tkachenko, Oksana Shylo, Kateryna Mitchenko, Zoia Miroshnyk, Natalia Kvitka, Olha Charyieva Abstract: This study aims to develop and test a multivariable psychosocial prediction model of subjective well-being in Ukrainian adults (n = 1,248) 1.5 years after the 2022 Russian invasion of Ukraine. The research design followed the “Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis” checklist. The online survey combined a questionnaire on sociodemographic characteristics and specifics of living in wartime, as well as validated self-reported inventories: The Modified BBC Subjective Well-being Scale, Acceptance and Action Questionnaire – Version 2 and Connor–Davidson Resilience Scale-10. The initially developed model was tested through regression analysis, which revealed nine variables as predictors of the subjective well-being scores within the sample, explaining 49.3% of its variance. Among them, the strongest were living with a friend and receiving mental health care systematically. They were almost twice as influential as forced displacement abroad and trauma exposure, which predicted lower well-being, and living with a spouse, which forecasted higher well-being scores. Two resilience subscales – adjustment and restoring and resistance – as predictors of better well-being and perceived unsuccess in life and age as predictors of lower well-being were relatively weaker but statistically significant. The obtained results support the previous evidence on the essential role of accessible mental health services and social support in times of war, as well as the deteriorative effect of trauma exposure and forcible taking refuge on subjective well-being. Citation: Mental Health Review Journal PubDate: 2024-04-24 DOI: 10.1108/MHRJ-01-2024-0006 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Nikita Sakaria, Christopher Sanderson, Simon Watkins, Victoria Boynton Abstract: This service evaluation aims to understand the experiences of service users (SUs) who accessed an early intervention in psychosis (EIP) service during the Coronavirus pandemic using qualitative and quantitative methodologies and compare these to a previous pre-pandemic study conducted within the same service (Watkins et al., 2018). This paper collated experiences of individuals accessing an EIP service to inform service development. Questionnaires and individual interviews were conducted to provide quantitative and qualitative data. Descriptive statistics and T-test confidence intervals were created from the results and compared to findings of Watkins et al. (2018). Interviews were transcribed verbatim and analysed using Braun and Clarke’s (2006) thematic analysis. Data showed participants were largely satisfied with all areas of the service with “work or education”, “living skills”, and “addictions” scoring highest. Though participants reported no overall dissatisfaction, satisfaction levels dropped in “social activities” compared to the findings of Watkins et al. (2018), perhaps due to the national restrictions put in place to manage the spread of Coronavirus during this time. Interview analysis identified three themes of importance consistent with prior literature, highlighting the importance of relationships and validation during recovery. This evaluation did not consider whether participants had accessed the service prior to the pandemic or only during, meaning that some participants could have a point of comparison with the service pre-pandemic, whereas others might not. Similarly, the participants were not the same as those of the Watkins et al.’s (2018) evaluation, meaning that direct comparisons of pre- and post-pandemic experiences were not possible. In addition, this evaluation collected data at only one time point early in the pandemic; therefore, it is unknown if client experiences of services differed as the pandemic and restrictions continued over time. The Covid-19 pandemic has been an unprecedented challenge for health services, and the effects of this are becoming widely reported. This evaluation of clinical services offers a valuable perspective of service user experience of receiving mental health services during a global health crisis further offering a comparison to pre-pandemic services and the experiences of those who used them. Citation: Mental Health Review Journal PubDate: 2024-04-22 DOI: 10.1108/MHRJ-09-2022-0060 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Karen J. Burnell, Paul Everill, Eva Makri, Louise Baxter, Kathryn Watson Abstract: Engaging with heritage to support mental health and wellbeing has become a focus of research and policy, more recently moving towards social prescription of heritage interventions. While there are benefits to active participation, there are potential risks to those taking part and to the non-renewable historic remains and landscape that form the core of these projects. The purpose of the current research paper was to develop best practice guidelines for organisations offering heritage projects as interventions for people who live with mental health issues to protect both participants and heritage. There were two research phases; a Sandpit with World Café discussions to produce a set of research priorities, and a Delphi Consultation, using three questionnaires distributed over six months, to develop best practice guidelines. The panel in both phases comprised experts through lived experience, policy, practice and research. The Authentic and Meaningful Participation in Heritage or Related Activities (AMPHORA) guidelines cover three stages: project development, project delivery and project follow-up, with a set of action points for each stage. Of particular importance was authentic participation and expertise to ensure appropriate management of heritage/ historic environment assets and support for participants. The AMPHORA guidelines can assist all organisations in the delivery of safe projects that support the mental health of those involved, as well as enhancing and protecting the historic environment. To the best of the authors’ knowledge, these are the first research-led guidelines that help heritage organisations support those living with mental health issues. Citation: Mental Health Review Journal PubDate: 2024-04-02 DOI: 10.1108/MHRJ-12-2022-0076 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Yi Wu, Tianxue Long, Jing Huang, Yiyun Zhang, Qi Zhang, Jiaxin Zhang, Mingzi Li Abstract: This study aims to synthesize the existing serious games designed to promote mental health in adolescents with chronic illnesses. This study conducted a review following the guidelines of Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Searches were conducted in databases PubMed, Scopus, Web of Science, Cochrane Library, cumulative index to nursing and allied health literature, PsycINFO, China national knowledge infrastructure Wanfang, VIP Database for Chinese Technical Periodicals and SinoMed from inception to February 12, 2023. A total of 14 studies (describing 14 serious games) for improving the mental health of adolescents with chronic diseases were included. Of all the included games, 12 were not described as adopting any theoretical framework or model. The main diseases applicable to serious games are cancer, type 1 diabetes and autism spectrum disorder. For interventional studies, more than half of the study types were feasibility or pilot trials. Furthermore, the dosage of serious games also differs in each experiment. For the game elements, most game elements were in the category “reward and punishment features” (n = 50) and last was “social features” (n = 4). Adolescence is a critical period in a person’s physical and mental development throughout life. Diagnosed with chronic diseases during this period will cause great trauma to the adolescents and their families. Serious game interventions have been developed and applied to promote the psychological health field of healthy adolescents. To the best of the authors’ knowledge, this study is the first to scope review the serious game of promoting mental health in the population of adolescents with chronically ill. At the same time, the current study also extracted and qualitatively analyzed the elements of the serious game. Citation: Mental Health Review Journal PubDate: 2024-03-25 DOI: 10.1108/MHRJ-07-2023-0038 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Katie Russell, Nima Moghaddam, Anna Tickle, Gina Campion, Christine Cobley, Stephanie Page, Paul Langthorne Abstract: By older adulthood, the majority of individuals will have experienced at least one traumatic event. Trauma-informed care (TIC) is proposed to improve effectivity of health-care provision and to reduce likelihood of services causing retraumatisation. This study aims to assess the effectiveness of staff training in TIC in older adult services. TIC training was delivered across eight Older Adult Community Mental Health Teams in the same UK organisation. Questionnaires were administered before and after training: a psychometrically robust measure, the Attitudes Related to Trauma-Informed Care, was used to assess TIC-related attitudes, and a service-developed scale was used to measure changes in TIC competence. Data was analysed using linear mixed effects modelling (LMM). Qualitative data regarding the impact of training was gathered one month after training through a free-text questionnaire. There were 45 participants, all of whom were white British. LMM on pre- and post-data revealed that staff training significantly increased competencies across all measured TIC domains. Overall, staff attitudes were also significantly more trauma-informed after training. Qualitatively, staff identified time as the only additional resource required to deliver the skills and knowledge gained from training. Training was found to be effective in increasing TIC-related skills and attitudes. Organisations aiming to become trauma-informed should consider staff training as one aspect of a wider development plan. To the best of the authors’ knowledge, this paper is the first to examine TIC training for staff working in Older Adults Mental Health Services. Recommendations for services aiming to develop a trauma-informed culture have been provided. Citation: Mental Health Review Journal PubDate: 2024-03-01 DOI: 10.1108/MHRJ-07-2023-0037 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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Authors:Jackson Lord, Rachel Sabin-Farrell Abstract: The transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner’s perspectives on the URICA. Correlational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data. The URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient’s outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful. This study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies. Citation: Mental Health Review Journal PubDate: 2024-02-09 DOI: 10.1108/MHRJ-04-2023-0019 Issue No:Vol. ahead-of-print, No. ahead-of-print (2024)
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