Trial by YouTube: effects of expert psychiatric witness testimony on viewers' opinions of Amber Heard and Johnny Depp.

AIMS AND METHOD: We aimed to assess whether viewing expert witness evidence regarding the mental health of Johnny Depp and Amber Heard in the 2022 court case in the USA would affect viewers' attitudes towards the mental health of the two protagonists and towards mental illness in general. After viewing excerpts of the cross-examination evidence, 38 trial-naive undergraduate students completed the Prejudice towards People with a Mental Illness (PPMI) scale. RESULTS: Following viewing, participants held more stigmatising views of the protagonists than they held about mental disorders in general. CLINICAL IMPLICATIONS: It is plausible that mass media trial coverage further stigmatises mental illness.

Inferring stochastic group interactions within structured populations via coupled autoregression.

The internal behaviour of a population is an important feature to take account of when modelling its dynamics. In line with kin selection theory, many social species tend to cluster into distinct groups in order to enhance their overall population fitness. Temporal interactions between populations are often modelled using classical mathematical models, but these sometimes fail to delve deeper into the, often uncertain, relationships within populations. Here, we introduce a stochastic framework that aims to capture the interactions of animal groups and an auxiliary population over time. We demonstrate the model's capabilities, from a Bayesian perspective, through simulation studies and by fitting it to predator-prey count time series data. We then derive an approximation to the group correlation structure within such a population, while also taking account of the effect of the auxiliary population. We finally discuss how this approximation can lead to ecologically realistic interpretations in a predator-prey context. This approximation also serves as verification to whether the population in question satisfies our various assumptions. Our modelling approach will be useful for empiricists for monitoring groups within a conservation framework and also theoreticians wanting to quantify interactions, to study cooperation and other phenomena within social populations.

'It's not everybody's snapshot. It's just an insight into that world': A qualitative study of multiple perspectives towards understanding the mental health experience and addressing stigma in healthcare students through virtual reality.

Objective: The resurgence of virtual reality (VR) technologies has led to their increased use in contemporary healthcare education. One promising application is simulating the experiences of individuals with mental health conditions (MHCs) to reduce stigma among future healthcare professionals. This study set out to explore what those impacted by, or involved in, the education of healthcare students think about using VR in this way. Methods: One individual interview and five focus groups were conducted with healthcare students (n = 7), healthcare educators (n = 6), and lived experience experts (n = 5). Before sharing their perspectives, participants familiarised themselves with VR equipment and immersive materials simulating MHCs. The constant comparative method and thematic analysis were used to analyse the data. Results: Participants recognised the acceptability and utility of VR for addressing mental health stigma in healthcare students, emphasising the immersive nature of this technology. However, some participants raised concerns about the limited insight VR could provide into the experiences of patients with the same MHCs and its potential emotional impact on users. Participants recommended the incorporation of interactive, realistic environments with a person-centred focus into future VR-based stigma reduction interventions while stressing the importance of providing healthcare students with opportunities for reflection and support. Conclusions: Healthcare students, healthcare educators, and lived experience experts highlighted both advantages and barriers associated with using VR to understand the experience of patients with MHCs. Furthermore, the recommendations put forward can inform the design, content, and delivery of VR-based stigma reduction interventions in healthcare education.

Investigating associations between self-compassion, self-criticism and psychotic-like experiences.

OBJECTIVES: Dimensional approaches suggest psychotic symptoms exist along a continuum, with psychotic-like experiences (PLEs) being an expression of a non-clinical psychosis phenotype. Existing research indicates self-criticism may contribute to symptom maintenance, frequency and distress, whereas self-compassion may act protectively. Associations between self-criticism, self-compassion and PLEs in the general population have received less attention. The present study sought to investigate these associations. It was hypothesised that PLE endorsement would be associated positively with self-criticism and negatively with self-compassion. DESIGN: Quantitative cross-sectional study. Data collected via an online questionnaire. METHODS: Five hundred thirty-one participants completed the Self-Compassion Scale (Short Form), the Forms of Self-Criticising/Attacking and Self-Reassuring Scale and the Transpersonal Experiences Questionnaire. Individuals with a psychosis-related diagnosis were excluded. The data were analysed using linear regression, accounting for the effects of demographic variables. RESULTS: Self-criticism subtype self-hatred was associated with PLEs. Subtype self-inadequacy was not. No association was found between self-compassion and PLEs. Educational attainment was negatively associated with PLE endorsement. CONCLUSIONS: Self-criticism, but not self-compassion, is associated with PLE endorsement, suggesting they are separate factors with different relationships to PLEs. Further research is needed to confirm the direction of the interaction. Either way, psychological interventions (where needed) could target self-criticism and may be important in assessing psychosis risk.

Problematic Internet Use in adolescents: New psychometric evidence for the Spanish short form of the Compulsive Internet Use Scale.

OBJECTIVES: Problematic Internet Use (PIU) has become a worldwide problem in recent years. Among screening instruments for PIU, the Compulsive Internet Use Scale (CIUS) is perhaps the most widely used. Psychometric properties of the full CIUS are not convincing, however, and the short form (CIUS-S) has shown promising results, albeit limited to the English version, with little evidence in Spanish. Therefore, the aim of the present work was to study the psychometric properties of the CIUS-S scores in a large sample of Spanish adolescents. METHOD: The sample consisted of 1790 participants, 816 male (45.6%), 961 female (53.7%), and 13 other (0.7%) . Mean age was 15.70 years (SD = 1.26). RESULTS: The five-items one-dimensional model displayed appropriate goodness-of-fit indices. Strong measurement invariance model across age and partial across gender was found. Furthermore, the CIUS-S was positively associated with several indicators of poor well-being and mental health, and negatively associated with prosocial behavior, self-esteem, and feeling of belonging. CONCLUSION: Overall, the CIUS-S scores appear reliable and valid in its Spanish version for adolescent populations, supporting its aim to detect and prevent a problem that has become a major worldwide issue in the last years.

Safety and usability of proning pillows in intensive care: A scoping review.

OBJECTIVES: Proning is an established technique for the care of intubated patients with severe respiratory failure. Positioning devices used to support the head and body of patients placed in the prone position are often associated with the formation of pressure injuries. Despite robust literature on the prevention and monitoring of pressure injuries, little is described about the role of proning pillows on pressure injuries. The objective of this review is to understand the extent of evidence pertaining to the safety and usability of different types of proning pillows in the intensive care setting. REVIEW METHOD: A scoping review of the literature was completed using predefined search terms in three databases and identified 296 articles. An additional 26 were included from reference lists. Twenty studies are included in the analysis; most were published in the past 3 years, with >50% in surgical settings. DATA SOURCES: Three databases were searched: PubMed, Scopus, and EMBASE. REVIEW METHODS: The review followed the PRISMA Extension for Scoping Reviews, and data were reviewed using Covidence. RESULTS: The most prevalent proning pillow is a standard, noncontoured foam head positioner. It is responsible for the majority of facial pressure injuries in all settings of care. Memory foam pillows and helmet-based systems offer improved surface pressure distribution, although their usability in the intensive care setting remains poorly studied. Inflatable air-cell-based devices present an alternative, but the lack of supporting research and the costs may explain their poor uptake. Several articles proposed the use of pressure sensor systems to evaluate devices. We propose a set of ergonomic parametres to consider when choosing or designing a positioning device for proned patients. CONCLUSION: The evidence pertaining to the safety and usability of proning pillows in the intensive care setting is scarce, which provides opportunities for future research to improve the efficacy in the prevention of pressure injuries and the user experience.

A randomised controlled trial (RCT) exploring the impact of a photography intervention on wellbeing and posttraumatic growth during the COVID-19 pandemic.

BACKGROUND: Emerging evidence points to rising levels of psychological distress resulting from the COVID-19 pandemic. There is a need for self-administered, low-cost, and accessible interventions that facilitate wellbeing and growth. METHODS: This study used a randomised controlled trial (RCT) design to investigate the effects of a two-week positivity-oriented photography intervention on wellbeing and posttraumatic growth in comparison to a control group. Participants were adults between the ages of 21 and 80 living in the UK recruited between May and August 2020 (n = 109). RESULTS: After adjusting for baseline wellbeing, both wellbeing and PTG were significantly higher in the intervention group compared to the control group following intervention completion, with this effect remaining similar at one-month follow-up. CONCLUSIONS: The study offers preliminary evidence that a brief self-administered photography intervention could hold therapeutic value.

Perception of COVID-19 threat, low self-efficacy, and external locus of control lead to psychological distress during the COVID-19 pandemic.

While it is well documented that the COVID-19 pandemic has had critical consequences for individuals' mental health, few studies to date have investigated the influence of psychological factors on psychological distress in the context of COVID-19. This study explores the influences of self-efficacy, health locus of control, and COVID-19 threat perception on psychological distress (DASS-21). 180 adults completed an online set of standardised questionnaires. Results indicated that self-efficacy had a significant relationship with all three subscales of psychological distress. However, COVID-19 threat perception was significantly associated with stress. External health locus of control was significantly associated with depression by the chance externality subscale, and stress by the powerful others externality subscale. Additionally, external health locus of control was found to moderate the relationship between COVID-19 threat perception and depression.

Problematic Internet Use among adolescents: Spanish validation of the Compulsive Internet Use Scale (CIUS). / Uso Problemático de Internet en adolescentes: Validación en español de la Escala de Uso Compulsivo de Internet (CIUS).

Problematic use of the Internet among adolescents has risen in the last decade. The Compulsive Internet Use Scale (CIUS) is one of the most frequently internationally-used tools developed to assess Problematic Internet Use (PIU). However, evidence concerning its validity and reliability in its Spanish version for the adolescent population is currently lacking. Thus, the main goal of the present study was to analyse the psychometric properties of CIUS scores in a large sample of Spanish adolescents. The sample consisted of 1,790 participants (53.7% female, mean age = 15.70 years old, SD = 1.26). The one-dimensional model displayed appropriate goodness of fit indices after error covariance of five items were allowed to correlate. Strong measurement invariance was found for the one-dimensional model across age and gender. The McDonald's Omega coefficient for the total score was 0.91. Furthermore, PIU was positively associated with different indicators of poor wellbeing and psychological difficulties and negatively associated with prosocial behaviour, self-esteem and sense of belonging to the educational centre. The study provided evidence of validity for the CIUS, confirming its utility for screening PIU in non-clinical adolescents.

La Escala de Uso Compulsivo de Internet (Compulsive Internet Use Scale, CIUS) es uno de los instrumentos más empleados a nivel internacional para evaluar el Uso Problemático de Internet (UPI). Sin embargo, no existen evidencias de validez y fiabilidad de las puntuaciones de la versión española en población adolescente. Por ello, el principal objetivo de este estudio fue analizar las propiedades psicométricas de las puntuaciones de la CIUS en una muestra representativa de adolescentes españoles. La muestra contó con 1.790 participantes (53,7% mujeres, edad media = 15,70 años, DT = 1,26). El análisis de la estructura interna del instrumento mostró unos índices de bondad de ajuste apropiados para el modelo unidimensional después de que se permitiera correlacionar la covarianza de errores de cinco ítems. Se encontró invarianza de medición fuerte para el modelo unidimensional en las variables de edad y género. El coeficiente Omega de McDonald para la puntuación total fue 0,91. Además, el UPI se asoció positivamente con diferentes indicadores de malestar y dificultades psicológicas y negativamente con el comportamiento prosocial, la autoestima y el sentido de pertenencia al centro educativo. Este estudio arroja evidencias de validez de la CIUS, y sugiere que puede ser una herramienta apropiada para medir el UPI en adolescentes de la población general.

Psychosocial hazards, posttraumatic stress disorder, complex posttraumatic stress disorder, depression, and anxiety in the U.K. rail industry: A cross-sectional study.

This study examined posttraumatic stress disorder (PTSD), complex PTSD, depression, and anxiety among U.K. rail workers. A cross-sectional survey examining exposure to seven psychosocial hazards (bullying/harassment; verbal abuse; physical and sexual assault; and hearing about, seeing the aftermath of, or witnessing a fatality), working conditions, physical health, and the impact of COVID-19 was administered to 3,912 participants. Outcome measures were the ITQ, PHQ-9, and GAD-7. Among trauma-exposed participants, 24.3% met the criteria for PTSD or CPTSD; 38.6% and 29.2% of all participants scored in the moderate-to-severe range on the PHQ-9 and GAD-7, respectively. Data were analyzed using logistic and linear regression. Bullying/harassment was positively associated with GAD-7 scores, f2 = .001, and PTSD and CPTSD, ORs = 1.83-2.02. Hearing about and witnessing a fatality were associated with PTSD and CPTSD, ORs = 1.77-2.10. Poorer ergonomics at work were positively associated with PHQ-9 and GAD-7 scores, f2 = .001. Higher job satisfaction was associated with lower odds of PTSD and CPTSD, ORs = 0.87-0.91, and negatively associated with PHQ-9 and GAD-7 scores, f2 = .008-.01. Work intensity was associated with PTSD and CPTSD, ORs = 1.79-1.83, and positively associated with PHQ-9 and GAD-7 scores, f2 = .02-.03. Reporting more physical health problems was associated with PTSD, OR = 1.07, and positively associated with GAD-7 and PHQ-9 scores, f2 = .008-.01. The results suggest bullying/harassment and work intensity are important variables in employee mental health and could drive future research and industry initiatives.

Neurocognitive Functioning in Adolescents at Risk for Mental Health Problems.

BACKGROUND: The main goal of the study was to assess the neurocognitive performance in adolescents at high psychometric risk for mental health problems. METHOD: A sample of 48 participants at high risk for mental disorders and an age-gender matched healthy comparison group of 48 adolescents were identified from a community-derived sample of 1,509 adolescents. The Strengths and Difficulties Questionnaire problems and the University of Pennsylvania Computerized Neuropsychological Test Battery for children (included 14 tasks assessing five neurobehavioral domains: executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed) were used. RESULTS: Relative to healthy comparison participants, individuals at high risk showed significant impairments across almost all neurocognitive domains (executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed). CONCLUSIONS: These findings demonstrate that neurocognitive impairments can be shown in adolescents at high psychometric risk for mental health problems before the onset of more severe psychological problems.

Study of Positive and Negative Affect and Neurocognitive Functioning in Adolescents.

The main purpose of the present work was to study neurocognitive performance of adolescents at risk for emotional difficulties. The sample included a total of 1,509 adolescents from stratified random cluster sampling. Derived from this sample, a group of high-risk (n = 92) and a comparison group (n = 92) were selected based on the short version of the Positive and Negative Affect Schedule (PANAS) for comparison on the University of Pennsylvania computerized neuropsychological test battery for children (PENN). A Multivariate analysis of covariance (MANCOVA) was performed taking the scores on the PENN as dependent variables and the two groups derived from the scores of the PANAS (at risk vs. comparison) as a fixed factor. Adolescents at high risk of presenting affectivity problems showed statistically significant differences in several different neurocognitive domains, in accuracy, λ = .820, F(9, 160,000) = 3.913, p < .01, partial η² = .180; speed, λ = .502, F(5, 88,000)= 17.493, p < .01, partial η² = .498; and efficiency, λ = .485, F(4, 89,000) = 23.599, p <.01, partial η² = .515. The high risk group showed lower neurocognitive performance than the comparison group. In addition, a positive statistically significant correlation was found between all the neurocognitive competences (p < .05). Results found in this study reveal that neurocognitive impairments can be shown in adolescents at psychometric high risk for emotional problems before transition to more severe psychological problems.

Liquid metal-tailored gluten network for protein-based e-skin.

Designing electronic skin (e-skin) with proteins is a critical way to endow e-skin with biocompatibility, but engineering protein structures to achieve controllable mechanical properties and self-healing ability remains a challenge. Here, we develop a hybrid gluten network through the incorporation of a eutectic gallium indium alloy (EGaIn) to design a self-healable e-skin with improved mechanical properties. The intrinsic reversible disulfide bond/sulfhydryl group reconfiguration of gluten networks is explored as a driving force to introduce EGaIn as a chemical cross-linker, thus inducing secondary structure rearrangement of gluten to form additional ß-sheets as physical cross-linkers. Remarkably, the obtained gluten-based material is self-healing, achieves synthetic material-like stretchability (>1600%) and possesses the ability to promote skin cell proliferation. The final e-skin is biocompatible and biodegradable and can sense strain changes from human motions of different scales. The protein network microregulation method paves the way for future skin-like protein-based e-skin.

Improving substance misuse outcomes in contingency management treatment with adjunctive formal psychotherapy: a systematic review and meta-analysis.

OBJECTIVES: Contingency management (CM) is a treatment for substance misuse that involves the provision of incentives. This review examines the hypothesis that adding another formal psychotherapy, such as cognitive-behavioural therapy (CBT) or motivational enhancement therapy (MET), to CM improves substance use outcomes at both treatment end and at post-treatment follow-up compared with CM only. DATA SOURCES: Searches were performed in December 2017 and July 2019 of seven electronic bibliographic databases (MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, CINAHL, PsycEXTRA), as well as online trial registries and EThoS, and were followed by reference list screening. ELIGIBILITY CRITERIA: Included studies were randomised controlled trials of adults (18-65) who were using illicit substances, alcohol or tobacco. Studies featured an experimental arm delivering CM combined with a structured evidence-based psychotherapeutic intervention and a CM-only arm. Studies published up to July 2019 were included. DATA EXTRACTION AND SYNTHESIS: The primary outcome was biometrically verified point prevalent abstinence (PPA) at treatment end. Secondary outcomes included biometrically verified PPA at post-treatment follow-up and self-reported days of use at treatment end and post-treatment follow-up. Pooled risk ratios for PPA outcomes and standardised mean differences for days of use were calculated using random effects models. Risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS: 12 studies (n=1654) were included. The primary analysis found no evidence of a synergistic effect in PPA at treatment end (relative risk (RR) 0.97, 95% CI 0.85 to 1.09; p=0.57). Sensitivity analysis of studies featuring CBT/MET also found no evidence of an effect (RR 0.92; 95% CI 0.79 to 1.08; p=0.32). None of the secondary outcomes showed any evidence of benefit. CONCLUSION: The results of the meta-analyses found no evidence that combining CM with another intervention improves the short-term or long-term effects of CM treatment.

A systematic review of structural MRI investigations within borderline personality disorder: Identification of key psychological variables of interest going forward.

Existing models of Borderline Personality Disorder (BPD) suggest that a combination of genetic vulnerability, childhood trauma, and disrupted attachment can lead to the marked emotional lability, impulsivity and interpersonal difficulties observed clinically. Brain structural differences in frontal, limbic and hippocampal regions have been reported in BPD. Less clear is how specific psychological factors relate to these structural differences, and how consistently this is found across studies. This was the focus of the present review. Eighteen studies published between 2004 and 2018 met inclusion criteria encompassing 990 participants. Study quality was assessed using the Nottingham-Ottawa Scale. We also introduce a newly devised scale to assess MRI reporting quality. The most frequently investigated psychological variable were impulsivity (9 studies), depression (8), trauma (6), aggression (6), severity of symptoms (3), global functioning, abuse and dissociation (2). Study quality varied, however, a trend was observed where newer studies were higher in reporting quality. Impulsivity demonstrated greater association with frontal structures, trauma related to the hypothalamus and limbic systems, and aggression with hippocampal and frontal structures. The present review recommends greater exploration of neurocognitive and psychosis-related features such as delusions, paranoia and voice-hearing in future studies, and to investigate cortical changes in longitudinal designs.

FIB-Patterned Nano-Supercapacitors: Minimized Size with Ultrahigh Performances.

Advances in microelectronic system technology have necessitated the development and miniaturization of energy storage devices. Supercapacitors are an important complement to batteries in microelectronic systems; and further reduction of the size of micro-supercapacitors is challenging. Here, a novel strategy is demonstrated to break through the resolution limit of micro-supercapacitors by preparing nano-supercapacitors (NSCs) with interdigital nanosized electrodes using focused ion beam technology. The minimization of the size of the NSCs leads to a large increase in capacitance, with a high areal capacitance of 9.52 mF cm-2 and a volumetric capacitance of 18 700 F cm-3 , far superior to those of other reported works. Size reduction and the narrowing of the physical separation between nanoelectrodes are proved to be the most crucial factors in the enhancement of capacitive performances. New charge-storage mechanisms are discovered with a remarkable nonfaradaic double-layer capacitance that exists due to the considerable inner electric field force at the nanoscale. The developed strategy and the first set of data provided here shed light on the design and fabrication of flexible interdigitated NSCs that rival state-of-the-art supercapacitors in performance.

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology.

Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a model of good practice for CRTs, via one-day fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate fidelity and the rest as low fidelity, with no team achieving high fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess model fidelity in CRTs. There is a need for development and testing of interventions to enhance model fidelity and facilitate improvements to these services.

The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial.

BACKGROUND: Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS: To evaluate a 1-year programme to improve CRTs' model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD: Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS: All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS: The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.

Recent advances in micro-supercapacitors.

Micro-supercapacitors (MSCs) possessing the remarkable features of high electrochemical performance and relatively small volume are promising candidates for energy storage in micro-devices. Tremendous effort has been devoted in recent years to design and to fabricate MSCs with different active electrode materials, including carbon-based materials, conducting polymers, and graphene/metal oxide composites. Moreover, various methods have been developed to prepare MSCs, such as photolithography, laser direct writing, printing methods. This review presents a summary of the recent developments in MSC technology, including electrode materials, fabrication methods, and patterning. Finally, future developments, perspectives, and challenges in the MSC industry are also discussed.

Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial.

BACKGROUND: High resource expenditure on acute care is a challenge for mental health services aiming to focus on supporting recovery, and relapse after an acute crisis episode is common. Some evidence supports self-management interventions to prevent such relapses, but their effect on readmissions to acute care following a crisis is untested. We tested whether a self-management intervention facilitated by peer support workers could reduce rates of readmission to acute care for people discharged from crisis resolution teams, which provide intensive home treatment following a crisis. METHODS: We did a randomised controlled superiority trial recruiting participants from six crisis resolution teams in England. Eligible participants had been on crisis resolution team caseloads for at least a week, and had capacity to give informed consent. Participants were randomly assigned to intervention and control groups by an unmasked data manager. Those collecting and analysing data were masked to allocation, but participants were not. Participants in the intervention group were offered up to ten sessions with a peer support worker who supported them in completing a personal recovery workbook, including formulation of personal recovery goals and crisis plans. The control group received the personal recovery workbook by post. The primary outcome was readmission to acute care within 1 year. This trial is registered with ISRCTN, number 01027104. FINDINGS: 221 participants were assigned to the intervention group versus 220 to the control group; primary outcome data were obtained for 218 versus 216. 64 (29%) of 218 participants in the intervention versus 83 (38%) of 216 in the control group were readmitted to acute care within 1 year (odds ratio 0·66, 95% CI 0·43-0·99; p=0·0438). 71 serious adverse events were identified in the trial (29 in the treatment group; 42 in the control group). INTERPRETATION: Our findings suggest that peer-delivered self-management reduces readmission to acute care, although admission rates were lower than anticipated and confidence intervals were relatively wide. The complexity of the study intervention limits interpretability, but assessment is warranted of whether implementing this intervention in routine settings reduces acute care readmission. FUNDING: National Institute for Health Research.