Effective support for those who are "hard to engage": a qualitative user-led study.

BACKGROUND: Up to 30% of people with mental health problems drop out of contact with mental health services with negative implications for continuity of care. Services with an assertive outreach approach aim to sustain engagement. AIMS: This study explored the perceptions and needs of people often described as "hard to engage" in order to understand more about how services can best support them. METHODS: This was a service user led qualitative study involving participants with serious mental health problems. Interviews were held with 33 people using assertive outreach or voluntary sector services and 15 people who had disengaged from services. Data were analysed for emergent themes. RESULTS: Relationships with staff were central to maintaining engagement with services. Almost all participants wanted help for their problems, and preferred services that responded to their priorities and offered practical support with everyday living. Negative perceptions of inpatient care were common, and a focus on medication put many participants off mental health services. Many participants were not receiving support for the full range of their complex needs. CONCLUSIONS: Difficulties in sustaining engagement with mental health services does not necessarily mean that people do not want help. Participants were intolerant of service-determined priorities.

The MATISSE study: a randomised trial of group art therapy for people with schizophrenia.

BACKGROUND: Art Therapy has been promoted as a means of helping people who may find it difficult to express themselves verbally engage in psychological treatment. Group Art Therapy has been widely used as an adjunctive treatment for people with schizophrenia but there have been few attempts to examine its effects and cost effectiveness has not been examined. The MATISSE study aims to evaluate the clinical and cost effectiveness of group Art Therapy for people with schizophrenia. METHOD/DESIGN: The MATISSE study is a three-arm, parallel group, pragmatic, randomised, controlled trial of referral to group Art Therapy plus standard care, referral to an attention control 'activity' group plus standard care, or standard care alone. Study participants were recruited from inpatient and community-based mental health and social care services at four centres in England and Northern Ireland. Participants were aged over 18 years with a clinical diagnosis of schizophrenia, confirmed by an examination of case notes using operationalised criteria. Participants were then randomised via an independent and remote telephone randomisation service using permuted stacked blocks, stratified by site. Art Therapy and activity groups were made available to participants once a week for up to 12 months. Outcome measures were assessed by researchers masked to allocation status at 12 and 24 months after randomisation. Participants and care givers were aware which arm of the trial participants were allocated to. The primary outcomes for the study are global functioning (measured using the Global Assessment of Functioning scale) and mental health symptoms (measured using the Positive and Negative Syndrome Scale) assessed at 24 months. Secondary outcomes were assessed at 12 and 24 months and comprise levels of group attendance, social function, satisfaction with care, mental wellbeing, and costs. DISCUSSION: We believe that this is the first large scale pragmatic trial of Art Therapy for people with schizophrenia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN46150447.

The great divide: a qualitative investigation of factors influencing researcher access to potential randomised controlled trial participants in mental health settings.

BACKGROUND: External validity is central to pragmatic trials. Recruitment of a 'representative' sample is fundamental to this. However, recruitment is a complex process, requiring, first researcher access to eligible participants. Questions have been asked about the match between study samples and real-world clinical patients and the impact this has on generalisability of findings. METHOD: Using interview and observational data from a grounded theory process evaluation of a multicentre trial, we investigated factors influencing referral. RESULTS: We found evidence of a fundamental disjunction between research and clinical practice manifested in varying 'filtering' processes. Organisational culture and the knowledge and attitudes of service providers regarding research generally and specifically in this RCT resulted in exclusion of very many potentially eligible participants. CONCLUSIONS: These findings have policy and practical implications and highlight the need for development of genuinely collaborative partnerships between the research and clinical communities. Importantly, we suggest that the CONSORT recommendations be further refined to identify the potential study population.

Patient confidentiality, clinical data and NHS research--a researcher's guide.

More stringent research governance in the NHS has led to an increased focus on the importance of patient confidentiality. But relatively low levels of knowledge of the Data Protection Act and common law duty of confidentiality among some researchers and research managers cause difficulties in getting research projects off the ground. The authors outline the main issues surrounding research, data protection and patient confidentiality, and provide guidance for researchers, clinicians and managers on how to conduct research appropriately.

Patient confidentiality, clinical data and NHS research - a researcher's guide.

More stringent research governance in the NHS has led to an increased focus on the importance of patient confidentiality. But relatively low levels of knowledge of the Data Protection Act and common law duty of confidentiality among some researchers and research managers cause difficulties in getting research projects off the ground. The authors outline the main issues surrounding research, data protection and patient confidentiality, and provide guidance for researchers, clinicians and managers on how to conduct research appropriately.

Research governance and students: what are NHS trusts looking for?

Student research in the National Health Service (NHS) must now be conducted within the framework of research governance and research ethics. In this paper, Tony Soteriou and Gill Hek highlight the considerations that undergraduate, post-registration and postgraduate students, as well as their supervisors and course lecturers need to make at the outset of planning student research in the NHS.

Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial.

OBJECTIVES: To evaluate the clinical effectiveness of group art therapy for people with schizophrenia and to test whether any benefits exceed those of an active control treatment. DESIGN: Three arm, rater blinded, pragmatic, randomised controlled trial. SETTING: Secondary care services across 15 sites in the United Kingdom. PARTICIPANTS: 417 people aged 18 or over, who had a diagnosis of schizophrenia and provided written informed consent to take part in the study. INTERVENTIONS: Participants, stratified by site, were randomised to 12 months of weekly group art therapy plus standard care, 12 months of weekly activity groups plus standard care, or standard care alone. Art therapy and activity groups had up to eight members and lasted for 90 minutes. In art therapy, members were given access to a range of art materials and encouraged to use these to express themselves freely. Members of activity groups were offered various activities that did not involve use of art or craft materials and were encouraged to collectively select those they wanted to pursue. MAIN OUTCOME MEASURES: The primary outcomes were global functioning, measured using the global assessment of functioning scale, and mental health symptoms, measured using the positive and negative syndrome scale, 24 months after randomisation. Main secondary outcomes were levels of group attendance, social functioning, and satisfaction with care at 12 and 24 months. RESULTS: 417 participants were assigned to either art therapy (n=140), activity groups (n=140), or standard care alone (n=137). Primary outcomes between the three study arms did not differ. The adjusted mean difference between art therapy and standard care at 24 months on the global assessment of functioning scale was -0.9 (95% confidence interval -3.8 to 2.1), and on the positive and negative syndrome scale was 0.7 (-3.1 to 4.6). Secondary outcomes did not differ between those referred to art therapy or those referred to standard care at 12 or 24 months. CONCLUSIONS: Referring people with established schizophrenia to group art therapy as delivered in this trial did not improve global functioning, mental health, or other health related outcomes. TRIAL REGISTRATION: Current Controlled Trials ISRCTN46150447.

Artefact or reality? Increases in persons notified to the Regional Drug Misuse Database in the South West of England, 1996-2001.

The incidence of new persons and repeat attenders presenting for treatment for problem drug misuse in the South West of England more than doubled from 1996-1997 to 2000-2001. During this time there was an increase in the number and severity of chronic cases, both in terms of the prevalence of heroin and crack-cocaine use and in the frequency of injecting and sharing injecting equipment. Growth in the availability of treatment, changes in notification practice and sub-regional variation make it difficult to be confident about real rates of increase, or age, gender and substance misuse changes, but the size of these changes mean they are unlikely to be purely artefactal.