Exploring the experiences of high-risk groups during the first UK Covid-19 lockdown through creative methods.

Background: Groups at high risk of severe illness/death from COVID-19 (older people and those identified as clinically extremely vulnerable: CEV) experienced increased restrictions, poor mental health and loneliness during the first UK lockdown. Methods: Seventeen older adults, eight CEV adults, one parent of a CEV child, and two family carers of CEV adults, shared their experiences of the first UK lockdown through various media: written reflections, interviews, poetry, videos, photographs, and visual artwork. Results: Through a positive psychology lens, five themes were identified: experiencing loss; community and connection; finding joy, hope and optimism; adapting to change; and sense- and meaning-making. Conclusion: High-risk groups fostered wellbeing and flourishing and formed a sense of coherence in a time of great loss. Engagement with artistic, creative, and cultural activities facilitated this. The arts not only provided a creative means of collecting data but was also identified as a central thread in the findings.

'Social media comes with good and bad sides, doesn't it?' A balancing act of the benefits and risks of social media use by young adults with long-term conditions.

Young adults are frequent users of social media, but the help and hindrance of social media for living well with long-term conditions (LTCs) in young adulthood is little-researched. The aim of this paper was to explore the experiences of social media use amongst young adults with LTCs. Interviews with 15 young adults with LTCs explored their experiences of using social media more broadly and in relation to online health communities. Social media came with both 'good and bad sides' which required a balancing act to manage (overarching theme), as reflected in the following subthemes: (1) Relationships: reducing social isolation versus need for face-to-face contact; (2) Comparisons: normalising versus negative (upward) comparisons; (3) Community: fitting in versus feeling left out; (4) Emotions: inspiring versus distress contagion; and (5) Knowledge: exchanging useful information versus fear of decline. The findings highlight the importance of young adults' self-reflection/awareness of social media's impact on their wellbeing, identifying when limited or increased use may be preferable. Whilst there is a 'good' to social media such as increased feelings of belonging and connection, this should not be the sole focus of future self-management interventions; as its use also contributes to feelings of distress, fear and not fitting in, and participants desire face-to-face contact.

The role of collaborative working between the arts and care sectors in successfully delivering participatory arts activities for older people in residential care settings.

In the UK support for older people living in residential care to undertake meaningful activities is provided by Activities Co-ordinators. There is also a growing trend for care home providers to invite arts organisations into care settings to deliver a range of arts and cultural activities. These arts and cultural activities are delivered by Arts Facilitators, who are distinct from Activities Co-ordinators because their practice is specifically in an art form. This paper presents findings from the Creative Journeys research project which focused on exploring the role of participatory arts within residential care home in developing and maintaining social relationships between residents and staff. One of the objectives of the research was to identify factors which facilitated or hindered the delivery and impact of the activities. Data collection methods included observations and semi-structured interviews with residents and staff. Thematic analysis was conducted on the qualitative data. It was found that a key factor in the successful delivery of the groups was the working relationship between the Arts Facilitators and the Activities Co-ordinators. This relationship is explored and presented under three main themes: the collaborative process, practicalities and preparation and the approach of the Arts Facilitator. The Activities Co-ordinators' role is an under-researched area, but they play a central role in supporting visiting arts organisations to deliver the sessions and in enabling residents to attend and engage with meaningful activities.

The long and winding road of discontinuing long-term use of antidepressants: Learning from my experience.

WHAT IS KNOWN ON THE SUBJECT?: More people experience withdrawal symptoms when weaning off antidepressants than previously thought; particularly after taking them for a long time. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: I explore my own experience of weaning off antidepressants; detailing conflicting advice I have received from healthcare professionals, and the mental and physical withdrawal symptoms I experienced. I relate my experiences to a growing body of research, which have important implications for improving care. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout. Clinical guidance needs to be updated to provide appropriate evidence-based information/advice/recommendations for how best to support patients when coming off of antidepressants. ABSTRACT: A significant proportion of the UK population are taking antidepressants, and have been taking them for at least a year. Clinical guidelines have controversially stated that withdrawal symptoms when weaning off antidepressants are mild and resolve after one week, with the proviso that they can be severe only if the drug is stopped abruptly. However, recent evidence suggests this is not the case. I describe my own experiences of tapering the dose of my antidepressants after several years of taking them. I describe my encounters with healthcare professionals throughout this period, detailing conflicting advice I have received, along with describing the mental and physical withdrawal symptoms I have experienced. My experiences relate to a growing body of research, which have important implications for improving care. Potential learning outcomes are that healthcare professionals should make patients aware of potential withdrawal symptoms they may experience before they wean off antidepressants; regularly review their progress; consider helping them access psychological support whilst weaning off; and engage in open and collaborative conversations with patients throughout the process. Clinical guidance needs to be updated to provide appropriate evidence-based information, advice, and recommendations for how best to support patients when coming off of antidepressants.

The impact of living with long-term conditions in young adulthood on mental health and identity: What can help?

BACKGROUND: It has been suggested that the mental health impacts of living with long-term conditions are greater in young adulthood compared to older adulthood, due to greater disruption to identity and routine life events. OBJECTIVES: To explore the impact of living with long-term conditions in young adulthood on mental health and identity, and what helps living well with these conditions. METHODS: Fifteen in-depth interviews with young adults with various conditions were conducted and analysed thematically. RESULTS: Themes related to the impacts on mental health and identity include the following: negative mood and depression; anxiety and fear for the future; and identity as 'ill'/abnormal compared to former self and 'normal' others. Themes related to suggestions for addressing negative impacts include the following: promotion of positive thinking; support reaching acceptance with altered identity and limitations (through stages of denial, anger, depression, then acceptance); and more professional mental health support. DISCUSSION: In order to promote mental health and a positive sense of self/identity, young adults with long-term conditions should be offered advice and support on positive thinking; the long and difficult process of reconstructing identity; and reaching acceptance. This is particularly important for young adults for whom the identity reconstruction process is more complex and psychologically damaging than for older adults, as this life stage is associated with health/vitality and illness represents a shift from a perceived normal trajectory to one that appears and feels abnormal.

A mixed-methods evaluation of a Recovery College in South East Essex for people with mental health difficulties.

Recovery Colleges aim to assist people with mental health difficulties in the journey to recovery through education. They bring together professional and lived experience of mental health challenges in a non-stigmatising college environment and operate on college principles. All courses are designed to contribute towards well-being and recovery. Despite the ever-growing number of Recovery Colleges (both in the UK and internationally), the evaluative evidence is limited; comprising mostly non-peer-reviewed evaluations, audits and case studies. The present article comprises a mixed-methods evaluation of a newly established Recovery College in South East Essex, UK. The evaluation comprised questionnaires of mental well-being and social inclusion at baseline and 3 and 6 month follow-up, in addition to three focus groups. There were significant improvements in both mental well-being and social inclusion from baseline to 6 month follow-up (25 participants completed the measure of well-being at both time points and 19 completed the measure of social inclusion). This was supported by additional free-text questionnaire comments and focus group findings (17 participants participated across the focus groups), with reports of increased confidence, reduced anxiety and increased social inclusion/reduced social isolation. Additionally, at 6 month follow-up a majority of respondents were planning on attending courses external to the Recovery College, volunteering and/or gaining paid employment. Challenges and recommendations identified through the focus groups indicate the importance for standardisation of processes (which is particularly important when multiple organisations are involved in the running of a Recovery College), as well as consideration of longer-running courses. Funders should continue to invest in the Recovery College movement as the growing evidence-base is demonstrating how these colleges can help address the high prevalence of mental health difficulties, by promoting mental well-being and social inclusion.

PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare.

Reducing physical intervention in mental health inpatient care is a global priority. It is extremely distressing both to patients and staff. PROactive Management of Integrated Services and Environments (PROMISE) was developed within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to bring about culture change to decrease coercion in care. This study evaluates the changes in physical intervention numbers and patient experience metrics and proposes an easy-to-adopt and adapt governance framework for complex interventions. PROMISE was based on three core values of: providing a caring response to all distress; courage to challenge the status quo; and coproduction of novel solutions. It sought to transform daily front-line interactions related to risk-based restrictive practice that often leads to physical interventions. PROactive Governance of Recovery Settings and Services, a five-step governance framework (Report, Reflect, Review, Rethink and Refresh), was developed in an iterative and organic fashion to oversee the improvement journey and effectively translate information into knowledge, learning and actions. Overall physical interventions reduced from 328 to 241and210 across consecutive years (2014, 2015-2016 and 2016-2017, respectively). Indeed, the 2016-2017 total would have been further reduced to 126 were it not for the perceived substantial care needs of one patient. Prone restraints reduced from 82 to 32 (2015-2016 and 2016-2017, respectively). During 2016-2017, each ward had a continuous 3-month period of no restraints and 4 months without prone restrains. Patient experience surveys (n=4591) for 2014-2017 rated overall satisfaction with care at 87%. CPFT reported fewer physical interventions and maintained high patient experience scores when using a five-pronged governance approach. It has a summative function to define where a team or an organisation is relative to goals and is formative in setting up the next steps relating to action, learning and future planning.

The impact of the arts in healthcare on patients and service users: A critical review.

This review provides an updated evaluation of the emerging body of literature on the value of the arts in healthcare settings. Internationally, there is growing interest in the use of the arts in the healthcare context supported by the number of research studies reported in the nursing and medical literature. There is evidence that arts interventions have positive effects on psychological and physiological outcomes on patients in a hospital environment. A critical review of the literature between 2011 and 2016 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: cultural activities, outcomes and healthcare settings. Initial searches identified 131 potentially relevant articles. Following screening and review by the research team, a total of 69 studies were included in the final review. The majority of studies examined the effect of music listening on patients/service users (76.8%). These studies were primarily quantitative focusing on the measurable effects of music listening in a surgical context. Overall, the studies in the review support the growing evidence base on the value of the arts in a variety of healthcare settings for patients/service users. The review findings suggest that now is the time for different voices and art forms to be considered and represented in the research on arts in healthcare. Further research is also required to strengthen the existing evidence base.

Is restraint a 'necessary evil' in mental health care? Mental health inpatients' and staff members' experience of physical restraint.

Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, 'is restraint a necessary evil?', contained subthemes fitting into two ideas represented in the quote: 'it never is very nice but…it's a necessary evil'. It 'never is very nice' was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is 'never very nice', it is a 'necessary evil' when used as a last resort due to safety concerns. Mental health-care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff.

Healthcare professionals' perceptions of the value and impact of the arts in healthcare settings: A critical review of the literature.

BACKGROUND: Internationally there is growing interest in the use of the arts in the healthcare context evidenced by the number of research studies reported in the nursing and medical literature. Establishing successful projects in healthcare environments will to some extent be reliant on the cooperation of staff working in these settings: healthcare professionals and their cultural values will be the lynchpin in the relationship between the artists organising the activities and the patients. This review appraises healthcare professionals' perceptions of the value of the arts in healthcare settings, and the impact of the arts on healthcare professionals. METHODS: A critical review of the literature between 2004 and 2014 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: arts activities; healthcare settings, and healthcare providers. Studies were included if they were written in English, explored the attitudes of healthcare professionals on the use of the arts in healthcare settings or the impact of arts activities on healthcare staff. Studies conducted in community venues and/or reporting on arts therapies (art, drama or music) were excluded. An initial 52 studies were identified and following screening for relevance and quality 27 articles were reviewed. Arts interventions were diverse and included music listening, visual arts, reading and creative writing, and dance. RESULTS: Despite some methodological limitations of the reviewed studies it was found that the majority of staff believed that engaging in arts interventions has a positive impact on patients' health and well-being. The findings suggest that arts interventions are perceived to have an impact on patients' stress, mood, pain levels, and sleep. Furthermore, staff believed that the arts can enhance communication between staff and patients, helping to build rapport and strengthen interactions. The majority of reported staff outcomes were positive, with arts activities in healthcare settings found to: decrease stress, improve mood, improve job performance, reduce burnout, improve patient/staff relationships, improve the working environment and improve well-being. CONCLUSIONS: This review fills a gap in the literature, providing the first review of healthcare professional's views of the arts in healthcare settings and the impact of arts activities on healthcare staff. The largely positive perceptions of staff will aid in the implementation of arts activities in healthcare settings, which will enhance care and benefit both patients and healthcare staff.