What about the children? Adult mental health practitioners' experiences and views of family-focused practice in Early Intervention Services.

BACKGROUND: There is a significant risk of negative outcomes for families when a parent experiences serious mental illness. Family-focused practice (FFP) emphasises the "whole family" as the unit of care and has been found to improve outcomes for service users and their families. Despite its benefits, FFP is not routinely implemented in UK adult mental health services. This study explores adult mental health practitioners' experiences and views of FFP within Early Intervention Psychosis Services in the UK. METHODS: Sixteen adult mental health practitioners employed in three Early Intervention Psychosis teams in the Northwest of England were interviewed. Interview data were analysed using thematic analysis. RESULTS: Five core themes were generated: (1) A limited understanding of FFP, (2) Our practitioners, (3) Our approach, (4) Our families and (5) Our services. Practitioners' understanding of FFP was limited and typically excluded dependent children. Practitioners' age, professional and personal experience, and preconceptions of families influenced delivery, and in turn, the engagement approach they adopted impacted families' responsiveness. The diversity and dynamics of service user families such as age, socioeconomic status, culture and stigma impacted FFP. An operational context characterised by insufficient resources reduced FFP; however, organisational structures such as leadership, clinical supervision and multi-disciplinary teams facilitated FFP. CONCLUSIONS: FFP is not yet embedded within Early Intervention Services. Practice recommendations include agreeing on a formal definition of FFP and its scope; the development of FFP policy; clarity in relation to staff responsibilities and identities; the adoption of a collaborative approach which encourages service user choice and for time to be ring-fenced to prioritise FFP. Future research should ascertain service user and family views on the facilitators and barriers to engaging with FFP in Early Intervention Services.

Parents who experience psychosis: A qualitative exploration.

OBJECTIVES: Psychosis can present parents with complex parenting challenges and significant adverse outcomes for parents and their children have been reported. However, remarkably little is known about how parenting is experienced by these parents. Therefore, this qualitative study aimed to understand the lived experiences of parents with psychosis, including how parenting support was experienced. DESIGN AND METHODS: Using interpretative phenomenological analysis (IPA), eight biological parents (five mothers and three fathers) with psychosis were recruited and interviewed from early intervention in psychosis services in the Northwest of England. RESULTS: Three superordinate themes and seven subordinate themes were identified. Theme 1 'Living with the Struggle: Painfully Disconnected' captured a persistent parenting struggle that distanced parents from their children and support due to all-consuming experiences of psychosis, fear and risk-focused service support. Theme 2 'Desired and Vulnerable Position: Comfortably Connected' captured parental experiences of symptom relief through connection with their children, alongside parental need to be integrated with the systems around them. Theme 3 'Exposed: Parenting Under a Spotlight' represented parental experiences of inescapable observation and judgement from the systems around them. CONCLUSIONS: Novel insights into the role of misaligned parent and service priorities in parental perceptions of powerlessness, shame and disconnection from their children, valued parenting identities, and system supports are presented. Systemic interventions that target stigma, provide system-wide psychoeducation and promote person-centred, compassionate and meaningful connections between parents and the systems they live within are needed to promote better parenting outcomes.

Perceived empowerment in people with a dual diagnosis of schizophrenia spectrum disorder and substance misuse.

PURPOSE: The aims of the present study were to validate a measure of empowerment in a British population of people with a dual diagnosis of schizophrenia and substance misuse and assess relationships between empowerment and other key outcomes. METHOD: Patients participating in a large randomised control trial for Motivational Interviewing for Drug and Alcohol misuse in Schizophrenia or psychosis (MIDAS trial) completed measures of empowerment, symptoms, global functioning and substance use at baseline, 12- and 24-month follow-ups. RESULTS: A three factor model of empowerment: self-efficacy and control; power and anger; and activism provided the best fit of the data across all three time points. There was some evidence of associations between empowerment and both symptoms and global functioning, although these associations were not consistent across subscales. Changes in empowerment predicted changes in symptoms and functioning at follow-up. CONCLUSIONS: Empowerment is a broadly defined construct and its meaning may differ across different populations of people with severe and enduring mental health problems. Empowerment is a key component of recovery and should be assessed in treatments in addition to more traditional outcome measures of symptoms and functioning.

Integrated motivational interviewing and cognitive-behavioural therapy for bipolar disorder with comorbid substance use.

Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered.

The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis.

AIM: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances. BACKGROUND: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill-equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice. METHOD: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health difficulties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues. FINDINGS: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non-clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specific factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non-clients. CONCLUSION: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care.

Distress in Parkinson's disease: contributions of disease factors and metacognitive style.

Research has suggested that the high levels of depression and anxiety observed in Parkinson's disease are a primary consequence of its pathophysiology. This study aimed to test the hypothesis that a psychological factor, metacognitive style, is significantly associated with distress, independent of previously identified disease-related risk factors. Distress, metacognitive style and disease factors were assessed in 44 people with a diagnosis of Parkinson's disease. People with a specific metacognitive style had an increased vulnerability to distress over and above previously identified disease factors; this suggests future directions for the development of psychological interventions.