Levelling the playing field: Exploring inequalities and exclusions with a community-based football league for people with experience of mental distress.

INTRODUCTION: Sport workforce strategy in the United Kingdom (UK) has identified the occupational therapy profession as being ideally positioned to contribute to public health agendas relating to tackling physical inactivity amongst marginalised populations, such as disabled people and people with experience of mental distress. However, a robust understanding of the enablers, restrictions, and exclusions such groups encounter when seeking to participate in sport and physical activity is currently lacking. METHODS: This study aimed to gain an in-depth understanding of the different ways people with experience of mental distress talked about their participation in a community-based football league in England, in the UK. Nine people took part in this strand of a larger participatory action research (PAR) study, which used go-along interviews as the method of data collection. In alignment with PAR seeking to address power imbalances, the data from the go-along interviews were analysed through a Foucauldian lens using a collaboratively produced analytic framework. FINDINGS: Participants constructed the community-based football league as fostering feelings of purpose and belonging, against a backdrop of them describing experiencing stigma and exclusion when seeking to be active in their wider communities. They used the concept of occupational marginalisation to further interpret their situation. CONCLUSION: Understanding why and how people participate in football extends beyond seeing it as an individual exercise to shared social lives and occupations. With this perspective, occupational therapists could address occupational marginalisation in partnership with community sports organisations, collaborating for wider social change beyond specialist services.

Brown Adipose Tissue Exhibits a Glucose-Responsive Thermogenic Biorhythm in Humans.

High abundance of brown adipose tissue (BAT) is linked to lower glycaemia in humans, leading to the belief that BAT may protect against diabetes. The relationship between BAT glucose utilization and systemic glucose homeostasis has not been defined. In this paper we have characterized glycaemic excursions and BAT thermogenic responses in human brown adipocytes, BAT explants, and healthy adults through supraclavicular temperature profiling, revealing their circadian coupling in vivo and in vitro, orchestrated by UCP1, GLUT4, and Rev-erbα biorhythms. Extent of glycated haemoglobin also correlated positively with environmental temperature among community-dwelling patients. These data uncover potential crosstalk between BAT and glucose regulatory pathways, evident on cellular, tissue, individual, and population levels, and provide impetus to search for BAT harnessing strategies for therapeutic purposes.

'It's like having a day of freedom, a day off from being ill': exploring the experiences of people living with mental health problems who attend a community-based arts project, using interpretative phenomenological analysis.

To explore the psychosocial benefits of participating in a 2-year community arts project, eight people living with long-term mental health problems were interviewed. The project involved participants in selecting items of professional artwork, creating personal responses and curating a public exhibition. Interviews were analysed using interpretative phenomenological analysis. Participants experienced the arts project as improving self-worth, emancipating self from illness labels, offering a sense of belonging, enabling acquisition of valued skills and offering meaningful occupation and routines. Some regarded their developing creative skills as improving their self-management of mental health. However, some anticipated the project's ending with anxiety.

Peer support in adult mental health services: a metasynthesis of qualitative findings.

OBJECTIVES: Peer support involves people in recovery from psychiatric disability offering support to others in the same situation. It is based on the belief that people who have endured and overcome a psychiatric disability can offer useful support, encouragement, and hope to their peers. Although several quantitative reviews on the effectiveness of peer support have been conducted, qualitative studies were excluded. This study aimed to synthesize findings from these studies. METHOD: A qualitative metasynthesis was conducted, involving examination, critical comparison, and synthesis of 27 published studies. The experiences of peer support workers, their nonpeer colleagues, and the recipients of peer support services were investigated. RESULTS: Peer support workers experiences included nonpeer staff discrimination and prejudice, low pay and hours, and difficulty managing the transition from "patient" to peer support worker. Positive experiences included collegial relationships with nonpeer staff, and other peers; and increased wellness secondary to working. Recipients of peer support services experienced increased social networks and wellness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings highlight training, supervision, pay, nonpeer staff/peer staff relationships, as important factors for statutory mental health peer support programs.

Community-based rehabilitation in Jordan: challenges to achieving occupational justice.

PURPOSE: This paper presents theories of occupational and social justice and applies the theoretical tenets to a community-based rehabilitation (CBR) program in a Palestinian refugee camp in Jordan. METHOD: The example of building a playground for children with disabilities, and other aspects of the social, political and cultural context in Jordan are described in relation to the theory and practice of CBR, occupational and social justice. RESULTS: Key concepts are explained, analyzed and applied, namely occupational justice, social justice, occupational form and occupational deprivation (a strong determinant of occupational injustice), all of which were relevant in the refugee camp where children with disabilities were deprived of resources and chances to play. CONCLUSION: Grounding CBR in an occupational justice framework offers justification and inspiration for occupational therapy in similar settings deprived of resources and opportunities wherein both individuals and communities could benefit. IMPLICATIONS FOR REHABILITATION: Occupational deprivation, such as that seen in refugee camps, is associated with poor mental health and physical frailty. CBR in refugee camps can lead to both occupational justice and social justice for persons with disabilities. Disability laws and legislation must be implemented, not just stated on paper, in order to address the rights of persons with disabilities and social justice.

Meeting in the mist: key considerations in a collaborative research partnership with people with mental health issues.

OBJECTIVES: This study explored the experiences of an established collaborative research group, which were collected as data to gain research skills. Currently ideas about user involvement and knowledge transfer have not been considered together, indicating possible gaps in knowledge. PARTICIPANTS: Eight members of the group took part, including five people using local mental health services, an assistant and an occupational therapist from local services, and an academic. METHODS: Experiences of collaborative working were explored in phases. Structured individual reflections were recorded and shared for initial analysis. A group discussion prepared for constant comparative analysis, which synthesized the emerging themes. RESULTS: Participants had gained and shared skills, understanding and knowledge. "Meeting in the mist" was a metaphor to explain the journeys experienced by participants, within a collaborative cycle. This cycle was central to a visual model, "Creating space", which suggested the importance of allowing sufficient time and space to work for a shared vision of the future. A final theme was the "warp factor", which drew on relativity theory to highlight the sense of innovation. CONCLUSIONS: Collaborative work can be based on knowledge transfer and ideas about user involvement, generating tangible benefits for all involved, including engaging in productive occupations.

A qualitative study of service user experiences of occupation in forensic mental health.

BACKGROUND/AIM: This qualitative study explored occupational engagement of those detained in forensic units. Legal and institutional restrictions on occupation have implications for their health and wellbeing. METHOD: Twenty-six current forensic mental health service users participated in five focus groups, which were audio-recorded, transcribed verbatim and subjected to constant comparative analysis. FINDINGS: The participants highlighted previous occupations, current occupations and hopes. Key aspects were control over decision-making, motivation and support, generating suggestions alongside positive experiences of occupational therapy. CONCLUSIONS: Institutional barriers could be overcome with a dynamic balance between risk management and mental health promotion through occupation. This demands a sustained focus on occupation for everyone involved in providing care and treatment in these settings.

Diabetes guidelines: easier to preach than to practise?

OBJECTIVE: To review the management of glycaemia, blood pressure and serum lipids in a hospital outpatient diabetes clinic, the director of which co-authored the current national diabetes management guidelines. DESIGN: Retrospective audit. SETTING: Outpatient diabetes clinic in a tertiary referral teaching hospital, Sydney, NSW. STUDY POPULATION: 96 patients with type 1 diabetes (mean age, 44.4 [SD, 12.8] years) and 509 patients with type 2 diabetes (mean age, 64.4 [SD, 12.0] years) attending the clinic in 2003, who had undergone formal review of complications. MAIN OUTCOME MEASURES: Weight, height, control and treatment of glycaemia, blood pressure and serum lipids, and prevalence of diabetic microvascular complications. RESULTS: Glycated haemoglobin (HbA(1c)) was < 7% in 13% of type 1 and 30% of type 2 diabetes patients, and > 8% in 47% and 34%, respectively. 35% of patients with type 1 diabetes and 71% of patients with type 2 diabetes were treated with antihypertensive agents. Of these patients, 29% and 24%, respectively, had blood pressure readings

Living in a glasshouse: exploring occupational alienation.

BACKGROUND: Community mental health care has shifted focus from resettlement to empowerment, reflecting a wider agenda for social inclusion. PURPOSE: This study evaluated mental health day services from the perspectives of thirty-nine clients. METHOD: Data analysis of the four focus groups explored the implications for occupational therapy. The data collected were subjected to constant comparative analysis and theoretical sampling. RESULTS: Participants described how mental health day services structured their day and enabled access to support networks. However, many perceived aspects of the services as fostering their dependence and threatening sessions they valued. This dependency led to them feeling alienated and wishing to seek greater influence over decisions about their current and future life. The concept of occupational alienation was used to further interpret their situation. PRACTICE IMPLICATIONS: Occupational therapy could overcome occupational alienation experienced by mental health day service clients, through the development of services within and beyond day services which promote a sense of belonging and offers meaningful occupation.