Children in out-of-home care's right to family and cultural connection: Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives.

BACKGROUND: Children have a right to participate in decisions about their lives. They also have the right to family and cultural connection, including when they are removed due to child protection concerns. However, the literature highlights barriers children in out-of-home care experience connecting to family-of-origin and culture. Moreover, this literature is predominantly from the perspective of practitioners and carers, with children's perspectives notably absent. OBJECTIVE: This qualitative study addresses this gap by exploring Aboriginal and/or Torres Strait Islander and non-Indigenous Australian children's perspectives and experiences of family and cultural connection while in out-of-home care. It seeks to uphold children's right to express their views on matters that impact their lives. PARTICIPANTS AND SETTING: The participants were 62 children aged 4-15 years (x̄=9 years), who were in out-of-home care in Queensland (Australia). Forty-two of the children were non-Indigenous and 20 identified as Aboriginal and/or Torres Strait Islander children. METHODS: Lundy's (2007) model of participation guided the data collection approach. Art-based graphic-elicitation interviews were conducted. Verbatim transcripts were analysed thematically. RESULTS: Children had differing levels of understanding as to why they could not reside with their family. Most children referred to a family-of-origin member not living with them as important in their lives, but it was not always their parent/s. Siblings were mentioned frequently. Barriers to connections with family included distance and cost of travel, parents not attending visits and being uncontactable, incarcerated or deceased. Whilst most children desired increased connection with family, a few wished for reduction or cessation. Aboriginal and/or Torres Strait Islander children showed varying levels of connection to culture with both siblings and carers playing key roles in enabling greater connection. CONCLUSIONS: Graphic-elicitation interviews provided an important opportunity for children to voice their experiences of and preferences regarding family and cultural connection. The inclusion of children's voices is needed to inform responsive policies and practices that safely support their rights to family and culture when in out-of-home care.

Why we need to pursue both universal and targeted prevention to reduce the incidence of affective and psychotic disorders: Systematic review and meta-analysis.

The effectiveness of universal preventive approaches in reducing the incidence of affective/psychotic disorders is unclear. We therefore aimed to synthesise the available evidence from randomised controlled trials. For studies reporting change in prevalence, we simulated all possible scenarios for the proportion of individuals with the disorder at baseline and at follow-up to exclude them. We then combined these data with studies directly measuring incidence and conducted random effects meta-analysis with relative risk (RR) to estimate the incidence in the intervention group compared to the control group. Eighteen studies (k=21 samples) were included investigating the universal prevention of depression in 66,625 individuals. No studies were available investigating universal prevention on the incidence of bipolar/psychotic disorders. 63 % of simulated scenarios showed a significant preventive effect on reducing the incidence of depression (k=9 - 19, RR=0.75-0.94, 95 %CIs=0.55-0.87,0.93-1.15, p=0.007-0.246) but did not survive sensitivity analyses. There is some limited evidence for the effectiveness of universal interventions for reducing the incidence of depression but not for bipolar/psychotic disorders.

The Lived Experiences of Family Members and Carers of People with Psychosis: A Bottom-Up Review Co-Written by Experts by Experience and Academics.

Informal caregivers of individuals affected by psychotic disorder can play a key role in the recovery process. However, little research has been conducted on the lived experiences of carers and family members. We conducted a bottom-up (from lived experience to theory) review of first-person accounts, co-written between academics and experts by experience, to identify key experiential themes. First-person accounts of carers, relatives, and individuals with psychosis were screened and discussed in collaborative workshops involving individuals with lived experiences of psychosis, family members, and carers, representing various organizations. The lived experiences of family members and carers were characterized by experiential themes related to dealing with the unexpected news, the search for a reason behind the disorder, living with difficult and negative emotions, dealing with loss, feeling lost in fragmented healthcare systems, feeling invisible and wanting to be active partners in care, struggling to communicate with the affected person, fighting stigma and isolation, dealing with an uncertain future, and learning from one's mistakes and building resilience and hope. Our findings bring forth the voices of relatives and informal carers of people with psychosis, by highlighting some of the common themes of their lived experiences from the time of the initial diagnosis and throughout the different clinical stages of the disorder. Informal carers are key stakeholders who can play a strategic role, and their contributions in the recovery process merit recognition and active support by mental health professionals.

The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics.

Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.