Routine outcome measurement: recovery, quality of life and co-production.

Patient-reported outcome measures (PROMs) are self-rated, but may not take in other aspects of the patient's perspective, such as the inclusion of domains that reflect service-user priorities. The clinician's view still has priority, although this situation has shifted in recent years. The Recovering Quality of Life (ReQoL) offers an advance in this area. Declaration of interest None.

Difficulties in implementing supported employment for people with severe mental health problems.

People with severe mental health problems have low rates of open employment. Despite good evidence for the effectiveness of Individual Placement and Support (IPS), these schemes are not widely implemented. Their implementation is hampered by clinician and societal attitudes and the effect of organisational context on implementing IPS schemes with sufficient fidelity.

Friendship in people with schizophrenia: a survey.

OBJECTIVE: To explore the quantitative and qualitative aspects of friendship in people with schizophrenia. To examine emotional and behavioural commitment, experiences of stigma, and the impact of illness factors that may affect the making and keeping of friends. The difference in the perception between the researcher and participants of the presence of problems in friendships was also investigated. METHODS: The size and quality of the social networks of 137 people with established schizophrenia or schizoaffective disorder, aged 18-65 in one geographical area of southeast England was ascertained using a semi-structured interview. Qualitative aspects of friendship were measured using objective, pre-determined, investigator-rated criteria. RESULTS: The mean number of friends reported by respondents was 1.57. Men were less likely to report friendships than women (29 vs. 53%, χ (2) = 13.51, df 1, p < 0.001). Of the 79 people who had a friend, 75 named someone amongst fellow service users. The quality of these friendships was generally good. Emotional commitment to friendship and mistrust were more important than current clinical state in determining whether or not the participant has friends. Most of those without friends did not see the lack of friendship as a problem. The researcher was up to three times more likely to report a problem than the participant. CONCLUSIONS: The friendship network size was found to be small but the quality of friendship mostly positive and highly valued. The majority of friendships were with other service users made during attendances at day hospitals and drop-in centres thus underscoring the importance of this service provision. Psychosocial intervention programmes need to take into account psychological factors that impact upon friendship.

Sexual problems in schizophrenia: prevalence and characteristics. A cross sectional survey.

OBJECTIVE: To determine the prevalence and characteristics of psychosexual problems in people with schizophrenia, and to compare the subjects' and researcher's perceptions of the presence of these problems. METHODS: Cross-sectional survey of 137 people with established schizophrenia or schizoaffective disorder, aged 18-65 in one geographical area of southeast England, using a semi-structured interview format. RESULTS: A total of 74% of men and 82% of women reported at least one ICD-10 defined sexual problem. Arousal problems were associated with physical health problems in men. Orgasm problems were more common in people in relationships. The researcher was about three times more likely to record a sexual problem than the respondents were to report one. CONCLUSIONS: People with schizophrenia report sexual dysfunction that is similar in nature but which occurs at a higher rate than is reported in the general population. There are gender differences and differences in the perception of psychosexual problems between those with schizophrenia and the researcher.

Dismantling the social safety net: social security reforms, disability and mental health conditions.

This article examines the effects of UK welfare reform since 2008 on people with mental health conditions and disabilities. The results have been profound, particularly during a time of economic austerity, damaging the social safety net and pushing many vulnerable people into poverty and hardship. It has perpetuated inequalities and increased the social exclusion of disabled groups. The holes in the safety net require repair, alongside extensive social policy reform to both protect and empower people with disabilities and long-term conditions.

Person-centred care and psychiatry: some key perspectives.

This paper outlines the importance of person-centred approaches to the practice of contemporary medicine and psychiatry. In considering the many aspects of person-centred approaches it outlines some key perspectives, including freedom and human rights; improving individual practice and the quality of services; increasing clinicians' work satisfaction; combining value-based and evidence-based practice; and the training of future generations of psychiatrists.

In-patient and residential alternatives to standard acute psychiatric wards in England.

BACKGROUND: Acute psychiatric wards have been the focus of widespread dissatisfaction. Residential alternatives have attracted much interest, but little research, over the past 50 years. AIMS: Our aims were to identify all in-patient and residential alternatives to standard acute psychiatric wards in England, to develop a typology of such services and to describe their distribution and clinical populations. METHOD: National cross-sectional survey of alternatives to standard acute in-patient care. RESULTS: We found 131 services intended as alternatives. Most were hospital-based and situated in deprived areas, and about half were established after 2000. Several clusters with distinctive characteristics were identified, ranging from general acute wards applying innovative therapeutic models, through clinical crisis houses that are highly integrated with local health systems, to more radical voluntary sector alternatives. Most people using the alternatives had a previous history of admission, but only a few community-based services accepted compulsory admissions. CONCLUSIONS: Alternatives to standard acute psychiatric wards represent an important, but previously undocumented and unevaluated, sector of the mental health economy. Further evidence is needed to assess whether they can improve the quality of acute in-patient care.

Can the effects of a 1-day CBT psychoeducational workshop on self-confidence be maintained after 2 years? A naturalistic study.

The continued high prevalence of depression in the general population has been in part attributed to a reluctance to consult and also to the limited capacity of psychological therapy services. In a previous randomized controlled trial, self-referral day-long workshops, each for 25 people, offering a cognitive-behavioral therapy approach, seemed to be effective at 3-month follow-up [Brown et al., 2004]. In this study, both experimental group participants and waiting list control participants who went on to attend the workshops (n=102) were followed up and 54.9% provided data after 2 years. The dropout mechanism was investigated and random effects models were used for all analyses. This is a naturalistic study that lacked a control group and had a relatively high attrition rate. The results nevertheless suggest that positive changes in depression, anxiety, distress, and self-esteem achieved at 3 months follow-up were largely maintained at 2 years for those who were "depressed" (Beck Depression Inventory [BDI] scores of 14 and above). However, nondepressed (BDI scores below 14) did not show any significant change. The overall results of this naturalistic study indicate that a very brief, intensive, and large-scale intervention can largely maintain its effects for participants with depression over a 2-year period.

Mental Health and Social Care and Social Interventions.

In common parlance, the term 'social' is used in many senses ranging from the way society is organised to the rank or status someone has in society; to activities that involve meeting with other people; to the experience, behaviour and interaction of persons forming groups; and to promoting companionship and communal activities. [...].

Implementing Supported Employment. Lessons from the Making IPS Work Project.

Individual Placement and Support (IPS) is an internationally accepted and effective form of supported employment for people with severe mental health conditions. Despite its strong evidence base, the implementation of IPS has been slow and inconsistent. In England, a demonstration project, Making IPS Work, was developed to offer support for the implementation of IPS in six local sites National Health Service Mental Health trusts. The project aimed to: Establish Individual Placement and Support services within clinical teams; develop high fidelity practice and leave a sustainable IPS service beyond the project. The number of people gaining open employment in each site was monitored. Fidelity checks were carried out at three sites by independent assessors. Stakeholders were interviewed over the 18-month lifetime of the implementation period to examine the experience of developing the services in the six sites. A total of 421 jobs were found for people with mental health conditions over 18 months with a large variation between the highest and lowest performing sites. The sites assessed for fidelity all attained the threshold for a 'Good Fidelity' service. The new services were readily accepted by mental health service users, clinical staff and managers across the trust sites. Maintaining the funding for the Individual Placement and Support services beyond the project period proved to be problematic for many sites. Placing the services within a broader strategy of improving psychosocial services and bringing together decision making at the corporate, commissioning and clinical management level were helpful in achieving success. The growth and maintenance of these services is difficult to achieve whilst the current cost pressures on the NHS continue.

Debating personal health budgets.

Personal health budgets (PHBs) were piloted in the National Health Service (NHS) in England between 2009 and 2012 and were found to have greater positive effects on quality of life and psychological well-being for those with mental health problems than commissioned service, as well as reducing their use of unplanned care. The government intends to extend PHBs in England for long-term conditions, including mental health, from April 2015. Given the importance of engaging clinicians in the next phase of PHB development, we provide an overview of the approach, synthesise the evidence from the national pilot and debate some of the opportunities and challenges. Balancing individual choice and recovery with concerns for risk, equity and the sustainability of existing community services is the central tension underpinning this innovation in mental health service delivery.

Prevalence of suicide ideation in two districts of Uganda.

Suicide ideation is common in all communities but research on suicidal behavior in Sub-Saharan Africa is scarce. The aim of this study was to determine the prevalence of self-reported suicidal ideation in two contrasting districts of Uganda. The method employed was a systematic sample of 939 respondents residing in Adjumani and Bugiri districts, using the Beck Scale for Suicide Ideation (BSS). Results indicated a higher rate of suicidal ideation in females, the unemployed and in Adjumani district. Consistent with other international studies, high rates of suicidal ideation were found in the Ugandan population. The higher prevalence of suicide ideation in the Adjumani District appears to be a symptom of psychosocial distress related to many years of social and political turmoil and the poor socio-economic conditions. In-depth observational studies are needed to fully understand the process of suicide ideation in Uganda.

The response inventory for stressful life events (RISLE) I. refinement of the 100-item version.

BACKGROUND: No indigenous screening instruments are available for the detection of depression and suicide risk relevant to the context of patients in Uganda. The Response Inventory for Stressful Life Events (RISLE) may be an appropriate tool, but requires validation. OBJECTIVE: The paper reports on the development of the RISLE and the refinement of the 100-item RISLE into a shorter version for use in large samples. METHODS: Two samples were used in the validation exercise: a general population sample from Adjumani and Bugiri districts and a student sample from Makerere University in Kampala district. The RISLE responses were subjected to Principal Components Analysis and Discriminant Function Analysis. The 100-item RISLE and resulting shorter version were compared and their concurrent validity assessed by comparing test results to the individuals' responses to the Beck Depression Inventory (BDI) and the Beck Scale for Suicide ideation (BSS). RESULTS: Nine hundred thirty nine questionnaires were available for the population sample, 101 for the student sample. The 100-item RISLE was reduced to 36-items without loss of face validity. Both the 100- and 36-item versions had high internal consistency, were highly correlated with each other and with the BDI and BSS. CONCLUSION: The 36-item RISLE appears to be an advance on the 100-item version, retaining its internal consistency and concurrent validity.

The response inventory for stressful life events (RISLE) II: validation of the 36-item version.

BACKGROUND: A 36-item version of the Response Inventory for Stressful Life Events (RISLE) was derived from the longer 100 item version. The 36-item version may be more appropriate for use in larger population sample. OBJECTIVE: To compare the responses of the 36-item RISLE to interview derived psychiatric diagnoses and suicidal ideation in a sub-sample of the general population and student samples reported in the accompanying paper. METHODS: Clinical interviews using the Mini International Neuropsychiatric Interview (MINI) were carried out on 67 members of the general population and 58 members of the student samples. Receiver Operating Characteristic (ROC) curves were constructed for the RISLE responses using current depressive disorder, any current psychiatric disorder, and past month suicidality variables. Sensitivities, specificities, predictive values and likelihood ratios were determined based on various cut-off points based on ROC curves. Kappa statistic was determined to evaluate the level of agreement between the result of questionnaire surveys and research clinical interviews at different cut-off points on the RISLE. RESULTS: The probability of correct detection of current depression was 79%, any current psychiatric disorder 83% and past month suicidality 83%. The optimal cut-offs for the general population was 10 and for the students 6. High scores on the 36-item RISLE were associated with a past history of suicide attempt and recent and past suicide ideation. CONCLUSION: The 36-item RISLE appears to have good concurrent validity and may be a reasonable screening instrument for psychological distress in the Ugandan population. The results suggest that the RISLE alone is capable of screening for both depressive mood and suicidal ideation effectively at different cut-off points. Thus the RISLE is capable of achieving what normally takes two scales such as the BDI and BSS to do separately. However, further validation work is required using larger population samples in clinical interviews in prospective studies.

Mental health and poverty in the UK - time for change?

Poverty and income inequality have increased in the UK since the 1970s. Poverty and mental ill-health are closely associated and disadvantage can have long-term consequences. In addition, the recent recession and austerity measures have had a detrimental effect on people with mental health problems and the mental health of the population. Mental health services can play a role in addressing the problems of poverty and inequality.

Diaspora and peer support working: benefits of and challenges for the Butabika-East London Link.

The International Health Partnership ('the Link') between the East London NHS Foundation Trust and Butabika Hospital in Uganda was set up in 2005. It has facilitated staff exchanges and set up many workstreams (e.g. in child and adolescent psychiatry, nursing and psychology) and projects (e.g. a peer support worker project and a violence reduction programme). The Link has been collaborative and mutually beneficial. The authors describe benefits and challenges at individual and organisational levels. Notably, the Link has achieved a commitment to service user involvement and an increasingly central involvement of the Ugandan diaspora working in mental health in the UK.