Clio Berry

Another rather than other: experiences of peer support specialist workers and their managers working in mental health services

Purpose – The integration of peer support workers with lived experience of mental health problems into existing mental health services has been found beneficial in some ways. However, some peer support workers have experienced unique challenges in terms of role confusion and limited opportunities for networking and support. Qualitative research and evaluation regarding peer support worker integration is limited. This paper aims to address this issue.Design/methodology/approach – The current paper presents a qualitative evaluation of the experiences of two peer support specialist (PSS) workers and their managers within one UK mental health trust. The PSS workers and managers were interviewed individually using a semi‐structured format. Thematic analysis was applied to the interview transcripts.Findings – In agreement with prior research and evaluation, positive experiences and challenges were identified in relation to PSS employment, both for PSS workers and their teams. Overarching themes concern the PSS ...

Expectations and illusions: a position paper on the relationship between mental health practitioners and social exclusion

Over the last 10 years, the social inclusion agenda has been gaining momentum as a policy driver in mental health services. Prior to the seminal Social Exclusion Unit (SEU) report, Mental Health and Social Exclusion, there was a lack of awareness concerning the pervasive links between social exclusion and mental health problems. In the report, the SEU suggested that mental health practitioners themselves may actually be contributing to this social exclusion. This finding has been given limited coverage in both social inclusion literature and research. The current paper is a positioned commentary further exploring the relationship between practitioners and the social exclusion of mental health service users. A literature review was conducted in order to identify themes among factors which appear to moderate and contribute to this relationship. These factors are presented and implications for inclusive practice are explored.

Direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness and social inclusion in young people experiencing psychosis

OBJECTIVE Social inclusion and vocational activity are central to personal recovery for young people with psychosis. Studies with people experiencing long term psychosis suggest negative self-beliefs are important, but less is known about whether this association is present for young service users or about the potential influence of positive self-beliefs such as hopefulness. The aim of the current paper was to investigate the direct and indirect associations between dysfunctional attitudes, self-stigma, hopefulness, social inclusion and vocational activity for young people with psychosis. METHOD A 5-month longitudinal study was conducted with young psychosis service users. Measures of dysfunctional attitudes and self-stigma and vocational activity were obtained at baseline. Measures of hopefulness, social inclusion and vocational activity were obtained at follow-up. RESULTS Hopefulness mediates the associations between self-stigma, social inclusion and vocational activity. Self-stigma may have a greater influence on social inclusion with age. Dysfunctional attitudes do not significantly predict social inclusion or change in vocational activity status. CONCLUSION Findings suggest that the impact of self-stigma may extend beyond social and occupational withdrawal and undermine subjective community belonging. Findings encourage an increased emphasis on facilitating hopefulness for young people who experience psychosis.

Brief Coping Strategy Enhancement for Distressing Voices: an Evaluation in Routine Clinical Practice

BACKGROUND Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access. AIMS We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice. METHOD This was a service evaluation comparing pre-post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations (PSYRATS-AH). RESULTS Data were available from 101 patients who had completed therapy. A reduction approaching clinical importance was found on the PSYRATS distress scale post-therapy when compared with the baseline. CONCLUSIONS The findings from this study suggest that CSE, as a focused and brief form of CBTp, can be effective in the treatment of distressing voices within routine clinical practice. Within the context of the limitations of this study, brief CSE may best be viewed as the beginning of a therapeutic conversation and a low-intensity intervention in a stepped approach to the treatment of distressing voices.

Evaluating socially inclusive practice: part two ‐ findings from a mental health team

A tool was created to evaluate the socially inclusive practice of mental health teams. The tool was based on the 2007 Department of Health best practice guide for the workforce, Capabilities for Inclusive Practice (CfIP), itself based on The 10 Essential Shared Capabilities (Hope, 2004). The tool comprised three parts, a team questionnaire, a service user questionnaire, and a Care Programme Approach (CPA) care plan documentation analysis (see previous paper on pp31‐41). This paper focuses on piloting the tool with mental health teams within Sussex Partnership NHS Foundation Trust as a means of showcasing the evaluation tool. Detailed findings are reported from one assertive outreach team (AOT). The findings suggest that although the team professed limited knowledge of CfIP, they endorsed all capabilities in their practice, although a low response rate limits the extent to which the current findings are generalisable. The triangulation of data provided by the tool facilitates an exploration of the variance of capabilities across team, service user, and care planning perspectives, meaning that specific areas for the improvement of the delivery of inclusive practice can be easily identified.

Facilitating hope as protection against social disability and the development of an Early Youth Engagement model in first episode psychosis services (the EYE project)

Abstract presented at the 9th International Conference on Early Psychosis To the New Horizon, 17 November 2014, Tokyo, Japan

Evaluating socially inclusive practice: part one ‐ a tool for mental health services

This paper gives an overview of the development and pilot implementation of a tool to evaluate socially inclusive practice. There are strong links between social inclusion and better mental health outcomes for people who access services, yet a very limited amount of research exists concerning ways to evaluate socially inclusive practice within mental health services. The paper describes the creation of a tripartite tool to access the views of mental health teams who work with service users, and the service users themselves. As part of the movement towards recovery and social inclusion, the Department of Health requires that social and occupational needs become embedded in care plans alongside health needs (DoH, 1999), and so an analysis of care plan documentation completed the evaluation tool. A pilot evaluation was conducted with three mental health teams in Sussex and found issues with engagement and response rate. Lessons learned and future implications are discussed.

An exploration of young people’s narratives of hope following experience of psychosis

ABSTRACT Aims: To expand understandings of how young people with psychosis experience hope. This included to which factors young people attributed changes in their hopefulness and the role played by professionals and others with lived experience. Method: Ten young people recovering from an experience of psychosis were interviewed using narrative methodology. Results: The experience of hope as an overarching strand throughout the narratives had three common elements: sense of belonging, which included social inclusion, the importance of information and the significance of planning and occupation. Professionals played an important role in facilitating small steps forwards. Conclusions: The findings suggest the importance to young people of a sense of belonging and achieving small goals to facilitate hopeful thinking and, for clinicians, the value of supporting new peer relationships and meaningful occupation.

Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature.

The experience of hearing voices (‘auditory hallucinations’) can cause significant distress and disruption to quality of life for people with a psychosis diagnosis. Psychological therapy in the form of cognitive behavior therapy (CBT) for psychosis is recommended for the treatment of positive symptoms, including distressing voices, but is rarely available to patients in the United Kingdom. CBT for psychosis has recently evolved with the development of symptom-specific therapies that focus upon only one symptom of psychosis at a time. Preliminary findings from randomized controlled trials suggest that these symptom-specific therapies can be more effective for distressing voices than the use of broad CBT protocols, and have the potential to target voices trans-diagnostically. Whilst this literature is evolving, consideration must be given to the potential for a symptom-specific approach to overcome some of the barriers to delivery of evidence-based psychological therapies within clinical services. These barriers are discussed in relation to the United Kingdom mental health services, and we offer suggestions for future research to enhance our understanding of these barriers.