Hilary Mairs

Life Skills Training in Schizophrenia

Rehabilitation approaches incorporating life skills training are widely employed in the treatment of individuals with schizophrenia. However, whether such approaches are effective is unknown (Nicol et al 2003). This pilot study assessed the effectiveness of a life skills training intervention for people with a diagnosis of schizophrenia, facilitated by occupational therapists working in community mental health teams. Seventeen clients with a diagnosis of schizophrenia and a life skill deficit or deficits were recruited from two National Health Service trusts and participated in up to 12 sessions of life skills training, based upon a treatment manual written specifically for the study. The intervention was facilitated by eight occupational therapists who received training in life skills therapy. A pre-intervention and post-intervention experimental design was used to assess the effectiveness of the programme, with measures of psychiatric symptoms and social functioning being conducted by an independent assessor who was naïve to the intervention being used. For the 13 participants who completed the life skills intervention, participation was found to reduce negative symptoms and overall levels of general psychopathology, although this was not reflected in social functioning. Indeed, a statistically non-significant deterioration in social functioning was found upon completion of the intervention. This uncontrolled study does not allow definitive evaluation of the value of life skills training in schizophrenia, but it does provide justification for a larger-scale controlled trial of a manual based approach to life skills training with this client group.

Development and pilot investigation of behavioral activation for negative symptoms

Negative symptoms cause functional impairment and impede recovery from psychosis, not least, because of limited developments in empirically validated treatments. This article details a pilot evaluation of a behavioral activation (BA) treatment with eight people presenting with psychosis and marked negative symptoms. The rationale for this development was that BA is effective in treating depression, a condition that shares overlapping features with negative symptoms. Results provide preliminary support for feasibility and effectiveness of BA for negative symptoms in terms of treatment adherence, retention, and initial outcomes. However, additional advantages may accrue from revisions to the BA treatment.

Obesity and Serious Mental Ill Health: A Critical Review of the Literature

Individuals who experience serious mental ill health such as schizophrenia are more likely to be overweight or obese than others in the general population. This high prevalence of obesity and other associated metabolic disturbances, such as type 2 diabetes and cardiovascular disease, contribute to a reduced life expectancy of up to 25 years. Several reasons have been proposed for high levels of obesity including a shared biological vulnerability between serious mental ill health and abnormal metabolic processes, potentially compounded by unhealthy lifestyles. However, emerging evidence suggests that the most significant cause of weight gain is the metabolic side effects of antipsychotic medication, usual treatment for people with serious mental ill health. In this paper we review the prevalence of obesity in people with serious mental ill health, explore the contribution that antipsychotic medication may make to weight gain and discuss the implications of this data for future research and the practice of mental health and other professionals.

Evidence-Based Practice in Mental Health: A Cause for Concern for Occupational Therapists?

This opinion piece considers the profile of occupational therapy within the literature informing the evidence base for current mental health practice. It highlights a number of concerns for occupational therapists practising in this field and advocates that it is time to engage with the available evidence base and generate a research agenda to support the activity of mental health occupational therapists.

Clinician views of referring people with negative symptoms to outcome research: A questionnaire survey

This paper reports on a survey of mental health clinician views of including people with psychosis and negative symptoms in outcome research. A questionnaire was forwarded to clinicians (the majority of whom were mental health nurses) completing post-registration undergraduate and postgraduate degree courses in psychosocial interventions for psychosis. Fifty questionnaires were returned (a response rate of 84.7%). A total of 47% of respondents indicated that they might refrain from offering this group as potential participants to clinical trials. Thematic analysis suggests views that negative symptoms are not amenable to treatment inform such decisions. The results highlight the potential difficulties faced by researchers investigating new treatments for people with negative symptoms, and suggest further exploration of clinician views of referring this group to research and psychosocial treatments is warranted.

Accredited training in psychosocial interventions for psychosis: a national survey

The widespread provision of evidence‐based psychosocial interventions (PSI) for people who experience psychosis and their families requires that the mental health workforce has access to educational and training programmes in these treatment approaches. Such training has been available in England since 1992 when the first PSI programmes were established at The Institute of Psychiatry, London and The University of Manchester. While training is now more widely available (Brooker, 2002), little is known about the extent and distribution of training across England, or of the detail of individual programmes. To remedy this, the NIMHE National PSI Implementation Workgroup conducted a survey of university accredited PSI education/training in January 2006.Twenty‐six courses were represented in the returns from the eight regions served by CSIP regional development centres. This paper presents the findings of this survey and discusses the current provision of PSI training in England in 2006.

Continuing professional education: Motivations and experiences of health and social care professional’s part-time study in higher education. A qualitative literature review

OBJECTIVES To understand the motivations and experiences of health and social care professionals undertaking part-time, accredited, continuing professional education in higher education. DESIGN A review following systematic principles. DATA SOURCES Systematic searches for literature published between January 2000 and December 2015 using the databases: SCOPUS, Web of Science, Medline, PsychINFO, Social Policy and Practice and CINAHL. REVIEW METHODS Studies were included if they were published in the English language and were qualitative in design, focussing on the motivations and experiences of staff engaged in part-time, accredited, higher education study. Three reviewers appraised the quality of the selected studies. RESULTS Thirteen qualitative studies were identified for the review. Motivating factors for staff to engage in part-time, accredited, continuing professional development study included: personal and professional drivers, influence of workplace/management and funding and availability. Key themes in relation to how staff experienced study included: the demands of adjusting to the academic requirements of higher education study; the experience of juggling competing demands of study, work and family; and the presence or absence of support for part-time study in the personal and professional arenas. CONCLUSIONS Health and social care professionals experience a number of challenges when engaging in part-time, continuing professional education in higher education institutions. A significant challenge is the juggling of competing demands of study, work and family, and this may have a negative impact on learning. Research is needed to inform how higher education can address the specific learning needs of this population and develop pedagogic approaches that are both responsive to need and support of effective learning.

Can community volunteers work to trace patients defaulting from scheduled psychiatric clinic appointments

To the Editor: Mental illness is set to become the second largest source of economic and social burden worldwide by 2020.

Carer and mental health professional views of a psychosocial treatment for negative symptoms in psychosis: a qualitative study.

BACKGROUND Trials of complex interventions should be preceded by in-depth piloting of the treatment in order to ensure clear definition of critical components and establish feasibility and acceptability. OBJECTIVES This study aimed to elicit views of extending behavioural activation, an evidence-based treatment for depression, to the negative symptoms observed in psychosis from the perspectives of carers of people with mental health problems and mental health professionals. DESIGN Qualitative study. SETTING School of Nursing, Midwifery and Social Work and carer support organisation, North West of England, United Kingdom. PARTICIPANTS Fifteen participants were recruited from a local carer support group. Nineteen mental health professionals were recruited from post-registration university based programmes. METHODS We used focus groups and semi-structured interviews. Thematic analysis using a constant comparative approach was employed to capture key concepts and themes. RESULTS There was support for behavioural activation for negative symptoms in psychosis from some mental health workers and many of the carers; however both groups identified barriers to its implementation. Professionals highlighted internal factors, the difficulty in engaging people with negative symptoms in psychosocial treatments and services more broadly while carers identified a number of external, practical barriers. For those who saw some utility in the treatment approach, the benefit of expanding the treatment to include community based sessions as well as formal behavioural activation meetings were recognised. However, a number of mental health professionals remained sceptical as to its potential to reduce negative symptoms. Professional and carer views generally concurred in relation to family involvement, indicating that restricted engagement could be helpful, but that further participation might actually be counterproductive. CONCLUSIONS Acceptability for many carers and some professionals was evident and support further evaluation of behavioural activation for negative symptoms. Significant issues to be addressed include the balance of formal talking based sessions and community based sessions to support activation for people with negative symptoms and mental health professional pessimism in relation to this symptom cluster. The current study supports the phased development and careful piloting of complex healthcare interventions before progression to large scale evaluation.

Working in Mental Health and Deafness

The publication of Towards Equality and Access (Department of Health 2004) made clear the intention of the Department of Health to locate the care and treatment of deaf people with mental health problems within local rather than national services. It is, therefore, more likely that this group will be referred, at least initially, to local services, who may have limited experience of, and indeed inadequate resources for, working with people who are deaf and have mental health problems. This opinion piece outlines guidance for therapists and others working in mental health services with this group, focusing specifically upon deaf people who use British Sign Language as a first language.