I. Marsh

Study to assess the effect of a structured communication approach on quality of life in secure mental health settings (Comquol): study protocol for a pilot cluster randomized trial.

BackgroundForensic mental health services have largely ignored examining patients’ views on the nature of the services offered to them. A structured communication approach (DIALOG) has been developed with the aim of placing the patient’s perspective on their care at the heart of the discussions between patients and clinicians. The effectiveness of the structured communication approach in community mental health services has been demonstrated, but no trial has taken place in a secure psychiatric setting. This pilot study is evaluating a 6-month intervention combining DIALOG with principles of solution-focused therapy on quality of life in medium-secure settings.Methods and designA cluster randomized controlled trial design is being employed to conduct a 36-month pilot study. Participants are recruited from six medium-secure inpatient services, with 48 patients in the intervention group and 48 in the control group. The intervention uses a structured communication approach. It comprises six meetings between patient and nurse held monthly over a 6-month period. During each meeting, patients rate their satisfaction with a range of life and treatment domains with responses displayed on a tablet. The rating is followed by a discussion of how to improve the current situation in those domains identified by the patient. Assessments take place prior to the intervention (baseline), at 6 months (postintervention) and at 12 months (follow-up). The primary outcome is the patient’s self-reported quality of life.DiscussionThis study aims to (1) establish the feasibility of the trial design as the basis for determining the viability of a large full-scale trial, (2) determine the variability of the outcomes of interest (quality of life, levels of satisfaction, disturbance, ward climate and engagement with services), (3) estimate the costs of the intervention and (4) refine the intervention following the outcome of the study based upon the experiences of the nurses and patients. The intervention allows patients to have a greater say in how they are treated and targets care in areas that patients identify as important to them. It is intended to establish systems that support meaningful patient and caregiver involvement and participation.Trial registrationCurrent Controlled Trials,ISRCTN34145189

Teaching participation in occupations to first year occupational therapy students: an action research study

Introduction: This article describes the development of a first year occupational therapy module, ‘Participation in Occupations’, and the design and development of a mediating tool, Contexts of Participation: the Critical Thinking Tool, in a British university. Method: Using an action research process, the module content, learning and teaching strategy and new conceptual tools were designed to promote an enhanced understanding of the central importance of occupation to occupational therapy and, in particular, the role of participation in occupations in forming and reforming an individual within unique contextual situations. The inclusion of theory from disability studies and the use of a transformative approach to higher education were also investigated. Findings and discussion: The study spans 16 cohorts of students and reflects on the findings, which include increased client-centredness and greater appreciation of the complex nature of participation and its role in health and wellbeing.

Historical phenomenology: understanding experiences of suicide and suicidality across time

Different cultures at different moments in history have constructed suicide differently. That seems an obvious statement, and any book which offers up a history of the topic confirms the fact. For Ian Hacking, “[t]he meanings of suicide itself are so protean across time and space that it is not so clear that there is one thing, suicide” (Crit Inq 35:1, 2008), and it is not so hard to agree that meanings, descriptions and representations change, but beyond these, are there non-contingent (ahistorical and acultural) features of suicide? Is there perhaps an unchanging experience of suicidality? Many modern theories implicitly suggest there is (e.g. Edwin Shneidman’s notion of psychache and Thomas Joiner’s constructs of perceived burdensomeness and thwarted belongingness can be read as attempts to describe underlying universals in the experience of suicide).

Boundaries, Thresholds, and the Liminal in Youth Suicide Prevention Practice

This chapter explores some of the ways youth suicide and suicidality are discursively constructed by young people, academics, and professionals working in the field of youth suicide prevention. It looks to problematize some of the assumptions which underpin current mainstream suicide prevention practices in relation to young people, and to draw attention to the restrictions placed on our understanding of, and responses to, youth suicide through the rather limited (and limiting) discursive resources at our disposal when we try to “speak the truth of youth suicide” using knowledge produced by means of positivist research methods. What we are trying to do is understand how youth suicide is talked about, and what is done in relation to the issue, through a focus on language use and by critically examining the assumptions commonly made about what it is like to be suicidal, what causes suicide, and what are deemed appropriate practices of prevention. In other words, we are interested in the question, what does youth suicide prevention do?1 We also take up a few ideas, mostly around boundaries, thresholds, transitions, liminal experiences and spaces, drawn from anthropology, literature, education, feminist scholarship, performance studies and related fields. We aim to illuminate aspects of academic constructions of youth suicide, the expressions of first-person experiences of suicidality, and therapeutic practices with young suicidal people, not usually visible in traditional, mainstream, modernist, suicide prevention literature.