Patrick Welsh

Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study.

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis.

Metacognitive beliefs in adolescents with an at‐risk mental state for psychosis.

The self‐regulatory executive function model suggests that metacognitive beliefs play a role in all forms of psychological disorder, including psychosis. However, our understanding of these beliefs and their relationship with symptoms in adolescents with an at‐risk mental state (ARMS) for psychosis is limited.

Youth Speak: increasing engagement of young people in mental health research

Abstract Background: Patient and Public Involvement is now an essential part of health-related research. Evidence suggests that research that involves patients and members of the public can enhance methodological rigor and facilitate the implementation of research findings. Aims: Our paper describes the development of a youth research group (Youth Speak) aimed at increasing youth engagement in mental health research. Method: We provide a selective review of the literature and outline the challenges and benefits of involving young people in research. Examples of how our group has facilitated involvement and the challenges we have encountered are also discussed. Results: Meaningful involvement of young people in mental health research is poorly documented or significantly lacking given the dearth of published literature. This may reflect the difficulty of obtaining sustained funding which is required to facilitate non-tokenistic involvement or a perception that young people are unable to provide meaningful contributions in this area. Conclusions: By establishing groups such as Youth Speak, which focus on the long-term involvement and development of young people in all stages of the research process, we hope to empower young people so that they can reshape youth mental health services.

Attitudes and knowledge of child and adolescent mental health clinicians in relation to the psychosis risk syndrome.

Aim: To evaluate the knowledge and attitudes of clinicians in a Child and Adolescent Mental Health Service in relation to the ‘At‐Risk Mental State’ concept in psychosis.

Adolescent family perceptions in the At-Risk Mental State for psychosis

There is a long‐standing interest in the relationship between patients affected by psychosis and their families. Previous research also suggests that perceived family dysfunction is a factor commonly associated with psychological problems in adolescence. The current study examined the role of self‐reported family perceptions in the context of adolescents with an At‐Risk Mental State (ARMS) for psychosis.

'I’m not insane, my mother had me tested' : the risk and benefits of being labelled 'at-risk' for psychosis.

In this article we examine the identification of young people deemed to be at an elevated risk of developing psychosis (often referred to as an At-Risk Mental State for psychosis). Although this is not a new concept within psychiatry, there has been a growing interest in this topic because of the proposed inclusion of an official ‘Psychosis Risk Syndrome’ in the 2013 Diagnostic and Statistical Manual. Although we discuss the risks and benefits associated with the categorisation of individuals based on the concept of risk itself, we also draw upon observations from one of our own research studies. We interviewed six adolescents with an identified At-Risk Mental State analysing the data using an Interpretative Phenomenological Analysis framework. We identified three key themes: ‘It is better to say it’, ‘How others would take me’ and ‘Just to have somebody to talk to’. Within these themes, participants endorsed risk identification as a means of personally justifying and explaining their current symptoms, as well as providing a sense of optimism that their condition was not yet fully formed. Concerns regarding stigmatisation were identified although rarely experienced. These findings indicate that there are indeed personal benefits for screening for psychosis risk in young people, despite the ‘undesirability’ of identification reported in other areas of health. The benefits observed may reflect genuine differences in adolescent mental health or the methodological constraints of this exploratory study. Nevertheless, the results contribute to the understanding and ongoing debate of screening for illness in potential ‘at-risk’ populations.

Getting it right! Enhancing youth involvement in mental health research

Few studies relating to youth mental health have actively involved young people in the design and conduct of research.

Attitudes of patients and clinicians in relation to the at-risk state for psychosis

In the last decade, advances have been made in identifying young people who may be at relatively high risk (HR) of developing psychosis. Given the controversial and experimental nature of the HR concept, the attitudes and experiences of mental health professionals and patients are likely to influence practice in this area. Previous work has been published that has speculated on the potential risks and advantages of identifying and intervening within the HR state. However, few have attempted to capture the attitudes and experiences of patients and professionals towards this concept. This article provides, via the collation of existing research reports, a reflection on the views, attitudes and experiences of these key stakeholders.

Assessing adolescent preference in the treatment of first-episode psychosis and psychosis risk.

The objective of this study was to investigate the treatment preferences of adolescents with a first‐episode psychosis (FEP) or at‐risk mental state (ARMS) for psychosis.

Perceptions of family functioning in adolescents who self-harm

This study compares the self-reported family functioning of 21 adolescents presenting at four UK medical wards with self-harming behaviour with those obtained from a sample of adolescents drawn from the local community. Adolescents hospitalized for self-harm reported that their families were more dysfunctional than healthy controls on the family perceptions scale. However, this difference was not observed when covariates such as emotional and behavioural distress were controlled for. Poor levels of agreement between adolescents and adult family members in relation to family perceptions were also observed. The findings suggest that adolescents who engage in significant self-harm perceive impairments in their family functioning. These reported impairments may be the result of concurrent emotional and behavioural distress or some form of interaction between family functioning and distress. A comprehensive family assessment to detect absolute changes and disparities in perceived family functioning may therefore help guide family interventions in this context. Practitioner points * Adolescents who are hospitalized for self-harm report significant impairments in family functioning compared with healthy controls. * Adolescent and adult family members appear to disagree on the degree of impaired family functioning. * A comprehensive family assessment may therefore help guide family interventions in hospitalized adolescents. Language: en