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Abou Seif N, Wood L, Morant N. Invisible experts: a systematic review & thematic synthesis of informal carer experiences of inpatient mental health care. BMC Psychiatry 2022; 22:347. [PMID: 35596170 DOI: 10.1186/s12888-022-03872-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 03/11/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The negative impact of caregiving on carers' physical and psychological wellbeing is well documented. Carers of mental health inpatients have particularly negative experiences and largely report being dissatisfied with how they and their loved one are treated during inpatient care. It remains unclear why, despite policies intended to improve inpatient experiences. A comprehensive review of carers' inpatient experiences is needed to understand carer needs. As such, we aimed to conduct a systematic review and thematic synthesis of carer experiences of inpatient mental health care. METHODS We searched MEDLINE, PsycINFO, Embase and CINAHL for qualitative studies examining carer experiences of mental health inpatient care. Searches were supplemented by reference list screening and forward citation tracking of included studies. Results were synthesised using thematic synthesis. Our protocol was registered on PROSPERO (CRD42020197904) and our review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. FINDINGS Twelve studies were included from 6 countries. Four themes were identified: the emotional journey of inpatient care; invisible experts; carer concerns about quality of care for their loved one; and relationships and partnership between carers, service users and staff. INTERPRETATION Greater attention should be paid to ensure carers are well-supported, well-informed, and included in care. More emphasis must be placed on fostering positive relationships between carers, service users and staff and in facilitating continuity of care across inpatient and community services to provide carers with a sense of security and predictability. Further research is needed to explore differences in experiences based on carer and service user characteristics and global context, alongside co-production with carers to develop and evaluate future guidelines and policies.
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Wood L, Constant C, Byrne A. Exploring the experience of acute inpatient mental health care from the perspective of family and carers of people experiencing psychosis: A qualitative thematic analysis study conducted during the COVID-19 pandemic. Int J Ment Health Nurs 2021; 30:1620-1629. [PMID: 34313393 PMCID: PMC8447470 DOI: 10.1111/inm.12915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
Family and carers play an important role in supporting service users who are in receipt of acute mental health inpatient care, but they can also be significantly emotionally and physically impacted. The aim of this study was to examine their needs and priorities during this time. Fourteen family and carers of inpatients experiencing psychosis completed semi-structured interviews examining their experiences of inpatient care during the COVID-19 pandemic. Thematic analysis was used to analyse data. Four key themes were identified: 'A turbulent journey to hospital admission', 'I need information and support', 'Maintaining my relationship with my loved one' and 'Inpatient care is a mixed bag'. Each theme comprised four or five subthemes. The findings demonstrated that family and carers feel excluded from inpatient care and struggled to maintain contact with their loved ones, which was exacerbated by COVID-19 related restrictions. Communication and being regularly informed about their loved one's care, as well as visiting loved ones, was particularly problematic. Inpatient care needs to be more inclusive of family and carers and ensure they are kept in mind at every stage of the admission.
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Affiliation(s)
- Lisa Wood
- Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Ilford, UK.,Division of Psychiatry, University College London, London, UK
| | - Callam Constant
- Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Ilford, UK
| | - Alison Byrne
- Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Ilford, UK
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3
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Boden-Stuart ZVR, Larkin M, Harrop C. Young adults' dynamic relationships with their families in early psychosis: Identifying relational strengths and supporting relational agency. Psychol Psychother 2021; 94:646-666. [PMID: 33774896 DOI: 10.1111/papt.12337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Most existing research on the family context of psychosis focuses on the 'burden' of caring for people experiencing psychosis. This research is the first to ask young people experiencing early psychosis to 'map' and describe their experiences and understandings of their family relationships, and how they have related to their psychosis and recovery. DESIGN The research took an inductive, multimodal hermeneutic-phenomenological approach (Boden, Larkin & Iyer, 2019, Qual. Res. Psychology, 16, 218-236; Boden & Larkin, 2020, A handbook of visual methods in psychology, 358-375). METHOD Ten young adults (18-23), under the care of early intervention in psychosis services in the UK, participated in an innovative relational mapping interview (Boden, Larkin & Iyer, 2018), which invited participants to draw a subjective 'map' of their important relationships. This visual methodology enables subtle, complex, ambivalent, and ambiguous aspects of the participants' experiences to be explored. RESULTS Findings explore the participants' accounts of how they love, protect, and care for their families; how they wrestle with family ties as they mature; and their feelings about talking about their mental health with loved ones, which was typically very difficult. CONCLUSIONS This paper advances understanding of recovery in psychosis through consideration of the importance of reciprocity, and the identification and nurturance of relational strengths. The capacity of a young person to withdraw or hold back when trying to protect others is understood as an example of relational agency. The possibility for extending strengths-based approaches and family work within the context of early intervention in psychosis services is discussed. PRACTITIONER POINTS Young adults experiencing early psychosis may benefit from support to identify their relational strengths and the opportunities they have for reciprocity within their family structures, where appropriate. Relational motivations may be important for a range of behaviours, including social withdrawal and non-communication. Services may benefit from exploring the young person's relational context and subjective meaning-making in regard to these actions. Young adults experiencing early psychosis may benefit from opportunities to make sense of their family dynamics and how this impacts on their recovery. Attachment-based and relationally oriented interventions that increase trust and openness, and reduce feelings of burdensomeness are likely to support family functioning as well as individual recovery.
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Hopkins L, Kuklych J, Pedwell G, Woods A. Supporting the Support Network: The Value of Family Peer Work in Youth Mental Health Care. Community Ment Health J 2021; 57:926-936. [PMID: 32720005 DOI: 10.1007/s10597-020-00687-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/18/2020] [Indexed: 11/28/2022]
Abstract
Reported rates of mental illness continue to climb amongst young Australians. In a family environment the carers of these young people play a highly influential role in their recovery process, however this responsibility can also have significant emotional, financial and health impacts on carers. This paper details the findings of an evaluation project examining the impact and effectiveness of a newly developed and implemented Family Peer Support Work model. Benefits were found which included: family care-givers receiving emotional support and empathy; reduced stress, loneliness, isolation and stigma; bridging between the family and the clinical care team; helping families to navigate through the complexities of the care system; and connecting families to other services. Clarity on role definition for the FPSWs evolved over the course of implementation along with a clearer articulation of the model of care and emergent knowledge on useful elements of training, ongoing professional development, mentoring and wellbeing.
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Affiliation(s)
- Liza Hopkins
- Alfred Health, Mental and Addiction Health, 999 Nepean Hwy, Moorabbin, VIC, 3189, Australia.
| | - Jacinta Kuklych
- Alfred Health, Mental and Addiction Health, 999 Nepean Hwy, Moorabbin, VIC, 3189, Australia
| | - Glenda Pedwell
- Alfred Health, Mental and Addiction Health, 999 Nepean Hwy, Moorabbin, VIC, 3189, Australia
| | - Aysha Woods
- Alfred Health, Mental and Addiction Health, 999 Nepean Hwy, Moorabbin, VIC, 3189, Australia
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5
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Liverpool S, Hayes D, Edbrooke-Childs J. An Affective-Appraisal Approach for Parental Shared Decision Making in Children and Young People's Mental Health Settings: A Qualitative Study. Front Psychiatry 2021; 12:626848. [PMID: 33633610 PMCID: PMC7899973 DOI: 10.3389/fpsyt.2021.626848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The majority of existing shared decision making (SDM) models are yet to explicitly account for emotion as an influencing factor to the SDM process. This study aimed to explore the role of parents' and carers' emotional experiences as a concept that has implications for SDM in children and young people's mental health (CYPMH) settings. Methods: A social constructivist grounded theory approach, analyzing data from focus groups (n = 4) and semi-structured interviews (n = 33) with parents and healthcare professionals, was undertaken. Participants were identified and selected at CYPMH sites and through social media platforms or in-person advertising as part of a larger feasibility trial. Interviews and focus groups were audio-recorded and transcribed verbatim. Thematic analysis moved from open to focused coding. Results: The majority of the sample consisted of mothers of adolescent girls. Healthcare professionals had an average of 7.54 (SD = 6.24) years of work experience in CYPMH outpatient capacities. Findings suggested that parents are "expected to, but not always able to" engage in SDM. Themes and subthemes described an affective-appraisal SDM process capturing: (1) views and experiences of SDM, (2) parents' emotional states, (3) the influence of emotions on SDM, and (4) key support systems accessed. The emerging affective-appraisal framework highlighted that negative emotional states hindered parents' active involvement in SDM, and positive emotions encouraged involvement in SDM. Conclusion: The current findings describe an SDM model specific to CYPMH. This new understanding contributes to addressing a possible theory to practice gap opening new challenges and opportunities for academic enquiry.
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Affiliation(s)
- Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
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Valentine L, Grace D, Pryor I, Buccilli K, Sellars M, Francey S, Simmons M. "When I'm Thinking Straight, I Can Put Things in Place for When I'm Not." | Exploring the Use of Advance Statements in First-Episode Psychosis Treatment: Young People, Clinician, and Carer Perspectives. Community Ment Health J 2021; 57:18-28. [PMID: 33058044 DOI: 10.1007/s10597-020-00721-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
Advance statements represent a promising but relatively unexplored means to empower young people with first-episode psychosis to actively participate in their own mental health care. This qualitative study explored the use of advance statement's for young people with first-episode psychosis, as well as their carers and clinicians, and provided actionable feedback on how to better meet the needs and preferences of these key stakeholders and more effectively implement advance statements in clinical settings.
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7
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Rodrigues R, Beswick A, Anderson KK. Psychiatric hospitalization following psychosis onset: A retrospective cohort study using health administrative data. Early Interv Psychiatry 2020; 14:235-240. [PMID: 31696672 DOI: 10.1111/eip.12893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/18/2019] [Accepted: 10/19/2019] [Indexed: 11/28/2022]
Abstract
AIM There is limited evidence examining admissions in early psychosis. We sought to estimate the proportion of people with a psychiatric admission within 2 years of the first diagnosis of psychosis, and to identify associated risk factors. METHOD We constructed a cohort of incident non-affective psychosis cases using health administrative data and identified the first psychiatric hospitalization after psychosis onset. We compared hospitalization rates across sociodemographic, clinical and service-use factors. RESULTS One in three patients had an admission within 2 years of first diagnosis. Younger age, migrant status, diagnosis of psychosis not otherwise specified, and prior substance use were associated with increased hospitalization rates, whereas family physician involvement in diagnosis was protective. CONCLUSIONS Adolescents, immigrants and people presenting with diagnostic instability or prior substance use issues may benefit from interventions aimed at reducing hospitalization risk. Increasing primary care access and utilization among youth with early psychosis may also reduce hospitalization rates.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adam Beswick
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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8
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Stuart R, Akther SF, Machin K, Persaud K, Simpson A, Johnson S, Oram S. Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2020; 6:e19. [PMID: 32043435 PMCID: PMC7176830 DOI: 10.1192/bjo.2019.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. AIMS We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. METHOD We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. RESULTS The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. CONCLUSIONS Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.
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Affiliation(s)
- Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Karen Machin
- Visiting Lecturer, School of Health and Social Work, University of Hertfordshire, UK
| | - Karen Persaud
- Honorary Research Associate, NIHR Mental Health Policy Research Unit, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Alan Simpson
- Professor of Mental Health Nursing, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Director (KCL), NIHR Mental Health Policy Research Unit, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London; Director (UCL), NIHR Mental Health Policy Research Unit; and Consultant Clinical Psychiatrist, Camden and Islington NHS Foundation Trust, UK
| | - Sian Oram
- Lecturer and Head of the Section of Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; Deputy Director (KCL), NIHR Mental Health Policy Research Unit, UK
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9
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Green T, Bonner A, Teleni L, Bradford N, Purtell L, Douglas C, Yates P, MacAndrew M, Dao HY, Chan RJ. Use and reporting of experience-based codesign studies in the healthcare setting: a systematic review. BMJ Qual Saf 2019; 29:64-76. [PMID: 31548278 DOI: 10.1136/bmjqs-2019-009570] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/18/2019] [Accepted: 09/10/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Experience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities. METHODS Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study. RESULTS We identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity. CONCLUSION EBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner. TRIAL REGISTRATION NUMBER CRD42018105879.
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Affiliation(s)
- Theresa Green
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Laisa Teleni
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Natalie Bradford
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Louise Purtell
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Margaret MacAndrew
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Hai Yen Dao
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Raymond Javan Chan
- School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, Australia .,Division of Cancer Services Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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10
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Mui EYW, Chan SKW, Chan PY, Hui CLM, Chang WC, Lee EHM, Chen EYH. Systematic review (meta-aggregation) of qualitative studies on the experiences of family members caring for individuals with early psychosis. Int Rev Psychiatry 2019; 31:491-509. [PMID: 31547726 DOI: 10.1080/09540261.2019.1659236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the importance of the role of caregivers of people with psychosis being widely recognized, comprehensive understanding of their experience is limited. A thorough understanding of the experience of caregivers over the journey of the illness, particularly during its early stages, is crucial. Qualitative studies published between 1 January 1949 and 31 January 2018 were obtained from seven databases based on PICo search strategy. Meta-aggregation methodology of the Joanna Briggs Institute (JBI) was adopted to aggregate existing qualitative findings about caregivers' experiences. Twenty-eight qualitative studies on 635 caregivers and family members were included in the review. Six inter-related categories-'stigma', 'help-seeking', 'service encounter', 'emotional challenges', 'on becoming a caregiver' and 'making sense of experience'-were aggregated from 129 themes from the sub-acute stage, the acute stage and the recovery or residual stage. Three statements about caregivers' experiences of their relative's first episode of psychosis were synthesized from the findings. Results highlighted the need of incorporating caregiver intervention into the existing services to support the emotional challenges, uncertainty, and stigma-related burden along the caregiving journey.
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Affiliation(s)
- Esther Yee Wai Mui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Sherry K W Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Pik Ying Chan
- Department of Social Work and Social Administration, The University of Hong Kong , Hong Kong SAR , China
| | - Christy L M Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Wing C Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
| | - Edwin H M Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China
| | - Eric Y H Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong , Hong Kong SAR , China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong , Hong Kong SAR , China
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11
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Bögle S, Boden Z. ‘It was like a lightning bolt hitting my world’: Feeling shattered in a first crisis in psychosis. Qualitative Research in Psychology 2019. [DOI: 10.1080/14780887.2019.1631418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah Bögle
- London South Bank University, Division of Psychology, School of Applied Science, London, UK
| | - Zoë Boden
- University of Brighton, School of Applied Social Science, Brighton, UK
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12
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Abstract
Informal carers are increasingly involved in supporting people with severe and enduring mental health problems, and carers' perceptions impact the wellbeing of both parties. However, there is little research on how carers actually make sense of what their loved one is experiencing. Ten carers were interviewed about how they understood a loved one's psychosis. Data were analysed using a hermeneutic-phenomenological approach. Three themes described the carers' effortful quest to understand their loved one's experiences while maintaining their relational bonds. Carers described psychosis as incomprehensible, seeing their loved one as incompatible with the shared world. To overcome this, carers developed hermeneutic 'mooring points', making sense of their loved one's unusual experiences through novel accounts that drew on material or spiritual explanations. The findings suggest that informal carers resist biomedical narratives and develop idiosyncratic understandings of psychosis, in an attempt to maintain relational closeness. We suggest that this process is effortful - it is hermeneutic labour - done in the service of maintaining the caring relationship. Findings imply that services should better acknowledge the bond between carers and care-receivers, and that more relationally oriented approaches should be used to support carers of people experiencing severe mental health problems.
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13
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Thompson J, Boden ZV, Newton EK, Fenton K, Hickman G, Larkin M. The experiences of inpatient nursing staff caring for young people with early psychosis. J Res Nurs 2019; 24:75-85. [PMID: 34394509 PMCID: PMC7932446 DOI: 10.1177/1744987118818857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early intervention services aim to improve outcomes for people with first episode psychosis and, where possible, to prevent psychiatric hospital admission. When hospitalisation does occur, inpatient staff are required to support patients and families who may be less familiar with services, uncertain about possible outcomes, and may be experiencing a psychiatric hospital for the first time. AIMS Our study aimed to understand the process of hospitalisation in early psychosis, from the perspective of inpatient nursing staff. We were particularly interested in their experiences of working with younger people in the context of adult psychiatric wards. METHODS Nine inpatient nursing staff took part in semi-structured interviews, which were transcribed and then analysed using interpretative phenomenological analysis. RESULTS Five themes are outlined: 'it's all new and it's all learning'; the threatening, unpredictable environment; care and conflict within the intergenerational relationship; motivation and hope; and coping and self-preservation. CONCLUSIONS The phenomenological focus of our approach throws the relational component of psychiatric nursing into sharp relief. We reflect on the implications for organisations, staff, families and young people. We suggest that the conventional mode of delivering acute psychiatric inpatient care is not likely to support the best relational and therapeutic outcomes.
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Affiliation(s)
- Jessica Thompson
- Clinical Psychologist, School of Psychology, University of Birmingham, UK
| | - Zoe Vr Boden
- Senior Lecturer, Department of Psychology, London Southbank University, UK
| | - Elizabeth K Newton
- Consultant Clinical Psychologist, Coventry and Warwickshire Partnership Trust
| | - Kelly Fenton
- Clinical Psychologist , Leicestershire Partnership NHS Trust, UK
| | - Gareth Hickman
- Senior Clinical Psychologist, Coventry and Warwickshire Partnership Trust, UK
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14
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Hasson-Ohayon I, Goldzweig G, Lavi-Rotenberg A, Roe D, Pijnenborg GHM. Illness representations among parents of children and adults with serious mental disorders: A systematic review and theoretical model. Eur Psychiatry 2019; 58:27-37. [PMID: 30769239 DOI: 10.1016/j.eurpsy.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Cognitive representations of an illness have an important impact on psychological outcomes. The current systematic review explored 1) the characteristics of illness representations held by parents of children and adults with serious mental illness (SMI), and 2) the associations of these representations with both parents' and patients' psychological outcomes. METHOD PSYINFO and PUBMED were screened for eligible studies published between January 2000 and August 2018. Selection was based on PRISMA guidelines. Reference lists of these papers were checked for additional references. Two independent coders extracted all relevant data. RESULTS The search resulted in 31 relevant studies, which were divided, by type of methodology, into three sections: quantitative, qualitative, and mixed quantitative-qualitative. In each section, findings were divided in accordance with the two research questions. CONCLUSION Parents struggle to make meaning of their child's illness, often holding stigmatizing ideas about the illness and blaming themselves for its existence. More longitudinal studies that include both of the child's parents, as well as interventional studies, are needed to expand our knowledge of ways to help parents construct more beneficial representations of their children's illnesses.
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Affiliation(s)
| | - Gil Goldzweig
- School of Behavioral Sciences, The Academic College of Tel-Aviv Yaffo, Israel
| | | | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel; Department of Clinical Medicine, Psychiatry, Aalborg University, Denmark
| | - Gerdina Hendrika Maria Pijnenborg
- GGZ Drenthe Mental Health Institute, Department of Psychotic Disorders, Assen, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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15
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Abstract
Recently, health policy in the UK has begun to engage with the concept of 'parity of esteem' between physical and mental healthcare. This has led one recent initiative to improve service provision for first episode psychosis, which aims to bring it into line with some of the principles underpinning good practice in cancer care. In this paper, we consider some of the metaphorical consequences of likening psychosis to cancer. While we find the comparison unhelpful for clinical purposes, we argue that it can be a helpful lens through which to examine service provision for psychosis in young people. Through this lens, specialist community-based services would appear to compare reasonably well. Inpatient care for young people with psychosis, on the other hand, suffers very badly by comparison with inpatient facilities for teenage cancer care. We note some of the many positive features of inpatient cancer care for young adults, and-drawing upon previous research on inpatient psychiatric care-observe that many of these are usually absent from mental health facilities. We conclude that this metaphor may be a helpful rhetorical device for communicating the lack of 'parity of esteem' between mental and physical healthcare. This inequity must be made visible in health policy, in commissioning, and in service provision.
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Affiliation(s)
| | - Zoë Boden
- London South Bank University, London, UK
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16
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Ruggeri M, Lasalvia A, Santonastaso P, Pileggi F, Leuci E, Miceli M, Scarone S, Torresani S, Tosato S, De Santi K, Cristofalo D, Comacchio C, Tomassi S, Cremonese C, Fioritti A, Patelli G, Bonetto C. Family Burden, Emotional Distress and Service Satisfaction in First Episode Psychosis. Data from the GET UP Trial. Front Psychol 2017; 8:721. [PMID: 28559862 PMCID: PMC5432637 DOI: 10.3389/fpsyg.2017.00721] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/21/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Literature has documented the role of family in the outcome of chronic schizophrenia. In the light of this, family interventions (FIs) are becoming an integral component of treatment for psychosis. The First Episode of Psychosis (FEP) is the period when most of the changes in family atmosphere are observed; unfortunately, few studies on the relatives are available. Objective: To explore burden of care and emotional distress at baseline and at 9-month follow-up and the levels of service satisfaction at follow-up in the two groups of relatives (experimental treatment EXP vs. treatment as usual TAU) recruited in the cluster-randomized controlled GET UP PIANO trial. Methods: The experimental treatment was provided by routine public Community Mental Health Centers (Italian National Health Service) and consisted of Treatment as Usual plus evidence-based additional treatment (Cognitive Behavioral Therapy for psychosis for patients, Family Intervention for psychosis, and Case Management). TAU consisted of personalized outpatient psychopharmacological treatment, combined with non-specific supportive clinical management and informal support/educational sessions for families. The outcomes on relatives were assessed by the Involvement Evaluation Questionnaire (IEQ-EU), the General Health Questionnaire (GHQ-12), and the Verona Service Satisfaction Scale (VSSS-EU). Differences within and between groups were evaluated. Results: At baseline, 75 TAU and 185 EXP caregivers were assessed. In the experimental group 92% of relatives participated in at least 1 family session. At follow-up both groups experienced improvement in all IEQ and GHQ items, but caregivers belonging to the EXP arm experienced a significantly greater change in 10 IEQ items (mainly pertaining to the “Tension” dimension) and in GHQ items. Due to the low sample size, a significant effectiveness was only observed for 2 IEQ items and 1 GHQ-12 item. With respect to VSSS data at follow-up, caregivers in the EXP arm experienced significantly greater satisfaction in 8 items, almost all pertaining to the dimensions “Relatives' Involvement” and “Professionals' Skills and Behavior.” Conclusions: The Family intervention for psychosis delivered in the GET UP PIANO trial reduced family burden of illness and improved emotional distress and satisfaction with services. These results should encourage to promote FIs on caregivers of first-episode psychosis patients.
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Affiliation(s)
- Mirella Ruggeri
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy.,Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Antonio Lasalvia
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova and Azienda OspedalieraPadova, Italy
| | | | - Emanuela Leuci
- Department of Mental Health, Azienda USL ParmaParma, Italy
| | - Maurizio Miceli
- Department of Mental Health, Azienda USL FirenzeFirenze, Italy
| | - Silvio Scarone
- Department of Psychiatry, University of MilanoMilan, Italy
| | | | - Sarah Tosato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Katia De Santi
- UOC Psichiatria, Azienda Ospedaliera Universitaria IntegrataVerona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Carla Comacchio
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Simona Tomassi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
| | - Carla Cremonese
- Department of Neurosciences, University of Padova and Azienda OspedalieraPadova, Italy
| | - Angelo Fioritti
- Department of Mental Health, Azienda USL BolognaBologna, Italy
| | - Giovanni Patelli
- AO Ospedale Niguarda Ca' Granda Milano, MHD Programma2000Milan, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of VeronaVerona, Italy
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17
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Abstract
Inpatient mental health services in the United Kingdom are currently dissatisfactory for service-users and staff. For young people with psychosis, being hospitalized is often distressing, and can lead to disengagement with mental health services. This article describes how we took three qualitative research studies about hospitalization in early psychosis (exploring the perspectives of service-users, parents, and staff) and translated them into service improvements developed in collaboration with a range of stakeholders, including service-users, carers, community and inpatient staff, and management. We used an adapted form of experience-based co-design (EBCD), a participatory action-research method for collaboratively improving health care services. The use of EBCD is still relatively novel in mental health settings, and we discuss how we adapted the methodology, and some of the implications of using EBCD with vulnerable populations in complex services. We reflect on both the disappointments and successes and give some recommendations for future research and methodological development.
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Affiliation(s)
- Michael Larkin
- University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Zoë V R Boden
- University of Birmingham, Edgbaston, Birmingham, United Kingdom London South Bank University, London, United Kingdom
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