Journal of Public Mental Health

Published by Emerald
Online ISSN: 2042-8731
Print ISSN: 1746-5729
Publications
Genetic and environmental factors are associated with psychosis risk, but the latter present more tangible markers for prevention. We conducted a theoretical exercise to estimate the proportion of psychotic illnesses that could be prevented if we could identify and remove all factors that lead to increased incidence associated with ethnic minority status and urbanicity. Measures of impact by population density and ethnicity were estimated from incidence rate ratios [IRR] obtained from two methodologically-similar first episode psychosis studies in four UK centres. Multilevel Poisson regression was used to estimate IRR, controlling for confounders. Population attributable risk fractions [PAR] were estimated for our study population and the population of England. We considered three outcomes; all clinically relevant ICD-10 psychotic illnesses [F10-39], non-affective psychoses [F20-29] and affective psychoses [F30-39]. One thousand and twenty-nine subjects, aged 18-64, were identified over 2.4 million person-years. Up to 22% of all psychoses in England (46.9% within our study areas) could be prevented if exposures associated with increased incidence in ethnic minority populations could be removed; this is equivalent to 66.9% within ethnic minority groups themselves. For non-affective psychoses only, PAR for population density was large and significant (27.5%); joint PAR with ethnicity was 61.7%. Effect sizes for common socio-environmental risk indicators for psychosis are large; inequalities were marked. This analysis demonstrates potential importance in another light: we need to move beyond current epidemiological approaches to elucidate exact socio-environmental factors that underpin urbanicity and ethnic minority status as markers of increased risk by incorporating gene-environment interactions that adopt a multi disciplinary perspective.
 
Purpose – Police in England and Wales are empowered, under Section 136 of the Mental Health Act 1983 (s136), to detain individuals thought to be a danger to themselves or to others. Use of this authority is widespread, but varies across districts and attracts controversy because of inconsistent application and the fact that it requires police to make judgements about mental health. The purpose of this paper is to examine police attitudes to and criteria for using s136. Design/methodology/approach – The authors conducted focus groups with 30 officers in urban and rural areas of three different regions across England and Wales. Group interviews were audio-recorded, transcribed, and analysed using open and axial coding. Findings – Use of s136 authority has major implications for police work; liaison with mental health services is seen as desirable but often ineffective due to resource constraints and the latter's lack of availability. The decision to invoke s136 depends on social context and other particulars of individual cases. Research limitations/implications – Although the findings have limitations with respect to generalisability across the whole of the UK, there are patterns of responses which have major implications for policy recommendations. Practical implications – Police decisions to apply s136 reflect an implicit values-based classification of and response to emotionally disturbed behaviour, in light of available institutional and social supports. Social implications – Tasked primarily with protecting the public and keeping the peace, police “diagnoses” of risk often contrast with that of mental health professionals. Originality/value – A highly original piece of research which has attracted further funding from BA/Leverhulme.
 
Parental illness can affect child and adolescent psychosocial well-being. Mental health effects of parental bereavement generally and HIV-related bereavement specifically have been poorly explored in children. HIV-related illness has a number of specific features that may directly affect mental health considerations. Infection is clustered in families. Bereavement is often multiple. Death is often preceded by severe illness and multiple opportunistic infections. AIDS is stigmatised, which may impede disclosure, social support and adjustment. In low-income countries where HIV infection is concentrated, access to palliative care as well as medical care may be limited. This review systematically identifies studies on HIV and bereavement in children. Searches of electronic databases for relevant articles revealed 14 studies examining bereavement with sufficient measurement and controlled methodology providing standardised behavioural and emotional outcome measures. Scrutiny of the results revealed the majority (12: 86%) recorded an adverse behavioural or emotional impact on the child. A detailed analysis of the studies provides insights to risks as well as protective factors that may inform future interventions. Only one systematic intervention was identified whereby a coping skills intervention had positive and long-lasting effects. This paper examines urgent future needs and the requirement for evidence-based policy and provision.
 
Purpose – There has been extensive growth in the employment of mental health peer support workers (PSWs) over the last decade. However, limited research exists when exploring how PSWs make sense of the transition of entering and enacting the role. The purpose of this paper is to explore the lived experience of NHS employed PSWs’ transition from their own experiences of mental health problems to provide a service to support individuals with their mental health problems. Design/methodology/approach – The study used purposive sampling to recruit seven participants who were individually interviewed using a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Findings – Three superordinate themes were identified: fluctuating identities, PSW role and organisational culture. These were interpreted as interdependent with interrelating subordinate themes. Research limitations/implications – Participants considered the complex, idiosyncratic and changeable nature of the transitions and the impact on their individual, interpersonal and collective identities. Emotional and practical support appeared to assist the transition whilst competing roles and blurred boundaries constrained the enactment of the new role. Implications for practice and research are provided. Originality/value – Reports on original research and adds to the sparse UK literature in this area.
 
Phobias and panic disorder are commonly treated within primary care settings. Cognitive behavioural therapy (CBT) is a recommended treatment for these disorders but access is limited due to too few therapists, expense and patients' reluctance to enter therapy. Computerised CBT (CCBT) is a self-help option designed to offer patients the potential benefits of CBT with less therapist involvement. The review described here sought to identify studies evaluating the effectiveness of CCBT for phobias and panic disorders.
 
Little is known about the health, well-being and social interaction benefits of physical activity in adults with a learning disability. This is probably due to the methodological barriers to research and the problem of gaining informed consent from the participants. This paper describes a feasibility study, where six adults with learning disabilities regularly attended a weight management and fitness session. An observation methodology was tested to see if it was possible to gather quantitative evidence on well-being and social interaction during participation in the sessions. Issues about veridicality, consent, validity and controls are discussed.
 
This article focuses on group work with children using a board game format. Combining the principles of group work and board games helps to engage and motivate children and adolescents to address and work through their difficulties. Lifegames are a series of six therapeutic board games developed for group work with children and adolescents who encounter adversity in their life as a consequence of bereavement, family break up, poor relationships, bullying, chronic illness or obesity. The games facilitate the understanding and disclosure of the complex feelings experienced by children and young people when they are confronted with traumatic life events. The games encourage and assist the participants to obtain and maintain behavioural change. Lifegames are a means to assist professionals in their group work with children and adolescents.
 
This paper presents the findings of an investigation into a mental health promotion initiative in young offender institutions across England. The study involved a survey of staff attitudes towards mental health promotion, and surveyed practice run by these staff. Analysis of staff descriptions of mental health promotion revealed a degree of confusion and a lack of clarity over the definition of mental health and mental health promotion. The concept of a mental health promotion initiative which aimed to improve the well-being of the general inmate and staff population was not a shared vision and not part of the core work of either health care staff or prison officers. It is recommended that any future campaigns on mental health or health promotion should have a central lead, with some flexibility to allow for the development of local initiatives, fostering local relationships and partnerships.
 
Background: There is a growing policy imperative to promote positive mental health as well as preventing the development of mental health problems in children. This paper summarises the results of published systematic reviews evaluating interventions to promote mental health and prevent mental illness in children. Method: A search was undertaken of ten electronic databases using a combination of medical subject headings (MeSH) and free text searches. Systematic reviews covering mental health promotion or mental illness prevention interventions aimed at infants, children or young people up to age 19 were included. Reviews of drug and alcohol prevention programmes or programmes to prevent childhood abuse and neglect were excluded because these have been the subject of recent good quality reviews of reviews. Critical appraisal of all studies was undertaken using a standardised appraisal tool for systematic reviews. Where possible effect sizes and 95% confidence intervals are reported. A narrative summary has been provided. Results: A total of 27 systematic reviews were included and grouped pragmatically under the following headings: parenting interventions; programmes for the prevention of anxiety and depression, programmes to promote self esteem, violence and aggression prevention programmes, school-based programmes, and general reviews. Included studies targeted a range of risk and protective factors, and a range of populations (including both parents and children). While, many lacked methodological rigour, overall, the evidence is strongly suggestive of the effectiveness of a range of interventions in promoting positive mental well-being, and reducing key risk factors for mental illness in children. Conclusion: A variety of programmes have been shown to be effective in promoting children’s mental health, albeit with modest effect sizes. Based on this evidence, arguments are advanced for the preferential provision of early preventive programmes.
 
This paper describes some findings from an evaluation of the effectiveness of a community development project that aimed to overcome inequalities in mental health care experienced by members of the local black and minority ethnic (BME) communities. A participatory action research design was used, involving people from BME communities who had experienced mental health problems and external stakeholders. The study relied largely on qualitative methodology. Findings reported here indicate that participants in the project valued the culturally and spiritually relevant support they received, but felt that more opportunities were needed for training and employment, greater representation on the project's management committee, and greater awareness of the project in the community. External stakeholders felt that the project gained credibility from its community base and valued its ability to work across faith traditions and cultures. It was also seen as successful in acting as a bridge between the communities and statutory services, although there were concerns about the project's relationship with frontline services. The paper proposes two models of community development that primary care trusts may wish to adopt - radical or consensus, or a mixture of both - in order to address inequalities in mental health service provision.
 
Purpose – In contrast to the attention it has received in related fields of research, body image has remained understudied within the field of public health. This is highly problematic, given a growing body of evidence implicating body dissatisfaction in a range of other public health concerns. The paper aims to discuss these issues. Design/methodology/approach – This commentary is based on a review of the public health, body image, eating disorder, and mental health literatures. Findings – Body dissatisfaction is implicated in a range of public health concerns, including impaired psychological health (e.g. depression) and eating- and weight-related problems (e.g. eating disorders, obesity). Originality/value – Given these associations, as well as the high levels of body dissatisfaction in the population, the authors argue for a critical need to address the prevalence of body image concerns as a public health issue worthy of greater consideration within programs and policies; dedicated funding for research on antecedents, consequences, and intervention strategies; and allocated resources for training.
 
This paper brings together evidence and theories from a number of disciplines and thinkers that highlight multiple, sometimes incommensurable understandings about well‐being. We identify three broad strands or themes within the literature(s) that frame both the nature of the problem and its potential solutions in different ways. The first strand can be categorised as the ‘hard’ science of wellbeing and its stagnation or decline in modern western society. In a second strand, social and political theory suggests that conceptualisations of well‐being are shaped by aspects of western culture, often in line with the demands of a capitalist economic system. A third theme pursues the critique of consumer culture's influence on well‐being but in the context of broader human problems. This approach draws on ecology, ethics, philosophy and much else to suggest that we urgently need to reconsider what it means to be human, if we are to survive and thrive. Although no uncontroversial solutions are found within any of these themes, all play a necessary part in contributing to knowledge of this complex territory, where assumptions about the nature of the human condition come into question.
 
In this paper, the author comments on the influence of political structures on public mental health. Using psychoanalytic theory and a Kleinian framework, the author suggests that current political systems and culture can be inhibiting of mental development and health. The paper explores the concept of democracy as an ideal and the effects it has on public mental health. The paper raises the question of political restructuring as a means of promoting mental health and suggests that there is a role for further interdisciplinary work in this area.
 
People who have used mental health services in Scotland have the lowest employment rates of all working ages, despite a national programme for mental health and well-being that provides significant investment in anti-stigma initiatives and employment support services. This paper qualitatively identifies barriers to employment from the perspectives of people who have experienced mental health issues by conducting in-depth focus groups with 20 people who have experienced mental health issues undertaken through collaborative research involving people who have experienced mental health issues alongside practitioners and academics. Researchers who have experienced mental health issues instigated and determined the direction, execution and dissemination of the study. The findings add to the growing evidence base outlining the complex and interlinked barriers to employment which include previous experience of workplace discrimination, financial uncertainty, disclosure concerns, quality of jobs available and the potential of work at times to worsen mental health conditions. Despite this, most participants expressed hopefulness and resilience. Many wanted paid work and outlined practical steps that employers can take in terms of recruitment and retention. However, participants also stressed the equal importance of voluntary work and not just as a step to paid employment. A multiple-perspectives approach provides important insights into the complex and sensitive policy area of mental health and employment. Meaningful involvement of people who have used mental health services should be a central aspect of further research that aims to understand and address these barriers. This study has shaped the development of a national service user research consortium in Scotland.
 
This paper brings together findings from current research into mental health and employment from an economic perspective. The economic impact of reduced employment and productivity for people with mental health problems is described from both individual and societal viewpoints. Interventions reported to have an impact on employment are considered, looking at both clinical interventions that have reported employment outcomes and interventions that have as their primary target the improvement of employment outcomes. The paper also describes the impact of common mental health problems on employment and productivity and reports the findings of some studies in this area. However, the quantity and quality of economic information in this area are limited.
 
Purpose – The purpose of this paper is to examine the long-term outcomes for 15 young people on a range of indicators including school success, involvement with other agencies and the perceived effectiveness by the family. Design/methodology/approach – Semi-structured telephone interviews were used to gather a range of both quantitative and qualitative data. Interviews were with a parent of the referred child ( n =15). Findings – In all, 87 per cent of care-givers interviewed rated the service they had received as helpful 85 per cent reported these changes to be maintained at the three year follow-up. Rate of school exclusion was only 7 per cent and 0 per cent of families went on to have involvement with statutory social services or the youth justice system. Research limitations/implications – This is a small-scale study offering a small sample ( n =15) of families previously referred to this Family Intervention Team, at a three-year post-intervention period. More routine longitudinal information needs to be gathered for a more robust indication on long-term outcomes. Practical implications – The impact this study will have on the team involved will be in its recommendations for further long-term outcome studies; but also in feeding back to the service the significant key messages from those interviewed. Social implications – Contributing to a wider understanding of the long-term benefits of early intervention. Originality/value – This paper offers some new though small statistical data in the growing pool of statistics that are indicating positive outcomes for early intervention and family intervention projects.
 
Purpose – Workplace stress is a particular issue in the fire service. Research suggests this is related to excessive demands, relationships with senior managers, changing roles and exposure to traumatic events. The purpose of this paper is to evaluate the impact on managers of three mental health promotion interventions. First, a locally developed course entitled “Looking after Wellbeing at Work” (LWW), second, an internationally developed training course: Mental Health First Aid (MHFA). Third, an hour-long leaflet session (LS). Design/methodology/approach – This study used a random allocation design. In total, 176 fire service line managers were randomly allocated to one of the three training conditions: LWW, MHFA, or a control condition (LS). Participants completed The Attitudes to Mental Illness Scale (Luty et al. , 2006) and a locally developed “Mental Health Stigma Questionnaire” pre- and post-intervention. Results were analysed using a MANOVA. Participants were also asked to complete a general evaluation, rating all aspects of the courses from poor to excellent. In total, 30 participants were also chosen at random to conduct telephone interviews about their experience of the course. Results were analysed using thematic analysis. Findings – The LWW and MHFA courses were associated with statistically significant improvements in attitudes to mental illness and knowledge/self-efficacy around mental health, comparing pre- and post-scores, and comparing post-scores of the two training courses with a LS. The general evaluations of the LWW and MHFA courses indicated the mean rating for all aspects of both training conditions was good to excellent. Two themes were identified across the qualitative interviews: participants described they were more able to recognise and respond to mental health problems; and participants described changing attitudes towards mental health. Research limitations/implications – The strengths of this study are the number of participants, random allocation, and multiple facets of evaluation. The quantitative evaluation is limited, as one of the questionnaires has untested psychometric properties. The control condition was limited as it was only offered for one hour, making comparison with two-day training problematic. The qualitative evaluation was useful in gaining descriptive data, however, it may have been possible to conduct a more in-depth analysis with a smaller number of participants. Originality/value – The results from this study indicate that providing training in mental health awareness and promotion was considered helpful, by managers in the Fire Service and had positive outcomes for attitudes and understanding about mental health. While there are limitations, initial results of training in mental health promotion are promising. Such training has the potential to promote the public's mental health and wellbeing, and improve the quality of life for people with mental health problems.
 
Baseline and impact Likert scale scores for recovery, dangerousness, unpredictability and social distance
Qualitative feedback from participants organised within a knowledge, attitude, and behaviour framework
Stigma and discrimination towards people with mental health problems is a global issue, imposing a considerable public health burden in terms of social isolation, limited life chances, delayed help-seeking behaviour and stress. While numerous initiatives have been undertaken to address these issues, an evidence base for what works is still emerging. This paper explores the impact of 15 population-level awareness workshops delivered over a five-month period to 137 participants. These were employees drawn from workplaces identified as being important in the day-to-day lives of people with mental health problems. Evaluation approaches maximised specificity, sensitivity and anonymity and they assessed participant knowledge, attitude and behaviour. The workshops significantly improved participant knowledge. Attitude change was more complex with an overall significant improvement in attitudes, particularly in relation to unpredictability and recovery, but not dangerousness, which had more positive baseline attitudes. Social distance, a proxy for behavioural intent, had significant improvements in relation to ‘moderate’ social contact only. Qualitative feedback indicated that complex, unanticipated and positive messages had been absorbed by participants and influenced beliefs and behavioural intent. Service user narratives focusing on recovery were identified as the most valuable component of the intervention.
 
In a multi-agency, multilevel and multisystem scenario, the Provincial Education Office in Naples promoted a training module for the prevention of child neglect and abuse through a successful partnership approach. A training course, presented on a modular basis, was directed at teachers and heads of the nursery and primary schools throughout Naples. The object was to raise awareness, competence and coping skills when incidences of child abuse and neglect were presented.The aims of the module were:¦ to give participants the means to recognise both the signs of hidden problems in the child's behaviour and the disguised signs of maltreatment and abuse¦ to support the school representatives and help them to acquire the necessary competencies to enable them to become a reference point for the child, so aiding the child in the disclosure of information and subsequent protection processes¦ to promote an effective working methodology, through joint collaboration between school workers, health and social services staff and the magistracy¦ to enable the course participants to acquire competence through acquiring appropriate knowledge and skills by the assimilation of relevant information.A semi-structured questionnaire was drawn up to evaluate the training module. A hundred and seventy-nine school teachers and school managers completed the questionnaire prior to receiving the training, and a hundred and fiftyfour after; the results provided positive evidence of the effectiveness of the programme. The analysis of the data and comparison of the results highlighted the interest in gaining more knowledge of the subject, especially among the younger participants. It is important to emphasise that while they were on the course participants welcomed the proposal for joint working between the school, health and social services and the legal authorities. However, no positive changes were observed in relation to the involvement of the judiciary, who have for some time been considered with suspicion and reserve. The course also encouraged the school workers to develop a greater appreciation of the benefits to be derived from a multidisciplinary approach to this issue.
 
Line graph showing the monthly consultation number to the psychiatric out-patient clinic during the year 2010 
Purpose – The purpose of this paper is to demonstrate how a psychiatric clinic in a general hospital can function in conflict-ridden Iraq through the easing of patient access to services. Design/methodology/approach – The workload of psychiatrists was analyzed for one year (2010) at the psychiatry consultation clinic located in the campus of the Medical City Hospital in Central Baghdad which is also a training center. Findings – A total of 2,997 consultations (both adults and children) occurred in 2010. In total, 96 percent were self or family referrals. Patient services were provided by five consulting psychiatrists for a variety of psychiatric disorders. The main therapeutic intervention was the prescription of psychotropics. Research limitations/implications – Despite the turbulent circumstances and limited mental health resources in Iraq, this clinic was established as a model to attract patients for consultation and triage management to reduce appointment defaults and delayed care. Practical implications – The data can contribute to the planning and development of mental health services in Iraq, contributing to the current body of literature and serving as a model for other conflict areas. Originality/value – To best of the understanding this study is the first in the country.
 
Purpose – The aim of the research is to assess the extent and value of mental health service user (MHSU) involvement in research in England. Design/methodology/approach – This is a knowledge review, including academic and “grey” literature, and documented testimonial evidence. Findings – The involvement of MHSUs in mental health research has become mainstream. There is clear evidence that involving MHSUs in research adds value. Four gaps in the literature were identified. First, a lack of evidence from non-service-user researchers about their experience of working with MHSUs. Second, a lack of recognition that anyone involved in research may hold more than one role. Third, failure to treat carers as separate from MHSUs, or – often – to include them at all. Fourth, a lack of understanding that MHSUs may have a useful role to play in research on topics other than mental health. Research limitations/implications – The literature would benefit from some evidence about non-service-user researchers’ experiences of working with MHSU researchers. Carers should be recognised much more widely as different from MHSUs and with a valid role to play in mental health research from their own perspectives. MHSU researchers, and carer researchers, should be offered opportunities for involvement in research on topics other than mental health. Practical implications – The evidence shows that involving service users in research can benefit everyone involved and the research itself. The process can be challenging for all concerned. However, there is now plenty of guidance about how to involve service users in research for maximum benefit to all (e.g. Faulkner, 2004b; SURGE, 2005; Morgan, 2006; Tew et al. , 2006; Kotecha et al. , 2007; Schrank and Wallcraft, 2008, pp. 243-247; Leiba, 2010, pp. 160-169; Armes et al. , 2011; Morrow et al. , 2012, p. 114). This guidance should be consulted by researchers, funders, ethics committees, and other stakeholders at the earliest possible stage of any relevant project. Social implications – It is essential to recognise and acknowledge that anyone involved in research may hold more than one role. Embracing multiple and mutable identities is not an easy process, as the literature shows, and attempts to do so are likely to produce resistance at every level. Nevertheless, the example of the survivor researchers suggests that doing this has the potential to enrich our individual and collective experience, and therefore society as a whole. Originality/value – The paper is written by an independent researcher who is also a carer for people with mental health problems: a viewpoint which is rarely found in the literature. The literature suggests that power imbalances and identity issues are at the root of most difficulties and gaps. Social identity and categorisation theory offers a useful theoretical perspective. The paper will be of value to anyone interested in mental health research, whether as a student, service user/survivor, researcher or teacher.
 
This article discusses the state of the art concerning the meaning and value of model programmes in mental health promotion and mental disorder prevention. Model programmes are considered an important instrument for improving the quality, social impact and cost-effectiveness of promotion and prevention. However, there is a lack of conceptual clarity and insight in the processes and mechanisms for successful use of model programmes in this field. This article offers a further clarification of the concept of model programmes and discusses its pros and cons and current views on the process of programme development and programme use. The discussion will be based particularly on recent experiences with model programmes in Europe. Until recently, prevention research was directed mainly at the design and testing of new model programmes. However, successful use of the 'model programme strategy' requires more attention to the pre-conditions for effective dissemination, adoption and implementation of model programmes. Only when this multi-phased process is taken into account and the required pre-conditions and quality criteria are specified can one expect that model programmes will be more effective at a community level. The consequences of this view for prevention science and prevention research policies are discussed. To implement such a multi-phased process successfully, not only are conceptual clarity and a scientific underpinning crucial, but also collaborative organisational structures are needed at national and international level if the range of complementary tasks is to be executed effectively and efficiently.
 
Three articles in the inaugural issue of this Journal discuss the idea of mental health promotion. Here, each is discussed in terms of claims, assumptions and, in some cases, weaknesses such as an unreconstructed account of mental illness prevention, the mistake of relying on an arbitrary definition of mental health and problems with relying on 'resilience' as a central concept. It is argued that none of the papers pays enough attention to social experiences and processes, cultural values and norms on which all judgements about what promotes and demotes mental health are based. In response to this critique, the ten-element map of mental health promotion and demotion is referred to as a more comprehensive, illuminating and, in the end, more philosophically sound account.
 
Socio demographic profile of adolescents who participated in the study
Final regression model for depression among adolescents in the sampled secondary schools in Jimma town, Ethiopia, 2018(n = 546)
Purpose Dietary patterns are important for the physical and psychological development of adolescents. The purpose of this study is to determine magnitude and severity of depression and its relation with diet diversity score (DDS) among adolescent high school students. Design/methodology/approach A cross-sectional study was conducted among 546 adolescents selected from schools using multistage sampling technique. Dietary intakes were assessed using a 24-h dietary recall, and depression severity and prevalence were assessed by PHQ-9A. A structured questionnaire was used to collect data. Linear regression analysis was used, and unstandardized beta ( ß ) coefficients with 95% confidence intervals (CI) were computed to determine the association of depression and its severity with dietary diversity score. Findings In all, 546 questionnaires were filled completely and consistently making a response rate of 97.3%. The dietary diversity score in 97 (17.8%) of the adolescents were between 1 and 3 (low dietary diversity score) but 259 (47.4%) scored greater than 6 (high dietary diversity score). Chi-square test revealed that with a decrease in DDS from highest to lowest level, the percentage of moderate to severe and severe depression slightly increased (3.4%). In addition, the percentage of moderate to severe and severe depression who consumed meat, fish and milk and dairy products slightly increased (3% and 3.2%). Multivariate adjusted regression analysis demonstrated that dietary diversity score was found to be inversely associated with depression severity and prevalence. Originality/value It was found that linear association between diet diversity and depression severity, and prevalence after adjustment for relevant con-founders. The study provided epidemiological evidence of a robust association of dietary pattern with depression symptoms' severity and prevalence in adolescents.
 
Purpose The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature. Design/methodology/approach This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers. Findings Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively. Research limitations/implications The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge. Originality/value This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research.
 
Purpose This paper aims to present findings from 440 responses regarding the experiences of supervision, coping and well-being of 83 service providers and policymakers from eight countries working to support children’s well-being during the COVID-19 pandemic. Design/methodology/approach A smartphone survey hosted on a custom-built app was used. The data were analysed using qualitative content analysis. The data were gathered in the last quarter of 2020. Findings While most respondents described the supervision they received as “useful” – both personally and professionally – and reported several characteristics of effective supervision practices, concerns about not receiving optimal support were also voiced. Respondents shared a range of stress management and other self-care practices they used but also revealed their difficulties optimally managing the stresses and anxieties during the COVID-19 pandemic. As a result, some respondents shared they were feeling helpless, unmotivated and unproductive. Yet, overall, responses were imbued with messages about hope, perseverance and self-compassion. Originality/value Using a bespoke smartphone app, rich and intimate insights were generated in real time from a wide range of professionals across high- and low- and middle-income countries – indicating the need to better support their well-being and service delivery.
 
Purpose This paper aims to demonstrate early psychological concomitants of the Covid-19 pandemic in England on a sample of younger and older people. Design/methodology/approach A cross-sectional quantitative questionnaire (n = 1608) was conducted on the Prolific website. Participants completed the PERMA Scale (Flourishing), the four Office of National Statistics (ONS4) Well-being Questions, the Clinical Outcomes Measure in Routine Evaluation (CORE-10) and the short University of California Los Angeles Brief Loneliness Scale. Findings Data were gathered on March 18, 2020, near the start of the Covid-19 pandemic. This study looks at the effects of the developing pandemic on younger participants (18 to 25 years, n = 391) and older participants (60 to 80 years, n = 104). Flourishing levels for older participants were significantly higher (M = 107.96) than for younger participants (M = 97.80). Younger participants scored significantly higher on the ONS4 for anxiety and lower than the older participants for happiness, life satisfaction and having a worthwhile life. Levels of psychological distress (CORE-10) were also significantly lower for older participants (M = 9.06) than for younger participants (M = 14.61). Finally, younger participants scored significantly higher on the Brief UCLA Loneliness Scale (M = 6.05) than older participants (M = 4.64). Research limitations/implications From these findings, the Covid-19 pandemic was having a significantly greater effect on younger people in England, less than one week before the UK went into “lockdown”. Scores for both the Younger and Older groups on all the study measures were worse than normative comparisons. The study had no specific measure of Covid-19 anxiety, but nor was one available at the time of the survey. Practical implications This study suggests that younger people (18 to 25) may be a more vulnerable group during the Covid-19 pandemic than many may have realized. Social implications As a recent British Psychological Society report concluded, there is a lot of untapped wisdom amongst older groups in society. Originality/value This is one of the earliest studies to look at psychological distress before England went into “lockdown.”
 
Purpose This paper aims to assess the knowledge, perceptions and mental health impact of COVID-19 among students in Rwanda. Design/methodology/approach This paper is a cross-sectional online survey questionnaire. Findings The mean knowledge score among the 375 respondents was 75.14% (SD ± 19.1), with 195 (55.1%) of the respondents scoring below 80%. Students who believed that COVID-19 education was sufficient were more likely to have lower knowledge levels (OR = 1.84, 95% CI = 1.15; 2.94). While most respondents were aware of their vulnerability to the virus, they did not see themselves at risk of becoming infected. The percentage of respondents reported to have some form of mental health issues was 49.7%. The three most important factors in influencing mental health were age, history of mental health issues, and the way news was reported. Education quality was less affected for those who received online schooling (OR = 0.55, 95% CI = 0.33, 0.94). Practical implications Education about COVID-19 should be strengthened by capitalizing on existing online and offline learning platforms to frequently update new or changing information. Originality/value This paper was the first study assessing the knowledge, perception and mental health impact of COVID-19 among Rwanda students.
 
Purpose This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020. Design/methodology/approach This paper aims to present a thematic synthesis of mental health policies published in England from 1999 to 2020. The authors specifically focus on ethnicity-related mental health issues highlighted in policies, policy recommendations and performance measurements of policy implementation. Findings Findings from this synthesis demonstrate that ethnic mental health inequalities remain comparable over the past two decades. Ongoing issues include a lack of data on the ethnicity of mental health services users. Where data is available, these highlight ethnic inequalities in access to, experiences of and outcomes of mental health services, as well as a lack of cultural capability in health-care professionals. Policy recommendations have also remained the same during this time and include: collecting data on the ethnicity of service users, raising awareness of the cultural needs of Black and Minority ethnic populations amongst health-care professionals, recruiting BME staff into mental health care services and improving community engagement. The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Practical implications The synthesis identified poor indicators of performance measurement on policy implementation and weak monitoring regimes. Originality/value This paper presents a thematic synthesis of mental health policies published in England from 1999 to 2020.
 
Purpose – The purpose of this paper is to investigate the claim by the Chief Medical Officer for England that “There is virtually no robust, peer-reviewed evidence to support a ‘well-being’ approach to mental health”. Design/methodology/approach – Secondary research using research literature from two widely available databases, Scopus and Applied Social Sciences Index and Abstracts. Randomised controlled trials were sought that focused on “well-being” (including well-being or wellness), from 2004 to the present. Findings – With both clinical samples and non-clinical populations, a variety of experimental trials were found. Studies were identified with both positive benefits and no benefits from intervention. The most numerous type of paper reported positive benefits for clinical patients. Research limitations/implications – Only a single reader classified the studies in this investigation, so the inter-rater reliability may be limited. Only two databases were searched. However, future work (such as that in progress by the What Works Centre for Wellbeing) may find an abundance of evidence on mental well-being. Practical implications – In many settings, well-being can improve after intervention. Social implications – What is measured as “well-being” may need to take into account the perspective of the specific population being studied. Originality/value – This small-scale study was undertaken to inform policy in the new Public Mental Health Network.
 
Purpose This study aims, firstly, to analyse the contribution of socio-economic determinants to mental health (MH) inequalities before the economic crisis, in 2006, and again in a year during recovery, 2016, and secondly, to analyse the changes in these contributions between the two points in time in Barcelona city. Design/methodology/approach The concentration index (CI) was calculated for MH inequalities for the population aged 16 or older using the Barcelona Health Surveys for 2006 and 2016. MH was measured with the 12-item General Health Questionnaire. The CI was broken down for each year and gender based on a set of socio-economic determinants plus social support and the presence of chronic diseases. The contribution of each factor to variation in MH inequality between the two points in time was analysed with Oaxaca decomposition. Findings Income inequalities in MH increased for men and women (a CI from −0.06 in 2006 to around −0.16 in 2016). Employment status and social class are the main contributors to MH inequalities (more than 50%), except for women in 2006 that is chronic disease. The main contribution to increases in MH inequality between 2006 and 2016 was due to unemployment (26.5% men, 23.8% women), being a student (22.8% men, 20.7% women), homemaker in women (30.7%) and men in the manual class (31.6%). Originality/value MH inequalities have been amplified between the two years among the economically vulnerable population or for those who are out of the labour market with unexpected changes for women.
 
Purpose With encouragement from the World Health Organisation, national suicide prevention policies have come to be regarded as an essential component of the global effort to reduce suicide. However, despite their global significance, the construction, conceptualisation and proposed provisions offered in suicide prevention policies have, to date, been under researched; this study aims to address this gap. Design/methodology/approach we critically analysed eight contemporary UK suicide prevention policy documents in use in all four nations of the UK between 2009 and 2019, using Bacchi and Goodwin’s post-structural critical policy analysis. Findings The authors argue that across this sample of suicide prevention policies, suicide is constructed as self-inflicted, deliberate and death-intentioned. Consequently, these supposedly neutral definitions of suicide have some significant and problematic effects, often individualising, pathologising and depoliticising suicide in ways that dislocate suicides from the emotional worlds in which they occur. Accordingly, although suicide prevention policies have the potential to think beyond the boundaries of clinical practice, and consider suicide prevention more holistically, the policies in this sample take a relatively narrow focus, often reducing suicide to a single momentary act and centring death prevention at the expense of considering ways to make individual lives more liveable. Originality/value UK suicide prevention policies have not been subject to critical analysis; to the best of the authors’ knowledge, this study represents the first attempt to examine the way in which suicide is constructed in UK suicide prevention policy documents.
 
Purpose The purpose of this study is to evaluate the increase in suicide rates for Kansas residents, as well as quantify the difference in suicide rates between men and women across the State of Kansas. Design/methodology/approach To evaluate increases in suicide rates, a joinpoint regression analysis was conducted to calculate the annual percentage change in suicide rates. To evaluate differences between sex characteristics, a one-way analysis of variance was conducted. Findings Results of a joinpoint regression analysis found that the annual percentage change in the suicide rates of Kansas did increase significantly between 2009 and 2018. Furthermore, the rate of suicide increase among women was greater than the suicide rate increases of men. Originality/value The value of this study provides context to the suicide literature that could allow for better local and statewide policy decisions.
 
Purpose Stress has considerable impacts on human health, potentially leading to issues such as fatigue, anxiety and depression. Resource loss, a common outcome of disasters, has been found to contribute to stress among disaster survivors. Prior research focuses heavily on clinical mental health impacts of disaster experience, with less research on the effect of cumulative stress during long-term recovery. To address this gap, the purpose of this paper is to examine the influence of stressors including resource loss and debt on mental health in a sample of households in Moore, Oklahoma, impacted by a tornado in 2013. Design/methodology/approach For this pilot study, questionnaires were mailed to households residing along the track of the May 2013 tornado in Moore, OK. Descriptive statistics were calculated to report sample characteristics and disaster experience. Independent associations between disaster losses and demographic characteristics with the outcome mental health were examined with χ² and unadjusted logistic regression analysis. Adjusted logistic regression models were fit to examine resource loss and mental health. Findings Findings suggest that the tornado had considerable impacts on respondents: 56.24 percent (n=36) reported that their homes were destroyed or sustained major damage. Greater resource loss and debt were associated with mental health distress during long-term recovery from the Moore, OK, 2013 tornadoes. Research limitations/implications The association between resource loss and mental health point to a need for interventions to mitigate losses such as bolstering social support networks, incentivizing mitigation and reducing financial constraints on households post-disaster. Originality/value This study contributes to a better understanding of long-term, accumulated stress post-disaster and the impact on health to a literature heavily focused on clinical outcomes.
 
Purpose – The purpose of this paper is to report on the development and results of the Mental Health Inclusion Index. Design/methodology/approach – Data gathering and interviews with key policy makers in 30 countries in Europe (the EU28 plus Switzerland and Norway). Data gathered enabled the production of an 18 indicator benchmarking index ranking the 30 countries based on their commitment to integrating people with mental illness. Findings – The main findings were: mental illness exacts a substantial human and economic toll on Europe, and there is a substantial treatment gap, especially for people with common mental health problems. Germany’s generous social provision and strong healthcare system put it number one in the Mental Health Integration Index. The UK and Scandinavian states come next. The lowest-scoring countries in the index are from Europe’s south-east, where there is a long history of neglect of mental illness and poorly developed community services. One needs to understand that the leading countries are not the only ones providing examples of best practice in integrating those with mental illness. Employment is the field of greatest concern for people with mental illness, but employment is also the area with the most inconsistent policies across Europe. A distinction can be made between countries whose policies are aspirational and those where implantation is support by substantial and most importantly sustained, resource investment. Europe as a whole is only in the early stages of the journey from institution- to community-based care. Lack of data makes greater understanding of this field difficult, and improvement can only be demonstrated by repeated surveys of this kind, based on more substantial, comprehensive and coherent information. Research limitations/implications – Usual caveats about the use of surveys. Missing data due to non-response and poverty of mental health inclusion data in many European countries. Practical implications – The author reflects on the findings and considers areas for future action. The main implications are: better services result from substantial, but most importantly, sustained investment; and that employment is most important to people with mental health problems, but is one of the most inconsistent policy areas across Europe. Social implications – Supports the need for consistent investment in community mental health services and more consistent employment policies in Europe. Originality/value – This survey is the first of its kind in Europe, and was conducted by the Economist Intelligence Unit in London, and sponsored by Janssen.
 
Purpose Death by suicide among Black people in the USA have increased by 35.6% within the past decade. Among youth under the age of 24 years old, death by suicide among Black youth have risen substantially. Researchers have found that structural inequities (e.g. educational attainment) and state-specific variables (e.g. minimum wage, incarceration rates) may increase risk for suicide among Black people compared to White people in the USA. Given the limited understanding of how such factors systematically affect Black and White communities differently, this paper aims to examine these relationships across US states using publicly available data from 2015 to 2019. Design/methodology/approach Data were aggregated from various national sources including the National Center for Education Statistics, the Department of Labor, the FBI’s Crime in the US Reports and the Census Bureau. Four generalized estimating equations (GEE) models were used to examine the impact of state-level variables on suicide rates: Black adults suicide rate, Black youth (24 years and younger) suicide rate, White adult suicide rate and White youth suicide rate. Each model includes state-level hate group rates, minimum wage, violent crime rates, gross vacancy rates, and race-specific state-level poverty rates, incarceration rates and graduation rates. Findings Across all GEE models, suicide rates rose between 2015–2019 (ß = 1.11 – 2.78; ß = 0.91 – 1.82; ß = 0.52 – 3.09; ß = 0.16 – 1.53). For the Black adult suicide rate, state rates increased as the proportion of Black incarceration rose (ß = 1.14) but fell as the gross housing vacancy rates increased (ß = −1.52). Among Black youth, state suicide rates rose as Black incarcerations increased (ß = 0.93). For the adult White suicide rate, state rates increased as White incarceration (ß = 1.05) and percent uninsured increased (ß = 1.83), but fell as White graduation rates increased (ß = −2.36). Finally, among White youth, state suicide rates increased as the White incarceration rate rose (ß = 0.55) and as the violent crime rate rose (ß = 0.55) but decreased as state minimum wages (ß = −0.61), White poverty rates (ß = −0.40) and graduation rates increased (ß = −0.97). Originality/value This work underscores how structural factors are associated with suicide rates, and how such factors differentially impact White and Black communities.
 
Thematic chart of online friendship and mental well-being during focus group interviews 
Purpose – The purpose of this paper is to investigate the relationship between online friend networks and the mental well-being (MWB) of adolescent males. Design/methodology/approach – The study used a mixed methods approach: first, questionnaire involving a validated MWB scale and questions regarding online friendship to 14-15 year old males (n=521); and second, focus group interviews (n=8) of between six and eight members three months later. Findings – Positive and negative associations were recorded between online friends and well-being. A positive relationship (p < 0.05) was found between the number of online friends and well-being scores. However, higher numbers of online friends were also associated with increases in negative online experiences namely, receiving embarrassing posts online or risky activities such as, chatting frequently with strangers. Online friends may influence perceptions of social support, status and belonging, each of which may contribute positively or negatively to well-being. However, by increasing these perceptions, online friends may cause additional distress when their presence does not provide tangible support during a crisis period. Originality/value – Online friends provide the context to which young males explore and negotiate the online world. To date, little mixed methods research has focused exclusively on the MWB of online friends. Policy makers could do well to consider the growing prominence of online social networking and produce targeted programmes to educate young people on the benefits and pitfalls of building large online “friend” networks.
 
Purpose – This paper aims to demonstrate the effectiveness of group therapy programmes for adult survivors of childhood sexual abuse (CSA), looking specifically at The Butterfly Programme, an eight week programme of healing that uses various therapeutic methods, to show how women who have experienced a form of CSA and remain deeply affected, can become more empowered through group therapy. Design/methodology/approach – By looking at venues where the programme can be delivered and where disclosure may occur, the report provides further statistics on how women survivors are affected into adulthood. Information is given on the emotional benefits of group therapy, the structure of the programme and how survivors take an active role by working closely with the facilitator. Findings – Through questionnaires, completed at the beginning and end of the programme the effectiveness of the programme is assessed with improvements in self‐esteem measured against the Rosenberg self‐esteem scale, a reliable ten‐item, self‐report measure of global self‐esteem. Data taken from 59 women demonstrate the positive effects of group therapy. Originality/value – The report shows how The Butterfly Programme enables women to address difficult emotions associated with their experience of CSA, helping them to reduce their dependency on “peripheral” medical services, and instead assists them to improve their education and employment prospects as well as improving their personal relationships.
 
Purpose University academicians are struggling to engage in teaching, supervision, research and publication. The purpose of this paper is to determine how academicians cope with the various burdens of academia work stressors to overcome burnout. Design/methodology/approach A cross-sectional study was conducted from January to July 2017. In total, 327 research university academicians were selected using a proportional stratified randomized sampling. Validated measures were used to collect data on perceived work stressors (teaching, research, interpersonal conflicts and career development), coping strategies (adaptive and maladaptive coping) and perceived burnout (emotional exhaustion (EE), depersonalization and personal accomplishment (PA)). The data were gathered via computer assisted self-interviewing (CASI). The research statistical model was tested by two-steps of assessment replicating covariance-based structural equation modeling (CB-SEM) with bootstrapping procedure to generalize the sample to the hypothesized model. Findings Overall data fit the hypothesized model well (CMIN/df=1.788, GFI=0.833, CFI=0.921, TLI=0.916, RMSEA=0.047) with various degree of explanatory value for EE, depersonalization and PA were 60, 49 and 22 percent, respectively. Academicians were resilient against the burden of teaching. However, they did adopt coping mechanisms to overcome research challenges and interpersonal conflicts. The effects of research and interpersonal conflicts on tri-dimensional burnout mediated by maladaptive coping ( f² effect size=0.37) had a larger effect than interpersonal conflicts toward burnout mediated by adaptive coping ( f² effect size=0.02). Practical implications Academicians adopt maladaptive coping for research and interpersonal conflicts to suppress burnout. An integrative approach at both organization and individual levels is crucial to enhance appropriate coping mechanism to curb with burnout among the academicians of a research university. Originality/value This is the first study in Malaysia which uniquely estimate the effects of academician’s work stressors toward burnout with introducing coping strategies as mediators toward work stressors and burnout relationship which has been analyzed via CB-SEM.
 
Purpose A number of initiatives have been developed to ensure easy access to mental health services for Black and Asian Minority Ethnic (BAME) communities. Improving Access to Psychological Therapies (IAPT) is a service that delivers first line interventions for South Asian women; however, little is known about what makes IAPT accessible for this population. This paper aims to explore South Asian women’s experiences of accessing psychological therapy and whether therapy within IAPT helps individuals to re-frame their experiences within their own cultural context. Design/methodology/approach A qualitative approach was used. Semi-structured interviews were carried out with South Asian women who accessed an IAPT service. Ten participants took part in the study and interviews were analysed using thematic analysis. Findings Six themes were identified; access, experience, cultural framework, therapist characteristics, expectations and “sticking with it”. Having a good therapeutic relationship with the therapist was key. While cognitive behavioural therapy (CBT) enabled clients to manage their symptoms, manualised CBT led to a sense of dissatisfaction for some. Clients spoke of having to make a forced choice to either deny their culture or leave their culture at the door to access therapy. Cultural and religious exclusion had a negative impact on therapy particularly for those whose difficulties were related to their cultural or religious context. Practical implications Culture and religion continues to be excluded from psychological therapy for South Asian Women. A cultural shift is required from within IAPT services to maintain engagement for this group. Further clinical implications are discussed. Originality/value While the experiences of Black and Asian ethnic minority groups accessing secondary mental health services has been explored, this study explores and highlights the experiences of South Asian Women accessing therapy in primary care, and uniquely identifies the processes that enable women to engage in therapy.
 
Top-cited authors
Hetan Shah
  • Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College
Hans Ivers
  • Laval University
Caroline Biron
  • Laval University
Cary Cooper
  • The University of Manchester
Jean-Pierre Brun
  • Laval University