Nick Bouras’s research while affiliated with King's College London and other places

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Publications (113)


Happy times, careers and happenstance in UK psychiatry: time, timeliness, timelessness, eternity and contemporality
  • Article
  • Full-text available

August 2024

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13 Reads

BJPsych Bulletin

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Nick Bouras

To address some challenges facing psychiatrists today we discuss issues of happenstance and fulfilment in psychiatric careers through some of the record and reflections of four psychiatrists since the 1950s. We trace the changes in psychiatry attendant to the transition from the welfare to the neoliberal state and=its contemporary postmodern culture. We highlight the crucial importance of political-cultural as well as technological developments in determining psychiatric service management and provision, and clinical practice and career outcomes. In the light of this impact, in a global era that some highly respected authorities consider in apocalyptic terms, we advocate for the incorporation of training in political awareness and activism in the psychiatric curriculum and practice. We suggest that this is necessary for social justice and patient welfare and that it will help safeguard psychiatric professionalism, conscience and self-esteem.

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Metacommunity: the current status of psychiatry and mental healthcare and implications for the future

May 2024

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19 Reads

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4 Citations

BJPsych International

We review the origins and history of community psychiatry and the challenges posed to it by advancing technology and the neoliberal political economy and society that have prevailed since the 1990s. We summarise both achievements and shortcomings and argue that the term ‘community’ fails to acknowledge the gap between its original ambition and the outcomes of its implementation. We argue that, because of the changes that have taken place, the implementation of community psychiatry's objectives as conceived originally is likely to continue to fail. To sharpen current awareness and thinking and optimise future policy discourse and service strategies we revisit the concept of ‘metacommunity’. This is a historical descriptive label that aims to encapsulate the fundamental transformations that have taken place. These in turn demand of psychiatrists and other mental health providers both more socially critical thinking and mental health activism in the public sphere. Ultimately, beyond both community and metacommunity psychiatry, what is required is a democratic psychiatry.


Madness and society in Britain

August 2022

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23 Reads

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3 Citations

BJPsych Bulletin

The fiftieth anniversary of the Royal College of Psychiatrists, and the publication of a detailed multidisciplinary social history of British psychiatry and mental health in recent decades have offered an opportunity to take a helicopter view and reflect on the relation between psychiatry and changing British society. We argue that the time has come to move on from the rhetoric of deinstitutionalisation and community mental healthcare to lead public debate and advocacy for the needs of the mentally ill in the new era of ‘meta-community psychiatry and mental healthcare’. We need to respond effectively to the increasing awareness of mental health problems across society, aiming for a pluralist, integrated and well-funded reform led by joint professional and patient interests which could be unstoppable if we all work together.


Forensic Issues in Intellectual Disability and Autism Spectrum Disorder

May 2022

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47 Reads

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4 Citations

Offending in people with intellectual disability (ID) and/or autism spectrum disorder (ASD) is poorly understood. The evidence suggests that people with ID and/or ASD may be overrepresented in the criminal justice system and their presence is associated with an increased likelihood of future recidivism and custodial or more restrictive or punitive sentencing. The detection of offenders with ID and/or ASD has not been a priority across the criminal justice system which has concentrated on identifying offenders with severe mental illness. There is a growing evidence based on interventions such as risk assessment tools for people with ID but less so for those with ASD. Specific offence-related interventions such as sex offending treatment programmes that have shown promise and have been adopted into clinical practice. However, the treatment and management of offending behaviours in people with ID and/or ASD is complex. Targets for treatment to reduce future risk can include communication, anger, poor assertiveness, poor self-esteem, social isolation and frustration. A lack of treatment outcome studies means there is little evidence of the effectiveness of interventions aimed at preventing future offending although there has been support for CBT and some other psychological interventions. Deficits in ability, understanding and functioning associated with ID and ASD often mean lifelong involvement from multiple agencies for those who have contact with the criminal justice system, although in many places these are rarely provided for this group.


Mental Health Services

January 2022

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51 Reads

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1 Citation

The ongoing debate for the past 30 years has been on the model of mental health services for people with intellectual disability (ID), specifically around how these services should be delivered. A strategic approach could have been more effective in ensuring care pathways that connect the various agencies of health, social care, support and education services. Rather than the diluted approach of providing mainstream services to all, the evidence is always in the direction of specialist models being most effective. There is still a need for further research into how different models impact on service user’s experiences of mental health care as current evidence indicates that there are problems around making mental health services accessible for people with ID. High-quality services are effective, safe and give service users a good experience and as such mental health services for people with ID and/or autism need to demonstrate that they are improving outcomes for people with ID and/or autism. Further evidence is still required on which aspects of community-based models and interventions are most effective in the long term, for example, on the rates of hospital admissions.KeywordsAutism spectrum disorderIntellectual disabilityMental health servicesPerson-centred servicesQuality improvementSpecialist services


Introduction: Mind State and History in Britain 1960–2010

June 2021

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34 Reads

The period 1960–2010 has been one of marked change in UK society and mental health services. Prominent changes have included deinstitutionalisation and community care in mental health. These have taken place in an evolving framework of liberalisation, marketisation and globalisation. The global financial crisis of 2008 and the increasing impact of information technology, social media and artificial intelligence have ushered in a new era of meta-community care, which is now affected by the shock of Covid-19. It is timely to look back over the half-century of 1960-2010 to study and learn the lessons from developments in mental health during what has been labelled the neoliberal era, now in retreat.


Epilogue: Mind, State, Society and ‘Our Psychiatric Future’

June 2021

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81 Reads

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1 Citation

Mind, State and Society examines the reforms in psychiatry and mental health services in Britain during 1960–2010, when de-institutionalisation and community care coincided with the increasing dominance of ideologies of social liberalism, identity politics and neoliberal economics. Featuring contributions from leading academics, policymakers, mental health clinicians, service users and carers, it offers a rich and integrated picture of mental health, covering experiences from children to older people; employment to homelessness; women to LGBTQ+; refugees to black and minority ethnic groups; and faith communities and the military. It asks important questions such as: what happened to peoples' mental health? What was it like to receive mental health services? And how was it to work in or lead clinical care? Seeking answers to questions within the broader social-political context, this book considers the implications for modern society and future policy. This title is also available as Open Access on Cambridge Core.


Mind State and Society: Social History of Psychiatry and Mental Health in Britain 1960-2010

June 2021

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32 Reads

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15 Citations

Mind, State and Society examines the reforms in psychiatry and mental health services in Britain during 1960–2010, when de-institutionalisation and community care coincided with the increasing dominance of ideologies of social liberalism, identity politics and neoliberal economics. Featuring contributions from leading academics, policymakers, mental health clinicians, service users and carers, it offers a rich and integrated picture of mental health, covering experiences from children to older people; employment to homelessness; women to LGBTQ+; refugees to black and minority ethnic groups; and faith communities and the military. It asks important questions such as: what happened to peoples' mental health? What was it like to receive mental health services? And how was it to work in or lead clinical care? Seeking answers to questions within the broader social-political context, this book considers the implications for modern society and future policy. This title is also available as Open Access on Cambridge Core.


Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities: CANDID

March 2021

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303 Reads

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15 Citations

The Camberwell Assessment of Need for adults with Developmental and Intellectual Disabilities (CANDID) is a widely used tool for the assessment of health and social needs of people with intellectual disabilities and mental health problems. It uses the assessment approach adopted by CAN, the world's leading mental health needs assessment measure. Two versions of the CANDID are available: CANDID-S (short version) and CANDID-R (research version). Both versions are aimed at researchers and practitioners working with people with intellectual disabilities, and are suitable for clinical use in community and hospital-based services. Fully updated based on current policy, practice and terminology, this second edition introduces a more intuitive need rating system and an accessible rating algorithm. Guidance on how to use the measures is provided, as well as an overview of research developments since the first edition. The assessment forms are freely available to download from the CAN website (researchintorecovery.com/can) and cambridge.org.


Community Mental Health and Support Services

January 2021

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47 Reads

Service provision in the United Kingdom (UK) for those individuals with intellectual and developmental disabilities (IDD) and coexisting mental health problems remains unfunded and under-developed. Heavily determined by widespread and enduring dualistic thinking, leading patients to bounce between mental health and IDD services. Community services in the UK for people with IDD and coexisting mental health problems, particularly for older adults, remain non-standardised, not researched based and with limited evaluations of clinical outcomes and cost effectiveness. Future research into the effectiveness of community services for people with IDD needs to focus on service components rather than whole-service models.


Citations (78)


... Ikkos & Bouras offer an interesting analysis of the failure of the community psychiatry approach to achieve its original goals in highincome countries such as the USA and UK. 1 They accurately identify how factors such as neoliberal policies, globalisation and digital technology have drastically altered the societal landscape on which the concept of 'community' was originally based. ...

Reference:

Towards democratised psychiatry: building metacommunities for inclusive and equitable global mental health
Metacommunity: the current status of psychiatry and mental healthcare and implications for the future

BJPsych International

... For example, the meaning parents attach to their childrens' symptoms and their associated beliefs about the symptoms, causes, prognosis, and most appropriate path of care can be described within the context of that specific culture. After all, even the impact of disability is influenced by the sociocultural context in which the individual or the family lives (O'Hara & Bouras, 2007). Different cultural models of child rearing and child development exist in every society, in turn the attribution of meaning and understanding e.g., intellectual disability (ID) would vary greatly across cultures (ibid). ...

Intellectual disabilities across cultures
  • Citing Chapter
  • October 2007

... Especially because of failures of social policies and services since 2008, continuity of care, mental symptom control and physical health have suffered 20 and the families of those with severely disabling mental health conditions have too often been let down by the quality (or lack) of care and felt overwhelmed by the burden placed on them. 18,21 1979 and the neoliberal and technological challenge to community psychiatry A pivotal year was 1979: 22 first, the election of Margaret Thatcher in the UK (and Ronald Regan the year after in the USA) ushered in the drive to market fundamentalism and a new globalisation; second, the award of the Nobel Prize in Physiology or Medicine for the development and commercialisation of the computed tomography (CT) scanner headlined the technology that from now on would turn psychiatry away from social and towards biological priorities; and third, the publication of Jean-François Lyotard's La Condition Postmoderne (The Post-Modern Condition) 23 signalled the rise of capital, metrics and management at the expense of feelings, narrative and difference. The introduction of the concept of metacommunity is meant to highlight the transformational significance of these changes in political economy and the contemporaneous rapid advances in clinical and information technology and their impact on psychiatry. ...

Madness and society in Britain

BJPsych Bulletin

... Any of these symptoms can be observed regardless of language capabilities or level of intellectual disability, but the depression in persons with ID tends to be more insidious and changes seen may be less dramatic. 5 The symptoms include: ...

Practice guidelines for the assessment and diagnosis of mental health problems of adults with intellectual disability
  • Citing Chapter
  • February 2004

... Ambiguous papers were discussed with the second reviewer to reach consensus. We also hand-searched the references of the selected articles, of general guidelines both in pediatric and adult populations [16,17,57], of review articles in adults [25,39,42,46,56], and of a review in pediatric anxiety [35]. The studies were included when depression was assessed in children and adolescent youths with ID. ...

Practice guidelines for the assessment and diagnosis of mental health problems in adults with intellectual disability
  • Citing Book
  • February 2001

... A careful assessment of mental state will be necessary, as making a diagnosis of a psychiatric disorder in a person with intellectual disabilities can be difficult. 4,22 In some cases, previous behaviour may return on dose reduction or withdrawal. In these circumstances, a full functional assessment of the behaviour will be necessary, including the assessment of predisposing (e.g. ...

Practice Guidelines for the Assessment and Diagnosis of Mental Health Problems in Adults with Intellectual Disability - Croatian translation

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Tim Matthews

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Geraldine Holt

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... In 'Continental Philosophy of Psychiatry: The Lure of Madness' (Ikkos, 2023c;Morgan, 2022) Morgan, a clinical and academic mental health nurse and philosopher, creates his montage in order to rescue those plural traditions of psychiatry (phenomenological psychiatry, social psychiatry and psychoanalysis) that are often, but not always, marginalised in contemporary accounts. In 'Mind State and Society: Social History of Psychiatry in Britain 1960-2010' (Ikkos & Bouras, 2021) the editors, both clinical and academic psychiatrists, create their montage through giving voice to a diverse and sometimes contradictory range of voices who have lived and reflected on psychiatry during the period under study, from the most established (e.g. Conservative minister of health or professor of psychiatry researching the biology of schizophrenia) to the least so, including women from oppressed minorities, some with lived experience of mental health services. ...

Mind State and Society: Social History of Psychiatry and Mental Health in Britain 1960-2010
  • Citing Book
  • June 2021

... The Learning Disabilities Needs Assessment Tool (Painter et al., 2016) has been designed to assess the mental health needs of people with IDs and therefore has a very specific focus. The CANDID-S (Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities -Short Form; Xenitidis et al., 2003) was derived from a needs' assessment instrument of persons with mental health problems and does not include all needs relevant for people with IDs (McCausland et al., 2010), and in particular for older people with IDs (Strydom et al., 2005). Therefore, the CANDID-S has some shortcomings regarding persons with IDs. ...

Camberwell Assessment of Need for Adults with Developmental and Intellectual Disabilities: CANDID
  • Citing Book
  • March 2021

... Chaplin (2009) reviewed the relevant literature and found that even in areas with highly developed ID services, people with ID continue to be admitted to general psychiatric services; this suggests that general mental health services need to be adequately prepared to engage, treat and manage individuals with dual disability, even in cases where comprehensive specialist services operate. Bouras and Holt (2009) conclude that the argument for the provision of mental health care from generic services appears sound and is widely supported. In a later paper, suggests that the preferred model should involve the provision of services primarily through mainstream services, with specialist services available where appropriate for those with more complex needs. ...

The planning and provision of psychiatric services for adults with intellectual disability
  • Citing Chapter
  • February 2012