Recent Submissions

  • Findings from three neurodevelopmental psychiatry educational events aimed at medical students and junior doctors

    Shaikh, Nasreen; Singh, Niraj (2022)
    Aims. To review feedback from three Neurodevelopmental Psychiatry educational events attended by medical students and junior doctors, to establish their impact and whether they can influence interest in Psychiatry/Neurodevelopmental Psychiatry as a career. Methods. Three events were organised to a) increase understanding of Neurodevelopmental Psychiatry and b) promote career interest in the specialty, aiding recruitment efforts. Two were Face to Face Events (FFEs) whereas one was an Online Event (OE) in keeping with COVID-19 restrictions. The programme for the events was varied including key clinical topics such as Intellectual Disability, autism, ADHD and epilepsy as well as leadership, management, research and training information. Presentations were approximately 20 min in duration. 31 delegates attended the 2018 FFE, 28 attended the 2019 FFE and 65 attended the 2020 OE. The 2018 FFE and 2020 OE were primarily attended by medical students whereas the 2019 FFE was attended primarily by junior doctors. Delegates rated each presentation from 1 (poor) to 5(excellent) and provided comments. At the 2018 and 2019 FFEs we assessed impact on career interest. Results. * The majority of delegates from both FFEs agreed that such events helped to facilitate understanding of neurodevelopmental psychiatry and encourage recruitment to psychiatry. * The majority of delegates at the 2019 FFE agreed that their interest in a career in neurodevelopmental psychiatry had increased following attendance * Attendance was highest at the 2020 OE and overall rating was 4.63/5. * Across the events, popular topics were Autism, Career path and Physical Health needs in Intellectual disability. * Themes in terms of comments included "friendly, inspiring speakers" and "opportunity for interactivity" (noted at OE). Conclusion. Both the OE and FFEs were enjoyed by medical students and junior doctors. Analysis showed key topics such as autism attract interest but also that diverse topics in different formats are important. Human factors that seemed important included inspiring, friendly speakers and a relaxed, interactive atmosphere. OEs are cost-effective and have the potential to attract a bigger audience but may present a challenge in terms of interaction. FFEs impact positively on career interest and this needs to be assessed further in terms of online events.
  • Typology of employers offering line manager training for mental health

    Thomson, Louise (2024)
    BACKGROUND: Mental ill health has a high economic impact on society and employers. National and international policy advocates line manager (LM) training in mental health as a key intervention, but little is known about employer training provisions. AIMS: To explore the prevalence and characteristics of organizations that offer LM training in mental health. METHODS: Secondary analysis of existing longitudinal anonymised organizational-level survey data derived from computer-assisted telephone interview surveys collected in four waves (2020:1900 firms, 2021:1551, 2022:1904, 2023:1902) in England, before, during and after a global pandemic. RESULTS: The proportion of organizations offering LM training in mental health increased pre- to post-pandemic (2020:50%, 2023:59%) but 41% do not currently provide it. Logistic regression confirmed that LM training is more likely to be offered by large-sized enterprises, organizations with a larger proportion of employees who are younger (aged 25-49), female, disabled and from ethnic minority communities. Sector patterns were inconsistent, but in 2023, organizations from the 'Hospitality' and 'Business Services' sectors were more likely to provide LM training than other sectors. CONCLUSIONS: Continued efforts are needed to increase the proportion of employers offering LM training in mental health, particularly small- to medium-sized enterprises, and organizations with predominantly male, White and/or older workforces.
  • Experiences and impact of psychiatric inpatient admissions far away from home: A qualitative study with young people, parents/carers and healthcare professionals

    Nazir, Saeed; Horton, Kate; Morriss, Richard K.; Sayal, Kapil (2024)
    BACKGROUND: There are significant clinical, policy and societal concerns about the impact on young people (YP), from admission to psychiatric wards far from home. However, research evidence is scarce. AIMS: To investigate the impact of at-distance admissions to general adolescent units, from the perspectives of YP, parents/carers and healthcare professionals (HCPs) including service commissioners, to inform clinical practice, service development and policy. METHOD: Semistructured interviews with purposive samples of YP aged 13-17 years (n=28) and parents/carers (n=19) across five large regions in England, and a national sample of HCPs (n=51), were analysed using a framework approach. RESULTS: There was considerable agreement between YP, parents/carers and HCPs on the challenges of at-distance admissions. YP and parents/carers had limited or no involvement in decision-making processes around admission and highlighted a lack of available information about individual units. Being far from home posed challenges with maintaining home contact and practical/financial challenges for families visiting. HCPs struggled with ensuring continuity of care, particularly around maintaining access to local clinical teams and educational support. However, some YP perceived separation from their local environment as beneficial because it removed them from unhelpful environments. At-distance admissions provided respite for some families struggling to support their child. CONCLUSIONS: At-distance admissions lead to additional distress, uncertainty, compromised continuity of care and educational, financial and other practical difficulties, some of which could be better mitigated. For a minority, there are some benefits from such admissions. CLINICAL IMPLICATIONS: Standardised online information, accessible prior to admission, is needed for all Child and Adolescent Mental Health Services units. Additional practical and financial burden placed on families needs greater recognition and consideration of potential sources of support. Policy changes should incorporate findings that at-distance or adult ward admissions may be preferable in certain circumstances.
  • Health service improvement using positive patient feedback: Systematic scoping review

    Lloyd, Rebecca; Gaskin-Williams, Amy; Slade, Mike; Kotera, Yasuhiro; Loughlin-Ridley, Joanne; Enston, Claire (2023)
    BACKGROUND: Healthcare services regularly receive patient feedback, most of which is positive. Empirical studies suggest that health services can use positive feedback to create patient benefit. Our aim was to map all available empirical evidence for how positive patient feedback creates change in healthcare settings. METHODS: Empirical studies in English were systematically identified through database searches (ACM Digital Library, AMED, ASSIA, CINAHL, MEDLINE and PsycINFO), forwards and backwards citation, and expert consultation. We summarise the characteristics of included studies and the feedback they consider, present a thematic synthesis of qualitative findings, and provide narrative summaries of quantitative findings. RESULTS: 68 papers were included, describing research conducted across six continents, with qualitative (n = 51), quantitative (n = 10), and mixed (n = 7) methods. Only two studies were interventional. The most common settings were hospitals (n = 27) and community healthcare (n = 19). The most common recipients were nurses (n = 29). Most outcomes described were desirable. These were categorised as (a) short-term emotional change for healthcare workers (including feeling motivated and improved psychological wellbeing); (b) work-home interactional change for healthcare workers (such as improved home-life relationships); (c) work-related change for healthcare workers (such as improved performance and staff retention). Some undesirable outcomes were described, including envy when not receiving positive feedback. The impact of feedback may be moderated by characteristics of particular healthcare roles, such as night shift workers having less interaction time with patients. Some factors moderating the change created by feedback are modifiable. CONCLUSION: Further interventional research is required to assess the effectiveness and cost-effectiveness of receiving positive feedback in creating specific forms of change such as increases in staff retention. Healthcare managers may wish to use positive feedback more regularly, and to address barriers to staff receiving feedback.
  • Ethnic inequalities among NHS staff in England: Workplace experiences during the COVID-19 pandemic

    Morriss, Richard K. (2024)
    OBJECTIVES: This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study. METHODS: An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). RESULTS: Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health. CONCLUSIONS: Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.
  • The impact of reduced routine community mental healthcare on people from minority ethnic groups during the COVID-19 pandemic: Qualitative study of stakeholder perspectives

    Franklin, Donna (2024)
    BACKGROUND: Enduring ethnic inequalities exist in mental healthcare. The COVID-19 pandemic has widened these. AIMS: To explore stakeholder perspectives on how the COVID-19 pandemic has increased ethnic inequalities in mental healthcare. METHOD: A qualitative interview study of four areas in England with 34 patients, 15 carers and 39 mental health professionals from National Health Service (NHS) and community organisations (July 2021 to July 2022). Framework analysis was used to develop a logic model of inter-relationships between pre-pandemic barriers and COVID-19 impacts. RESULTS: Impacts were largely similar across sites, with some small variations (e.g. positive service impacts of higher ethnic diversity in area 2). Pre-pandemic barriers at individual level included mistrust and thus avoidance of services and at a service level included the dominance of a monocultural model, leading to poor communication, disengagement and alienation. During the pandemic remote service delivery, closure of community organisations and media scapegoating exacerbated existing barriers by worsening alienation and communication barriers, fuelling prejudice and division, and increasing mistrust in services. Some minority ethnic patients reported positive developments, experiencing empowerment through self-determination and creative activities. CONCLUSIONS: During the COVID-19 pandemic some patients showed resilience and developed adaptations that could be nurtured by services. However, there has been a reduction in the availability of group-specific NHS and third-sector services in the community, exacerbating pre-existing barriers. As these developments are likely to have long-term consequences for minority ethnic groups' engagement with mental healthcare, they need to be addressed as a priority by the NHS and its partners.
  • Healthcare professionals' experiences of recovery-oriented collaboration between mental health centres and municipalities: A qualitative study

    Watson, Emma (2024)
    Collaboration within mental health centres and with municipalities in Western European healthcare has presented challenges due to structural and cultural disparities. The Danish healthcare system faces obstacles that impact mental healthcare services, particularly in cross-sectorial cooperation. Our aim was to investigate healthcare professionals' experiences of recovery-oriented collaboration within a mental healthcare setting across hospitals and municipalities to gather a deeper understanding of this issue. Twenty-four employees were purposively sampled from mental health centres in Copenhagen and focus group interviews were conducted to explore their perceptions of working together. Inductive content analysis was used to analyse the data and identify themes and categories. The participants emphasised challenges in communication and coordination to improve collaboration within across the two sectors. This study can contribute to a greater understanding of collaboration between mental health centres and municipalities. It aims to inspire improvements in communication, coordination, and the optimisation of mental health service delivery across sectors.
  • Clinical decision-making style preferences of European psychiatrists: Results from the ambassadors survey in 38 countries

    Slade, Mike (2022)
    BackgroundWhile shared clinical decision-making (SDM) is the preferred approach to decision-making in mental health care, its implementation in everyday clinical practice is still insufficient. The European Psychiatric Association undertook a study aiming to gather data on the clinical decision-making style preferences of psychiatrists working in Europe.MethodsWe conducted a cross-sectional online survey involving a sample of 751 psychiatrists and psychiatry specialist trainees from 38 European countries in 2021, using the Clinical Decision-Making Style – Staff questionnaire and a set of questions regarding clinicians’ expertise, training, and practice.ResultsSDM was the preferred decision-making style across all European regions ([central and eastern Europe, CEE], northern and western Europe [NWE], and southern Europe [SE]), with an average of 73% of clinical decisions being rated as SDM. However, we found significant differences in non-SDM decision-making styles: participants working in NWE countries more often prefer shared and active decision-making styles rather than passive styles when compared to other European regions, especially to the CEE. Additionally, psychiatry specialist trainees (compared to psychiatrists), those working mainly with outpatients (compared to those working mainly with inpatients) and those working in community mental health services/public services (compared to mixed and private settings) have a significantly lower preference for passive decision-making style.ConclusionsThe preferences for SDM styles among European psychiatrists are generally similar. However, the identified differences in the preferences for non-SDM styles across the regions call for more dialogue and educational efforts to harmonize practice across Europe.
  • Turning hierarchy on its head: Are parallel learning partnerships the solution to creating inclusive cultures in healthcare?

    Clifford, Naomi; Clarke, Martin; Conchar, Catherine (2023)
    Background It is important that NHS Trusts create inclusive and compassionate organisational cultures in which black and minority ethnic (BME) staff can progress equitably. Race equality and development initiatives can be implemented to address this. The introduction of reverse and reciprocal mentoring programmes in numerous organisations has had varying levels of success. These programmes can emphasise and perpetuate hierarchical differences in pairs, causing barriers to creating mutually beneficial partnerships.Objectives This paper reports the evaluation findings of a race equality and professional development initiative: the Parallel Learning Partnerships (PLP) Programme. Launched in April 2021, 27 of the Trust’s Executive and senior leadership team members were paired with 27 BME colleagues for 1 year. The authors aimed to determine the efficacy of the initiative’s design and implementation, and partner experiences and outcomes, particularly in relation to learning and any evidence of genuinely equal partnerships.Participants Twenty-six programme participants responded to an online survey. One-to-one semistructured interviews were conducted with 12 programme participants.Results Findings revealed that the majority of participants developed effective and highly valued non-hierarchical learning partnerships. This was despite impacts of the COVID-19 pandemic creating additional pressures and affecting partnership meetings and activities. Partner outcomes included greater understanding and awareness around race equity matters, improved confidence and motivation, and enhanced leadership skills in relation to inclusivity and compassion.Conclusion The pilot programme has been largely successful in providing an effective mechanism for BME staff to engage and connect with the Trust’s executive and senior leaders on a reciprocal, equal and mutually beneficial basis. PLP resulted in a variety of beneficial outcomes for both groups of partners which may not have been possible within comparable mentoring models. Additional positive impacts to the wider organisation are anticipated to be evident in time with the programme’s continuation.No data are available. This is due to participants not having provided consent for this.
  • Experiences of deliberate practice orientated psychological skills training for cancer care staff: Barriers and facilitators to learning and implementation in practice

    Rathbone, James; Gibbons, Felicity; Brooks, Dan; Mays, Chloe; Malins, Samuel (2023)
    This study explored participant-reported facilitators and barriers to learning and implementation from a 2-day training in psychological assessment and intervention skills for cancer staff, involving deliberate practice and supervision. Twenty-six semi-structured interviews were analysed using thematic analysis leading to four meta-themes: perceived practicality of training, impact of training: practice and its effects, implementation transfer processes and supervision engagement. Analysis identified a learning process to implementation: observation and practice of techniques during training facilitated participant learning; personal use and relevance of training content encouraged reflection, which enabled selection of appropriate tools for clinical practice; gains in commitment and confidence to use techniques supported participants to adapt clinical consultations, and supervision further facilitated implementation. Changing practice increased confidence, sense of achievement and engagement with participants’ own wellbeing. Interactive training, deliberate practice and continuous learning were facilitators to implementation whilst time constraint and low confidence in using techniques in remote consultations were barriers.
  • Widening participation - recruitment methods in mental health randomised controlled trials: a qualitative study

    Hall, Charlotte L.; Rennick-Egglestone, Stefan; Martin, Jennifer L. (2023)
    BACKGROUND: Barriers to mental health research participation are well documented including distrust of services and research; and stigma surrounding mental health. They can contribute to a lack of diversity amongst participants in mental health research, which threatens the generalisability of knowledge. Given the recent widespread use of the internet in medical research, this study aimed to explore the perspectives of key partners on the use of online (e.g. social media) and offline (e.g. in-person) recruitment as an approach to improving diversity in mental health randomised controlled trials (RCTs). METHODS: Face-to-face and online interviews/focus groups with researchers working in mental health and Patient and Public Involvement partners in the United Kingdom. Recordings were transcribed and analysed using a combination of inductive and deductive thematic analysis. RESULTS: Three focus groups and three interviews were conducted with a total N = 23 participants. Four overarching themes were identified: (1) recruitment reach; (2) Demographic factors that affect selection of recruitment method; (3) safety of technology, and; (4) practical challenges. Five main factors were identified that affect the choice of recruitment method: age, complexity of mental health problem and stigma, cultural and ethnicity differences and digital divide. The use of online methods was considered more accessible to people who may feel stigmatised by their mental health condition and with a benefit of reaching a wider population. However, a common view amongst participants was that online methods require closer data monitoring for quality of responders, are not fully secure and less trustworthy compared to offline methods that enable participants to build relationships with health providers. Funding, staff time and experience, organisational support, and technical issues such as spam or phishing emails were highlighted as practical challenges facing online recruitment. All participants agreed that using a hybrid approach tailored to the population under study is paramount. CONCLUSIONS: This study highlighted the importance of offering a flexible and multifaceted recruitment approach by integrating online with offline methods to support inclusivity and widening participation in mental health research. The findings will be used to develop considerations for researchers designing RCTs to improve recruitment in mental health research.
  • Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records

    Butler, Debbie; Gerrard, Louisa; Waldram, David (2023)
    BACKGROUND: Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person's medicines. However, there is limited evidence about access to and the impact of routine medication reviews for older adults in the general population, particularly in the UK. We aimed to quantify the proportion of people aged 65 years and over with a medication review recorded in 2019 and describe changes in the numbers and types of medicines prescribed following a review. METHODS: We used anonymised primary care electronic health records from the UK's Clinical Practice Research Datalink (CPRD GOLD) to define a population of people aged 65 years or over in 2019. We counted people with a medication review record in 2019 and used Cox regression to estimate associations between demographic characteristics, diagnoses, and prescribed medicines and having a medication review. We used linear regression to compare the number of medicines prescribed as repeat prescriptions in the three months before and after a medication review. Specifically, we compared the 'prescription count' - the maximum number of different medicines with overlapping prescriptions people had in each period. RESULTS: Of 591,726 people prescribed one or more medicines at baseline, 305,526 (51.6%) had a recorded medication review in 2019. Living in a care home (hazard ratio 1.51, 95% confidence interval 1.40-1.62), medication review in the previous year (1.83, 1.69-1.98), and baseline prescription count (e.g. 5-9 vs 1 medicine 1.41, 1.37-1.46) were strongly associated with having a medication review in 2019. Overall, the prescription count tended to increase after a review (mean change 0.13 medicines, 95% CI 0.12-0.14). CONCLUSIONS: Although medication reviews were commonly recorded for people aged 65 years or over, there was little change overall in the numbers and types of medicines prescribed following a review. This study did not examine whether the prescriptions were appropriate or other metrics, such as dose or medicine changes within the same class. However, by examining the impact of medication reviews before the introduction of structured medication review requirements in England in 2020, it provides a useful benchmark which these new reviews can be compared with.
  • Suicidal thoughts and behaviour among healthcare workers in England during the COVID-19 pandemic: A longitudinal study

    Morriss, Richard K. (2023)
    BACKGROUND: During the COVID-19 pandemic, concern has been raised about suicide risk among healthcare workers (HCWs). We investigated the incidence risk and prevalence of suicidal thoughts and behaviour (STB), and their relationship with occupational risk factors, among National Health Service HCWs in England between April 2020 and August 2021. METHODS: In this longitudinal study, we analysed online survey data completed by 22,501 HCWs from 17 NHS Trusts at baseline (Time 1) and six months (Time 2). The primary outcome measures were suicidal ideation, suicide attempts, and non-suicidal self-injury. We used logistic regression to investigate the relationship between these outcomes and demographic characteristics and occupational factors. Results were stratified by occupational role (clinical/non-clinical). RESULTS: Time 1 and Time 2 surveys were completed by 12,514 and 7,160 HCWs, respectively. At baseline, 10.8% (95% CI = 10.1%, 11.6%) of participants reported having experienced suicidal thoughts in the previous two months, whilst 2.1% (95% CI = 1.8%, 2.5%) of participants reported having attempted suicide over the same period. Among HCWs who had not experienced suicidal thoughts at baseline (and who completed the Time 2 survey), 11.3% (95%CI = 10.4%, 12.3%) reported such thoughts six months later. Six months after baseline, 3.9% (95% CI = 3.4%, 4.4%) of HCWs reported attempting suicide for the first time. Exposure to potentially morally injurious events, lack of confidence about raising safety concerns and these concerns being addressed, feeling unsupported by managers, and providing a reduced standard of care were all associated with increased suicidal ideation among HCWs during the COVID-19 pandemic. At six months, among clinicians, a lack of confidence about safety concerns being addressed, independently predicted suicidal ideation. CONCLUSION: Suicidal thoughts and behaviour among healthcare workers could be reduced by improving managerial support and enhancing the ability of staff to raise safety concerns.
  • Best practice guidelines for citizen science in mental health research: Systematic review and evidence synthesis

    Todowede, Olamide; Kotera, Yasuhiro; Rennick-Egglestone, Stefan; Repper, Julie
    Partnering with people most affected by mental health problems can transform mental health outcomes. Citizen science as a research approach enables partnering with the public at a substantial scale, but there is scarce guidance on its use in mental health research. To develop best practise guidelines for conducting and reporting research, we conducted a systematic review of studies reporting mental health citizen science research. Documents were identified from electronic databases (n = 10), grey literature, conference proceedings, hand searching of specific journals and citation tracking. Document content was organised in NVIVO using the ten European Citizen Science Association (ECSA) citizen science principles. Best practise guidelines were developed by (a) identifying approaches specific to mental health research or where citizen science and mental health practises differ, (b) identifying relevant published reporting guidelines and methodologies already used in mental health research, and (c) identifying specific elements to include in reporting studies. A total of 14,063 documents were screened. Nine studies were included, from Australia, Belgium, Canada, Denmark, Netherlands, Spain, the UK, and the United States. Citizen scientists with lived experience of mental health problems were involved in data collection, analysis, project design, leadership, and dissemination of results. Most studies reported against some ECSA principles but reporting against these principles was often unclear and unstated. Best practise guidelines were developed, which identified mental health-specific issues relevant to citizen science, and reporting recommendations. These included citizen science as a mechanism for empowering people affected by mental health problems, attending to safeguarding issues such as health-related advice being shared between contributors, the use of existing health research reporting guidelines, evaluating the benefits for contributors and impact on researchers, explicit reporting of participation at each research stage, naming the citizen science platform and data repository, and clear reporting of consent processes, data ownership, and data sharing arrangements. We conclude that citizen science is feasible in mental health and can be complementary to other participatory approaches. It can contribute to active involvement, engagement, and knowledge production with the public. The proposed guidelines will support the quality of citizen science reporting.
  • Integrated care system (Ics) pharmacy medicines optimisation and sustainability checklist for Nhs green plans

    O'Hare, Aileen (2023)
    Context The work was co-produced by the Chief Pharmaceutical Officer’s Clinical Fellow (CPhO) based at the GPhC 2021/22 and the University Hospitals Dorset Medicines Optimisation Pharmacist and Sustainability Lead for pharmacy who is also a member of Pharmacy Declares which is a diverse collaborative of climate conscious pharmacy professionals based in the UK. Pharmacy Declares vision is to rapidly galvanise pharmacy professionals and professional/regulatory bodies into action to tackle the climate & ecological crisis and protect lives. The climate & ecological crisis is a health emergency and its drivers and solutions are shared with other health and social care priorities Pharmacy Declares are calling for: Financial divestment from fossil fuels and reinvestment of funds into environmentally & socially beneficial arenas. Declarations of Climate Emergency‒honest recognition of the situation in which we find ourselves. Climate- Health Leadership & Education promoting an understanding of the climate and ecological crisis, our roles in contributing to it and simultaneously in its mitigation Specialist advice was sought from antimicrobial stewardship leads, primary care pharmacy teams, community pharmacy teams, clinical commissioning groups, secondary care pharmacy and anaesthetic leads. The target audience for this programme of work was integrated care system (ICS) pharmacy leadership and medicines optimisation teams as well as integrated care boards, net zero executive officer and integrated care partnerships. Issue/Challenge Climate change poses a major threat to our health as well as our planet. The environment is changing, that change is accelerating, and this has direct and immediate consequences for our patients, the public and the NHS. In October 2020, the NHS became the world’s first National Health Service to commit to reaching Net Zero. The ‘Delivering a Net Zero Health Service report sets out the NHS’s clear ambition and the Greener NHS programme is working with pharmacy staff across integrated care systems to ensure this most important of sectors is at the forefront of net zero healthcare. It builds on exemplar work already evident across the country and promotes sharing of best practice to reduce the environmental impact of healthcare delivery, whilst simultaneously making economic efficiencies and improving patient outcomes. Thanks to NHS people, partners, and suppliers, a Greener NHS is emerging. A year on from setting net zero targets, the NHS was on track to reduce its emissions equivalent to powering 1.1 million homes for a year. Together, we can achieve even more. To support the development of integrated care system (ICS/ICB/ICP) green plans we co-designed and developed a ICS pharmacy and medicines optimisation sustainability checklist to support ICS pharmacy leadership groups to develop multi year green initiatives for their local systems. We have received support from the Chief Pharmaceutical Officer’s office to develop the checklist and it is due to be presented to ICS leadership teams and chief pharmacists on the 7th Sept 2022. In collaboration with colleagues across the interface and representing diverse specialities, we developed a tableau of options for the delivery of sustainability within pharmacy green plans. Rather than being viewed as a compulsory check list of new targets to be achieved in year 1, we suggested that it will enable ICS teams to bring together the many ‘sustainability supporting work plans already in existence. We hope that it will showcase how teams can re-evaluate the potential of pharmacy services to reduce carbon emissions and hence, promote wider community health and acknowledge the latent power of multi-sector working. It is envisioned that over time Green Plans will be adapted according to local need and workforce capacity, as well as the growing proficiency within our profession to deliver planetary health Assessment of issue and analysis of its causes We identified that there was no single source of ICS pharmacy and medicines optimisation sustainability green plan guidance. Pharmacy teams were creating green plans in sector specific silos and there was a need to assimilate the workplans into one single ICS pharmacy green plan tableau of ideas. We collated the individual green plan ideas and linked them to relevant primary and secondary care pharmacy commissioning contractual frameworks, investment & impact fund, NHS contract, CQUINs and direct enhanced services. We linked many of the health benefits to the NHS Long Term Plan. Using contacts in higher education establishments we were able to determine the level of sustainability education and training for pharmacy undergraduate and post graduate students. We made recommendations to aid the development of pharmacy and medicines optimisation sustainability syllabuses to support undergraduate and post graduate pharmacy net zero and sustainability training. Through ICS pharmacy and medicines optimisation leadership webinars we engaged the senior leadership teams and invited a couple of the teams to comment on our initial proposal. We have received support from the Chief Pharmaceutical Officer’s office to develop the checklist/tableau and was presented to ICS Pharmacy Chief Pharmacists and Senior leaders. The document was very positively received with many of the stakeholders stating that it would support their work plans and conversations with the ICB in their ICS. Impact This national ‘do once’ approach to pharmacy and medicines optimisation sustainability green plans will improve productivity and efficiency for ICS pharmacy teams and may even accelerate the role out of such workplans. This was seen as positive benefit of our work and could be replicated for other priority areas across pharmacy ICS teams. ICSs will use the NHS Model Health System, Open prescribing, Prescqipp and EPACT 2 data to benchmark the delivery of pharmacy green plans at Trust and System level to provide insights on specific NHSE Net Zero initiatives. Health Benefits The climate emergency is also a health emergency and if left unabated it will disrupt care and affect patients and the public at every stage of our lives. Poor environmental health will contribute to major diseases, including cardiac problems, asthma and cancer, our efforts must be accelerated. Pharmacy system leaders were advised to incorporate climate adaptation into all service delivery models across all sectors of pharmacy to deliver sustainable pharmacy practice across the profession. Intervention The intervention has taken 9 months from inception to delivery of the Green Plan checklist to the Pharmacy and Medicines optimisation ICS leadership group. The work has also been shared with the NHSE Net Zero team to inform their work. We engaged with NHSE teams to ensure it complemented NHS Net Zero policies. This work has allowed us to roll out pharmacy and medicines optimisation sustainability green plans at scale across England through engagement with ICS chief pharmacists and leadership groups. To support spread and scale of this work the tableau of green plan ideas has also been shared with pharmacy colleagues in the devolved nations to inform their work. One Scottish colleague is working with the Scottish government developing a programme of work on medications and the environment and it is hoped our document will provide examples for her workstream. We have also shared this work with other NHSE Patient Safety and antimicrobial stewardship teams as sections of the checklist focused on medication safety, antimicrobial stewardship and admission avoidance. The document has been upload to the Future NHS Collaboration Platform to support teams developing their own local ICS green plans. ICS chief pharmacists stated that the document would aid their discussions with ICB Net Zero Chief Executive Officers. This work has contributed to my understanding of leadership through developing networks, engaging with stakeholders and NHSE leadership groups, collaborating across sectors and systems of the profession and engaging with senior leaders in each sector for optimal benefit of patients and the public. Involvement of stakeholders, such as patients, carers or family members: We engaged with multiple stakeholder groups during the development of the sustainability green plan checklist as is was a multisector cross cutting document we required stakeholder engagement from patient/medication safety groups, antimicrobial stewardship leads, undergraduate and postgraduate education, net zero, respiratory, anaesthetic and pharmacy medicines optimisation teams. Key Messages Development of collaborative multisector ICS pharmacy and medicines optimisation leadership sustainability green plan Multisector working to achieve unified pharmacy and medicines optimisation ICS sustainability goals Allow pockets of expertise to flourish but benefit the system as a whole Aligns with the Long Term Plan and Core20PLUS5 and complements existing NHSE Net Zero policies and NHS national contractual frameworks and enhanced services. Lessons learnt We have learnt that developing a national document is the first step in a very long process of stakeholder engagement, sharing with networks and engaging with the right audiences using the most influential advocates of your work. In this instance our target audience were ICS chief pharmacists. We had to wait for the right ICS webinar opportunity to share our work in the most efficient way, of the 42 ICS chief pharmacists we presented to 38 which was a successful delivery plan. We have also now shared our work on the NHS Futures platform and via social media where it was warmly received by a cross section of the pharmacy workforce. Measurement of improvement Measure improvement using data and metrics from the following ICS dashboards on an ongoing basis through ongoing engagement with ICS chief pharmacists and medicines optimisation teams. Data and Dashboards that teams will access to monitor implementation NHS Model System RxInfo EPACT NHSBSA Prescqipp Open Prescribing Greener NHS Dashboard Strategy for improvement The programme of work took 9 months from inception to fruition and was mainly co-delivered by the GPhC CPhO Clinical Fellow and the Medicines Optimisation Pharmacist Sustainability lead at University Hospitals Dorset . Engagement with specialist interest groups across all sectors of the profession was required to fine tune the content of the document. Feedback was requested during a national webinar with the ICS chief pharmacists group which we will be collating in due course.
  • Digital training program for line managers (managing minds at work): Protocol for a feasibility pilot cluster randomized controlled trial

    Frost, Alexandra C.; Vaughan, Benjamin (2023)
    BACKGROUND: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. OBJECTIVE: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. METHODS: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. RESULTS: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. CONCLUSIONS: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48758.
  • Conversation Analysis Based Simulation (CABS): A method for improving communication skills training for healthcare practitioners

    O'Brien, Rebecca (2023)
    BACKGROUND: Actors portraying simulated patients are widely used in communication skills training in healthcare, but debates persist over the authenticity of these interactions. However, healthcare professionals value simulation-based training because of the opportunity to think and react in real time, which alternatives cannot provide. OBJECTIVE(S): To describe a method for the use of simulation which maximises authenticity by grounding training in real, observed, patterns of patient communication. DESIGN: Naturally occurring care interactions were video recorded and analysed using conversation analysis (CA) to identify communication patterns. We focused on sites of recurring interactional trouble as areas for training, and identified more and less effective ways of dealing with these. We used the CA findings to train actors portraying simulated patients, based on the observed interactional patterns. SETTINGS AND PARTICIPANTS: Patients living with dementia and healthcare practitioners (HCPs) on two acute healthcare of the elderly wards in the English East Midlands. OUTCOME MEASURES: One month later HCPs reported using the skills learned in clinical practice. Masked-ratings of before and after simulated patient encounters confirmed these self-reports in relation to one key area of training. RESULT(S): The Conversation Analysis Based Simulation (CABS) method used in this setting showed positive results across a range of quantitative and qualitative outcome measures. What is significant for the transferability of the method is that qualitative feedback from trainees highlighted the ability of the method to not only illuminate their existing effective practices, but to understand why these were effective and be able to articulate them to others. DISCUSSION/CONCLUSION: While the CABS method was piloted in the dementia care setting described here, it has potential applicability across healthcare settings where simulated consultations are used in communication skills training. Grounding simulated interaction in the observed communication patterns of real patients is an important means of maximising authenticity. PATIENT AND PUBLIC CONTRIBUTION: The VideOing to Improve dementia Communication Education (VOICE) intervention which piloted the CABS method was developed by a multidisciplinary team, including three carers of people with dementia. People living with dementia were involved in the rating of the before and after video simulation assessments. Copyright © 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.
  • Assessing the priority of human rights and mental health: the PHRAME approach

    Carter, Grace; Watson, Danielle (2023)
    BACKGROUND: Protecting all human rights of people with mental health conditions is globally important. However, to facilitate practical implementation of rights, it is often necessary to decide which of these rights should be given priority, especially when they conflict with each other. AIMS: The aim of the Priorities of Human Rights and Mental Health (PHRAME) project is to develop a replicable approach to establish a proposed set of high-priority human rights of people with mental health conditions, to facilitate practical decision-making and implementation of such rights. METHOD: A two-stage Delphi-style study with stakeholders was conducted to generate a list of key rights of people with mental health conditions, and rank priorities among these rights in terms of feasibility, urgency and overall importance. RESULTS: The stakeholders in this study consistently ranked three rights as top priorities: (a) the right to freedom from torture, cruel inhuman treatment and punishment; (b) the right to health and access to services/treatment; and (c) the right to protection and safety in emergency situations. CONCLUSIONS: Insights from PHRAME can support decision-making about the priority to be given to human rights, to guide practical action. This approach can also be used to assess how human rights are prioritised in different settings and by different stakeholders. This study identifies the clear need for a central voice for people with lived experience in research and implementation of decisions about the priority of human rights, ensuring that action respects the opinion of people whose rights are directly affected.
  • Training in neuropsychiatry: views of early career psychiatrists from across the world

    Seun-Fadipe, Champion T. (2023)
    BACKGROUND: Training and practice in neuropsychiatry varies across the world. However, little is known about the experiences and opinions of early career psychiatrists (ECPs) across different countries regarding neuropsychiatry. AIMS AND METHOD: To investigate neuropsychiatry training experiences, practices and opinions among ECPs across different countries. An online survey was distributed to ECPs in 35 countries across the world. RESULTS: A total of 522 participants took part in this study. Responses show that neuropsychiatry is integrated to a variable extent in psychiatric training curricula across the world. Most respondents were not aware of the existence of neuropsychiatric training or of neuropsychiatric units. Most agreed that training in neuropsychiatry should be done during or after the psychiatry training period. Lack of interest among specialty societies, lack of time during training, and political and economic reasons are regarded as the main barriers. CLINICAL IMPLICATIONS: These findings call for an improvement in the extent and in the quality of neuropsychiatry training across the world.
  • Plausible subjective experience versus fallible corroborative evidence: The formulation of insanity in Nigerian criminal courts

    Oluwaranti, Oluwaseun (2023)
    Insanity as a defence against criminal conduct has been known since antiquity. Going through significant reformulations across centuries, different jurisdictions across the globe, including Nigeria, have come to adopt various strains of the insanity defence, with the presence of mental disorder being the causative mechanism of the crime as their central theme. A critical ingredient in the Nigerian insanity plea is the presence of 'mental disease' or 'natural mental infirmity' as the basis for the lack of capacity in certain cognitive and behavioural domains resulting in the offence. Mental disorders, which are the biomedical formulations of this critical legal constituent are primarily subjective experiences with variable objective features. Using illustrative cases based on psycho-legal formulation as well as reform-oriented and fundamental legal research, it is shown that Nigerian courts have held that claims of insanity based on the accused person's evidence alone should be regarded as "suspect" and not to be "taken seriously." Thus, Nigerian judicial opinions rely on non-expert accounts of defendants' apparent behavioural abnormalities and reported familial vulnerability to mental illness, amongst other facts while conventionally discountenancing the defendants' plausible phenomenological experiences validated by expert psychiatric opinion in reaching a conclusion of legal insanity. While legal positivism would be supportive of the prevailing judicial attitude in entrenching the validity of the disposition in its tenuous precedential utility, legal realism invites the proponents of justice and fairness to interrogate the merit of such preferential views which are not supported by scientific evidence or philosophical reasoning. This paper argues that disregarding the subjective experience of the defendant, particularly in the presence of sustainable expert opinion when it stands unrebutted is not in the interest of justice. This judicial posturing towards mentally abnormal offenders should be reformed on the basis of current multidisciplinary knowledge. Learning from the South African legislation, formalising the involvement of mental health professionals in insanity plea cases, ensures that courts are guided by professional opinion and offers a model for reform.

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