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Strategies to improve recruitment in mental health clinical trials: A scoping review (RE-MIND study)BACKGROUND: Lower-than-expected recruitment continues to be one of the major causes of trial delays, and trials to improve mental health are no exception. Indeed, recruitment challenges in trials of vulnerable populations, such as those living with mental health illness, can even be exacerbated. To address this, researchers are turning to digital and online recruitment strategies, e.g. web-based approaches and multi-media in order to (1) increase recruitment efficiency (recruit to target and on time) and (2) improve diversity in mental health clinical trials to be more inclusive and reduce health inequity. There is, however, inconclusive evidence on the success of digital and online recruitment strategies in mental health clinical trials. The RE-MIND study comprised a scoping review to assess the impact of using such recruitment strategies in mental health clinical trials to inform a more systematic scoping review. METHODS: A cohort of 191 recently published RCTs and randomised feasibility studies were identified from the NIHR Journals Library and top two mental health journals (based on citation metrics), Lancet Psychiatry and JAMA Psychiatry. Population characteristics including gender, ethnicity and age were summarised for inclusivity using descriptive statistics, and recruitment strategies were compared to examine differences in their success in recruiting to target. RESULTS: After screening, 97 articles were included for review. The review findings showed no evidence that offline or mixed strategies were superior for achieving recruitment targets in mental health trials. However, there was a suggestion that trials using a mixed recruitment strategy improved inclusivity and tended to recruit closer to the target. CONCLUSIONS: The key finding was that consideration should be given to a mixed methods approach to recruitment not only to enable wider and more diverse participation in mental health trials but also to realize greater efficiency.
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Navigating the medical journey: Insights into medical students' psychological wellbeing, coping, and personalityBACKGROUND AND AIMS: In recent years, increased awareness of the psychological wellbeing of healthcare professionals and students has become a pressing public health issue affecting care delivery. Medical students undergo rigorous training programs that can affect their psychological wellbeing. Despite increased awareness of mental health issues among medical students, research often focuses on negative aspects, overlooking potential positive contributors to wellbeing. This study aims to explore both negative and positive factors influencing medical students' psychological wellbeing, considering coping strategies and personality traits to inform targeted support measures for diverse student needs. METHODS: A mixed-methods approach was employed to investigate medical students' psychological wellbeing, coping strategies, and personality traits. Quantitative data was gathered via self-report questionnaires and analysed using regression models. Additionally, qualitative insights were obtained from semi-structured interviews and analysed thematically to capture students' perceptions and experiences. RESULTS: The analysis revealed moderate to high levels of stress, anxiety, and depression among medical students, along with decreased life satisfaction. Regression analysis showed that problem-focused coping positively impacted medical students' psychological wellbeing, whereas emotion-focused and avoidance coping showed less favourable effects. Notably, problem-focused coping partially mediated the relationship between stress and depression. Furthermore, personality traits, particularly agreeableness and conscientiousness, played a pivotal role in shaping medical students' coping strategies and mental health outcomes. Based on thematic analysis, codes gave rise to three overarching themes and corresponding subthemes. CONCLUSIONS: The study underscores the significance of addressing both positive and negative factors impacting medical students' wellbeing and highlights the need for tailored support considering individual personality traits that influence coping strategies and mental health. It also identifies challenges within medical education, emphasising the necessity for stress management programs, mental health support, and curricula promoting problem-solving skills. Prioritising medical students' wellbeing may not only foster good mental health among future professionals but may also enhance future healthcare quality.
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Applying critical discourse analysis to cross-cultural mental health recovery researchThe purpose of this paper is to demonstrate how critical discourse analysis (CDA) frameworks can be used in cross-cultural mental health recovery research. CDA is a qualitative approach that critically appraises how language contributes to producing and reinforcing social inequalities. CDA regards linguistic productions as reflecting, consciously or unconsciously, the narrators' understandings of, or attitudes about, phenomena. Mental health recovery research aims to identify and address power differentials, making CDA a potentially relevant approach. However, CDA frameworks have not been widely applied to mental health recovery research. We adapted established CDA frameworks to our cross-cultural mental health recovery study. The adapted methodology comprises (1) selecting discourses that indicate positive changes and (2) considering sociocultural practices informed by relevant cultural characteristics identified in our previous research, without placing value judgments. Our adapted framework can support cross-cultural mental health recovery research that uses CDA.
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Bridging the gap: A qualitative study exploring the impact of the involvement of researchers with lived experience on a multisite randomised control trial in the national probation service in England and WalesINTRODUCTION: Methodological and ethical arguments support the involvement of individuals with lived experience in research to reduce engagement barriers and ensure those directly affected by studies contribute to knowledge generation. However, there is limited evidence on the impact of including researchers with lived experience of serving a prison or community sentence in clinical trials. This qualitative study aimed to explore the value of involving researchers with lived experience of the criminal justice system as data collectors in the Mentalization for Offending Adult Males (MOAM), a multisite RCT conducted in the National Probation Service in England and Wales. METHODS: Semi-structured interviews were conducted with 30 trial participants and 17 key stakeholders, either in person or via telephone. The interviews were transcribed verbatim and analysed thematically. FINDINGS: Five themes emerged for trial participants and 11 for key stakeholders. For some, lived experience researchers helped overcome engagement barriers by fostering common ground with participants who were serving a prison or community sentence during recruitment. Participants reported that the involvement of lived experience researchers enhanced the study by facilitating knowledge transfer in certain instances. However, their inclusion did not eliminate all barriers and, for some participants, introduced new challenges to engagement. CONCLUSION: Forensic lived experience researchers bridged the gap by fostering trust between data collectors and participants. Future studies should ensure that lived experience researchers receive adequate clinical supervision to support their role. The adopted methodology challenged assumptions about knowledge generation and stereotypes associated with being an ex-offender, benefiting both lived experience and traditional researchers. PATIENT OR PUBLIC CONTRIBUTION: The study was developed in collaboration with User Voice (charity number: 1136047), who contributed to the study's design and conduct. The service user organisation co-designed the interview schedule and directed the protocol for participant payments, emphasising a consistent approach to avoid tokenism and ensure equal recognition of all contributions. The dissemination plan was developed in partnership with individuals with lived experience of the criminal justice system.
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Opportunities and challenges to delivering a trial for depressive symptoms in primary care during the COVID-19 pandemic: Insights from the Alpha-Stim-D randomised controlled trialBACKGROUND: Randomised controlled trials (RCTs) are widely regarded as the most powerful research design for evidence-based practice. However, recruiting to RCTs can be challenging resulting in heightened costs and delays in research completion and implementation. Enabling successful recruitment is crucial in mental health research. Despite the increase in the use of remote recruitment strategies and digital health interventions, there is limited evidence on methods to improve recruitment to remotely delivered mental health trials. The paper outlines practical examples and recommendations on how to successfully recruit participants to remotely delivered mental health trials. METHODS: The Alpha Stim-D Trial was a multi-centre double-blind randomised controlled trial, for people aged 16 years upwards, addressing depressive symptoms in primary care. Despite a 6-month delay in beginning recruitment due to the COVID-19 pandemic, the trial met the recruitment target within the timeframe and achieved high retention rates. Several strategies were implemented to improve recruitment; some of these were adapted in response to the COVID-19 pandemic. This included adapting the original in-person recruitment strategies. Subsequently, systematic recruitment using postal invitations from criteria-specific search of the sites' electronic health records was added to opportunistic recruitment to increase referrals in response to sub-target recruitment whilst also reducing the burden on referring sites. Throughout the recruitment process, the research team collaborated with key stakeholders, such as primary care clinicians and the project's Patient and Public Involvement and Engagement (PPI/E) representatives, who gave advice on recruitment strategies. Furthermore, the study researchers played a key role in communicating with participants and building rapport from study introduction to data collection. CONCLUSIONS: Our findings suggest that trial processes can influence recruitment; therefore, consideration and a regular review of the recruitment figures and strategies is important. Recruitment of participants can be maximised by utilising remote approaches, which reduce the burden and amount of time required by referring sites and allow the research team to reach more participants whilst providing participants and researchers with more flexibility. Effectively communicating and working collaboratively with key stakeholders throughout the trial process, as well as building rapport with participants, may also improve recruitment rates.
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The impact of life story work during peer worker training: Identity reconstruction, social connection, and recoveryOBJECTIVE: Personal recovery has become a guiding vision in mental health care, and peer workers play a key role in assisting individuals on their recovery journey. As a component of training to prepare for this role, peer workers need to engage with their own life story, in order to support recovery in both them and in the service users they will assist. The purpose of the present study was to explore the impact of life story work on peer workers. METHOD: Fifteen individuals training to be peer workers were interviewed to explore the impact of telling and listening to life stories. Reflexive thematic analysis involving two analysts was conducted. RESULTS: Three main themes were identified: (a) life story work as identity reconstruction, (b) social connection through life story sharing, and (c) negative impacts of engaging with life stories in peer worker training. Each theme was connected to a number of subthemes. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Life story work can both facilitate personal recovery in peer workers during their training and aid them in utilizing their stories in their future peer worker roles. Training needs to prepare peer workers to deal with the future role-related challenges of life story work. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
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Healthcare Professionals' experience with the implementation of a recovery-oriented approach across in-patient units and assertive community treatmentINTRODUCTION: Recovery-oriented approaches in mental health emphasize personal growth, agency, and meaningful community integration. While endorsed by policies and reforms, the practical implementation of such approaches remains challenging, particularly in settings like Denmark, where structural fragmentation, professional hierarchies, and resource constraints may limit the adoption of holistic recovery principles. METHODS: This qualitative study employed focus group interviews with 21 health professionals from inpatient units and Assertive Community Treatment (ACT) teams in Danish mental health services. Using inductive content analysis, we examined participants' perceptions, understandings, and experiences in implementing personal recovery-oriented practices. RESULTS: Four categories emerged: (1) "Creating New Control in Recovery" highlighted the importance of personal agency and collaborative care involving patients, families, and community stakeholders; (2) "Recovery-Oriented Practice within Professional Parameters" underscored efforts to balance patient preferences with clinical responsibilities; (3) "Barriers to Implementing Recovery-Oriented Practice" revealed systemic constraints, resource limitations, and emotional strain on staff; and (4) "Advocating for a Paradigm Shift towards Recovery-Oriented Approaches" emphasized the desire for interprofessional collaboration, the inclusion of peer workers, and structural reforms. DISCUSSION/CONCLUSION: The findings demonstrate that while Danish health professionals recognize the value of personal recovery-oriented care, their capacity to realize this approach is constrained by organizational structures, professional hierarchies, and limited resources. Strengthening systemic support, enhancing interprofessional collaboration, and integrating peer expertise are critical to fostering more equitable, person-centered mental health services. These insights contribute to a nuanced understanding of recovery-oriented implementation in European contexts and may inform strategies that better support professionals and service users in achieving sustained, meaningful recovery.
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Rapid review of facilitating reflective practice groups with staff in adult inpatient mental health settingsReflective practice is poorly defined and often lacks distinction from other practices, such as clinical supervision. In the UK, the National Health Service (NHS) faces unparalleled challenges within the context of chronic underfunding, high staff attrition, and the recent global pandemic. Frontline staff are desperately trying to meet the demands of their roles and services are struggling to prioritise their professional development and wellbeing, further exacerbating these problems. This rapid review of the evidence sought to identify barriers and facilitators of Reflective Practice Groups (RPGs) within adult inpatient mental health services, using three databases. Two-hundred and one unique references were retrieved, yielding eight papers meeting the inclusion criteria. Barriers to facilitating RPGs included: practicalities; individual and team expectations; needs and competencies of facilitators; and organisational issues. Studies suggested solutions including facilitating RPGs off-ward to reduce disruptions and protect the space; increasing psychological safety by incorporating clear guidelines and expectations for attendees; and organisational support. The review highlighted universal challenges faced by healthcare professionals and organisations in facilitating and accessing RPGs. The review illustrates the paucity of research in this area, which may be due to nebulous definition and inconsistencies between different organisations. Implications for practice are discussed.
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Improvement of trainee engagement with the Royal College of Psychiatrists (Trent Division)Aims. The Psychiatric Trainees Committee (PTC) is a national community of psychiatric trainees comprised of representatives from all College areas. Over our recent term, Dr Deepa Krishnan, Dr Kris Roberts and Dr Emma McPhail covered the Trent region. In addition to national roles, we were keen to encourage trainees to engage with the PTC to improve trainee advocacy in line with National PTC strategy. Engaged and supported trainees are vital for ensuring good standards of patient care, and for safeguarding the future of the workforce in terms of recruitment and retention, which further intersects with ongoing quality and provision of patient care. The agreed aims, which were agreed with the RCPsych Trent Executive Committee, were formulated in-line with the national PTC priorities for 2021-2022: 1,to enhance communication, visibility and reach of the RCPsych within trainees in the Trent region; and 2, being mindful of challenges around recruitment and retention in psychiatry training posts, to improve education and support for trainees. Methods. Using quality improvement methodology, we hypothesised there to be two aspects to trainee engagement. These were conceptualised in two ways: emotional engagement (meaning feeling supported, valued, and promotion of well-being); and intellectual engagement (meaning cognitive stimulation, recognition, and access to opportunities to develop knowledge). A free, online trainee-specific conference, the first of its kind in the Trent Division, was agreed as an intervention to address trainee engagement across both domains. Because it was run "for trainees by trainees", we were able to tailor the content to be specifically helpful and relevant to trainees. We were keen to offer a varied program within the broad domains affecting engagement and we were delighted to be able to secure an exciting line-up of speakers both from within the Trent region and from further afield. Results. The conference proved so popular to sign up to that it had to be closed early. The conference gathered excellent feedback from participants, with 100% of trainees rating the conference overall as "good" or "excellent." Conclusion. The Trent PTC hopes to run the conference again in the coming year, we hope it will become a regular fixture in the RCPsych Trent calendar, to ensure that trainees are kept at the heart of division planning. This project spearheaded by trainees for trainees to improve trainee engagement and support exemplifies collaborative leadership.
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Mental Health Nursing SkillsNo abstract available
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Behavioural activationNo abstract available
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Caring: The essence of mental health nursingNo abstract available
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Perspectives of healthcare professionals on cross-sectoral collaboration between mental health centers and municipalities: A qualitative studyAIMS: This paper aims to explore the intricacies of cross-sectoral collaboration in mental health care, focusing on the perspectives of health professionals across various disciplines. It seeks to understand how collaboration can enhance service delivery and patient outcomes while identifying existing challenges. BACKGROUND: The evolving healthcare landscape emphasizes the importance of integrating services across sectors, particularly in mental health care, to improve continuity and efficiency of care. DESIGN: The study utilizes qualitative methods to investigate health professionals' experiences with cross-sectoral collaboration in mental health services. METHODS: Purposive sampling was used to select 21 health professionals for focus group discussions held at a mental health center in Region Zealand, Denmark. Data was collected through these discussions, and content analysis was performed to extract key themes. The data collection took place in 2022. RESULTS/FINDINGS: Health professionals recognized the potential benefits of cross-sectoral collaboration, such as enhanced service delivery and improved patient outcomes. However, significant barriers were identified, including bureaucratic obstacles, communication gaps, and insufficient organizational support. CONCLUSION: Cross-sectoral collaboration in mental health care offers significant advantages, but challenges must be addressed to fully realize its potential. Efforts should focus on policy reforms, organizational support, and fostering interdisciplinary communication to improve care delivery.
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Outcomes from attachment-based group interventions for foster carers and adoptive parents: A systematic reviewExisting research has shown that group work focused on attachment theory may help carers increase their understanding about the needs of children in care and improve skills in managing difficult behaviours. Despite the potential benefits of attachment-based group interventions, there is a lack of adequate evidence to demonstrate their efficacy among carers and children in care. This systematic review aimed to study the carer and child outcomes from attachment-based group interventions for foster carers and adoptive parents. We included published studies in English that looked at carer and/or child outcomes following attachment-based group interventions for carers fostering or having adopted a child less than 18 years of age. An initial search of relevant databases was completed in June 2021, which was followed up by an updated search in November 2023 and two citation searches, one in June 2022 and another in December 2023. Duplicates were screened and following a review of 91 full texts, 28 articles were included. Qualitative and quantitative outcomes were analysed. Following intervention, there was a general trend of improvements in carer understanding, enhanced skills, better carer responsiveness and more satisfied carer–child relationships. Although there seems to be a perceived benefit from carers, no consistent pattern of change was noted in child psychopathology or challenging behaviours.
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The response of the secretary of state and the "supervised discharge" provision of the UK mental health bill 2022: Potential problems and opportunities in the wake of Secretary of State for Justice v MM [2018] UKSC 60This article considers the legal regulation of discharge conditions that amount to deprivation of liberty (DoL) in the sense of Article 5 of the European Convention on Human Rights following the UK Supreme Court's decision in Secretary of State for Justice v MM in 2018. The 2019 response of the Secretary of State for Justice to the MM judgment and the proposed "Supervised Discharge" provision of the UK 2022 Mental Health Bill are reviewed from a critical perspective with several important problems identified. It is recommended that the advice of the Secretary of State to make use of leave provisions under s17 of the MHA in place of conditional discharge is considered cautiously as this may be liable to future legal challenge. The 2022 Draft Bill is likely to yield an effective solution but it is lacking important provisions to ensure accountability of healthcare providers where Supervised Discharge is authorised, opportunities for therapeutic relaxations of restrictions, and safe systems for the recall and conveyance of patients under the Supervised Discharge regime.
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Misrepresentation by online study participants-a threat to data integrityAs a group of researchers experienced in collecting health research data using online methods, we have become increasingly concerned with the problem of participants misrepresenting themselves within our studies. Forms of misrepresentation include participants providing false information against inclusion criteria or creating multiple online personas to participate in a study multiple times.
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Health professionals on cross-sectoral collaboration between mental health hospitals and municipalities: A critical discourse analysisThis study investigates the role of language in cross-sector collaboration between mental health hospitals and municipalities, focusing on the challenges of maintaining continuity of care and integrating patient-centered approaches. Using Fairclough's framework for critical discourse analysis, we examined focus group interviews with 21 healthcare professionals, including nurses, social workers, and psychiatrists, to identify key themes and patterns in how cross-sector collaboration is discussed. The analysis revealed a dominant medicalized discourse in hospital settings, which often emphasized structured care processes like treatment plans and medication management, overshadowing more flexible, patient-centered approaches common in community-based services. Power dynamics were evident, with hospital professionals frequently positioned as active agents, while patients and community-based workers were portrayed in more passive roles. Although efforts to involve patients in decision-making were noted, these were often controlled by professionals, reflecting a mediated approach to patient empowerment. The findings highlight the cultural and structural divides between hospital and community services and suggest the need for improved communication strategies, integrated care pathways, and a shift toward more inclusive, patient-centered care models. Addressing these discursive barriers is crucial for achieving more effective, integrated, and patient-centered care, ultimately improving outcomes for patients.
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Academic psychiatry is everyone's businessThis editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.
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Questions on travel and sexual behaviours negatively impact ethnic minority donor recruitment: Effect of negative word-of-mouth and avoidanceBACKGROUND AND OBJECTIVES: Donor selection questions differentially impacting ethnic minorities can discourage donation directly or via negative word-of-mouth. We explore the differential impact of two blood safety questions relating to (i) sexual contacts linked to areas where human immunodeficiency virus (HIV) rates are high and (ii) travelling to areas where malaria is endemic. Epidemiological data are used to assess infection risk and the need for these questions. MATERIALS AND METHODS: We report two studies. Study 1 is a behavioural study on negative word-of-mouth and avoiding donation among ethnic minorities (n = 981 people from National Health Service Blood and Transplant (NHSBT) and the general population: 761 were current donors). Study 2 is an epidemiology study (utilizing NHSBT/UK Health Security Agency (UKHSA) surveillance data on HIV-positive donations across the UK blood services between1996 and 2019) to assess whether the sexual risk question contributes to reducing HIV risk and whether travel deferral was more prevalent among ethnic minorities (2015-2019). Studies 1 and 2 provide complementary evidence on the behavioural impact to support policy implications. RESULTS: A high proportion of people from ethnic minorities were discouraged from donating and expressed negative word-of-mouth. This was mediated by perceived racial discrimination within the UK National Health Service. The number of donors with HIV who the sexual contact question could have deferred was low, with between 8% and 9.3% of people from ethnic minorities deferred on travel compared with 1.7% of White people. CONCLUSION: Blood services need to consider ways to minimize negative word-of-mouth, remove questions that are no longer justified on evidence and provide justification for those that remain.
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Vaccine hesitancy for COVID-19 explored in a phenomic study of 259 socio-cognitive-behavioural measures in the UK-REACH study of 12,431 UK healthcare workers [In Press]Background Vaccination is key to successful prevention of COVID-19 particularly nosocomial acquired infection in health care workers (HCWs). ‘Vaccine hesitancy’ is common in the population and in HCWs, and like COVID-19 itself, hesitancy is more frequent in ethnic minority groups. UK-REACH (United Kingdom Research study into Ethnicity and COVID-19 outcomes) is a large-scale study of COVID-19 in UK HCWs from diverse ethnic backgrounds, which includes measures of vaccine hesitancy. The present study explores predictors of vaccine hesitancy using a ‘phenomic approach’, considering several hundred questionnaire-based measures.
