Recent Submissions

  • Integrated review of lifestyle interventions targeting diet and exercise in early or first-episode psychosis

    Griffiths, Chris; Hina, Farah (2021)
    Aims: Life expectancy is reduced by 10 - 20 years in psychotic disorders compared with the general population, largely due to high incidence of physical health disorders: heart attack, stroke, obesity, cardiovascular disease (CVD), and type 2 diabetes. Early or first-episode psychosis patients can be especially vulnerable to physical health, psychological and social consequences of antipsychotic medication weight gain. The aim of this paper is to review diet and exercise lifestyle interventions employed to address these issues. Method: A review of research evidence on lifestyle interventions (diet and exercise) for individuals with early or first-episode psychosis (2000 to 2020) was undertaken. An internet-based literature search employed Medline, PsycINFO, Embase, PubMed and Web of Science. Results: Nine studies meeting the criteria were identified: comprising of three exercise intervention studies, one diet intervention study, and five combined diet and exercise intervention studies. Only one study used a RCT design with prior power analysis to determine participant numbers, two had a RCT design, two had a comparison group and four had no control group. Overall, these studies show that exercise and diet focused interventions may provide beneficial physical and mental health outcomes, but participant engagement and behaviour change may be difficult to achieve in early or first-episode psychosis due to individual factors associated with the experience of psychosis and medication prescribed, and health service related factors. Conclusion: There is a need for evidence-based lifestyle programmes in early or first-episode psychosis that includes individually targeted evidence based exercise and diet interventions. Further appropriately powered RCTs are required to strengthen the evidence base.
  • Practitioner perspectives on best practice in non-treatment factors that support the delivery of repetitive transcranial magnetic stimulation

    Walker, Kate; Griffiths, Chris (2021)
    Accessible Summary What is known about the subject? The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomes To date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment. There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices. What this paper adds to existing knowledge? This study provides unique insights into service and personalized non-treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patients. It reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice? The need to apply findings for the development of best practice guidance. Factors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff.
  • Wearable physical activity and sleep tracker based healthy lifestyle intervention in early intervention psychosis (EIP) service

    Griffiths, Chris; Walker, Kate; Leathlean, Chloe (2022)
    Background: Physical activity, sleep, mental health, physical health, wellbeing, quality of life, cognition, and functioning in people who experience psychosis are interconnected factors. People experiencing psychosis are more likely to have low levels of physical activity, high levels of sedation, and sleep problems. Intervention: An eight-week intervention; including the provision of a Fitbit and its software apps, sleep hygiene and physical activity guidance information, as well as three discussion and feedback sessions with a clinician. Participants: Out of a sample of 31 using an early intervention psychosis (EIP) service who took part in the intervention, fifteen participants consented to be interviewed—9 (60%) males and 6 (40%) females, age range: 19 - 51 years, average age: 29 years. Method: In-depth interviews investigating patient experience of the intervention and its impact on sleep, exercise, and wellbeing were undertaken. Thematic analysis was applied to analyse the qualitative data and content analysis was used to analyse questions with a yes/no response. Results: Most of the participants actively used the Fitbit and its software apps to gain information, feedback, and set goals to make changes to their lifestyle and daily routines to improve quality of sleep, level of physical activity, and exercise. Conclusion: The intervention was reported to be beneficial, and it is relatively easy and low cost to implement and therefore could be offered by all EIP services. Furthermore, there is potential value for application in services for other psychiatric disorders, where there is often a need to promote healthy lifestyle, physical activity, and effective sleep.
  • Treatment resistant depression (TRD) service outpatient’s experience of sleep, activity, and using a Fitbit wearable activity and sleep tracker

    Griffiths, Chris; Walker, Kate; Willis, Andy; Pollard, Lorraine (2022)
    Purpose Depression, physical health, well-being, sleep and physical activity are interlinked. Healthy levels of physical activity and effective night-time sleep can reduce depressive symptoms. In the context of their lives and symptoms of depression, this paper aims to understand participants’ experiences of using a Fitbit, physical activity and sleep and the barriers and facilitators for healthy sleep and physical activity. Design/methodology/approach Qualitative methods were used to conduct interviews with 19 patients (4 male; 15 female) diagnosed with treatment-resistant depression undergoing transcranial magnetic stimulation (TMS) treatment for depression. Reflexive thematic analysis was used. Findings Healthy sleep and physical activity levels are interlinked and reduce depressive symptoms as well as improving well-being and physical health. A Fitbit is useful to enhance physical activity, self-awareness, motivation, healthier lifestyles and effective sleep. Barriers to healthy sleep and physical activity levels included depressive symptoms, environmental factors and anxieties. Facilitators for healthy sleep and physical activity levels included knowledge of the benefits, support from family and friends and applying sleep hygiene. Practical implications There is a need to provide interventions using wearable activity trackers that build on the links between increased physical activity, improved sleep, enhanced well-being, better physical health and lower depressive symptoms. Originality/value To the best of the authors’ knowledge, this is the first time that patients undergoing TMS have had their experiences of sleep, activity and using a Fitbit investigated and reported.
  • Older forensic mental healthcare patients in England: demographics, physical health, mental wellbeing, cognitive ability and quality of life [version 2; peer review: 2 approved]

    Walker, Kate; Griffiths, Chris (2022)
    Background: Older individuals (e.g., 55 years and over) constitute a growing proportion of the forensic mental health patient population. As a group, they are vulnerable to health outcomes similar to other individuals with serious mental disorders of the same age; however, these concerns can be compounded by complex forensic-related care backgrounds and clinical presentations, lengthy periods of time spent in prison or psychiatric hospitals, substance use histories, and crime perpetration or victimisation. The healthcare needs and strengths of this group are not well understood. The aim of this study was to identify and describe the demographic, physical health, mental wellbeing, cognitive ability, and quality of life profiles of older forensic patients in community, low, medium, and high security settings in England. Methods: A cross-sectional quantitative study design was used. N=37 forensic patients aged 55 years and over completed six questionnaires. Data were also collected from patient records. Results: Most patients were male and were diagnosed with psychosis. The most frequently committed index offence types were violent offences. Patients were prescribed 7.6 medications on average and had average anticholinergic effect on cognition scores of 2.4. Nearly half the sample had diabetes, with an average BMI score of 31.7 (indicating obesity). Possible cognitive impairment was identified in 65% of the sample. Patients’ assessments of their recovery-related quality of life and mental wellbeing were comparable to published UK general population values. Assessments of quality of life were positively correlated with the ability to undertake everyday activities and cognitive performance. Conclusions: We suggest that forensic services are well-placed to provide holistic mental and physical care to this group but that they should co-develop with patients a greater range of age-appropriate meaningful activities that are mindful of mobility issues and consider implementing more cognition-based and physical health interventions.
  • Investigation of physical activity, sleep, and mental health recovery in treatment resistant depression (TRD) patients receiving repetitive transcranial magnetic stimulation (rTMS) treatment

    Griffiths, Chris; Leathlean, Chloe; Jiang, Harmony (2022)
    Background Repetitive transcranial magnetic stimulation (rTMS) is effective in treating depression; however, the effect on physical activity, sleep and recovery is unclear. This study investigated rTMS effect on physical activity and sleep through providing patients with a Fitbit and software apps; and reports the impact of rTMS on depression, anxiety and mental health recovery. Methods Study design was a pre and post data collection without a control, with twenty-four participants with treatment-resistant depression (TRD). Measures used were Fitbit activity and sleep data, and patient-rated Recovering Quality of Life (ReQoL-20), Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder (GAD-7). Results Response and remission rates were, respectively: 34.8% and 39% for PHQ-9; 34.8% and 47.8% for GAD-7. ReQoL-20 response and reliable improvement were 29.4% and 53%. PHQ-9, GAD-7 and ReQol-20 scores significantly improved, with large effect sizes. Analysis of Fitbit activity and sleep data yielded non-significant results. The Fitbit data machine learning model classified two levels of depression to 82% accuracy. Limitations rTMS treatment was open-label and adjunct to existing antidepressant medication. No control group. Female patients were overrepresented. Conclusions Improvements on the ReQoL-20 and aspects of sleep and activity indicate the positive impact of rTMS on the individual's real world functioning and quality of life. A wearable activity tracker can provide feedback to patients and clinicians on sleep, physical activity and depression levels. Further research could be undertaken through a sufficiently powered RCT comparing rTMS versus rTMS with use of a Fitbit, its software applications, and sleep and physical activity advice.
  • Effectiveness of a Fitbit Based Sleep and Physical Activity Intervention in an Early Intervention Psychosis (EIP) Service

    Griffiths, Chris; Hina, Farah; Jugon, Sue; Willis, Gemma; Yardley, Samantha; Walker, Jonathon; Kelbrick, Marlene (2022)
    Purpose: Compared to levels in the general population, people with experiences of psychosis have poorer physical fitness, more sedentary behaviour, lower physical activity, more sleep problems, and a higher incidence of insomnia. The aim of the current study was to examine the feasibility and impact of an intervention with the goal of addressing these issues. Method: Design: intervention with outcome measure data collection, with no control group. Forty-nine early intervention psychosis (EIP) service patients took part in an intervention: provision of a Fitbit, Fitbit software apps, sleep hygiene, and physical activity guidance, and three discussion sessions with clinicians. The sample consisted of 29 males and 20 females, with age range of 17 - 54 years, and average age of 29.5 years. Measures used were Fitbit activity and sleep data, and self-rated Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS) and Positive and Negative Affect Schedule (PANAS). Results: WEMWBS scores significantly improved, with a medium effect size. PANAS negative affect (NA) dropped significantly. Analysis of Fitbit activity and sleep data yielded non-significant results. Conclusion: The intervention was acceptable to EIP patients and is feasible. Improvements in mental wellbeing and negative affect indicate the positive impact of the intervention on mental health. EIP services should consider assessing sleep quality and physical activity/exercise levels, and using this study’s intervention to promote wellbeing and mental health within recovery focused practice. Further research could be undertaken through a sufficiently powered randomised control trial (RCT) comparing this intervention and treatment as usual (TAU).
  • Effectiveness of online mindfulness training for people experiencing mental illness

    Griffiths, Chris; Hina, Farah; Pollard, Lorraine; Reid, Isabel (2022)
    Background: Evidence has shown that self-guided web application mindfulness training can improve mental health. In this study, the “Be Mindful” online-based mindfulness training software application was offered through a United Kingdom (UK) universal community healthcare provider to patients with a mental illness diagnosis. Be Mindful is an online course providing instruction on mindfulness theories and practice training, progress tracking, integrated guidance/feedback, and motivational emails. Objective: The aim of this paper is to present feasibility findings and outcomes on anxiety, depression, and stress of an intervention offering Be Mindful. Participants were adults who had a mental illness diagnosis and were under the care of community mental health services. Methods: Open-label patient cohort design, with no control group. Pre- and post-intervention assessment using participant self-report measures: Generalised Anxiety Disorder-7 (GAD-7); Perceived Stress Scale (PSS-10); and Patient Health Questionnaire-9 (PHQ-9; a measure of depression severity). Results: Two hundred and seventy-four started and thirty-one patients completed the Be Mindful programme and outcome measures. PSS scores at baseline significantly improved from 24.6 (1.79) to 18.7 (2.05) at the end (p < 0.001), with a large effect size of 0.498. GAD-7 scores at baseline significantly improved from 11.4 (1.3) to 8.00 (1.35) at end (p < 0.001), with a medium effect size of 0.354. PHQ-9 scores at baseline significantly improved from 13.7 (1.42) to 9.09 (1.76) to 9.81 (1.77) at end (p < 0.001), with a medium effect size of 0.378. Limitations: There was no control group, and the intervention was adjunct to existing treatment. Conclusions: Be Mindful can be offered through a UK community NHS Trust and can have a significant impact on symptoms of anxiety, depression, and stress in patients with experience of mental illness. Roll-out through community mental health providers to people with experience of mental illness is justified. Well-designed and sufficiently powered randomised controlled trials of theory-driven online mindfulness training for mental illness patient populations are required.
  • An exploration of patient experience of sleep, physical activity, and exercise in early psychosis

    Griffiths, Chris; Walker, Kate; Leathlean, Chloe (2022)
    Background Compared to the general population, people with experience of psychosis have poorer physical fitness, higher levels of sedation, lower levels of physical activity, more sleep problems, and higher incidence of insomnia. Methods Thirty-one early intervention psychosis (EIP) service patients took part in an eight-week intervention: provision of a Fitbit, Fitbit software apps, sleep and physical activity guidance, and three discussion sessions with clinicians. Fifteen participants consented to be interviewed, 9 males and 6 females, age range 19–51, average age 29. In-depth interviews investigating patient experiences of sleep and physical activity were conducted. Thematic analysis was employed. Results Patients using an EIP service experience particular issues, problems, and barriers to engaging in effective and healthy sleep and physical activity/exercise; these can have a negative effect on mental and physical health, wellbeing, recovery, and sociability. Patients used factors such as medication, social support, practical strategies, and motivation enhancement to overcome issues, problems, and barriers. Discussion Healthy effective sleep and physical activity/exercise is important to EIP service patients’ wellbeing and mental and physical health. EIP services should consider and assess sleep and physical activity/exercise issues, and promote healthy effective sleep and physical activity/exercise within recovery focused practice.
  • The impact of COVID-19 on acute psychiatric admissions for first and repeated episode psychosis

    Kelbrick, Marlene; Griffiths, Chris; Saba, Ansari; Paduret, Gabriela; Tanner, James; Mann, Nick; Johnson, Sara (2023)
    Abstract Background: There is limited evidence of the longer-term impact of the COVID-19 pandemic on acute admissions for psychosis in the UK. Aims: We examined the impact of COVID-19 on rates of admissions for first and repeated episode psychosis, and changes in patient profile and seasonal patterns, over a period of 12 months. Method: We conducted a retrospective case note review of all patients admitted with a primary psychosis (F20-29 ICD 10 diagnosis) to an NHS psychiatric inpatient unit. We compared the 12 months pre-COVID-19 period between 1 March 2019 and 28 February 2020, and the 12 months post-COVID-19 period between 1 March 2020 and 28 February 2021. Results: The results showed increase rates of admissions post-COVID-19 in both first and repeated episode psychosis, the patient profile had more females and older age in the repeated episode group, with increased employment rates. Combined group data for both pre- and post-COVID-19 periods showed an increased trend in spring and summer admissions, and even though not statistically significant, more pronounced post-COVID-19. Conclusions: Our findings highlight the effect of the COVID-19 pandemic on acute psychosis admissions over a 12-month period. The results provide evidence for the ‘stress-pathogenesis’ in the context of genetic vulnerability in psychosis. Preventative strategies in the context of the ‘stress-pathogenesis model’, improved access to and responsiveness within NHS transformation efforts needs to be adjusted to fit local need and environmental changes.
  • Social Prescribing through primary care: a systematic review of the evidence

    Griffiths, Chris; Hina, Farah; Jiang, Harmony (2022)
    Background: In primary care, social prescribing (SP) is where a patient is referred to a “link worker”, who considers their needs and then “prescribes” or connects them to appropriate community-based resources and services. Recent policy and guidance in the UK has significantly expanded the provision of SP to improve patient health and wellbeing. Methods: This study conducted a systematic review of evidence for SP effectiveness and to report needs addressed, interventions provided, and behaviour change techniques employed. Inclusion criterion was patient referral from primary care to a SP link worker. Online databases were searched for studies published from February 2016 to July 2021. Searches were restricted to English language only. Risk of bias assessment and a narrative analysis were undertaken. Results: Eight studies were included. All studies reported some positive outcomes. There were weaknesses and limitations in study design and in reporting of results: a lack of comparative controls, short duration and single point follow-up, a lack of standardised assessments, missing data, and a failure to consider potential confounding factors. All studies had features which indicated a high risk of bias. Conclusion: Evidence for the value and positive impact of SP is accumulating, but evaluation design remains relatively weak. There is a need to improve evaluation through robust methodological design and the adoption of universal outcome measures and evaluation/analytical framework. SP should seek to assess patient wellbeing, self-management, and quality of lifeoutcomes systematically, and adopt behaviour change techniques to enable healthier lifestyles in the short and long term.
  • Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) for Anxiety Treatment: Outcomes in a Community Healthcare Service

    Griffiths, Chris; Joseph, Leno; Caesar, Doreen; Lakkappa, Bharath; Leathlean, Chloe (2022)
    Abstract Background: Symptoms of anxiety disorders are highly common and can have a severe impact on people’s lives; they are typically treated with psychotherapy and/or anti-anxiety medication. These treatments are not suitable for, acceptable to, or effective for everyone. Alpha-Stim AID is a cranial electrotherapy stimulation (CES) device with evidence of effectiveness in treating symptoms of anxiety. In this study, Alpha-Stim AID was offered through a United Kingdom (UK) universal community healthcare provider, Intermediate Care Team (ICT) community healthcare service to patients who reported signs of anxiety. Objective: The aim of this paper is to present feasibility findings and outcomes on anxiety, health status, and quality of life. Methods: Open-label patient cohort design, with no control group. Participants were adults who reported symptoms of anxiety and were under the care of universal national health service (NHS) Intermediate Care Team (ICT) community healthcare service in the United Kingdom (UK). Pre- and post-intervention assessment used participant self-report measures: generalised anxiety disorder (GAD-7) and health related quality of life (EQ-5D-5L). The three ICT staff members who offered the Alpha-Stim AID to patients completed a questionnaire on their experience. Results: Eighteen patients used the Alpha-Stim and completed outcome measures. GAD-7 scores significantly improved from 13.9 (SD = 4.3) to 7.3 (SD = 5.7) (p < 0.001), with a large effect size of 0.88. Analysis of EQ-ED-5L health index score conversions indicated perceived quality of life increased from 0.31 (SD = 0.25) to 0.48 (SD = 0.28) at end (p = 0.036), with a small effect size of 0.12. EQ-VAS scores at baseline improved from 49.2 (SD = 24.0) to 64.4 (SD = 26.2) at the end (p = 0.05), with a small effect size of 0.12. Limitations: There was no control group, and the intervention was adjunct to existing treatments. Conclusions: Alpha-Stim AID CES can be offered through a UK NHS Trust Intermediate Care Team (ICT) community healthcare service and can have a significant positive impact on symptoms of anxiety, quality of life, and health status in patients who report experience of anxiety symptoms. Roll-out through community mental health providers to people with experience of anxiety symptoms is feasible. An appropriately designed and sufficiently powered randomised controlled trial of Alpha-stim for anxiety is required.
  • The experience of using Alpha-Stim AID cranial electrotherapy stimulation (CES) for symptoms of anxiety

    Griffiths, Chris; Walker, Kate; Jiang, Harmony (2023)
    Background: Alpha-Stim AID is a self-administered, cranial electrotherapy stimulation (CES) device with evidence of effectiveness in treating symptoms of anxiety. In this study, Alpha-Stim AID was offered through a United Kingdom (UK) primary care social prescription service to patients with symptoms of anxiety. This study explored the experience and impact of using Alpha-Stim AID cranial electrotherapy stimulation (CES) through in-depth interviews. Methods: Out of a sample of 57 using Alpha-Stim AID, fifteen participants consented to be interviewed. The age range of the participants was 26–65 years (M = 46.6); 10 (67%) were female and 5 (33%) male. Data were analysed using thematic analysis. Results: There was support for the acceptability and useability of Alpha-Stim AID. Most participants described a positive impact in their lives and would recommend it to others. Themes that emerged offered insights into how people used the Alpha-Stim and their experiences of the effects. Conclusions: It is important to identify anxiety symptoms and offer patients choice of treatment options. The results support the use of Alpha-Stim AID as a treatment option for people with symptoms of anxiety. Access to Alpha-Stim AID should not be restricted by being able to afford to buy it. An appropriately designed randomised control trial (RCT) is required.
  • Clinical effectiveness of active Alpha-Stim AID versus sham Alpha-Stim AID in major depression in primary care in England (Alpha-Stim-D): a multicentre, parallel group, double-blind, randomised controlled trial

    Griffiths, Chris (2023-03)
    Background Randomised sham-controlled trials of cranial electrostimulation with the Alpha-Stim Anxiety Insomnia and Depression (AID) device have reported improved anxiety and depression symptoms; however, no adequately powered sham-controlled trials in major depression are available. We investigated whether active Alpha-Stim AID is superior to sham Alpha-Stim AID in terms of clinical effectiveness for depression symptoms in major depression. Methods The Alpha-Stim-D trial was a multicentre, parallel group, double-blind, randomised controlled trial, recruiting participants from 25 primary care centres in two regions in England, UK. Eligible participants were aged 16 years or older with a current diagnosis of primary major depression, a score of 10–19 on the nine-item Patient Health Questionnaire, and had been offered or prescribed and reported taking antidepressant medication for at least 6 weeks in the previous 3 months. Main exclusion criteria were contraindications to Alpha-Stim AID device use, having persistent suicidal ideation or self-harm, neurological conditions, a substance use disorder or dependence, an eating disorder, bipolar disorder, or non-affective psychosis, or receiving psychological treatment in the past 3 months. Eligible participants were randomly assigned (1:1, minimised by region, anxiety disorder, and antidepressant use) to 1 h daily use of active (100 μA) or sham Alpha-Stim AID treatment for 8 weeks. Randomisation was via an independent web-based system, with participants, outcome assessors, and data analyst masked to treatment assignment. The primary outcome was change from baseline in score on the 17-item Hamilton Depression Rating Scale (HDRS-17, GRID version) at 16 weeks after randomisation, with participants analysed by intention to treat (ITT; all randomly assigned participants). Safety was assessed in all randomly assigned participants. The trial is registered with the ISRCTN registry (ISRCTN11853110); status completed. Findings Between Sept 8, 2020, and Jan 14, 2022, 236 eligible participants were randomly assigned to active or sham Alpha-Stim AID (n=118 each). 156 (66%) participants were women, 77 (33%) were men, and three (1%) self-reported as other gender; 200 (85%) were White British or Irish; and the mean age was 38·0 years (SD 15·3; range 16–83). 102 (86%) participants in the active Alpha-Stim AID group and 98 (83%) in the sham group were followed up 16 weeks after randomisation. In the ITT population, mean change in GRID-HDRS-17 at 16 weeks was –5·9 (95% CI –7·1 to –4·8) in the active Alpha-Stim AID group and –6·5 (–7·7 to –5·4) in the sham group (mean change difference –0·6 [95% CI –1·0 to 2·2], p=0·46). Among the 236 participants, 17 adverse events were reported in 17 (7%) participants (nine [8%] participants in the active Alpha-Stim AID group; and eight [7%] participants in the sham group). One serious adverse event of suicidal ideation leading to hospitalisation was reported in the sham group, which was judged to be unrelated to the device. Interpretation Active Alpha-Stim AID was safe and acceptable, but no more clinically effective than sham Alpha-Stim AID in major depression. Funding
  • Systems and Processes that Enable Progress for Older Forensic Mental Health Patients

    Walker, Kate; Griffiths, Chris (2022)
    Older forensic mental health patients have complex needs and requirements; service provision is required to address mental health, offending risk and issues associated with aging (geriatric care). This study aimed to identify the systems and processes that enable valued progress (in terms of quality of life, health, wellbeing, recovery and reduced risk) for older forensic mental health patients. Interviews were conducted with 48 members of staff working with these patients in secure hospitals or the community. Thematic analysis was used to analyze the data. Four overarching themes were identified regarding what facilitated or acted as a barrier in relation to quality of life, health, wellbeing and recovery. Multidisciplinary input, an individualized approach and implementing holistic and needs-led care was found to facilitate progress. However, lack of resources, excluding the patients in care planning, gaps in expertise and knowledge, and a lack of specialized units that could address mental health, forensic and elderly needs were found to be barriers. Extensive, multilevel and wide-ranging support is required specifically for older forensic mental health patients. Joint working is required between older adult and forensic mental health services incorporating geriatric medicine expertise in order to implement co-produced care and treatment plans.
  • Quality of life, wellbeing, recovery, and progress for older forensic mental health patients: a qualitative investigation based on the perspectives of patients and staff

    Walker, Kate; Griffiths, Chris (2023)
    Purpose There is a lack of research informing service requirements for older (aged≥55 years) forensic mental health patients. The aim of this research was to increase knowledge about older forensic mental health patients’ quality of life, wellbeing, recovery, and progress, in order to make recommendations of how to facilitate and enhance these factors. Methods In-depth interviews with patients (N = 37) and staff (N = 48) were undertaken; data were analysed using thematic analysis. Results Environmental (e.g., physical, structural and facilities), relational (staff, family and friends) and individual (characteristics, feelings, behaviours) factors were identified as enablers and/or obstacles to wellbeing, recovery, progress and quality of life. Conclusions The physical and psychological environment of services needs to be adapted to meet the needs of patients. Therapeutic relationships with staff should be encouraged and a person-centred and individual recovery approach adopted. Prosocial relationships with peers, friends and family need to be fostered to enable positive recovery outcomes. Older patients should be empowered to develop a sense of autonomy to enable quality of life, wellbeing, and recovery, and progress.
  • Alpha-Stim AID cranial electrotherapy stimulation (CES) anxiety treatment: anxiety, depression and health-related quality-of-life outcomes in primary health-care social prescribing services

    Griffiths, Chris; Jiang, Harmony; Walker, Kate; Smart, David; Zafar, Azhar; Deeks, Sarah; Galvin, Sinead; Shah, Taz (2023)
    Purpose This study aims to evaluate the effect of Alpha-Stim Anxiety, Insomnia and Depression (AID) cranial electrotherapy stimulation (CES) on anxiety, depression and health-related quality of life for primary care social prescribing service patients with anxiety symptoms. Design/methodology/approach Open-label patient cohort design with no control group. A total of 33 adult patients (average age 42 years) completed six weeks of Alpha-Stim AID use. Pre- and post-intervention assessment with participant self-report measures: Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7) and European Quality of Life Five Dimension (EQ-5D-5L). Findings Reliable improvement and remission rates, respectively, were 53.39% and 33.3% for GAD-7; 46.7% and 29.5% for PHQ-9. There was a significant improvement in GAD-7 and PHQ-9 with large effect sizes. EQ-5D-5L results showed significant improvements in health-related quality of life. Perceived quality of life increased by 0.17 on the health index score, with the intervention adding 1.68 quality-adjusted life years (QALYs). Practical implications Alpha-Stim AID can be delivered through a primary health-care social prescribing service and most patients will use as prescribed and complete treatment course. Alpha-Stim AID CES may be an effective anxiety and depression treatment for people with anxiety symptoms. The widespread roll-out of Alpha-Stim AID in health-care systems should be considered. Originality/value To the best of the authors’ knowledge, this is the first study to respond to the UK’s National Institute for Health and Care (NICE) request for the collection of real-world data to understand better Alpha-Stim AID in relation to people’s treatment uptake, response rates and treatment completion rates (NICE, 2021).
  • Care for older forensic mental health patients: A consensus guidance document

    Tomlin, Jack; Walker, Kate; Yates, Jen; Dening, Tom; Griffiths, Chris (2023)
    Abstract Background It is important to investigate the needs, experiences, and outcomes of older forensic mental health inpatients. In this consensus document, we offer practitioners working with older forensic inpatients recommendations to meet the unique older-age-related needs of this group. Method We report on the findings of a scoping review of service provision and age-responsive interventions for this population. We complement this with a review of qualitative studies investigating staff and patient views on age-responsive inpatient care. Results The guidance synthesizes this evidence into sections on: epidemiological studies of demographic, clinical, and legal profiles; qualitative studies; investigations of patient need; evidence for interventions tailored to this patient group; future directions for research; and finally, recommendations for practice. Forensic patients over the age of 50 years have a different set of psychological and physical health needs from their peers. There is a dearth of dedicated interventions and support to assist patients through secure services and into the community. Conclusions We suggest service providers involve older patients in treatment and service organization decisions, adapt interventions to be responsive to this group, train staff to recognize physical vulnerabilities and cognitive decline, and embrace methods of communication developed in other areas of care, such as dementia Care.
  • Understanding the underlying mechanisms of action for successful implementation of social prescribing

    Walker, Kate; Griffiths, Chris; Jiang, Harmony (2023)
    There is growing evidence for the use of social prescribing as a means of facilitating healthy lifestyle behavior changes by linking patients to sources of support in the community. However, there are gaps in understanding about what works to facilitate and enable this behavior change i.e. , the mechanisms of actions underpinning social prescribing delivery. This study used a qualitative approach involving interviews with 18 Social Prescription Link Workers (SPLWs). Reflective thematic analysis was used to analyze the data. Through this, an overall theme of “Theoretical underpinning: Solution-focused and strengths-based” was identified. This was made up of sub-themes relating to mechanisms underpinning: the SPLWs’ role (comprising asking questions, motivational interviewing and the therapeutic alliance); the patients’ role, (empowerment and active engagement); and the approach adopted (solution building, goal and action orientated). To formalize this, a framework could be developed for SPLWs that encapsulates the solution-focused strengths-based approach for application within social prescribing. This framework can then be embedded into practice facilitating more successful healthy lifestyle behavior change for social prescribing patients.