• Conditionally Discharged Restricted Patients in a General Adult Community Mental Health Setting

  Saleem, Muhammad; Kelbrick, Marlene; Halim, Zakaria; Adesola, Adekunle; Nkire, Joel; Ansari, Saba; Paduret, Gabriela (2024)

  Little is known about the proportion and patient profile of conditionally discharged patients supervised by general adult community mental health teams (CMHTs). In this study, the authors evaluate the number of patients and their demographic, clinical and risk profile, and current practice in terms of supervision and structures. Supervision in the community is time- and resource-intensive. There is a need for NHS Trusts to ensure adequate support and structures, supervision, training and joint working opportunity with forensic services to ensure safe quality care.
• Effectiveness of preventive intervention programmes aiming to improve oral health in children who have undergone caries-related dental extractions: a rapid review

  Kouassi, Sarah Maurena (2024)

  Objective: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. Methods: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. Results: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. Conclusion: Few published studies have explored preventionbased interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies. Keywords: tooth extraction, general anaesthesia, preventive dentistry, dental health services, Dental caries, dental care for children.
• Psychometric attributes associated with attrition within a prison-based democratic therapeutic community

  Roberts, Rachel (2023)

  Purpose The purpose of this paper is to examine the psychometric characteristics of male offenders who joined a democratic therapeutic community and their relationship to attrition. Design/methodology/approach Residents who left therapy prematurely during the assessment phase (N = 46) and residents who left therapy prematurely during core therapy (N = 202) were compared to residents who completed therapy (N = 52) on two psychometric measures: Raven’s Standard Progressive Matrices and The Blame Attribution Inventory. Findings A multinomial logistic regression analysis showed higher levels of external blame can predict attrition during therapy; those with higher levels of external attribution are significantly more likely to leave therapy prematurely, including both during the assessment phase and during core therapy. Raven's Standard Progressive Matrices score did not significantly predict whether an individual left therapy prematurely. Originality/value Support was found for existing research within the academic evidence base. The findings have both empirical and clinical utility, suggesting during the assessment phase of therapy, practitioners can identify residents that may require additional support to maintain engagement, minimising the potential for premature departure. The implications of the findings are discussed, with suggestions made for future research.
• Community treatment orders in an early intervention for psychosis service

  Paduret, Gabriela; Kelbrick, Marlene (2023)

  Little is known about the use and effectiveness of community treatment orders (CTOs) in early psychosis. Here, the authors describe their service evaluation of patients within an NHS early intervention for psychosis service subject to CTO over a period of three years in order to evaluate the rates of CTO use, demographic, and clinical characteristics of those subject to CTO, as well as clinical outcomes. This study demonstrates how CTO use, where deemed necessary, can create real-life, positive outcomes for service users.
• The experience of navigating sexuality for transgender and gender non-conforming people: a meta-ethnographic review

  Pipkin, Alastair; Cotton, S; Shearn, C (2023)

  Background The current research builds on a previous review of the literature which explored sexuality during gender transition. There has been increased attention toward TGNC people across academic, political, and healthcare fields since the previous review, as well as shifts in language use and health interventions, justifying a need for more contemporary understandings. Aim The current systematic review explores the experience of sexuality during gender transition. Methods A meta-ethnography was conducted on 16 papers that focused specifically on TGNC people’s experiences of their sexualities. Results The main findings were the intersection of gender and sexuality; the importance of re-writing labels around sexuality, bodies and relationships; (re)negotiating changes in sexual, romantic and/or physical relationships due to transitioning; and changes in a sense of community and belonging. Discussion The results have implications for supporting TGNC people navigating their identities by recognizing the multiple and intersecting levels of influence within which they are situated.
• You can’t be too many things: the experiences of gender-affirming care for trans people of color – a thematic analysis

  Pipkin, Alastair (2023)

  Background: Barriers to healthcare and negative healthcare experiences are frequently reported by transgender people, which is known to be compounded by intersectional issues including racism. Aims: The present study aimed to explore the experiences of trans people of color accessing a national Gender Service in the United Kingdom, to better understand the facilitators and barriers to positive healthcare experiences. Methods: Six transgender people of color attended two separate focus groups. Thematic analysis was used to identify themes in the data. Results: Three themes were identified: The Western-biased model of gender-affirming care; the lack of diversity in support provided throughout medical transition; and lack of visibility and community. Participants talked of various ways in which their ethnicity and cultural backgrounds raised apprehensions and negative experiences within their gender-related care, such as assumptions being made about their transition process, and a general lack of visibility such as not seeing examples of the outcomes of surgeries and in community spaces. Conclusions: The findings are discussed in relation to previous research, noting that culturally-inclusive models of transition, increased access to diverse, inclusive community spaces and further research in this field is needed to improve healthcare experiences.
• Core20PLUS5: His Majesty’s Prison and Probation Service – an approach to address inequities in healthcare for people in contact with the criminal justice system

  Lad, Sunil (2023)

  People involved in the criminal justice system are one of the population target cohorts of Core20PLUS5, a national National Health Service (NHS) England approach to support reduction of healthcare inequalities. For the health and justice system to be socially equitable, fair and just, the leadership across the health landscape has a central role to play to ensure this vulnerable group has an equitable opportunity for improved healthy life expectancy, regardless of their multiple disadvantages. On the 75th year of the inception of the NHS, this article is a call to action to bring about sustainable change through data reporting, digital innovation, accelerating preventative programmes and system leadership in order to achieve equitable access, excellent experience and optimal outcomes. It acknowledges the detrimental impact of crime and the importance of improving a range of health and social outcomes for this group.
• Birth trauma: the elephant in the nursery

  Butterworth, Sarah (2023)

  Method The current study used a multiperspectival (dyadic) IPA approach to interview eight participants (N = 4 heterosexual couples) where one parent was help-seeking for the experience of birth trauma. Results Analysis resulted in four superordinate themes: (1) From perfect plan to shattered reality, (2) Trauma in the healthcare system, (3) Trauma in the family system and (4) The post-trauma family: Navigating the new normal. Discussion Parents described a shared experience of birth trauma during birth. However, fathers’ perceived trauma ended in the delivery room whilst mothers’ continued far beyond this. The dyadic focus showed a divergence of experience postnatally: differing levels of awareness to distress existed between partners, mothers experienced bonding difficulties and parents took to separate coping mechanisms. The trauma remained invisible and unspoken as couples avoided discussions about the birth, coped silently and separately. The parents identity changed following the trauma as individuals, couples and as a family. Conclusion The time following a traumatic birth is experienced differently by mothers and fathers. Parents seldom discuss the trauma, hold differing perceptions of roles and needs, and struggle to support each postnatally. Clinical implications and recommendations are discussed.
• A service evaluation of the Behavioural Treatment for Substance Abuse (BTSA) programme for forensic dual diagnosis populations

  Scarborough, Nadja (2023)

  Literature links mental health problems comorbid with substance abuse with increased recovery time. There is limited research evaluating the effectiveness of substance abuse treatments for dual-diagnosis patients. This project aimed to evaluate the effectiveness of the BTSA group with this population. Questionnaires measuring motivation, locus of control, confidence to abstain and self-efficacy were administered to six different cohorts of BTSA participants (N = 38) at baseline, post, and follow-up stages. In addition, participants from the most recent BTSA cohort (N = 4) attended a post-program focus group, to provide information about their experiences of the intervention. Statistical analyses revealed that participants’ confidence in their ability to manage substance abuse was significantly higher post group, but the hypotheses that there would also be significant improvements in participants’ self-efficacy, motivation, and locus of control following completion of the program were not supported. Thematic analysis identified three key themes relevant to participants, namely validation, psychoeducation and identifying progress. This project provided valuable insights into participants’ experiences of the group, highlighting what they had gained form the intervention, and the impact on them from having Recovery Champions working in conjunction with NHS staff to facilitate the intervention. Limitations are discussed, alongside recommendations for improving the program.
• Evaluating social drop-in facilities and their impact on social recovery in early intervention in psychosis services

  Marriott, Charlotte (2022)

  “Social recovery” is a long-cited aim within the UK early intervention in psychosis (EIP) services; however, there is a lack of evidence regarding existing social recovery provisions and how these can be improved. This paper aims to evaluate an existing social drop-in facility within an EIP team, ran within the Birmingham and Solihull Mental Health NHS Foundation Trust, and highlight the potential benefits of delivering such services for people diagnosed with first episode psychosis. Attendance and basic demographic statistics (age, gender and ethnicity of attendees) were collected over a period of 13 weeks. In addition, two semi-structured focus groups were conducted: one with EIP staff members (community psychiatric nurses and support workers) and the other with current service users, with both groups describing their satisfaction and experience of the drop-in facility and how it can be improved. Inductive thematic analysis was used to analyse data from both focus groups, with six overarching meta-themes being identified: reflection, environment, emotional experience, recovery, activities and interactions. Service users and staff reflected that the drop-in facility was an asset to the service, although work could be done to improve overall attendance. This paper explores how a social drop-in facility can provide a supportive, positive environment that aids recovery from psychosis for service users and improves working conditions for the EIP staff.
• Clinical practice guideline for clozapine use in patients with COVID-19

  Ansari, S; Kelbrick, M; Paduret, G; Diaz, N; Menzel, R; Rogers, R; Wareham, C; Griffiths, C; Jugon, S; Tidy, K; et al. (2023)

  National and local guidelines focus mainly on clozapine monitoring frequency, and actions based on full blood count results. Prescribing clozapine in the context of COVID-19-positive patients brings a complexity of challenge beyond this. In this article the authors put forward an example of a practical clinical guideline in this regard.
• Angle of BRINK - a new way to measure Haglund's deformity

  Reilly, Ian (2023)

  Introduction Haglund’s deformity, an abnormality of the postero-superior corner of the calcaneum, is a common, critically debated cause of posterior heel pain. Several radiological indices such as Fowler-Philip angle, Ruch pitch, Chauveaux-Liet angle, calcaneal pitch angle, parallel pitch lines, and X–Y ratio have been described to measure this deformity. However, most of these lack specificity and have variable intra- and inter-observer reliability. Purpose The study aims to describe a new radiological “angle of BRINK” (Botchu-Reilly-Iyengar-Nischal-Kakarala) to measure Haglund’s deformity. Patient and methods We performed a retrospective cohort analysis, assessing 20 weight-bearing lateral ankle radiographs of patients with Haglund’s deformity (Haglund’s cohort) and 100 radiographs without the deformity (normal cohort). Demographic details and angle of BRINK to measure Haglund’s deformity were measured for each patient. Statistical analysis was performed using t-test and inter-observer reliability was calculated using kappa coefficient. Results The mean angle of BRINK to measure Haglund’s deformity in the normal cohort was 20.04° (SD 4.88), and in the Haglund’s cohort was 25.1° (SD 3.3). This was statistically significant with a p-value of less than 0.0001. There was excellent intra- and inter-observer reliability with kappa value of 0.8. Conclusion Our proposed radiological angle of BRINK to measure Haglund’s deformity is simple and easy to calculate on standard weight-bearing radiographs. Contrary to the traditional measurements used to estimate the deformity, it has shown a good intra- and inter-observer reliability and can support surgical decision-making process for management of patients with symptomatic Haglund’s deformity.
• 

  Changes in parental sleep from pregnancy to postpartum: a meta-analytic review of actigraphy studies

  Parsons, Leo (2023)

  Sleep changes in new parents are widely observed but there is no extant meta-analysis of changes to sleep parameters in this group. We completed a meta-analysis of changes in actigraphy-measured parent sleep between pregnancy and the end of the first year of a child's life. A search of six databases was completed. Following review using predetermined inclusion and exclusion criteria, 16 papers were left for review. Data were extracted, analysed and each paper was reviewed for methodological quality. Where possible, subgroup analysis was completed based on time since birth and location of the study, and meta-regression of parent age. Parents' total sleep time and sleep efficiency were shown to decrease following the birth of a child, with wake after sleep onset increasing. This change was most notably observed in the first four weeks after birth. Up to 16 weeks post-birth, differences were still apparent, but sleep parameters were beginning to return to pre-birth levels. New parents experience a significant change in multiple sleep parameters following the birth of a child. Future data collection, using best practice actigraphy measurement, reporting a broader range of variables and including fathers, as well as mothers, is warranted.
• 

  Personality traits of university students with smartphone addiction

  Amirlatifi, Elham Sadat (2023)

  Background: Nowadays smartphone use is increasing drastically. There is a higher prevalence of smartphone addiction in some specific personality traits. Objectives: The goal of this study is to evaluate the association of smartphone addiction with personality traits. Methods: This study is correlational research. Three hundred and eighty two students of Tehran universities were asked to answer the smartphone addiction scale (SAS) questionnaire and the Persian version of the Cloninger temperament and character inventory (TCI) questionnaire. After the smartphone addiction questionnaire assessment, individuals with smartphone addiction were identified and compared to the non-smartphone addicted group in terms of personality traits. Results: One hundred and ten individuals (28.8%) were prone to smartphone addiction. Mean scores of people with smartphone addiction were higher in novelty-seeking, harm avoidance, and self-transcendence than the non-addicts and were statistically significant. In persistence and self-directedness, the mean scores of the smartphone addiction group were lower than the non-addicts and were statistically significant. Individuals with smartphone addiction had higher reward dependence and lower cooperativeness however they were not statistically significant. Conclusions: high novelty seeking, harm avoidance, self-transcendence, low persistence, and self-directedness which indicate narcissistic personality disorder, could have a role in smartphone addiction.
• Surgical excision of intractable plantar keratoses (corns) of the foot: a scoping review

  Reilly, Ian (2023)

  Background: Hyperkeratosis is a hypertrophic thickening of the skin. A callus (tyloma) is considered diffuse thickening, whereas a corn—also known as a clavus, heloma durum, or intractable plantar hyperkeratosis (IPK)—is a more focal, circumscribed hyperkeratotic lesion with a central conical core of keratin. Treatment (including surgical excision) of plantar keratoses is often sought because of pain and discomfort. The aim of this study was to collect and chart data regarding the surgical excision of plantar corns. The emerging themes were then mapped so that suggestions for areas of future research could be made. Methods: A scoping review of the literature was performed using the six-stage methodologic framework (minus stage 6) proposed by Arksey and O’Malley incorporating the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews reporting guideline. A database search by means of the United Kingdom National Health Service Care Advanced Database Search yielded 1,056 articles, 12 of which appeared to be of potential relevance. After removing five duplicate articles, this total was reduced to seven, which were retrieved as full texts. Three were excluded. Thirteen further articles were found through Google Scholar and reference lists from the full texts retrieved to give 17 articles for review. One was discounted as not being in English/irrelevant; and one article did not relate to IPK excision, leaving 15 articles for data extraction. Results: Iterative charting of the included articles yielded overlapping codes and two main themes. The first theme was closure: by primary intention (with or without a skin flap) or by secondary intention. The second theme was whether excision was performed in combination with IPK excision with other (bony) surgery. Conclusions: There is modest evidence that excision of the lesion with either primary closure or healing by means of secondary intention can be useful for the management of IPKs. A further consideration is an emerging hypothesis that many of these IPKs are viral in origin, rather than mechanical, which implies that prospective studies are required with cross-reference to lesion excision by anatomical site and histopathologic confirmation of the diagnosis.
• Compassion and gender diversity: evaluation of an online compassion-focused therapy group in a gender service

  Pipkin, Alastair; Smith, Aimee (2023)

  Transgender and gender non-conforming (TGNC) people may experience minority stress and internalised transnegativity, leading to increased psychological distress. Self-compassion has been suggested as a protective factor which can buffer against the impact of minority stress and stigma. This service evaluation study examined the outcomes of a novel compassion-focused therapy group intervention delivered online in a Gender Service. Twenty-one TGNC adults participated in the group and completed pre-group and post-group measures of psychological distress, internalised transnegativity, and compassion to self, to others, and from others. Participants had high levels of psychological distress and low levels of self-compassion pre-group. At the group level, there was a significant increase in levels of compassion to self and from others, and a significant decrease in pride (reverse scored) and alienation internalised transnegativity subscales. At an individual level, compassion to self and compassion from others were the most frequent areas where significant change was observed post-group. The compassion-focused therapy group appears to be effective in increasing levels of self-compassion and reducing aspects of internalised transnegativity, but without clear impact on psychological distress. This is preliminary evidence in support of the use of compassion-focused therapy groups within gender services, but further research is warranted and encouraged.
• 

  Biomechanical comparison of medio-plantar and plantar plate fixation for first tarsometatarsal joint arthrodesis

  Uddin, Akram (2023)

  Plantar plate positioning has been demonstrated as biomechanically superior. However, some operators remain resentful about the morbidity of the surgical approach. To provide improved plate fixation for first tarsometatarsal joint arthrodesis with respect to the tibialis anterior tendon, a medio-plantar plate was developed. The purpose of this biomechanical study was to compare its construct stability to that of a plantar plate construct. Twelve pairs of fresh frozen human specimens were used in a matched pair test. Each pair was fixed with a 4 mm compression screw and either a plantar locking plate or a medio-plantar locking plate. A cantilever beam test was performed in dorsiflexion. Before and after cyclic loading (5000 cycles; 40 N), bending stiffness and relative movements at the joint space were monitored in a quasi-static test including optical motion tracking. Maximum load and bending moment to failure were investigated in a load-to-failure ramp test. The bending stiffness of both groups did not significantly differ before (plantar 49.9 N/mm ± 19.2; medio-plantar 53.9 N/mm ± 25.4, p = 0.43) or after (plantar 24.4 N/mm ± 9.7; medio-plantar 35.3 N/mm ± 22.0, p = 0.08) cyclic loading but decreased significantly in both groups (p < 0.01) after cyclic loading. Relative movement increased significantly during cyclic testing in both groups (p < 0.01) but did not differ significantly between the groups before (p = 0.29) or after (p = 0.16) cyclic loading. Neither load nor bending moment to failure were significantly different (plantar 225 N ± 78, 10.8 Nm; medio-plantar 210 N ± 86, 10.1 Nm, p = 0.61). Both plate constructs provided equivalent construct stability, both being well suited for Lapidus arthrodesis.
• 

  Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analyses

  Day, Rebecca; Nah, Ryan (2023)

  Background Persecutory delusions are a major psychiatric problem that often do not respond sufficiently to standard pharmacological or psychological treatments. We developed a new brief automated virtual reality (VR) cognitive treatment that has the potential to be used easily in clinical services. We aimed to compare VR cognitive therapy with an alternative VR therapy (mental relaxation), with an emphasis on understanding potential mechanisms of action. Methods THRIVE was a parallel-group, single-blind, randomised controlled trial across four UK National Health Service trusts in England. Participants were included if they were aged 16 years or older, had a persistent (at least 3 months) persecutory delusion held with at least 50% conviction, reported feeling threatened when outside with other people, and had a primary diagnosis from the referring clinical team of a non-affective psychotic disorder. We randomly assigned (1:1) patients to either THRIVE VR cognitive therapy or VR mental relaxation, using a permuted blocks algorithm with randomly varying block size, stratified by severity of delusion. Usual care continued for all participants. Each VR therapy was provided in four sessions over approximately 4 weeks, supported by an assistant psychologist or clinical psychologist. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 2 (therapy mid-point), 4 (primary endpoint, end of treatment), 8, 16, and 24 weeks. The primary outcome was persecutory delusion conviction, assessed by the Psychotic Symptoms Rating Scale (PSYRATS; rated 0–100%). Outcome analyses were done in the intention-to-treat population. We assessed the treatment credibility and expectancy of the interventions and the two mechanisms (defence behaviours and safety beliefs) that the cognitive intervention was designed to target. This trial is prospectively registered with the ISRCTN registry, ISRCTN12497310. Findings From Sept 21, 2018, to May 13, 2021 (with a pause due to COVID-19 pandemic restrictions from March 16, 2020, to Sept 14, 2020), we recruited 80 participants with persistent persecutory delusions (49 [61%] men, 31 [39%] women, with a mean age of 40 years [SD 13, range 18–73], 64 [80%] White, six [8%] Black, one [1%] Indian, three [4%] Pakistani, and six [8%] other race or ethnicity). We randomly assigned 39 (49%) participants assigned to VR cognitive therapy and 41 (51%) participants to VR mental relaxation. 33 (85%) participants who were assigned to VR cognitive therapy attended all four sessions, and 35 (85%) participants assigned to VR mental relaxation attended all four sessions. We found no significant differences between the two VR interventions in participant ratings of treatment credibility (adjusted mean difference –1·55 [95% CI –3·68 to 0·58]; p=0·15) and outcome expectancy (–0·91 [–3·42 to 1·61]; p=0·47). 77 (96%) participants provided follow-up data at the primary timepoint. Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater improvement in persecutory delusions (adjusted mean difference –2·16 [–12·77 to 8·44]; p=0·69). Compared with VR mental relaxation, VR cognitive therapy did not lead to a greater reduction in use of defence behaviours (adjusted mean difference –0·71 [–4·21 to 2·79]; p=0·69) or a greater increase in belief in safety (–5·89 [–16·83 to 5·05]; p=0·29). There were 17 serious adverse events unrelated to the trial (ten events in seven participants in the VR cognitive therapy group and seven events in five participants in the VR mental relaxation group). Interpretation The two VR interventions performed similarly, despite the fact that they had been designed to affect different mechanisms. Both interventions had high uptake rates and were associated with large improvements in persecutory delusions but it cannot be determined that the treatments accounted for the change. Immersive technologies hold promise for the treatment of severe mental health problems. However, their use will likely benefit from experimental research on the application of different therapeutic techniques and the effects on a range of potential mechanisms of action.
• Racialised minority women's experiences of psychological intervention across perinatal and maternal mental health services.

  Harris, K; Fox, J (2024)

  Policies such as The Perinatal Mental Health Care Pathways document (2018) state mothers and birthing people experiencing psychological difficulties should have timely access to evidence-based psychological therapies. However, psychological distress often goes unidentified in racialised minority women and birthing people who have poorer experiences and outcomes within perinatal contexts compared to White women. Whilst limited research has focused on this within the perinatal period, there is greater recognition concerning how culturally sensitive practices can facilitate equity in care outcomes. This service evaluation aimed to explore racialised minority women's experiences of psychological intervention within a Perinatal and a Maternal Mental Health Service to evaluate service provision and inform service development. Semi-structured interviews with eight women who accessed psychological intervention were analysed using thematic analysis. Two superordinate themes were constructed, with findings suggesting participants had mostly positive experiences of psychological intervention. Cornerstones of therapeutic engagement comprised six subthemes: empathy, flexibility, the utility of psychological approaches, acknowledging family and community systems, points of difference and cultural context as a 'spotlight'. This theme encapsulated psychological therapist's relational and interventional approaches alongside participant preferences which influenced intervention experiences. Therapists were generally experienced as empathic and flexible although some participants desired greater flexibility relating to various practical aspects. Psychological approaches were experienced as beneficial although some wanted greater exploration of childhood trauma and found trauma-focused CBT emotionally demanding. Most participants preferred female therapists due to various socio-cultural reasons and felt systemic factors and their cultural context were acknowledged which enhanced the therapeutic relationship and outcomes where relevant with the inverse also apparent. History repeating itself comprised three subthemes (lack of representation, mistrust of the system and disorientation in help-seeking). This reflected mainly Black participants' negative healthcare experiences and structural racism. Therapeutic and organisational implications are discussed. Copyright © 2024, British Psychological Society. All rights reserved.
• 

  “Well-Track” healthy lifestyle (physical activity, sleep hygiene, diet, wearable activity tracker) coaching in Severe Mental Illness (SMI)

  Griffiths, Chris; Sheldon, Alice; Smith, Gerry (2024)

  Background: People who experience Severe Mental Illness (SMI) often have low levels of physical activity, high levels of sedentary behaviour, poor diet, and sleep problems. These factors are linked to worse mental health symptoms, lower wellbeing, greater hopelessness, lower quality-of-life, and physical health-related diseases, including cardiovascular disease, stroke, hypertension, osteoarthritis, cancer, chronic obstructive pulmonary disease, obesity, and diabetes, contributing to 15 - 20 years reduced life expectancy. Purpose/Aim: This study investigates the impact of Well-Track healthy lifestyle intervention in SMI, it addresses the question: “What is the effect of Well-Track on mental wellbeing and sleep quality/insomnia for SMI patients?”. Methods: An open-label patient cohort design with no control group. Pre-intervention, 4-week and 8-week intervention assessments using participant self-report measures: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) and Sleep Conditioning Index (SCI). Participants were seventy-six Community Mental Health Team (CMHT) participants, 35 males and 41 females, with an age range of 20 - 65, and average age of 41 years. An eight-week intervention: a free-to-keep wearable tracker (instructions, set up, and access to apps), exercise, diet and sleep hygiene advice, a motivational interview and goal-setting session and two follow-up support sessions with a health coach. Results: WEMWBS scores significantly improved, from 37.52 (SD 10.18) to 42.35 (SD 7.14) at 4 weeks and to 44.06 (SD 6.03) at 8 weeks, with large effect sizes. SCI scores significantly improved, from 12.03 (SD 7.29) to 15.45 (SD 8.00) at 4 weeks and to 17.26 (SD 8.12) at 8 weeks, with large effect sizes. Conclusion: Well-Track was integrated into a SMI physical health check service and was found to be beneficial in terms of improving wellbeing and sleep quality and reducing incidence of insomnia. Well-Track could be delivered through all CMHT and SMI physical health check services to promote healthy lifestyle behaviours.

View more