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Perceived training needs of mental health professionals to identify and respond to domestic abuse: a qualitative studyPurpose This study aims to understand the training needs of mental health professionals in early access services to inform the development of evidence-based, inclusive and trauma-informed training for identifying and responding to domestic abuse (DA) within mental health settings. Design/methodology/approach A qualitative design was used, with semi-structured interviews (n = 20) and two focus groups (n = 8; n = 4) with professionals from two National Health Service Trusts. Reflexive thematic analysis was conducted from a constructionist perspective, with themes co-developed by researchers and a lived experience advisory panel. Findings There are six key themes that were identified: (1) knowledge about diverse service users; (2) recognising signs of DA, including subtle and non-physical forms; (3) sensitive questioning techniques; (4) preference for in-person, interactive learning; (5) accessible, regular and up-to-date training; and (6) the value of lived experience in training design and delivery. Professionals expressed a need for culturally competent, skills-based training that fosters confidence in identifying and responding to DA in complex clinical contexts. Practical implications Findings provide actionable insights for service leaders and educators in developing and embedding effective DA training within mental health services. Originality/value To the best of the authors’ knowledge, this is the first UK-based qualitative study to detail the training needs of mental health professionals in relation to identification and responding to DA in mental health settings. It highlights the importance of co-designed, experiential training that integrates lived experience and contextual nuance, addressing current gaps in both content and delivery format.
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Transcranial Direct Current Stimulation (tDCS) used at home for people with self-reported depression: impact on self-reported concentration problemsBackground: There is a high prevalence of concentration and cognitive functioning problems in people with depression. Research evidence indicates that transcranial direct current stimulation (tDCS) can improve cognitive functioning, and an aspect of cognitive functioning is the ability to concentrate. Flow FL-100 is a tDCS device self-administered at home. Purpose/Aim: To investigate the impact of 1, 2, 3, 6 and 10 weeks of Flow Neuroscience AB FL-100 tDCS use on self-reported concentration problems in people with depression, using the Montgomery-Åsberg Depression Rating Scale Self (MADRS-S) concentration problem question. Methods: A retrospective analysis of MADRS-S self-report data collected between 2020 and 2024. Results: Out of 20197 tDCS users with self-reported depression at baseline, 10,888 had concentration problems (53.9%). Among those who adhered to the tDCS protocol, the proportion who moved from having concentration problems to not having them was 29.3% at one week, 37% at two weeks, 45.2% at three weeks, 54.7% at six weeks, and 57.4% at ten weeks. Concentration problems strongly correlate with depression. Conclusion: The results show that tDCS can reduce concentration problems in those with self-reported depression. Some people experience concentration problems despite addressing lifestyle and environmental factors that can negatively affect concentration. There are negative side effects of some methods of improving concentration, for example, the use of stimulants. tDCS could be a valuable alternative approach to reducing concentration problems in people experiencing depression. Appropriately designed and powered randomised controlled trials (RCTs) are warranted to investigate the impact of tDCS on cognitive functioning and concentration.
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Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) for anxiety in chronic breathlessness: a qualitative exploration of feasibility, usability, and acceptabilityBackground: Anxiety is common in people living with chronic breathlessness. Cranial Electrotherapy Stimulation (CES) with the Alpha-Stim Anxiety, Insomnia, Depression (AID) has evidence of effectiveness in the treatment of anxiety disorders, but little is known about its feasibility, usability, and acceptability for people living with anxiety associated with chronic breathlessness. Aim: To explore individuals’ experiences of using Alpha-Stim AID to manage their anxiety associated with their breathlessness. Methods: Participants were recruited from two hospices, with advanced chronic respiratory disease and breathlessness and anxiety, and followed either a Set Dose Regime (SDR) or a Personalised Dose Regime (PDR). Semi-structured interview with 15 participants who had used Alpha-Stim AID (SDR and/or PDR) daily for eight weeks were analysed thematically using the predefined domains of feasibility, usability, and acceptability. Results: Feasibility: the Alpha-Stim AID was readily integrated into daily routines, providing a valued hour of calmness and fostering adherence to Alpha-Stim AID use. Usability: most participants reported benefits including reduced anxiety, improved mood, better sleep, and subtle mindset shifts such as cognitive reframing, although a minority reported limited impact. Acceptability: The device was perceived as simple to use and intuitive and associated with no or mild transient side effects, with PDR enhancing comfort, perceived control, and engagement. Conclusions: Alpha-Stim AID is a low-burden, well-tolerated adjunctive intervention for anxiety in people with breathlessness, with potential benefits extending beyond symptom relief. Future research should explore long-term effects, the mechanisms underpinning mindset change, and strategies for optimisingpersonalizing dosing regimens.
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“Hospital at home” mental health psychiatric hospital return to the community transition support: impact on self-reported wellbeingBackground: People who are discharged from mental health psychiatric hospitals often have low average levels of wellbeing and require support to improve wellbeing, enable mental health recovery, and facilitate successful transition back into the community to prevent mental health crisis and readmission. Low levels of wellbeing are linked to worse mental health symptoms, anxiety, and depression. Intervention: Hospital at Home is a two-week intervention that provides at-home support for people who are discharged from a mental health hospital or who are at risk of a mental health crisis and hospital admission. It is a trauma-informed, behaviour-change, and strengths-based approach; staff provide individualised practical and emotional support, identifying needs and goals to help individuals stabilise, build confidence, develop and apply coping strategies, recover, self-manage, connect with community-based services and resources, and reconnect with previous social contacts and activities. Purpose/aim: This study investigated the impact of Hospital at Home on wellbeing. The study addressed the question: “What is the impact of Hospital at Home transition support on self-reported psychological wellbeing?” Methods: An open-label patient cohort design with no control group was used. Pre- and post-intervention assessments were conducted using the self-report measure, the Short Warwick–Edinburgh Mental WellBeing Scale (WEMWBS). Participants were 102 Hospital at Home clients, 28 (27.5%) males and 74 (72.5%) females. The average age of the participants was 50.1 years (range 25 to 95 years; SD = 14.8). Results: Prior to the start of participation in Hospital at Home, 89% of participants reported low wellbeing, with only 11% reporting in the normal range of wellbeing. At the end of participation in Hospital at Home, 54% reported in the normal range of wellbeing and 2% in the high range of wellbeing. SWEMWBS scores significantly improved by 5.52 points (SD = 4.05) with a very large effect size (Cohen’s d = −1.36). SWEMWBS scores significantly improved in participants with a primary diagnosis of anxiety by 5.44 points (SD = 4.14) with a very large effect size (Cohen’s d = −1.31). SWEMWBS scores significantly improved in participants with a primary diagnosis of depression by 5.28 points (SD = 3.76) with a very large effect size (Cohen’s d = −1.40). SWEMWBS scores significantly improved in participants with a primary diagnosis of schizophrenia by 6.60 points (SD = 3.79) with a very large effect size (Cohen’s d = −1.74). Conclusion: Hospital at Home was found to be beneficial in terms of improving wellbeing, which is linked to improvements in mental health. The SWEMWBS results indicate improvements in optimism, self-efficacy, calmness, coping, clarity of thinking, closer connections with others, and personal agency, which can enhance a successful return to the community, mental health recovery, and reduce the risk of relapse and readmission. Hospital at Home is relatively low-cost and can be offered by all mental health providers. Further research is justified to support roll-out.
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Real-world evaluation of at-home cranial electrotherapy stimulation (CES) for the management of sleep, anxiety, depression, stress, quality of life, and self-efficacyBackground Direct-to-consumer neuromodulation technologies are transforming how sleep and mood disorders are self-managed outside clinical settings. Cranial electrotherapy stimulation (CES) is a low-intensity, portable intervention with growing accessibility but limited evidence in non-clinical populations and real-life contexts. This naturalistic cohort study investigated the effects of CES on sleep, anxiety, depression, stress, quality of life, and self-efficacy in a real-world, community-based setting. Methods Sixty adults agreed to use the Alpha-Stim AID CES device daily for 21 days (40–60 min/day). Validated self-report measures were completed at baseline, day 21 (end-of-treatment), and day 42 (follow-up). A subsample (n = 27) wore actigraphy devices to monitor objective sleep changes. Results By day 21, sleep quality significantly improved, with 48 % achieving insomnia remission and 50 % a reduction in daytime sleepiness. Actigraphy data corroborated subjective sleep improvements. Anxiety and depression remission rates were 72.3 % and 71.2 %, with improvements maintained three weeks post-intervention. Stress levels decreased, while self-efficacy, wellbeing, and quality of life improved, with moderate to large effect sizes. CES was rated as safe, acceptable, and easy to use: 48 % of participants preferred it over psychotherapy or medication. Discussion CES is a safe, self-administered intervention that benefits sleep, mental health, and quality of life. This study presents the first actigraphy evidence of CES effects on sleep in a diverse, non-clinical population. Findings support a novel framework for accessible, non-pharmacological interventions for sleep and wellbeing with sustained impact at three-week follow-up. Results have significant implications for sleep quality and mental health, especially for populations underserved by traditional healthcare.
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The experience and impact of a Fitbit-based physical activity and sleep hygiene intervention for older adults experiencing cognitive declineObjectives: This study aimed to understand the experience and impact of a physical activity and sleep wrist-worn tracker (Fitbit)-based healthy lifestyle intervention for older patients attending a memory assessment service, who are experiencing cognitive impairment but do not receive a dementia diagnosis. Methods: A qualitative design was employed. Semi-structured interviews were conducted with a purposeful sample of thirteen participants recruited from a memory assessment service. Thematic analysis, that was data driven and inductive, was undertaken to analyse the data. Results: Two global themes were developed. “Understanding exercise and sleep as part of my lifestyle” was made up of themes representing how participants viewed exercise and sleep as part of their lifestyles in terms of acknowledging the positive impacts and the barriers to exercise and sleep. The second global theme “Understanding my experience of the healthy lifestyle intervention” was made up of themes that identified the positive impact of the intervention regarding improving health and wellbeing, enabling validation of proactive behaviours and motivation to engage in healthy lifestyle behaviours, so promoting positive behaviour change. Conclusion: Patients experiencing age-related cognitive impairment, applied and benefited from a healthy lifestyle Fitbit-based intervention to facilitate and promote physical activity, better sleep hygiene and healthy lifestyles.
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Integrating a unique leg Strengthening Device (S-Press) into physiotherapy rehabilitation practice, a qualitative examinationMuscle deconditioning due to hospitalisation is problematic, causing delayed discharges, more nursing, carer, or social service support following discharge, and possible discharge to a care home rather than the patient’s own home. Muscle deconditioning is associated with increased mortality, infections, depression, and reductions in patient mobility and ability to engage in their activities of daily living. Preserving muscle strength and function should form part of patients’ rehabilitation plans. Progressive resistance training (PRE) offers the most cost-effective way of preserving muscle strength and function; however, it is not routinely carried out in hospitals. A leg strengthening device (the S-Press) has been developed with the aim of improving access to effective PRE for adults. Using a qualitative approach, thematic analysis of interviews with physiotherapists, patients, and relative carers about their experience of using the S-Press provided insight into integrating PRE into patients’ rehabilitation, what promoted or prevented its use, and the outcomes associated with its use. Four overall themes emerged from the data. “Experience of Users” described that the S-Press was accessible, convenient, time efficient, portable, and manoeuvrable, and it provided an objective measure of progress. “Facilitators” included findings around how the S-Press was easy to use, motivational, and comfortable when in use. “Barriers” comprised the inability of some patients to use the S-Press independently and the identification of obstacles that prevented consistent use. “Impact and Benefits” represented the perceptions of increased leg strength and psychological benefits. The S-Press is beneficial for patients’ rehabilitation by offering PRE that is simple and easy to use, acceptable to both patients and professionals, and can be integrated as part of patients’ rehabilitation plans.
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A qualitative study exploring the experience and value of flow Transcranial Direct Current Stimulation (tDCS) and behaviour therapy training software used at home for Community Mental Health Team (CMHT) patients with symptoms of depressionBackground: Flow FL-100 is a self-administered transcranial direct current stimulation (tDCS) device with evidence of effectiveness in treating symptoms of depression. The Flow intervention also provides access to software application delivered wellbeing behaviour therapy training. Flow was offered by a community mental health team (CMHT) to those who experienced depressive symptoms. Participants completed six weeks use of Flow. This study explored participants’ experiences and views on feasibility, acceptability, useability, and value of Flow. Methods: A qualitative methodological approach was employed, involving in-depth semi-structured interviews. Interpretative Phenomenological Analysis (IPA) was applied. Out of a sample of 27 participants using Flow, 14 participants, seven females and seven males consented to be interviewed. The age range was 21 - 63 years (M = 40.21, SD = 13.99). Results: There was support for the feasibility, acceptability, useability and value of Flow. Most participants used Flow as per standard protocol and described a positive impact on depressive symptoms, mood, motivation, and functioning. Conclusion: Flow has been successfully integrated into a CMHT depression treatment. It is important to offer CMHT patients an evidenced-backed alternative to existing depression treatments (anti-depressant medication and psychotherapies). The results support the use of Flow as a treatment option for CMHT patients with symptoms of depression.
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Post-COVID Rehabilitation Service: COVID-19 Yorkshire Rehabilitation Scale (C-19 YRS) and Health-Related Quality of Life EuroQol Five-Dimensional Five-Level Questionnaire (EQ-5D-5L) Outcomes.Background: In the United Kingdom (UK) long COVID symptoms are defined as symptoms that are unexplained by an alternative diagnosis and persist for more than 12 weeks after acute COVID-19. Long COVID services have been commissioned in the UK to respond to patient needs. Purpose/Aim: To investigate whether a post-COVID rehabilitation service and its interventions have a positive impact on patients’ outcomes as measured by the COVID-19 Yorkshire Rehabilitation Scale (C-19 YRS) and the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L) health-related quality of life scale. Methods: A retrospective investigation was conducted using routinely collected data (baseline and a 12-week follow-up) from service users of a post-COVID rehabilitation service. Twenty-one EQ-5D-5L and thirty C-19 YRS datasets were collected. Results: There was a significant improvement in symptom severity on the C-19 YRS score from baseline (M = 19.57, SD = 6.41) to 12-week follow-up (M = 17.13, SD = 7.60), with a medium effect size. There was a significant improvement in functional disability on the C-19 YRS score from baseline (M = 8.14, SD = 4.20) to 12-week follow-up (M = 7.17, SD = 4.38), with a small-medium effect size. There was an improvement in C-19 YRS “overall health”, but this was not statistically significant. The EQ-5D-5L dimension of “usual activities” improved, with a significant decrease in issues reported from baseline (M = 3.19, SD = 1.03) to follow-up (M = 2.86, SD = 1.24), with a small-moderate effect size. The EQ-5D-5L dimension “mobility issues” improved; participants reported mild to moderate issues (level 2) at baseline and no issues (level 1) at follow-up. Conclusion: The results show that a post-COVID rehabilitation service can have a significant positive impact on symptoms of long COVID and real-world functioning. It is essential that treating long COVID symptoms remains a healthcare priority. As there is a move away from specific long COVID services there is a need for effective services for tackling long-term conditions and symptoms that have occurred due to COVID-19.
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Facilitators and barriers to participation of patients with treatment resistant depression in a randomised controlled trial of two forms of personalised magnetic resonance imaging targeted transcranial magnetic stimulation (the BRIGhTMIND trial)BACKGROUND: Magnetic resonance imaging (MRI) can personalise the site of transcranial magnetic stimulation (TMS) delivered as a course of 20 sessions for treatment-resistant depression (TRD). Facilitators and barriers to a randomised controlled trial (RCT) of MRI personalised TMS is understudied. AIM: Qualitative analysis to explore facilitators and barriers behind RCT participants' experience of personalised MRI-targeted TMS in people with TRD. METHODS: Nineteen participants from the BRIGhTMIND RCT of two forms of MRI personalised TMS, completed semi-structured interviews exploring the reasons behind the uptake and experience of TMS. The sample included fifteen participants who completed the treatment course and four who declined to proceed before randomisation. Interviews were analysed using thematic analysis, co-produced between researchers and patients and public involvement contributors. RESULTS: Facilitators were "hope" regarding the treatment itself, the influence of research staff, interest in a new treatment, and altruism. Barriers were concerns about their ability to commit to the trial and the nature of the TMS itself. Throughout the themes, clinicians and researchers made a difference by explaining and setting realistic expectations of the treatment and building rapport through daily patient contact. CONCLUSION: The study highlights the importance of understanding patients' concepts and experiences of TMS. The provision of optimal information to patients twinned with offering TMS outside office hours and the most efficacious, acceptable regimes of TMS delivery may maximise participation (Trial registration number ISRCTN19674644, registered on 01/10/2018). TRIAL REGISTRATION: Trial registration: ISRCTN19674644|| http://www.isrctn.org/ ) registered on 01/10/2018. Trial Identifying numbers: CPMS 39297, IRAS 245025.
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“Well-Track” healthy lifestyle coaching in severe mental illness: a qualitative study exploring participant experience and impactBackground: Unhealthy lifestyle behaviours contribute to the poor physical health experienced by people with severe mental illness (SMI). Severe mental illness symptoms and the medications used in treatment make adopting a healthy lifestyle challenging. Intervention: Well-Track uses a wearable activity tracker and three sessions with a health coach to promote healthy lifestyle behaviour change. The tracker allows physical activity, sleep and calorie expenditure to be monitored. The coach provides personalised support and accountability through motivational interviewing, goal-setting, healthy lifestyle advice and feedback. Participants: Fifteen participants under the care of a community mental health team (CMHT) were interviewed following their completion of the intervention. They comprised 7 females, 7 males and 1 non-binary, with an age range of 21 to 62 years. Methods: Individual in-depth one-to-one interviews were conducted. The qualitative data collected were analysed using thematic analysis. Results: Participants benefitted from the combination of the activity tracker and health coaching. By setting personalised goals, monitored by the tracker and supported by the health coach, individuals increased physical activity and improved their sleep hygiene and eating habits. Participants described enhanced physical fitness and healthy weight management alongside improvements in mood, self-confidence, positive self-identity and reduced social isolation. Conclusion: Well-Track can enable healthy lifestyle changes to improve the physical and mental health and well-being of people with SMI.
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Transcranial Direct Current Stimulation (tDCS) and online wellbeing training used at home for perinatal and maternal loss patients with adiagnosis of depression: depression, real world-functioning, and quality of life outcomesBackground: There is a high prevalence of depression in the perinatal period and for women who experience maternal loss, which is linked to worse real-world functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a tDCS device self-administered by a patient at home in combination with a software application-delivered wellbeing behaviour therapy training. Training modules include: “Behaviour activation”, “Mindfulness”, “Exercise for your brain”, “An anti-depression diet”, and “Therapeutic sleep”. Purpose/Aim: This study is the first to introduce Flow FL-100 tDCS in combination with a software application-delivered wellbeing behaviour therapy training into a Specialist Perinatal Mental Health Service and Maternal Mental Health Service. In addition to the support and interventions provided by these services, this study investigated the impact on depression, real-world functioning, and health-related quality of life for patients diagnosed with depression. Methods: An open-label patient cohort design with no control group. Baseline and 6-week follow-up assessments were completed using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Results: Twenty-five female patients completed six weeks of tDCS treatment. Their average age was 36 years, and their ages ranged from 27 to 42 years. Reliable improvement and remission rates for PHQ-9 were 64% and 52%, respectively. PHQ-9 and WSAS scores significantly improved, with large effect sizes. EQ-5D-5L results showed significant improvements in the EQ health index score and EQ-VAS score, with medium effect sizes. Conclusion: tDCS and online wellbeing behaviour therapy training can be successfully integrated into Perinatal Mental Health Service and Maternal Mental Health Service depression treatment offer. This study’s findings provide evidence that tDCS and online wellbeing behaviour therapy training delivered in conjunction with the interventions provided by Specialist Perinatal Mental Health and Maternal Loss Psychology Services for patients with depression diagnosis can provide improvements in depression symptoms, functioning and quality of life. It is important to be able to offer an evidence-based addition and/or alternative to existing depression treatments (antidepressant medication and psychotherapies).
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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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“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a Community Mental Health Team (CMHT) service: depression, functioning, and health-related quality of life outcomesBackground: People who experience severe mental illness (SMI) have a high prevalence of depression symptoms, which is linked to worse functioning and quality of life. Research evidence indicates that transcranial direct current stimulation (tDCS) can reduce symptoms of depression. Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivered wellbeing behaviour therapy training. Purpose/Aim: This study investigates if Flow can be introduced to a Community Mental Health Team (CMHT) service and the impact of Flow in treating depression. The study addresses the questions: “what are the depression reliable improvement and remission rates?” and “can Flow significantly reduce depressive symptoms and improve real world functioning (everyday, social and occupational functioning) and health-related quality of life?”. Methods: An open-label patient cohort design with no control group. Pre-intervention and 6-week follow-up intervention assessments using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Participants were 31 CMHT patients, 15 males and 16 females, with an age range of 21 to 64 years, and average age of 42 years. Results: PHQ-9 reliable improvement and remission rates were 51.61% and 12.9%, respectively. PHQ-9 scores significantly improved, from 20.9 (SD 5.55) to 14.6 (SD 7.33) at 6 weeks, with large effect size. WSAS scores improved from 31.3 (SD 6.02) to 22.5 (SD 11.43) at 6 weeks, with large effect size. EQ-5D-5L results showed significant improvements in the health index score, and three EQ-5D-5L dimensions (“mobility”, “self-care”, and “pain”). Conclusion: Flow tDCS treatment was integrated into a CMHT service and was found to be beneficial in terms of improving functioning and quality of life and reducing depression symptoms. Flow FL100 tDCS and wellbeing behaviour therapy training could be offered through all CMHT services to people with SMI to treat depression, enable better functioning, and improve quality of life.
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Breaking the silence: addressing domestic abuse in mental health settings—identification, screening, and respondingIndividuals experiencing domestic abuse (DA) struggle to disclose victimization, but as frequent users of mental health services, this is a pivotal setting for identification and addressing DA. This systematic review of 20 studies investigates DA identification, screening, and responses within mental health settings. Three databases were searched using these inclusion criteria: adults aged 18 and older accessing mental health services, samples comprising mental health professionals (or combination). No geographical restrictions were applied. All studies were peer-reviewed and published in English between January 2000 and December 2023. Studies had to incorporate screening for DA between (ex-)partners and/or response to disclosure within mental health settings. The findings revealed considerable variation in DA screening methods from direct screening tools to retrospective analyses of patient files. Professionals report barriers in identifying DA, including uncertainty about their role, time constraints, and the importance of building trust with service users. Nonetheless, many highlight the importance of routinely asking about DA. A small number of interventions have been effective in enhancing professionals’ readiness to address DA, but it remains unclear what format of training is most effective. Service users report feelings of shame and fear of not being believed when disclosing DA, but are aided by therapeutic engagement and enhanced professional awareness. There is a lack of diverse inclusion in the research. In summary, there is considerable scope to develop good practice to support mental health professionals’ ability to identify and respond to DA across assessment tool and training, but also in understanding what facilitates service users to disclose.
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Alpha-Stim AID Cranial Electrotherapy Stimulation (CES) anxiety and depression treatment for adults in a social prescribing service: anxiety and depression outcomesBackground: Generalised anxiety disorder (GAD) is common and can negatively impact people’s wellbeing and functioning. GAD treatment includes psychotherapy and/or anti-anxiety medication, which are not acceptable to or effective for many people experiencing GAD. Alpha-Stim AID cranial electrotherapy stimulation (CES) has evidence of effectiveness in the treatment of anxiety and depression. Purpose: Evaluation of Alpha-Stim AID on anxiety and depression for adults with GAD symptoms using a social prescribing service. Methods: An open-label patient cohort design with no control group. Twenty-six adult patients, 22 females and 4 males, with an age range of 24 to 68 years and an average age of 49 years, completed 6 weeks of Alpha-Stim AID use. Pre- and post-intervention assessments were undertaken using participant self-report measures: Generalised Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9). Results: Reliable improvement and remission rates were 42% and 19% for GAD-7; 38% and 27% for PHQ-9. GAD-7 and PHQ-9 significantly improved with large effect sizes. Conclusions: A social prescribing service can offer, and patients will choose to use Alpha-Stim AID, which may be useful in the treatment of anxiety and depression. This study addresses the need for real-world data on Alpha-Stim AID in relation to response rates. It contributes to how Alpha-Stim Aid can be used in social prescribing services, including through a group-based pathway.
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Self-administered “Flow” Transcranial Direct Current Stimulation (tDCS) depression treatment in a Crisis Resolution and home Treatment (CRT) service: functioning, and health-related quality of life outcomesBackground: Transcranial direct current stimulation (tDCS) has research evidence that it can reduce symptoms of depression. Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application that delivers wellbeing behaviour therapy training. Purpose/aim: The purpose of this study was to investigate if Flow can be introduced to a Crisis Resolution & Home Treatment (CRT) service and the impact of Flow in treating depression. The study addresses the questions: 1) “what are the depression reliable improvement and remission rates?” and 2) “can Flow significantly reduce depressive symptoms and improve real world functioning (every-day, social and occupational functioning) and health-related quality of life?”. Methods: An open-label patient cohort design with no control group. Pre-intervention and 6-week follow-up intervention assessments using the participant self-report measures: Patient Health Questionnaire (PHQ-9), Work and Social Adjustment Scale (WSAS), and EuroQol five-dimension (EQ-5D-5L). Participants were 49 CRT patients, 19 males and 30 females, with an age range of 20 to 66 years, and average age of 42 years. Results: PHQ-9 reliable improvement and remission rates were 57.1% and 14.3%. PHQ-9 scores significantly improved, from 23.1 (SD 3.44) to 14.8 (SD 6.82) at 6 weeks, with a large effect size. PHQ-9 suicide/self-harm related question significantly improved from 2.51 (SD 0.77) to 1.08 (SD 1.17), with a large effect size. WSAS scores significantly improved, from 33.6 (SD 5.22) to 21.9 (SD 10.82) at 6 weeks, with a large effect size. EQ-5D-5L results showed significant improvements in the health index score, global assessment of health EQ-VAS from 34.2 (22.26) to 51.6 (24.95), and three EQ-5D-5L dimensions (“self-care”, “usual activity”, and “anxiety/depression”). Conclusion: A CRT service effectively integrated Flow tDCS treatment. Flow was beneficial in terms of improving functioning and quality of life and reducing depression symptoms and thoughts of suicide/self-harm. Flow FL100 tDCS and wellbeing behaviour therapy training could be offered through all CRT services to treat depression, reduce thoughts of suicide/self-harm, enable better functioning, and improve quality of life.
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“Well-Track” healthy lifestyle (physical activity, sleep hygiene, diet, wearable activity tracker) coaching in Severe Mental Illness (SMI)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.
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Apprenticeships and T-levels: an alternative pathway into health careThis article explores Northamptonshire Healthcare Foundation Trust’s (NHFT’s) innovative approach to addressing workforce challenges in the healthcare sector through apprenticeships and T-levels. NHFT offers various apprenticeship opportunities, ranging from entry-level healthcare support roles to pre-registration and post-registration nursing across different specialties. The article also looks at NHFT’s collaborations with local educational institutions and primary care training hubs to provide pathways for individuals who transitioned from different careers into nursing through apprenticeships. Additionally, the introduction of T-levels offers younger people practical experience in health care alongside classroom learning, opening pathways into nursing careers. The benefits of apprenticeships in providing financial support, practical experience, and career progression are highlighted. Overall, these alternative pathways play a crucial role in developing and retaining local healthcare professionals, addressing workforce challenges and reducing reliance on international recruitment.
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“Flow” Transcranial Direct Current Stimulation (tDCS) for depression treatment in a primary healthcare general practice — an open-label cohort study measuring Montgomery-Åsberg Depression Rating Scale (MADRS-S) outcomes.Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression Rating Scale (MADRS-S). Results: MADRS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADRS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.
