Islamophobia: A British Muslim Perspective

Elimination of restrictive practices (physical/mechanical restraint and seclusion) from adult acute mental health care services has been demanded internationally for many decades. This study aimed to: (1) Identify priority issues in the elimination of and use of alternative approaches to restrictive practices (seclusion and physical/mechanical restraint) in rural/regional acute adult mental healthcare services, as told by mental healthcare service users and practitioners, (2) identify the community-based, system-level feedback loops that enhance or reduce the use of restrictive practices and viable alternatives and, (3) identify potential action areas to improve system structures to increase regional mental healthcare services' ability to eliminate restrictive practices and use alternative approaches. Group model building (GMB) workshops were held with a small group (n = 9) of mental healthcare practitioners and service users with lived experience of restrictive practice use. This participatory approach enables exploration and visual mapping of local structures causing behaviour patterns of practitioner and service user concern over time - in this case, the barriers, and enablers to alternative approaches to restrictive practices in adult acute mental healthcare services within the Geelong-Barwon region. This is the first study that specifically applies GMB in the discussion of the elimination of restrictive practices in mental health in the non-metropolitan regional/rural context. Participants identified four key priorities in relation to eliminating restrictive practices: (1) self-advocacy, (2) continuity of care, (3) early intervention, and (4) safety for all. The study findings were distilled into a novel preliminary set of mental healthcare practitioner and service user action ideas.

Valuing quality in mental healthcare: A discrete choice experiment eliciting preferences from mental healthcare service users, mental healthcare professionals and the general population

BACKGROUND There have been suggestions that electronic health records (EHRs) should be expanded beyond clinical mental health care services to a broader array of care services that support mental health service users, which we call an integrated electronic care record (IECR). Previous research has considered service users’ general views on information being stored and shared via an EHR. However, little consideration has been given to service users’ attitudes toward how EHRs should be used in the provision of care or the concept of an IECR. OBJECTIVE This study aimed to understand mental health care service users’ perspectives on an IECR and how it should be used in practice when receiving care. METHODS Ten people with lived experience of accessing multiple services in Australia’s mental health care system were provided with 2 vignettes that depicted fictional service users making decisions about an IECR. Participants were asked to respond to several scenarios that the fictional service users might experience in their journey through the mental health care system with an IECR. Participants provided written responses and took part in a semistructured interview to discuss their responses. An interpretative phenomenological analysis was undertaken, which led to 5 major themes and 15 subthemes being developed. RESULTS Service users wanted an IECR that they had control over, supported them as equal partners in their care, and contributed toward more collaborative and proactive mental health care. However, participants were concerned that care professionals’ perspectives would be privileged in the IECR and overshadow service users’ needs. Participants also had concerns that stigmatizing and discriminatory information documented in their IECR would negatively impact their interactions with the mental health care system and their access to care. Participants saw value in an IECR bringing together information to support collaborative and proactive care. However, participants thought that the benefits of the IECR had to be balanced with potential risks to their privacy. Participants thought that the IECR should contain only information relevant to their care and should be shared only with relevant care professionals. There were concerns that service users might lack the skills, resources, and information required to manage their IECR. CONCLUSIONS An IECR has the potential to fill the gaps in an increasingly complex and fragmented mental health care system but risks entrenching service users’ experiences of stigma and discrimination unless service users are meaningfully involved in their IECR.

Aim of the studyTo analyze mental health anti-stigma campaigns in the post-Communist region and identify their main patterns and characteristics.Subject or material and methodsQualitative interviews with nine experts from the national mental health care service user organizations from the post-Communist countries.ResultsThe paper presents the situation of mental health care in the region, identifies and discusses peculiarities of local mental health anti-stigma campaigns and presents findings of the qualitative experts’ research. It reveals a twofold positive effect of mental health service users’ activism, which has an individual therapeutic effect as well as helps fight stigma.DiscussionMental health service users' activism echoed the trends in Western countries. Yet in the post-Communist region, these initiatives emerged, developed and evolved over a concentrated period of time. Given such circumstances, certain mental health activists have preserved the institutional and evolutionary memory of the paradigm change from its very beginning in the early 90s. Mental health service users’ activism has a twofold positive effect because it is both useful for their own personal healing, growth, and self-realization as well as for fighting stigma at societal level.ConclusionsIn some countries such activism has failed to reveal its full potential due to lack of financial resources, widespread stigma and lack of leadership abilities. This gap is partially filled in by the human rights and mental health advocacy organizations. Nevertheless, their initiatives and advocacy campaigns insufficiently reveal mental health care service users' perspectives. This leads to certain tensions between both types of organizations, while service users feel being manipulated, publicly stripped and exploited.

BackgroundThere have been suggestions that electronic health records (EHRs) should be expanded beyond clinical mental health care services to a broader array of care services that support mental health service users, which we call an integrated electronic care record (IECR). Previous research has considered service users’ general views on information being stored and shared via an EHR. However, little consideration has been given to service users’ attitudes toward how EHRs should be used in the provision of care or the concept of an IECR.ObjectiveThis study aimed to understand mental health care service users’ perspectives on an IECR and how it should be used in practice when receiving care.MethodsTen people with lived experience of accessing multiple services in Australia’s mental health care system were provided with 2 vignettes that depicted fictional service users making decisions about an IECR. Participants were asked to respond to several scenarios that the fictional service users might experience in their journey through the mental health care system with an IECR. Participants provided written responses and took part in a semistructured interview to discuss their responses. An interpretative phenomenological analysis was undertaken, which led to 5 major themes and 15 subthemes being developed.ResultsService users wanted an IECR that they had control over, supported them as equal partners in their care, and contributed toward more collaborative and proactive mental health care. However, participants were concerned that care professionals’ perspectives would be privileged in the IECR and overshadow service users’ needs. Participants also had concerns that stigmatizing and discriminatory information documented in their IECR would negatively impact their interactions with the mental health care system and their access to care. Participants saw value in an IECR bringing together information to support collaborative and proactive care. However, participants thought that the benefits of the IECR had to be balanced with potential risks to their privacy. Participants thought that the IECR should contain only information relevant to their care and should be shared only with relevant care professionals. There were concerns that service users might lack the skills, resources, and information required to manage their IECR.ConclusionsAn IECR has the potential to fill the gaps in an increasingly complex and fragmented mental health care system but risks entrenching service users’ experiences of stigma and discrimination unless service users are meaningfully involved in their IECR.

Purpose: The paper documents the views of South African mental health care service users on policy directions and service developments that are required to support their recovery. Method: Semi-structured interviews were conducted with forty service users and service user advocates. A framework analysis approach was used to analyse the qualitative data. Results: Service user priorities included addressing stigma, discrimination and disempowerment, and the links between mental health and poverty. They suggested that these challenges be addressed through public awareness campaigns, legislative and policy reform for rights protection, development of a national lobby to advocate for changes, and user empowerment. Users suggested that empowerment can be facilitated through opportunities for improved social relatedness and equitable access to social and economic resources. Conclusions: This study suggests three strategies to bridge the gap between mental health care service users rights and needs on one hand, and unsupportive attitudes, policies and practices on the other. These are: giving priority to service user involvement in policy and service reform, creating empathic alliances to promote user priorities, and building enabling partnerships to effect these priorities.Implications for RehabilitationPeople living with psychosocial difficulties have a right to involvement in policy and service development, and their involvement has value for their recovery.The range of priorities people living with psychosocial difficulties identify as policy and service priorities to support their recovery requires policy makers and practitioners to work within a development, not an illness-focused approach.Policy implementers and practitioners need support to transform their ideological and practice framework from that of expert to that of enabler of service user involvement in treatment decisions, and public policy research and service development.

A key feature of South Africa's state health care strategy since 1994 has been the development and expansion of services towards integrated health care at primary health care level. Within the new system, emphasis has been on the integration of patients with mental health care needs with other patients where multiple health conditions and needs would be addressed simultaneously. As part of a larger study into mental health care in a predominantly rural district, we investigated the experiences of facility managers and mental health service users in rural clinics within the system of care. We were interested both in their views as to the advisability of the integrated model and the ways in which they managed any challenges they may have experienced within the system at local level. Data were collected through once-off semi-structured interviews with facility managers and mental health care service users to gather qualitative information. Narratives were transcribed and translated into English. Transcriptions were imported to Atlas.ti 22 and analysed through Thematic Analysis. The integration of mental health care into routine primary health services poses challenges to treatment delivery and to patients who come for treatment. Our study also suggests resegregating mental health care as a possible solution to facilitate service delivery and treatment to service users. This research provided first insights into facility managers' and service users' views of integrated mental health care at primary health care level in this district. While mental health care services have been expanded and integrated into primary health care over recent years, the system may not have been as streamlined as in other parts of the country. The integration of mental health into primary health care can pose various challenges to facilities, health care providers, and mental health service users. Managers in these constrained circumstances have observed that resegregating mental health care from physical treatment, as in the past, may be deemed more effective for health care provision and reception. Generalised integration of mental health treatment with physical care should be approached with caution unless there is wider scale provisioning and greater organisational change.

Lifelong learning is recognized as an important tool to reduce social exclusion, but out of the many investigations into the provision of lifelong learning in Europe none has yet sought to examine the specific situation of mental health care service users. This study examines the provision of lifelong learning for this disadvantaged group; it identifies current policies and explores the access to, and nature of, lifelong learning practices for mental health care service users in eight European countries. Data have been collected through a literature and policy review and through questionnaires completed by mental health practitioners in the eight countries. The study found broad compliance amongst the eight countries with the Lisbon policy goals on lifelong learning, but evidence of specific lifelong learning provision for mental health care service users is patchy and sporadic. The study identified the main benefits of, and the barriers to, the participation in lifelong learning for mental health care service users from the viewpoint of mental health professionals and practitioners. The implications for practice were described, and suggestions for actions were made for improving the lifelong learning provision for the target group.

In this article, we discuss what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this conduct in a detached sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing.

This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder,...

BackgroundOn average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI).MethodsData collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff (n= 18) and CMHT staff (n=4), a focus group with CMHT staff (n=8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data.ResultsThe results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and mental health.ConclusionThere is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI.

When we face an equation with an unknown variable, we 'solve for x', using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. This paper investigates what Erving Goffman called the 'stigma situation': 'the situation of the individual who is disqualified from full social acceptance.'The core argument is that to successfully incorporate the experiential knowledge of mental health care service users, we must first solve for stigma-that is, we must determine the nature and scope of its significance, and then mitigate its effects. The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.

Persons with substance use disorders (SUD) make up a considerable proportion of mental health care service users worldwide. Since 2010, Belgian mental health care has undergone a nationwide reform ('Title 107') aiming to realize a mental health care system that fosters more intensive collaboration, strengthens the cohesion and integration across and between different services, and is more responsive to the support needs of all service users. Although persons with SUD were named as a prioritized target group, how this reform impacted the lives and recovery journeys of persons with SUD remains understudied. This study aims to investigate how persons with SUD, regardless of whether they have co-occurring mental health issues, experience the accessibility of mental health care in light of the 'Title 107' reform. Data were collected by means of in-depth interviews with a heterogeneous sample of persons with SUD (n=52), recruited from five regional mental health networks in Belgium. In-depth interviews focused on experiences regarding (history of) substance use, accessibility of services and support needs, and were analyzed thematically. Five dynamic themes came to the fore: fragmentation of care and support, the importance of "really listening", balancing between treatment-driven and person-centered support, the ambivalent role of peers, and the impact of stigma. Despite the 'Title 107' reform, persons with SUD still experience mental health care services as 'islands in the stream', pointing to several pressing priorities for future policy and practice development: breaking the vicious cycles of waiting times, organizing relational case management, tackling stigma and centralizing lived experiences, and fostering recovery-promoting collaboration.

Given the intricate link between the soma and the psyche, this study sought to identify whether the presence of physical co-morbidities among sufferers of depression altered the impact of computerised cognitive behavioural therapy (CCBT). Five-hundred-and-ninety service users used Beating the Blues (BtB) - an established CCBT programme - in an NHS specialist CBT unit. A control group, a standard intervention group, and a physical co-morbidity intervention group were compared on pre- and post-Beck Depression Inventory II (BDI-II) scores. Statistically significant differences on the BDI-II were found between the control group and each of the intervention groups, but not between the intervention groups themselves. A quarter of BtB completers in each intervention group achieved reliable and clinically significant change and were said to be ‘recovered.’ A further 23.8 per cent of the standard intervention group and 26.8 per cent of the physical co-morbidity group showed reliable improvement. These findings provide compelling evidence that CCBT may be of value to service users presenting with a variety of physical co-morbidities and depression at all levels of mental health care.

There is growing consensus that consideration of the Social Determinants of Mental Health should be at the centre of mental health care provision. To facilitate this, a validated means to assess mental health service users' social contextual information is arguably needed. We therefore developed a questionnaire to assess the Social Determinants of Mental Health in clinical practice. Our guideline-informed development consisted of three steps; i) construct and purpose definition, ii) initial item generation based on the literature, similar questionnaires, and a selection of the ICD-10, iii) evaluation, revision, and content validation of the questionnaire. Initially we developed 249 items that were reduced, revised, and validated in several stages to 73 items. Content validation of the questionnaire was achieved through surveys and focus groups including mental health care service users and professionals. The surveys and focus groups indicated the need for a standardised assessment of adverse social factors and highlighted that the benefits of such an assessment would be a more holistic approach to identifying and addressing fundamental factors involved in the development of mental health difficulties. Importantly, this study also revealed how any assessment of the Social Determinants of Mental Health must prioritise the assessed person having a central role in the process and control over their own data. The focus groups identified contradicting recommendations regarding the most suitable context to administer the questionnaire. The resulting questionnaire can be considered to be theoretically robust and partially validated. Future research is discussed.