Crisis Point Research Articles

Navigating the COVID-19 pandemic two years on: experiences of carers of people with dementia from the British IDEAL cohort

We explored carers’ experiences during the COVID-19 pandemic in England to identify long-term impacts and implications, and to suggest future support for caregivers. Data were collected during COVID-19 rapid response studies from carers participating in a British longitudinal cohort study. Semi-structured interview data were compared to accounts from previous interviews conducted during the first 18 months of the pandemic. There was indication of some return to pre-pandemic lifestyles, but without appropriate support, carers risked reaching crisis point. Evidence points to a requirement for assessment and management of support needs to ensure well-being and sustainable dementia caregiving.

Mapping the insomnia patient journey in Europe and Canada.

Insomnia affects daily functioning and overall health, and is thus associated with significant individual, societal, and economic burden. The experience of patients living with insomnia, their perception of the condition, and its impact on their quality of life is not well documented. The objective of this study was to map the patient journey in insomnia and identify unmet needs. Participants were individuals with insomnia, and healthcare professionals (HCPs) who treat insomnia, in the United Kingdom, France, Germany, Italy, and Canada. Qualitative interviews (50 patients, 70 HCPs) and a quantitative survey (700 patients, 723 HCPs) were conducted to inform the patient-journey mapping and obtain information on the emotions, perceptions, and experiences of patients and HCPs. The patient journey comprises seven phases. The first defines the onset of insomnia symptoms. Phase 2 represents self-initiated behavior change to improve sleep (e.g., sleep hygiene, reducing caffeine, exercise). The next phase is characterized by use of over-the-counter (OTC) treatments, which generally fail to provide lasting relief. Phase 4 describes the first HCP consultation (occurring several months to several years after onset) and typically occurs at a crisis point for the patient; patients may be looking for an immediate solution (e.g., medication), which may not align with their HCP's recommendation. The following stage comprises sleep hygiene/behavioral changes (±OTC treatment) under HCP guidance for many patients, although offering prescription treatments without a sleep hygiene stage under supervision is more common in some countries. Phase 6 describes prescription medication initiation, where patients fluctuate between relief/hopefulness and a sense of failure, while HCPs try to balance the need to provide relief for the patient while maintaining best medical practice and minimizing adverse effects. The final phase (living with long-term insomnia) represents an indefinite period during which sleep issues remain unresolved for many patients, with most of them continuing to use prescription treatments for longer than indicated and creating their own variable, self-managed regimens combining multiple modalities. This patient journey analysis for insomnia revealed seven distinct phases, highlighting different touchpoints where insomnia management could be optimized.

Evaluating a Smartphone App (MeT4VeT) to Support the Mental Health of UK Armed Forces Veterans: Feasibility Randomized Controlled Trial.

Previous research demonstrates that less than 50% of military veterans experiencing mental health difficulties seek formal support. Veterans often struggle to identify problems as mental health difficulties. In addition, they may fail to recognize the need for support before reaching a crisis point and face difficulties navigating care pathways to access support. A feasibility trial was conducted to assess a novel digital smartphone app (Mental Health Toolkit for Veterans Project [MeT4VeT]) for UK Armed Forces (UKAF) veterans experiencing mental health difficulties. The trial aimed to explore the feasibility and acceptability of trial procedures for a later randomized controlled trial (RCT) and to assess the acceptability of the MeT4VeT app. Participants were recruited at UK military medical centers, by advertising on social media, and through veteran third-sector organizations between February and November 2021, and assessed for eligibility (male, owned a smartphone, served at least 2 years in the UKAF, left the UKAF within the last 2 years, not undertaking formal mental health treatment). Eligible participants were assigned, on a 1:1 ratio, to either the intervention group (full app) or a control group (noninteractive app with signposting information). Three key objectives were determined a priori to assess the practicality of running an RCT including an assessment of recruitment and retention, evaluation of the technical app delivery and measurement processes, and acceptability and usability of the intervention. In total, 791 individuals completed the participant information sheet, of which 261 (33%) were ineligible, 377 (48%) declined or were unable to be contacted for consent, and 103 (13%) did not download the app or complete the baseline measures. Of this, 50 participants completed baseline measures and were randomly assigned to the intervention group (n=24) or the control group (n=26). The trial was effective at enabling both the technical delivery of the intervention and collection of outcome measures, with improvements in mental health demonstrated for the intervention group from baseline to the 3-month follow-up. Recruitment and retention challenges were highlighted with only 50 out of the 530 eligible participants enrolled in the trial. The acceptability and usability of the MeT4VeT app were generally supported, and it was reported to be a useful, accessible way for veterans to monitor and manage their mental health. The results highlighted that further work is needed to refine recruitment processes and maintain engagement with the app. Following this, an RCT can be considered to robustly assess the ability of the app to positively affect mental health outcomes indicated within this trial. ClinicalTrials.gov NCT05993676; https://clinicaltrials.gov/ct2/show/NCT05993676.

Strengths-based Approaches—Perspectives from Practitioners

Abstract Despite its popularity, relatively little is known about strengths-based approaches in adult social work. In order to explore how strengths-based models and approaches are developed and implemented in social work and social care in England, and how these models are impacting practice, a two-stage project was conducted between December 2020 and October 2021. An online survey was completed by thirty-two respondents and a sub-sample of ten semi-structured interviews were conducted with social work and social care professionals involved in organising, managing, delivering or commissioning strengths-based approaches. The majority of participants were social workers. A range of positive outcomes were reported including improved reported well-being and satisfaction for people accessing services and enriched interactions (greater empathy, trust, better rapport), particularly for social workers. Challenges included incompatibility of systems and organisational structures; workload pressures and a depleted workforce; limited resources and applying the model at crisis point. The principles and values associated with adopting a strengths-based approach appear consistent with providing high-quality social work. The challenge for researchers—and to some extent practitioners—is how to meaningfully capture the nuanced impact of such a multi-dimensional approach. The challenge for policy is how to operationalise and replicate the benefits.

OO-MA-KP-ABE-CRF: Online/Offline Multi-Authority Key-Policy Attribute-Based Encryption with Cryptographic Reverse Firewall for Physical Ability Data

In many universities, students’ physical ability data are collected and stored in the cloud through various sensing devices to save computational and storage costs. Therefore, how to effectively access data while ensuring data security has become an urgent issue. Key-policy attribute-based encryption (KP-ABE) not only enables secure one-to-many communication and fine-grained access control but also adapts to data sharing in static scenarios, making it more suitable for the cloud sharing of physical ability data. In this paper, we construct an online/offline multi-authority key-policy attribute-based encryption with a cryptographic reverse firewall for physical ability data. This scheme uses multi-authority to avoid the single point of failure crisis of a single authority, and is combined with a cryptographic reverse firewall to resist backdoor attacks. In addition, the scheme uses outsourcing decryption to save users’ computing costs, and utilizes offline/online technology to move a large amount of computing offline, reducing the online burden. Finally, the experiment shows the feasibility of the scheme.

MENTAL HEALTH IN SCHOOLS

With a growing number of children and young people facing probable mental health disorders, schools are in a unique position to address pupils' wellbeing before conditions reach crisis point

The Grammar of Belonging: Bodies, Borders and Kin in the Belarusian—Polish Border Crisis

This article aims to be what Jasbir Puar referred to as ‘an unfolding archive’. It makes a critical intervention at a historical crisis point as it is unfolding. It sets out to examine the logic that writes the relations between bodies, borders and kin during the political crisis that transpired at the border of Belarus and Poland in 2021. I think of this logic in terms of a ‘grammar’, drawing on the idea articulated by Hortense J. Spillers, where ‘American grammar’ fleshes out the connection between slavery, kinship, nation-building and the processes of gendering. I examine the rubrics of the hegemonic national grammatics in contemporary Poland, which establishes who counts as kin and who belongs to the nation in the context of the border crisis. I offer the concept of ‘declining’ kinship to seek generative (im)possibilities to articulate affinities and solidarities running against the dominant system of reproductive nationalism.

Intersectional Edges in Adrienne Kennedy’s Funnyhouse of a Negro and The Owl Answers

This article aims to explore intersectional boundaries in the construction of formations through the analysis of Adrienne Kennedy’s plays, Funnyhouse of a Negro (1964) and The Owl Answers (1965) Intersectionality challenges the axes of power by interrogating the experiences of the marginal voices who are exposed to simultaneous and interactive oppression. Positions of the disadvantaged identities predetermined through cultural construction in these plays reveal the discrimination debates at a junction where identity crisis points out what it means to be both black and woman, and the denial of intersections to keep the differences alive. The juxtaposition of intersectional voices against privileged ones provides a lens through which one can understand the systematic nature of oppression and inequality. One’s being aware of her/his own position means realizing how confronted identities are constructed and positioned. Thus, trying to struggle against domination and invisibility in such a construct draws a road map of a journey to self-definition and required consciousness to resist. Within the framework of intersectionality, the present study offers a focus on black females’ experience and social and political consequences of a culturally adapted construction through race, gender, sex, and class.

Now is the time to fix the clinical research workforce crisis.

The clinical and translational research enterprise is recognized by many as the "evidence generation system." While there have been several calls to revolutionize this enterprise to more effectively deliver the fruits of biomedical science to patients and society, significant issues across the clinical research workforce are pervasive. Perhaps the most visible sign is the widening gap between supply and demand for competent staff. Underpinning this, is a perfect storm of complex issues. Now reaching crisis point, this problem is far bigger than a staffing issue and ultimately jeopardizes the "engine" of drug and device development. With the current perilous state of the workforce, proposed enterprise fixes are likely to languish far out of reach, given that even "business as usual" is under threat. In fact, a glaring disconnect is evident between the visionary discourse on how to revolutionize the clinical research enterprise and the sober recognition that operationalization of any such vision rests on the shoulders of a workforce that's in dire straits. In this article, we provide a brief forensic analysis of the workforce problem and an initial indication of where solutions may lie.

Strategies to Prevent Suicide and Attempted Suicide in New South Wales (Australia): Community-Based Outreach, Alternatives to Emergency Department Care, and Early Intervention

Background: This study describes the development of a system dynamics model to project the potential impact of a series of proposed suicide prevention interventions in New South Wales (NSW, Australia) over the period 2016 to 2031. Methods: A system dynamics model for the NSW population aged ≥ 20 years which represented the current incidence of suicide and attempted suicide in NSW was developed in partnership with a consortium of stakeholders, subject matter experts, and consumers with lived experience. Scenarios relating to current suicide prevention initiatives were investigated to identify the combination of interventions associated with the largest reductions in the projected number of attempted suicide and suicide cases for a 5-year follow-up period (2019–2023). Results: The largest proportion of cases averted for both suicide and attempted suicide over the intervention period was associated with community-based suicide prevention outreach teams and peer-led drop-in facilities (6.8% for attempted suicide, 6.4% for suicide). A similar proportion of potential cases averted of both attempted suicide and suicide (6.4%) was evident for targeted interventions focusing only on those in the population with suicidal thoughts and a previous history of attempted suicide. Conclusion: Initiatives that are characterised by the short-term stabilisation of suicidal distress at the point of crisis, averting the need for a hospital encounter, and the referral of individuals to non-acute community-based care were associated with the largest potential reductions in suicidal behaviour in NSW.

The shifting issue content of left–right identification: cohort differences in Western Europe

Over the last decades, the rising salience of new issues has transformed politics in Western Europe. How has this transformation affected citizens’ left–right identities? This study shows how new issues have become integrated into the meaning of left–right among Western Europeans through generational replacement. Mechanisms of political socialisation and elite cue taking imply that how strongly an issue is associated with left–right identities should reflect this issue’s politicisation during a cohort’s formative years. In line with this, an analysis of the European Social Survey for 12 Western European countries from 2002 to 2018 reveals that environmental protection and immigration attitudes are more strongly associated with left–right positions among those born later. Attitudes towards redistribution tend to be less relevant within more recent cohorts in some countries, though period effects after the European debt crisis point in the opposite direction. This study enhances our understanding of the evolution of political conflict.

Hong Kong in Transition: Photography and Liberation at the End of the Pacific War

Abstract This article thinks with and against photographs taken by British military photographers in Hong Kong at the end of World War II, during the transition from Japanese back to British colonial rule. Building on Lisa Yoneyama's account of the “postwar settlements” through which “the war's meaning” was defined and contained, I situate the photographs as part of a broader British effort to reassert the legitimacy of colonial rule at a crisis point for empire by refiguring Asian liberation as an affordance, or synonym, of British (re)occupation. At the same time, I read the photographs for what they can tell us about the liberatory knowledges that Asian colonial subjects had cultivated, or might have, throughout years of war and occupation. In this way, the article meditates on the predicaments of liberation in an Asian place where the horizon of decolonization continues to be difficult to discern, focusing on the care work necessary for survival as a crucial site and practice of liberatory political imagining.

Changing the culture for the future: time to take brain drain in academics seriously.

Many trainees (see Glossary) pursue academic careers because of the freedom of independent/critical thinking, intellectual satisfaction of creativity and imagination, and the responsibility of mentoring the next generation of scholars. While all of these qualities are still inspiring, and a society always needs minds of critical and creative thinking, we are approaching a crisis point in academia, especially in the life sciences [1–3]. In addition to an already increasingly demanding system of publication and promotion, the recent pandemic has taken a scorching toll, particularly on young researchers [4,5].

Homelessness and primary care: Problems and solutions

As the housing circumstances of a person or family become uncertain, they often encounter a variety of people and services before losing their home. Each point of contact can be an opportunity to identify or prevent homelessness. They might have a social worker, attend addiction services, visit a food bank, or contact their GP. GP practices are embedded in local communities, and with many daily patient contacts primary care has potential to connect those at risk with appropriate services before a crisis point.

Young people face ‘unacceptable’ delays in eating disorder services

NHS waiting times to access treatment for eating disorders are at crisis point following the pandemic, with experts warning that delays could be putting children's lives at risk and need to be tackled urgently

Challenging perceptions of fast and slow in contemporary fashion: A review of the paper dresses trend in the United Kingdom and the United States during the 1960s

Writing in 2022 we are at a global crisis point, as our use of the planet’s finite resources outstrips supply. Our current lifestyles continue to perpetuate this problem by encouraging excessive and wasteful models of consumption. One of the most detrimental industries for this is the clothing industry. Our fashion cycle is now programmed to be ‘ultra-fast’, encouraging excessive consumption of garments causing myriad environmental issues. This article argues that there are developing models of both manufacture and consumption, which can satiate this need for ‘fast’ fashion whilst being part of the wider sustainable fashion conversation. Rather than understanding the short-term life cycle of clothing as inherently unsustainable, this can be reframed as matching a garment’s use phase to the longevity of the material it is made from. This article uses a material culture approach to explore original 1960s paper garments, alongside a critical analysis of the sustainability of their manufacture and disposal from a green chemical perspective. Using the combined knowledge and experience of its authors, from historians and sustainable fashion designers to green chemists and biochemical engineers, this article demonstrates how such garments could inspire new models of sustainable fashion production and consumption. We argue that the current paradigm of slow fashion as the only antidote to fast fashion must be challenged. Instead, the fashion and textile sector must consider a range of solutions to the environmental burden of fast fashion that are human-centred and sympathetic to all consumer demographics and needs.

The Debate on Reforms of the WTO Appellate Process: A Proxy for a More Serious Discussion of the Future of the WTO

Thirty years after its founding, the WTO is experiencing unprecedented turmoil and uncertainty, as the United States has raised questions relating to its national sovereignty and expressed serious doubts about the effectiveness of multilateralism. Perhaps more importantly, United States representatives have questioned the fairness of Appellate procedures that appear to run counter to the interests of the United States. A recent dispute between Hong Kong and the United States over the question of the “branding” of goods emanating from the customs territory of Hong Kong has served as a “crisis point” or proxy to the larger dispute between the United States and China relating to needed reforms in the organization. How this dispute is resolved may go a long way in determining both the future of multilateralism and the participation of the United States in the World Trade Organization itself.

Causes of Ecological Crisis and the Necessity of Ecological Education in the Encyclical Laudato Si’

The modern ecological crisis that today radically affects people and the nature reveals the deeper causes that lie within people themselves. First of all, people no longer understand themselves in the key of creation, they no longer understand themselves and the created world as gifts from the Creator, but are intoxicated with power combined with technology and science in the instrumental-rational key and understand themselves as the sole creators of their own fates. Relying on the hermeneutic key to understanding creation, Pope Francis starts from the Creator and exposes this crucial anthropological fallacy, the price of which has unforeseeable effects on the created reality. The paper points out the fundamental problems and difficulties of the modern ecological crisis, seeking to show that it is actually hidden in the crisis of the humanity. Following the contemplations and ideas that Pope Francis presented in the encyclical Laudato Si’, the paper seeks to highlight the neuralgic points of the contemporary ecological crisis by showing ways out of the labyrinth of anthropological self-sufficiency. The need for and importance of education for environmental awareness, i.e., a responsible, mature and moral approach to created reality, are emphasized. In the final part of the paper, the rapprochement to freedom is highlighted, in line with the human dignity that has its source in God the Creator. Answering the question of why ecological education is important and crucial, the conclusion shows that it is the only right path of authentic humanity that bears the mark of creation in God’s image, and that people are called to act responsibly towards the created reality.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

Review: Crisis responses for children and young people - a systematic review of effectiveness, experiences and service organisation (CAMH-Crisis).

In England, one in six children aged 5-19 has a probable diagnosable mental health disorder. This is a major public health problem, with multiple agencies adopting varying approaches to care delivery for children and young people (CYP) in crisis. To examine the organisation of crisis services across education, health, social care and voluntary sectors; the experiences and perceptions of CYP, families and staff; the effectiveness of current approaches to care and the goals of crisis intervention. A systematic review of all relevant English language evidence regarding the provision and receipt of crisis support for CYP aged 5-25 (PROSPERO-CRD42019160134). Seventeen databases were searched from 1995 to 2021 and relevant UK-only grey literature was identified. Critical appraisal was conducted using appropriate design specific appraisal tools. A narrative approach to synthesis was conducted. In total, 138 reports (48 reports covering 42 primary research studies; 36 reports covering 39 descriptive accounts of the organisation services and 54 UK-only grey literature reports) were included. The evidence suggests that crisis services were organised as follows: triage/assessment-only, digitally mediated support approaches, and intervention approaches and models. When looking at experiences of crisis care, four themes were identified: (a) barriers and facilitators to seeking and accessing appropriate support; (b) what children and young people want from crisis services; (c) children's, young people's and families' experiences of crisis services; and (d) service provision. In determining effectiveness, the findings are summarised by type of service and were generated from single heterogenous studies. The goals of crisis services were identified. Despite a lack of high-quality international studies, findings suggest that support prior to reaching crisis point is important. From this work, various aspects of crisis care have been identified that can be incorporated into existing services across education, health, social care and the voluntary sector.