Irish Mental Health Service Research Articles

Turning on “the Photographer Mind”: Experiences of Mental Health Service Users in a Tutor-Led Photography Group in an Irish Context

A photography group was established in one Irish mental health service during the Covid 19 pandemic to impact isolation, wellbeing, and recovery. This research explored the experience, benefits and challenges of group-based photography. Qualitative interviews were conducted with four participants and analyzed using Reflexive Thematic Analysis. Four themes were identified: a progression from beginner to amateur photographers; looking at the world with a photographer’s eye; working together as a photography team; and recognition of the interaction between occupation and wellbeing. The research indicates that photography can provide an immersive occupational experience and develop skills for people experiencing mental health challenges.

Using a Safety Planning Mobile App to Address Suicidality in Young People Attending Community Mental Health Services in Ireland: Protocol for a Pilot Randomized Controlled Trial.

Over 700,000 people die by suicide annually, making it the fourth leading cause of death among those aged 15-29 years globally. Safety planning is recommended best practice when individuals at risk of suicide present to health services. A safety plan, developed in collaboration with a health care practitioner, details the steps to be taken in an emotional crisis. SafePlan, a safety planning mobile app, was designed to support young people experiencing suicidal thoughts and behaviors and to record their plan in a way that is accessible immediately and in situ. The aim of this study is to assess the feasibility and acceptability of the SafePlan mobile app for patients experiencing suicidal thoughts and behaviors and their clinicians within Irish community mental health services, examine the feasibility of study procedures for both patients and clinicians, and determine if the SafePlan condition yields superior outcomes when compared with the control condition. A total of 80 participants aged 16-35 years accessing Irish mental health services will be randomized (1:1) to receive the SafePlan app plus treatment as usual or treatment as usual plus a paper-based safety plan. The feasibility and acceptability of the SafePlan app and study procedures will be evaluated using both qualitative and quantitative methodologies. The primary outcomes are feasibility outcomes and include the acceptability of the app to participants and clinicians, the feasibility of delivery in this setting, recruitment, retention, and app use. The feasibility and acceptability of the following measures in a full randomized controlled trial will also be assessed: the Beck Scale for Suicide Ideation, Columbia Suicide Severity Rating Scale, Coping Self-Efficacy Scale, Interpersonal Needs Questionnaire, and Client Service Receipt Inventory. A repeated measures design with outcome data collected at baseline, post intervention (8 weeks), and at 6-month follow-up will be used to compare changes in suicidal ideation for the intervention condition relative to the waitlist control condition. A cost-outcome description will also be undertaken. Thematic analyses will be used to analyze the qualitative data gathered through semistructured interviews with patients and clinicians. As of January 2023, funding and ethics approval have been acquired, and clinician champions across mental health service sites have been established. Data collection is expected to commence by April 2023. The submission of completed manuscript is expected by April 2025. The framework for Decision-making after Pilot and feasibility Trials will inform the decision to progress to a full trial. The results will inform patients, researchers, clinicians, and health services of the feasibility and acceptability of the SafePlan app in community mental health services. The findings will have implications for further research and policy regarding the broader integration of safety planning apps. OSF Registries osf.io/3y54m; https://osf.io/3y54m. PRR1-10.2196/44205.

“These are people just like us who can work”: Overcoming clinical resistance and shifting views in the implementation of Individual Placement and Support (IPS)

PurposeIndividual Placement and Support (IPS) is a recovery-based approach to support people with mental health difficulties back into employment. Embedding of IPS within the mental health Multi-Disciplinary Team (MDT) is a key component of IPS fidelity; however, few studies have examined how those involved with IPS implementation navigate this process. This article explores how IPS Employment Specialists (ES) and Occupational Therapist (OT) Managers integrated and embedded IPS within traditionally-oriented MDTs as part of a national reform program in the Republic of Ireland.MethodsThe study design was qualitative, descriptive with data collected through three focus groups with 17 IPS ESs and 11 OT Managers. Data were analyzed using thematic synthesis.ResultsThree key themes emerged from analysis. The first characterizes the context into which IPS landed, described as one marked by clinical resistance, doubt, and fear of risk. The second explores the strategies and factors that helped with the introduction of IPS into Irish mental health services. These included strategies, such as providing education and information about IPS and reassuring the MDT about IPS governance and IPS ES’ competencies. The evidenced-based nature of IPS and its attached accountabilities through IPS fidelity measures were perceived to be an important factor in its acceptance. The final theme encapsulates perceptions of how IPS impacted on the MDTs’ views of people with mental health difficulties. Findings suggest a shift in the ways in which MDTs view their clients. Initial fears about work capacity and risk shifted towards seeing people beyond the label of ‘service user’ and their diagnosis.ConclusionsIt is contended that IPS is an approach that allows practitioners to engage with real recovery-practice and may be one key to unlocking how a recovery approach can truly trickle down and embed itself within mental health service provision and support mental health system reform.

Creating alchemy within an Irish mental health service

Purpose This paper aims to describe a novel community development and how the synergies arising from the interaction of diverse perspectives (including arts and health, person centredness, co-production and shared leadership) have led to a transformative initiative for individuals and a local community in the Republic of Ireland. Design/methodology/approach This is a descriptive case study. It includes the personal narrative of an expert by experience who is one of the co-authors. Links to short digital films are also included along with references to internal evaluation documents and published literature. Reflections from the nurses who contributed to the initiative and a university academic are also incorporated. Findings A space in the community built around the principles of relational practice has evolved into an alchemical space, enabling creativity, recovery and well-being. The benefits arising out of this network of social relationships have contributed to personal recovery, integration with the local community and generated social capital. This has enhanced mental health and well-being locally. Practical implications Statutory Irish health policy is reflective of developments in health care internationally, with an emphasis on greater delivery of care in the community. This views citizens as active partners in the maintenance of their health and well-being. This case study illustrates how this has unfolded in practice in a rural mental health community context. Originality/value This paper adds to the evidence base that demonstrates the potential benefits of participation in the arts to individual recovery journeys. In addition, it shows that when arts and health perspectives coalesce with the wider domain of relational practice, the synergies arising contribute positively to the health and well-being of local communities.

Keyworker mediated enhancement of physical health in patients with first episode psychosis: A feasibility/acceptability study.

Early intervention for people experiencing first episode psychosis is a priority, and keyworkers are vital to such services. However, keyworkers' roles in addressing first episode psychosis patients' physical health are under researched. This study addresses this knowledge gap by evaluating a keyworker-mediated intervention promoting physical health among first episode psychosis patients. The study was informed by the Medical Research Council's Framework for Complex Interventions to Improve Health. First episode psychosis participants were recruited from three Irish mental health services. The intervention was evaluated in terms of its feasibility/acceptability. Feasibility outcomes were mixed (recruitment rate=24/68 [35.3%]; retention rate=18/24 [75%]). The baseline sample was predominantly male (M:F ratio=13:6; Med age=25 y; IQR=23-42 y). Common health issues among participants included overweightness/obesity (n=11) and substance use (smoking/alcohol consumption [n=19]). Participants' initial health priorities included exercising more (n=10), improving diet (n=6), weight loss (n=7) and using various health/healthcare services. The intervention's acceptability was evidenced by the appreciation participants had for physical health keyworkers' support, as well as the healthy lifestyle, which the intervention promoted. Acceptability was somewhat compromised by a low-recruitment rate, variable linkages between keyworkers and general practitioners (GPs) and COVID-19 restrictions. Physical health-oriented keyworker interventions for first episode psychosis patients show promise and further evaluation of such initiatives is warranted. Future interventions should be mindful of participant recruitment challenges, strategies to enhance relationships between keyworkers and GPs, and if necessary, they should mitigate COVID-19 restrictions' impacts on care.

Psychological Impact of the COVID-19 Pandemic on Mental Health Nurses

The aim of this research was to assess the psychological effects of the novel coronavirus disease (COVID-19) on mental health nurses. An internet-based questionnaire that included the Impact of Event Scale-Revised (IES-R) and the Zung Self Rating Anxiety Score (SAS) was used to assess the impact of the pandemic on the wellbeing of mental health nurses in an Irish mental health service. Among the nurses surveyed (n = 161), 12% of the participants had an overall IES-R score from 24 to 32 indicating that posttraumatic stress disorder (PTSD) was a clinical concern, while 38% had an overall IES-R score >32 indicating that PTSD was a probable diagnosis. The mean SAS score that had been converted to anxiety index scores was 40.78 (SD = 9.25). The results showed that 30% of mental health nurses experienced anxiety levels from moderate to extreme. Overall findings confirm that mental health nurses are experiencing psychological distress as a result of working during the COVID-19 pandemic. Nurses who were <30 years of age or who were in their current roles for less than a year or were ward-based and worked full-time, were most likely to be affected. Working during COVID-19 has not been routine work practice and for a cohort of workers who are already under pressure, the sacrifice in terms of general well-being has been immense. The offer of individualized psychological support for mental health nurses working during the pandemic should be both practical in nature and flexible enough to meet individual needs.

Exploring the experiences of mental health professionals engaged in the adoption of mobile health technology in Irish mental health services

BackgroundThe World Health Organization report that an estimated 793,000 people died by suicide in 2016 globally. The use of digital technology has been found to be beneficial in the delivery of Web-based suicide prevention interventions. Research on the integration of digital technology within mental health services has indicated that despite the proliferation of technology, engagement by patients and professionals in adopting such technology can be poor.ObjectivesThe current study aims to explore the experiences of 15 mental health professionals involved in integrating mobile health technology into their practice. A secondary aim was to identify the drivers and barriers to the adoption of such technology by mental health professionals, and to consider what theoretical models could best account for the data.MethodsSemi-structured interviews, conducted from July to October 2019, were used to explore the experiences of mental health professionals engaged in the adoption of mobile health technology within mental health services. Mental Health professionals and clinician managers working in HSE Child and Adolescent Mental Health, Adult Mental Health, and Primary Care Psychology services were recruited for the study. Qualitative interview data was transcribed and analysed using NVivo. Thematic Analysis was used to identify themes.ResultsFour major themes were identified: Accessibility, ‘Transitional Object’, Integration, and Trust. Within these 4 major themes, a total of 9 subthemes were identified: Service Accessibility, Immediate Access, Client Engagement, Adjunct-to-therapy, Therapeutic Relationship, Infrastructural Support, Enhancing Treatment, Trust in the Technology, Trust in the Organisation.ConclusionsOverall, Diffusion of Innovation Theory provides a useful theoretical framework which is consistent with and can adequately account for many of the Major and Subthemes identified in the data. In addition, ‘Transitional Objects’, a key concept within Object Relations Theory, could offer a means of better understanding how patients and professionals engage with digital technology within mental health services particularly.

Anxiety levels among health care workers within Irish mental health services during COVID-19: a survey

AimsThe aim of this survey was to assess any fluctuations in anxiety levels experienced by mental health workers during the COVID-19 pandemic and the association between these changes and variables of information dissemination, risk management, and managerial support.MethodA survey was created to assess variables of information dissemination, risk management, and managerial support. The GAD-7 was employed as measure for anxiety during and pre the pandemic The survey was conducted online via an anonymised questionnaire and disseminated by management through the heads of various disciplines within the mental health work force, using the local email portal in the Cork region. It was made available for research participation for a period of one month(JULY).Following this stage, the reported data were analysed utilizing paired samples t-test, Pearson's correlations, and a hierarchical regression. Demographic variables were controlled for during analysis.Result102 mental health healthcare workers participated in the survey (81.2% Female, 18.8% Male). The mean GAD-7 total scores for Pre-COVID-19 doubled in the during COVID-19 condition. The largest effect can be seen on the GAD-7 facet of “feeling afraid as if something awful might happen” with pre-COVID-19 GAD-7 mean scores more than quadrupling during COVID-19 conditions.Managerial support had a moderate negative relationship with GAD-7 scores during the COVID-19 pandemic. Information dissemination total scores also had a moderate positive correlation with managerial support total scores and perceived risk/safety total scores. There was no correlation found between the GAD-7 total scores during COVID-19 pandemic and Information dissemination total scores nor Risk/safety total scores. Childcare was a concern for 64% of staff that it was applicable to; 45% of these staff considered altering work hours; 17% reported issues from management regarding these requests.ConclusionMental health workers have seen a dramatic increase in anxiety since the COVID-19 pandemic, particularly in the context of expecting something bad to happen. Managerial support appears to be a protective factor for increased anxiety levels in this population. Childcare has been a predominant concern and altering working hours to accommodate this has been problematic for almost 1 in 5 mental health workers. Staff satisfaction with information dissemination positively affects perceived managerial support and perceived risk management.This study is limited by the utilization of a novel self-created measure for examining variables specific to the COVID-19 pandemic and to the employment of a retrospective measure to obtain baseline anxiety scores of staff members before the pandemic.

Nursing leadership in response to the COVID-19 crisis in an Irish independent mental health service

Mental health nurses have been at the forefront of adjusting practice during the COVID-19 pandemic through novel means, including the delivery of technology-mediated interventions, upskilling on infection control and adapting practice to ever-changing national guidelines. The aim of this article is to describe an Irish mental health service's adaption to the global pandemic from the perspective of the nurse leadership involved. A case study approach was used describing the degree of adjustment and collaborative practice in ‘tackling the spread’ documented with both staff and service users in mind. The case describes how mental health nurses were central to designing and overseeing the implementation and delivery of numerous initiatives across the service. They were also required to respond quickly and sensitively to service users' needs, while remaining true to the core values of mental health nursing practice. As the backbone of our health service, nurses continue to prove their ability to adapt flexibly, operationalise change at high intensity, provide quality care to service users in a professional and compassionate manner while managing their own safety, fears, personal circumstances and mental health.

Identifying occupational therapy outcome measures supportive of recovery-orientated mental health services in Ireland

Purpose No occupational therapy outcome measures have been designed specifically for recovery-orientated services.This paper aims to identify occupational therapy outcome measures relevant to mental health practice and assess them against recovery principles adopted by Irish Mental Health Services. Design/methodology/approach A narrative review methodology was used to appraise outcome measures against CHIME recovery principles. Findings A systematic search across 13 databases identified eight well-established outcome measures commonly used within occupational therapy mental health literature. The included outcome measures were appraised using a recovery alignment tool. Practical implications All outcome measures connected to some recovery processes. Those using semi-structured interview formats and notably the Canadian Occupational Performance Measure (COPM) had the strongest alignment to recovery processes. Originality/value This is the first known review which provides some validation that the included outcome measures support recovery processes, yet the measures rely heavily on therapist’s skills for processes to be facilitated. It recommends that ways to better support the process of partnership in occupational therapy mental health outcome measures be explored and further research be undertaken.

Nurse leadership in implementing digital change in an Irish mental health service

Nurse leadership in implementing digital change in an Irish mental health service

"Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings.

WHAT IS KNOWN ON THE SUBJECT?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. ABSTRACT: Description The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020-under review). Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim To explore PSI-trained MHNs' experiences of using PSI within Ireland. Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research.

A phenomenological exploration of transgender people's experiences of mental health services in Ireland.

This study sought to explore the personal experiences of transgender people with Irish mental health services. The transgender community have been identified as an underserved, under-researched community in Ireland and abroad. While there has been a surge in research carried out with the community in recent years, there is little known about the personal experiences of Irish transgender people with mental health services. Interpretative phenomenological analysis was used to inform data collection and analysis of semi-structured interviews carried out with four research participants all identifying as transgender and having experienced accessing Irish mental health services. Three themes emerged: affirmative experiences, non-affirmative experiences and clinician relationship. Lack of information and non-affirmative experiences are contributing to poor clinician-patient relationships with transgender populations and impacting attrition. Nurse managers have a central role in supporting a transgender-positive organisational approach to care by ensuring policies, care practices and the environment are supportive of sexual and gender expression by role modelling attitudes of respect and inclusivity. In order to provide appropriate and responsive services to transgender people, there needs to be in place strategies to enable the development of confident, competent and knowledgeable staff.

Mental Health Nurses' Knowledge of Clozapine

Clozapine, sold under the brand name Clozaril, is an antipsychotic medication prescribed since the 1970s as an effective treatment for individuals with treatment resistive schizophrenia. Medical experts have produced extensive literature on the need for close monitoring as this medication can cause life threatening adverse effects. Mental health nurses play a vital role in the management of clozapine, however to date just one study specifically examines psychiatric/mental health nurse’s knowledge of this medication. Nurses need to be aware of the adverse effects and be able to provide psychoeducation to help support and inform clients prescribed this medication. This study used a survey questionnaire. A clozapine knowledge questionnaire with 18 questions was developed by De Hert et al. to explore psychiatric/mental health nurse’s knowledge on the adverse effects of clozapine. We distributed a shortened version of this knowledge questionnaire (12-multi-choice questions) to 209 mental health nurses working within one Irish Mental Health Service. One hundred and twenty-nine (n = 129) nurses completed the questionnaire with a response rate of 62%. Our results indicated that over 40% of mental nurses had not received sufficient education on clozapine medication during their formal education. We found that just 50% of participants scored over six correct questions out of 12 questions on various areas of knowledge related to clozapine medication. We identified gaps in knowledge on clozapine medication in relation to on myocarditis, epilepsy and metabolic syndrome. We highlighted gaps in mental health nurses’ knowledge of clozapine medication that need to be improved in order to help clients. We advocate additional education on clozapine medication at undergraduate education and through educational packages at the service level.

Knowledge and confidence of clinicians in Irish CAMHS when working with transgender youth; and the factors clinicians report will assist them in this work.

The Health Service Executive (HSE) Quality Improvement Division (2016) report states that young people who identify as transgender are one of the highest risk groups for suicidal ideation, self-harm, and completed suicides and may require significant input in Irish Child and Adolescent Mental Health Services (CAMHS). This research represents the first exploration of CAMHS staff's capacity within an Irish mental health service to support transgender youth by considering their knowledge about and confidence in working with these youth. A multi-method design was used to evaluate the knowledge and confidence levels of CAMHS clinicians in supporting transgender youth and to identify what factors would enable them to conduct this work. A questionnaire and a survey about supporting transgender youth were distributed to all clinicians in five Irish-based CAMHS services (N = 71), using an online platform. Additionally, semi-structured interviews were conducted with six clinicians. Quantitative, content, and thematic analyses were performed. CAMHS staff reported limited knowledge and experience about supporting transgender youth. Findings indicated that both of these factors undermined their confidence in supporting these youths. Clinicians expressed a need for additional clinical education delivered through expert consultation, presentations, and learning from 'experts by experience'. CAMHS clinicians need and want further clinical education about supporting transgender youth and their families. Recommendations are made for enhancing the knowledge, confidence, and competence of CAMHS clinicians using methods identified as acceptable by clinicians, in order to best support these youths.

Sustaining Staff Who Support

The Irish Mental Health Service has undergone significant transformation in recent decades, with A Vision for Change, the national policy on mental health, outlining a multidisciplinary approach facilitated through local Community Mental Health Teams (CMHTs). Despite this emphasis on teamworking, there has been little formal direction around teamworking and team functioning within CMHTs and there is no recognition of the complexities that often arise within groups of people. International research reiterates the importance of positive teamworking when providing a health service; that is that an awareness of group dynamics, and an ability to address any difficulties can enhance team functioning. This study examined the group dynamics that arise within CMHTs to determine the impact that this has on team functioning. This was done through an interpretive phenomenological approach whereby ten CMHT professionals were interviewed using a semi-structured format that focused on their attitudes and experiences of working in their multidisciplinary teams. The findings demonstrated that interprofessional group dynamics were a consistent feature of CMHTs. The Consultant Psychiatrist is usually viewed as nominal lead of individual CMHTs, which had a direct impact on team functioning. This impact on team functioning was exacerbated by unclear lines of governance, with many CMHT members reporting to line managers external to the team. Specific further study is needed to develop this research on a national level, which would include research with teams where a Team Coordinator has been appointed.Key Words: Community Mental Health Teams; Leadership; Groups; Teamwork; Interdisciplinary; Governance

Should all community mental health teams be sectorised?

Sectorised catchment areas have characterised Irish mental health service delivery since the devolution of institutional care. Unlike other catchment areas, the Cluain Mhuire Community Mental Health Service (CMCMHS) never sectorised. With the development of Community Health Networks (CHNs) and Primary Care Centres, the CMCMHS has come under renewed pressure for structural change. We aimed to consider the implications of these proposed changes on staff and service users. We obtained demographic information comparing the CHNs with respect to attendee numbers, new referrals and admissions over a 1- year period. Secondly, we conducted an anonymous survey seeking opinions on the proposals to switch to a sector-based model and/or specialist inpatient care. Referral and admission rates differed across CHNs, broadly consistent with populations. About 36% of staff and 33% of service users supported changing to a sector-based system. In the event of a sector-based system of care being implemented, 66% of service users felt that existing service users should remain under the care of their current team. There was little support among any group for the development of specialist inpatient teams. We discuss the benefits and drawbacks of sectorisation of mental health service provision. Most patients did not want to change teams either as current service users or as re-referrals (indicating it will take a significant time to transition to a sector-based system). Without clear pathways towards integration with primary care teams, the advantages of sectorisation may not outweigh the challenges associated with its implementation.

Towards a Recovery Orientated Mental Health Service

Background: In 2006, in a policy document entitled a Vision for Change(Department of Health, 2006), Ireland undertook to move towards a modern,recovery orientated public mental health service characterised by holisticcare, individualised care planning, the provision of accessible support,increased involvement of service users in decisions about their treatmentand care and greater continuity of care across the mental health services.More than a decade on, it remained unclear to what extent Irish mentalhealth services had progressed towards the modern, recovery orientatedsystem outlined in A Vision for Change (Department of Health, 2006).

Smartphone and video game use and perceived effects in a community mental health service.

Gaming is a growing area and there are conflicting reports on its harms and benefits. There is also increasing interest in the use of gaming clinically. This research aims to enhance our understanding of video and smartphone game use, and perceptions, among outpatients attending an Irish general adult mental health service. An anonymised, opportunistic survey of outpatients attending an Irish general adult mental health service was completed. Respondents were self-selecting and self-administering of the survey. The response rate was 13% (n = 93). Younger patients were significantly more likely to own a smartphone (p = 0.00). Those who played videogames were significantly younger than those who did not (p = 0.00). Younger age groups were significantly more likely to have heard of (p = 0.00), and used (p = 0.01), Pokémon GO. Over 19% (n = 18) of respondents played video games. Nearly 24% (n = 16) of those with a smartphone played games on it daily. No respondents reported specifically using games for health reasons. The two individuals who found Pokémon GO usage increased their exercise levels, also reported mental health benefits from it. Individuals' gaming use and age did not significantly impact on whether they were positive or negative in their opinions towards video and smartphone games. There is an opportunity to deliver interventions to Irish mental health service outpatients through smartphone and video games. Our small study suggests this to be underutilised currently. As more frequent users, perhaps younger individuals would most benefit from gamification of interventions and the use of existing games that have possible physical and mental health benefits. This requires further research.

Forging successful partnerships in psychosis research: lessons from the Cavan-Monaghan First Episode Psychosis Study.

Embedding psychosis research within community mental services is highly desirable from several perspectives but can be difficult to establish and sustain, especially when the clinical service has a rural location at a distance from academic settings with established research expertise. In this article, we share the experience of a successful partnership in psychosis research between a rural Irish mental health service and the academic department of a Dublin medical school that has lasted over 30 years. We describe the origins and evolution of this relationship, the benefits that accrued and the challenges encountered, from the overlapping perspectives of the academic department, the mental health service and psychiatric training. We discuss the potential learning that arose from the initiative, particularly for national programme planning for early intervention in psychosis, and we explore the opportunities for enhanced training, career development and professional reward that can emerge from this type of partnership.