A qualitative meta-synthesis of service users' and carers' experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update.

BACKGROUND: Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. METHODS: We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. RESULTS: Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. CONCLUSIONS: Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. PROTOCOL REGISTRATION: The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).

Randomised controlled trial of the Community Navigator programme to reduce loneliness and depression for adults with treatment-resistant depression in secondary community mental health services: trial protocol.

BACKGROUND: New treatments are needed for people with treatment-resistant depression (TRD), who do not benefit from anti-depressants and many of whom do not recover fully with psychological treatments. The Community Navigator programme was co-produced with service users and practitioners. It is a novel social intervention which aims to reduce loneliness and thus improve health outcomes for people with TRD. Participants receive up to 10 individual meetings with a Community Navigator, who helps them to map their social world and set and enact goals to enhance their social connections and reduce loneliness. Participants may also access group meet-ups with others in the programme every 2 months, and may be offered modest financial support to enable activities to support social connections. METHODS: A researcher-blind, multi-site, 1:1 randomised controlled trial with N = 306 participants will test the effectiveness of the Community Navigator programme for people with TRD in secondary community mental health teams (CMHTs). Our primary hypothesis is that people who are offered the Community Navigator programme as an addition to usual CMHT care will be less depressed, assessed using the PHQ-9 self-report measure, at 8-month, end-of-treatment follow-up, compared to a control group receiving usual CMHT care and a booklet with information about local social groups and activities. We will follow participants up at end-of-treatment and at 14 months, 6 months after end-of-treatment follow-up. Secondary outcomes include the following: loneliness, anxiety, personal recovery, self-efficacy, social network, social identities. We will collect data about health-related quality of life and service use to investigate the cost-effectiveness of the Community Navigator programme. DISCUSSION: This trial will provide definitive evidence about the effectiveness and cost-effectiveness of the Community Navigator programme and whether it can be recommended for use in practice. The trial is due to finish in August 2025. TRIAL REGISTRATION: Prospectively registered on 8th July 2022 at: ISRCTN13205972.

Applying the cultural adaption framework to the Early Youth Engagement (EYE-2) approach to early intervention in psychosis.

OBJECTIVES: Disengagement from Early Intervention in Psychosis (EIP) services is pronounced in individuals from racially minoritized or diverse ethnic backgrounds, lesbian, gay, bisexual, transgender, and queer or questioning individuals, and individuals from some religious or spiritual backgrounds. The Early Youth Engagement in first episode psychosis study (EYE-2) is a cluster randomized controlled trial that tests a new engagement intervention. The current study aimed to (i) explore perspectives of service users from diverse backgrounds in relation to spirituality, ethnicity, culture and sexuality on engagement and the EYE-2 approach and (ii) use an evidence-based adaptation framework to incorporate their needs and perspectives into the EYE-2 resources and training. METHODS: This qualitative study used semi-structured interviews to explore service users' experiences and perspectives on EYE-2 approaches and resources. The study was conducted within EIP teams across three inner-city sites in England chosen to reflect diverse urban populations. Topic guides covered participant's identity, perceptions of EYE-2 resources, and experience of using mental health services. Transcribed interviews underwent thematic analysis. RESULTS: In this study, 21 service users aged 18 to 35 (M = 25.4; SD = 5.5) participated in semi-structured interviews. Seven key themes were identified across the four domains of the cultural adaptation framework: Differing cognitions and beliefs; multiple facets of culture; language as a barrier to engagement; stigma and discrimination; adaptations to EYE-2 resources; trust in therapeutic alliance; and individual differences in therapeutic preferences. CONCLUSIONS: The emergent themes highlighted a need to cater to various aspects of cultural diversity when developing EIP materials and services.

Left Prefrontal tDCS during Learning Does Not Enhance Subsequent Verbal Episodic Memory in Young Adults: Results from Two Double-Blind and Sham-Controlled Experiments.

Recent studies suggest that transcranial direct current stimulation (tDCS) applied over the prefrontal cortex (PFaC) may enhance episodic memory ability. As such, there is ongoing interest in the therapeutic potential of this technique in age-related memory decline. At the same time, the findings are not yet conclusive regarding the magnitude of this effect, and assumptions regarding underlying brain mechanisms of stimulation-induced changes in behaviour are yet to be tested in detail. Here, we evaluated the effect of tDCS over left PFC on verbal episodic memory in young adults. Two separate randomized, double-blind, sham-controlled experiments were carried out using (1) incidental learning followed by a recognition test and (2) intentional learning followed by a free recall. In both studies, participants performed a learning task with active or sham tDCS during the encoding period, followed by retrieval tasks on the same day and the next day. The results suggest that, contrary to expectations, active tDCS did not enhance memory performance relative to sham tDCS. Possible reasons behind the lack of enhancement effects are discussed, including the possibility that memory enhancement effects of tDCS may be smaller than first thought. Scientific practices that could improve estimation accuracy in the field are also discussed.

The Lived Experience of Caregiving and Perception of Service Provision among Family-Caregivers of People with Late-Stage Parkinson's: A Qualitative Study.

Background: The complex nature of late-stage Parkinson's requires multiagency support and leads to an increased burden on family members who assume a multiplicity of responsibilities. The aim of this study is to further understand the lived experiences of family-caregivers and their perception of, and satisfaction with, service provision. Methods: This qualitative substudy was a part of the European multicentre Care of Late-Stage Parkinsonism (CLaSP) project. Purposive sampling resulted in a sample of eleven family-caregivers of people with late-stage Parkinson's, who were interviewed using semistructured open-ended questions. Thematic analysis followed. Findings. Three overarching themes were developed from the data: ensuring continuous support is vital to providing care at home, perceiving unmet service provision needs, and advocating and co-ordinating all aspects of care take their toll. These themes include not only experience of services that caregivers find supportive in order to deliver care but also of disjointed care between multiple agencies, a perceived lack of Parkinson's expertise, and there was a lack of anticipatory future planning. The constancy and scope of the family-caregiver role is described, including the need to project manage multiple aspects of care with multiple agencies, to be an advocate, and to assume new roles such as managing finances. Multiple losses were reported, which in part was mitigated by gaining expertise through information and support from professionals and organised and informal support. Conclusion: The intricacies and consequences of the family-caregivers' role and their experience of service provision indicate the need to acknowledge and consider their role and needs, fully involve them in consultations and provide information and joined-up support to improve their well-being, and ensure their continuous significant contribution to the ongoing care of the person with Parkinson's.

Statistical analysis plan for the Early Youth Engagement in first episode psychosis (EYE-2) study: a pragmatic cluster randomised controlled trial of implementation, effectiveness and cost-effectiveness of a team-based motivational engagement intervention to improve engagement.

BACKGROUND: Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium-long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and health services. This study will evaluate the effectiveness of a team-based motivational engagement intervention, the Early Youth Engagement (EYE-2) intervention. METHODS AND DESIGN: The EYE-2 trial is a cluster randomised controlled trial comparing the EYE-2 intervention plus standardised EIP service to standardised EIP service alone, with randomisation at the clinical team (cluster) level. The study aimed to enrol 950 young people (aged 14-35 years) with first episode psychosis in 10 teams per arm. RESULTS: The primary outcome is time to disengagement: days from the date of allocation to care coordinator to date of the last contact following either refusal to engage with an EIP team or lack of response to EIP contact for 3 consecutive months which will be analysed using a shared frailty model. Secondary outcomes are Health of the Nation Outcome Scale (HoNOS), Process of Recovery Questionnaire (QPR), DIALOG (a service user-reported measure of quality of life and treatment satisfaction) and service use outcomes which will be analysed using mixed effects regression models. DISCUSSION: This paper is the detailed statistical analysis plan for the EYE-2 trial. Any changes to, or deviations from, this plan will be described and justified in the final trial report. TRIAL REGISTRATION: ISRCTN 51629746 . Prospectively registered on 7 May 2019. Date assigned 10 May 2019.

Exploring the Development, Validity, and Utility of the Short-Form Version of the CHoice of Outcome In Cbt for PsychosEs: A Patient-Reported Outcome Measure of Psychological Recovery.

The original CHoice of Outcome In Cbt for psychosEs (CHOICE) measure was designed in collaboration with experts by experience as a patient-reported "Psychological Recovery" outcome measure for cognitive-behavioral therapy for psychosis (CBTp). A short version (CHOICE-SF) was developed to use as a brief outcome measure, with a focus on sensitivity to change, for use in future research and practice. CHOICE-SF was developed and validated using 3 separate samples, comprising 640 service users attending 1 of 2 transdiagnostic clinics for (1) CBTp or (2) therapies for voice hearing or (3) who took part in the treatment as usual arm of a trial. In the initial subsample of 69 participants, items from the original CHOICE measure with medium to large effect sizes for change pre- to post-CBTp were retained to form the CHOICE-SF. Internal consistency, construct validity, and sensitivity to change were confirmed, and the factor structure was examined in 242 participants. Specificity was confirmed by comparison with 44 participants who completed CHOICE at 2 time points but did not receive therapy. Validation of CHOICE-SF was carried out by confirming factor structure and sensitivity to change in a new sample of 354 and a subsample of 51 participants, respectively. The CHOICE-SF comprised 11 items and 1 additional personal goal item. A single-factor structure was confirmed, with high internal consistency, construct validity, and sensitivity to change. The CHOICE-SF is a brief, psychometrically robust measure to assess change following psychological therapies in research and clinical practice for people with psychosis and severe mental illness.

Experiences of health services and unmet care needs of people with late-stage Parkinson's in England: A qualitative study.

AIM: To explore experiences of health services and unmet care needs by people with late-stage Parkinson's in England. METHOD: Ten participants, at Hoehn and Yahr stage 4 or 5, were interviewed using semi-structured open-ended questions. Data were analysed using qualitative thematic analysis. FINDINGS: Participants reported that whilst under the treatment of specialist hospitals, the majority of care provision had shifted into the community, often because hospital-based services were felt to be difficult to access and have limited benefit to them. When using health-care services, participants frequently experienced having to 'fit-in' to service structures that did not always accommodate their complex needs. Despite high levels of disability, participants expressed their desire to maintain their identity, normality of interests and activities in their lives, including remaining in their own homes. This was facilitated by bespoke care and equipment, and positive relationships with care providers. Knowledge on disease management was a key factor in their perceived ability to remain in control. Family caregivers had a central role in facilitating care at home. There was uncertainty about and little planning for the future, and moving to a residential nursing home was perceived an undesirable but potentially necessary option for future care. CONCLUSION: Unmet care needs identified by people with late stage Parkinson's in England include greater flexibility of healthcare structures and bespoke service provision, to accommodate their individual complex needs. Support in their own homes and positive relationships with healthcare providers help People with Parkinson's (PwP) to maintain a degree of normality and identity, and provision of information help them maintain some control. There is a need for more informed discussions on future care planning for this specific population.

Effects of transcranial direct current stimulation over the posterior parietal cortex on episodic memory reconsolidation.

Consolidated memories may return to labile/unstable states after their reactivation, thus requiring a restabilization process that is known as reconsolidation. During this time-limited reconsolidation window, reactivated existing memories can be strengthened, weakened or updated with new information. Previous studies have shown that non-invasive stimulation of the lateral prefrontal cortex after memory reactivation strengthened existing verbal episodic memories through reconsolidation, an effect documented by enhanced delayed memory recall (24 h post-reactivation). However, it remains unknown whether the left posterior parietal cortex (PPC), a region involved during reactivation of existing episodic memories, contributes to reconsolidation. To address this question, in this double-blind experiment healthy participants (n = 27) received transcranial direct current stimulation (tDCS) with the anode over the left PPC after reactivation of previously learned verbal episodic memories. Memory recall was tested 24 h later. To rule out unspecific effects of memory reactivation or tDCS alone, we included two control groups: one that receives tDCS with the anode over the left PPC without reactivation (n = 27) and another one that receives tDCS with the anode over a control site (primary visual cortex) after reactivation (n = 27). We hypothesized that tDCS with the anode over the left PPC after memory reactivation would enhance delayed recall through reconsolidation relative to the two control groups. No significant between groups differences in the mean number of words recalled on day 3 occurred, suggesting no beneficial effect of tDCS over the left PPC. Alternative explanations were discussed, including efficacy of tDCS, different stimulation parameters, electrode montage, and stimulation site within the PPC.

Transcranial direct current stimulation applied after encoding facilitates episodic memory consolidation in older adults.

Episodic memory shows the largest degree of age-related memory decline. There is evidence that consolidation, the process that stabilizes memories after encoding, is reduced in older adults. Previous studies have shown that transcranial direct current stimulation (tDCS) applied during intentional encoding or immediately after a contextual reminder enhanced delayed episodic memory performance, suggesting a potential interaction between tDCS and consolidation or reconsolidation processes. The present randomized, double-blind, sham-controlled study addressed the question whether tDCS applied immediately after verbal encoding enhances episodic memory recall through consolidation in healthy older adults. Twenty-eight participants received tDCS (Active or Sham) over the prefrontal cortex (anode over the left dorsolateral prefrontal cortex and cathode over the contralateral supraorbital region), a brain region contributing to episodic memory function. Verbal recall was tested two days and one month later. The results showed that recall performance at one month was enhanced in the Active tDCS group relative to the Sham group. These findings suggest that tDCS applied off-line immediately after encoding over the prefrontal cortex interacts with the processes promoting consolidation of episodic memories in healthy older adults. Targeting consolidation by means of tDCS might be a novel strategy for reducing episodic memory decline.

Electrophysiological correlates and psychoacoustic characteristics of hearing-motion synaesthesia.

People with hearing-motion synaesthesia experience sounds from moving or changing (e.g. flickering) visual stimuli. This phenomenon may be one of the most common forms of synaesthesia but it has rarely been studied and there are no studies of its neural basis. We screened for this in a sample of 200+ individuals, and estimated a prevalence of 4.2%. We also document its characteristics: it tends to be induced by physically moving stimuli (more so than static stimuli which imply motion or trigger illusory motion); and the psychoacoustic features are simple (e.g. "whooshing") with some systematic correspondences to vision (e.g. faster movement is higher pitch). We demonstrate using event-related potentials that it emerges from early perceptual processing of vision. The synaesthetes have a higher amplitude motion-evoked N2 (165-185ms), with some evidence of group differences as early as 55-75ms. We discuss similarities between hearing-motion synaesthesia and previous observations that visual motion triggers auditory activity in the congenitally deaf. It is possible that both conditions reflect the maintenance of multisensory pathways found in early development that most people lose but can be retained in certain people in response to sensory deprivation (in the deaf) or, in people with normal hearing, as a result of other differences (e.g. genes predisposing to synaesthesia).