Understanding illness experiences of employees with common mental health disorders.

BACKGROUND: Common mental health disorders (CMHDs) are a leading cause of sickness absence. To address this, a Fit for Work Service (FFWS) was introduced in Greater Manchester, UK, in 2010, offering case-managed and multidisciplinary interventions to early-stage sickness absentees experiencing physical health conditions and/or associated psychosocial problems, to enable a speedy return to work. AIMS: To explore the illness experiences of employees who contacted or were referred to the Greater Manchester FFWS (GM-FFWS). METHODS: A qualitative in-depth study, using narrative interviews with GM-FFWS service users who experienced mental ill-health. Interviews were recorded, transcribed and analysed for key themes. RESULTS: There were 21 interviews available for analysis. Multiple disruptive life events overwhelmed employees' capacity to cope, triggering mental ill-health. For some individuals, the onset of mental ill-health was unexpected and had profound psychological effects on participants' sense of self and personal identity. In certain cases, previous bouts of emotional distress contributed to an underlying psychology of low self-esteem. Mobilizing resources was often a significant factor in supporting recovery. The illness experience led to a process of self-re-evaluation among some participants. CONCLUSIONS: Disruptive events at work have the potential to threaten an individual's sense of self. Employee's experiences of CMHDs can only be fully understood if there is awareness of how these experiences emerge from a person's biography and subsequently inform their responses to contemporary life events. The design of future clinical and non-clinical workplace interventions should take account of these biographical aspects of the illness experience.

Food for thought: pilot randomized controlled trial of lay health trainers supporting dietary change to reduce cardiovascular disease in deprived communities.

BACKGROUND: Cardiovascular disease (CVD) accounts for 30% of UK deaths. It is associated with modifiable lifestyle factors, including insufficient consumption of fruit and vegetables (F&V). Lay health trainers (LHTs) offer practical support to help people develop healthier behaviour and lifestyles. Our two-group pilot randomized controlled trial (RCT) investigated the effectiveness of LHTs at promoting a heart-healthy lifestyle among adults with at least one risk factor for CVD to inform a full-scale RCT. METHODS: Eligible adults (aged 21-78 years), recruited from five practices serving deprived populations, were randomized to health information leaflets plus LHTs' support for 3 months (n = 76) versus health information leaflets alone (n = 38). RESULTS: We recruited 114 participants, with 60% completing 6 month follow-up. Both groups increased their self-reported F&V consumption and we found no evidence for LHTs' support having significant added impact. Most participants were relatively less deprived, as were the LHTs we were able to recruit and train. CONCLUSIONS: Our pilot demonstrated that an LHT's RCT whilst feasible faces considerable challenges. However, to justify growing investment in LHTs, any behaviour changes and sustained impact on those at greatest need should be demonstrated in an independently evaluated, robust, fully powered RCT.

Dealing with drug misuse.

This paper provides a background to current trends in the treatment of drug misuse in the UK. It presents an argument for adopting a client-centred approach emphasising harm minimisation, as a means of reducing the negative impact of drug misuse behaviour on the community, particularly in housing estates. The paper concentrates on opiate misuse as this currently presents the greatest challenge to society in the UK, although the use of cocaine and other stimulants is on the increase.