The cognitive behavioural prevention of suicide in psychosis: a clinical trial.

BACKGROUND: Suicide behaviour in psychosis is a significant clinical and social problem. There is a dearth of evidence for psychological interventions designed to reduce suicide risk in this population. AIMS: To evaluate a novel, manualised, cognitive behavioural treatment protocol (CBSPp) based upon an empirically validated theoretical model. METHODS: A randomly controlled trial with independent and masked allocated and assessment of CBSPp with TAU (n=25, 24 sessions) compared to TAU alone (n=24) using standardised assessments. Measures of suicide probability, and suicidal ideation were the primary outcomes and measures of hopelessness, depression, psychotic symptoms, functioning, and self-esteem were the secondary outcomes, assessed at 4 and 6 months follow-up. RESULTS: The CBSPp group improved differentially to the TAU group on two out of three primary outcome measures of suicidal ideation and suicide probability, and on secondary outcomes of hopelessness related to suicide probability, depression, some psychotic symptoms and self-esteem. CONCLUSIONS: CBSPp is a feasible intervention which has the potential to reduce proxy measures of suicide in psychotic patients.

When prison is "easier": probationers' perceptions of health and wellbeing.

PURPOSE: There are currently over 300,000 offenders in England and Wales and the majority, around 240,000, are in the community on probation. However, there is a paucity of research on their health and healthcare needs. The purpose of this paper is to explore issues around health and access to health services for those on probation. In particular the paper explores what people on probation consider to be the key health issues currently affecting them, and to identify barriers to accessing healthcare in the community. DESIGN/METHODOLOGY/APPROACH: The authors ran six focus groups with a total of 41 participants; two were with staff and the others with men and women on probation. In each focus group, the researchers used semi-structured guide and the discussions were recorded electronically and then transcribed. The paper adopted a thematic analytical framework and used NVivo 7 to facilitate analysis. FINDINGS: Both probationers and professionals largely agreed about the key issues which included substance use and mental health problems. However, the most important issue for probationers was dealing with the stress of being on probation which was not generally recognised by professionals. All participants recognised the impact of issues such as housing, finances and employment on the wellbeing of probationers and were concerned about the lack of access to health services, in particular mental health and alcohol services. RESEARCH LIMITATIONS/IMPLICATIONS: This was a small study conducted in one part of England and therefore it is not clear that the findings are generalisable. However, it raises important issues about the mental health needs of probationers and the lack of appropriate services for them. Effective services may have positive impact on re-offending and further research is needed to evaluate models of care. PRACTICAL IMPLICATIONS: The challenge remains for local health service commissioners and providers and the probation service to work together to provide appropriate and accessible services for all those on probation. ORIGINALITY/VALUE: Nearly one-quarter of a million people are on probation at any one time in the UK but the existing evidence on their health is patchy and dated. Little is known about effective health interventions or the extent to which their health needs are met. This study shows that probationers see the stress of being on probation as their most important health concern. Both probationers and staff recognise that mental health and substance use are persistent problems and that these important health needs in these areas are not being met by existing services.

Translating CBT for voices into a program for carers: a pilot study.

BACKGROUND: The treatment of persisting psychotic symptoms with cognitive behavioural therapy (CBTp) is now established as an evidence-based treatment; however its availability remains limited. We piloted a novel CBTp skills-based group training program for carers. The aim was to reduce service users' auditory hallucinations severity through carers' use of basic CBTp methods in their regular interactions. METHOD: Eight carer-service user dyads and one carer-carer-service user triad participated. Carers attended the 10-week (25-hour) program, and completed measures of subjective burden and expressed emotion (EE) over a 30-week period that included a baseline phase prior to the training and implementation phase. Service users completed weekly interviews assessing voice symptomatology. Analyses were conducted for each dyad using time-series methods. RESULTS: The training program was rated highly. Improvements in symptoms and carer burden ranged from none to clinically significant across different dyads. Carer implementation of strategies was related to reduced symptoms in one dyad; reductions in EE were related to symptom improvements in two dyads. CONCLUSIONS: There may be benefits in training carers in behavioural and cognitive management of persisting hallucinations. Possible mechanisms for improvements in voice symptomatology include reduction in carers' EE, and carer implementation of strategies taught.