The nature and correlates of paid and unpaid work among service users of London Community Mental Health Teams.

Aims. Little is known about how the rates and characteristics of mental health service users in unpaid work, training and study compare with those in paid employment. Methods. From staff report and patient records, 1353 mental health service users of seven Community Mental Health Teams in two London boroughs were categorized as in paid work, unpaid vocational activity or no vocational activity. Types of work were described using Standard Occupational Classifications. The characteristics of each group were reported and associations with vocational status were explored. Results. Of the sample, 5.5% were in paid work and 12.7% were in unpaid vocational activity, (including 5.3% in voluntary work and 8.1% in study or training). People in paid work were engaged in a broader range of occupations than those in voluntary work and most in paid work (58.5%) worked part-time. Younger age and high educational attainment characterized both groups. Having sustained previous employment was most strongly associated with being in paid work. Conclusions. Rates of vocational activity were very low. Results did not suggest a clear clinical distinction between those in paid and unpaid activity. The motivations for and functions of unpaid work need further research.

Catching life: the contribution of arts initiatives to recovery approaches in mental health.

This paper draws on a qualitative study that was undertaken as part of a national research study to assess the impact of participatory arts provision for people with mental health needs. It explores how arts and mental health projects may facilitate some of the key elements of what has been termed a 'recovery approach' in mental health. It is argued that it is precisely these elements--the fostering of hope, creating a sense of meaning and purpose, developing new coping mechanisms and rebuilding identities--which are hard to standardize and measure, yet may be the most profound and significant outcomes of participation in such projects. Therefore, in the context of a growing emphasis on recovery-orientated mental health services, while not necessarily being appropriate for all service users, arts and mental health initiatives could make an essential contribution to the future of mental health and social care provision.

Understanding the social context of violent and aggressive incidents on an inpatient unit.

The English National Service Framework for Mental Health stipulates that the highest quality of health care should be provided for mental health service users. Incidents of aggression and violence militate against achieving that goal, yet such incidents are frequently reported in inpatient settings. Much research in this area reflects a dualistic, perpetrator/victim conceptualization of incidents. This study aimed to take a more systemic approach by treating violent and aggressive incidents as social interactions and by seeking to understand the social contexts in which they took place. In this paper we describe and discuss the main themes to emerge from 15 staff accounts of 11 incidents on one ward. A striking theme reflected throughout the interview data was the lack of staff engagement with clients, and particularly an inability to look at the world through clients' eyes in interpreting their behaviour. We conclude that the 'zero tolerance' campaigns currently being conducted in the UK in relation to aggression towards NHS staff are unlikely to succeed without attention to understanding why aggressive behaviour arises and identifying features of the caring environment that may contribute to it. Rather than adopting a position of 'zero tolerance', we argue that three steps are required following an aggressive incident: emotional support; critical reflection and learning; and the pursuit of accountability.

African and African Caribbean users' perceptions of inpatient services.

It has been suggested that well-documented differences in African and African Caribbean people's contact with mental health services may stem from the organization, processes and practices of services themselves. This article presents the findings of a qualitative study which explored the inpatient experiences of a sample of African and African Caribbean people. Although some positive experiences were described, in the main, participants' accounts revolved around a sense of loss of control and around experiences of overt and implicit racism. Underpinning these experiences were relationships with staff that were perceived to be unhelpful. On the basis of both the positive and negative experiences described, we draw conclusions about the changes required to ensure that inpatient services more effectively meet the needs of this group.

Broadening the partnerships: experiences of working across community agencies.

The creation of inter-agency partnerships to deliver mental health services that meet the health and social care needs of service users is now a central strand of UK national policy and a considerable body of literature has developed around the concept of partnership. The date, however, the focus has been on partnerships between the specialist health and social services, or between these services and primary care. In the course of a study aimed at identifying the mental health training needs of a broader range of community agency staff, it became apparent that partnership working was problematic for the majority of agencies. Focus group discussions were carried out with staff from 21 agencies working across five practice contexts. On the basis of the data obtained we describe the extent of inter-agency working and the barriers to its development. The implications for meeting clients' mental health needs are then considered and means suggested for broadening inter-agency working to include a wider range of relevant agencies.

Evaluation of community mental health services: comparison of a primary care mental health team and an extended day hospital service.

Alongside mental health policies emphasising the need to focus on people experiencing serious, long-term problems, recent general healthcare policy is leading to the development in the UK of a primary care-led National Health Service. While most primary care-led mental health initiatives have focused on supporting general practitioners (GPs) in managing milder depression and anxiety, this article describes an evaluation comparing primary care-based and secondary care-based services for people with serious long-term problems. A survey of service users was carried out at three points in time using three measures: the Camberwell Assessment of Need, the Verona Satisfaction with Services Scales and the Lancashire Quality of Life Profile. Staff views were sought at two time intervals and carers' views were obtained towards the end of the 2-year study period. The results indicate that both services reduced overall needs and the users' need for information. The primary care service also reduced the need for help with psychotic symptoms whereas the secondary care service reduced users' need for help with benefits and occupation. There were no major differences in terms of satisfaction or quality of life. Primary care-based services therefore appear to have the potential to be as effective as more traditional secondary care services. However, a more comprehensive range of services is required to address the whole spectrum of needs, a conclusion supported by the views of staff and carers.

Young people's understanding of mental illness.

Research exploring young people's perspectives on mental health is at an early stage of development and few studies have focused in detail on mental distress or illness. This paper reports findings from a qualitative study which used case vignettes in group and individual interviews to explore the ways in which the young people who took part constructed their understanding of what constitutes mental illness. In essence, they did so by drawing on their own experiences to distinguish between behaviours with which they could identify in some way and those with which they could not. An overview of previous relevant research is provided in the Introduction, followed by a description of the methods and sampling strategies used. The main findings of the study are then presented in relation to the ways in which young people defined unusual behaviour, their understanding of the behaviours associated with different mental health problems and their attitudes to the people concerned. Finally, some ways in which health promotion might build on the findings are identified and discussed.

Mental health training needs of primary health care nurses.

The primary health care team (PHCT) has a critical role to play in the care of people with mental health problems. However, little attention has been paid to the mental health training and preparation required by primary health care nurses. This paper reports on a training needs assessment undertaken in one London health authority area. The findings indicate that primary health care nurses are undertaking a wide range and increasing volume of mental health work with little preparation and training. Specific training needs include time and space to identify training gaps; basic training in mental health, safe working practices and management of role boundaries; and multidisciplinary training. In addition, NHS trusts, primary care groups and health authorities need to clarify which aspects of nurses' mental health workloads are appropriate to their role and develop policies, procedures and training to support them in undertaking that role.

Mental health: what do we know, how did we find it out and what does it mean for nurses?

In recent years service providers, practitioners and academics have all moved away from the term mental illness in favour of mental health. At the same time nurses have been increasingly asked to go beyond work aimed at the alleviation or reduction of mental illness and to actively promote mental health. Such a perspective acknowledges that those who experience mental illness can equally experience and have the potential for mental health. In this paper we review key works from within psychology and health promotion (including medical sociology) that have shed light on the factors that influence mental health in its positive sense. Throughout the review we are careful to reflect on the role that research methods have played in constructing our current understanding of mental health. The aim of the review is to provide nurses with the knowledge that is necessary to undertake the challenge of promoting mental health in a practical but also reflective way.

Current conceptualizations of mental health and mental health promotion.

Health promotion is generally agreed to be underpinned by a set of principles which distinguish it from other disciplines and professions. This paper takes these principles as the starting point for a review of the literature of mental health promotion. The aim is to clarify the ways in which mental health and mental health promotion are currently conceptualized, in order to identify areas where health promotion can make a unique contribution to complement that of other interest groups. In the first section, it is suggested that current definitions of mental health are inadequate for health promotion practice in that they either equate health with the absence of illness or present a culturally skewed, individualized and 'expert'-led version of what it means to be mentally healthy. The second section then traces the implications of these definitions as they emerge from the literature relating to mental health promotion practice. The paper concludes with a discussion of some ways in which health promotion specialists might begin to develop a mental health promotion agenda which is more consistent with health promotion principles.

Astrophysical and biological constraints on radiopanspermia.

We have carried out a series of calculations involving bacteria and viruses embedded in dust grains, which are ejected from our solar system by radiation pressure and travel through space to other star systems. Under many conditions this type of panspermia is impractical, primarily because the ultraviolet (UV) radiation of the present Sun inactivates the micro-organisms. However, if the organisms are shielded by an absorbing material like carbon and if ejection takes place in the red-giant phase of a one solar mass star like our Sun, there is a significant probability that the micro-organisms can reach another star system alive (i.e. with only sub-lethal damage from UV and ionizing radiation). In addition to panspermia with viable micro-organisms, it is possible to seed the Galaxy with inactivated ones whose DNA and RNA fragments may provide the initial information necessary to start biological evolution in favourable environments.