A review of mental health and wellbeing under climate change in small island developing states (SIDS).

Small island developing states (SIDS) are often at the forefront of climate change impacts, including those related to health, but information on mental health and wellbeing is typically underreported. To help address this research lacuna, this paper reviews research about mental health and wellbeing under climate change in SIDS. Due to major differences in the literature's methodologies, results, and analyses, the method is an overview and qualitative evidence synthesis of peer-reviewed publications. The findings show that mental health and wellbeing in the context of climate change have yet to feature prominently and systematically in research covering SIDS. It seems likely that major adverse mental health and wellbeing impacts linked to climate change impacts will affect SIDS peoples. Similar outcomes might also emerge when discussing climate change related situations, scenarios, and responses, irrespective of what has actually happened thus far due to climate change. In the context of inadequate health systems and stigmatisation of mental health diagnoses and treatments, as tends to occur globally, climate change narratives might present an opening for conversations about addressing mental health and wellbeing issues for SIDS.

Understanding more about how young people make sense of their siblings changing gender identity: How this might affect their relationships with their gender-diverse siblings and their experiences.

The gender roles and identity of siblings have been found to be an important factor in the nature and quality of sibling relationships. With an increasing number of young people identifying as gender-diverse or transgender, this research aimed to develop a greater understanding of how young people make sense of their siblings' gender diversity. Semi-structured interviews explored the experiences of eight sibling participants (aged 11-25 years) who have a sibling identifying as gender-diverse. Five overarching themes emerged from the thematic analysis of their transcribed interviews. These themes encapsulated commonalities and nuances within the sibling participants' experiences and revealed a process of adjustment. Developing an increased understanding of transgender issues appeared to enable young people to embrace supportive roles, and as a consequence, they reported that their relationships with their gender-diverse siblings were enhanced. However, the sibling participants' increased understanding of transgender issues also generated significant fears and concerns about their siblings' well-being and their sibling relationships. From understanding more about these eight young people's experiences, suggestions are given for how specialist services might best support siblings of gender-diverse young people along their processes of adjustment.

Climate Change: From Science to Practice.

PURPOSE OF REVIEW: Climate change poses a significant threat to human health. Understanding how climate science can be translated into public health practice is an essential first step in enabling robust adaptation and improving resiliency to climate change. RECENT FINDINGS: Recent research highlights the importance of iterative approaches to public health adaptation to climate change, enabling uncertainties of health impacts and barriers to adaptation to be accounted for. There are still significant barriers to adaptation, which are context-specific and thus present unique challenges to public health practice. The implementation of flexible adaptation approaches, using frameworks targeted for public health, is key to ensuring robust adaptation to climate change in public health practice. The BRACE framework provides an excellent approach for health adaptation to climate change. Combining this with the insights provided and by the adaptation pathways approach allows for more deliberate accounting of long-term uncertainties. The mainstreaming of climate change adaptation into public health practice and planning is important in facilitating this approach and overcoming the significant barriers to effective adaptation. Yet, the immediate and future limits to adaptation provide clear justification for urgent and accelerated efforts to mitigate climate change.

The Lancet Countdown: tracking progress on health and climate change.

The Lancet Countdown: tracking progress on health and climate change is an international, multidisciplinary research collaboration between academic institutions and practitioners across the world. It follows on from the work of the 2015 Lancet Commission, which concluded that the response to climate change could be "the greatest global health opportunity of the 21st century". The Lancet Countdown aims to track the health impacts of climate hazards; health resilience and adaptation; health co-benefits of climate change mitigation; economics and finance; and political and broader engagement. These focus areas form the five thematic working groups of the Lancet Countdown and represent different aspects of the complex association between health and climate change. These thematic groups will provide indicators for a global overview of health and climate change; national case studies highlighting countries leading the way or going against the trend; and engagement with a range of stakeholders. The Lancet Countdown ultimately aims to report annually on a series of indicators across these five working groups. This paper outlines the potential indicators and indicator domains to be tracked by the collaboration, with suggestions on the methodologies and datasets available to achieve this end. The proposed indicator domains require further refinement, and mark the beginning of an ongoing consultation process-from November, 2016 to early 2017-to develop these domains, identify key areas not currently covered, and change indicators where necessary. This collaboration will actively seek to engage with existing monitoring processes, such as the UN Sustainable Development Goals and WHO's climate and health country profiles. The indicators will also evolve over time through ongoing collaboration with experts and a range of stakeholders, and be dependent on the emergence of new evidence and knowledge. During the course of its work, the Lancet Countdown will adopt a collaborative and iterative process, which aims to complement existing initiatives, welcome engagement with new partners, and be open to developing new research projects on health and climate change.

Transition to adult services for young people with mental health needs: A systematic review.

BACKGROUND: Young people's transition from child and adolescent (CAMHS) to adult mental health services (AMHS). OBJECTIVES: To systematically review evidence on the effectiveness of different models of CAMHS-AMHS transitional care, service user and staff perspectives, and facilitators of/barriers to effective CAMHS-AMHS transition. DATA SOURCES: A systematic search in May 2012 of Medline, PsycINFO, CINAHL, EMBASE, AMED, Health Business Elite, HMIC, Cochrane Database, Web of Science and ASSIA; ancestral searches; and consultation with experts in the field. STUDY SELECTION: Qualitative, quantitative and mixed-methods primary research on the CAMHS-AMHS health-care transition of young people (aged 16-21 years) with mental health problems. DATA EXTRACTION: Two reviewers independently completed a standardised data extraction form and critically evaluated identified documents using a validated appraisal tool for empirical studies with varied methodologies. RESULTS: A total of 19 studies of variable quality were identified. None were randomised or case-controlled trials. Studies incorporating service user/carer perspectives highlighted the need to tackle stigma and provide accessible, age-appropriate services. Parents/carers wanted more involvement with AMHS. Transitional care provision was considered patchy and often not prioritised within mental health services. There was no clear evidence of superior effectiveness of any particular model. CONCLUSIONS: High-quality evidence of transitional care models is lacking. Data broadly support the development of programmes that address the broader transitional care needs of 'emerging adults' and their mental health needs but further evaluation is necessary. Developing robust transitional mental health care will require the policy-practice gap to be addressed and development of accessible, acceptable, responsive, age-appropriate provision.

Evaluation of dementia training for staff in acute hospital settings.

The development, pilot and evaluation of a brief psychosocial training intervention (BPTI) for staff working with people with dementia in an acute hospital setting are described. The project had two phases. Phase one involved adapting an existing competency framework and developing the BPTI using focus groups. For the pilot and evaluation, in phase two, a mixed methods approach was adopted using self-administered standardised questionnaires and qualitative interviews. Qualitative analysis suggested that delivering skills-based training can develop communication, problem-solving and self-directed learning skills; benefit staff in terms of increased knowledge, skills and confidence; and be problematic in the clinical area in terms of time, organisation and the physical environment. These factors must be taken into consideration when delivering training. These changes were not reflected in the quantitative results and measures were not always sensitive to changes in this setting. Definitive conclusions cannot be drawn about the efficacy of the intervention, due to the contradictory outcomes between the quantitative and qualitative data. Further developments and research are required to explore how staff and organisations can be supported to deliver the best possible care.

Recognising excellence in medical education: a student-led award scheme.

BACKGROUND: The standard of clinical teaching is acknowledged by undergraduate medical students and their clinical teachers as being variable.(1) Furthermore, there is very little recognition by medical schools of the teaching expertise and efforts of clinical teachers.(2) INNOVATION: In response to these issues, a group of medical students at the University of Birmingham's Medical School have established an awards scheme called Recognising Excellence in Medical Education (REME). This is a student-led award scheme that is supported by the Dean and other senior medical school staff, and by the students' medical society. METHOD: This research used two focus groups, one comprising REME award winners and one comprising students who voted in the scheme, to discuss opinions regarding the awards, reasons why the students voted, and how clinical teachers feel about receiving the awards. DISCUSSION: The focus groups revealed that both students and their clinical teachers were very positive about the award scheme and the impact it has had, both personally and within the hospitals or Trusts of the award winners. The REME awards were viewed as motivating and encouraging for clinical teachers, and were particularly prized as teachers were nominated by their students.

Dementia care. 2: Exploring how nursing staff manage challenging behaviour.

BACKGROUND: This second in a three part series on dementia care explores different approaches to care; part 1 examined communication issues. Dementia care traditionally uses a medical approach to management, which focuses on the standard neurogenic disease paradigm, but now many care home staff and health professionals are moving towards a person centred approach, based on biopsychosocial explanations. AIM: This study sought to examine the extent to which care home staff have adopted a person centred approach. METHOD: Focus groups were carried out with 36 direct care staff from nine care homes. RESULTS: The study found evidence that both models of dementia care were in use. Three homes mainly used the medical approach, four the person centred approach and two were moving towards the latter. CONCLUSION: Training in biopsychosocial approaches to managing challenging behaviours in dementia is needed for care home staff, family and other health professionals.

Dementia care 3: evaluating the effects of wellbeing reviews on residents and staff.

BACKGROUND: This third in a three part series on dementia describes a pilot of weekly wellbeing reviews to discuss individual residents' needs on a continuing care unit. Part 1 focused on communication and part 2 examined different approaches to care. Aim To evaluate the effects of wellbeing reviews on residents and care staff. METHOD: A pilot cycle of reviews (one review per resident) was carried out, and reports and comments from the reviews analysed. RESULTS: Staff appreciated being able to reflect on and discuss a single resident in depth. CONCLUSION: Wellbeing reviews are a valuable addition to medically based ward rounds, with benefits for staff and residents.

Dementia care 1: Person centred approaches help to promote effective communication.

BACKGROUND: This first in a three part series on dementia care explores communication. The Gold Standards Framework includes a workstream on improving end of life care in care homes; communication is one of seven key tasks within the GSF. AIM AND METHOD: This study aimed to gather the views of care home staff on communication issues. Focus groups were conducted with 36 members of direct care staff from nine nursing and residential care homes. RESULTS: Three types of communication were identified: staff to staff, staff to resident, and staff to family. DISCUSSION AND CONCLUSION: The implications of different approaches to communication are discussed, and recommendations made for practice.