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A qualitative study focussing on the acquisition of psychotherapy competencies in core psychiatry training and the effect of COVID-19
No full textAcquiring competence in psychotherapy is a mandatory part of psychiatric training in the UK. Within their first 3 years of ‘Core Psychiatry’ training, doctors are expected to deliver both short-term and long-term psychotherapy treatments, supervised by the local Medical Psychotherapy tutor. During the Covid-19 pandemic, these treatments and their supervisions were carried out remotely. This pan-London qualitative research study, commissioned by the Health Education England London School of Psychiatry, aimed to explore trainees' and trainers' experiences of the psychotherapy curriculum within Core Psychiatric training, as well as their experiences of remote work during the pandemic. Seventeen participants were interviewed (out of 19 who came forward), including both trainees and trainers working within the London region. Thematic analysis of the transcripts of the semi-structured interviews identified five main themes with associated sub-themes. The results suggest that trainees found their psychotherapy experience to be enriching. However, there is work to be done around barriers and anxieties faced by trainees, for instance concerning the impact of patient drop out on training progression. Remote work posed additional issues for trainers and trainees in addressing psychotherapy competencies, with feelings of disconnection and loss being prominent
A systematic review of literature on homicide followed by suicide and mental state of perpetrators
Full text linkBackground - Homicide followed by suicide is rare, devastating and perpetrated worldwide. It is commonly assumed that the perpetrator had a mental disorder, raising concomitant questions about prevention. Though events have been reported, there has been no previous systematic review of the mental health of perpetrators.
Aims - Our aims were twofold. First, to identify whether there are recognisable subgroups of homicide–suicides in published literature and, secondly, to investigate the relationship between perpetrator mental state and aspects of the incident.
Methods - We conducted a systematic review of published literature on studies of homicide followed within 24 h by suicide or serious suicide attempt that included measures of perpetrator mental state.
Results - Sixty studies were identified, most from North America or Europe. Methodologically, studies were too heterogeneous for meta-analysis. They fell into three main groups: family, mass shooter, and terrorist with an additional small mixed group. There was evidence of mental illness in a minority of perpetrators; its absence in the remainder was only partially evidenced. There was no clear association between any specific mental illness and homicide–suicide type, although depression was most cited. Social role disjunction, motive, substance misuse and relevant risk or threat behaviours were themes identified across all groups. Pre-established ideology was relevant in the mass shooter and terrorism groups. Prior trauma history was notable in the terrorist group.
Conclusion - Research data were necessarily collected post-incident and in most cases without a standardised approach, so findings must be interpreted cautiously. Nevertheless, they suggest at least some preventive role for mental health professionals. Those presenting to services with depression, suicidal ideation, relationship difficulties and actual, or perceived, changes in social position or role would merit detailed, supportive assessment over time
How do we teach systemic leadership management and consultation? Reflections on delivering such a course
No full textWe are three women, different in many ways, some of which can be described via our cultural, past professional lives, current work, our ages, geography, colour and race. We are now two black women and one white, Jewish woman who have joined in co-creating and delivering on this systemic leadership and management course which has had several iterations and course leads in its long life at the Tavistock Clinic. Feedback from delegates on the course consistently shows us just how important it is to have aspects of difference represented in who is teaching and facilitating the conversations and learning. One idea might be that if delegates do not see someone chat looks like them their ability to fully acclimatise to new ideas may be compromised
University students’ access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England
Full text linkObjectives: In order to develop a better understanding of students’ access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems.
Methods: We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy – that is, how different needs are deemed deserving of health service attention – was particularly helpful to our understanding of the ongoing phenomenon of interest in the data.
Results: Each student’s access to mental health support was highly contingent on the student’s dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional’s service depended on the resources and relationships a student could draw upon, and the service’s relative permeability. Once there, what action professionals took was strongly influenced by the professional’s service expertise, resource constraints, the relationships the professional’s service had with other organisations, the students’ wishes, and whether students regarded treatment offers as acceptable.
Conclusions: Candidacy offers a useful lens to view university students’ access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources
Asking about my motorcycle: tracing a Covidian pathography through a child psychoanalytic psychotherapist’s recollection of his lockdown commutes
No full textIn this paper, I recollect the post-surgical loss of an important personal holding environment – my much-loved activity of running. In its aftermath the pandemic struck; and I describe my commute to and from my workplace, a public child mental health service in the UK, after finding a transitional object in a discarded bicycle, and later the purchase of my first motorcycle. I recount, from my perspective, my managers’ initial reactions to the challenging task of enabling a workforce to continue to care for child patients with mental illness. Then, seeking to understand the texture and depth of my experiences, I draw on several early personal recollections. I find that my mind posits a link to a childhood bicycle attachment that I forged in the wake of feelings of alienation from my mother; a situation that I am unsure I understood sufficiently during my training analysis. I then link a political dimension to my cycling with the initial response to the novel coronavirus by the UK’s government. As a result, I begin to construct a new holding environment for my experiences through autoethnography; as I trace a pathography that increasingly reveals the destructive impact on psychological services for children – and the frontline clinicians who staff them – of the austere, post-Brexit sociopolitical climate in which the pandemic occurred
Developing a group-based psychoeducation intervention for adoptive parents and foster carers in a specialist child and adolescent mental health service setting
No full textChildren and young people in foster and adoptive families are considered more vulnerable to a high level of mental health need when compared to peers who are not care-experienced or adopted. Acceptance of this view amongst clinical providers and policy makers has necessitated the development of specialist provision and dedicated care pathways within child and adolescent mental health services. In this provision, practitioner-initiated quality improvement projects help in appraising the effectiveness of clinical interventions in local contexts, as well as identifying areas for service learning and practice reflection. This article reports on the evaluation of a mentalisation-based psychoeducation group intervention for adoptive parents and foster carers. The evaluation activity took place in a single child and adolescent mental health service setting, starting during the COVID-19 pandemic, with the intervention being implemented online via videoconferencing. In the article, after introducing the intervention (based on the Family Minds model), an analysis of clinical data collected pre- and post-intervention is reported. Few results of the analysis regarding the two pre- and post-measures reached statistical significance, indicating only changes in the magnitude of stress in the parent/carer-child system. A series of reflections are posed that consider what this finding means in developing fit-for-purpose support for adoptive parents and foster carers in child and adolescent mental health service contexts
Understanding motivation towards education through exploring the educational experiences of young homeless people
No full textAims: The research explored the educational experiences of young homeless people. It is acknowledged that the outcomes and difficulties experienced within education, are different from those of the homeless population and their housed peers. This article aims to explore the educational experiences of young people to better understand their experiences with a focus on motivation. Seven participants were recruited from Centrepoint, a UK based youth homeless charity, all aged 18–19. Method: Interviews were used to capture the experiences of the young people, and Smith et al.'s (2009) IPA stages used to analyse them. Findings: Nine overarching themes were found: (1) avoiding and building a future; (2) motivation or change in motivation towards education; (3) lack of drive towards education; (4) needing additional support in school; (5) behavioural challenges or academic failings at school; (6) support from professionals and external organisations; (7) support from teachers; (8) unsupportive educational settings/professionals; (9) challenges meeting basic needs and accessing resources. Conclusions: The findings are discussed alongside Self-Determination Theory (Deci & Ryan, 2000; 2008) to better understand how these experiences might impact young homeless people's motivation towards engaging in education and what factors influence this motivation. The research encourages educational professionals to consider how these experiences might impact an individual educational journeys, and what they can do to support the experience of homeless individuals. Limitations of the research are considered, and opportunities for future research are identified
Push where it moves: Factors affecting engagement of homeless young people in employment, education and training, according to support staff
No full textAims: The difficulties faced by homeless young people (HYP) are complex and overlapping, such as inadequate support networks, mental health issues and domestic abuse. It is therefore important to identify the specific circumstances informing HYP's relationship with employment, education or training (EET). HYP are less likely to be EET than their housed peers and face significant barriers to engaging with EET (Dibb et al., 2019). Being not in employment education or training (NEET) significantly affects future employment, financial stability and health outcomes (Coles et al., 2010). This study aimed to develop an understanding of the barriers and facilitators, and their systemic impact on HYP accessing EET. Method: Thematic analysis (TA; Braun & Clarke, 2006) was used to explore qualitative interviews with nine staff members working with HYP in supported accommodation provider Centrepoint. Findings: The findings are organised into two broad themes: Motivation toward EET/NEET and Contextual Factors. Using Bronfenbrenner's Bioecological Model (2005), Contextual Factors is separated into Individual, Microsystem and Exosystem Factors. Conclusions: The findings are used to consider how professionals working with HYP might support them to move closer to engaging with EET. Tony Ryle's phrase, push where it moves, is drawn upon – this key principle of Cognitive Analytic Therapy (CAT) (Ryle & Kerr, 2001), suggests practitioners focus their therapeutic efforts in areas where their patients show potential for change or movement, rather than pushing against those areas where there is rigidity or resistance. Push where it moves is used to conceptualise the ways participants felt they might best encourage HYP towards EET
A psychoanalytic theoretical and clinical exploration of hope and hopelessness
Full text linkWe therapists all find ourselves engaging with recognisable feelings of hope and hopelessness in our work, as do our patients. These feelings were certainly a significant factor in much of the clinical work that I undertook with a traumatised adopted boy whom I saw in three times a week psychotherapy discussed in this thesis. His case included an oscillation between states of hope and hopelessness – a common factor in many if not all cases seen by child psychotherapists. Hope seems to be present when we make contact, and it fades away when we cannot. This thesis aims to understand what is going on, especially unconsciously, from a psychoanalytical perspective. It explores what psychoanalytic ideas we have available to further our understanding of the phenomenon, and it investigates what we can do to transform states of hopelessness into more hopeful ones. To do this, the thesis undertakes a thorough exploration of theory and related literature, as well as qualitative data analysis from an intensive case to ensure the emerging concepts are grounded in clinical experience.
The theory in combination with the analysis of the clinical data shows that hope and hopelessness are complex concepts. These concepts refer not only to routine ups and downs in the moods of both therapist and patient, but also to the trainee therapist’s difficulties in working with a challenging first case. The concepts also refer to the substantial issues faced by the patient in developing a coherent sense of himself and a belief that his experience had continuity and some hopeful elements
