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The content of Recovery College courses in England : a 71 college document analysis
Full text link© 2025 Takhi, Brown, Ronaldson, Lawrence,
McPhilbin, Ingall, Daryanani, Simpson, Jebara,
Lawrence, Kapka, Kotera, Dunnett, Hayes,
Stepanian, Yeo, Meddings, Rennison, Barrett,
Rowles, Miyamoto, Kroon, Namasaba,
Henderson and Slade. This is an open-access
article distributed under the terms of the
Creative Commons Attribution License (CC BY).
The use, distribution or reproduction in other
forums is permitted, provided the original
author(s) and the copyright owner(s) are
credited and that the original publication in
this journal is cited, in accordance with
accepted academic practice. No use,
distribution or reproduction is permitted
which does not comply with these terms.INTRODUCTION: Recovery Colleges (RCs) exist in 28 countries and across five continents. The concept of recovery and recovery-oriented care has become widespread internationally and embedded in policy documentation and mental health services. As a result, Recovery Colleges, which focus on adult learning and co-production, have now developed a global presence, but many psychiatrists are unfamiliar with this intervention. RCs can be categorized as 'Strengths Oriented', focusing on skills and knowledge development, or 'Community-oriented', emphasizing strengthening community and social connections. Research has not sufficiently investigated RC curriculum and how course provision differs depending on RC orientation. The study aimed to develop a typology of RC courses and assess differences in course types across RC orientations. METHOD: A document analysis was conducted. The websites of 88 RCs in England were searched to collect online prospectuses. Overall, 2,330 courses described in 551 documents from 71 RCs were collated. Inductive content analysis was applied to the course titles to develop a typology of courses offered. Mann-Whitney U tests were used to assess differences in the median number of course types offered by Strengths-Oriented versus Community-Oriented colleges. RESULTS: A typology of 14 superordinate course categories was created. The three most common course categories were Self-management of Well-being (96% RCs ≥1 course, median 10 courses per RC), Mental Health Conditions and Symptoms (85% RCs ≥1 course, 4 courses per RC), and Creativity (86% RCs ≥1 course, 3 courses per RC). The least common course categories included Issues relating to the Extended Support Network and Issues relating to Staff (38% RCs ≥1 course, 0 courses per RC) (6% RCs ≥1 course, 0 courses per RC). The median number of courses did not differ between Strengths-oriented versus Community-oriented RCs, with the exception of more Practical Life Skills (p=0.021) and Involvement, Co-production and Research (p=0.036) courses in Strengths-oriented RCs. CONCLUSIONS: RCs support mental health recovery through a diverse curriculum. Community-facing and strengths-based, health service-affiliated RCs offer similar courses. RCs prioritize equipping students with knowledge about living with mental health issues. Courses targeted to informal carers are lacking. Further cross-cultural extension of the typology is needed.https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2025.1605498/ful
A content review of national dementia plans : are human rights considered?
No full textThe World Health Organization has set a target for 75% of member states to have national dementia plans by 2025. These plans should align with human rights standards, such as the Convention on the Rights of Persons with Disabilities. The aim of this study was to complete a review of global national dementia plans and their human rights content according to the convention's principles. A categorization matrix of preidentified human rights themes was produced prior to data collection and extensive inclusion criteria were adopted to ensure thorough assessment using deductive content analysis. Each dementia plan was reviewed by at least two independent assessors. Forty plans were included in the final analysis. We found that basic human rights were covered by the plans, with community inclusion acknowledged in 39 plans (97.5%). However, there was less coverage of non-coercive practices and the participation of people with dementia in the design and delivery of services or policies, with only 24 plans (60%) mentioning these aspects. This is the first global review of human rights content within national dementia plans. More must be done to ensure that all such plans align with human rights standards so that the human rights of persons with dementia are respected, protected, and promoted.https://pmc.ncbi.nlm.nih.gov/articles/PMC12282884
A thematic analysis of the impact of therapist attachment on intersubjectivity when working with clients with complex trauma
No full textAim The current study explored the influence of therapists' self-reported attachment strategies on their therapeutic relationships with clients. Methods Twelve therapists working with individuals with complex trauma were interviewed and Thematic Analysis was used to generate themes from the data. Results Key findings identified a distinction between the therapeutic alliance and a secure attachment, based on the relationship's capacity to tolerate rupture. The study found that therapists' own attachment strategies affected empathy towards clients and how the underlying process may be related to identification, where over-identification was unhelpful. The study also identified, how therapists responded to client anger was related to their attachment strategies. Whilst avoidant/dismissive therapists were better able to contain client anger, this had the potential to impact upon attunement. Findings challenged the widely accepted view of therapists needing a secure attachment, rather warmth and proximity elicited negative responses from some clients. An unexpected finding was therapists' motivations and identified the therapeutic relationship as meeting the needs of some therapists. Conclusions Findings reinforce the premise of counselling psychology for reflective functioning and recommend that therapists acknowledge their own attachment strategies and wounds. A better understanding into these processes may enhance the therapeutic relationship and improve treatment outcome.https://onlinelibrary.wiley.com/doi/10.1002/capr.1289
Impact of dualism on the perception of treatability in psychiatry
Full text link© 2025 Latoo, Mistry, Alabdulla, Jan, Shariful Islam, Iqbal, et al., licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.Background: A false division between mental and physical disorders is supported by dualism, contributing to mental health stigma. There is a widespread misconception about the prognosis and treatment options for psychiatric diseases. This is despite data supporting the effectiveness of psychiatric treatments for a variety of illnesses that have been proven by meta-analysis. In general, the efficacy of drugs used to treat physical problems and psychiatric disorders is comparable. Method(s): In this article, experts from a variety of fields-including psychiatry, primary care, and general medicine-highlight how the paradigms based on dualism play a crucial role in maintaining the myths regarding psychiatric disorders, particularly those that relate to their treatability in comparison to physical health conditions. Result(s): There are numerous similarities between mental and physical problems in terms of the causes and treatment. Healthcare, like other complex human systems, is rife with uncertainty. In actuality, the severity and treatability of both physical and mental diseases range widely. Treatment response varies from person to person. There are certain physical and mental health disorders that respond well to treatment, some that do not, and some for which there are currently no effective cures. Conclusion(s): We believe that dualism, which promotes the separation of mental and physical phenomena, is the core driving force behind these misconceptions. These fallacies, in our opinion, are primarily motivated by dualism, which advocates the division of mental from physical occurrences. Copyright © 2025 Latoo, Mistry, Alabdulla, Jan, Shariful Islam, Iqbal, et al
Post-COVID Rehabilitation Service: COVID-19 Yorkshire Rehabilitation Scale (C-19 YRS) and Health-Related Quality of Life EuroQol Five-Dimensional Five-Level Questionnaire (EQ-5D-5L) Outcomes.
Full text linkCopyright © 2025 by author(s) and
Scientific Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/Background: In the United Kingdom (UK) long COVID symptoms are defined as symptoms that are unexplained by an alternative diagnosis and persist for more than 12 weeks after acute COVID-19. Long COVID services have been commissioned in the UK to respond to patient needs. Purpose/Aim: To investigate whether a post-COVID rehabilitation service and its interventions have a positive impact on patients’ outcomes as measured by the COVID-19 Yorkshire Rehabilitation Scale (C-19 YRS) and the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L) health-related quality of life scale. Methods: A retrospective investigation was conducted using routinely collected data (baseline and a 12-week follow-up) from service users of a post-COVID rehabilitation service. Twenty-one EQ-5D-5L and thirty C-19 YRS datasets were collected. Results: There was a significant improvement in symptom severity on the C-19 YRS score from baseline (M = 19.57, SD = 6.41) to 12-week follow-up (M = 17.13, SD = 7.60), with a medium effect size. There was a significant improvement in functional disability on the C-19 YRS score from baseline (M = 8.14, SD = 4.20) to 12-week follow-up (M = 7.17, SD = 4.38), with a small-medium effect size. There was an improvement in C-19 YRS “overall health”, but this was not statistically significant. The EQ-5D-5L dimension of “usual activities” improved, with a significant decrease in issues reported from baseline (M = 3.19, SD = 1.03) to follow-up (M = 2.86, SD = 1.24), with a small-moderate effect size. The EQ-5D-5L dimension “mobility issues” improved; participants reported mild to moderate issues (level 2) at baseline and no issues (level 1) at follow-up. Conclusion: The results show that a post-COVID rehabilitation service can have a significant positive impact on symptoms of long COVID and real-world functioning. It is essential that treating long COVID symptoms remains a healthcare priority. As there is a move away from specific long COVID services there is a need for effective services for tackling long-term conditions and symptoms that have occurred due to COVID-19.https://www.scirp.org/journal/paperinformation?paperid=14496
Inpatient compliance with levothyroxine timing : a clinical audit of administration practices and patient knowledge
No full textIntroduction: Levothyroxine, which is absorbed in the small intestine and, hence, is affected by the presence of food, is best taken up (60-80%) after a period of fasting. Hence, guidelines recommend that it is taken on an empty stomach, at least 30 min before food, caffeine-containing drinks and some medication.1-3 On busy wards with medication and meal rounds possibly functioning independently, sticking to this standard is challenging, and made more so by the knowledge gap. This audit aimed to evaluate inpatient compliance with timing recommendations, assess patient knowledge and identify concurrently prescribed medications that affect levothyroxine absorption. Material(s) and Method(s): This prospective audit was carried out at the Sherwood Forest Trust from August 26 to September 19, 2024. Inpatients who were taking levothyroxine were identified, and data were collected by reviewing EPMA and structured questionnaires administered to patients, assessing compliance, concurrent interacting medications and patient knowledge. The audit was performed against National Institute of Health and Care Excellence (NICE) guidelines, which state that levothyroxine should be administered at least 30 min before meals or other medication.3-5 Results and Discussion: Out of 51 patients audited, only 21.6% reported being compliant pre-admission. This dropped to 13.7% during inpatient stay (Fig 1). Only 3.9% of patients recalled being advised by a healthcare provider (pharmacist or GP) on correct timing, and the same proportion recalled having received leaflets/written education materials. Patients using dosette boxes took levothyroxine with other medication, and many were unaware that taking it with coffee or tea affected absorption,6 often taking levothyroxine before meals, but with a cup of coffee or tea. Concurrent prescriptions of proton pump inhibitors (PPIs) and calcium were common, with nearly 81.5% of patients on PPIs taking them at the same time as levothyroxine (Fig 2). Curiously, concurrent iron administration was not noted, in contrast to an audit at North Cumbria Integrated Care NHS Trust,7 which showed that 84% were taking it at the same time. Hospital morning routines, which consist of nursing shift handovers and mealtimes between 08;00 and 09;00, mean that levothyroxine is often taken with breakfast or during bundled morning rounds, limiting adherence to guidelines. Patient understanding of what constitutes an 'empty stomach' was inconsistent, with tea/coffee often substituted for water, and pharmacy labels were often brief, stating only 'take in the morning'. EPMA was also open-ended and did not provide alerts for concurrently administered interacting medications; neither did it provide a default closed window for administration. These systemic and educational gaps suggest the need for multi-level interventions to improve adherence. Conclusion(s): This audit elucidates unsatisfactory compliance with levothyroxine administration guidelines in hospitalised patients. Knowledge gaps, hospital routines and lack of enabling scaffolding via EPMA have been observed to be barriers to meeting the standards. Implemented interventions include default early-morning (06:00-07:00 h) EPMA scheduling paired with interacting medication alerts, updated pharmacy labels specifying 30 min before food, including coffee/tea, nursing team briefings and patient education material. Further planned interventions include flagging thyroxine for annual medication review and monitoring adherence to guidelines.https://www.sciencedirect.com/science/article/pii/S147021182500137X?via%3Dihu
Barriers to lead psychiatric clinical supervision - a cross-sectional survey
No full textAims: The Royal College of Psychiatrists (RCPsych) recommends that psychiatric trainees receive one hour of 1:1 supervision per week, with clinical supervisors allocated 0.25 PA (programmed activity) protected time per trainee weekly. The GMC National Training Survey 2023 found that 86% of trainees reported positive feedback on clinical supervision, though the survey was not psychiatry specific. Locally, the Resident Doctors Forum raised concerns about some trainees not receiving the recommended supervision time, prompting the introduction of a new supervision form. Aims were to identify and assess barriers to providing regular supervision to support the professional development of psychiatrists in training within Nottinghamshire Healthcare NHS Foundation Trust. Method(s):Aquestionnaire was developed based on the "Enablers and Barriers to Effective Clinical Supervision in the Workplace: A Rapid Evidence Review" to identify barriers to effective clinical supervision. It was emailed to all lead clinical supervisors in Adult Mental Health, with a two-week response deadline. The feedback was analysed using a mixed methods approach, combining quantitative and qualitative analysis. Result(s): The survey received a 30% response rate (21 out of 70 eligible trainers), with a distribution reflecting the grades of resident doctors in the trust: 34% supervising HST, 34% supervising CT, 19% supervising FY, and 13% supervising GPVTS. Key findings include: 67% of trainers felt their clinical workload allowed sufficient time for supervision, but 81% sometimes had to cancel due to clinical commitments. Trainers with sufficient time for supervision typically had protected time formally agreed in their job plans (85%). 80% of trainers faced cancellations due to trainee unavailability (e.g., shift work, staff shortages), and 10% felt supervision was hindered by inadequate resources, such as lack of private spaces. Awareness of the RCPsych supervision guidance was low (33%), and 50% were not familiar with or did not use the local supervision form. Opinions on the form were divided: half found it helpful, while the other half saw it as additional workload. Major barriers to effective supervision included intense clinical workload, time pressure, staff shortages, managing multiple trainees, and trainee unavailability due to on-call or leave commitments. Conclusion(s): Suggested actions to address these barriers include: Distributing the RCPsych guidance and Supervision Form to all trainers. Encouraging supervisors to schedule supervision mid-week to avoid conflicts with on-call shifts. Supervisors should discuss protected time in their job plans with clinical directors and work with medical education to find private workspaces for supervision.https://www.cambridge.org/core/journals/bjpsych-open/article/barriers-to-lead-psychiatric-clinical-supervision-a-crosssectional-survey/DA7B64F32D39111868B1348577DC680
The effect of the ketogenic diet on aggression and violence in patients with severe mental illness : a systematic review
No full textAims: The aim of this systematic review was to explore the existing literature on the impact of the ketogenic diet on aggressive and violent behaviour in patients with serious mental illness and the potential mechanisms involved, with the hypothesis that the ketogenic diet can reduce aggression and violence in this patient population. The ketogenic diet has proven to be useful as a therapeutic to reduce some clinical symptoms of certain neurological and psychiatric conditions, so this review was interested to determine if there were any correlations in impacts on behaviour in similar patient populations. Method(s): Following the PRISMA guidelines, a systematic review was conducted of the bibliographic databases MEDLINE, PsycINFO, Scopus, Web of Science, Cochrane Library, PubMed and Open Grey. The sources retrieved were narrowed down using specific inclusion and exclusion criteria and quality appraisal of the relevant sources was carried out using the Joanna Briggs Institute critical appraisal tools. Result(s): Of the 32 sources included in the final review, 26 of these, when linked together by association, supported the concept of the ketogenic diet reducing aggression either directly or indirectly via metabolites upon which the ketogenic diet can impact. Increased beta- hydroxybutyrate, gamma-aminobutyric acid and brain-derived neurotrophic factor were all observed when following the ketogenic diet and were, in most cases, associated with reduced aggression. Conclusion(s): Despite the limited literature available on the topic, the majority of the relevant sources supported the notion that the ketogenic diet could generally reduce aggression, an observation that could often be replicated in psychiatric settings. The conclusions made in this review were mostly formed by making associations between the available sources, so future research would need to be conducted with the specific focus of observing the impacts of the ketogenic diet on behaviour in psychiatric settings. Randomised controlled trials should be conducted in both inpatient and outpatient settings to enable further systematic reviews and metaanalyses to evaluate the ketogenic diet's potential for use as a nonpharmacological therapeutic in prescribing and patient care.https://www.cambridge.org/core/journals/bjpsych-open/article/effect-of-the-ketogenic-diet-on-aggression-and-violence-in-patients-with-severe-mental-illness-a-systematic-review/F38E4857367EC151AF454C70F3158C8
Current training landscape for novice robotic surgeons: an international investigative survey by the Junior-ERUS/Young academic urologists (YAU) robotics in urology working group
No full textIntroduction While robotic surgical training is crucial for preparing skilled surgeons, the landscape of available training programs is not well-defined. Many institutions offer structured curricula, yet transparency about training modalities, caseloads, and eligibility criteria for novice surgeons is limited. To address this gap, a structured survey was designed to assess robotic education offerings globally. Patients and methods A web-based survey was distributed to different robotic societies, institutions and dedicated robotic surgery experts, based on the Junior European Association of Urology Robotic Section (J-ERUS) network and the Young Academic Urologists (YAU) Robotic Section between February and September 2024. Furthermore, a peer-esteem snowballing approach allowed the survey to expand its reach through expert referrals. The survey captured information on training modalities, infrastructure, caseload, and case mix. Respondents were required to provide contact details for further follow-up, while their identities and institutions remained confidential. Results The survey achieved a 16.5% response rate, with 80 respondents from 49 institutions confirming robotic training opportunities. Training platforms included Da Vinci multi-port systems (71%), HUGO-RAS (15%), and Versius (8%). Training methods featured simulators (89%), dual-console training (65%), dry-labs (39%), and wet-labs (16%). Variability in training structures was observed, with 32% of institutions offering dedicated fellowships and 68% combining training with clinical duties. Institutions varied in case volumes (100–500 cases per year), and 41% indicated performing over 500 robotic procedures annually. Respondents predominantly answered that robotic surgery novices may access about 20% of these cases. Conclusion This study highlights the heterogeneity of robotic surgical education and the need for standardized, globally accessible training frameworks. Establishing an international consortium to map training programs and content could enhance transparency and support novice surgeons in selecting institutions that align with their career goals. It is critical to integrate emerging robotic platforms and evolving methodologies into curricula to ensure comprehensive and effective training.https://link.springer.com/article/10.1007/s00345-025-05845-
Ethical principles and challenges in end-of-life care for frail older adults
No full textProviding end-of-life care to frail, older adults with multiple comorbidities can be ethically complex. As frailty differs from single terminal illness, end-of-life care requires a carefully considered, ethically informed approach. The four core ethical principles of autonomy, beneficence, nonmaleficence and justice need to be applied within this context; they involve challenges specific to frail patients, including fluctuating mental capacity, the risks of aggressive interventions and equitable access to resources. Key ethical issues include do not attempt cardiopulmonary resuscitation orders, confidentiality, mental capacity assessments and palliative sedation. Health professionals require a structured framework for decision-making. By balancing patient dignity, quality of life and legal considerations, practitioners can understand ethical obligations and practical decision-making strategies. For frail, older adults, a compassionate, patient-centred approach that prioritises comfort and dignity, especially as people approach the end of life, ensures care is provided in line with both ethical and legal standards.https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2024.041