208 research outputs found
Changing the narrative: The British Psychological Society report ‘Understanding Psychosis and Schizophrenia’
No full textConversation with Anne Cooke and Peter Kinderman
Anne Cooke is the editor and Peter is a co-author of the British Psychological Society’s recent ground-breaking report ‘Understanding Psychosis and Schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’, which has attracted widespread media coverage and debate. It was written by a group of 25 clinical psychologists drawn from eight UK universities and the UK National Health Service, together with people who have themselves experienced psychosis.
It provides an accessible overview of the current state of knowledge, and its conclusions have profound implications both for the way we understand ‘mental illness’ and for the future of mental health services. In this talk Anne and described the motivation behind it, the reactions it has received, and outlined its main messages
Psychological Therapies, Psychological Therapists, Psychological Models of Mental Disorder and the Role of Applied Psychologists
No full textGuidelines from NICE (the National Institute for Health and Clinical Excellence) and academic papers have repeatedly stressed the effectiveness and appropriateness of psychological therapies for a range of mental health problems. The Department of Health’s and the Care Services Improvement Partnership’s (CSIP) Programme Improving Access to Psychological Therapies (IAPT) sets out a framework for action, including two national demonstration sites, to address these issues in England. Clearly, as experts in conducting and delivering psychological interventions, clinical and applied psychologists have a key role here. Psychologists are the key profession delivering such therapies, but the IAPT programme envisages an expansion of psychological therapists more generally. This means commissioners contracting with NHS Trusts (and potentially other bodies) to employ a range of professionals, including new graduates, to be trained in specific therapies such as cognitive behavioural therapy (CBT). Therefore, psychologists are also important as managers, supervisors and trainers of such psychological therapists. Psychologists’ training enables them to formulate individualised complex care plans where the application of manualised and deliverable packages of therapy can be integrated into more holistic care plans. This paper discusses the distinctive roles of psychologists and psychological perspectives in the light of these proposals. The paper is written from the perspective of one professional group – clinical psychology – and should be read in that context
Empirically grounded clinical interventions: Clinical implications of a psychological model of mental disorder
No full textKinderman (2005) presented a psychological model of mental disorder, based on a critique and reformulation of the biopsychosocial model. Kinderman suggested that disruption or dysfunction in psychological processes is a final common pathway in the development of mental disorder. These processes include, but are not limited to, cognitive processes. This 'mediating psychological processes model' proposes that biological and environmental factors, together with a person's personal experiences, lead to mental disorder through their conjoint effects on these psychological processes. The clinical implications of this model are discussed further here. It is proposed that formulations rather than diagnoses should predominate clinical planning, that these formulations should detail the hypothesised disruption to psychological processes or mechanisms, that psychological therapies should receive higher priority, and that medical, social and even psychological interventions are most likely to be clinically effective if they are designed on the basis of their likely beneficial impact on underlying psychological mechanisms. © 2006 British Association for Behavioural and Cognitive Psychotherapies
Professor Peter Kinderman's Message for Mental Health Awareness Week 2017
No full textProfessor Peter Kinderman's Message for Mental Health Awareness Week 201
An Error in the Kinderman-Ramage Method and How to Fix It
No full textAn error in the Gaussian random variate generator by Kinderman and Ramage is described that results in the generation of random variates with an incorrect distribution. An additional statement that corrects the original algorithm is given.Series: Preprint Series / Department of Applied Statistics and Data Processin
How well are we tackling the social determinants of mental health? An assessment of the quality of implementation studies and the examination of mental health care.
No full textOver recent decades, the context in which people live and work has become accepted as the fundamental factor driving health inequalities including factors such as the quality and security of people’s housing, employment, and education (Alegría et al., 2018; Pickett & Wilkinson, 2010; WHO Health Commission, 2008). Ultimately, these social inequities translate into people dying earlier than they should and spending more years of their shorter lives in poorer health. While impacting the most deprived communities, social inequalities follow a gradient, and negatively impact the health of all but the most affluent (Marmot & Bell, 2009).
These factors are known as the social determinants of health (SDOH), defined as “the conditions in which people are born, grow, live, work, age” (WHO Health Commission, 2008, p. 26).
More recently the literature has expanded beyond physical health to specifically explore the social determinants of mental health (SDMH). Research has implicated SDMH as a key driver influencing the development, severity and chronicity across a range of mental health diagnostic categories (Alegría et al., 2018; Shim & Compton, 2018). Allen et al. (2014) conducted a seminal review of SDMH, confirming that the higher the inequality, the higher the risk of various mental health diagnoses. Furthermore, these factors have been identified as key barriers to both, people accessing support (Comino et al., 2012; Ford et al., 2016; Goddard, 2008), and benefitting from it (Falconnier, 2009; Finegan et al., 2018).
The United Nations special rapporteur and human rights expert Daniel Pūras (2017), has argued for an urgent need for mental healthcare to prioritise targeting the SDMH. Additionally, there are mounting calls from organisations such as the World Health Organization (WHO) for mental health to be conceptualised firmly within the context of adverse social experiences, in contrast to “a growing over-emphasis on individual pathology” (Friedli & Organization, 2009, p. 7) through the dominant, bio-medical model, which many argue to be either limited or flawed (Division of Clinical Psychology, 2013; Johnstone & Boyle, 2018; Kinderman, 2021; World Health Organization, 2021).
Considering how the SDOH affect mental health, and how services respond to them is especially timely within the context of current social and economic challenges. Before the onset of the COVID-19 pandemic, health inequalities within the United Kingdom (UK) had increased following a decade of austerity policies (House of Commons, 2019; Marmot, 2020; Wickham et al., 2016). It was in this context that the COVID-19 pandemic presented itself, with a prominent review by Marmot et al. (2021) emphasising that the pre-existing inequalities will have been further exacerbated by the pandemic. The lingering effects of these two significant events and related policies are then compounded by the cost of living crisis (Harari et al., 2022; Levell & Karjalainen, 2021). Consumer prices are 21% higher in February 2024 than in 2021 (Harari, 2024), and it is important to note that even if high inflation rates are reduced, this is only a measure of how quickly prices increase – with prices expected to remain high for the foreseeable future (Cominetti et al., 2024). Consequently, any reductions in inflation rates bring little respite to 3.1 million low-income families with children forced to make sacrifices on essentials such as food and toiletries (Joseph Rowntree Foundation, 2023).
This thesis presents two papers exploring how mental health services can effectively respond to SDOH. A growing intervention to respond to such factors is the intervention of social prescribing (SP). However, the differential impact of social prescribing on different populations is unclear. Chapter one is a systematic review exploring the quality of reporting demographic characteristics and reporting rates in social prescribing studies to aid in answering this question. Beyond social prescribing as a bespoke intervention, there remains the question of how mental health services more broadly respond to such factors. Chapter two is an empirical qualitative study, exploring how mental health professionals become aware of SDOH present within the lives of service users, and how they respond to these factors once aware. Together, these two chapters aid reflections on how mental health services currently respond to the factors driving poor mental health and associated limitations. The conclusions from these chapters have ramifications for the structure of mental health services, and how they can meet the increasing demand
The social environment and psychosis: search for symptom specificity
No full textResearch with clinical and nonclinical samples has linked multiple psycho-social risk factors with psychosis. There has since been an emphasis on the importance of investigating specific symptoms experienced within the psychosis spectrum to better understand the psychological processes involved. The studies included in this doctoral thesis used cross sectional methods to explore relationships between specific social adversities and specific symptoms within the psychotic domain and also depression, using a number of different samples (students, client groups and general population). This thesis also explores mediating mechanisms between adversities and specific symptoms, paying particular attention to the role of specific adversities in paranoid ideation.
I found that perceived childhood inequality, neglect and adulthood social deprivation and insecure attachment styles predicted paranoid thoughts in student, epidemiological and clinical samples. In my student study I further developed and validated a tool to measure perceived relative deprivation. I then used this tool and found that personal perceptions of injustice and low social rank mediated the relationship between perceived relative deprivation and paranoia. In my epidemiological study I found that experiences of discrimination, lack of trust and stress partially explained the relationship between current social disadvantage and paranoia. In my two clinical studies I found that negative self-esteem explained the association between insecure attachment dimensions and paranoia, and strong perceptions of injustice and an over perception of justice in the world explained the association between childhood emotional neglect and paranoia.
Considering hallucinations, I found specific associations between perceived childhood deprivation and hallucinations in my student sample and between sexual abuse and hallucinations in my patient sample, although none of the mediating variables tested in this thesis accounted for these associations, suggesting other mechanisms may be important.
The findings of the current studies suggest that it is possible to identify specific associations between adversity and psychotic symptoms in general, and highlight the need to develop a science of public mental health, which at present barely exists as a discipline. In the future, more complex and imaginative designs examining specific environments, specific outcomes, and specific mediating mechanisms will be required if this is to be achieved
Stigma: A Linguistic Analysis of the UK Red-Top Tabloids Press’s Representation of Schizophrenia
No full textBowen, M., Kinderman, P., & Cooke, A. (2019). Stigma: a linguistic analysis of the UK red-top tabloids press’s representation of schizophrenia. Perspectives in Public Health, 139(3), 147-152. Copyright © 2019 SAGE. Reprinted by permission of SAGE Publications.Aims.
Media representations of mental health problems may influence readers’ understanding of, and attitude towards, people who have received psychiatric diagnoses. Negative beliefs and attitudes may then lead to discriminatory behaviour, which is understood as stigma. This study explored the language used in popular national newspapers when writing about schizophrenia and considered how this may have contributed to the processes of stigmatisation towards people with this diagnosis.
Methods.
Using corpus linguistic methods, a sample of newspaper articles over a 24 month period that mentioned the word ‘schizophrenia’ was compared with a similar sample of articles about diabetes. This enabled a theory-driven exploration of linguistic characteristics to explore stigmatising messages, whilst supported by statistical tests (Log-Likelihood) to compare the data sets and identify words with a high relative frequency.
Results.
Analysis of the ‘schizophrenia’ data set identified that overtly stigmatising language (e.g. “schizo”) was relatively infrequent, but that there was frequent use of linguistic signatures of violence. Articles frequently used graphic language referring to: acts of violence, descriptions of violent acts, implements used in violence, identity labels and exemplars of well-known individuals who had committed violent acts. The word ‘schizophrenic’ was used with a high frequency (n=108) and most commonly to name individuals who had committed acts of violence.
Discussion.
The study suggests that whilst the press have largely avoided the use of words that press guidance has steered them away from (e.g. “schizo” and “psycho”) that they still use a range of graphic language to present people with a diagnosis of schizophrenia as frighteningly ‘other’ and as prone to violence. This repetition of negative stereotypical messages may well contribute to the processes of stigmatisation many people who experience psychosis have to contend
Psychological Processes Mediate the Impact of Familial Risk, Social Circumstances and Life Events on Mental Health
No full textBackground. Despite widespread acceptance of the 'biopsychosocial model', the aetiology of mental health problems has provoked debate amongst researchers and practitioners for decades. The role of psychological factors in the development of mental health problems remains particularly contentious, and to date there has not been a large enough dataset to conduct the necessary multivariate analysis of whether psychological factors influence, or are influenced by, mental health. This study reports on the first empirical, multivariate, test of the relationships between the key elements of the biospychosocial model of mental ill-health.Methods and findings; Participants were 32,827 (age 18-85 years) self-selected respondents from the general population who completed an open-access online battery of questionnaires hosted by the BBC. An initial confirmatory factor analysis was performed to assess the adequacy of the proposed factor structure and the relationships between latent and measured variables. The predictive path model was then tested whereby the latent variables of psychological processes were positioned as mediating between the causal latent variables (biological, social and circumstantial) and the outcome latent variables of mental health problems and well-being. This revealed an excellent fit to the data, S-B χ² (3199, N = 23,397) = 126654•8, p< •001; RCFI = •97; RMSEA =•04 (•038-•039). As hypothesised, a family history of mental health difficulties, social deprivation, and traumatic or abusive life-experiences all strongly predicted higher levels of anxiety and depression. However, these relationships were strongly mediated by psychological processes; specifically lack of adaptive coping, rumination and self-blame.Conclusion. These results support a significant revision of the biopsychosocial model, as psychological processes determine the causal impact of biological, social, and circumstantial risk factors on mental health. This has clear implications for policy, education and clinical practice as psychological processes such as rumination and self blame are amenable to evidence-based psychological therapies.<br/
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