Experiences of mental health services for ‘black’ men with schizophrenia and a history of disengagement: A qualitative study

Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as ‘black’. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in‐depth, semi‐structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) “People just keep hounding me”, (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants’ experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.     

A literature review to assess the reliability and validity of measures appropriate for use in research to evaluate the efficacy of a brief harm reduction strategy in reducing cannabis use among people with schizophrenia in acute inpatient settings

There is a growing body of evidence looking at the effects of cannabis use on those with schizophrenia with concerning results. This has led to the development of a number of interventions that are intended to improve outcomes for this client group. However, the methodological quality of some dual diagnosis research has been questioned in reviews for using outcome measures that are not tested as reliable and valid in the population for which they are intended for use. This literature review assesses the self-report measures that have been reliability and validity tested in populations of people with schizophrenia who use cannabis and reports on their appropriateness for use in further research studies. An overview of the most appropriate biochemical tests for cannabis is also given.     

Community psychiatric nurses' experience of working with people who engage in deliberate self-harm

This paper reports on a study that explored community psychiatric nurses' experiences of working with people who self-harm. Interpretative Phenomenological Analysis was used with eight experienced community psychiatric nurses who participated in semi-structured interviews. Established quality control procedures were utilized including audit of the analysis process and validating the results with participants. The participants described struggling to conceptualize self-harm behaviour and generally reported finding working with people who self-harm stressful particularly in terms of managing the emotional impact upon themselves and the boundaries of their professional responsibilities in relation to managing risk. The therapeutic relationship was viewed as crucial and a variety of coping methods to manage the impact of the work, which had largely developed through 'on the job', experience were described. The results highlight the potential difficulties faced by community staff and can be translated into clear recommendations for training and support.     

The experience of men using an upper limb prosthesis following amputation: positive coping and minimizing feeling different

Purpose. Psychosocial factors are likely to play a crucial role in adjustment to upper limb amputation and prosthesis use, and yet have received only minimal exploration within the literature. This study therefore, sought to gain a rich understanding of the experience of living with an upper limb amputation and of using a prosthetic arm and hand.

Methods. The qualitative method of Interpretive Phenomenological Analysis was used. Purposive sampling culminated in a homogenous sample of 11 males with unilateral upper limb amputations, who wore a prosthesis at least weekly. Semi-structured interviews were carried out, transcribed and analysed according to the methodology.

Results. Participants identified a theme of ongoing awareness of difference in appearance and ability. Consequently, participants described themes of psychosocial and functional adjustment to minimize this sense of difference. This was facilitated by the participants' prostheses and their positive coping style. Within this, participants also identified the personal meanings of their prosthesis and highlighted the terms of its use. The minimization of their sense of difference resulted in participants regaining a sense of worth.

Conclusions. The findings offer a greater psychological insight into adjustment from an upper limb amputation and the role of prostheses. These findings have implications for both the clinical rehabilitation of patients who undergo upper limb amputations, as well as for future research into the use and value of prostheses in facilitating the adjustment to this experience.     

The effects of cannabis abuse on the symptoms of schizophrenia: patient perspectives

ABSTRACT: This study explored explanatory models used by individuals with schizophrenia in relation to continuing cannabis abuse. Cannabis is known to exacerbate positive symptoms, compound the effects of negative symptoms, and lead to relapse, having a negative effect upon quality of life. If this is so, why would people choose to continue the drug use? Most previous studies exploring this phenomenon have used quantitative methodology where the questions asked have been preset by the researchers and the subjective experience of the patient has been minimized. Qualitative methodology was utilized in this study in order to give voice to the patients’ perspectives, and contribute to the knowledge of the frameworks of meanings employed by patients. The majority of participants in this study did not perceive that they had a mental illness and they held strong beliefs regarding the usefulness of cannabis. They gave explanations for their continuing cannabis use that expanded the understanding from previous studies. These included that they sought the drug effects of cannabis use for clarity of voices, control of symptoms, to feel normal, perceived improvement in cognitive function, reduced psychological pain and increased energy. These beliefs may influence a person's adherence with treatment and their future cannabis use. This research has implications for clinical practice as clinicians may lack insight into the importance of the phenomenological beliefs of a person with schizophrenia. This lack of insight by the clinician into the phenomenological beliefs may impact on the development of a therapeutic relationship.     

Challenges in relating to mental health professionals: Perspectives of persons with severe mental illness

A previous analysis showed that mental health service users experienced profound loneliness, struggled to relate to other people, and were careful in considering what to share with health‐care professionals. Being recognized by professionals in relationships may contribute to recovery processes characterized by ‘connectedness’, ‘hope and optimism’, ‘identity’, ‘meaning’, and ‘empowerment’. This paper regards people as mainly seeking contact and meaning (relational perspective) and aims to describe service users' understanding of being in relationships with professionals, and how these relationships may limit or enhance recovery. Interpretative phenomenological analysis was used to analyze data from in‐depth interviews. Participants described three levels of connectedness with professionals: (i) being detached; (ii) being cautious; and (iii) being open and trusting. Level of connectedness seemed to be associated with opportunities for promoted recovery. Trusting relationships may strengthen identity, provide opportunities for meaning and hope, and contribute to opening new perspectives, and lessen significance of internal voices. Adopting a relational perspective may assist professionals in recognizing the service user as a person involved in making sense of life experiences and in the process of connecting to other people.     

The importance of cannabis culture in young adult cannabis use

Abstract

Background: Research into drug use initiation has focussed on drug use as risky behaviour. Qualitative research suggests that a culturally derived set of beliefs about the positive effects of cannabis play an important role in the production and maintenance of cannabis use.

Methods: An online survey questionnaire was designed to measure both perceived positive and negative effects of cannabis. The questionnaire was submitted to a factor analysis, and two factors were extracted: a positive and a negative effect scale. Using regression analyses, associations with cannabis use, perception of general use and perception of general acceptance of use were assessed.

Results: After removing respondents based on age and responses to questions, 1416 valid survey questionnaires were collected. In bivariate analyses, both positive effects and negative effects were associated with use (p?<?0.001), perceived normative use (p?<?0.001) and acceptance of use (p?<?0.001). In multivariate analyses, only glorification remained consistently associated with perceived use, acceptance and all categories of use (p?<?0.001).

Conclusions: Positive beliefs about the effects of cannabis use are important and form part of a cannabis culture, which are essential for understanding initiation and maintenance of cannabis use. These findings have important ramifications for cannabis preventive work and also call on further investigation into the relation between cannabis culture and individual use.     

Illness,normality and identity: the experience of heart transplant as a young adult

Purpose: End stage heart failure and transplant present great opportunities and challenges for patients of all ages. However, young adulthood may present additional specific challenges associated with the development of identity, career and romantic relationships. Despite recognition of greater mortality rates in young adults, consideration of the experience of transplant during this life stage has been largely overlooked in the literature. The aim of this study was to explore the experience of heart transplant in young adults.

Method: Interviews were conducted with nine participants across three transplant services in the United Kingdom and the data subject to interpretative phenomenological analysis.

Results: Analysis identified three themes. “Separating from illness” and “working toward normality” involved limiting the influence of illness on identity, as well as reengaging with typical functioning in young adulthood. “Integrating transplant into identity” involved acknowledging the influence of living with a shortened life expectancy.

Conclusions: The need for support that recognizes specific challenges of transplant as a young adult is discussed (e.g. the development of age specific end of life pathways, improved communication between transplant recipients, their families and teams), including consideration of the impact of societal discourses (e.g. gift of life) which provided additional challenges for patients.

• IMPLICATIONS FOR REHABILITATION

• Heart transplant presents specific challenges according to the recipient’s life stage.

• The needs of young adult recipients should be considered.

• Transplant professionals should consider providing opportunities for peer support and addressing the identities and values of young adult transplant recipients during rehabilitation.

     

The compatibility of psychosocial interventions (PSI) and assertive outreach: a survey of managers and PSI-trained staff working in UK assertive outreach teams

In recent years, there has been an increased emphasis on providing psychosocial interventions (PSI) and assertive outreach (AO) for people with severe and enduring mental illness living in the UK. This paper presents the findings of a telephone survey conducted with managers and PSI-trained staff working for AO teams in the Northwest of England. The aim of the study was to gain an insight into staff attitudes regarding the compatibility of PSI and AO. The survey also gathered more general information about the nature of the AO teams and the number of PSI-trained staff working within them. The results indicate that, although PSI-trained staff believe that PSI and AO are compatible, AO is not immune to the barriers to PSI implementation that exist in other service areas. There also appears to be a question regarding the extent to which teams are maintaining fidelity to the original AO model that was outlined by Stein and Test.     

Exploring the experiences of self-determination of individuals with mild intellectual disabilities and epilepsy

Background

While epilepsy can decrease quality of life and self-determination in individuals without intellectual disabilities, the impact of epilepsy on experienced self-determination in people with intellectual disabilities remains unclear.

Method

We conducted semi-structured interviews with six adults (four men, two women) aged 30–61 with mild intellectual disabilities and drug-resistant epilepsy to investigate their experiences of self-determination. The data were analysed using Interpretative Phenomenological Analysis.

Results

Three main themes were identified: (A) I am a competent person with epilepsy; (B) My social needs: being accepted as I am and stability in relationships; and (C) Being in control.

Conclusions

In this study, the impact of epilepsy on experienced self-determination of people with mild intellectual disabilities outweighs the influence of intellectual disabilities. Identity formation, friendships with peers, and autonomy support in risk management are identified as important topics in supporting this group.     

The experience of young people with depression: a qualitative study

People who develop depression experience a maelstrom of emotions as they struggle to understand what is happening to them. While the experience has been comparatively well documented in older adults, much less is known about the depression experience and responses of young people. In this study, we aimed to explore the experience of young people diagnosed with depression. Twenty-six young people were recruited from a youth mental health service. A qualitative interpretative design was used, incorporating semi-structured, audio-recorded interviews. Results provided four overlapping themes, reflecting the young people's difficulties in coming to terms with, and responding in self-protective, harmful and at times life-threatening ways to their depression: (1) struggling to make sense of their situation; (2) spiralling down; (3) withdrawing; and (4) contemplating self-harm or suicide. Study conclusions are that young people faced considerable difficulties coming to terms with, and responding to, depression. Improving young people's understanding of depression and its treatment, reducing community stigma and providing accessible and youth-focused services remain important targets for intervention. It is also important to improve mental health literacy in the community to increase awareness of depression and how mental health professionals, including nurses, respond effectively to the young person.     

An interpretative phenomenological analysis of delusions in people with Parkinson's disease

Purpose: The purpose of this study was to examine the feasibility and effects of an upper extremity gaming system on impairments, activity and participation restrictions in persons with chronic stroke. Method: Nine participants with chronic (5.4 SD 3 years after stroke) upper extremity impairment due to stroke completed 18 sessions over 6 weeks with the Hand Dance Pro? gaming system that included trunk restraint. Measures collected at pretest and posttest included three-dimensional motion analysis of paretic upper extremity reaching, Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS). Data were analyzed across time, with effect sizes (Cohen’s d), and by categorizing participants with Fugl-Meyer Upper Extremity Motor Assessment scores (mild >50/66, moderate 26–50/66 and severe <26/66). Results: Statistically, significant improvements and medium-to-large effect sizes from pretest to posttest were found with ipsilateral reaching kinematic outcomes of movement duration, mean velocity and elbow excursion (p < 0.05). Participants with mild impairment demonstrated the greatest change in elbow excursion. No significant differences and small effect sizes were found for the WMFT and SIS. Conclusion: The gaming intervention with high repetitions of reaching to targets and trunk restraint was feasible and led to improvements in upper extremity movement kinematics in this group of participants with chronic stroke.

Implications for Rehabilitation

• Persons with chronic stroke can tolerate a high number of repetitions (between 800 and 2000) of reaching for targets during 30 minutes of playing a video game.

• Gaming systems that incorporate multiple repetitions of reaching for targets with trunk restraint can improve movement patterns in the paretic upper extremity of persons with chronic stroke.

     

Critical evaluation of the use of research tools in evaluating quality of life for people with schizophrenia

Schizophrenia may lead to impairments in many aspects of life, including physical, cognitive, and role functioning. The subjective quality of life of people with schizophrenia has been shown to be lower than in the general population and appropriate patient-assessed health outcome measures are necessary to capture the distress and disability experienced by people living with a serious mental illness. Although psychiatry has been slow to become involved in quality of life measurement, the use of quality of life instruments has now been recognized as a means of evaluating the outcome of care interventions, in terms of symptoms and functioning. This paper evaluates the effectiveness of two widely used instruments: The Medical Outcomes Study Short Form Health Survey (SF-36) and The Lancashire Quality of Life Profile (LQoLP) in terms of reliability and validity in measuring the quality of life of people with schizophrenia. The LQoLP appeared to be best suited for evaluation of care programmes, whereas the SF-36 was more appropriate for medical trials, comparisons between patient groups, and assessment of the direct consequences of treatment on health and function. Subjective quality of life should, however, be considered to be distinct from clinical status and quality of life assessment should include the broadest range of indicators, to reflect the holistic ethos of mental health nursing.