Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.

“I just can’t, I am frightened for my safety, I don’t know how to work with her” Practitioners’ experiences of client violence and recommendations for future practice

To what extent is the therapist-client relationship damaged following client perpetuated violence and what steps can we take to diminish its impact? Much of the information we have on client violence comes from multiple mental health disciplines in the US and the UK over the last 20-30 years and has formed a useful, though sometimes dated and sporadic, quantitative baseline to delineate a range of issues. However, there is limited systematic research on how practitioner psychologists process the violence in the course of their everyday practice and how this impacts the therapist-client dynamic. Using Interpretative Phenomenological Analysis (IPA), we explored seven therapists’ experiences of client violence across a range of work sites – acute psychiatric hospital wards, forensic hospital wards and community mental health teams. Three main themes were documented: processing the moment-to-moment experience of client violence; professional vulnerabilities and needs as a result of client violence; and the ruptured therapeutic relationship. Strategies for supporting practicing psychologists and providing continuing professional care for clients include challenging self-doubt and re-energizing professional competencies as well as repairing ourselves and repairing the therapeutic relationship. Recommendations for credentialing and regulatory bodies in relation to client violence are also highlighted.

Spirituality and Basketball Fanship: An Interpretative Phenomenological Analysis and Synthesis

The world of competitive sport affords an individual the opportunity to enter a spiritual community adding meaning that transcends one’s current understanding of life (Parry et al. 2007). Previously established dimensions of sports fanship (group affiliation, psychological commitment and team identification) share characteristics commonly associated with religious or spiritual affiliation indicating that fans may generate substantial life meaning from observing sporting encounters. In the present study, 12 male basketball fans (M=32.42; SD=7.97) completed semi-structured interviews immediately prior to viewing a competitive match at the 2011 European Basketball Championships (Vilnius, Lithuania). Interviews were structured under four headings; 1) the most memorable moment as a basketball fan, 2) thoughts, feelings and emotions attached to their team, 3) affiliation to the team in the context of the fan’s meaning of life, 4) connection with members of the fan’s sporting community. Interpretative Phenomenological Analysis was employed to analyse interview transcripts. Raw data clustered into four dimensions; 1) devotion, 2) obscure emotions, 3) connectedness, and 4) universal values. The results indicate that sports fanship is characterised by, and synonymous with, an established understanding of spirituality derived from membership of wider spiritual and/or religious communities. The findings hold implications for the marketing and membership of local, amateur and professional sports clubs and brands, as well as community development, health and welfare.

The Influence of Causal Explanations and Diagnostic Labeling on Psychology Students’ Beliefs About Treatments, Prognosis, Dangerousness and Unpredictability in Schizophrenia

This study explored views of 566 Italian psychology students about schizophrenia. The most frequently cited causes were psychological traumas (68%) and heredity (54%). Thirty-three percent of students firmly believed that people with the condition could recover. Reporting heredity among the causes, and identifying schizophrenia were both associated with prognostic pessimism, greater confidence in pharmacological treatments and lower confidence in psychological treatments. Schizophrenia labeling was also associated with higher perception of unpredictability and dangerousness. Compared to first year students, fourth/fifth year students more frequently reported heredity among the causes, and were more pessimistic about schizophrenia recovery. Stigma topics should be included in future psychologists’ education.

The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results

Background The Well London programme used community engagement, complemented by changes to the physical and social neighbourhood environment, to improve physical activity levels, healthy eating and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomised trial (CRT). The baseline survey data are reported here. Methods The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas; ranked in the 11% most deprived LSOAs in London by Index of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighbourhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating and mental wellbeing were assessed using standardised, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. Results There were 4107 adults and 1214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighbourhoods were broadly similar. There was greater between cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking and self-reported anxiety/depression were similar in the Well London population and the national Health Survey for England. Levels of physical activity were higher in the Well London population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions Randomisation of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.