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How can you take your writing to the next level? In this follow-up to their acclaimed handbook The Book You Need to Read to Write the Book You Want to Write, Sarah Burton and Jem Poster offer exercises and practical advice designed to set aspiring authors of fiction on their way to creating compelling short stories and novels. Carefully explaining the purpose and value of each exercise and encouraging writers to reflect on what they have learned in tackling each task, this themed collection of writing prompts provides both encouragement and inspiration. There are many books of prompts already available, but this one is different. Its structured, in-depth approach significantly increases the impact of the exercises, ensuring that storytellers use their time and talent to best effect – not only exploring their own creativity but also developing a wider and clearer understanding of the writer's craft.
Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
Methods
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Results
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.
Conclusions
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
Only a third of people with dementia receive a diagnosis and post-diagnostic support. An eight session, manualised, modular post-diagnostic support system (New Interventions for Independence in Dementia Study (NIDUS) – family), delivered remotely by non-clinical facilitators is the first scalable intervention to improve personalised goal attainment for people with dementia. It could significantly improve care quality.
Aims
We aimed to explore system readiness for NIDUS–family, a scalable, personalised post-diagnostic support intervention.
Method
We conducted semi-structured interviews with professionals from dementia care services; the Consolidated Framework for Implementation Research guided interviews and their thematic analysis.
Results
From 2022 to 2023, we interviewed a purposive sample of 21 professionals from seven English National Health Service, health and social care services. We identified three themes: (1) potential value of a personalised intervention – interviewees perceived the capacity for choice and supporting person-centred care as relative advantages over existing resources; (2) compatibility and deliverability with existing systems – the NIDUS–family intervention model was perceived as compatible with service goals and clients’ needs, but current service infrastructures, financing and commissioning briefs constraining resources to those at greatest need were seen as barriers to providing universal, post-diagnostic care; (3) fit with current workforce skills – the intervention model aligned well with staff development plans; delivery by non-clinically qualified staff was considered an advantage over current care options.
Conclusions
Translating evidence for scalable and effective post-diagnostic care into practice will support national policies to widen access to support and upskill support workers, but requires a greater focus on prevention in commissioning briefs and resource planning.
In this editorial we, as members of the 2022 NICE Guideline Committee, highlight and discuss what, in our view, are the key guideline recommendations (generated through evidence synthesis and consensus) for mental health professionals when caring for people after self-harm, and we consider some of the implementation challenges.
Dialogue can be used to develop characters and progress plot but also needs to be dramatically necessary: characters need good reasons to impart information. Characters’ voices need to be differentiated. Dialogue injects energy; too much reported speech and action saps it. How to deliver information through dialogue without it feeling artificial. The value of what is not said and what stands behind the spoken words. The significance of silence. The constructed nature of ‘realistic’ dialogue. The debate over ‘said’. A guide to conventional and unconventional ways of punctuating dialogue. Managing accent and dialect. The problem of ‘other world’ speech. Managing a character’s thoughts.
‘If dialogue in fiction faithfully reflected speech in real life it would often be boring – full of repetitions, non sequiturs, digressions, irrelevancies, trivia and hesitations; it would also take up far too much space. The writer’s aim is to make dialogue appear authentic.’
Who is telling the story and how are they telling it? The difference between the author and the narrator. Respective advantages and disadvantages of first- and third-person narrative voices. Varieties of first-person narrative. Unreliable narrators. Varieties of third-person narrative. Multiple narrative viewpoints. Direct address to the reader. ‘Other world’ narrative voices.
‘Most stories pivot on the question of which character knows what and – crucially – what your reader knows and when you let them know it. The choice of narrative voice and point of view defines how much the reader can know.’
Publishing short stories: writing websites, print periodicals, competitions. Submission tips. The relationship between agents and editors. How editors make decisions. Targeting and pitching a novel. Understanding and getting value from rejection. Holding your nerve. The writing life: a place to work; a time to work; keeping a notebook; finding a community of writers. Writer’s block and how to avoid it. Set achievable goals. The pleasures of writing.
‘If we believe we’ve said everything we want to say we may as well give up writing. Everything we write is an adventure, an attempt at mastering what we might never quite conquer. You’ve finished when you know you’ve done everything you can to make it as true and good as it can be.’
Knowing when to stop: define your parameters. ‘The past is a foreign country: they do things differently there’ – take no small detail of everyday life for granted. Start broad and shallow; later go deep and narrow. The big story and the little story – keeping the balance right. Keeping research unobtrusive. Historical fiction: checklist of areas for initial research and suggested sources.
‘We’re not looking for historical truth but for fictive plausibility, on terms the writer must establish with the reader. A better question than ""Is this true?"" is “Have I made this seem plausible?”’
What does ‘write what you know’ mean? The bedrock of human experience is essentially the same in any age and this is part of what writers ‘know’. We bring imagination – and sometimes research – to our own experience when we write. Everything we have lived through is potentially valuable material; writing involves transforming this material. Even inspiration comes from within. The need to top up our own personal reservoir of experience. All ideas begin ‘What if…’ The importance of pushing beyond what we know we can do easily: creativity thrives when we are outside our comfort zone.
‘The magic isn’t out there somewhere, waiting to be discovered: the ingredients are in you right now, in your experience and in your imagination, waiting for you to make the unique connections that will enable you to discover it.’
The function of the beginning of a story. You don’t have to get the opening right before you can make any progress. Different kinds of openings. Starting with exposition. Starting in medias res. The necessity of having a sense of an ending while writing. Judging when to stop. The importance of how the story lands, rather than where it ends. The role of tension in a story. The cliffhanger. Arousing the reader’s curiosity. The importance of pace and how to sustain it. Methods of interrogating your writing for tension and pace.
‘Each chapter needs a narrative function. If you can’t summarise the purpose of a chapter you would be wise to check that it really does have a function. The other way to interrogate your writing for pace and tension is to ask yourself: What does the reader want to know at the end of this chapter?’
Character and plot are inextricably intertwined: characters make plot. Methods of introducing character. Investigating the respective usefulness of ‘showing’ and ‘telling’. A well-drawn character accumulates in the reader’s mind rather than springing fully fledged from the first page. How ‘showing’ character aids the creative process. Individualising characters. A character wants something; motive drives action and action drives plot. The relationship between narrative voice and character. The problems of too many characters. Managing minor characters. Believable characters are not always consistent; characters are fluid and flawed. Over-planning characters can be dangerous, limiting their potential and removing their ability to evolve.
‘For our characters to approach the texture of ""real"" people the writer, as well as the reader, needs to be curious about them, and that is impossible if we have removed their capacity to surprise us.’
Blending skills and strategies. Editing techniques. Getting value from a critical reader. Editing in response to notes. Trouble-shooting. Interpreting and addressing the causes of problems.
‘Identifying the problem isn’t the hard part. The hard part is finding the courage, where necessary, to revise radically. People often assume the editing process is about cutting bad writing, but it’s just as important to be prepared to cut good writing that no longer serves the narrative.’