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A collaborative evaluation of remote consultations in mental health services was undertaken by mental health service providers, experts by experience, academic institutions and a Health Innovation Network in south London, UK. ‘Learning healthcare systems’ thinking was applied. Workstream 1 reviewed international published evidence; workstream 2 synthesised findings from three health provider surveys of the perceptions and experiences of staff, patients and carers; and workstream 3 comprised an electronic survey on local projects.
Results
Remote consultations can be acceptable to patients and staff. They improve access for some while restricting access for others, with digital exclusion being a key concern. Providing tailored choice is key.
Clinical implications
The collaboration generated learning to inform choices by healthcare providers to embed or adapt remote delivery. A key output was freely downloadable survey questions for assessing the quantity and quality of appointments undertaken by phone or video or face to face.
I’m a member of ‘the human race’, as well as being a mother of four children. My middle child was diagnosed with a mental illness in 2016. I experienced some different emotions during that difficult time. I was so frightened regarding my son’s unusual behaviour. I could not understand what was happening, or why this was happening within my family. At times, I felt angry because everything seemed to be out of my control. I began to isolate myself. I could not even tell my family or friends in the first instances; it was too embarrassing. I did not want to speak to anyone. I felt so disappointed in myself; I thought I had failed in my duties as a mother. Sometimes, the feeling of guilt would consume me so much. My stomach would constantly be in pain. My head and heart would always be pounding so loud. My sleeping patterns were altered so much that I could not remember if I managed to close my eyes at times during those bleak nights.
I am an informal carer for my partner, and I have been playing this role for several years. I also have a daughter aged six years old. Being a carer has been challenging due to managing the different role and responsibilities as a partner, carer, and a father.
My brother was different right from childhood. A lot of firsts in the family were witnessed in him. The age gap between him and his immediate younger sibling was the shortest (less than two years). He stood and walked later than his five siblings and he was the only one to have a febrile seizure. However, my brother was also more sociable than anyone else in our family; the only one interested in the entertainment industry. As a child, sometimes he would manifest some baffling behaviours that our straitlaced family found difficult to understand. This led to punishments in an effort to curb some of these behaviours. I think because he was punished more often than the well-behaved siblings, perhaps he had a feeling of not being loved as much as they were.
I was 11 when my mum told me that she was going into hospital because her ‘headaches’ were troubling her. We were on a walk together and I remember her starting to talk as she took my hand to cross the road. I asked her how long she’d be away for, and she told me that she didn’t know but it may be a few months. I’m 44 now and she still hasn’t come home. I promised her on that walk that I would write to her every day. I kept that promise, writing each night before I went to bed. I wrote until I ran out of paper, but I never heard back. I used to hide the letters under my mattress and, every so often, I would give my dad a carrier bag full of ‘My Little Pony’ envelopes to give to her. I didn’t ever ask him what she said or even if he gave them to her but that feeling when I didn’t hear back is one that I’ll never forget. My mum had a number of hospital admissions prior to this one. Nobody ever told me what was really happening though. I would just see my dad standing in my mum’s spot by the school gate and I’d know that she was gone again.
Psychosis is the generic name given to a range of illnesses that can affect the mind and interfere with how a person thinks, feels and behaves. The term psychosis covers several different conditions, for example, drug-induced psychosis, psychotic depression, schizoaffective disorder and schizophrenia spectrum disorders. The precise name used can change over time and will depend upon the pattern and length of difficulties that an individual has. A diagnosis of schizophrenia is considered the most severe type of psychotic illness and almost one person in every hundred people will be diagnosed at some point in their life. It used to be thought that schizophrenia was a discrete illness that was quite separate from other psychotic illnesses such as depressive psychosis.
It has truly been strange to be asked to write a piece from a carer’s perspective as when it comes to family, you never see yourself as a carer, probably due to the stigma that is attached to mental ill health and ‘looking after family’ in the South Asian culture.
This set of first-hand accounts offers insights into the diversity that exists in carer experiences and caregiving impacts in psychosis, and in carers’ ideas and suggestions about strategies that have supported their coping.
Supporting a relative living with a psychotic disorder can be uniquely challenging when compared to other health conditions, leaving many family carers isolated and struggling with questions: Why us? How do others cope? Is it my fault? How much more can I take? This collection of personal accounts provides family carers with a helpful framework to make sense of their individual experiences and support their own coping and wellbeing. It details the myriad of positives, challenges and life-changing experiences that families encounter following the development of a psychotic illness in a loved one. The authors of these accounts are varied and include the parents, partners, siblings and children of those experiencing psychosis. This book will also serve as an excellent resource for psychiatrists, psychiatric nurses, psychologists, social workers, GPs and students who should find the book relevant both for their own practice and for those families they support.
High intensity interval training (HIIT) may improve a range of physical and mental health outcomes among people with severe mental illnesses (SMI). However, there is limited data on patients’ reported attitudes towards HIIT and its implementation within inpatient settings, and there remains an absence of data on attitudes towards HIIT from informal family carers of service users and healthcare professionals, who both have key roles to play in facilitating recovery outcomes in service users. This study sought to qualitatively investigate, in inpatients with SMI, carer and staff groups, perspectives on implementing HIIT interventions for patient groups in inpatient settings.
Method
Seven focus groups and one individual interview were conducted. These included three focus groups held with inpatients with SMI (n = 12), two held with informal carers (n = 15), and two held with healthcare professionals working in inpatient settings (n = 11). An additional individual interview was conducted with one patient participant. The focus group schedule comprised open- ended questions designed to generate discussion and elicit opinions surrounding the introduction of HIIT on inpatient mental health wards. Data were subject to a thematic analysis.
Result
Two key themes emerged from the data, across all participants, that reflected the ‘Positivity’ in the application of HIIT interventions in psychiatric inpatient settings with beliefs that it would help patients feel more relaxed, build their fitness, and provide a break from the monotony of ward environment. Moreover, the short length of HIIT sessions was deemed appealing to mitigate against difficulties that many inpatients can experience with motivation, interest and attention, and was considered to be more appealing than more lengthy forms of exercise, which may require greater physical exertion. The second theme related to ‘Implementation concerns’, that reflected subthemes about i) low patient motivation, particularly with older participants, those administered many medications, and for those with less positive memories of exercise ii) patient safety, including concerns surrounding the intensity of HIIT and inclusion of patients with physical health comorbidities and iii) practical logistical factors, including having access to the right sports clothing and staff availability to supervise HIIT.
Conclusion
HIIT for inpatients with SMI was actively endorsed by patients, carers and healthcare professionals. Patient safety and baseline motivation levels, and practical service considerations were all noted as potential barriers to successful implementation and are worth considering in preparation for trialing a new intervention.