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A retrospective examination of care pathways in individuals with treatment-resistant depression
- Elana Day, Rupal Shah, Rachael W. Taylor, Lindsey Marwood, Kimberley Nortey, Jade Harvey, R. Hamish McAllister-Williams, John R. Geddes, Alvaro Barrera, Allan H. Young, Anthony J. Cleare, Rebecca Strawbridge
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- Journal:
- BJPsych Open / Volume 7 / Issue 3 / May 2021
- Published online by Cambridge University Press:
- 14 May 2021, e101
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- Article
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Background
Individuals with treatment-resistant depression (TRD) experience a high burden of illness. Current guidelines recommend a stepped care approach for treating depression, but the extent to which best-practice care pathways are adhered to is unclear.
AimsTo explore the extent and nature of ‘treatment gaps’ (non-adherence to stepped care pathways) experienced by a sample of patients with established TRD (non-response to two or more adequate treatments in the current depressive episode) across three cities in the UK.
MethodFive treatment gaps were considered and compared with guidelines, in a cross-sectional retrospective analysis: delay to receiving treatment, lack of access to psychological therapies, delays to medication changes, delays to adjunctive (pharmacological augmentation) treatment and lack of access to secondary care. We additionally explored participant characteristics associated with the extent of treatment gaps experienced.
ResultsOf 178 patients with TRD, 47% had been in the current depressive episode for >1 year before initiating antidepressants; 53% had received adequate psychological therapy. A total of 47 and 51% had remained on an unsuccessful first and second antidepressant trial respectively for >16 weeks, and 24 and 27% for >1 year before medication switch, respectively. Further, 54% had tried three or more antidepressant medications within their episode, and only 11% had received adjunctive treatment.
ConclusionsThere appears to be a considerable difference between treatment guidelines for depression and the reality of care received by people with TRD. Future research examining representative samples of patients could determine recommendations for optimising care pathways, and ultimately outcomes, for individuals with this illness.
eight - From researching heritage to action heritage
- Edited by Helen Graham, University of Leeds, Jo Vergunst, University of Aberdeen
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- Book:
- Heritage as Community Research
- Published by:
- Bristol University Press
- Published online:
- 27 April 2022
- Print publication:
- 13 March 2019, pp 171-186
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Summary
Introduction
During 2012 and 2013, Researching Community Heritage (RCH) brought together community researchers in South Yorkshire and Derbyshire with a team of staff and students from the University of Sheffield to find out more about our local and regional heritage. Community and university researchers shared their expertise as both specialists in academic subjects and specialists in the places and communities where they live.
A programme of workshops during the first year led to over 30 applications to the Heritage Lottery Fund's (HLF’s) All Our Stories grant scheme. In many cases, the university researchers acted as advisors for these applications and the community researchers brought the ideas, inspiration and leadership. In other projects, the community and university researchers jointly devised the proposal, offering a shared intellectual and personal vision for the research.
We were delighted when 14 of the projects were offered funding by the HLF, and we devoted the second year of RCH to making these projects a success. Working together, we learned about our region and its history looking at both the fine grain of everyday lives (for instance, the pastimes and social lives of people in the Sheffield suburb of Heeley during the last hundred years) and the broader processes that were shaped by and that, in turn, shaped our communities (such as military training on Langsett Moor during the Second World War).
In this chapter, we present a few of the RCH projects in more depth, and introduce the activities of narrative, creative practice and engaged learning that were shared ways of working during the research. We reflect on how these activities engaged the participants with heritage as a creative and social process, rather than heritage as a body of immutable facts about the past. Through this attentiveness to process during RCH, we became conscious of how researching was a means of enfranchising participants, and of revealing and contesting inequalities within and beyond the projects. Inspired by Nancy Fraser's (2000) thinking on social justice and the application of her ideas in heritage studies (Waterton and Smith, 2010), we propose an ‘action heritage’ framework for undertaking co‑produced heritage research. We began RCH with the seemingly straightforward aim of helping local community organisations find out more about their heritage.
Six - What is the role of artists in interdisciplinary collaborative projects with universities and communities?
- Edited by Keri Facer, University of Bristol, Kate Pahl, Manchester Metropolitan University
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- Book:
- Valuing Interdisciplinary Collaborative Research
- Published by:
- Bristol University Press
- Published online:
- 05 April 2022
- Print publication:
- 05 April 2017, pp 131-152
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Summary
Introduction
In this chapter we provide a way of thinking about the impact of artists working collaboratively in order to co-produce ideas with a range of people, including people working in universities. The drive to make art with communities in order to effect change and support community activism has had a long history both in the UK and globally (Kester, 2005; Bishop, 2012). As projects have become more interdisciplinary and collaborative, contemporary artists have been increasingly visible working with academics from a variety of disciplines, including Social Science, Pure Science, and the Arts and Humanities. Artists work within contexts such as schools and hospitals, and when doing so, can challenge conventional practices. This includes ‘artist in residence’ programmes, where artists respond to place, site and people. In the 1960s Barbara Steveni, John Latham and others initiated the radical and influential ‘Artists Placement Group’, based in the UK but with European links, which situated artists within unfamiliar spaces including factories, places of work and businesses (Slater, 2000). They argued that coming from the ‘outside’, an artist might unsettle or question ways of doing things in a setting, create a space for a different kind of practice to take shape, or open up new pathways for thinking. Other partnerships, for example between artists and teachers, created new configurations of practice, enabling them to work together in new and unexpected ways. Often artists’ approaches will be different from established norms, creating an unexpected experience for all collaborators. For example, in a school, an artist might suggest stretching time to work on children's messy play longer, while teachers are more likely to remain within the timetable structure. Artists’ interventions can change the way people do things that might not have been considered previously. In a hospital, aesthetic considerations suggested by an artist can change how light and space are deployed in a waiting room, altering how people feel in the space. On a council estate, sculpture provides a focal point, or a one-off event might create a new configuration of how space is used and appreciated by those who live there. While the impact of artists working in such contexts may be recognised, what happens in the fine detail of these encounters is not always clear.