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Health Care Professionals’ Perspectives of Early Intervention in Psychosis Services: A Qualitative Study
- Michelle Rickett, Tom Kingstone, Veenu Gupta, David Shiers, Paul French, Belinda Lennox, Carolyn Chew-Graham
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S68
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- Article
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Aims
An Early Intervention in Psychosis (EIP) service offers treatment in the community to people with a first episode of psychosis. EIP is meant to be given for three years; after this time, those who are well are discharged to their GP, while those with ongoing symptoms and care needs are transferred to a general community mental health team. People can become unwell at this time of change and might benefit from longer treatment with EIP. We also know that some people who are well could possibly have been discharged back to their GP earlier. The EXTEND programme aims to develop a more tailored approach to EIP services based on the needs of each individual and understand the health, social, and cost-benefits of this approach.
MethodsThis qualitative study sits within a larger programme of work. Ethics and HRA approvals gained. Semi-structured interviews were conducted with health care professionals from primary and specialist care, managers and commissioners, to understand why and how decisions about duration of EIP care are made. Interviews have been transcribed and thematic analysis using principles of constant comparison is being conducted. Patient and public involvement is key to all stages of the study.
ResultsFive interviews with General Practitioners and twelve interviews with EIP healthcare professionals, managers and commissioners have been conducted. Initial analysis suggests that access to EIP services can be challenging. Initial engagement is needed before therapy can begin. Decisions about duration of care can depend upon availability of access to Community Mental Health teams. Discharge planning rarely involves communication between primary and specialist care, and this can be a difficult transition, particularly when discharge is back to primary care. The pathway back into mental health care following discharge can be difficult. Trusting relationships between service users and EIP professionals are key to the success of EIP care. Healthcare professionals would value - and in some cases are given - flexibility to extend EIP care beyond 3 years.
We have developed a model to illustrate the patient journey through the EIP service which will be presented for the first time at the conference.
ConclusionThis research provides a framework to understand decision-making around duration of care, discharge planning and practices, and post-discharge support for EIP service users. The next phase of the study will be interviews with service users and carers to explore their experiences of EIP services, duration of care and discharge planning.
fifteen - The place of theatre in representations of ageing
- Edited by Alan Walker, The University of Sheffield
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- Book:
- The New Dynamics of Ageing Volume 2
- Published by:
- Bristol University Press
- Published online:
- 13 April 2022
- Print publication:
- 25 July 2018, pp 285-306
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Summary
Prologue
The interdisciplinary ‘Ages and Stages’ project, funded initially under the New Dynamics of Ageing (NDA) programme, has evolved into a continuing collaboration between Keele University and the New Vic Theatre, Newcastle-under-Lyme. The first ‘Ages and Stages’ project (2009–12) examined historical representations of ageing within the Vic's ground-breaking documentaries and docudramas (produced between 1964 and 1995), and explored the contemporary recollections and experiences of older people who are, or have been, associated with the theatre in different ways. Archival and interview material was drawn together to create the ‘Ages and Stages’ exhibition and a new, hour-long, documentary drama, ‘Our Age, Our Stage’. Between 2012 and 2013, further funds were secured from the Arts and Humanities Research Council (AHRC) follow-on scheme to focus on translational work, and we were subsequently awarded two additional grants by the AHRC under their Cultural Value Project. In this chapter we concentrate on the first three-year project; readers interested in following through what we have done subsequently are invited to visit the ‘Ages and Stages’ and ‘Live Age Festival’ websites (www.keele.ac.uk/agesandstages and www.liveagefestival.co.uk).
Act One: Setting the scene
Social and critical gerontologists, as well as literary and cultural scholars, are increasingly interested in the artistic engagement of older people, and in how the arts may construct, perpetuate or challenge stereotypical views of old age and existing models of the ageing process (Gullette, 1997, 2004, 2011; Basting, 1998, 2009; Small, 2007; Lipscomb and Marshall, 2010; Mangan, 2013). While recent reviews (Cutler, 2009; Castora-Binkley et al, 2010; Mental Health Foundation, 2011; Noice et al, 2014) affirm the value of older people's engagement in cultural activities, they also point to a lack of research on theatre and drama more specifically. This is despite the fact that, as Lipscomb (2012) argues, theatre provides us with an untapped potential for interdisciplinary collaborations and investigations; it is a cultural arena in which both ageing and older people are highly visible as audience members, participants, characters and increasingly, as performers (Bernard and Munro, 2015).
In terms of representations, there is a long tradition of theatre drawing heavily on stereotypes of older people and on deficit models of the ageing process, extending back to early Greek tragedies (Charney, 2005; Robson, 2009).
three - Understanding and transforming ageing through the arts
- Edited by Alan Walker, The University of Sheffield
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- Book:
- The New Science of Ageing
- Published by:
- Bristol University Press
- Published online:
- 04 March 2022
- Print publication:
- 29 August 2014, pp 77-112
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Summary
Introduction
Ageing can be both understood and described as a storied process, part of what Holstein and Gubrium (2011, p 103) have described as ‘the narrative quality of lives’. We hear and tell stories about growing old; we read and watch published and filmed stories about older people; we are surrounded by images of ageing with their implicit narratives. Such stories permeate our social world and shape our expectations about older people and about growing old ourselves. In this chapter we intend to explore this process further, drawing on research that has explored the character of the stories that older people tell about their lives and, in some cases, making the links to more formal narratives found in genres such as fiction and other representational practices, in collaborative artwork, in art galleries and the theatre. We are particularly interested in how dominant social representations of ageing (Moscovici, 2000) can be contested through a process of active narrative work, that is, engaging older people with representational processes at various levels as consumers of such narratives (as readers, as members of group interactions, as theatre goers, as social beings) and as producers of them (discursively, in interviews and groups, using diaries and through various forms of artistic expression). In highlighting such elements, we are interested in ways of challenging negative social representations of ageing through the active participation of older people in different art forms.
Both narrative making and narrative exchange are everyday processes of making sense of a changing world by which we provide a certain meaningful coherence to a series of events. Such narratives have a certain form and structure which can convey not only particular thoughts about those events, but also incorporate gestures, feelings and actions. As such, narratives can become not only descriptions of past events but plots for future actions. Freeman (2011) has described the phenomenon of ‘narrative foreclosure’ or the process by which we come to believe that life is over before it is physically ended. We stop developing initiatives and accept that decline and exclusion are inevitable. Public institutions often reinforce this narrative in their negative representations of ageing and in their exclusion of older people from a range of activities.
Narrative accounts are habitually and constantly exchanged and shared in everyday social interaction.
Ages and Stages: the place of theatre in the lives of older people
- MIRIAM BERNARD, MICHELLE RICKETT, DAVID AMIGONI, LUCY MUNRO, MICHAEL MURRAY, JILL REZZANO
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- Journal:
- Ageing & Society / Volume 35 / Issue 6 / July 2015
- Published online by Cambridge University Press:
- 10 March 2014, pp. 1119-1145
- Print publication:
- July 2015
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Despite the growing interest amongst gerontologists and literary and cultural scholars alike, in arts participation, ageing and the artistic outputs of older people, comparatively little attention has yet been paid to theatre and drama. Likewise, community or participatory theatre has long been used to address issues affecting marginalised or excluded groups, but it is a presently under-utilised medium for exploring ageing or for conveying positive messages about growing older. This paper seeks to address this lack of attention through a detailed case study of the place of one particular theatre – the Victoria/New Victoria Theatre in North Staffordshire, England – in the lives of older people. It provides an overview of the interdisciplinary Ages and Stages project which brought together social gerontologists, humanities scholars, psychologists, anthropologists and theatre practitioners, and presents findings from: the archival and empirical work exploring the theatre's pioneering social documentaries and its archive; individual/couple and group interviews with older people involved with the theatre (as audience members, volunteers, employees and sources); and ethnographic data gathered throughout the study. The findings reaffirm the continuing need to challenge stereotypes that the capacity for creativity and participation in later life unavoidably and inevitably declines; show how participation in creative and voluntary activities shapes meanings associated with key life transitions such as bereavement and retirement; and emphasise the positive role that theatre and drama can play as a medium for the inclusion of both older and younger people.