Shared decision-making is essential to patient-centred care, but remains underutilised in psychiatry, particularly when deciding whether to continue, reduce or stop antipsychotic medication after remission from first-episode psychosis (FEP). Existing decision aids do not fully address recovery goals such as autonomy, identity and social reintegration.

To co-develop a patient decision aid (PDA) prototype that supports individuals in making the decision to continue, reduce or stop antipsychotics following remission from FEP.

We used a patient-centred design process informed by International Patient Decision Aid Standards (IPDAS), User Centered Design (UCD-11) and the CHIME framework. A multidisciplinary steering group – including individuals with lived experience, clinicians, and researchers – co-developed the PDA. Iterative feedback was collected from an external advisory group of patient partners, caregivers and healthcare providers (n = 7). Acceptability was evaluated with structured questionnaires.

The final prototype, structured into five sections (decision overview, personal values, risks and benefits, planning and real-life experiences), demonstrated strong acceptability across stakeholders. Ratings improved with each iteration, with version 3 receiving near-perfect scores on clarity, usefulness and balance. Users described the tool as relatable and empowering. The inclusion of real-life stories and visual decision exercises were particularly valued. However, some clinicians expressed concerns about time constraints and workflow integration.

This recovery-oriented PDA prototype offers a practical, evidence-based resource to facilitate shared decision-making with respect to continuing, reducing or stopping antipsychotics after FEP. Although early feedback is promising, pilot testing is needed to evaluate its impact on decision quality, satisfaction and treatment outcomes.

Recovery Colleges are adult education initiatives supporting personal recovery for individuals with mental health difficulties. We characterised a national (England) inception cohort of mental health service users, students from the Recovery Colleges Characterisation and Testing 2 programme, and compared those attending different Recovery College types on sociodemographic, clinical, service use and student-reported outcomes over the 4 months prior to enrolment. Mixed-effects regression models were used to assess differences.

The cohort comprised 498 students from 36 Recovery Colleges across England; 77.7% attended strengths-oriented Recovery Colleges. Mean age was 39 years (s.d. 12); most were female (72.1%) and White (81.5%). Common diagnoses were mood (31.3%) and anxiety disorders (29.7%). No significant differences were found between students attending strengths- versus community-oriented Recovery Colleges.

Strengths- and community-oriented Recovery Colleges have similar service user student populations. Certain groups that may be underrepresented in Recovery Colleges and Recovery College research include older adults, men, those with developmental disorders and ethnic minority populations.

Forensic mental health services need a reliable and repeatable outcome measure to assess the progression of self-rated recovery during the forensic journey. The Questionnaire about the Process of Recovery (QPR) was developed in individuals with psychosis, and has been used to assess recovery in people with severe mental illness; however, its psychometric properties have not been studied in a forensic psychiatric cohort.

This study aimed to assess the psychometric properties of the QPR in a sample of individuals who currently access, or formerly accessed, high-security psychiatric care, including internal consistency, test–retest reliability, factor structure and criterion validity.

Psychometric analysis was undertaken in a sample of 146 current or former high-security patients. Confirmatory and exploratory factor analysis examined the latent test structure. Non-parametric comparisons of QPR score indices tested for differences according to individuals’ current setting (high-, medium- or low-security or open wards; community) as evidence of criterion validity.

A unique two-factor structure related to self-actualisation/empowerment and growth/insight fit forensic patients’ QPR responses. Internal consistency and test–retest reliability were adequate for QPR all-item scores for the original and shortened scales, as well as for the new forensic factor scores. QPR score indices differentiated patients by current setting (eta2 = 0.03–0.04), although only the forensic factor related to growth/insight was significant in corrected post hoc comparisons.

The original QPR is recommended for use to assess recovery progress in a forensic psychiatric sample. Forensic patients’ scores may be best represented using the unique two-factor structure identified.

This study investigated the prevalence of advance directives among patients receiving community care within the East London NHS Foundation Trust (ELFT), and to identify factors associated with their clinical application.

We analysed data from electronic health records of 4807 patients (aged 18–75 years), managed under the Care Programme Approach (CPA) in ELFT during 2021–2022. Demographic, clinical, service-level and patient-reported measures were analysed (binomial logistic regression).

A total of 31.2% of patients on the CPA had an advance directive. Black ethnicity, treatment in the forensic service or Newham, Luton and Bedfordshire localities, housing in socio-therapeutic facilities, diagnosis of personality disorder, ten or more previous admissions and engagement with DIALOG+ were positively associated with having an advance directive. DIALOG+ is the first approach that has been specifically developed to make routine patient–clinician meetings therapeutically effective. It is based on quality of life research, utilising the DIALOG scale (a patient-reported outcome measure), concepts of patient-centred communication, IT developments and components of solution-focused therapy, and is supported by an app.

This study highlights a complex interplay of cultural, social and systemic factors that influence advance care plan status. Structured communication, stronger therapeutic relationships and staff facilitation are likely to encourage advance care planning.

Low self-esteem is an important and potentially modifiable risk factor for the development and outcome of psychotic disorders. The factors involved in low self-esteem in psychotic disorders are not yet fully understood. The current study aims to investigate the cross-sectional and longitudinal associations between (changes in) self-esteem and severity of psychotic symptoms, internalized stigma, negative reaction to antipsychotics, personal recovery, childhood bullying, childhood trauma, and social support in symptomatically remitted first-episode psychosis (FEP) patients.

Data from the ongoing longitudinal Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment study were used. Participants were in symptomatic remission for 3–6 months after the FEP. Cross-sectional associations (N = 299) were investigated through Pearson’s correlations, and longitudinal changes (N = 238) were investigated via linear regressions with inverse probability weighting.

Cross-sectionally, we found that lower self-esteem was related to higher severity of symptoms, higher internalized stigma, higher childhood trauma (specifically emotional neglect), higher childhood bullying, more negative side effects of antipsychotic medication, lower personal recovery, and lower social support. Longitudinally, contrary to our hypothesis, we found that higher baseline internalized stigma, higher childhood trauma (specifically emotional abuse), and a higher baseline negative subjective reaction to antipsychotics predicted an increase in self-esteem after 6 months. Furthermore, a decrease in psychotic symptoms, internalized stigma, and negative subjective reaction to antipsychotics, and an increase in social support predicted an increase in self-esteem.

Early intervention programs for psychotic disorders should target factors related to changes in self-esteem. This might improve self-esteem and thereby promote recovery.

The concept partnership has developed since Sherry Arnstein first created the ladder of citizen participation. Within mental health discourse, this was first acknowledged by “A Vision for Change” (2006) and later, through adopting co-production (2017). In 2011, the College of Psychiatrists of Ireland, created a collective called Recovery Experience Forum of Carers and Users of Services (REFOCUS) which became a leading example of partnership between stakeholders in the organisation. However, REFOCUS’s impact on stakeholders needs to be examined.

A qualitative investigation using an autoethnography methodology is proposed. The approach allows for the interweaving of personal experiences with culture to create new knowledge. A focus group was conducted, and transcripts were subject to reflexive thematic analysis.

Seven out of fourteen participants, representing all three stakeholders, were available at time of interview. From the process of reflexive thematic analysis, five themes were constructed. Each with a number of sub-themes attached, which in turn represented stakeholder perspectives regarding REFOCUS.

This paper highlights several issues that need addressing in future research on REFOCUS. The paper demonstrates the continuous presence of stigma within Irish mental health services. However, it also highlights a number of beneficial aspects to REFOCUS including informal peer support, service users, and family member involvement in college activities as well as increasing meaning and purpose in one’s life along with a renewed identity different to that of the service user or family member.