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PurposeThe COVID-19 pandemic has potential to disrupt and burden the mental health care system, and to magnify inequalities experienced by mental health service users.MethodsWe investigated staff reports regarding the impact of the COVID-19 pandemic in its early weeks on mental health care and mental health service users in the UK using a mixed methods online survey. Recruitment channels included professional associations and networks, charities, and social media. Quantitative findings were reported with descriptive statistics, and content analysis conducted for qualitative data.Results2,180 staff from a range of sectors, professions, and specialties participated. Immediate infection control concerns were highly salient for inpatient staff, new ways of working for community staff. Multiple rapid adaptations and innovations in response to the crisis were described, especially remote working. This was cautiously welcomed but found successful in only some clinical situations. Staff had specific concerns about many groups of service users, including people whose conditions are exacerbated by pandemic anxieties and social disruptions; people experiencing loneliness, domestic abuse and family conflict; those unable to understand and follow social distancing requirements; and those who cannot engage with remote care.ConclusionThis overview of staff concerns and experiences in the early COVID-19 pandemic suggests directions for further research and service development: we suggest that how to combine infection control and a therapeutic environment in hospital, and how to achieve effective and targeted tele-health implementation in the community, should be priorities. The limitations of our convenience sample must be noted.

PurposeTo build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home.MethodsWe searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base.ResultsOur scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumer-directed and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model.ConclusionsOur theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home.Trial registrationPROSPERO 2018 registration number: CRD42018099693 (scoping review).PROSPERO 2018 registration number: CRD42018099200 (RCT systematic review).

Background Befriending is a popular form of volunteering in healthcare, and research suggests that it can be beneficial for people with mental illness. This study aimed to explore the experiences of a large sample of volunteer befrienders and patients who participated in the VOLUME trial, testing the efficacy of a structured befriending programme for individuals with psychosis. This is the first study to explore the specific challenges and benefits of befriending in both volunteers and patients in this population within the same programme. Methods A series of in-depth semi-structured interviews were conducted with 34 volunteer befrienders and 28 participating patients. All participants who had taken part in at least one befriending session were invited to be interviewed about their experiences with the aim of including a wide range of views, including those who were more or less engaged with the befriending programme. The data were analysed using Thematic Analysis. Results Four broad themes were developed from the analysis of the befriender and patient interviews which, although were largely discrete, captured the overall experiences of participating in the befriending programme: 1) Bridging the gap, 2) A genuine relationship that developed over time, 3) A big commitment, and 4) A flexible approach. Conclusions These results further support that, befriending programmes for individuals with psychosis can be a worthwhile experience for both befrienders and patients. However, participation also requires perseverance and flexibility from both sides. Different factors, such as incorporating participant preferences for frequency of meetings, have to be considered in the development and management of a befriending programme in order to provide effective support to both befrienders and patients.

Background Most people living with dementia want to remain in their own homes, supported by family and paid carers. Care at home often breaks down, necessitating transition to a care home and existing interventions are limited . To inform the development of psychosocial interventions to enable people with dementia to live well for longer at home, we qualitatively explored the views of people living with dementia, family carers and health and social care professionals, on how to achieve and maintain independence at home and what impedes this. Methods We conducted an inductive thematic analysis of qualitative interviews with 11 people living with dementia, 19 professionals and 22 family carers in England. Results We identified four overarching themes: being in a safe and familiar environment, enabling not disabling care, maintaining relationships and community connectedness, and getting the right support. For people living with dementia, the realities of staying active were complex: there was a tension between accepting support that enabled independence and a feeling that in doing so they were accepting dependency. Their and professionals’ accounts prioritised autonomy and ‘living well with dementia’, while family carers prioritised avoiding harm. Professionals promoted positive risk-taking and facilitating independence, whereas family carers often felt they were left holding this risk. Discussion Psychosocial interventions must accommodate tensions between positive risk-taking and avoiding harm, facilitating autonomy and providing support. They should be adaptive and collaborative, combining self-management with flexible support. Compassionate implementation of rights-based dementia care must consider the emotional burden for family carers of supporting someone to live positively with risk.

Volunteer befriending can be used to address social isolation in patients with psychosis. Traditionally this involves face-to-face encounters between a volunteer and a patient, but modern digital technology also makes it possible to have these interactions remotely. This study aimed to explore the views and interests of patients with psychosis about different formats of volunteering, face-to-face or digitally. A survey was conducted with patients with psychotic disorders in community mental health teams in London. Questions covered socio-demographic characteristics, quality of life, loneliness, views on the different formats of volunteering and types of volunteers, and their interest in getting volunteering support, face-to-face or digitally. Binary logistic regressions were used to investigate potential predictors of interest in getting volunteering support face-to-face or digitally. A total of 151 patients with psychotic disorders were included in this study. More than half of the patients (n = 87, 57.6%) had not heard about these volunteering programs. Many were interested in getting face-to-face (n = 87, 57.6%) and digital (n = 56, 37.1%) volunteering. For the face-to-face encounters, most preferred them to be weekly (n = 36, 41.4%), for one-hour (n = 32, 36.8%), and with an open-ended relationship (n = 45, 51.7%). For the digital contacts, most preferred them to be weekly (n = 17, 30.9%) and through text messages (n = 26, 46.4%). A minority of patients (n = 20, 13.2%) did not use digital technology. Patients with lower quality of life were significantly more likely to prefer face-to-face volunteering (p < .05). Younger patients and with fewer years of diagnosis were significantly more likely to prefer digital volunteering (p < .05). The variability in patients' interests suggests that different formats of volunteer support should be offered. Digital volunteering may become more important in the future, since many younger patients are interested in it.

ObjectivesTo explore how the self-management of comorbid long-term conditions is experienced and negotiated by people with dementia and their carers.DesignSecondary thematic analysis of 82 semi-structured interviews.SettingCommunity settings across the United Kingdom.Participants11 people with dementia, 22 family carers, 19 health professionals and 30 homecare staff.ResultsWe identified three overarching themes: (1) The process of substituting self-management: stakeholders balanced the wishes of people with dementia to retain autonomy with the risks of lower adherence to medical treatments. The task of helping a person with dementia to take medication was perceived as intermediate between a personal care and a medical activity; rules about which professionals could perform this activity sometimes caused conflict. (2) Communication in the care network: family carers often communicated with services and made decisions about how to implement medical advice. In situations where family carers or homecare workers were not substituting self-management, it could be challenging for general practitioners to identify changes in self-management and decide when to intervene. (3) Impact of physical health on and from dementia: healthcare professionals acknowledged the inter-relatedness of physical health and cognition to adapt care accordingly. Some treatments prescribed for long-term conditions were perceived as unhelpful when not adapted to the context of dementia. Healthcare professionals and homecare workers sometimes felt that family carers were unable to accept that available treatments may not be helpful to people with dementia and that this sometimes led to the continuation of treatments of questionable benefit.ConclusionThe process of substituting self-management evolves with advancement of dementia symptoms and relies on communication in the care network, while considering the impact on and from dementia to achieve holistic physical health management. Care decisions must consider people with dementia as a whole, and be based on realistic outcomes and best interests.

Background Befriending has become a widely used method for tackling social isolation in individuals with severe mental illness (SMI), and evidence exists to support its effectiveness. However, patient preferences for befriending remain unclear. We aimed to determine whether patients with SMI want a volunteer befriender and, if so, the volunteer characteristics and character of the relationship they would prefer. Methods A survey of outpatients was conducted across London-based community mental health teams, for individuals diagnosed with affective or psychotic disorders. Questions consisted of measures of demographic characteristics, befriending preferences and social context, including measures of time spent in activities, number of social contacts, loneliness and subjective quality of life (SQOL). Binary logistic regressions were used to investigate potential predictors of willingness to participate in befriending. Results The sample comprised of 201 participants with a mean age of 43 years. The majority (58%) of the sample indicated willingness to participate in befriending. In univariable analyses this was associated with less time spent in activities in the previous week, higher level of loneliness and lower SQOL. When all three variables were tested as predictors in a multivariable analysis, only lower SQOL remained significantly associated with willingness to take part in befriending. Relative to other options presented, large proportions of participants indicated preference for weekly (44%), 1-hour (39%) meetings with a befriender, with no limits on the relationship duration (53%). Otherwise, patient preferences exhibited great variability in relation to other characteristics of befriending schemes. Conclusions A substantial number of patients with SMI appear willing to take part in a befriending scheme. Patients with lower SQOL are more likely to accept befriending, so that befriending schemes may be a realistic option to help patients with particularly low SQOL. The large variability in preferences for different types of befriending suggests that there is no one-size-fits-all formula and that schemes may have to be flexible and accommodate different individual preferences.

In the UK, over 8 50 000 people are living with a diagnosis of dementia. Many of these people wish to remain living in their own homes which is often made possible by the support of family carers and paid home care workers. However, home care is a sector that has come under much scrutiny and the workforce is often criticised for providing unsatisfactory care1. At an organisational level there is a high turnover of home care workers who are typically low-paid and receive little training and support2. We have drawn from an ethnographic approach in order to explore the nature of home care first-hand and to develop an understanding of the knowledge and training needs of home care workers. This has involved participant-observations with eight home carers across six varied locations in England, as they provide home care for clients living with dementia. As a participant-observer, we have attempted to become immersed in the reality of home care as it is experienced in the real world for those involved. Qualitative observations have enabled us to go beyond the understanding gained through interviews in order to capture the everyday experience of dementia home care. In this presentation, we will discuss the experience of conducting ethnography in a complex social care setting, faced with challenges of observing in the context of scrutiny and mistrust. The process of engaging home carers and consenting people living with dementia will be shared in order to promote the use of qualitative observations as a way of gaining a more meaningful understanding of health and social care issues within the home care workforce. As part of a wider study, these findings aim to inform the intervention development of a training programme for paid home carers, to aid consistency and accessibility of training amongst the homecare workforce.ReferencesMuntaner C, et al. County and organizational predictors of depression symptoms among low-income nursing assistants in the USA. Sci Med 2006;63(6):1454–1465.Livingston G, et al. Making decisions for people with dementia who lack capacity: qualitative study of family carers in UK. BMJ2010;341:c4184.