Armed conflict is associated with significant long-term psychiatric morbidity. Interventions to reduce the incidence of psychiatric disorder following psychological trauma may be classified into three categories. Primary prevention includes the selection, preparation and training of individuals likely to be exposed to potentially traumatizing events. Secondary prevention comprises a variety of brief psychological techniques immediately or shortly after traumatizing life events, the best known of which is Psychological Debriefing. Tertiary interventions comprise the treatment of established PTSD and others. Psychiatric morbidity was studied in 106 British soldiers returning from UN peace-keeping duties in the former Republic of Yugoslavia. All 106 soldiers received an Operational Stress Training Package prior to their deployment and a randomly selected group also received a post-operational PD. Very low rates of PTSD and other psychopathology were found overall and the Operational Stress Training Package may have contributed to this. Elevated CAGE scores suggestive of significant alcohol misuse were observed in both groups and chemical avoidance behaviours arising from this may have masked psychopathology. CAGE scores diminished significantly in the debriefed group by the end of the follow-up period suggesting that PD may have been of benefit despite the apparent absence of PTSD. This study also demonstrates that a high incidence of psychiatric morbidity is not an inevitable consequence of military conflict.

The efficacy of critical incident stress debriefing (CISD) and psychological debriefing (PD) following potentially traumatising events has recently been challenged after a number of recent randomised controlled trials (RCTs) failed to demonstrate that CISD or PD prevents or reduces the incidence of posttraumatic stress disorder (PTSD). These studies have used measures of PTSD as the principal outcome and have generally not measured comorbid psychopathology, behavioral or social dysfunction. In a recent RCT of group debriefing amongst British soldiers returning from peacekeeping operations in Bosnia, PD had a significant effect in reducing a worrying level of alcohol misuse in the sample. The findings of this study suggest that that it is premature to conclude that debriefing is ineffective and that a broader range of outcome measures should be employed in future trials of debriefing.

Essence of Care (DoH 2001) developed from a commitment to explore the benefits of benchmarking in improving the quality of the fundamental and essential aspects of care (DoH 1999). The NHS Plan (DoH 2000) reinforced the importance of getting the basics right and improving the patient's experience. During the 18 months since the publication of the Essence of Care clinical benchmarks (DoH 2001), it has moved steadily from political rhetoric to clinical reality in the Central South Regional Group (CSRG). This article describes the role of the CSRG steering committee in co-ordinating the implementation of Essence of Care. This involved: Education about the benchmarking process. Support for implementation of the benchmarks. Evaluation of the process to date. Direction for future developments. The CSRG steering committee comprises representation from many of the trusts in the CSRG (Table 1), as well as the University of Southampton and New Forest PCT.

BackgroundA core purpose of mental health literacy is to enable everyone from all walks of life to manage and maintain wellbeing in daily life. However, mental health literacy in daily life context is not adequately captured by existing measures due to a prevailing focus on ‘mental disorder literacy’. We developed three measures of mental health literacy in terms of knowledge, and attitudes that may evoke the use of this knowledge, of signs and actions in everyday life when mental health is affected by depression, anxiety and stress. Construct validation was performed to examine the suitability of these measures for population health surveillance. MethodsIn October 2019 Public Health England, funded by the UK government, launched a digital resource, Every Mind Matters, aimed at improving mental health literacy in the general population and empowering action around daily life stress and anxiety, mood, and sleep. Baseline data for evaluating Every Mind Matters was collected via an online survey of the general public (n = 3262 adults). For construct validation, we investigated dimensionality and hypotheses of logical associations with mental health literacy. ResultsStructural validation results lend credence to our claim that the primary influence on item responses to the three measures is mental health literacy. These responses show logical associations with knowledge about sleep hygiene, attitudes indicative of stigma towards mental health, and some indirect experience with mental health difficulties. Item response theory information plots showed that total scale scores are sensitive to a wide range of individual differences in mental health literacy. This means the three knowledge and attitudes measures can be administered to a diverse group of people for early screening purposes or to evaluate the impact of public mental health interventions.Conclusions To monitor societal changes in mental health literacy, population surveillance will need measures that tap into lay knowledge and attitudes about mental health in the context of everyday life using non-technical language of the general public. More contextually informed data are needed to construct sound measurement for steering empirical debates about mental health literacy in societies with high- and low-resource healthcare systems.