Mental health service users (MHSUs) have elevated rates of cardiometabolic disturbance. Improvements occur with physical activity (PA) programs. We report the development and evaluation of three innovative peer-developed and peer-led PA programs: 1) walking; 2) fitness; and 3) yoga. Qualitative evaluation with 33 MHSUs in British Columbia, Canada, occurred. These programs yielded improvements for participants, highlighted by powerful narratives of health improvement, and improved social connections. The feasibility and acceptability of innovative peer-developed and peer-led programs were shown. Analyses revealed concepts related to engagement and change. Relating core categories, we theorize effective engagement of MHSUs requires accessibility on three levels (geographic, cost, and program flexibility) and health behavior change occurs within co-constituent relationships (to self, to peers, and to the wider community). This study highlights the benefits of peer involvement in developing and implementing PA programs and provides a theoretical framework of understanding engagement and behavior change in health programs for MHSUs.

Objective. Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1) facilitators that help mental health service users engage in better health behaviors and (2) the types of health programs mental health service users want to develop. Methods. A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. Results. Four major facilitator themes were identified: (1) factors of empowerment, self-value, and personal growth; (2) the need for social support; (3) pragmatic aspects of motivation and planning; and (4) access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. Conclusions and Implications for Practice. Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

Health care professionals need to understand mental health service recipients' perspectives of a "healthy lifestyle." An understanding of barriers within this context is required, as only then will we be able to empathize and assist as health care professionals. This study also shows that realistic, innovative, and pragmatic solutions occur when mental health service recipients are empowered.

He has published fiction, three volumes of poetry, and 18 books on the philosophy of mind, philosophical anthropology, literary theory, the nature of art, and cultural criticism. These offer a critique of current predominant intellectual trends and an alternative understanding of human consciousness, the nature of language and of what it is to be a human being. Abstract: Many of the difficulties of pinning down personal identity result from conflating different aspects of this rather complex notion. We need to tease out these different aspects so that we shall see it in the round, and grasp what is fundamental, what underpins all the various aspects of identity that are highlighted in different circumstances. First, there is my sense of who and what I am at any given time; and, secondly, there is my sense of being the same who or the same what over time. These subjective dimensions in turn have many elements, and I will examine these. I will argue that this question about the endurance of personal identity over time, while important, and a main theme of this talk, is not the fundamental question. Fully to address it, to grasp the essence of personal identity, we need to understand the sense of self, at any particular time.There are also what we might call "external" aspects of identity: those characteristics by which I am identified and classified by others, or by myself, taking an objective view on myself. It is these that supply objective criteria for my being counted, recognised, acknowledged as such and such a kind of person and as the same person on different occasions. They are closer to what is utilised in identification. They underpin my claim to be identical with Raymond Tallis, a person others have met before, of whom certain things can be expected, who has rights, duties, possessions and so on. Identity cards underline the link between identity and entitlements. These external aspects also fall short of being fundamental: they would not have any meaning without the subjective aspect of identity. The (in my view erroneous) primary focus on identity over time and (the equally erroneous) focus on external criteria for identity both distract from the core of the matterdthe experience "That I am." It explains, what is more, the tendency among some contemporary philosophers, to reduce personal identity to impersonal facts; to imagine that a third-person account will reveal the true nature of first-person being. Once this is appreciated, it will be seen that personal identity requires not only psychological continuity but also bodily stability. The talk will put forward an account of personal identity that combines both of these features. British Neuropsychiatry Association 23rd AGM, 12 February 2010Members' Poster Abstracts

Death of the teaching autopsy Autopsy findings are important to all clinicians, including general practitioners Editor-O'Grady identifies several reasons why autopsy rates have been falling worldwide, in particular why students in New Zealand are now banned from attending autopsies, with resultant loss of undergraduate teaching opportunities. 1 However, attending and watching an autopsy are not the only educationally relevant facets of autopsies: their findings are important to all clinicians, including general practitioners. Whitty et al found that autopsy findings (excluding coroners' reports) were poorly communicated to general practitioners in four districts in the north east Thames region. They received reports from only 39 of the 89 (47%) autopsies performed on their patients. 2 In our study of 578 deaths in a general practice (97.8% of all practice deaths) over 15 years the value of a death register in contributing to clinical governance was severely curtailed by lack of cause of death information. 3 Overall, 143 (24.7%) deaths were reported to the coroner, a percentage comparable with the average for all deaths in the United Kingdom. However, in only four (2.8%) of these deaths was the practice routinely sent a coroner's report on the results of the autopsy. After contacting relevant coroners specifically to request cause of death and autopsy information, no report was provided on 65 (61.3%) occasions (table), an experience similar to that reported from Manchester. 4 Given the pivotal position of general practice in the NHS, these findings point to significant disconnection of autopsy services from clinical services. O'Grady laments the development of a vicious circle, whereby lack of student contact with autopsies means clinicians will no longer be advocates of autopsies. 1 As Underwood says in his commentary, 90% of all autopsies in the United Kingdom are now performed by coroners, so it is not surprising that clinicians should feel unable to advocate autopsies. Failure to feed back autopsy findings to general practitioners is a lost educational opportunity on an enormous scale that could fairly easily be corrected.