A pilot validation study of a new measure of activity in psychosis

Jolley, Suzanne; Garety, Philippa; Dunn, Graham; White, Joanna; Aitken, Melissa; Challacombe, Fiona; Griggs, Mary; Wallace, Melissa; Craig, Tom

doi:10.1007/s00127-005-0982-x

Cited by 19 publications

(20 citation statements)

References 12 publications

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“…Their mean time-use diary scores were lower than those of other patients with a shorter duration of psychosis 83 and the severity of our study participants' problems is also reflected in their lengthy contact with mental health services and low mean GAF scores. The study may therefore have been too ambitious in expecting a specific intervention to be able to improve engagement in activity.…”

Section: Discussioncontrasting

confidence: 52%

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Killaspy

King

Holloway

et al. 2017

Programme Grants Appl Res

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BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

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Section: Discussioncontrasting

confidence: 52%

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Killaspy

King

Holloway

et al. 2017

Programme Grants Appl Res

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“…This study also incorporated an indicator of overall functioning [41]. Low overall functioning was not statistically associated with the social support and variables.…”

Section: Functioning and Social Supportmentioning

confidence: 99%

Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety

Sündermann

Onwumere

Kane

et al. 2013

Soc Psychiatry Psychiatr Epidemiol

152

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PURPOSE-To investigate social support and network features in people with first episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia.METHOD-Thirty eight people with first-episode psychosis were recruited for a cross-sectional study. Self report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted.RESULTS-One third of the sample (34%) had no confidant (95% CI 18.4%, 50.0%). The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (.35

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“…The Time Budget Measure. The measure developed by Jolley et al. (2005, 2006) takes the form of a weekly diary completed retrospectively during a structured interview with the participant.…”

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confidence: 99%

Anticipatory Pleasure Skills Training: A New Intervention to Reduce Anhedonia in Schizophrenia

Favrod

Giuliani

Ernst

et al. 2010

Perspectives in Psychiatric Care

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A pilot validation study of a new measure of activity in psychosis

Abstract: Results indicate that our measure is tapping the activity component of social functioning. A larger scale validation study and investigation of sensitivity to change is underway.

Cited by 19 publications

References 12 publications

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety

Anticipatory Pleasure Skills Training: A New Intervention to Reduce Anhedonia in Schizophrenia

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