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The performance culture of the health service means that the psychological
well-being of staff is becoming paramount in maintaining the workforce and
in sustaining psychological health and morale. A Charter for Psychological
Staff Wellbeing and Resilience is introduced that puts the onus on us and on
employers to make the necessary adjustments to their workplace cultures and
encourage professionals – us – to break through the barrier of stigma.
Web-based interventions for depression have burgeoned over the past 10 years as researchers and health professionals aim to harness the reach and cost-effectiveness that the internet promises. Despite strong clinical evidence of their effectiveness and policy support, web-based interventions have not become widely used in practice. We explored this translation gap by conducting an implementation pilot of MindBalance, a web-based intervention for depression built on the SilverCloud platform, in three IAPT services. We posed three questions: (1) Who chooses to use MindBalance? (2) Is MindBalance effective for these clients? (3) How do clients use MindBalance? Our results for questions (1) and (2) are commensurate with the positive findings in the literature on patient acceptability and clinical effectiveness for such interventions. Client usage, captured in adherence data as well as usage case-studies, was diverse and differed markedly from face-to-face sessions. The most surprising result, however, concerned the small number of people who were offered the intervention. We reflect upon why this was and discuss implementation issues that primary mental health services should consider when adding a web-based intervention to their services.
For armed forces personnel, data on help-seeking behaviour and receipt of treatment for mental disorders are important for both research and policy.
To examine mental healthcare service use and receipt of treatment in a sample of the UK military.
Participants were drawn from an existing UK military health cohort. The sample was stratified by reserve status and by participation in the main war-fighting period of the Iraq War. Participants completed a telephone-based structured diagnostic interview comprising the Patient Health Questionnaire and Primary Care Post-Traumatic Stress Disorder Screen (PC–PTSD), and a series of questions about service utilisation and treatment receipt.
Only 23% of those with common mental disorders and still serving in the military were receiving any form of medical professional help. Non-medical sources of help such as chaplains were more widely used. Among regular personnel in receipt of professional help, most were seen in primary care (79%) and the most common treatment was medication or counselling/psychotherapy. Few regular personnel were receiving cognitive–behavioural therapy (CBT). These findings are comparable with those reported for the general population.
In the UK armed forces, the majority of those with mental disorders are not currently seeking medical help for their symptoms. Further work to understand barriers to care is important and timely given that this is a group at risk of occupational psychiatric injury.
Terrorist attacks can have psychological effects on the general public.
To assess the medium-term effects of the July 2005 London bombings on the general population in London and to identify risk factors for persistent effects.
We telephoned 1010 Londoners 11–13 days after the bombings to assess stress levels, perceived threat and travel intentions. Seven months later, 574 respondents were contacted again and asked similar questions, and questions concerning altered perceptions of self and the world.
‘Substantial stress' (11%), perceived threat to self (43%) and reductions in travel because of the bombings (19%) persisted at a reduced level; other perceived threats remained unchanged. A more negative world view was common. Other than degree of exposure to the bombings, there were no consistent predictors of which people with short-term reactions would develop persistent reactions.
A longer-term impact of terrorism on the perceptions and behaviour of Londoners was documented.
We carried out a brief longitudinal mental health screen of 254 members of the UK's Air Assault Brigade before and after deployment to Iraq last year. Analysis of General Health Questionnaire (GHQ–28) scores before and after deployment revealed a lower score after deployment (mean difference=0. 93, 95% CI 0. 35–1. 52). This indicated a highly significant relative improvement in mental health (P < 0. 005). Moreover, only 9 of a larger sample of 421 (2%) exceeded cut-off criteria on the Trauma Screening Questionnaire. These findings suggest that war is not necessarily bad for psychological health.