ObjectiveTo investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams.DesignProcess evaluation nested within a cluster randomised controlled trial (RCT).Participants28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports.Setting14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention.ResultsThe factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles.ConclusionsThree findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure.Trial RegistrationControlled-Trials.com ISRCTN02507940

Detainees and carers would like to see the provision of a place of safety other than emergency departments or police stations, and this study reinforces the Mental Health Code of Practice 2008 which states that police stations should only be used on an exceptional basis.

Ethics approval and governance: The study was peer reviewed and registered as a service evaluation with the 2 gether NHS Foundation Trust Research and Development Support Unit and Data Protection Officer. AbstractAim: This study aimed to evaluate an eight-week carers group for people with first episode of psychosis receiving services from the Gloucestershire Recovery in Psychosis Early Intervention Team. Potential benefits for carers were assessed including changes in feelings of stress, isolation, recognition, and of being appreciated and valued.

The small number of published studies on the use of Section 136 (S136) of the Mental Health Act 1983 may reflect neither the current situation nor the true national picture as most of the research comes from large urban centres and was published before 1997. We studied the use of S136 between 2002 and 2006 in Gloucestershire, a rural English county with a population of approximately 585,000, by analysing data held by the police and local mental health services. On average 192 subjects (range 176-203) were detained each year under S136, equating to a population rate of 32.8 S136 detentions per 100,000 per year in Gloucestershire. In contrast to other published studies, ethnic minorities, particularly Afro-Caribbean males, were overrepresented only in a minor way. Of those individuals detained, about a third were admitted, a lower rate than in other studies. Acts or threats of self-harm were common (55%), but acts or threats of violence (28%) and evidence of intoxication (16%) were present in a minority, suggesting that detainees are more likely to pose a risk to themselves than others.

There is a gap in the expectations of the different agencies involved in the S136 process, which have the potential to be divisive if interagency pathways and agreements are not in place.

Aims and methodTo evaluate outcomes for service users during their first year of treatment in three English assertive outreach teams. Changes in health and social functioning, engagement with services, service use and need (rated by staff and service users) were evaluated.ResultsIn 49 service users we found a significant increase in mean staff-rated met needs up to 6 months of treatment. There were no significant changes in ratings of engagement or Health of the Nation Outcome Scales (HoNOS) scores at 6 and 12 months. Unmet needs rated by service users and staff showed a non-significant trend for improvement across a range of individual health and social domains. Duration of hospital admission reduced significantly between the 12 months before the evaluation and the 12 months of the evaluation. Formal and informal admission and levels of contact with crisis teams reduced over the study period.Clinical implicationsAlthough these results offer some support to the assertive outreach approach, further research in larger samples is needed to identify which changes in health and social functioning are associated with transfer to assertive outreach teams.

Background:The REFOCUS intervention was a whole team, complex intervention, designed to increase the recovery support off ered by community based, mental health staff . The intervention consisted of two components: Recovery promoting relationships, which focused on how staff work with service users, and Recovery working practices, which focused on what activities and tasks staff and service users could do together. Aim:We aimed to investigate the experiences of community mental health workers using the REFOCUS intervention to support personal recovery. Method:In the context of the REFOCUS Trial (ISRCTN02507940), 28 semi-structured individual interviews and 4 staff focus groups, with 24 participants were conducted and thematically analyzed.Results: Staff valued coaching training and used coaching skills to have tough as well as empowering, motivational conversations with service users. They were positive about the resources within the 'working practices' intervention component. The whole team training and refl ection sessions helped create team cultures, structures and processes which were conducive to supporting recovery practice. Conclusion:We recommend the wider use of coaching skills, strengths-based assessments, and approaches to support clinicians to broaden their understanding of service users' values, treatment preferences and to support striving towards personally-meaningful goals. Staff who used these working practices changed their beliefs about what their service users were capable of, and became more hopeful practitioners. A team-based approach to support recovery creates a learning environment in which staff can support and challenge one another, making sustained practice change more likely.[1-3]. Supporting personal recovery involves an emphasis on personalized care so service users can live a satisfying, hopeful and contributing life [4]. The literature providing guidance on how to implement recovery practice has been growing, though evidence suggests it remains problematic [5,6]. In a recent grounded theory of staff and manager perceptions

ICPs appeared to be successful in enabling a number of service users with complex difficulties to obtain and maintain tenancies in the community. There were some concerns about the quality of monitoring of the ICPs and some uncertainty about whether ICP staff would have the skills, support and training to promote recovery and increasing independence of service users. There was little evidence of service users moving on or reduction in care over time. There is a need for good inter-agency working for the successful deployment of this new form of service. There is also a need for more research, comparing ICPs with other forms of supported accommodation and considering the service user experience through qualitative research.