BackgroundPeople with mental illness experience high levels of morbidity and mortality from physical disease compared to the general population. Our primary aim was to compare how people with severe mental illness (SMI; i.e. schizophrenia-spectrum disorders and bipolar disorder) and non-psychotic mental illness perceive their: (i) global physical health, (ii) barriers to improving physical health, (iii) physical health with respect to important aspects of life and (iv) motivation to change modifiable high-risk behaviours associated with coronary heart disease. A secondary aim was to determine health locus of control in these two groups of participants.MethodsPeople with SMI and non-psychotic mental illness were recruited from an out-patient adult mental health service in London. Cross-sectional comparison between the two groups was conducted by means of a self-completed questionnaire.ResultsA total of 146 people participated in the study, 52 with SMI and 94 with non-psychotic mental illness. There was no statistical difference between the two groups with respect to the perception of global physical health. However, physical health was considered to be a less important priority in life by people with SMI (OR 0.5, 95% CI 0.2-0.9, p = 0.029). There was no difference between the two groups in their desire to change high risk behaviours. People with SMI are more likely to have a health locus of control determined by powerful others (p < 0.001) and chance (p = 0.006).ConclusionsPeople with SMI appear to give less priority to their physical health needs. Health promotion for people with SMI should aim to raise awareness of modifiable high-risk lifestyle factors. Findings related to locus of control may provide a theoretical focus for clinical intervention in order to promote a much needed behavioural change in this marginalised group of people.
Aims and method: Non-engagement with psychological therapy groups in mental health settings is a long-standing problem, with implications on group processes and service delivery. Little is known about service user-related factors hindering this engagement, especially on inpatient wards. We aimed to investigate the perspectives of service users on barriers to engagement with a therapeutic group facilitated by assistant psychologists. Experiences of therapy groups were explored via focus groups and in-depth semi-structured interviews with 16 participants on two acute wards.Data were analysed by means of thematic analysis adopting an inductive approach embedded in a constructivist paradigm.Results: The analysis identified three higher-order themes: ways that facilitators might encourage group attendance; a need for safe therapeutic conditions within the groups; and a need for good applicability of group content to recovery outside of hospital. The results are discussed with reference to psychological approaches, group therapy research and trauma-informed care.
Conclusion:Findings bear implications on clinical practice within inpatient mental health settings, specifically: (a) the need to approach service users individually to invite to groups and establish role expectancies; (b) supervision for facilitators focussing on difficult group dynamics and creating robust groups agreements to facilitate containment; (c) working with teams to ensure stable, protected physical spaces for groups on wards, in turn avoiding the re-traumatising effects of disruption; (d) emphasising that participation does not require sharing difficult personal information, to prevent destabilisation and improve uptake of group offer; and (e) increasing focus on applicability of skills through consideration of potential obstacles to their real-life application. K E Y W O R D S engagement, group cohesiveness, inpatient psychology groups, qualitative research, service user perspectives | 371 HARRIS et Al.
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