BackgroundElectroconvulsive therapy (ECT) is still being administered to approximately a million people annually. There have been no ECT versus simulated ECT (SECT) studies since 1985. The five meta-analyses of ECT versus SECT studies all claim that ECT is more effective than SECT for its primary target, severe depression. This review assesses the quality of those meta-analyses and of the 11 studies on which they are based.MethodsThe meta-analyses were evaluated primarily in terms of whether they considered the quality of the studies they included, but also in terms of whether they addressed efficacy beyond end of treatment. The methodological rigor of the 11 studies included by one or more of the meta-analyses was assessed using a 24-point Quality scale developed for this review.ResultsThe five meta-analyses include between 1 and 7 of the 11 studies. The meta-analyses pay little or no attention to the multiple limitations of the studies they include. The 11 studies have a mean Quality score of 12.3 out of 24. Eight scored 13 or less. Only four studies describe their processes of randomization and testing the blinding. None convincingly demonstrate that they are double-blind. Five selectively report their findings. Only four report any ratings by patients. None assess Quality of Life. The studies are small, involving an average of 37 people. Four of the 11 found ECT significantly superior to SECT at the end of treatment, five found no significant difference and two found mixed results (including one where the psychiatrists reported a difference but patients did not). Only two higher Quality studies report follow-up data, one produced a near-zero effect size (.065) in the direction of ECT, and the other a small effect size (.299) in favor of SECT.ConclusionsThe quality of most SECT–ECT studies is so poor that the meta-analyses were wrong to conclude anything about efficacy, either during or beyond the treatment period. There is no evidence that ECT is effective for its target demographic—older women, or its target diagnostic group—severely depressed people, or for suicidal people, people who have unsuccessfully tried other treatments first, involuntary patients, or children and adolescents. Given the high risk of permanent memory loss and the small mortality risk, this longstanding failure to determine whether or not ECT works means that its use should be immediately suspended until a series of well designed, randomized, placebo-controlled studies have investigated whether there really are any significant benefits against which the proven significant risks can be weighed.

BackgroundPsychosis following childbirth affects 1–2 mothers per 1000 deliveries. Onset is rapid and functioning is severely affected. Although prognosis in terms of symptom remission is generally good, long-term disability can persist. The study’s aim was to develop a theoretical understanding of recovery from psychosis following childbirth.MethodsSemi-structured interviews were conducted with 12 women with experience of psychosis following childbirth. Interview transcripts were analysed using grounded theory methodology.ResultsA theory of four superordinate themes was developed from the data, including: (i) the process of recovery; (ii) evolving an understanding; (iii) strategies for recovery; and (iv) sociocultural context. The process of recovery and women’s understanding of their experience were conceptualised as parallel processes, which informed one another. Women found that a diagnosis facilitated their use of particular strategies.ConclusionsThis study highlighted a complex and ongoing process of recovery from psychosis following childbirth. Sensitivity to a woman’s position in the process of recovery has the potential to facilitate professionals in assessing readiness for different interventions which will be likely to result in women feeling more understood, accepted and supported.

Since the closure of the UK asylums, 'the community' has become short hand for describing a variety of disparate and complex spaces, in which service users manage their experiences of distress. An examination of such spaces here forms the basis of an analysis of the way in which service users move through and within space, to establish agency and dis/order while distressed. Seventeen participants, with various experiences of mental distress took part in a qualitative study, and a further textual analysis was conducted on eight published autobiographies. In the context of the interviews, participants presented drawings of the spaces they occupy during times of crisis, wellbeing and recovery. All texts were analysed using a thematic approach, informed by theories of embodiment and relational space. In this paper, the focus is directed towards two key patterns of movement, in order to explore ways in which participants experiencing various forms of mental health crisis used space in order to maintain and manage feelings of agency. Firstly, incidents where participants described moving towards fluid, outside spaces are explored, with agency being established through seeking, and utilising, greater possibilities for action and engaging others. In addition, the opposite pattern of movement is also explored, using incidents where participants described moving indoors, using the private space of the home to establish order and restore feelings of agency and strength, in contrast to overwhelming experiences in public space. Connections between these patterns of movement and particular forms of distress are discussed. It is argued that community and private spaces are integral to the ways in which selfhood, agency and action is experienced in mental distress, which in turn has implications for policy, treatment and community action.

Increased time spent at home during COVID-19 exposed inequities in Australian housing quality and availability. Many Australians lack sufficient space to carry out activities shifted to their homes and the financial downturn rapidly increased stress around housing affordability. Research demonstrates living in unaffordable or poor-quality housing can negatively impact residents' mental health. This study explores the mechanisms through which housing moderates COVID-19's impact on mental health by analysing 2,065 Australians surveyed in mid-to-late 2020. Hierarchical linear regressions were used to examine associations between housing circumstances, neighbourhood belonging and mental-health outcomes (loneliness, depression, and anxiety), adjusted for demographics. Open-ended responses were analysed using thematic analysis and critical-realist epistemology. Feeling 'trapped' and 'helpless' because of insecure tenure or lack of money to improve housing conditions reduced participants' sense of control. Inadequate space and noise adversely impacted participants' well-being. Participants' housing contextincluding amenities, natural spaces, and social connectionsstrongly impacted their emotional experiences. Safe, secure, and suitable housing is a known determinant of safety and physical health; this study suggests it is also a critical factor for Australians' mental health. To improve mental health among the vulnerably-housed, future housing policy should not compromise on housing affordability, quality, space and access to nearby amenities.

Medium secure forensic psychiatric units are unique environments within the broader 'post asylum' landscape of mental health services. Length of stay is much greater, a recovery-focused care system is much more difficult to implement, and there is a paucity of suitable "step-down" services. The aim of this study was to examine how forensic psychiatric environments contribute to the shaping of recovery, by examining key features such as social interactions and agency. Here, we report on the findings from patients participating in a qualitative-visual study. This analysis forms part of larger study on staff and patient experiences of secure hospital space. In this paper, the analytical focus is directed towards two key elements of recovery -agency and relationality, using the concept of 'topology' and 'life-space', developed by the social psychologist Kurt Lewin. First, we explore how patients have relative freedom to move within institutional spaces, yet lack relational space. Secondly, we explore how life-space is expanded or compressed by the manner in which the patient's present life in hospital is connected or disconnected from their past or pending future. Finally, we discuss the implications of these findings for a recovery model within secure forensic settings, focussed on personalisation and expanded life-space.2

Concrete sites of mental health care have been argued to be relatively 'forgotten' under a community care model emphasising social inclusion and personalisation (Spandler, 2007; Bowers et al., 2005, 2006, 2009; Quirk et al., 2006). Drawing on two sets of data, visual interviews conducted with service users and already published narratives of distress; this paper examines the role of the material layout of these spaces in the production and negotiation of service users' subjectivity. Service use sites are here argued to partially act as 'heterotopias' (Foucault, 1986) of 'control' (Deleuze, 1992), with the detail of the material environments, dominated by observation, locks and barriers, acting to 'make visible' to service users a devalued and stigmatised service user position. Strategies to moderate this 'modulated' (Deleuze, 1992) subjectivity are described in community spaces, including using home, work or exercise spaces to moderate such a subject position.

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Psychological treatments of mental health issues have acquired a justifiable notoriety for their tendency to engage in generalisation and reductionism. By contrast, the emergent geographies of exclusion make visible the fine-grain material and spatial contours of the lives of individuals who experience mental health difficulties and distress. However, this can come at the cost of a relative neglect of the psychological. In this paper we propose a set of concepts for facilitating the study of intersecting planes of experience, which demonstrates the interdependency of the spatial, the psychological and the technological. Drawing on empirical work with participants who live with persistent anxiety, we demonstrate how online support networks mediatethat is transduct, intersect and transform-how experiences of anxiety are lived out. Attention to endogenous 'tactics' or 'modes of normativity' provides an interesting agenda for the emergent engagement of social psychology with social/cultural geography.