This study highlights the valuable role of mental health nurses in frontline emergency mental health care in particular mental health nurses skills in conducting a risk assessment in an emergency.

BackgroundDepression is a common mental health condition now viewed as chronic or long-term. More than 50 % of people will have at least one further episode of depression after their first, and therefore it requires long-term management. However, little is known about the effectiveness of self-management in depression, in particular from the patients’ perspective. This study aimed to understand how people with longer-term depression manage the condition, how services can best support self-management and whether the principles and concepts of the recovery approach would be advantageous.MethodsSemi-structured in depth interviews were carried out with 21 participants, recruited from a range of sources using maximum variation sampling. Interpretative Phenomenological Analysis was used by a diverse team comprised of service users, practitioners and academics.ResultsFour super-ordinate themes were found: experience of depression, the self, the wider environment, self-management strategies. Within these, several prominent sub-themes emerged of importance to the participants. These included how aspects of themselves such as hope, confidence and motivation could be powerful agents; and how engaging in a wide range of chosen activities could contribute to their emotional, mental, physical, social, spiritual and creative wellbeing.ConclusionsServices in general were not perceived to be useful in specifically facilitating self-management. Increased choice and control were needed and a greater emphasis on an individualised holistic model. Improved information was needed about how to develop strategies and locate resources, especially during the first episode of depression. These concepts echoed those of the recovery approach, which could therefore be seen as valuable in aiding the self-management of depression.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0550-6) contains supplementary material, which is available to authorized users.

BackgroundThe purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression.MethodModelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs).ResultsThree service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty.ConclusionsCost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services.

The numbers of individuals developing problems with gambling is on the increase. This study explored the nature of problem gambling through an analysis of the reported experiences of problem gamblers. A grounded theory approach involving the analysis of material from 14 male treatment seeking gamblers resulted in the identification of three main categories. These were emotion, control and costs of gambling. Central to the experience of all participants was the emotional nature of gambling, gambling being used either to induce or suppress arousal with a marked lack of other coping strategies. Control of gambling was an issue only in the context of efforts at behaviour change. Gambling costs were extensive including financial, relationship and emotional costs. Repeated failure of efforts at control resulted in tolerance of high levels of costs and repeated cycles of gambling. Patterns of interactions between these factors are identified in the emergent theory.