Springfield University Hospital

The overarching principle of ethical volunteering is to ‘do no harm’. Volunteers need to think carefully about how to behave, and what to teach and how to discuss ideas. There have been examples in the media of volunteers in charitable positions behaving inappropriately, including sexual exploitation of vulnerable people, and these cause huge suffering, trauma and humiliation to individuals and organisations. Nowadays organisations have strict safeguarding rules. It is critical to stay professional at all times.

A purposeful, conscientious and well-intentioned mental health volunteer needs to be informed about the background, principles and ethics of global mental health in order to be impactful. This chapter provides background to aid such efforts and introduces global mental health within the wider voluntary context.

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Imagery rescripting (ImRs) is a therapy technique that, unlike traditional re-living techniques, focuses less on exposure and verbal challenging of cognitions and instead encourages patients to directly transform the intrusive imagery to change the depicted course of events in a more desired direction. However, a comprehensive account of how and in what circumstances ImRs brings about therapeutic change is required if treatment is to be optimised, and this is yet to be developed. The present study reports on the development of a coding scheme of ImRs psychotherapy elements identified in the literature as potential ImRs mechanisms. The codes were assessed in relation to short-term outcomes of 27 individuals undergoing ImRs for post-traumatic stress disorder. The timing of the change in the image, degree of activation of the new image and associated cognitive, emotional and physiological processes, self-guided rescripting, rescript believability, narrative coherence and cognitive and emotional shift were identified as being related to symptom change and so are potentially important factors for the re-scripting process.

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ABSTRACT FROM: Webb RT, Antonsen S, Mok PL, et al . National Cohort Study of Suicidality and Violent Criminality among Danish Immigrants. PLoS ONE 2015;10:e0131915. Immigrant populations in the European Union (EU) have grown considerably in recent years with over 1 in 10 residents born in another country, two-thirds of whom come from beyond the EU.1 There is a need to better understand the impact of increasing diversity within immigrant populations and the nature of psychosocial difficulties caused by adversities, such as racism and marginalisation. In Denmark, the risk of mental illness is elevated across the spectrum of psychiatric disorders in immigrants.2 There is a strong correlation between violence to others and self-harming behaviours.3 Previous studies on violence among immigrants have mainly focused on the USA, most recently on serious violence in Mexican immigrant populations.4 Webb et al studied a cohort of over two million people born within a 23-year period and residing in Denmark on their 10th birthday. The Danish system of assigning a single personal identification number to each resident allowed the researchers to link records from several national databases, including the National Crime Register, Psychiatric Central Research Register and National Patient Register, to extract information about violent offending, suicide attempts and deaths by suicide. The study aimed to compare absolute risk between five categories: native Danes, intercountry adoptees, first-generation immigrants, second-generation immigrants with one foreign-born parent and second-generation immigrants with two foreign-born parents. The study also aimed to calculate gender-specific incidence rate ratios and cumulative incidence rates until age 40 years, for adverse events in each group. Covariates that were identified included psychiatric diagnosis, parental income, employment status and educational attainment. The study also …

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.

In the debate about a causal connection between childhood adversity and schizophrenia, one sometimes refers to the Bradford Hill criteria, but then the debate becomes a discussion about these criteria. Another approach would be to intervene and evaluate the effects.

The efficacy of cognitive-behavioral therapy (CBT) for bulimic disorders has been established in research trials. This study examined whether that efficacy can be translated into effectiveness in routine clinical practice. Seventy-eight adult women with bulimic disorders (bulimia nervosa and atypical bulimia nervosa) undertook individual CBT, with few exclusion criteria and a treatment protocol based on evidence-based approaches, utilizing individualized formulations. Patients completed measures of eating behaviors, eating attitudes, and depression pre- and post-treatment. Eight patients dropped out. The mean number of sessions attended was 19.2. No pretreatment features predicted drop-out. Treatment outcome was similar whether using treatment completer or intent to treat analyses. Approximately 50% of patients were in remission by the end of treatment. There were significant improvements in mood, eating attitudes, and eating behaviors. Reductions in bingeing and vomiting were comparable to efficacy trials. The improvements in this "real-world" trial of CBT for adults with bulimic disorders mirrored those from large, funded research trials, though the conclusions that can be reached are inevitably limited by the nature of the trial (e.g., lack of control group and therapy validation).