Two children died following a stabbing in Southport at a Taylor Swift-themed dance event in Stockport yesterday.

Nine more children were injured, with six in critical condition. Two adults were also injured according to Merseyside Police.

The free leaflet, from the University’s Parenting and Families Research Group available here was developed for the 91ֱ�� Arena bombing and then for the Grenfell fire, with trauma experts from around the country.

It is designed to  help those affected through the critical first few days after the  trauma, but also in the months that follow.

The leaflet is  designed to help parents and caregivers cope with their own emotions and stress and  will help them to understand common reactions in children and how best to care for them.

Professor Rachel Calam, who helped develop the leaflet said: “ This is a tragic incident; parents, children and teachers will need good psychological support to help the navigate through the coming days and months.

“What they are going through might include difficulties sleeping, thoughts and memories of what has happened popping into mind, bad dreams, irritability, feeling low, behavioural problems and avoiding activities they used to enjoy.

“This leaflet is advises them how keep going in such difficult times, and that experiencing some distress like that is entirely normal. There is no one way of feeling after a trauma.

“We developed this information to help anyone wondering how best to help their child through such a frightening and upsetting experience. We hope you find it helpful.”

For more For more family advice, visit the NHS  MindEd website .

Download the advice

“Trainee educational psychologists make a significant contribution to England’s educational psychologist workforce, supporting schools, families and local authorities, in identifying and supporting the full range of children’s needs. Their commissioned, doctoral research is central to the evidence base for professional practice and is actively disseminated to achieve positive impacts across the whole profession.” 

You can learn more about the Doctorate in Educational and Child Psychology, and 91ֱ�� Institute of Education by visiting .

The study - led by Professor Filippo Varese, Director of the Complex Trauma and Resilience Research Unit (C-TRU) at GMMH and the University of Manchester (UoM), Dr Paul French, Reader at 91ֱ�� Metropolitan University (MMU) and Clinical Academic at Pennine Care NHS Foundation Trust, and Dr Kate Allsopp, Research Fellow at GMMH and UoM - also emphasises the need to preserve the staff wellbeing hubs going forward as accessible, confidential sources of help for health and social care staff.

As the COVID-19 pandemic became associated with high levels of mental health difficulties such as anxiety, depression, post-traumatic stress disorder, and burnout among health and social care staff, the NHS funded 40 wellbeing hubs in England to support staff. The wellbeing hubs were modelled after which was established to support people affected by the 91ֱ�� Arena attack in 2017.

The staff wellbeing hubs (also known as Resilience Hubs) provided a variety of support to health and social care staff, who could self-refer to the services. Support offered included proactive outreach, rapid clinical assessment, access to evidenced-based psychological care, where required, and support for staff teams.

Between 2020 and 2022, the study evaluated four of these staff wellbeing hubs in the North of England.

In-depth interviews were conducted at three hubs with a diverse range of participants, including health and social care staff who used and did not use the staff wellbeing hubs for support, staff who worked at the hubs, and stakeholders involved in supporting staff within their organisations, such as occupational health and HR leads.

A total of sixty-three interviews were carried out in order to understand more about how the staff wellbeing hubs were set up, and people's experiences of getting mental health support during the pandemic.

“The Resilience Hubs were found to be important sources of support, which not only helped staff during the exceptional circumstances experienced during the pandemic but can also continue to do so going forward in the next stages of the NHS's recovery journey and beyond” says Dr Kate Allsopp, lead author of the paper. “Too often, workplace stress is seen as ‘just part of the job’ and often participants told us they waited until they were at breaking point before getting support, so the hubs’ model, which reaches out to offer support specifically to this group of staff, is vital.”

"The study's key findings demonstrate that the staff wellbeing hubs were perceived as a valuable source of support for staff, who reported very positive experiences,” said Professor Filippo Varese, the study's chief investigator. “Our research also emphasised the need for managers and employing organisations to genuinely and actively promote mental health support to staff, which can make an important difference to whether staff feel safe enough to seek support, he said”.

This study's findings emphasised the importance of health and social care employers prioritising and promoting mental health support for their employees. It also highlighted the need to create psychologically safe work settings and to resolve workplace stressors that can negatively impact on staff wellbeing, in order to prevent the development of mental health difficulties.

“Our research found the support provided through the resilience hubs was of real value. The stresses placed on health and social care staff during the pandemic were extreme; providing this additional support was an important step. Many staff continue to experience difficulties and these hubs continue to play a vital role for many. The real value of these hubs should be seen longer term with the ability to ramp up support in response to a wide range of complex large-scale incidents that affect our society,” said Dr Paul French.

The study recommends further outreach, and promotion in the future to raise awareness of the services provided by staff wellbeing hubs.

It also underlines the importance of diversity and cultural competence training in order to better meet the needs of underrepresented populations.

The findings are consistent with global studies and have significant policy implications for the entire health and care system. The findings are relevant not only in the context of the conditions brought about by the pandemic, but as part of ‘business as usual’ and in preparation of future crises that might, once again, severely tax the health and social care workforce.

The MCT-PATHWAY and PATHWAY Beacons led by Professor Adrian Wells  secured the place at the prestigious awards ceremony, to be held later this year, for their outstanding  contribution to healthcare

The scheme was among a record-breaking 1456 entries received for this year’s Awards, with 223 projects and individuals reaching the final shortlist, making it the biggest awards programme its 43-year history.

Approximately 100,000 people attend cardiac rehabilitation each year in the UK. The NIHR-funded PATHWAY programme is the UK’s first successful group-based mental health intervention (Metacognitive therapy; MCT) that can be delivered alongside usual cardiac rehabilitation (CR). Group-MCT+CR was found to significantly improve anxiety and depression and halve the deterioration rate in comparison to usual care.

This is of vital importance as heart disease patients suffer significant anxiety and depression, which is not routinely treated in cardiac services and is linked to poorer health outcomes, greater mortality, greater healthcare use, and poorer quality of life. The follow-on NIHR-funded PATHWAY-Beacons project is currently evaluating the effect of implementation and roll-out of MCT-PATHWAY in the NHS.

"The team and I are thrilled to be shortlisted for the mental health innovation of the year award. A big thank you to the HSJ judging panel and to all our collaborators and participants whose dedicated work has improved the mental wellbeing of people living with heart disease"   said Professor Wells, Chief Investigator, from The University of Manchester and GMMH NHS Trust.

Patients who have received MCT as part of the roll-out of MCT-PATHWAY given it rave reviews: One patient, Angus told the research team:  “I truly do not know if I would still be alive if it was not for the course”

And another, Jan said: “Without this service I don't think I would have got to were I am now, they gave me confidence that I could live my life again and feel normal, easing all the anxiety I felt after my cardiac event.”

HSJ editor Alastair McLellan, said: “It always gives me great pleasure to congratulate our finalists at this stage of the judging process and this year is no exception as we acknowledge MCT-PATHWAY and PATHWAY Beacons for being shortlisted in the category of Mental Health Innovation of the Year.

“However, it’s always important to remember that the HSJ Awards are not just a celebration of success stories but also a platform to shape the future of the NHS.

“We can’t wait to welcome our finalists to the awards ceremony in November and to recognise and applaud such impressive achievements across the sector – as well as coming together to help mark the 75th birthday of our great NHS. Huge thanks also go to our new headline partner, Vodafone, who share our mission of driving the standard of healthcare excellence and creating better patient experiences.”

The 2023 awards judging panel was made up of a diverse range of highly influential and respected figures within the healthcare community, including; Crystal Oldman, Chief Executive, Queen’s Nursing Institute; Dr Habib Naqvi MBE, Chief Executive, NHS Race and Health Observatory; Anne-Marie Vine-Lott, Director of Health, Vodafone; Sir Jim Mackey, National Director of Elective Recovery, NHS England, as well as a range of esteemed Chief Executives from NHS Trusts across the UK.

The analysis of data from 16.5 million people attending general practice and 41 thousand respondents to a survey where people reported their symptoms over time, published in The Lancet Regional Health – Europe, shows that while mental distress reported in the surveys increased in the short term during the first two waves of the pandemic,  the numbers affected quickly returned to pre-pandemic levels.

In addition, the study showed that the pandemic appears to have changed the ways in which people manage their mental health and access mental health care: although levels of mental distress went up in the surveys, the numbers of people seeking formal support from their GPs went down, and remained low by the end of 2021 -the period studied.

The study showed:

• Overall, primary care presentations for depression or anxiety dropped during the first wave by 4.6 fewer monthly appointments per 1000 patients and remained lower than expected up to the end of the study (December 2021).
• Self-reported psychological distress in the survey data exceeded expected levels during the first and second waves by 37% and 28% respectively, returning towards expected levels during the third wave.
• Women showed a larger drop in GP presentations compared to men following the pandemic, yet their mental health was more greatly affected.
• Fewer people were started on medications used to treat depression or anxiety, such as antidepressants, however fewer people stopped using their treatment.

According to the authors, the pandemic was likely to have changed how anxiety and low mood is managed, with fewer people attending treatment for potentially milder and more transient mental health problems.

The team also found the decrease in primary care appointments for depression or anxiety was greater than decreases for other diseases, such as urinary tract infections, arthritis or diabetes.

The study drew upon data from the Clinical Practice Research Datalink (CPRD) and the UK Household Longitudinal Survey (UKHLS).

The researchers analysed monthly changes in presentations and prescribed medications for anxiety and depression, as well as self-reported psychological distress from January 2015 to December 2021.

Senior author Dr Matthias Pierce from The Centre for Women’s Mental Health at The University of Manchester said: “Despite periods of distress during the pandemic, we did not find an enduring effect on anxiety and depression -common mental health problems which doctors regularly see patients for.

“But the fall in primary care presentations for anxiety or depression suggests that many people changed the way they used healthcare for mental distress, and there may be a shortfall between the number of people with anxiety or depression who need treatment but do not get it.

“However, more treatment does not necessarily translate into more people receiving the help they need. Common mental disorders may be better tackled by improving prevention measures and the quality of treatment. The pandemic can now provide a point of reflection in how treatment for these disorders is delivered.”

The paper ‘Changes to healthcare utilisation and symptoms for common mental health problems over the first 21 months of the COVID-19 pandemic: parallel analyses of electronic health records and survey data in England’ is available

She is Honorary Lecturer for the Doctorate in Clinical Psychology programme at the University and a Clinical Lecturer in the same department from 2010 to 2015, when she was also the Deputy Academic Director, and Chair of one of the five University-wide research ethics committees. 

Dr Trayner’s winning project will be the development of Goal Manager^®, an application that she developed to automate goal setting processes and administration in brain injury rehabilitation, her specialist area. The project was picked from over 900 applicants to be awarded £50,000 towards the further refinement of the platform. 

She will be building a Data Dashboard, a project which will support clinicians and researchers in answering some of the most unknown questions in rehabilitation. 

With millions of people in the UK requiring rehabilitation for various health conditions every year, as well as many millions more living with the long-term consequences of traumatic injuries and problems like stroke, Dr Trayner aims to be a leading light in the digital revolution in healthcare which will enable faster identification of patients’ difficulties, a more rich and specific understanding of needs, and a joining-up of services and pathways to mean that rehabilitation is more efficient and people can get better faster.

Dr Trayner has already won grants through Health Innovation 91ֱ��, and was awarded £20,000 in ERDF funds to run a trial of the existing platform within the NHS which commenced in January 2023. The Innovate UK grant will commence in April 2023, and the Goal Manager^® project design team will be joined by Professor Andrew Bateman of the University of Essex. Professor Bateman is lead for the rehabilitation theme for the National Institute of Health Research (NIHR) Brain Injury MedTech Co-operative, Director of NIHR Research Design Service for East of England and Chair of the UK Acquired Brain Injury forum. He will be assisting with the research behind the design and evaluation of the new Data Dashboard.

As well as being a neuropsychologist, Dr Trayner is a professional DJ, and has also established the first of its kind DJing for Rehabilitation school, BPM Rehab, right in the heart of Manchester, in partnership with DJ Mark One, an award winning, internationally renowned, platinum selling DJ. Together they are changing the face of rehabilitation and making music more accessible for so many whose lives have been changed by catastrophic events.

Dr Trayner is proud to be running her business from 91ֱ��, but works all over the UK and the world, spreading the message about leveraging technology to make the world more accessible and also designing interventions that people really want to help improve their lives.

The project, is run by Clinical Psychologists at The University of Manchester, Greater 91ֱ�� Mental Health NHS Foundation Trust, and Grounded Research based at Rotherham Doncaster and South Humber NHS Foundation Trust.

The feasibility study of cognitive analytic therapy, or CAT, aims to recruit 60 patients who have self-harmed at least three times in the past year.

It is the first time CAT – which is already widely used in the NHS - is being tested as a specific treatment for self-harm.

CAT, which has been shown to help people with complex mental health problems, supports people to change the relationship they have with themselves and others.

The trial called RELATE, short for Relational Approach to Treating Self-harm, will focus on resolving a range of questions, such as what participants think of the therapy, and if the data needed to properly test the therapy can be obtained.

If the results are positive, the researchers hope to carry out a larger scale trial to test if CAT is effective for adults who self-harm.

Self-harm is a major health concern in the UK that appears to be on the rise with rates increasing from 2.4% in 2000 to 6.4% in 2014.

Many people who self-harm may take an overdose or intentionally injure themselves in response to significant distress or difficult life situations.

RELATE is funded as part of a wider mental health research initiative run by the National Institute for Health and Care Research.

Project co-lead, Dr Peter Taylor from The University of Manchester and Greater 91ֱ�� Mental Health NHS Foundation Trust said: “Self-harm is often a sign of considerable distress and underlying difficulties. We need research to help find out which are the best ways of supporting people with these experiences.

“According to the Samaritans, getting support and therapy can be challenging for people who self-harm, and some people can feel they are bounced “from pillar to post”.

“That is why the availability of effective, accessible therapies for people who self-harm struggling to find support and therapy could make a huge difference to them.”

Dr Stephen Kellett from Grounded Research at Rotherham Doncaster and South Humber NHS Foundation Trust, who is also co-leading the project, said: “CAT helps to build an understanding with the client of the origins of their self-harm and different ways of being in the present day.”

The  two-page leaflet from the University’s Parenting and Families Research Group, has been made available, with support from the United Nations Office on Drugs and Crime Prevention Treatment and Rehabilitation Section (UNODC)

It is available in Turkish, Arabic and English and also as an audio recording in the languages for download on a dedicated UNODC website developed for the earthquake response.

The website also contains a number of other caregiver resources specifically for emergencies like the earthquake and is available  

The leaflets ,booklets and audio resources provide basic, evidence-based guidance on best ways to help both caregivers and children to live through crisis, and have been updates to ensure its relevance for the current emergency.

It  is designed to help parents and caregivers cope with their own emotions and stress and   will help them to understand common reactions in children and how best to care for them.

The Global Initiative to Support Parents (GISP)  - an interagency collaboration formed  to ensure every parent and caregiver around the world has access to parenting support - has shared the resources across their networks and newsletters.

GISP was formed by UNICEF, WHO, Parenting for Lifelong Health at the University of Oxford, the Early Childhood Development Action Network (ECDAN), and the Global Partnership to End Violence.

The United Nations Office on Drugs and Crime are  also working through the Regional Office for Middle East and North Africa - covering Syria, Lebanon and Jordan -  and South East Europe Office (Turkey) to disseminate them through the respective UN Emergency Relief Country Teams. 

The resources were originally created in collaboration with Syrian families and Turkish and Syrian humanitarian workers as a response to the stresses of flight and displacement.  Caregivers rate them highly.

The earthquakes have hit an area which is already home to many displaced Syrian families.

Dr El-Khani and Prof Calam have been working with UNODC for several years to develop a full set of resources for families living through the stresses of flight and displacement.

Prof Rachel Calam said: “ Our hearts go out to everyone affected by these terrible earthquakes. However hard it is to keep going in such difficult times, understanding common reactions, and supporting and encouraging children and young people emotionally and practically can help them to cope.”

Dr Aala El-Khani said: “We know that one of the most important predictors for the mental health of children who experience a crisis is the way they are cared for by their families. We hope these resources will be shared with those families so terribly affected by the earthquake in Syria, Turkey  and Lebanon, who need help and support.”

People with heart disease, or who have had a serious heart problem, such as heart attack or open-heart surgery, often experience stress and anxiety due to their medical condition. Many of these patients are referred into a cardiac rehabilitation (CR) programme, either at a clinic or remotely from their home, to support their recovery. Currently, psychological support and specific mental health treatment offered as part of these programmes varies by site and is limited. Yet, treating anxiety and depression is crucial as research shows that this type of distress reduces quality of life, and increases the risk of further heart problems and even death.

The findings from the , build on previous research which found that . This study shows that MCT can be delivered both in a group-based and home-based treatment, widening patient choice for mental health support in cardiac rehabilitation services.

In this study, 118 cardiac patients were randomly allocated to receive Home-MCT plus standard cardiac rehabilitation treatment, while 122 patients were allocated to standard CR. Patients receiving Home-MCT were provided with a self-help manual that they worked through at their own pace. The manual included modules on developing techniques to reduce worry and rumination (dwelling on the past), and new ways to react to negative or distressing thoughts. In addition to the manual, patients receiving Home-MCT also received support phone calls from trained staff to provide opportunities for reflection and to consolidate learning.

Patients in the trial who received home-based MCT experienced significant reductions in symptoms of anxiety, depression and post-traumatic stress, compared to those receiving standard CR only. The results indicate that Metacognitive Therapy can be effective when delivered both by a therapist in a group setting (as shown in previous research), and when accessed remotely from home. This flexibility in how MCT can be delivered will enable healthcare providers to offer patients greater choice in how they access psychological components of CR programmes.

Harriet Dawson was 22 years old when she had open heart surgery following the discovery of a hole in her heart. She then took part in the MCT-PATHWAY study. She commented:

"It was very self-guided. You had check-in calls every couple of weeks and I liked that.... I preferred that it was home-based because I didn’t have to compare and contrast my answer. A lot of it was about managing your stress, managing your worry, and how much of it us under your control.

“There weren’t many resources out there for me, for someone at the younger end of the spectrum and female. My heart event is a life milestone for me now, but home-based metacognitive therapy has allowed me to take control of it and has allowed me to reflect on it properly.”

Joanne Varker, Cardiac Rehabilitation Specialist Nurse at Royal Bolton Hospital, one of the NHS sites involved in the study, commented:

“Being involved in the Pathway 91ֱ�� was of great benefit to many of our patients. We had never had the option of offering a home-based therapy that could greatly aid our patients' understanding of the psychological issues caused by their heart attack and help their overall recovery. As a team we enjoyed taking part and being able to offer this, and saw many positive outcomes from our patients"

Professor Adrian Wells, PATHWAY Chief Investigator commented:           

‘It’s not surprising that people living with or recovering from serious heart problems experience symptoms of anxiety, depression and trauma. They are often recovering from potentially life-limiting conditions and uncertainty which understandably causes distress. What’s important is that we recognise this and provide patients with effective, evidence-based treatment options. The results of our trial have shown that home-based MCT can help cardiac patients discover new and more helpful ways to process their distressing thoughts, whether they are undergoing treatment at home or at a clinic.”

The trial compared the ‘Take Control Course’ for up to 20 people - devised by researchers at the University of Manchester - with standard talking therapy. Both took place in six weekly sessions.

The study is published in the journal Cognitive Behavioural Therapy and funded by the Economic and Social Research Council.

The course – based on Perceptual Control Theory- follows a precise programme, teaching attendees about the importance of control in life – when to pursue it, when to let go and how to balance conflicting priorities.

They learn how to face longstanding fears and anxieties, and how to see the bigger picture and longer term goals, drawing on their own strengths.

Participants aren’t required to talk about their mental health, but can if they wish.

The randomised controlled trial, conducted by The University of Manchester led team involved 156 people with were recruited from the NHS Improving Access to Psychological Therapies (IAPT) service.

They were offered either the Take Control Course or the established six sessions of one-to-one therapy provided by IAPT.

Participants, mostly referred by their GP,  were recruited from Salford Six Degrees Social Enterprise, a low-intensity IAPT Service.

After a six month follow up, there was no evidence of a difference in mental health outcomes between the two interventions. After another six months, however, there was not enough data to give conclusive results.

The measures used by the researchers included a Patient Health Questionnaire Depression Scale, Generalised Anxiety Disorder Questionnaire as well as other psychological tools.

Though, the course has been delivered by Six Degrees over the past eight years and has been adapted for use in high  schools for the 91ֱ�� Healthy Schools, this is the first time it has been assessed by a randomised trial. It has also been delivered online.

Lydia Morris, Clinical Lecturer at University of Manchester, was the lead author, working with Warren Mansell, Honorary Reader at The University of Manchester and Professor of Mental Health at Curtin University, Perth.

He said: “There are many effective talking therapies for common mental health problems such as anxiety and depression.

“However, training therapists are expensive, and some people prefer to meet in groups, rather than to talking to someone about their problems.

“The success of one to one talking therapies may often depend on the match between the therapist and client.

“The Take Control course, however is always delivered in exactly the same format.”

Dr Morris from co-developed the course as part of her PhD research.

She said: “This trial showed the Take Control Course could be an efficient alternative to one-to-one therapy for common mental health problems, as well as providing an evidence-based alternative for people who do not want individual therapy.”

Co-author Tanya Wallwork has been working with Salford Six Degrees over the past decade and was a co-author of the manual used by facilitators of the course:

She said: “As soon as I came across this course I knew how useful it could be. And the outcomes bear that out. Each week we use objective measures to assess the impact of using taking part in the course and the results are consistently good.

“The course came into its own during Covid when we started to give it via Zoom. It actually gives participants more choice-  as they can choose to be visible or not.”

One participant in the course said: “I found looking at goals and working out what’s important to me really helpful. Especially when I think something I worry about too much is just a small thing but using the upward arrow technique to work out why it’s important really helped me to look at the bigger picture rather than focusing on little things.”

The six sessions include:

• Discussing how life is about control -  working out what we want to have more control of, and what we can have less control of.
• What Blocks Our Control? Even worry, rumination and self-criticism are a problem only to the extent they get in the way of important life goals.
• Feeling in Control Short-Term versus Getting Control of Your Life. Goals are organized hierarchically
• Taking Control of the Things Around You. A flexible way to work out what we have in common with people despite our disagreements
• Building on Strengths, Qualities, and Resources. Encourage participants to recall the strengths, qualities and resources they have, especially at times when things are difficult for them
• Moving Forward: What Gets Me Stuck? What Helps? Participants complete a worksheet on the things that are helping them feel in control and signs that they are struggling, like a “relapse prevention” session in traditional CBT

The paper ‘A brief transdiagnostic group (the take control course) compared to individual low-intensity CBT for depression and anxiety: a randomized non-inferiority trial’ is available  

The drugs, which have a tranquillising effect, are frequently used in adults to treat major mental illness, such as schizophrenia.

However, they can be associated with substantial side-effects such as sexual dysfunction, infertility, and weight gain leading to diabetes.

The National Institute for Health and Care Excellence has approved the use of some antipsychotics in under 18’s with psychosis or with severely aggressive behaviour from conduct disorder

However the study, published in the Lancet Psychiatry, suggests they are prescribed for an increasingly broad range of reasons - the most common being autism.

The team examined primary care records of 7.2 million children and adolescents, aged 3 to 18, registered at selected English General Practices over the period 2000 to 2019.

The overall percentage who were prescribed antipsychotics was relatively small – 0.06% in 2000 and 0.11%  in 2019.

However, the increasing use of antipsychotics is a cause for concern, argue the researchers, given that their safety in children, who are still rapidly developing, has not been established.

The study also found that:

• Boys and older children – aged 15 to 18 – were more likely to be prescribed antipsychotics than girls and younger children; however, the increasing trends were evident in all groups.
• The older class of antipsychotics, that may be associated with extrapyramidal side effects such as movement disorders, were more commonly prescribed in more deprived areas.

Dr Matthias Pierce, senior research fellow at the University of Manchester’s Centre for Women’s Mental Health jointly lead the study.

He said: “This study demonstrates a concerning trend in antipsychotic prescribing in children and adolescents. We do not think the changes in prescribing necessarily relate to changes in clinical need; rather, it may be more likely to reflect changes in prescribing practice by clinicians.

“However, this study will help clinicians to evaluate the prescribing of antipsychotics to children more fully and will encourage them to consider better access to alternatives.”

Senior author, Professor Kathryn Abel from The University of Manchester said: “Antipsychotic medications continue to have a valuable role in the treatment of serious mental illness. These findings represent a descriptive account of antipsychotic prescribing to children and adolescents in the UK today and provide a window onto current practice.

“It is notable, and relevant to the current discourse, that we report inequities in prescribing as a result of deprivation levels; and that the indications for which approvals are available are no longer the commonest reason these medications are being prescribed. Broadening use of antipsychotics in developing young people begs questions about their safety over time and demands more research on this topic.”

The study is available at this

Photo by  on 

Irena Karpa, lead singer and songwriter of the band Qarpa recorded a 6 minute audio version of a two-page leaflet highlighting parenting skills resources which have been used by desperate families affected by the  invasion of Ukraine. She is also famed in the country as a writer and blogger. 

A video of her contribution is available

The UN says at least 262 children have been killed and 415 injured in attacks since the Russian invasion on 24 February.

Around 5.2 million Ukrainian children are affected by the conflict: three million inside the country and more than 2.2 million in refugee-hosting countries.

Published in 7 of the languages of countries receiving Ukrainian refugees, the resource was developed from the experience of displaced Syrian parents living through the country’s civil war.

The leaflets - in Ukrainian, Russian, English, Polish, Romanian, Dutch and German are available on the on the University of Manchester website and along with other resources  on a website.

They have now been made available, with support from the United Nations Office n Drugs and Crime Prevention Treatment and Rehabilitation Section (UNODC), in audio in , as well as , , and .

The leaflets have been used across Europe by NGOs, public health systems, charities, UK foster families and displaced families themselves and widely shared online. It is hoped that the audio recordings will help caregivers access the information more easily.

The work is based on the research of Dr Aala El-Khani, a University of Manchester psychologist and family skills programme trainer who developed numerous family skills interventions and parenting resources based on her experiences working with Syrian refugees in Syria, Turkey and the UK.

The academic, who is of Syrian heritage herself, worked with Professor Rachel Calam, Professor of Child and Family Psychology and Dr Kim Cartwright at The University of Manchester, to produce the leaflet.

It explains that anxiety, nightmares, bedwetting, withdrawal and even aggression are common responses to childhood trauma, and offers basic reminders and suggestions to parents for looking after themselves and their children.

Dr Aala El-Khani, who also works as an international consultant for UNODC said: “We know that one of the most important predictors for the mental health of children who experience conflict and displacement is the way that they are cared for by their families.

“Warm, positive parenting can help buffer children from psychological harm and that is the purpose of this initiative which is making a real difference to Ukrainian families affected by the war.

“One Polish group in Poland told us they had even been distributing the leaflets to exhausted parents at a train station, along with a warm drink.

“This provided families an opportunity to be open about the challenges they were facing, and help them to refocus on what they could do to be the best parent possible.

Seeing the leaflet, one relief worker in Romania told the team: "So really helpful, at first hand all the info guidance and advices,  Will make sure to have printed out forms and given to parents in need that cross the border from Ukraine to Romania.”

Another said: “Thank you for this valuable resource. We will use it among our networks and share it with those who are helping to provide pastoral support for traumatised Ukrainian refugees.”

Professor Rachel, Calam said: “We know that good family relationships are an important way to promote children’s mental wellbeing, which can help to counteract their actual experience in wartime - appalling though that may be.

“Our recently published in the journal Child and Adolescent Mental Health highlights this and what researchers have to say on this area.

“But overall, if families can provide warm, positive and secure parenting, that can be powerfully protective, and this information helps them to achieve just that

The videos/audio recordings are available on the website

Led by and The University of Manchester, the £255,000 study is funded by the (NIHR).

The feasibility study will recruit 45 patients in Greater 91ֱ�� over 12 months, and will be one of the largest trials so far to use an imagery focused therapy approach in psychosis.

The research team hope the therapy will help the up to 74% of people with psychosis who see intrusive pictures in their mind, by helping them understand and change the images, and replacing them with more positive ones.

These “pictures in the mind’s eye” are often associated with distressing voices other people cannot hear and beliefs that others mean to harm them.

The talking therapy, to be given over 12 weekly sessions, uses purely imagined images in addition to images from a person’s past (or things they are worried about happening in the future).

Antipsychotic medication can treat some symptoms of psychosis, however, around 74% of patients stop using it or change medications within 18 months because of debilitating side effects, or not reporting a benefit, underlining the desperate need for effective therapies.

An initial test of the therapy on 10 patients over the last two years showed the approach known as iMAPS, was acceptable, with some patients reporting positive benefits in reducing psychotic experiences and symptoms.

Now the study team are moving to a larger study.

Chief investigator Dr Chris Taylor, a consultant clinical psychologist at Pennine Care NHS Foundation Trust and Honorary Clinical Lecturer at The University of Manchester, said: “Our research aims to improve the current treatments for people with psychosis.

“Cognitive Behavioural Therapy (CBT), one of the current NICE recommended psychological therapies, has demonstrated a robust, but small effect on psychotic experiences, such as hallucinations and delusions.

“We know intrusive mental images such as flashbacks and flash-forwards are common for people with psychosis, and early life experiences can lead to developing negative beliefs about the self and others.”

He added: “The iMAPS therapy approach works to tackle these images and past negative experiences directly, which we hope will also lead to a drop in psychotic experiences.

“In many ways, it’s true to say that pictures speak louder than words.

“Our feasibility study aims to find out from patients about their experiences of taking part in the trial, receiving the therapy and suggestions for improvements to plan for a bigger, definitive trial.”

The funding from NIHR's Mental Health Research Initiative was part of a rapid call for in order to tackle the disparity between regional needs and mental health research activity.

Professor Katherine Berry, Professor of Clinical Psychology at The University of Manchester and Senior Co-applicant said: “It is excellent news that this research is starting in the North West of England.

“The project is the largest trial of therapy for people with psychosis that specifically targets distressing images. It represents a significant step for local mental health research. I'm personally really excited to be part of this project".

Thom’s story

When Thom was a student at a Northern University in his twenties, he was traumatised by the sinister featureless faces he saw in his mind’s eye.

He was forced to give up his course, because of the visions, which filled him with fear and dread and paranoia.

But when, over just eight weekly sessions, his therapist helped him to understand the images and imagine a sealed cell/armour wrapped around the faces, the fear and paranoia disappeared.

Thom went back to University and passed an undergraduate degree in psychology with flying colours, going on to take a Masters in the subject. He’s now hoping to work in role supporting others with mental health problems.

Thom said: “The therapy was really useful for me. It calmed me at a time when I wasn’t feeling calm at all.

“The therapy helped me take myself out of concentrating on what was in my mind’s eye and separate the images from those feelings of malign threat.

“I realised it wasn’t the figures but my feelings that were threatening me and realising that helped substantially.”

Dr Taylor said: The therapy worked very well for Thom, who now lives a successful and happy life. The approach appears acceptable to the initial people with psychosis who have tried it and we are encouraged by their feedback.

“iMAPS-2 is an important step on the journey to building evidence for the approach and his experience highlights  the potential we hope this therapy has to change lives for the better.”

Led by University of Manchester researchers, the system will be tested across six Higher Education Institutions and their partnering NHS Trusts in England, Wales and Scotland. The work is also being conducted in partnership with The McPin Foundation.

Called CONNECT, the project whose principle funder is the Wellcome Trust, aims to recruit up to 1100 people who experience psychosis. People will test the remote digital data collection system over 12 months.

Developed at The University of Manchester, the remote digital data collection system combines active and passive remote symptom, emotional, physical and contextual monitoring, along with regular clinical assessments.

The data from the project will be used to develop a relapse prediction algorithm and an adaptive sampling algorithm (for maximising engagement and information obtained from digital remote monitoring) using machine learning / AI methods.

Early Warning Signs, commonly reported to emerge in the days and weeks before a relapse, include anxiety, dysphoria, insomnia, and the beginnings of psychotic experiences.

However, signs are often missed or identified too late, and each patient’s Early Warning Signs are different, which up to now has made it difficult to design a system which can predict a relapse and open the door to time-sensitive, preventative treatment.

The remote digital data collection system designed by the research team sends regular prompts requesting the user complete a digital questionnaire at set times in the week, taking around 90 seconds to complete.

They system will also test whether data collected passively (via wearables and the Smartphone sensors), such as sleep disturbance, inactivity, social avoidance or sedentary behaviour, helps improve the predictive algorithm.

Machine learning methods will be used to detect complex high dimensional non-linear interactions to predict individual patient warning signs of relapse.

The Principal Investigator, Professor Sandra Bucci, said: “Psychosis is a common reason for contact with secondary care mental health services in the UK and a leading cause of disability worldwide.

Up to 80% of people who experience psychosis relapse within 5 years. Each relapse is associated with a higher risk of functional and clinical difficulties.

There is an urgent need to be able to efficiently predict relapse to enable timely intervention and a personalised treatment response.”

John Ainsworth, Professor of Health Informatics at The University of Manchester, said: “The system we will be developing at 91ֱ�� provides real-time and in-context patient-generated symptom data, obtained through our remote digital data collection system technology”.

Professor Bucci added: “The system has the exciting potential of providing advanced warning of the need for support and intervention. It also has the potential to give mental health teams a clearer picture of the ebb and flow of an individual’s mental health trajectory.

Our remote digital data collection system could be a crucial advance in the care of people with psychosis.”

Lynsey Bilsland, Head of Mental Health Translation at Wellcome, said: “There have been huge strides recently into improving the outcomes for patients with psychosis but we still need further research into better detection of the early warning signs. Our support recognises the potential of the CONNECT system to enable early identification of patients at risk of relapse. The insight gained could be transformative to how we manage psychosis.”

Instead, doing nothing when witnessing bullying. But why is this the case and what consequences does it have? Our recent research gives important clues.

Workplace bullying occurs when an employee is subjected to repeated behaviour that harass, exclude, or negatively affect someone’s work. This may range from obvious acts of physical violence to more ambiguous behaviour, such as mocking, insulting or socially excluding someone.

Bullying can seriously affect , with extreme cases leading to self-harm or suicide. On average, workplace bullying affects around , though some sectors, such as healthcare and higher education, report higher rates.

The impact of doing nothing

Workplace bullying has traditionally been seen as an issue just between the victim and bully – and dealt with accordingly. But bullying often occurs in front of others. in some organisations report witnessing bullying at work.

This is troubling. Witnessing bullying may harm , stimulating fear of how they might be treated in the future.

But how bystanders respond can either help or worsen the situation for victims. In our , we asked employees at a large university to answer questions about their experiences of bullying, as a victim or a bystander.

We showed bullying victims suffered less damage when they had helpful bystanders who actively intervened. Conversely, victims in groups with bystanders who did nothing experienced greater detriments.

We suggest that this is because victims in these situations must not only deal with bullying, but also understanding why others did not respond, which is more added stress. It seems to us bystanders are key in helping create an anti-bullying workplace culture.

that bystander responses to workplace bullying can be categorised in two ways: active versus passive, and constructive versus destructive. The former describes how proactive the response is in addressing the bullying situation, while the latter shows whether the response is intended to improve or worsen the situation for targets.

This gives four types of bystanders. There are active-constructive bystanders, who proactively and directly seek to improve the bullying situation by, for example, reporting the bully or confronting them. There are also passive-constructive bystanders who don’t directly “solve” the bullying, but listen to or sympathise with the target.
Passive-destructive bystanders, on the other hand, typically avoid the bullying and “do nothing”. While this may sound benign to some, targets may view passivity as . Finally, active destructive-bystanders actively worsen the bullying situation, for example, by openly siding with the bully or setting up situations where the bully can pick on people. They effectively become secondary bullies.

The psychology behind bystanding

Why do so many people fail to intervene when witnessing something they know is wrong or harmful? The most famous theory to explain the phenomenon, known as the , was inspired by the murder of . Kitty was a young woman in 1960s New York who was stabbed to death outside her apartment building while 38 residents watched from their windows. Initially, it was reported that not a single person intervened or called the police, showing passive-destructive responses – though this story and the theory itself .

That said, the effect , such as bullying, that don’t amount to a medical emergency. The bystander effect explains their actions by proposing that individuals are less likely to help when there are other people present. This makes us feel less personally responsible to act, especially in ambiguous situations.

, we tried to delve deeper into the psychological processes underlying bystander behaviour. Bullying is often subjective, with people interpreting the same situation differently. So, we were interested in understanding what interpretations lead to active-constructive responses, which are the most helpful.

For active-constructive responses to occur, employees must perceive that the incident is severe enough to warrant intervention. This can be ambiguous – is that offhand remark just a joke or something more?

Next, employees must perceive that the victim does not deserve what is happening to them. Work relationships are complex and in certain cases, such as when group performance is key, employees may not approve of others making mistakes or inconveniencing them and may perceive mistreatment as justified.

Finally, employees must perceive that they are able to intervene effectively. There are many cases where employees wish to act but don’t feel able to, such as if the bully is a supervisor, or if previous attempts to intervene have failed.

Taking action

While there is no one-size-fits-all solution to encourage bystander intervention, there are things you can try to help you better understand a target’s situation and, hopefully, become an active constructive bystander. Research suggests that perspective taking, or trying to see things through another point of view, can be beneficial.

that participants who are asked to take a perpetrator’s perspective are more likely to agree that misconduct has taken place, while participants who are asked to take the victim’s perspective don’t.

Organisations have a key part to play in stopping bullying and, ideally, should have anti-bullying policies that are easily accessible by employees. These policies should clearly and have transparent, confidential processes for reporting incidents that are either directly experienced or witnessed.

Policies and anti-bullying initiatives should have buy-in from senior management. This would ultimately help employees feel safe in speaking out.

Importantly, organisations should try to find the root causes of bullying and if there is anything they can change to reduce it. For example, high workload and poor communication may contribute to a bullying culture.

Organisations whose members can reflect on problem areas can then take appropriate actions to tackle them. Not only could this reduce bullying, but it can also improve overall workplace wellbeing.

, Presidential Fellow in Organisational Psychology, and , Professor of Organisational Psychology, . This article is republished from under a Creative Commons license. Read the .

The assessment of data from 157 studies of cognitive behavioural therapy led by University of Manchester and University of South Wales scientists is published today in the (29/03/22)

The study compared CBT alone and with one or two additional components such as social skills training, assertiveness training, relaxation techniques and psychoeducation.

All three protocols, they found, reduced depressive symptoms by a substantial 8.44 points on the Beck Depression Inventory, a 21 item self-reporting scale which measures symptoms of depression.

However only CBT with one or two additional components sustained the effects in the long-term, reducing depression to at least 5 or 8 points respectively after 6 months when compared to CBT alone.

In addition, CBT given with two extra components was more effective when delivered by non-mental health specialists such as nurses.

Age also appeared to affect the effectiveness of CBT: participants younger than 30 and younger than 59 responded better to CBT with two or one extra components respectively.

And the analyses also demonstrated that participants from lower socio-economic status responded better to CBT with two or one extra components.

Lead author Dr Ioannis Angelakis said: “Depression is the most common mental health condition with more than 264 million people being affected worldwide.

“It impacts negatively on people’s quality of life and is very costly for health and care systems, so understanding how to best to treat it is paramount.

“Our study shows that CBT can significantly reduce depression after treatment, however when given with one or two extra components it becomes effective in the long term.”

He added: “When enhanced CBT is given to younger people, policy makers should also focus on supporting non mental health professionals in giving this extra help.

“A nurse providing enhancements may also play the role of the main care co-ordinator for wider range of health problems

“That could explain why enhanced CBT seems more effective when they deliver it however more research is needed to understand this more fully.”

The MISST (Mental Imagery for Suicidality in Students Trial) is a collaboration between Greater 91ֱ�� Mental Health NHS Foundation Trust, University of Lancaster, and The University of Manchester.

It is funded by the National Institute of Health Research (NIHR), the research partner of the NHS, public health and social care.

Moving away from home, academic stress, and financial pressures can all impact on students, who sometimes struggle with their mental health at university.

A previous study found that up to 42% of students thought about suicide in the previous 12 months.

Universities offer counselling and mental health services which  are a source of support and help for struggling students, however, further effective therapies for preventing suicide are still needed.

MISST focuses on a novel talking therapy that is designed to help strengthen a person’s ability to recall and relive positive memories.

the therapy  is used as a way to counter the spiral of negative thoughts and feelings that can lead to suicidal thoughts.

Psychologists argue that by having the therapy, a person may be able to strengthen their ability to break free of spiralling  negative thoughts by immersing themselves in memories of more positive times.

Co-Principal Investigator Dr Jasper Palmier-Claus from Lancaster University said: “When people are suicidal, we know it can be hard for them to focus on positive experiences in the past, or imagine positive experiences in the future. There is a sort of tunnel-vision. The therapy aims to help people break free from this state by re-connecting with positive experiences in their life.”

The trial will aim to test the therapy with students studying in the North-West of England, who have had recent difficulties with suicidal thoughts or behaviour.

Participants will be randomly put into a group to either receive the new therapy, or regular treatment through their university counselling or support services.

MISST is a feasibility trial, which means the aim is to determine if a more powerful large-scale clinical trial would be possible to run. This includes checking what students think about the therapy and whether it is possible to recruit people to take part.

Co-Principal Investigator Dr Peter Taylor from The University of Manchester said: “This is a first step, but an important one. This trial will give us the information we need to plan what we call a “definitive trial”, one that will then tell us how effective the therapy is. The aim is to work towards having effective therapies available for universities to help prevent student suicide.”

MISST was funded as part of a wider mental health research initiative run by the NIHR. You can find out more about it

Samaritans (116 123) samaritans.org operates a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org , write to Freepost RSRB-KKBY-CYJK, PO Box 9090, STIRLING, FK8 2SA and visit www.samaritans.org/branches to find your nearest branch.

The University of Manchester team showed that in 1000 women, 4 are likely to self-harm over a year and this risk halves in pregnancy to 2, according to the research published in the British Journal of Psychiatry today (03/03/22).

And while women with a diagnosis of psychiatric disorder had a higher background risk of self-harm, their risk more than halved when pregnant.

Even after pregnancy, women over the age of 30 are at lower risk of self-harm. The risk reduction at 3-6 months after pregnancy is 13% for women aged 30 to 34, and 27% for women aged 35 to 45, compared to women of the same age who were not pregnant, reports in the study.

However, mothers under the age of 30 are more likely to self-harm between 3 and 6 months after giving birth.

Mums aged 15 to 19 are 66% more likely, 20 to 24 year-olds 40% more likely, and 25 to 29 year-olds 15% more likely to self-harm between 3 and 6 months after giving birth compared to women of the same age who were not pregnant, according to the study from The University’s Centre for Women’s Mental Health.

The study team identified and analysed almost 58,000 self-harm events in women aged 15 to 45 years between January 1990 and December 2017.

The data were linked to 1.1 million pregnancies and their outcomes, utilising the Clinical Practice Research Datalink and Pregnancy Register.

Though only a small number of women self-harm during and after pregnancy, the team argue that identifying those at risk will allow doctors to target resources to the women who need them most of all.

They also discovered:

• Overall, there was a small increase in risk of self-harm post pregnancy, but this risk was carried primarily by young women, aged 15 to 29 years.
• Unlike older women, adolescent women aged 15-19 with a history of self-harm are likely to continue to self-harm during pregnancy.

Lead author Dr Holly Hope said: “This study - which is the largest of its kind - makes important advances in our understanding of how pregnancy and the first year after giving birth affect self-harm risk.

“As we already know, self-harm among young women generally in the UK is increasing and self-harm is associated with up to a 50 times higher risk of suicide in women, that’s important.

“Significantly, we find that the risk of self-harm is indeed higher among women under 30 after giving birth, but reassuringly, for women over 30, the risks of self-harm decrease both during and after pregnancy.

“Latterly, women are increasingly likely to wait a few years until they have a baby which could be down to a number of factors, including their education and employment choices.

“Older women may be in a better financial and psychological position to care for themselves and their baby.

“Hormonal changes during pregnancy intended to promote maternal attachment and increase a sense of wellbeing. However, this mechanism might be overridden by other factors in some younger women.”

She added: “Older women might also be in a better position to take advantage of health services which do a good job in signposting them to services if they need help.

“This study shows us more clearly than before, in a contemporary population of women becoming pregnant, where the greatest risks of self harm  lie  which means resources might be more focussed on those at-risk age groups so they can be monitored more effectively and referred for help more efficiently.

“The most deprived neighbourhoods where teenage pregnancy is more common might benefit from a similar focus.”

Dr Jo Black, chair of the Perinatal Faculty at the Royal College of Psychiatrists, said: “By highlighting where resources are needed most, the findings could help ensure funding is better targeted to reach those at greatest risk.”

The study was funded by a European Horizon 2020 grant to Professor Kathryn Abel from The Centre for Women’s Mental Health at the University of Manchester.

The  paper Self-harm risk in pregnancy: a recurrent event survival analysis using UK primary care data  is  published

At one end of the spectrum, there are people called “”. They find face recognition easy – often successfully identifying people even if they have only seen them once, briefly or a long time ago. Conversely, people with “” are at the opposite end of the face recognition scale. They find it tricky to recognise faces and can therefore struggle to socially interact with those around them.

People with this type of “face blindness” may not realise they have it until they reach their teenage years or later. For most of us though, our face recognition ability falls between these extremes – we aren’t super-good, but we aren’t particularly bad either.

It may seem that face recognition is a single, isolated skill. But psychologists know that the ability depends on a number of different cognitive processes that interact in complex ways.

Measuring face recognition

If we are to test face recognition accurately, it is important that we know what it is. And it turns out that may produce different results.

One task used to measure how good we are at determining identity in unfamiliar faces is called “face matching”, captured, for example, by the . Here you are presented with two faces and asked whether they belong to the same person or different people. Performance across 40 pairs, ranges from being just over chance (guessing) to 100% correct.

Being good at face matching is particularly important for some jobs. Indeed, passport control officers verify identity by matching the identity of a live person to a photo in a passport.

But being good at face matching doesn’t necessarily make you a super-recogniser. Indeed some matching tasks may not be difficult enough to allow super recognisers to show off their skills. is an example of a “face learning task”. It measures your ability to learn and identify previously unknown faces. Specifically, you memorise the faces of different people and then try to pick them out of a line-up of three faces. The test starts very easy and gets progressively more difficult. Doing well on this task depends on your ability to see the visual differences between faces and to memorise them.

Finally, we can test familiar face recognition. When recognising familiar faces, we are tapping into our stored long-term memories of known people. We may know them as a family member or friend, or it may be someone from our favourite TV show. Most ask people to try to recognise famous faces either from current footage or use a test based on celebrity faces from before they were famous.
 

Performance across tasks

Interestingly, performance across different face tasks may be associated. So, if you are good at one face recognition task then you may also be good at other face tasks too. Some researchers that accounts for some correspondence in performance across tasks.

But this is not necessarily the case. You can be good at one task but impaired at another. And this is where the complexity lies. For example, if you have problems with working memory then you may struggle with face learning and familiar face recognition, but not necessarily with face matching. Similarly, being impaired at long term memory may make it particularly difficult to access memories of familiar people. Finally, problems with attention may affect your everyday face recognition but have less impact in the lab when you are fully focused on the task in hand.

Given the different measures of face recognition, we need to clearly define how we determine when someone is impaired (or a super-recogniser). Certainly, there is no single accepted test to measure face recognition ability. Instead, psychologists think that its best to measure face recognition using multiple tasks, exploring the different aspects of face recognition. On each task, performance from an individual is compared to that achieved by a large population of the general public.

We must also listen to a person’s report of their face recognition ability in their everyday lives. Some people may score normally on, for example, the Cambridge Face Memory Test in the lab, but struggle to recognise their friends and family in the street. Conversely, while poor performance across a number of face recognition tests is a good indicator for prosopagnosia, it is not necessarily a clear diagnosis of it.

More valid measures of face recognition that reflect real life still need to be developed. In real life, face recognition is much more complicated. Most of the existing face tasks use still images of faces, whereas in the real world faces move in complex and subtle ways. The full picture will rely on tests that can distinguish more carefully between different types of face impairment.
 

, Senior Lecturer in Experimental Psychology, . This article is republished from under a Creative Commons license. Read the .

The qualitative study of eight  young people, eight  family members and eight nursing staff by psychologists from The University of Manchester and Pennine Care NHS Foundation Trust is published in high profile journal PLOS ONE.

The professional connection between a clinician  and a patient -  known as a therapeutic relationship - can help improve outcomes for mental health patients say the research team.

Progress in psychotherapy and mental health care in general has previously been shown to strongly link to the therapeutic relationship between clinical professionals and service users.

However, the study highlights how nursing staff sometimes do not have the time or support to develop therapeutic relationships with their patients.

To achieve that, the researchers urge the employment of adequate staff numbers, focused training and time in cultivating connections between nursing staff and their patients.

“This research underlines the established point that therapeutic relationships between patients and staff are just as important as the specific treatment they are receiving, if not more so,” said Dr Sam Hartley, an honorary clinical lecturer  at The University of Manchester and Principal Clinical Psychologist with Pennine Care NHS Foundation Trust.

The young people, all based within child and adolescent mental health services across four sites in the UK, described how their relationships with nursing staff could impact on their progress through treatment.

The researchers interviewed the participants at length, and identified six themes which described therapeutic relationships, their development and maintenance.

One of the themes was centred around the feeling that therapeutic relationships are a treatment in their own right.

Dr Harley said: “Therapeutic relationships  are particularly pertinent in child and adolescent mental health inpatient services where relationships are especially complex and difficult to develop and maintain.

“Our analysis indicates that young people, families and nursing staff all agree these relationships are crucial to good outcomes. These groups would be better served by a system that prioritises the formation and maintenance of effective therapeutic relationships.

“This requires adequate staff numbers, training and time in cultivating connection and doing ‘normal’ things together.

“Consideration should also be given to aspects of the workforce that might impact on this being successful, such as staff retention, where continuity of care and relationships might be impeded.”

She added: “The balance between being human and professional is a tricky one and could benefit from ‘live’ focused staff support alongside more static training and supervision.

“We hope that the testimonies of these patients, nurses and parents, and our analysis will serve to drive policy makers, service managers and clinicians to focus on therapeutic relationships, as essential to quality inpatient care, and afford them the structures, support and significance they deserve.”

Citation: Hartley S, Redmond T, Berry K (2022) Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff. PLOS ONE 17(1): e0262070. 

An animated video summary is available

The large study of 10 to 19-year-olds between 2003 and 2018, published in the Journal of Child Psychology and Psychiatry, also puts forward a series of proposals to deal with the problem.

The study, funded by the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust (NCA).

It showed that 85% who later took their own lives consulted with their GP or a practice nurse at least once in the preceding year; the equivalent figure was 75% for those youngsters who harmed themselves non-fatally.

Lower than expected rates of diagnosis of psychiatric illness, around a third in both groups, were probably down to a lack of contact with mental health services, rather than an absence of psychiatric illness, argue the research team. Depression was by far the commonest of the examined conditions among both groups, accounting for over 54% of all recorded diagnoses.

Also, while suicide was more common in boys, non-fatal self-harm was more common in girls. Two-thirds of adolescents who died by suicide had a history of non-fatal self-harm.

And while self-harm risk rose incrementally with increasing levels of deprivation, suicide risk did not.

Suicide frequency did increase with age: two thirds occurred at 17-19. However, adolescents who self-harmed tended to be younger: almost 65% had their first recorded episode below age 17.

The study analysed the data of 324 adolescents who had died by suicide and 56,008 who had self-harmed, using the Clinical Practice Research Datalink, which contains interlinked general practice, hospital, and national mortality records.

Lead-author Lukasz Cybulski, a GM PSTRC PhD Fellow from the University of Manchester said: “That most adolescents who had harmed themselves or died by suicide were known to services in the preceding year highlights how important it is to identify their pathology and adequately treat it.

Ensuring timely access to effective treatment is a priority as we already know that people who experience psychiatric illnesses are at much higher risk of harming themselves or dying by suicide”

Co-author Dr Shruti Garg from The University of Manchester said: “Late adolescence can be a particularly vulnerable time for young people experiencing mental health problems. Improving access and provision of transition mental health services so that young people do not fall in the gap between CAMHS and adult mental health services should be a priority

Professor Nav Kapur from The University of Manchester and another of the study’s authors said: “Suicide and self-harm are complex behaviours with many potential causes. In young people, bullying, bereavement, health problems, and academic pressures can all be important antecedents.

“This means that a comprehensive approach to prevention is vital and one that requires coordination between families, schools, social services, and health professionals.”

“The association between deprivation and self-harm risk suggests that prevention must also target underlying social determinants, such as barriers to educational achievement, low income, unemployment, and crime.”

The most detailed study to date examining COVID-19 outcomes in people with different diagnoses of severe mental illness in the UK is published today (7/12/21) in the journal .

People with psychotic disorders showed 4.84 times higher odds of dying from COVID-19, compared to those without severe mental illness. The odds of dying from COVID-19 were 3.76 higher in people with bipolar disorder and 1.99 higher in people with major depressive disorder.

Among people with COVID-19, those with psychotic or bipolar disorders had the highest rates of infection leading to hospitalisation: 35.8% and 37.3% respectively, compared to 16.6% among with those without severe mental illness.

And among people with COVID-19 who were hospitalised, over half of those with psychotic disorders - 52.6% - did not survive compared to 37.5% among with those without severe mental illness.

The study was conducted in the UK Biobank, which is a large-scale biomedical database and research resource containing genetic, lifestyle and health information from half a million UK participants.

UK Biobank’s database, which includes blood samples, heart and brain scans and genetic data of the 500,000 volunteer participants, is globally accessible to approved researchers who are undertaking health-related research that’s in the public interest.

Of the individuals included in this study, 1,925 had a recorded history of schizophrenia or other psychotic disorders in their lifetime, 1,483 had bipolar disorder and 41,448 had major depressive disorder.

The samples were compared with 402,440 UK Biobank participants with no indicated history of these conditions.

UK Biobank participants were tracked from 31 January 2020, the first COVID-19 related death in the UK, until 28 February the next year.

A total of 16,282 people tested positive for COVID-19, while 2,885 were hospitalised and 1,081 died.

Though UK Biobank participants are now mostly over 65 years of age, and 95% white, the authors argue the results still have important implications for public health.

The higher rates of adverse COVID-19 outcomes among people with severe mental illness were partly linked to a range of factors including being male, belonging to an ethnic minority, older age and having certain respiratory and metabolic conditions.

However, over half of the excess risk could not be attributed to any of the sociodemographic, clinical or lifestyle factors measured, including a range of pre-existing physical health conditions.

Lead author Dr Lamiece Hassan from The University of Manchester said: “This is the most comprehensive study yet to examine COVID-19 outcomes in people with different types of severe mental illness in the UK.

“It shows that people with severe mental illnesses, and particularly psychosis, experience significantly poorer outcomes resulting from COVID-19, which are only partly explained by pre-existing physical health conditions.

Co-author Dr Brendon Stubbs from Kings College London added: “Engagement and action from all people working in the COVID-19 and physical health area is needed to address these disparities, to adopt a proactive approach to protecting this population in both the short and long-term.”

“That could, for example, include providing tailored health interventions for people living with mental illness, increasing access to vaccination programs and/or increasing the availability of screening and treatment for COVID-19, along with other physical health conditions which may worsen the health and social implications from COVID-19 for these underserved populations.”

Dr Joe Firth from The University of Manchester said: “The COVID-19 pandemic has further highlighted the poor physical health outcomes we see for people who experience severe mental illness. Clearly, there is an urgent need to provide enhanced care for this particularly high-risk group.”

The research**, published in The Journal of the American Medical Association Network Open (JAMA Network Open) today, was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust.

The study found there was an almost six-fold increase in the likelihood of reporting fatigue to a GP following a positive PCR test and a threefold increase in the risk of sleep problems compared to those without a positive test, for people who haven’t previously visited their GP for any of these reasons in the past.

There was also an 83% increase in mental illness following a positive PCR test. However, there was also a 71% increase in the risk of mental illness for people who received a negative PCR test compared to the general population. Researchers believe this throws some doubt about whether COVID-19 is directly causing mental illness, because it is clear that those who get a test are more likely to have risk factors for mental illness, for example pandemic-related anxieties.

Dr Matthias Pierce, researcher at The University of Manchester who led the work, said: “When we began this research project we wanted to investigate whether we could find any evidence in primary health care records that COVID-19 was linked to an increased risk of mental health illness, sleep and fatigue problems.

“While fatigue is clearly a consequence of COVID-19 the risk of experiencing sleep problems is also very high. However, we are sceptical regarding the extent that COVID-19 is directly causing people to become mentally ill, or whether those with a predisposition to mental illness are more likely to get tested.”

Professor Roger Webb, from The University of Manchester, who co-leads the Mental Health research programme at the NIHR GM PSTRC, said: “Our findings align with those generated by investigations conducted in other countries in revealing elevated risks of mental illness, self-harm, fatigue, and disrupted sleep patterns among people testing positive for infection during the pandemic. Establishing the mechanisms that have caused these outcomes to occur is the next major challenge for researchers in our field.”

Professor Carolyn Chew-Graham, a co-author on the paper, Professor of General Practice Research at Keele University and a General Practitioner, said “It is vital that general practitioners recognise the long-term impact of COVID-19 infection on their patient population. Offering follow-up to people who test positive for COVID-19 infection may help identify persisting symptoms, and sign-post people to the . The increased risk of developing mental health problems in people who tested negative may be due to health anxiety in these patients, and primary care has a role in identifying and supporting such patients.”

* Clinical Practice Research Datalink (CPRD-Aurum) dataset: a large UK primary care registry covering 19 million patients. It contains information on clinical events recorded by healthcare professionals, including diagnosis, symptoms and therapies.

** Is infection with COVID-19 causing an increased risk of psychological distress, psychotropic prescribing or sleep and fatigue problems? A study of patients in English primary care

Researchers analysed a new de-identified database that pulls together healthcare information from general practices across Greater 91ֱ�� to identify trends around self-harm by sex, age group, ethnicity and deprivation. They found a potentially concerning treatment gap for self-harm among men and people living in the most deprived areas.

The study’s* findings were published in today. The investigation was funded by the UK Research and Innovation (UKRI) and the National Institute of Health Research (NIHR) COVID-19 rapid response call. It was also supported by additional funding and researchers from the NIHR Greater 91ֱ�� Patient Safety Translational Research Centre (GM PSTRC) - a partnership between The Northern Care Alliance NHS Foundation Trust (NCA) and The University of Manchester.

Dr Sarah Steeg, Presidential Fellow in mental health epidemiology at The University of Manchester, who worked with researchers from the GM PSTRC on this study, said: “We believe the fact the number of people accessing healthcare for self-harm didn’t return to pre-pandemic levels by May 2021 is unlikely to be because these people aren’t harming themselves. It is more likely to be because people aren’t seeking help or aren’t seeking help in the same way as they did before the pandemic.”

There has been research that’s looked at self-harm during the first wave of the pandemic. However, despite further waves of COVID-19 and ongoing national and regional restrictions that affected Greater 91ֱ�� into the autumn/winter of 2020 and the spring of 2021, little was known about how many people were visiting their GP after harming themselves during that time.

Dr Steeg, continued: “The findings of our study are concerning as the deepening health inequalities we observed during the first wave of the pandemic, in 2020, didn’t recover by the spring of 2021. This could reflect a hesitance to seek help from health services in the way people did before the pandemic.”

Researchers believe the potential treatment gap among men is particularly concerning due to the increased risk of suicide for men if they have harmed themselves.

This is the first study to be published that used the Greater 91ֱ�� Care Record, which brings together healthcare and social care information. It meant researchers could examine the number of times self-harm was recorded across primary care (for example, general practices) every month until May 2021.

Professor Niels Peek, lead of the Safety Informatics theme at the GM PSTRC, who was also part of the team that created the Greater 91ֱ�� Care Record, said: “This is an important milestone for the Integrated Care System in Greater 91ֱ��. It tells us that we can use data from the Greater 91ֱ�� Care Record to accurately assess the impact of the pandemic on the 91ֱ�� population.”

* Temporal trends in primary care-recorded self-harm during and beyond the first year of the COVID-19 pandemic: time series analysis of electronic healthcare records for 2.8 million patients in the Greater 91ֱ�� Care Record

https://www.sciencedirect.com/science/article/pii/S2589537021004557

The study, which used data on hospital emergency department presentations across three cities and five hospitals for 10-19 year-olds between 2000-2016, is published today (21/09/21) in The Lancet Child and Adolescent Health.

Data which looked at increases in presentations over time found higher average annual increases among Black and South Asian young people and those from other non-white ethnic groups compared to white young people.

However, the researchers urge caution as the absolute increase in numbers, though statistically significant, was small. The findings might also have been accounted for by better recording or population changes.

And despite the increases, rates of self-harm remained highest in young people who were white.

The team analysed the data from 10,211 white, 344 Black, 619 South Asian and 732 other non-white children and adolescents who presented for self-harm at emergency departments in 91ֱ��, Oxford and Derby. The research was carried out as part of the Multicentre 91ֱ�� of Self-Harm in England.

Around half of Black, South Asian and other non-white young people received a specialist psychosocial assessment, compared to over 60% for white groups. Official guidance stipulates everyone who self-harms should be assessed.

Those from an ethnic minority background were more likely to live in economically deprived areas and less likely to be receiving mental health care than their white counterparts.

In terms of outcomes, risk of repetition was lower among ethnic minority groups when compared to white groups. There was little difference in suicide mortality but the overall number of suicide deaths was small.

Lead author Bushra Farooq, a researcher from the University’s Centre for Mental health and Safety said: “Self-harm in all children and adolescents has become a major public health concern in recent years.

“While the majority of presentations continue to be made by white children and adolescents, ethnic minority groups seem to account for an increasing proportion in recent years.

“It’s difficult to know what has driven this among ethnic minority groups specifically. Possible reasons include factors related to psychological health.

“Some people have also speculated that educational pressures or social media use might be driving the increase in young people as a whole but the evidence is far from clear. We know social media can be helpful for some young people.”

“Increases after 2011 may also be associated with deprivation, poverty, and or service related factors which might have particularly affected those living in poorer communities where a disproportionate number of ethnic minority groups live.”

“Unfortunately our study could only look at very broad ethnic groups. Within these broad groups there are some important differences. Future studies must acknowledge and explore these differences.”

Professor Nav Kapur, from The University of Manchester, senior author on the paper, added: “Historically we haven’t had very good information on self-harm and suicide in people from ethnic minorities. Data on young people from these communities has been even more sparse.

“Of course we must keep a close eye on the incidence of suicide and self-harm – the recent data published by the Office of National Statistics suggesting a high overall overate of suicide in people of mixed ethnicity emphasised just how important this is.

“But one of the big stories here is about inequity and access to services – young people from ethnic minority groups lived in more deprived areas, were less likely to be properly assessed and less likely to be in receipt of mental health care.

“We need to understand the reasons for these findings and make sure we do better in the future-whether that is through provision of culturally adapted mental health services or better staff training. We also need to stop thinking about people from ethnic minorities as part of a single group with uniform needs.”

‘Self-harm among children and adolescents by ethnic group: An observational cohort study from the Multicentre 91ֱ�� of Self-Harm in England’ is published in .

The Multicentre 91ֱ�� of Self-Harm in England is a longstanding research project involving collaboration between the University of Oxford, the University of Manchester, and Derbyshire Healthcare NHS Foundation Trust. It is funded by the Department of Health and Social Care.

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The collaboration between academics at The University of Manchester and Aarhus University in Denmark is published today (16/09/2021) in a special issue on suicide prevention of the journal Preventive Medicine.

The team investigated if long–term residential exposure to particulate matter (PM_2.5) with an aerodynamic diameter of less than 2.5µm and nitrogen dioxide (NO₂) during childhood was linked to later self-harm risk.

The interlinked Danish national registers provided a uniquely powerful data source for researchers; the study including over 1.4 million people born in Denmark between 1979 and 2006.

The team were able to track each person’s place of residence from their birth to their tenth birthday, as well as the length of time that they resided at each address. They assessed subsequent self-harm risk from tenth  birthday onwards up to a maximum age of 37.

The information was linked to measurements of the outdoor levels of PM_2.5 and NO₂ in the local neighbourhood over time.

Ambient outdoor air pollution consists of a complex mixture of gasses, particulate matters and inorganic and organic compounds. PM_2.5 and NO₂ are among the pollutants with the strongest adverse impact on physical health.

The gasses are emitted from a range of sources including car exhausts, power generation, shipping and domestic heating.

Lead author Dr Pearl Mok, Research Fellow at The University of Manchester said: “This is the first population-based longitudinal study to reveal that long-term exposure to two common pollutants: PM_2.5 and NO_2, during childhood, is associated with subsequently elevated self-harm risks.

“Our findings add to the growing evidence-base indicating that higher levels of air pollution exposure are linked with poor mental health outcomes.

“Although air pollution is widespread,  it is a modifiable risk factor and we therefore hope  our study’s findings will inform policymakers who are devising strategies to combat this problem.”

The team controlled for some of the factors known to influence self-harm risk including history of mental illness in cohort members’ parents and socioeconomic position, information that is available from the Danish registers.

And they showed that exposure to 19 μg/m³ or above of PM_2.5 on average per day from birth to 10th birthday was associated with a 48% higher risk of subsequent self-harm compared with a mean daily exposure of less than 13 μg/m³.

And for every 5 μg/m³ increase in exposure to PM_2.5 on average per day during childhood, they found the risk of subsequent self-harm rose by 42%.

Similarly, exposure to 25 μg/m³ or above of NO₂ on average per day from birth to 10th birthday was associated with a 50% higher risk of subsequent self-harm compared with a mean daily exposure of less than 10 μg/m³.

And for every 10 μg/m³ increase in exposure to NO₂ on average per day during childhood, the risk of subsequent self-harm rose by 21%.

Professor Roger Webb from The University of Manchester, a co-author on the study said: “A growing body of evidence in recent years has indicated that exposure to air pollution is also associated with adverse mental health outcomes.

“Children living in neighbourhoods with higher levels of air pollution have been reported to have increased risks of developing a range of psychiatric disorders including schizophrenia, depression, and attention-deficit hyperactivity disorder (ADHD).

“Though the mechanisms linking air pollution and development and exacerbation of mental disorders or its associated distress have not yet been explained, it has been well-established that it can cause inflammation and oxidative stress.

“This study is the first to provide valuable evidence on the association between childhood exposure to air pollution and subsequently elevated self-harm risk.

“However, further research is needed to investigate to what degree our findings can be generalised to other countries, especially lower- and middle-income countries where levels of ambient air pollution are far higher than they are in Denmark.”

91ֱ�� was funded by The European Research Council.

“Exposure to ambient air pollution during childhood and subsequent risk of self-harm: a national cohort study” is published in 

The research that’s been published today (insert date), in The Journal of Medical Internet Research, reveals the tool, which has previously been found to be effective, is liked by those with lived experience of self-harm. Therefore, it’s likely to be accepted and used widely, believe researchers.

The study, ‘Acceptability of a brief online theory-based intervention to prevent and reduce self-harm’ is funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

The new, online tool is based on a paper version used in hospitals that previous research found to be effective.

Dr Chris Keyworth, Lecturer in Psychology at the University of Leeds and lead for this study at the GM PSTRC, said: “We know that self-harm is happening more often across the UK and there’s a challenge to develop preventative strategies that work and are considered acceptable by those who self-harm.

“One important thing to consider is the amount of effort required to engage with a new intervention. We could develop an intervention that’s effective but, if those who use it think too much effort is involved, it won’t make the difference it’s designed to, and outcomes may be limited. So, an important part of our research was to uncover whether our new intervention was acceptable for people who have self-harmed.”

The tool is rooted on more than a decade of research on “volitional help sheets”, which have been used effectively to improve outcomes for people who have self-harmed. This new, online volitional help sheet is a list of situations that may act as triggers for someone with a history of self-harm. There’s also a list of responses to select designed to reduce the urge to self-harm.

Researchers worked with a patient and public involvement and engagement (PPIE) group with lived experience of self-harm to ensure the tool is as acceptable as possible and with the lowest level of effort. This involved ensuring all the situations listed were relevant and the language appropriate for those who self-harm. In total the tool includes 13 situations and 13 solutions. Once the tool was agreed by researchers and PPIE group members, it was tested by those with a history of self-harm through an online survey.

Dr Chris Keyworth, continued: “This research shows that the modifications made to our tool have been judged as acceptable by people with lived experience of self-harm which means it has more chance of making a difference. It has the potential to work well alongside patient healthcare, such as by GPs when helping to support people to reduce repeat self-harm, as well as people on their own at home.”

The research also identified how it could be further improved to increase its impact. For example, findings suggest it is harder for people to engage with the tool when they have harmed themselves in the last year. If the tool can be made easier to engage with for this group of people, it could prove to be useful as part of long-term support strategies, such as when the urge to self-harm may not be at its peak.

Professor Chris Armitage, from The University of Manchester behavioural science lead for the GM PSTRC and senior researcher on the project, said, “There are very few tools available to healthcare professionals who want to intervene to prevent self-harm and this research provides them with an option that, on the face of it, is simple to administer, but is in fact underpinned by decades of behavioural science research.”

Mette Isaksen, Senior Research and Evidence Manager at Samaritans, said: “Samaritans research found that people who have self-harmed want support to learn different coping strategies and reminders of what’s worked for them in the past. However, this type of support was hard to come by. We welcome this research, which worked directly with people who have self-harmed to develop a new support tool focused on exactly this. Much more needs to be done to ensure people who self-harm have ready access to a range of support options that are right for them.”

And those in the lowest wealth groups, they found, had up to twice the relative risk of developing depression than those in the highest wealth quintiles, as hearing loss disproportionally affected their quality of life.

Published in , the landmark study goes some way in laying to rest more than 40 years of research on whether hearing loss causes depression.

The data also showed that hearing aids have a stronger effect in alleviating symptoms of depression in poorer socio-economic groups than in wealthy ones.

And improved symptoms of depression were more pronounced among those using their hearing aids ‘most of the time’ than those using them ‘some of the time’.

The researchers analysed longitudinally the entire dataset of participants aged 50–89 years in 8 Waves of the English Longitudinal 91ֱ�� of Ageing (ELSA), from 2002 to 2017, examining 74,908 people.

The findings for the first time revealed that hearing loss affected people according to their socioeconomic position.

, from The University of Manchester who led the study, said: “Our study shows that hearing loss poses a substantial risk for depressive symptoms in older adults, especially those who experience socioeconomic inequalities.

“We also think that hearing aids could support the most vulnerable people who already lacked life opportunities compared to the most affluent.

“That way they were able to take more control of their lives and keep participating actively in society.”

Dr Tsimpida, a Chartered Psychologist and postdoctoral researcher based in the University’s Division of Medical Education, added: “We think it’s reasonable to identify hearing loss as a causal factor because we used advanced statistical techniques called dynamic cross-lagged path models (CLPMs) to estimate hearing loss and depression's relationship over time.

“We argue the early detection of hearing loss by primary care professionals in routine assessments may not only promote better hearing health but also prevent or delay the onset of depression.

“Increasing the hearing loss treatment rate could be one effective strategy for risk reduction of depression, given the high prevalence of hearing loss in older age and its low treatment levels.”

Co-author Dr Maria Panagioti said: “The existing evidence on the association between hearing loss and depression was conflicting; our study now adds to this body of knowledge by identifying for the first time the socioeconomic pattern in their relationship.”

“Focusing primarily on the role of the socioeconomic position may satisfactorily explain the causal, temporal and graded relationship between hearing loss and depression over time, which differs according to people’s status in the social hierarchy.

“Our study has important and novel clinical implications, as it adds to the understanding of the interrelationship between hearing loss and depression, and the potential impact of interventions with hearing aids for people’s mental health.”

Dr Tsimpida’s study is co-authored by , , and .

 The Dynamic Relationship between Hearing Loss, Quality of Life, Socioeconomic Position and Depression and the Impact of Hearing Aids: Answers from the English Longitudinal 91ֱ�� of Ageing (ELSA) is .

The , ‘Wasn't offered one, too poorly to ask for one – Reasons why some patients do not receive a psychosocial assessment following self-harm: Qualitative patient and carer survey’* was carried out before the COVID-19 pandemic and published in the Australian & New Zealand Journal of Psychiatry today. It was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

Dr Leah Quinlivan, from The University of Manchester and Research Fellow in the GM PSTRC’s Mental Health theme, led the study, and said: “We know self-harm is an important risk factor for suicide. Hospital attendance with self-harm represents an important opportunity to help alleviate distress and prevent suicide. However, the number of people who actually receive a mental health assessment when they attend A&E following self-harm varies widely. Overall, previous research has found that around half of people attending A&E don’t get one.

“We know that the risks for people who have harmed themselves are particularly high immediately following hospital attendance with self-harm, so it’s crucial they receive a mental health assessment. The risks are even higher when alcohol is involved and may be higher for women than men.

“That’s why our research is so important when looking at how to improve the safety of people who have attended A&E for self-harm. We have identified some of the reasons why there may be gaps in care from the perspective of people using services. This work could only have been completed with the involvement of patients and carers throughout the entire research process.”

The study found that potentially unsafe misconceptions about self-harm could influence who did and didn’t get help in some emergency departments. Despite the NICE guidelines that suggest everyone should receive an adequate assessment, some people who took part in the study told researchers that they were excluded from care if there was any presence of alcohol, they had repeated self-harm, or weren’t judged to be at high enough ‘risk’.

Dr Leah Quinlivan added: “Mental health is rapidly transforming as part of the NHS Long-Term Plan; and self-harm is recognised as a key area for quality improvement and policy. Now, more than ever, there is reason to be optimistic about the future of self-harm services, particularly if we listen to people with lived experience and the professionals who care for them.”

Nav Kapur, Professor of Psychiatry and Population Health at The University of Manchester and lead of the GM PSTRC’s Mental Health theme, said: “To help people get the care that they need and prevent further harm, it’s important that existing guidelines are followed and that recommended care is provided. For many years the guidance has been that anyone who attends hospital following self-harm receives a good mental health assessment. And the ‘how’ of assessment is just as important as whether service users receive one – compassion, respect and dignity are vital.”

Stephen Barlow, a co-author of the research with lived experience in this area said: “The research uncovers what it’s like for people who go to A&E following self-harm and it’s important that their voices are heard so changes can be made to make care safer.”

Caroline Harroe, the CEO of Harmless and The Tomorrow Project, leading service providers in the field of self-harm and suicide prevention said: “With self-harm being such a significant risk factor, and most deaths by those with a history of self-harm having previously been assessed as ‘low risk’, it is more important than ever that we make the most of every contact with someone who self-harms. 

“As someone who’s been turned away from treatment and as the CEO of a service who sees this in practice daily amongst our service users, it sadly comes as no surprise. Stigma and being ill-informed is not a satisfactory explanation for missing an opportunity to save someone’s life. It should be seen with the optimism and opportunity that it presents to that individual for whom the psychosocial assessment might be an important lifeline.”

The , which was codesigned and co-authored with people who have lived experience of self-harm and mental health services, found negative experiences were common, and revealed stigmatising comments about injuries from some hospital staff. Some participants reported being refused medical care or an anaesthetic because they had harmed themselves. This had a direct impact on their risk of repeat self-harm and suicide risk, as well as their general mental health.

The research, ‘Relieved to be seen - patient and carer experiences of psychosocial assessment in the emergency department following self-harm: qualitative analysis of 102 free-text survey responses’*, was published today in the journal BMJ Open. It was funded by the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust.

According to the research, the participants who received supportive assessments with healthcare staff reported feeling better, less suicidal and were less likely to repeat self- harm.

Dr Leah Quinlivan, from The University of Manchester, a Research Fellow at the GM PSTRC’s Mental Health theme, led the study, and said: “Our research looked at the care people received at A&E following self-harm. It’s part of an overall programme of work that aims to improve patient safety in mental health services. This research highlights the importance of learning from the experiences of individuals to help improve care for people who have harmed themselves. We involved patients and carers throughout the entire process and this enabled us to gain a greater insight into what patients want after they present to hospital having harmed themselves. ”

According to NICE guidelines anyone who arrives at A&E following a self-harm episode should receive a psychosocial assessment. The research has revealed how important these assessments are for people who harm themselves. For participants in the study, if the assessments were delivered correctly and with compassion, they reported being less likely to harm themselves in the future. The research also revealed that assessments can be helpful when staff work alongside the person affected by self-harm, and are empathetic to their emotional distress.

Participants in the research revealed what a negative experience looked like and this was when waiting times were unduly long, assessments overly standardised and a lack of compassion was shown by staff.

Elizabeth Monaghan, one of the co-authors with lived experience in this area said: “The research demonstrates the value of involving patients and carers throughout the research process. Our varied experiences of assessments in A&E during and after crises meant we were able to add helpful insights into the research design and findings.

“These insights shaped the research team’s understanding of what factors are helpful for A&E staff to be able to carry out assessments more effectively and with compassion. Being part of the research process all the way through has given me an opportunity to use my experiences to improve care as well as giving me valuable skills in being part of a team carrying out research in this sensitive area.”

Jenny Groves has 35 years of lived experience of self-harm and is the CEO and Founder of Battle Scars, a survivor led charity for people who have self-harmed. She, said: “This research shows the discrepancies in the procedures not just in different parts of the country but the huge differences in attitude and treatment even within the same emergency department.

“Ticking boxes, dismissing, judging and invalidating people who present at A&E following self-harm cause long-term damage and increase risk. Acceptance, compassion and a true person-centred approach, acknowledging the individual and their needs, can make a world of difference to someone who is struggling and resorting to self-harm to manage life.”

A UK wide survey of 2252 adults, carried out five weeks into the first lockdown revealed 95% of those surveyed were following lockdown restrictions. Of that 95% more than 80% reported finding it challenging. Adjusting to changes in daily routines, and mental and physical health struggles were the most common challenges faced by participants. Women and adults under the age of 55 were most likely to report experiencing challenges.

The research, ‘What challenges do UK adults face when adhering to COVID-19-related instructions? Cross-sectional survey in a representative sample’*, was published in the journal, Preventive Medicine. It was conducted by researchers at The 91ֱ�� Centre for Health Psychology and the National Institute for Health Research Greater 91ֱ�� Patient Safety Translational Research Centre (NIHR GM PSTRC). The Centre is a partnership between The University of Manchester and Salford Royal NHS Foundation Trust. .

Dr Chris Keyworth, research fellow in the Behavioural Science sub theme at the GM PSTRC and lead for this study, said: “Our research shows that during the first UK lockdown a high proportion of the people we surveyed did stick to the government rules. Understanding the impact of this on mental health is vital when looking at how to encourage people to do this long term and into the future.

“The first step is to identify the biggest challenges people faced and for which age group and gender.”

The challenge the most people reported facing was the changes in daily routines, followed by the impact on mental health and then the issues around physical health.

Dr Keyworth continued: “According to our survey more than 40% of people said they struggled with their mental health during the first lockdown. This is interesting because, in comparison, according to a 2016 study, one in six people reported experiencing a common mental health problem in a given week in England. This goes some way in quantifying the profound affect the restrictions had on the population at the time.”

The research highlights the importance of tailoring public health messages to age groups, genders or those with certain characteristics. The study’s findings suggest an urgent need to prioritise interventions which address the physical, psychological and social impacts of the pandemic. These may include interventions that aim to help people to change habits and support them in establishing new routines when faced with the sudden introduction of strict rules such as lockdown. Greater investment in services to improve physical and mental health that can be delivered remotely should also be a priority. Home-based interventions to promote physical health should be developed and more work put into improving access to healthcare professionals remotely.

These interventions should then be targeted at women, those under 55 and people without care commitments as they were identified as the most likely to struggle during a full lockdown.

Professor Chris Armitage, lead of the GM PSTRC’s Behavioural Science sub theme, said: “The findings show that by-and-large, the British public have been adhering to government COVID-19 instructions, but following the government lockdown rules comes at a personal cost. Greater attention needs to be paid to how following the rules can be sustained with targeted support measures.”

Dr Keyworth concluded: “Lockdown is undoubtedly challenging and, to ensure any future government restrictions and guidelines are followed it is important to learn from the behaviour of the population at a time when a high number of people were following the rules. We hope that our research will help to improve patient safety by aiding understanding. It can be used to guide the design of interventions and inform public health messaging both now and into the future.”

The definition, agreed by 59 UK experts is published in - one of the world’s leading scientific journals – and will provide welcome guidance to parents who want the best for their children at bedtime.

Funded by the Medical Research Council, the definition identifies 6 key areas,:

• Brushing teeth before bed.
• Time consistency for going to bed.
• Book reading before bed.
• Avoiding food/drinks before bed.
• Avoiding use of electronic devices before bed.
• Calming activities with child before bed including bath, shower, and talking.

The study also devises two different ways of scoring bedtime routines: one which measures a single routine and the other for activities over 7 days

A parent should aim to score at over 50 points to achieve an effective routine, says Dr George Kitsaras who led the study.

The same scoring system is used for another ‘dynamic measurement’ where depending how many nights a week parents achieve the activities they receive different, weighted scores multiplied by 1.0.

Dr Kitsaras said: “Bedtime routines are important family activities and have important implications on children’s wellbeing, development and health.

“Organisations as diverse as the to the and the are all engaged in this debate- but up to now, there has been no real scientific consensus to inform them; we need untie the conflicting signals and messages parents receive.

“This lack of a clear consensus-based definition of limits health professionals’ ability to communicate best practice effectively with families.

“Our definition considers the parental stresses and difficulties that might arise at bedtime while incorporating best practice and available scientific advice.

“This study for the first time provides that expert and scientific guidance.”

The psychologists, dentists, public health specialists and other experts from education, health visiting and sleep research participated in what is known as a Delphi Process, a method of achieving wider consensus by collecting opinions through several rounds of questions.

Eleven experts took part in an initial group, followed by 25 in round 2, 20 in round 3 and 13 in round 4.

Dr Kitsaras added: “All activities around bedtime matter for children’s development and wellbeing. From the wide range of activities around bedtime, our experts considered toothbrushing to be the most important to remember each night.

“There are strong links between inadequate oral hygiene practices and dental decay in children and adults. For children, early childhood caries can lead to higher occurrence of dental disease in later life and, in some cases, untreated childhood caries can lead to extractions under general anaesthetic causing additional problems for children and parents.

“Washing or having a shower each night before bed, on the other hand might be a common practice for families but our experts considered it to be part of a wider umbrella of child-parent interactions rather than a standalone practice we need to specifically target.

“I have no doubt the debate will continue and our definition might even be refined as more people engage with it.”

The paper ‘Defining and measuring bedtime routines in families with young children; a DELPHI process for reaching wider consensus’ is published in

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Developed by King’s College London, UCL and UCL Business, AVATAR therapy uses digital avatars to represent the auditory hallucinations experienced by people with psychosis to help them cope with the distress caused by the voices.

The launch event will take place with distinguished guests Sir Norman Lamb, Chair of South London and Maudsley NHS Trust and consultant clinical psychologist Dr Lisa Cameron, MP for East Kilbride, Strathaven and Lesmahagow.

It will include an introduction to the AVATAR2 trial and demonstrations of AVATAR therapy software by the trial team from the four trial sites; King’s College London, University College London, University of Manchester and University of Glasgow. There will be a panel Q&A session at the end of the afternoon.

These results build on a previous clinical trial, led by King’s and hosted by South London and Maudsley NHS Trust, which showed in 2018 that the therapy resulted in a rapid and substantial fall in frequency and associated distress of voices, when compared with supportive counselling alone at 12 weeks.

Professor Gillian Haddock from The University of Manchester said: "Auditory hallucinations can be frightening and distressing, so the prospect of trialing a new type of therapy is tremendously exciting. We’re delighted to be involved in this innovative project and are looking forward to collaborating with our NHS partners, Greater 91ֱ�� Mental Health Foundation NHS Trust and Pennine Care NHS Foundation Trust.”

The AVATAR2 trial has two clear aims

• To test two different forms of AVATAR therapy comparing each with a treatment as usual control and to find out which might be most helpful for people. People will be offered either six sessions (brief AVATAR therapy) or twelve sessions (extended AVATAR therapy), delivered weekly.
• To learn more about how AVATAR therapy may work, how it can be tailored to the individual and how best to deliver the therapy in clinical services.

Professor Philippa Garety, Chief Investigator and Principal Investigator of the AVATAR2 Trial at King’s College London, said: “We have made huge strides over the past few years towards finding a talking therapy that has the potential to substantially improve the quality of life for patients who hear voices. Hearing voices can be very distressing and AVATAR therapy offers an opportunity to put a face to the voice in such a way that humanises the experience.

“What we have seen so far is that this can become much more of a balanced conversation and that voices which were once considered overwhelming and scary can now become manageable. Now more than ever with increased isolation due to COVID-19, we are looking for robust, effective treatments that make the difference for our patients.”

An online event to mark the launch of the AVATAR 2 Clinical Trial will take place between 15:30 and 17:00

For more information on the AVATAR2 study, visit  

The team led by Dr Sharon McDonnell at The University of Manchester, in collaboration with the Support After Suicide Partnership, conducted the largest ever survey on the impact of suicide in the UK, with over 7,150 people sharing their experiences.

The survey was carried out from September 2017 to August 2018.

A third experienced losing more than one person to suicide and a third reported they engaged in high risk behaviours relating to alcohol and drug misuse, reckless financial behaviour, suicide and self-harm, sexual promiscuity and a disregard for personal safety while travelling.

Two thirds felt the provision of support services in their local area to be inadequate.

Dr McDonnell said: “This survey highlights the devastating and long-lasting impact of suicide on families and communities.

“We are calling for more awareness of the impact of suicide bereavement, more support and resources and the need to reduce the stigma surrounding suicide.”

Shirley Smith, member of Support After Suicide Partnership (SASP), lost her son to suicide in 2005 at the age of 19.

She said: “When we lost Daniel it came out of the blue. He had no previous mental health problems, he had a job, plans for the future. So losing him was like an atomic bomb going off: not just the initial explosion but the fallout afterwards.”

“But it didn’t just affect me and my immediate family: like ripples in a pond it affected everyone in the village where we lived friends, schoolchildren, teachers, the football team he played with. Even the police who came to our house that day.”

Dr McDonnell added: “Our results provide a compelling case, for easily accessible, long-term support and illustrates the need for a consistent quality of suicide bereavement support across all the UK.

“We hope the collective voices of those who took part in this study can be used to shape the support services currently being provided and implemented by a variety of organisations across the UK and in other countries.”

Hamish Elvidge, Chair of the Support after Suicide Partnership, said: “The results of this unique and vitally important research highlight the urgency of responding to the voices of all those who took part, by ensuring that everyone bereaved by suicide across the UK is offered the practical and emotional support that they need at such a difficult time in their lives.

“A heartfelt thank you to every person who took part. The results express a very poignant and personal picture, which will help to directly improve the provision of services available across the country.”

Julie Bentley, CEO of Samaritans, said: “Suicide is a tragedy that devastates friends, families and communities. We have to do more to help those at risk, ensuring bereavement support is available for everyone that needs it. Helping to provide practical and emotional help for those grieving is an important step forward.

“Checking in on one another and sharing how we are feeling whether it’s with a friend, family member or a confidential helpline like Samaritans can make a big difference. Talking can be life-saving. Anyone who might be struggling can call Samaritans for free on 116 123, email jo@samaritans.org or visit to find out more information, at any time of day or night, seven days a week.”

Journalists reporting issues around suicide can refer to the Samaritans’ and

Full report is  available

Hear Dr Sharon McDonald discussing her work in suicide bereavement on this Universaity of Manchester

A team of researchers led by King’s College London (KCL) which includes The University of Manchester will be extending the evaluation of the unique AVATAR therapy and assessing the feasibility of making it available in the NHS across the UK, thanks to funding from Wellcome.

Developed by UCL, UCL Business and KCL, AVATAR therapy uses digital avatars to represent the internal voices experienced by people with psychosis to help them cope with the distress caused by the voices. A previous clinical trial, led by King’s and hosted by South London and Maudsley NHS Trust, showed in 2017 that the therapy resulted in a rapid and substantial fall in frequency and associated distress of voices that was superior to a supportive counselling control condition at 12 weeks.

Led by researchers at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, the AVATAR project has now been awarded nearly £3.5 million additional funding by Wellcome to further assess the therapy’s effectiveness at four UK sites in Glasgow, 91ֱ�� and London and gauge its potential to be implemented in the NHS.

Around 60 to 70 per cent of people who have schizophrenia experience auditory hallucinations and these voices can often be distressing and threatening. AVATAR therapy involves the use of a digital simulation (avatar) of what the person believes is the source of the voice in a three-way discussion between participant, avatar and therapist.

Principal Investigator on the AVATAR project, Professor Philippa Garety from the IoPPN said: ‘Voices are common in people with psychosis and can be extremely distressing for individuals and their families. AVATAR aims to help diminish this distress and we are delighted that Wellcome are supporting this second trial of the therapy which aims to obtain a definitive picture on its effectiveness alongside assessing the economic and practical feasibility of implementing the therapy at a wider scale.’

AVATAR Therapy

The first phase of the therapy focusses on managing anxiety and supporting the participant to stand up to the avatar. The second phase considers the specific character and nature of the voice in more detail, during dialogues in which the avatar concedes power and control to the person. Both phases of the therapy have been refined in line with the results from the first AVATAR trial.

Emeritus Professor Tom Craig from IoPPN who led the first AVATAR trial said: ‘The previous trial showed very promising results that demonstrated that AVATAR therapy could help those with psychosis cope with distressing auditory hallucinations. At that time, we knew the next step to bringing this therapy to patients was to look in more detail at the effectiveness of the therapy and to evaluate it in centres across the UK. We are now building on the results from the previous trial to look at the suitability of different aspects of the therapy for different patients and how it could ultimately become available nationwide.’

Professor Gillian Haddock and Professor Sandra Bucci from the University of Manchester, Division of Psychology and Mental Health, School of Health Sciences will lead the 91ֱ�� arm of the study.

Multi-centre trial

This new trial will evaluate the AVATAR therapy in more depth and assess the cost-effectiveness and feasibility of rolling out the therapy across the UK. The trial will recruit 345 participants across eight clinical settings in four centres linked to the Universities of Glasgow of Manchester, UCL and KCL. This will involve training therapists in AVATAR therapy across the UK. Participants will be allocated to receive brief AVATAR therapy (first phase only), extended AVATAR therapy (first and second phases) or treatment as usual. The software has also been further developed to make it more usable for busy clinicians.

Professor Mark Huckvale from UCL who is responsible for the software system that supports the therapy said: ‘The proposed outcomes of this new trial will be a tested system for providing AVATAR therapy and a body of clinicians trained in its use, both of which are essential for its wider availability.’

Aims of the research

Recruitment is planned to start in January 2021 and the trial will have four main goals:

• To examine the effects of brief and extended AVATAR therapy in order to provide insight into which patients would be likely to benefit from the different versions.
• To assess the relative cost-effectiveness of the two versions of AVATAR therapy compared to routine treatment.
• To broaden the availability of AVATAR therapy by increasing the number of staff trained across several geographically dispersed NHS settings.
• To provide the evidence on effects and cost-effectiveness necessary to take AVATAR therapy to recommendation by guideline bodies such as NICE.

Ann Mills-Duggan, from Wellcome's Innovations team, said: ‘Through our Psychosis Flagship funding, projects like AVATAR aim to improve the outcomes for patients with psychosis by improving diagnosis, maximising the impact of early treatment and developing new, targeted interventions.

‘The AVATAR project has already delivered exciting results from the previous trial that resulted in a significant reduction in the occurrence and distress from internal voices experienced by those with psychosis. Through continuing this funding, we hope to receive crucial insight from this new study into the potential of the therapy and hopefully improve the lives of even more patients.’

A radical counselling method could be an effective way to help children with mental health problems returning to school after the COVID-19 lockdown, according to University of Manchester psychologists.

The study, which analysed the outcomes and feedback from 16 students aged 11 to 19 to Method of Levels therapy (MOL), found it to be ‘feasible and acceptable’ when assessed over 6 months.

The findings, published in the British Journal of Guidance and Counselling, show the method could help more young people access timely support in a time of increasing pressure on mental health services.

Senior UK educators have recognised the seriousness of children’s mental health problems as a result of COVID-19.

Unlike conventional therapies, MOL doesn’t require detailed assessments, screening and diagnosis.

“Lockdown has been very tough for many children- and is likely to be linked to poor mental health because it takes away their sense of control”, said lead author and honorary researcher at 91ֱ�� Dr Anamaria Churchman.

“But this method gives it back to them by empowering them with the freedom to choose when and how often to access support.”

This is likely to increase service efficiency by allowing more young people to access support.

Unlike conventional approaches, MOL gives recipients choice and control over attendance by using a self-booking system.

It also allows them to choose what problems to work on, in their own timeframe. MOL therapists follow rather than lead the participant in talking about problems, and do not make suggestions or give advice.

She said: “There is much evidence to suggest that in the UK, adolescents’ mental health present an ever-growing concern - especially during the COVID-19 crisis.

“Even in 2017, research showed that one in eight children aged five to 19 years old had a mental disorder. It’s highly likely the situation worsened considerably under lockdown.

“Government sees this as an area of concern and schools are identified as an optimum hub for offering support.”

She added: “Conventional therapy is often hard to access, expensive, and can take away choice and control from young people.

“When 'expert teams’ decide the best treatment for young people without involving them in the decision, the results are often far from satisfactory, with young people dropping out, refusing to attend treatment or failing to make progress.”

Students booked a wide-ranging number of sessions at differing intervals and set personalised goals related to their emotional or mental wellbeing, showing differences in personal needs and preferences.

Conventional sessions typically offer everyone the same number of sessions and parents or teachers choose when and for how long young people access support- even though young people might not feel ready to talk, or prefer not to miss certain lessons to receive support.

Some of the young people reported needing more support, which, say the team, infers their needs are not being met when following an adult driven model.

However, when accessing MOL sessions, young people chose the number and frequency of sessions booked. This ranged from 1 to 18 based on their own, personal needs.

On completion, most young people displayed an increase in scores for empowerment and ability to resolve psychological conflict and overall distress levels decreased.

The benefits were sustained two months after completion of the six-month study. Full-scale trials will be needed next.

Confidentiality, the opportunity to talk freely and feel listened to, the opportunity to get things off their chest and to feel understood and respected were reported as being helpful.

Co-author Dr Warren Mansell said: “MOL can be applied to a wide range of mental health problems but hasn’t yet been tried on children and adolescents, so we’re pleased it seems to be effective.

“It’s another important application of Perceptual Control Theory which proposes that people function well when they are able to control important areas of their lives.

“We’d love this approach to be used in any setting where young people are present. It goes hand in hand with holistic approaches now being increasingly used in mental health.”

The paper ‘A process-focused case series of a school-based intervention aimed at giving young people choice and control over their attendance and their goals in therapy.’ is published in the British Journal of Guidance and Counselling

Bisexual people are up to six times more likely to engage in non-suicidal self-injury compared to other sexual orientations, according to University of Manchester researchers.

The study of self-injury - a common problem that can include cutting, hitting, burning or scratching yourself - used data from 24 independent studies, and is published in the Journal of Affective Disorders.

It found that bisexual people had:

• 6.07 times greater odds of self-injury compared to heterosexual people in the past 12 months.
• 4.57 times greater odds of self-injury than heterosexual people over their lifetime.
• 4.37 times greater odds of self-injury than gay men over their lifetime.
• 2.13 times greater odds of self-injury than gay men and lesbian women over their lifetime.

Symptoms of anxiety and depression were often associated with self-injury in bisexual people, as were problems such as physical assault, bullying and feeling of not belonging, though a small number of studies looked at these associations so more research is needed say the researchers.

With a team of psychologists, trainee clinical psychologist and lead author Brendan Dunlop is currently running an online study investigating the relationship between bisexuality and non-suicidal self-injury called Self injury in young bisexual people: a longitudinal investigation (SIBL) .

is asking young bisexual people, aged 16-25, to record their experiences each week for six weeks. The team are hoping to investigate whether difficult experiences like biphobia and psychological factors, such as how people think and feel, are related to self-injury for young bisexual people.

He said: “Self-injury can occur across all sections of society, cultures, genders, ages and sexualities. However, mental health outcomes for bisexual people, appear to be consistently worse than other sexual orientations.

“Self-injury often shows an individual is in distress or struggling with overwhelming emotions. But it can also have physical consequences, such as infection and scarring, and increase the risk of other high-risk behaviour, including suicide.

“it’s important we understand why this behaviour occurs, so we can identify ways of better supporting those who struggle with self-injury.”

He added: “This review paper highlights the need for early identification and prevention of self-injury in bisexual people.

“We do recognise, however, that bisexual people may not always attend groups or services because of difficulties of biphobia or difficulties with feelings of belonging within the LGBTQ+ community.

“So alternative means may be necessary to reach them, such as links to mental health support on online, posters aimed at bisexual people displayed in LGBTQ+ venues and support services engaging directly with the bisexual community.

“Educational and voluntary organisations could play a role in supporting bisexual people who may present with these difficulties.

Email sibl@manchester.ac.uk to find out more about taking part in the SIBL study.

The Covid-19 lockdown is hitting the mental health of women, young peoples and parents of children under 5 the hardest according to a study led by researchers at The University of Manchester, King’s College London and the National Centre for Social Research and the National Centre for Social Research.

The study provides the first high quality information on mental health during the pandemic, drawing on 17,452 participants in the UK’s largest longitudinal study, Understanding Society.

In April, around a third of people in the UK were experiencing clinically significant levels of psychological distress, compared with around one fifth before the pandemic.

Increases were greater in some groups than others: 33% of women, 32% of parents with young children and 37% of young people were experiencing this level of distress under lockdown say the team whose study is published in .

The analysis reflected the UK situation one month into lockdown, although the team argues that as the economic recession bites and mortgage holidays time out, the impact on mental health inequalities may deepen.

Established pre-pandemic inequalities in people with pre-existing health conditions, low-income homes and Asian ethnicity in mental health were maintained, but did not significantly widen by the end of the first month of lockdown.

And the team did not find significant deterioration in mental health in men and the over- 45s, although they acknowledge that many men will be suffering the effects of low income or having young children at home.

Future studies, they say, should examine ways that men may express distress for example through addictions - perhaps drinking excessively, taking drugs or gambling.

The authors took account of trends in mental health in the five years leading up to the pandemic allowing them to investigate changes in mental health before and after pandemic.

It covered people’s difficulties with sleep, concentration, problems in decision making, strain and feeling overwhelmed.

Dr Matthias Pierce is from the at The University of Manchester and lead author on the study.

He said “This pandemic appears to be having a very detrimental effect on young people, and young women in particular.

“This group had already been experiencing worsening mental health in the years prior to lockdown and this is being exacerbated by the pandemic.

“We estimate as many as 44 percent of young women are experiencing clinically significant levels of mental distress compared with 32 percent before the pandemic”

He added: “Covid-19 presents the greatest physical risk to older people, men, ethnic minorities and those with underlying health conditions.

“But it appears to be the mental health of the young and of women that is disproportionately affected by COVID- this may flow from the governments’ pandemic response and strategies to mitigate transmission of the disease .

“The higher mental distress in women widens established mental health inequalities and highlights how important it is that providers make sure to maintain people’s access to services for domestic violence, sexual and reproductive health. Availability of childcare is also urgently needed.”

Professor Kathryn Abel added “This is a unique study of mental distress in the UK in the weeks following lockdown and shows significant increases for some, but not all.

“Established health inequalities persist with rates of mental distress remaining particularly high in those with pre-existing conditions, living in low income homes and of Asian ethnicity.

But new inequalities in mental distress have also emerged: those living with young children and those in employment at the start of the pandemic now at risk of larger increases in mental distress.”

Professor Tamsin Ford from the University of Cambridge said: “Young people are least at risk from acute infection but are bearing the brunt of the lockdown. The poorer mental health of young people in this sample is deeply concerning as it occurs in addition to mounting evidence of both deteriorating mental health and worse outcomes for those with childhood mental health conditions. However, we need similar data on younger teenagers and children who may be at even higher risk.”

The research team also consists Professor Dr Matthew Hotopf from NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust & King’s College London

At The University of Manchester, our people are working together and with partners from across society to understand coronavirus (COVID-19) and its wide-ranging impacts on our lives.  to support the University’s response to coronavirus or visit the University’s  to lend a helping hand.

Ambulance workers who took part in a University of Manchester led study have told of the complex challenges they face in responding to suicide without adequate training and support.

The qualitative interview study by experts at 91ֱ�� and Keele University, funded by the National Institute for Health Research is published in the journal Frontiers in Psychology.

The ambulance workers told the research team that as first responders to the scene of a death by suicide:

• they are exposed to many distressing suicides during their working lives, including the suicide of colleagues, and all had been personally bereaved by suicide;
• they are often faced with managing distressed friends and relatives of the deceased with little professional training in how to respond to those bereaved by suicide;
• there is little acknowledgement in the workplace that suicides may be traumatic, opportunities for staff debriefing are rare, and staff are reluctant to access work-based support services due to potential stigmatisation.

Though limited by a relatively small sample of 9 people from one English ambulance service in 2014, its themes, say the researchers, may be relevant in other parts of the UK and beyond.

“We know ambulance staff are exposed to suicide related incidents on almost a daily basis. However, we fail to identify, acknowledge and address their unmet needs dealing with this issue, despite our awareness that exposure to suicide, is a known risk factor for further suicide,” said Dr Sharon McDonnell, Honorary Research Fellow at The University of Manchester, Managing Director of Suicide Bereavement UK and PI of the study.

“All participants in the study reported losing at least one colleague to suicide. This finding alone highlights the urgency of future research, exploring the magnitude of this problem.”

She added: “Ambulance staff reported feeling helpless, hopeless, ill-equipped and unsupported in the workplace, when exposed to suicide. This issue was especially pertinent when they encountered intense grief reactions from those bereaved by suicide. The urgency of providing high quality care, support and training to assist and empower staff to manage these profoundly distressing circumstances cannot be underestimated.”

Full paper available at: 

Patients recovering from COVID-19 could suffer significant long-term effects, according to research into the experiences of people hospitalised by previous coronavirus outbreaks.

Researchers at the universities of Leeds, 91ֱ�� and Hull have for the first time collated evidence on physical, psychological and social impacts among patients who fell victim to Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) – two previous viral infection outbreaks similar to the current COVID-19 pandemic.

These previous outbreaks resulted in respiratory and exercise capacity problems in the first six months after hospitalisation, mental health problems including post-traumatic stress disorder, anxiety and depression in up to a third of survivors at six months and beyond. Quality of life for one third of survivors was impaired even 12 months after discharge from hospital.

Publishing their findings in the Journal of Rehabilitation Medicine, the researchers warn that rehabilitation clinicians and services should anticipate similar health problems in survivors of COVID-19.

Dr Manoj Sivan, an Associate Clinical Professor and Consultant in Rehabilitation Medicine at the University of , was lead clinician on this research.

He said: “COVID-19 is a new illness and the acute phase has already been devastating for people in many countries across the globe.

“While we have all rightly been busy creating capacity in acute service and saving lives, we must not forget those being discharged from the hospitals. We don’t really know the long-term health problems these survivors face in the recovery phase of this pandemic.

“We do though have the two previous coronavirus outbreaks to learn from. This research gives us a rough idea of the rehabilitation needs in the first year after discharge. This allows us to prepare and plan services to meet their needs and work towards the best possible care for these patients in the community.”

Co-author Dr Stephen Halpin, Senior Research Fellow and Consultant in Rehabilitation Medicine at Leeds is, like Dr Sivan, also a member of the University of Manchester’s Division of Neuroscience and Experimental Psychology.

He said: “This highlights the importance of developing strong follow-up multidisciplinary rehabilitation services and has directly informed our management of COVID-19 patients in Leeds.”

Co-author Dr Abayomi Salawu is Honorary Senior Lecturer at Hull York Medical School and Consultant in Rehabilitation Medicine at Hull University Teaching Hospitals NHS Trust.

He said: “Considering the novel nature of COVID-19, we can only guess what the impact in the medium to long term on the survivors will be. However, we do know that patients who required ICU input for more than two weeks are likely to have ongoing rehabilitation needs irrespective of the diagnosis.

“This work has enabled us to develop a unique comprehensive follow-up and rehabilitation pathway. This has been designed despite current prevailing circumstances that have had significant impact on what services can be provided by the rehabilitation therapy teams in the community.

“It is anticipated that when we subsequently do a service evaluation of this follow-up pathway that we have created across Yorkshire for patients with COVID-19, we will be able to add more evidence to the expanding knowledge base in managing it.”

The authors identified almost 1,200 previous international studies into the harmful long-term clinical outcomes for survivors of SARS and MERS coronavirus infections after hospitalisation or intensive care unit admission. They carried out a systematic review of 28 of those studies – the majority of which related to SARS cases; 23 were included in their meta-analysis.

The researchers cautioned: “At this stage it is not possible to conclude whether the long-term outcomes identified in SARS and MERS patients will also occur in COVID-19 survivors.

“However, as SARS and MERS belong to the same family of virus as COVID-19, and the clinical features are looking identical, including severe respiratory distress and intensive care admission in severe cases, the long-term picture is likely to be similar with COVID-19.

“Rehabilitation clinicians and services should plan ahead for timely follow-up, screening and interventions to enable best possible recovery and quality of life for these individuals.”

Acute multidisciplinary rehabilitation while in hospital, post-acute rehabilitation in rehabilitation or respiratory units once discharged from hospital, and long-term rehabilitation interventions in the community are all recommended to optimise physical, psychological and functional recovery for those recovering from coronavirus.

Ideal multidisciplinary rehabilitation teams must include physiotherapists, occupational therapists, psychologists, speech and language therapists, dietitians, and physicians in rehabilitation medicine – with links to acute respiratory and intensive care teams and relevant community rehabilitation teams.

The authors also recommend that further research should be carried out into COVID-19 survivors, focusing on capturing lung function abnormalities, exercise capacity, psychological and cognitive impairments and, ultimately, quality of life.

The paper, “", is published in the Journal of Rehabilitation Medicine (DOI: 10.2340/16501977-2694).

More than 150 experts from 35 countries have developed an online that allows anyone to calculate their risk of contracting and spreading the virus that causes COVID-19.

The tool - called ‘Your COVID-19 Risk’ - helps estimate the risk you may be putting yourself –and those around you– of contracting and spreading COVID-19.

The tool also collects data internationally, which the team hope will be able to help governments and health agencies on the best measures to take in their region.

Many of the volunteers are psychologists, specializing in behavior change, though epidemiologists, virologists and other professions are also part of the team.

One of the volunteers is Dr Tracy Epton, a behaviour change expert, from The University of Manchester.

She said: “Until we have a vaccine behaviour needs to take centre stage if we are to combat this dreadful virus.

“The advice we provide is based on theory and evidence - it is personalised dependent upon the answers people give. It not only tells people what they need to do to reduce their risk but how to do it.

“This way, users can minimize the risk to themselves and their loved ones.”

She added: “This would not have been possible without an extremely rigorous, systematic, and scalable approach, which manifested itself in the project’s infrastructure.

“The more people that use the tool, the more information we get. This will enable governments and health agencies to keep improving their messages to the general public.”

The tool measures things which we all have some form of control – and can do something about but does not include risks related to underlying health conditions.

It uses three risk factors: hand hygiene, keeping sufficient distance in public places, and avoiding going out to compute how at risk people are in contracting and in spreading the virus.

The tool is based on key behavioural risk factors related to contracting and spreading the virus published in scientific articles since COVID-19's first appearance in December 2019.

To use the tool, visit Your COVID-19 Risk at .

Early results from a study by researchers at Swansea University and The University of Manchester shows people are torn over whether they will use the COVID-19 contact tracing smartphone app planned for release in the UK.

The study finds:

• Only one-third of people taking part said they will be downloading the app, with the rest either saying they will not be downloading it or are not yet sure.
• Common concerns are that the app will infringe on people’s privacy, will stigmatise those with COVID-19, or will not be used by enough people for it to be effective.
• Misinformation about the app and how it works is common.
• Some people are actively avoiding COVID-19 news coverage which may be contributing to lack of information about the app and might affect whether they use it.

The researchers conducted online focus groups with UK adults across a range of gender, ethnic, age and occupational backgrounds to explore their attitudes on the proposed NHSX contact tracing app currently being trialled in the Isle of Wight.

Though the 5 focus groups consisted of 22 people, the researchers say because it is a qualitative study, it is likely to be indicative of general public opinion.

The research is led by Dr Simon Williams, Senior Lecturer in People and Organisation at Swansea University, with collaborations from Dr Kimberly Dienes and Professor Christopher Armitage of The University of Manchester’s Centre for Health Psychology, and Dr Tova Tampe, an independent consultant at the World Health Organization (WHO).

Dr Williams from Swansea University said: “Our study suggests that the government is far from guaranteed the level of support they need to have the kind of uptake that will make a big difference. A lot of work needs to be done to build public confidence and trust in their handling of COVID-19, and to improve communication around the app, especially after recent criticism over the handling of lockdown easing.

“The protection of privacy remains a widespread concern. People associated the app with the growth of ‘Big Brother’ surveillance. People were also concerned that uptake would not be high enough for it to be effective. The irony of course is that if enough people decide not to use it because they think others won't, it becomes a kind of self-fulfilling prophesy.”

Dr Dienes, Lecturer in Clinical and Health Psychology at The University of Manchester and co-author of the study said: “People who told us they would download the app indicated they would do it for the “greater good”, which means those people trusted the app and what the government is trying to achieve. Indeed, the question of whether they trusted the government had their wellbeing at heart, seemed to be at the centre of their concerns and positive intent to download.

“It seems one of the main reasons why some people are worried about privacy is they either do not have enough information or have the wrong information. For example, one of the big misconceptions is that the app allows its users to specifically identify, and even stigmatise, those with COVID-19 symptoms among their contacts and in their vicinity, which is not the case. Also, some people are starting to actively avoid news on COVID-19, because they find it too overwhelming. So, it is important that Government gets the information out there in as many ways as possible, much as they did initially with the lockdown guidance.”

Dr Williams added: “We recommend that government should communicate as clearly as possible and using a variety of media. They should switch to a de-centralised approach, focus on reassuring the public over privacy, and promote the key message that using the app is part of a collective responsibility to stop the spread of the virus and can help save lives.”

The study has been published on the pre-print server medRxiv at: