Anne Krayer

Background: People with severe mental illness (SMI) are nearly three times more likely to lose all their natural teeth and five times more likely to have tooth decay compared to the general population, negatively impacting their physical and mental health and well‐being. There is a need for greater focus on this area in research, policy and practice to reverse this unacceptable inequality. To address this health inequality, we aimed to co‐produce a system‐level intervention to improve oral health in people with SMI. Methods: Building on our initial work, seven online stakeholder consultations and one in‐person co‐production workshop were conducted to co‐produce a system‐level intervention. Consultations were conducted with a total of 23 stakeholders to discuss different intervention components. The stakeholders included people with lived experience of SMI, their family members and carers, mental and dental healthcare professionals and dental public health consultants. Notes were taken and summarised for each consultation session, and an in‐person workshop plan was drafted based on the online consultations. The final workshop was conducted with 13 participants (10 of whom had participated in the earlier consultation and 3 of whom were new to the study) to determine which intervention components would be feasible and acceptable through discussing the practical requirements and constraints of implementing a system‐level intervention. Detailed notes were taken and analysed using the Acceptability, Practicability, Effectiveness, Affordability, Side‐Effects and Efficacy (APEASE) framework. Results: Six intervention delivery steps ‐ including suggested intervention components for an integrated model of dental supportwere identified and agreed in the workshop: (1) having dental health professionals visit the mental health setting, (2) initiating conversation around dental health in a mental healthcare setting, (3) providing a brief dental check‐up using a dental mirror, (4) tailoring oral health maintenance‐related advice, (5) providing positive reinforcement and (6) providing continuous engagement and support accessing dental visits. These components were believed to be potentially acceptable to service providers and service users, and feasible to deliver. Conclusion: We co‐produced a system‐level integrated model of dental support to improve oral health in individuals with SMI. The insights from the co‐production process and resulting recommendations will inform future intervention development. Patient and Public Contribution: People with lived experience of SMI, their carers/family members, and mental and dental healthcare professionals were involved in every stage of developing the intervention. We conducted a series of consultations with these aforementioned stakeholders prior to the intervention co‐production workshop. Stakeholders provided their perspectives on the intervention components. The stakeholders also joined and contributed to the co‐production workshop and helped design the intervention.

Introduction: Psychosis is a particularly stigmatised condition in adolescent populations, with prevalent stigmatising beliefs surrounding it including negative stereotypes around dangerousness, unpredictability and chronicity. Additionally, the first episodes of psychosis increase significantly during late adolescence, and there is a lack of understanding and recognition of psychosis in young people. Given these factors, psychosis appears to be an important topic for mental health literacy and anti‐stigma programmes. However, there is a lack of consensus surrounding the best way to construct psychosis anti‐stigma interventions for young people. Voices of people with experience of psychosis seem crucial in this regard, but their experiences of stigma and discrimination are rarely heard. By including their perspectives along with those of other stakeholders, we aim to ensure that we gain a better, more balanced perspective on how to talk about psychosis with young people. Methods: This study reports on the co‐design process of a psychosis anti‐stigma educational intervention for young people using the short‐form Guidance for Reporting Involvement of Patients and the Public (GRIPP‐2) checklist as a guiding framework. Six workshops were held over 3 months, with experts with experience of psychosis working with clinicians and academics. These workshops explored the differing views of these groups on how we understand, talk about and perceive psychosis. Results: This process resulted in an educational module named ‘Reality and Psychosis’, which we believe will prove effective in not only educating but also diminishing stigma surrounding psychosis among young people. Conclusion: By incorporating various perspectives, we hope to provide a well‐rounded and balanced approach to addressing the complexities of discussing psychosis with young people. The GRIPP‐2 checklist also proved to be a useful framework for assisting the reporting process. Patient or Public Contribution: Individuals with lived experience of psychosis participated throughout the co‐design process. Specifically, they contributed to the six workshops by sharing their personal experiences of stigma, discrimination and recovery, which informed the development of the educational module. This helped ensure the voices of those directly affected by psychosis were authentically represented.

Background: With a rising prison population, a substantial portion of whom are identified as substance misusers, it is important to understand the availability of treatment pathways, their successes and areas for improvement. Given the likely importance of national factors in criminal justice and substance use service provision, we chose to focus on one country. Aim: To review substance misuse treatment and outcomes for such treatments as implemented in British prisons for men. Methods: We conducted a mixed‐methods systematic review, searching Ovid MEDLINE, Ovid Embase, APA PsycINFO, CINAHL Plus, Sociology Collection, Web of Science Core Collection and Social Science Premium Collection between 1 January 2000 and 5 June 2024. Included were empirical, peer‐reviewed studies of processes and outcomes of UK male prison‐based substance misuse programmes. Primary outcomes included changes in substance use, withdrawal symptoms and experiences of interventions, whereas secondary outcomes encompassed quality of life, locus of control and mental health. Because of study design heterogeneity, meta‐analysis was not possible. Analysis followed JBI methodology with a convergent synthesis. Results: Fourteen studies were included: 8 qualitative, 5 quantitative studies of which 3 were randomised control trials (RCTs) and 1 mixed‐methods study, with a combined sample of 4037 participants engaged in opioid substitute treatment (OST) and/or psychosocial interventions. Four key themes emerged: the power of purposeful activity, strengthening support systems, bridging patient needs with treatment plans and, for those in opiate programmes, experiences and engagement with opioid substitution treatments. Conclusions: Participants articulated diverse treatment needs, highlighting the necessity of individualised and tailored reduction or maintenance plans. Treatment requires a comprehensive approach with the aim of facilitating effective social integration.

Introduction: Intentional injuries can be broadly classified into those that are self-inflicted (eg, suicide, self-harm), and those that are inflicted by others (eg, homicide, assault). Many risk factors are the same for all intentional injuries. It is widely accepted that there needs to be a public health approach to self-harm and interpersonal violence prevention, including surveillance of presentations to emergency departments. Self-harm and interpersonal violence are important causes of morbidity and mortality in Wales. Interpersonal violence surveillance is already operationalised in Wales, but variables are limited and case ascertainment may not be complete. There is no self-harm register. The aim of this study is to understand the utility of existing systems in North Wales that collect data about self-harm and interpersonal violence, and how a registry could be implemented to address any unmet needs. Methods and analysis: The project consists of five work packages. First, process mapping will be used to understand the pathways by which patients access emergency care, and how data are collected about patients. Second, routinely collected data will be explored to understand the burden of disease, and the strengths and limitations of existing data collection systems. Third, semi-structured interviews will be completed with stakeholders to understand their needs and experiences. Fourth, semi-structured interviews with third sector organisations which work with people with lived experience of self-harm or interpersonal violence will explore the acceptability of data collection. Fifth, a method will be developed that would enable economic evaluation of a self-harm and interpersonal violence register. Ethics and dissemination: Results will be used to understand whether a self-harm and interpersonal violence registry is required in Wales. The results have the potential to influence local and national strategy on intentional injury prevention. Results will be disseminated to local services, regional and national programme teams, and published as a peer-reviewed journal article.

Introduction: A clinical registry is a systematically collected database of health-specific information about a patient population. Clinical registries can be used for a variety of purposes including surveillance, monitoring of outcomes and patient care. The establishment and maintenance of clinical registries come with a significant cost. This scoping review aims to identify the methods used to economically evaluate clinical registries including their costs and benefits. Methods: This systematic scoping review protocol has been developed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The final review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The electronic databases Medline, Embase, Cochrane Library and The Cumulative Index to Allied Health Literature(CINAHL) database will be searched. Relevant national organisation websites will be searched to identify empirical studies within grey literature. The inclusion criteria include studies that economically evaluate clinical registries and are published in the English language from inception to February 2025. Two reviewers will independently screen 100% of titles and abstracts and full texts of studies for inclusion. Data will be extracted from eligible studies prior to being assessed for quality using a multi-tool approach. Ethics and dissemination: The findings of this review will be published in an international peer-reviewed journal. They are likely to be of interest to custodians of existing clinical registries and to those wishing to establish or evaluate clinical registries. Keywords Clinical registries, economic evaluation, costs, cost-effectiveness, health economics, registry based studies

Background: The classification of mental disorders used to be based only on people seen by hospital psychiatrists. In fact, most people with a mental disorder were, and are, not seen by psychiatrists because of decisions made prior to psychiatric consultation. The first description of this ‘pathway’ to care and its levels and filters was published by Goldberg and Huxley in 1980. Aims: To conduct a review of papers relevant to the application of the Goldberg–Huxley model in the 21st century. Method: Systematic review (PROSPERO registration CRD42021270603) of the pathway to psychiatric care in the 21st century. The review concentrates on community surveys and passage through the first filter (consultation in primary care or its equivalent). Ten databases were searched for papers meeting the defined inclusion criteria published between 2000 and 2019 and completed on 15 February 2020. Results: In total, 1824 papers were retrieved, 137 screened fully and 31 included in this review. The results are presented in a table comparing them with previous research. Despite major social, economic and health service changes since 1980, community prevalence and consultation rates remain remarkably consistent and in line with World Health Organization findings. Passage through the first filter is largely unchanged and there is evidence that the same factors operate internationally, especially gender and social parameters. Conclusions: The Goldberg–Huxley model remains applicable internationally, but this may change owing to an increasingly mixed mental health economy and reduced access to primary care services.

Self-harm registers (SHRs) are an essential means of monitoring rates of self-harm and evaluating preventative interventions, but few SHRs exist in countries with the highest burden of suicides and self-harm. Current international guidance on establishing SHRs recommends data collection from emergency departments, but this does not adequately consider differences in the provision of emergency care globally. We aim to demonstrate that process mapping can be used prior to the implementation of an SHR to understand differing hospital systems. This information can be used to determine the method by which patients meeting the SHR inclusion criteria can be most reliably identified, and how to mitigate hospital processes that may introduce selection bias into these data. We illustrate this by sharing in detail the experiences from a government hospital and non-profit hospital in south India. We followed a five-phase process mapping approach developed for healthcare settings during 2019–2020. Emergency care provided in the government hospital was accessed through casualty department triage. The non-profit hospital had an emergency department. Both hospitals had open access outpatient departments. SHR inclusion criteria overlapped with conditions requiring Indian medicolegal registration. Medicolegal registers are the most likely single point to record patients meeting the SHR inclusion criteria from multiple emergency care areas in India (e.g., emergency department/casualty, outpatients, other hospital areas), but should be cross-checked against registers of presentations to the emergency department/casualty to capture less-sick patients and misclassified cases. Process mapping is an easily reproducible method that can be used prior to the implementation of an SHR to understand differing hospital systems. This information is pivotal to choosing which hospital record systems should be used for identifying patients and to proactively reduce bias in SHR data. The method is equally applicable in low-, middle- and high-income countries.

Background: Evidence regarding the experience and perceptions of police personnel with suicide in South Asia is limited. This study explored the lived experiences and perceptions of suicide among police personnel in an Indian state. The focus was on explanations of and reasons for suicide. Methods: We conducted 20 qualitative interviews in 2021 with police of different ranks, guided by a topic guide. The reflexive thematic analysis approach was supported by the use of NVivo 12, a qualitative software package. Results: We explore three intersecting key themes around suicide in the police force, including: (1) the stressful police environment; (2) expectations of mental strength; and (3) police image and help-seeking. We discuss the tensions between these themes and how to address the challenges of supporting police personnel. Conclusions: To support and improve police personnel’s mental well-being training and support are needed but also broader changes at the organisational level. These need to take social and historical factors into account. An increased level of suicide and mental health literacy will not only benefit the police force but also the general public, and it would be very timely with recent changes in the Indian mental health and suicide policy context.

Introduction Over 800 000 people die due to suicide each year and suicide presents a huge psychological, economic and social burden for individuals, communities and countries as a whole. Low-income and middle-income countries (LMICs) are disproportionately affected by suicide. The strongest risk factor for suicide is a previous suicide attempt, and other types of self-harm have been found to be robust predictors of suicidal behaviour. An approach that brings together multiple sectors, including education, labour, business, law, politics and the media is crucial to tackling suicide and self-harm. The WHO highlights that evaluations of the knowledge and attitudes that priority groups, not only healthcare staff, have of mental health and suicidal behaviour are key to suicide prevention strategies. The aim of this systematic review is to examine the knowledge, attitudes and experiences different stakeholders in LMICs have of self-harm and suicide. Methods and analysis MEDLINE, Embase, PsycINFO, CINAHL, BNI, Social Sciences and Cochrane Library will be searched. Reviewers working independently of each other will screen search results, select studies for inclusion, extract and check extracted data, and rate the quality of the studies using the Strengthening the Reporting of Observational studies in Epidemiology and Critical Appraisals Skills Programme checklists. In anticipation of heterogeneity, a narrative synthesis of quantitative studies will be provided and metaethnography will be used to synthesise qualitative studies. Ethics and dissemination Ethical approval is not required. A report will be provided for the funding body, and the systematic review will be submitted for publication in a high-impact, peer-reviewed, open access journal. Results will also be disseminated at conferences, seminars, congresses and symposia, and to relevant stakeholders. PROSPERO registration number CRD42019135323.

Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti-social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti-social behaviour. We conducted a multi-method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi-structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti-social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.