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This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.

Referral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.

All clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.

With a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

This paper aims to discuss the utility of eye movement desensitization and reprocessing (EMDR) therapy as a treatment for children with intellectual disabilities (ID) who have experienced trauma.

Relevant National Institute for Health and Care Excellence (NICE) guidance and literature were reviewed to provide support for the use of EMDR as a treatment for trauma in children with ID.

There is a growing body of evidence which demonstrates that EMDR therapy is successful for the treatment of trauma in adults and children. However, for children with ID, the research is limited despite those with ID being more likely than non-disabled peers to experience trauma such as abuse or neglect.

EMDR can only be facilitated by trained mental health nurses, psychiatrists, psychologists (clinical, forensic, counselling or educational) or occupational therapists or social workers with additional training. Finally, general practitioners who are experienced in psychotherapy or psychological trauma and have accreditation. Therefore, this highlights that there may be a lack of trained staff to facilitate this intervention and that those who are generally working with the client closely and long term such as learning disability nurses are not able to conduct this intervention.

This paper presents an account of NICE guidance and evidence of the efficacy of EMDR as a treatment for adults, children and those with ID.

From the authors’ personal and professional experiences, they have observed that autistic women are uniquely at risk of interpersonal trauma. Given the tendency for autistic women to be overlooked in research and practice, this study aims to rectify this by exploring the relevant literature and including the voices of autistic women throughout this paper.

This study completed a literature review of quantitative and qualitative data relating to exposure to interpersonal trauma in autistic women. This study also reviewed relevant discursive evidence available on in memoirs and reports. This study also included dialogue between us as authors from an auto/“Autie”-ethnographic position.

Both clinical literature and discursive evidence support the idea that autistic women are uniquely at risk of interpersonal trauma, in particular, sexual victimisation. Explanatory factors are considered. Studies exploring rates of post-traumatic stress disorder (PTSD) were less consistent. Further evidence is required to better understand how autistic women experience and express PTSD and to inform assessment and treatment modifications.

To the best of the authors’ knowledge, this is the first paper to integrate clinical literature and discursive evidence on the topic of interpersonal trauma in autistic women. It provides useful insights into the experiences of autistic women in this space, directions for urgently needed future research and modifications to clinical practice.

The purpose of this study is to investigate the psychological consequences of human trafficking and to reveal the importance of appropriate post-trafficking psychological interventions. Specifically, this study provides a detailed analysis of human trafficking categories, as well as the characteristics of victims and traffickers’ motives. More recent data in the literature show that trauma-coerced attachments and complex post-traumatic stress disorder are also observed among trafficking survivors.

Each of the mentioned mental disorders is presented separately, and results are discussed throughout this study. Consequently, psychological interventions are proposed in accordance with the human trafficking category, survivors’ characteristics and needs and with the relevant personal risk factors determined among victims.

Sex trafficking can have a severe effect on a victim’s mental health, and mental health disorders are substantially higher in human trafficking victims compared to non-trafficked victims or general psychiatric population. Limitations, implications and future recommendations are discussed.

A limited number of past studies evaluated the mental health consequences and identified that survivors have a higher prevalence of anxiety disorders, depression disorders and post-traumatic stress disorder.

The purpose of this paper is to report on the implementation of the World Health Organization (WHO) trauma care checklist (TCC) (WHO, 2016) in an emergency department in a tertiary hospital in Nepal. This research was undertaken as part of a Hybrid International Emergency Medicine Fellowship programme (Subedi et al., 2020) across UK and Nepal, incorporating a two-year rotation through the UK National Health Service, via the Medical Training Initiative (MTI) (AoMRC, 2017). The WHO TCC can improve outcomes for trauma patients (Lashoher et al., 2016); however, significant barriers affect its implementation worldwide (Nolan et al., 2014; Wild et al., 2020). This article reports on the implementation, barriers and recommendations of WHO TCC implementation in the context of Nepal and argues for Transformational Leadership (TL) to support its implementation.

Explanatory mixed methods research (Creswell, 2014), comprising quasi-experimental research and a qualitative online survey, were selected methods for this research. A training module was designed and implemented for 10 doctors and 15 nurses from a total of 76 (33%) of clinicians to aid in the introduction of the WHO TCC in an emergency department in a hospital in Nepal. The quasi-experimental research involved a pre- and post-training survey aimed to assess participant’s knowledge of the WHO TCC before and after training and before the implementation of the WHO TCC in the emergency department. Post-training, 219 patients were reviewed after four weeks to identify if process measures had improved the quality of care to trauma patients. Subsequently six months later, a qualitative online survey was sent to all clinical staff in the department to identify barriers to implementation, with a response rate of 26 (n = 26) (34%) (20 doctors and 6 nurses). Descriptive statistics were used to evaluate quantitative data and the qualitative data were analysed using the five stepped approach of thematic analysis (Braun and Clarke, 2006).

The evaluation of the implementation of the WHO TCC showed an improvement in care for trauma patients in an emergency setting in a tertiary hospital in Nepal. There were improvements in the documentation in trauma management, showing the training had a direct impact on the quality of care of trauma patients. Notably, there was an improvement in cervical spine examination from 56.1% before training to 78.1%; chest examination 125 (57.07%) before training and 170 (77.62%) post-training; abdominal examination 121 (55.25%) before training and 169 (77.16%) post-training; gross motor examination 13 (5.93%) before training and 131 (59.82%) post-training; sensory examination 4 (1.82%) before training and 115 (52.51%) post-training; distal pulse examination 6 (2.73%) before training and 122 (55.7%) post-training. However, while the quality of documentation for trauma patients improved from the baseline of 56%, it only reached 78% when the percentage improvement target agreed for this research project was 90%. The 10 (n = 10) doctors and 15 (n = 15) nurses in the Emergency Department (ED) all improved their baseline knowledge from 72.2% to 87% (p = 0.00006), by 14.8% and 67% to 85%) (p = 0.006), respectively. Nurses started with lower scores (mean 67) in the baseline when compared to doctors, but they made significant gains in their learning post-training. The qualitative data reported barriers, such as the busyness of the department, with residents and medical officers, suggesting a shortened version of the checklist to support greater protocol compliance. Embedding this research within TL provided a steer for successful innovation and change, identifying action for sustaining change over time.

The study is a single-centre study that involved trauma patients in an emergency department in one hospital in Nepal. There is a lack of internationally recognised trauma training in Nepal and very few specialist trauma centres; hence, it was challenging to teach trauma to clinicians in a single 1-h session. High levels of transformation of health services are required in Nepal, but the sample for this research was small to test out and pilot the protocol to gain wider stakeholder buy in. The rapid turnover of doctors and nurses in the emergency department, creates an additional challenge but encouraging a multi-disciplinary approach through TL creates a greater chance of sustainability of the WHO TCC.

International protocols are required in Nepal to support the transformation of health care. This explanatory mixed methods research, which is part of an International Fellowship programme, provides evidence of direct improvements in the quality of patient care and demonstrates how TL can drive improvement in a low- to medium-income country.

The Nepal/UK Hybrid International Emergency Medicine Fellowships have an opportunity to implement changes to the health system in Nepal through research, by bringing international level standards and protocols to the hospital to improve the quality of care provided to patients.

To the best of the authors’ knowledge, this research paper is one of the first studies of its kind to demonstrate direct patient level improvements as an outcome of the two-year MTI scheme.

Post-migration stress is an important aspect of refugees’ mental health, but little is known about the relationship with insomnia. The purpose of this study was to investigate the assication between different post-migration stress factors and insomnia among Syrian refugees living in Norway.

The authors analysed survey data from the REFUGE study with 873 Syrian adults who resettled in Norway between 2015 and 2017. Potential participants were randomly selected from The Norwegian Population Register. Insomnia was measured using the Bergen Insomnia Scale. Perceived-discrimination, navigation difficulties, financial strain and loss of social status were measured via the refugee post-migration stress scale. The authors ran logistic regression analyses, controlling for socio-demographics, potentially traumatic experiences and symptoms of post-traumatic stress.

Overall, 59% (95% CI, 56%–62%) of the sample reported experiencing insomnia. In the fully-adjusted model, only financial strain and navigation difficulties were significantly associated with increased odds of insomnia. Loss of social status was also related to insomnia but only before adjusting for symptoms of post-traumatic stress.

Financial strain and navigation difficulties appear to be the most important post-migration stress factors in terms of insomnia among Syrian refugees living in Norway. Ameliorating these difficulties could potentially reduce insomnia among refugees. Since insomnia is a risk factor for the subsequent development of post-traumatic stress and depression, it is important to prevent or improve symptoms of insomnia among Syrian refugees, especially considering the high prevalence found in this study.

The purpose of this study is to explore mental health difficulties, including risk and protective factors, which may impact on symptom severity after exposure to crisis situations (war, terrorism and/or natural disasters), among first responders from uniformed services.

Peer-reviewed journal articles published in English between January 2012 and March 2022 were searched in ProQuest, Wiley, Google Scholar and PubMed databases. In total, 12 articles were obtained from an original screening of 94,058 articles. Full article texts were screened for content and quality by two reviewers, with high agreeability.

Post-traumatic stress disorder and depression were the most common diagnoses. Risk factors identified were pre-deployment factors of overweight, low cognitive ability and social support, existing emotional difficulties, negative childhood experiences and stressful life events; during crisis situations factors of higher frequency and subjective severity of combat, increased rates of combat stress reaction, high levels of concerns for life and family, more stressful mission position, threat of death/severe injury and high rate of killing the enemy; and post-deployment factors, such as low social support and physical health, lack of coping mechanisms and use of avoidance strategies and social stigma. Protective factors increasing resilience and lessening symptom severity were reported as pre-deployment cognitive ability, high social support, stable physical health, effective coping, post-traumatic growth and high levels of perceived adequacy in pre-deployment preparation and training. In addition to main findings, data about author(s), publication type, population, age, type of crisis and evaluation measures were extracted. Key findings and related theories, gaps in literature and recommendations are discussed.

As yet, however, research into the factors that could serve as risk and/or protective factors are not clearly indicated in terms of post-crisis recovery. As per the authors’ knowledge, this study is an initial approach to considering this area.

This study aims to extend the current debate on refugee entrepreneurship in Jordan. It empirically investigates the impact of COVID-19 on refugee women’s entrepreneurship, highlighting their experiences, constraints and opportunities.

The study design is epistemologically grounded in the heuristic 8Ms extended gender-cognisant entrepreneurship framework. An interpretive qualitative approach was used involving 30 semi-structured interviews with refugee women entrepreneurs across Jordan, with manual thematic data analysis.

Some of the main opportunities available to refugee women were linked with high levels of resilience and push and pull factors. The constraints were mainly pandemic induced and included access to funds; mobility restrictions; access to business knowledge, training and online learning platforms; rising xenophobia and discrimination; exhaustion; and stress.

The study findings can be used by non-governmental organisations to support refugees in realising their full potential. They also provide practical insights into refugee women entrepreneurs’ lived experiences for better policymaking.

This empirical study contributes to the existing knowledge on refugee women entrepreneurs’ constraints and opportunities by presenting a sensitive, in-depth analysis of their current trends and dynamics in the context of Jordan. To the best of the authors’ knowledge, this is the first study to empirically test the extended 8Ms entrepreneurship model to capture the voices and shared experiences of Jordanian refugees.

The purpose of this article is to examine synergies between a eudaimonic model of psychological well-being (Ryff, 1989) and mental health practice. The model grew out of clinical, developmental, existential and humanistic perspectives that emphasized psychological strengths and capacities, in contrast to the focus on emotional distress and dysfunction in clinical psychology.

Conceptual foundations of the eudaimonic approach are described, along with the six components positive functioning that are used to measure well-being. These qualities may be important in facilitating the recovery experiences, which are of interest in Mental Health and Social Inclusion.

Four categories of empirical evidence about eudaimonia are reviewed: how it changes with aging, how it matters for health, what are its biological and neurological underpinnings and whether it can be promoted. Major contemporary forces against eudaimonia are also considered, including ever-widening inequality, the enduring pandemic and world-wide strife. In contrast, encounters with the arts and nature are put forth as forces for eudaimonia. The relevance of these ideas for mental health research and practice is considered.

Enormous suffering defines our contemporary world. Such realities call for greater attention to factors that undermine as well as nurture the realization of human potential, the core of eudaimonic well-being.

Mental health is often defined as the absence of mental illness. The novelty of the eudaimonic approach is to define mental health as the presence of well-being, assessed with different components of positive functioning.

The rates of offending and re-offending for young males are higher than any other population. Whilst the UK Ministry of Justice (2020) states that rehabilitation programmes should aim to build a positive identity, little is known about the subjective experiences of how this occurs. Various theories and models suggest that the development of a positive identity assists rehabilitation for young men with convictions (i.e. Johns et al., 2017). Therefore, the current study aimed to gather personal narratives from male, young offenders with the intention of understanding identity development.

Twelve interviews were conducted with young men with convictions aged between 18 and 25 years who had almost completed a rehabilitation process within the community. Narrative analysis was used to analyse the data. All were engaging with the rehabilitation service as a result of conviction for low to medium level offences, including burglary, harm of another person and drug related offences.

Three plots were identified which explain identity when committing offences: “The Powerless”, “The Feared” and “The Disconnected”. One plot was evident within the narratives which explained positive identity when rehabilitated: “The Connected”. The findings illustrate the importance of an approach which considers various aspects of a young offender’s life.

The current study further adds to knowledge base of young offender rehabilitation by providing a systemic understanding of how men with convictions’ identity develop pre- and post-rehabilitation. New implications for trauma informed practice are discussed.