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The current focus on psychological well‐being and the treatment of people experiencing common mental disorder in primary care is of interest to health professionals and economists alike (Centre for Economic Performance Mental Health Policy Group, 2006). This brings with it an important opportunity to consider how services for people living with long term medical conditions may benefit from developments in widening access to psychological therapies. The National Service Framework for Longterm Conditions (DoH, 2005a) aims to improve the quality of life for people living with chronic medical conditions. Further to this, NICE Guidelines for the Management of Chronic Obstructive Pulmonary Disease (COPD) (NICE, 2004a) specifically focuses attention on quality of life issues for COPD sufferers and the influence of co‐morbid mental disorder on the ability of individuals to optimise selfmanagement of their condition. By examining issues relating to co‐morbidity of common mental disorders within the long‐term condition of COPD this paper concerns itself with how the agenda for widening access to psychological therapies delivered through a stepped model of care and the introduction of new mental health workforce roles such as community matrons, case managers and primary care graduate mental health workers (PCGMHWs) provides an opportunity for primary care services to integrate mental health care into chronic disease management for COPD, which in turn may provide a model for the development of services for other long‐term medical conditions.

It is widely acknowledged that there is a significant gap between the demand for psychological therapy services and the supply (Bower & Gilbody, 2005). It is also well‐known that the health needs of people with learning disabilities are typically greater than those of the rest of the population, and that they are more likely to experience mental health problems and psychological distress (Lindsey, 2002). Difficulties in accessing psychological therapy services and long waiting times have been commonplace in recent years (Richards et al, 2003). Current moves towards modernising the NHS have led to increased accountability and competition between health providers, and many providers of psychological services have tried to increase their accessibility, effectiveness and efficiency. Adaptations to referral pathways and service delivery models in psychological care services have made changes to how clients access services and the input they receive. Accessible services, employing collaborative and stepped care models, have been identified as effective in delivering services in ways which best meet the needs of individuals and maximise the efficient use of resources (Bower & Gilbody, 2005). In our local psychology service for adults with learning disabilities, we have attempted to develop service delivery strategies and modernise referral routes so that services can be delivered which better meet the needs of our client group by optimising accessibility, efficiency and effectiveness.

This paper aims to evaluate the effectiveness of a stepped-care primary care psychology service through triangulating clinical outcome data, service user satisfaction ratings and feedback from referrers.

A mixed method approach including a repeated measures design (pre- and post-clinical data on standardised psychometrics) for clinical outcomes and an online and postal survey with quantitative and qualitative elements offered to all service users and referrers to the service.

In total, 125 service users completed a full intervention with the service with 56% treatment completers demonstrating a reliable reduction in the symptoms of low mood and 49.6% in anxiety. Of those within the clinical range for depression at assessment, 66.67% achieved clinical recovery following an intervention. Of those within the clinical range for an anxiety disorder at assessment, 62.03% achieved clinical recovery following an intervention. Service users reported high levels of satisfaction with the service specifying particular interpersonal qualities of the therapists and the individualisation of service provision as crucial positive factors. Referrers similarly reported high levels of overall satisfaction with the service, specifying that the speed of response to referral and length of intervention was of greatest importance to them.

Stepped-care psychological interventions reduce psychological distress in treatment completers with mild to moderate symptoms of anxiety and low mood. The overall interpersonal experience may be of greater importance to service users in their evaluation of a service than clinical outcomes. In their relationship to a Psychology service, referrers value speed of response and ongoing feedback. Building a robust, highly valued service may require the triangulation of evidence from all key stakeholders.

This paper provides a pragmatic template of how a rigorous evaluation of a primary care psychology service requires evidence from multiple stakeholders.

There is growing evidence examining mindfulness-based interventions (MI) for people with intellectual disabilities (IDs). As discussed in this paper, MI may be particularly suited for people with ID given high rates of difficulties in identifying and regulating emotions and as this approach may rely less on cognitive ability compared to other therapies. This study aims to assess the acceptability and preliminary effectiveness of a six-session MI group [the Coping Well Group (CWG)] delivered within routine clinical practice.

Six separate cohorts (n = 25) of adults with ID attended CWG. Quantitative data were collected from service users, including a pre- and post-quality of life (QoL) measure and qualitative data from group facilitators.

Roughly one-half (53%) of service users invited to the group attended at least one session, with low levels of dropout observed among group attendees. A significant improvement in QoL was reported demonstrating a small effect (d = 0.46, p = 0.022) after attending the group. Most service users (72%) were referred to the CWG for help managing difficult emotions. One-half (44%) of attendees required individual therapy after attending the group. Limitations of the evaluation and potential future research are discussed.

The current evaluation contributes a practice-based service evaluation of an MI group for people with ID and mental health difficulties to the currently limited evidence base. To the best of the authors’ knowledge, this is one of the first studies to investigate the impact of group psychological interventions collecting data across cohorts and assessing QoL, a more general measure of well-being than has been used previously.

The purpose of this paper is to distinguish knowledge gained vs skills learned as two learning-related training criteria; and to then test the impact of two career motivation variables, home care intent and stepping stone, for explaining these training criteria beyond controlled-for variables.

The research used a sample of 720 personal/home care aides (P/HCAs) who filled out pre-training and post-training surveys. Training consisted of 25 modules, lasting approximately 100 hours on various P/HCA knowledge bases, with training sessions generally five to six hours/day, four to five days/week over a three to four week period. Factor analyses, correlation, and hierarchical regression analyses were used to test the hypotheses.

Results showed that these two learning outcomes, knowledge gained vs skills learned, could be differentiated and reliably measured. Subsequent hierarchical regression analyses showed additional discriminant validity for these two learning outcomes. For the two measured career motivation variables, home care intent and stepping stone, home care intent was positively related to both learning outcomes but stepping stone only had a significant positive impact on skills learned. Training delivery was significantly related only to knowledge gained, while instructor rating was significantly related only to skills learned.

A unique sample of P/HCA trainees was utilized to test for this previously untested learning outcome distinction. As the population ages and demand increases for P/HCAs, additional training and studies evaluating such training will be needed.

The transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner’s perspectives on the URICA.

Correlational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data.

The URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient’s outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful.

This study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies.

This paper aims to explore the value that care from a primary mental health care nurse (PMHCN) can bring to people with mental health (MH) problems in health-care delivery.

This study used a focus group of 20 PMHCNs working in primary care (PC) health settings in Saudi Arabia before using thematic content analysis to describe and explore their views and experiences of the integration of MH care into PC units. The researchers used a semi-structured interview format, which began with open-ended probes and proceeded to use of theoretical sampling based on emerging data related to their experiences and perceptions in the integration process.

Four main themes were derived from the thematic analysis of interviews: collaboration, knowledge and experience, awareness and orientation care and influential role.

This study’s use of qualitative research methods has certain limitations, including the small sample size of 20 participants, which means that it may not be representative of all primary MH nurses in primary health-care centers in Saudi Arabia. To make the results applicable to a broader audience, the researcher sought to moderate this limitation by including participants with extensive experience in multiple settings and nurses of different ages.

The cost implications of the PMHCN service are not yet comprehensively understood, but it is apparent that this model is not only regarded extremely positively by MH practitioners but may also have significant benefits in terms of patient outcomes. The configuration of local services and relevant patient demographics will affect the extent to which this study’s findings are transferable. Meanwhile, further research in this area could seek to provide further evidence about the aspects of the PMHCN service model, such as secondary care referrals and waiting times, accident and emergency attendances and patient recovery rates and the impact of providing such a service on health-care practitioners as well as its cost-effectiveness.

This study’s findings suggest that PMHCNs believe that their care improves the quality of PC for patients in PC settings. Elements of the PC placement that professionals particularly valued include their ability to assist patients in their own community and the inclusion of volunteer stakeholders who act as preceptors. The participants expressed a need for improvement of policy related to referrals within the clinics.

Drawing on a performative ontology, this article extends the literature on health promotion in organizations by exploring how health promotion is performed in care work. The focus of the study is on health promotion in a context of illness and/or decline, which form the core of the studied organizational activities. The paper addresses the following question: how do care workers working in elderly care and mental health care organizations accomplish health promotion in the context of illness and/or decline?

The article develops a performative approach and analyses material-discursive practices in health promoting care work. The empirical material includes 36 semi-structured interviews with care workers, observations and organizational documents.

Two central material-discursive health promoting practices in care work are identified: confirming that celebrates service users as residents and the organizations as a home, and balancing at the limits of health promotion. The practices of balancing make the limitations of health promotion discernible and involve reconciling health promotion with that which does not neatly fit into it (illness, unachievable care aims, the institution and certain organizing). In sum, the study shows how health promotion can structure processes in care homes where illness and decline often are particularly palpable.

The paper explores health promotion in a context rarely explored in organization studies. Previous organization studies have to some extent explored health promotion and care work, but typically separately. Further, the few studies that have adopted a performative approach to material-discursive practices in the context of care work have typically primarily focused on IT. We extend previous organization studies literature by producing new insights: (1) from an important organizational context of health promotion and (2) of under-researched entanglements of human and non-human actors in care work providing a performative theory of reconciling organizational tensions.

The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them.

IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned.

There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning.

This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research.

To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally.

Institutional pharmaceutical services have widely evolved over the past 20‐30 years. Hospital pharmacy practice has changed from a profession concerned chiefly with the bulk preparation and distribution of drug products to one centred on ensuring optimal drug therapy. Whereas hospital pharmacists were charged with maintaining large drug stock on nursing units, many of them now provide individualised patient therapies. The practice of hospital pharmacy has therefore become one encompassing all aspects of drug therapy, from the procurement of drugs and drug delivery devices, their preparation and distribution, to their most appropriate selection and use for each patient. Hospital pharmacy services have traditionally had little involvement at the key stages in patients’ hospital care. This leads to the conclusion that the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today’s health‐care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health‐care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.