Case formulation - Theory and Practice

 Still sorting papers, I've discovered copies of slides from the COPE course University of Manchester on Case Formulation by John McGovern.

An original purpose for Hodges' model is to help bridge the theory-practice gap.

The slides include -

• content: ingredients - preliminary formulation
• a means of understanding an individual's problems and distress in line with cognitive behavioural theory
• hypothesis to explain acquisition, and maintenance of problem
• not piecemeal

ROLE OF CASE FORMULATIONS

Bridge between theory and practice

a flexible tool for guidance

an explanatory framework to share with the patient

How types of formulation can be related to situations (Hodges' model is situated) - inference chain.

Comprehensive formulation - reflects the template that supports data gathering

inc. core beliefs - conditional beliefs

Questions for Preliminary Formulation

Main Ingredients - includes social support/relationships/employment/finances

(so this touches on determinants)

Choosing Treatment Targets

group exercise and summary

c/o HSE.ie - Model of Care for People with Mental Disorder and Co-existing Substance Use Disorder (Dual Diagnosis)

"The definition of Dual Diagnosis for this Model of Care is: ‘the co-morbid disorders due to substance use and/or addictive behaviours along with the presence of mental disorder(s)’. The disorders of substance use include disorders of alcohol use." p.10.

Model of Care for People with Mental Disorder and
Co-existing Substance Use Disorder (Dual Diagnosis)

INDIVIDUAL
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INTERPERSONAL    :     SCIENCES              
HUMANISTIC --------------------------------------  MECHANISTIC
SOCIOLOGY :   POLITICAL
|
GROUP

mental disorder addictive behaviour - inc. gambling and gaming disorder lived experience recovery (here?) [cognitive access: orientation, insight, literacy, communication ..] training patient and	Demographics: Adult Dual Diagnosis team cover population of 300,000 Adolescent Dual Diagnosis teams 10 to 17 years lived experience data gathering p a th w  a ys [ physical access: place, time] e-health, therapeutic modules reablement, recovery (here?)
public involvement Carers Social Inclusion Social capital lived experience Vulnerable women, communities, homeless, ethnic minorities, refugees, recovery (here?) rehabilitation	Dual Diagnosis Service funding [ planned - in-patient beds ] TRAINING Service users lived experience interdepartmental discussion re. service provision for prison population probation services asylum seekers, immigrants Key Performance Indicators recovery (here?)

FOR: Economic, Educational, Environmental, Social, Political DETERMINANTS . .

READ: Cognitive, Physical, Social and Political ACCESS

My source: https://twitter.com/h2cm/status/1661299925391384576?s=20

Update on draft papers iii

There was news today about the draft paper on:

"First Episode of Psychoses, Early Intervention, Cardiovascular Nursing, Research Methods and Hodges' model."

It has been accepted and I can submit formally. 👍

This project - yes, a further distraction (that has borne fruit) started in March resulting in 4,800 words, an illustration of the model and 4 figures (2x2 tables). That I think, with the editors, guide the reader in applying Hodges' model, or at least the scope of its application, which is situated and person-centred.

I approached a journal regards the draft "Society, Technology and COVID19 in Hodges' model". Having reduced the original 12000 words to 7700, the paper is of interest, but is (as expected) too long. There is the possibility of reducing the word count to 5000, or splitting the essay.

This invites revisiting the original and teasing out the informational themes: fake news, mis- dis- malinformation and agnotology (in part 2?). Then I would (to a degree), finally be returning to the concept of 'information':

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.

- which keeps 'calling' (with complexity, emergence...).

I will consider the options, but submit the above: an instance of much appreciated encouragement and support by the editors. Writing this has proved an enjoyable challenge.

As ever, if you have any sources to add to the bibliography, wonder about using Hodges' model I would be pleased to hear from you: h2cmng at yahoo.co.uk

Update on draft papers ii

The draft paper on cardiovascular nursing, first episode psychosis, research methods and Hodges' model is just about finalised; at 4700 words, 4 figures (one illustration of the model, plus three 2x2 tables) and 42 references.

One of the oldest drafts is c. 2013; in mitigation I completed an MRES in-between. This is on case formulations, diagrams and Hodges' model and is quite near completion. Although now of course the references and literature need to be re-examined. There's a new rationale to pick this up - and it connects with work below.

Another effort morphed into two papers, following an initial inquiry with a journal (lost in the email archive). The focus is Threshold concepts, Liberty Protection Safeguards - a change from DoLS, the care context is nursing homes and the residential sector applying Hodges' model.

This draft has served a purpose, forming the basis of a presentation to the virtual Threshold Concepts Conference last year. News will follow soon regards next year:

9th Biennial Threshold Concepts Conference (I really miss the Specialist Group on TCs in Health, but also appreciate the time such a commitment takes.)

Last summer, seduced by reference to 'advanced studies' (and a call that presented a broad door, sufficient to get h2cm through) I responded to a call on technology, and society. Liaising with the editor, we added - COVID-19 and Hodges' model. Before I knew it, I'd amassed more than 12,000 words in six weeks. The comments even when far from final draft, were poor. No encouragement at all. Contact was lost, blanked in fact: the paper slept. 

Months later, picking it up again, I can see why. It was poor.

I've taken some -ve critique previously. Welcome it in fact: so the Earth-bound vacuum was rude.

When working on the Michel Serres paper:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

- some rather negative feedback proved the spur to the final work - that I think (and been told) is coherent, engages and 'delivers'(?).

This will be the result again, but the chain reaction has to be tempered and channeled.
Clear the desk - clear the desk! I am my own worst enemy...!

The latest paper, and its being co-authored has proved an enormous help, in time management, discipline and focus (despite COVID intervening):

Jones P, Wirnitzer K. Hodges’ model: the Sustainable Development Goals and public health – universal health coverage demands a universal framework. BMJ Nutrition, Prevention & Health 2022;0:e000254. doi:10.1136/bmjnph-2021-000254

Out of the technology, society text, a structured work - maybe two - will materialise.

Swiss army knife

 

After wittering on about legacy problems in nursing, and health care for quite a while, I've wondered about an original purpose Hodges' model - that of curriculum design, planning, development. As ever, it is just one tool in the toolkit, but regards nursing curricula, mental health nursing, the general Vs specialist distinction Hodges' model can be the ubiquitous Swiss army knife:

Boyer's model, Hodges' model, scholarship, future website and Drupal

 

Noting and replying to threads on twitter, Hodges' model can help articulate the arguments for the future of mental health nursing as a distinct pathway of study, discipline, and profession.*

So if you're struggling to complete a paper, keep going!

That mention, back in 2009 of a 'future website' is embarrassing though.

*A post re. the BBC Panorama TV expose will follow in the future.

Update on draft papers ;-)

Please excuse the intended irony, as need for an - 'update' could refer to far more than papers.*

Across the life of W2tQ (since April 2006...) there are many posts about papers by other people, papers planned and less frequently work published. 

A paper that started in 2017 has finally been accepted and we (not the Royal variety - which is a critical joy) await the proof. 

I'm really grateful to my co-author who stayed the course on what has been an utter roller-coaster and with COVID too. I look forward to sharing details and hence news of their ongoing research elsewhere - in Europe.

Another paper conceived in March has progressed more rapidly. With the initial draft well received, I'm addressing some revisions from editors, which are straightforward. 

I still need to 'see' these two birds in my hands, to believe: it will be worth it (I think?) to add these to the bibliography, as:

• SDGs are fundamental in global health and reveal the scope and relevance of h2cm;
  
• nutrition is critical in public (mental) health, policy and sustainability;
• there is more to follow from the 'mapping' that is exercised on W2tQ [2x2 HTML tables thus far], in these, and other papers;
• the psychoses constitute a severe mental health condition that can also illustrate the impact on individuals, friends, family and society;
• in health (and social) care we must address parity of esteem in and across theory, practice, management, policy, and research;
  
• how do (research) methods figure in Hodges' model (a mapping approach);
• what does a similar mapping of cardiovascular medicine and nursing reveal?
  

These bibliographical additions may help researchers in health, social care, and other fields find the model. While it is disappointing to find out about papers that reference h2cm 'after the writing' this still counts. It is a reference, not a collaboration! This is very welcome and a key purpose of the blog, and presence - @h2cm - on twitter. 

It would be validating, so 'me' [massaging ego] but it would also be contradictory. 

Hodges' model is simple, isn't it? 

In its basic form, blank and template - it presents virgin territory for the user(s) to overlay with their map according to context.

I'll post again about three remaining drafts papers, one dates back to 2012 (I was full-time then) and one that is in two parts. I've learnt a lot (again) with the two 'nearbies' and will post and list details when able. 

If I can help you, your project - I'd be pleased to do so.

*a website for example!

See also: the blog's bibliography in the sidebar, plus -

'New' citation: "Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire."

Re-Inventing Schizophrenia: Updating the Construct

INDIVIDUAL

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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

Schizophrenia Research
	Re-Inventing Schizophrenia: Updating the Construct

Re-Inventing Schizophrenia: Updating the Construct. Edited by Rajiv Tandon, Matcheri Keshavan, Henry Nasrallah. Schizophrenia Research. Volume 242, Pages 1-150 (April 2022).

My source:
https://twitter.com/JeroticStefan/status/1508898715473530888?s=20&t=X61DSrPzEyLvX-FhzY5r-A

Need for bio-psycho-socio-POLITICAL perspectives - spiritual too.

Previously on W2tQ: DSM

 

gameChange VR therapy

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

"The issue is an urgent one: all too often, individuals with psychosis find day-to-day life so anxiety-provoking that they simply withdraw. Everyday tasks — getting on a bus, doing the shopping, speaking to other people — become very challenging. Work and home life suffer. And mental and physical health deteriorate. Psychological therapy can be very beneficial here. But it needs to be the right kind of therapy. What works best is active coaching in the situations that trouble people, helping patients move beyond their fears. However, this is difficult without a skilled therapist who has the time to get out and about with patients. And patients often find the idea frightening. The result is that a potentially powerful treatment is seldom actually delivered."

VIRTUAL REALITY

Source: Flyer from Salford - Early Intervention Team, Sept-Dec 2020 (Great team too!).

VR on archived site 1998-2015:

https://web.archive.org/web/20110903071731/http://www.p-jones.demon.co.uk/linksTwo.htm 

https://web.archive.org/web/20110727043926/http://www.p-jones.demon.co.uk/Introvrn.htm

CLEAR as a Mental Health Million...?

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group - population

ASK  about underlying social problems	TREAT  the immediate health problem ...
REFER to local social support resources	ADVOCATE for

Constantly rationalising; it's still the Northern summer holidays, people are away, not everyone's on twitter, the tweet's still warm, blimey - get a life ...!

I wonder how no one else can consider the very obvious 'fit' between key elements of the CLEAR initiative and Hodges' model, sufficient to consider the tweet of that post worthy of a like at least? Not a one. (There's another post perhaps..?)

Oh well... Plough on ...

The other week Mental Health Million on twitter featured a gif that caught my eye again today. This graphic provides a lesson that also incorporates CLEAR.

If we consider the ASK advice, then this supposes of course that the person, patient, client is engaged with the health professional. Engaged, to such an extent that in competency terms the professional's interpersonal skills come to the fore. It really is how we ask, and at that first encounter that is crucial.

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

ASK  about underlying social problems	TREAT  the immediate health problem ...
REFER to local social support resources	ADVOCATE for

Although I may write about the importance of parity of esteem in mental and physical health this is often thought of in funding, research terms and the physical health of people with more chronic forms of mental illnesses who are prescribed and take long term psychotropic medication. It is not easy to envisage the extent of the challenges for patients, their families and the health and social care team. The CLEAR website notes the use of the initiative across many health contexts and hence conditions, including dementia.

The animation tweeted by Mental Health Million and their reference to the 'One in Four' statistic, highlights the complex nature of 'care pathways'.

Yes, the solutions are "out there" but the key is making them available.

No pun intended, but pathways are often taken for granted in the sense that they are CLEARed and straightforward to follow. CLEAR checks this assumption and takes a global approach. CLEAR and Hodges' model draw attention to the humanistic, the social side of medicine, health care. These are often not factored in from the outset, as a vital part of the outcome process (policy, purposes and practices).

As mental health care professionals realise that ability to 'ask' can be hard-won in terms of the patience that needs to be exercised.
The counterpoint to that is a twitter thread last week. A person with mental illness and in difficulty at that time, was suggesting that the professionals "Go Away" (not exactly the words used).

As this animation suggests, getting referred is one thing, being heard and seen is another. Getting to the point were dialogue is possible is a delicate negotiation. Mutual respect, being able to agree to disagree. Do we agree as to the type of the fruit on the tree; never mind what might be 'low-hanging'?  Whatever the perceived and actual differences we must try to reduce that distance, listen, share and make progress.

No one should have to sit, walk, Be alone if they do not want to. ...

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

When you report an eating disorder to the medical profession, but your BMI is within *normal* range. pic.twitter.com/BCFJnnJ6yo — MentalHealthMillion (@MentalHealthMil) September 3, 2019	TREAT the immediate health problem
REFER to local social support resources	ADVOCATE for

Study: Measuring Different Types of Relationship Styles in Psychosis

Division of Psychology and Mental Health
2nd Floor, Zochonis Building
The University of Manchester
Brunswick Street
Manchester
M13 9PL

Participant Information Sheet

Measuring Different Types of Relationship Styles in Psychosis

You are being invited to take part in a research study developing a questionnaire to measure different types of relationship styles in psychosis. Before you decide whether or not you would like to take part in the study, please read the following information carefully so that you can understand what taking part would involve for you. Then click the button at the bottom of the page to continue. If you have any questions or queries about taking part in the study, please contact the principal investigator, Catherine Pollard (catherine.pollard AT postgrad.manchester.ac.uk). You do not have to make a decision straight away, so if you have any doubts or feel unsure please take some time to think it over.

What is the study about?

Our early relationships have been linked to the development of psychosis, a mental health problem that means people interpret things differently from those around them. Psychosis involves experiences such as hallucinations, where a person hears, sees and in some cases feels, smells or tastes things that are not there; or delusions, where a person has strong beliefs that are not shared by others.

When people are young, they develop a sense of how they relate to themselves, others and the world. This includes how others relate to them. Some people grow up seeing their parent/guardian as fearful. Research suggests that when these young people grow up they are more likely to report hearing voices and feel paranoid. However, it is not clear how this happens.

At the moment, it is difficult to understand why these people are more likely to hear voices and feel paranoid. Therefore, more research needs to be done. We aim to develop a questionnaire that measures whether people have grown up feeling scared of their parent/guardian so that we can use this in research to help us understand the link between feeling fearful in early relationships and the development of psychosis.

This study will not directly offer you any benefit, but the study addresses a gap in psychosis research. Our work will help to understand the development of unusual experiences and help us develop more treatments for distressing experiences.

Please CONTINUE READING...

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

SELF beliefs early relationships  lived experiences sensory experiences - hear, see, feel, smell, taste ... hallucinations, delusions psychosis, distress, trauma Confident with	WORLD Involved in major accident antipsychotic medication Diagnosis  Evidence-base Measures
English language OTHERS social environment parent(s), guardian, significant others fear, traumatic loss of other  Therapeutic input: CBT, Psychologist	WORLD Treatment in a Mental Health Unit / Hospital Input from Community Mental Health Team or Early Intervention Service

subjective ------------------------------------------------------------------------------------- OBJECTIVE

qualitative -------------------------------------------------------------- QUANTITATIVE

My source:
@HearingVoicesUK & @RSInPsychosis
https://twitter.com/HearingVoicesUK/status/1073647206685663232

Hellblade: Senua's Sacrifice

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

My source: BBC World Service

"Hallucination Machine" = Humanistic insights?

individual

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INTERPERSONAL : SCIENCES

humanistic --------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

See also:

Sussex Centre for Consciousness Science

Video source - Wired How scientists are manipulating the mind with VR

[Preprint] The Hallucination Machine: A Deep-Dream VR platform for Studying the Phenomenology of Visual Hallucinations Keisuke Suzuki, Warrick Roseboom, David J. Schwartzman, Anil K. Seth
bioRxiv 213751; doi: https://doi.org/10.1101/213751

My source:
Moody, O. (2017) Trip without the high on Sussex University’s hallucination machine, The Times,  20 November. p.21.

Hodges' model: Evidence-Based Integrated Healthcare - Policy, Mental Health & Research Funding

individual

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INTERPERSONAL : SCIENCES

humanistic ---------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group

Mental health research 3% Quarter of all health costs	Medical Research...
2011-2014  33% rise in mental health related incidents dealt with by the police	Council.. £801.4 million for projects - mental health allocated £21.8 million Funding also via other bodies - National Inst. for Health Research

My source: Bennett, R. (2016) Research fund spends 3% on mental health. The Times, 25 March 2016. p.24.

‘Brain training’ app may improve memory and daily functioning in schizophrenia

Cambridge Advanced Training Programme
Credit: Peak

A ‘brain training’ iPad game developed and tested by researchers at the University of Cambridge may improve the memory of patients with schizophrenia, helping them in their daily lives at work and living independently, according to research published today. ... [3 August 2015].


My source: 
FT Weekend Magazine, 15/16 August 2015, p.41.

"The Five Phases of Psychosis" - a 2:38 minute film by Jim van Os

Jim van Os is a consultant psychiatrist and Professor of Psychiatric Epidemiology at Maastricht University, in The Netherlands.

I wonder, is it possible to conceive of an approach (model of madness) and response system sophisticated enough to allow us to jump straight from Phase 2 to Phase 5 in the model the film describes?

This would mean a jump straight from the 1:00 second mark to the 2:00 second mark in this film and miss as much as possible of the messy, often horrific and, arguably, mostly iatrogenic, two stages in between?

For a more detailed discussion of one possible model of madness that could support the development of a response system, here is a 15 minute film by Jim van Os - Connecting to Madness, TEDxMaastricht

Jim is a psychiatric epidemiologist and has co-authored 198 journal articles since 2013 according to Google Scholar.

He most recent work is published in a leading Dutch newspaper this week, co-authored by other leaders of Dutch psychiatric organisations. In this Click hear, outlining the case that schizophrenia does not exist at http://www.nrc.nl/handelsblad/van/2015/maart/07/laten-we-de-diagnose-schizofrenie-vergeten-1472619 (download and use Google Chrome for instant translation).

Part of this opinion has translated for us by Margreet de Pater, who wrote:

Their declaration includes 12 points

1. There is no clear difference between psychotic and other human experiences.
2. 15 % of adolescents have psychotic experiences and 80% of these disappears during development.
3. 3.5 % of people have psychotic experiences that need help, their diagnosis is psychosis susceptibility syndrome, which is different for every person.
4. 20 % of these people have an unfavorable prognosis.[with the right help people with psychosis do bounce back]
5. A psychotic experience is often a reaction on trauma, a life event, disappointment, discrimination or humiliation. The thesis that it is a symptom of an underlying brain disease is scientifically not correct, and leads to a negative view [expectation] of recovery.
6. Everyone has his own special mix of psychotic symptoms, the classifications which psychiatry makes in schizo- family of diagnoses etc. is incorrect. [But everyone has a different mix of symptoms, and does not fit well in a diagnostic box.
7. People with psychotic experiences need hope and a perspective. Recovery is a mental process. People need to cope with their psychosis susceptibility with help of a schooled person with lived experience and if necessary of a doctor and a therapist
8. (These services should be there) From the very first moment
9. Going back to own environment, work and school is most important also when there are still some symptoms, waiting for complete cure is counterproductive.
10. Everyone with psychotic symptoms must be invited to talk about it, the theme of the psychosis is the key to underlying problems
11. Everybody with psychotic experience must be offered psychotherapy
12. Sometimes anti-psychotic medicines can be useful when experiences are too overwhelming, but they don´t cure.

They conclude that: Schizophrenia fortunately does not exist, psychosis does and is treatable

Best Wishes
Philip Benjamin
MHN BEd MMind&Soc
Chair, ISPS Australia

...

My source:
NURSE-PHILOSOPHY & PSYCHIATRIC-NURSING at JISCMAIL.AC.UK

WMHD II c/o LSE: Investing in crisis care for people with schizophrenia makes moral and economic sense

“When someone has a mental health crisis, it is distressing and frightening for them as well as the people around them. Urgent and compassionate care in a safe place is essential – a police cell should never need to be used because mental health services are not available. For me, crisis care is the most stark example of the lack of equality between mental and physical health.” 

(The Rt Hon Norman Lamb MP, Care and Support Minister)

There is a strong moral and economic case for investing in innovative approaches that support people with schizophrenia to live independently in the community. Crisis resolution and home treatment teams and crisis houses can help reduce the need for expensive hospital admissions with some studies suggesting that the costs of care can be reduced by up to 30% through these service models. There is a clear potential for Clinical Commissioning Groups to make better use of their resources by investing in home treatment teams and crisis houses as approaches to crisis resolution.

Read more of this post

My source: The London School of Economics and Political Science, Health and Social Care blog email

Hodges' model in recovery ...

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

World Mental Health Day 2014: or...

https://www.time-to-change.org.uk/WMHD

http://www.mentalhealth.org.uk/our-work/world-mental-health-day/world-mental-health-day-2014/

or - World Parity of Esteem Day 2014?

Computer-based 'avatar' therapy promising for persecutory auditory hallucinations

A study in the British Journal of Psychiatry has reported symptom reductions among patients hearing voices, who developed computerised 'avatars' of the voices and then engaged in dialogue with them. When compared with treatment as usual during a randomised trial, the therapy group showed mean reductions in scores for auditory hallucinations and for the omnipotence and malevolence of the voices. The researchers conclude: 'Patients who are able to sustain a dialogue with their persecutor feel much more in control.'
BJP June 2013, 202:428-433

Source:
http://www.mental-health-forum.co.uk/news-blog.html

In addition see and listen to:

UCL news:  Avatar therapy helps silence voices in schizophrenia

BBC Radio 4: http://www.bbc.co.uk/news/health-23141916

Conceptual Reflections on Schizophrenia - Hodges' model

A decade ago I was studying the Psychosocial Interventions for Psychosis (COPE) pathway part-time at Manchester University. The student body was interprofessinal made up of nurses, psychologists, occupational therapists, nurses and if memory serves me right people from the voluntary (third) sector. What I learned then left me wondering where I had been all those years since qualifying (lost in IT....).

There are many universities now delivering this curriculum, presenting the very latest research. The lecturers are frequently the researchers themselves, working in ongoing multicenter trials studying  various aspects of the treatment and care management of psychosis.

This is why it is very alarming to hear of the lack of progress not just within in-patient care as per the findings of the Schizophrenia Commission, but the delivery of care for these individuals and their families across the health and social care system. Of course, as a former student and holder of a PG(Dip.) I am not at present practising these skills formally.

In the h2cm table that follows I have highlighted some of the main concepts across the care domains of Hodges' model:

INTERPERSONAL : SCIENCES

SOCIOLOGY : POLITICAL

beliefs, perception, attention, anxiety, stress, vulnerability, pleasure, feedback, motivation, mood, therapies, therapeutic relationship, communication, assets, cognitive triad, perception, delusions, hallucinations, positive and negative symptoms, person-centered care, existing coping strategies, mental health assessment, literacies (3Rs, emotional, health), salience, attention, attribution, meaning, creativity

physical health, weight, fitness, side effects, medication, atypical antipsychotics, evidence, genetics, research, diagnosis, (cognitive) information processing, dual diagnosis, risk, models of care, recovery, hierarchy of clinical evidence, care processes - assessment, care planning, access to interventions, audio recording of sessions, protocols, DSM IV

clinical supervision, social attitudes - family, friends, community, stigma, myth, media, carers, familes, social relationships, network, self help groups, survivors, www.hearing-voices.org/ activities, daily routine, 'value' of a diagnosis - pros & cons (discuss), community centers, clinical supervision, positive risk management, employment, social history of mental health, social psychiatry, stories,education - schools & community, 'community care', housing

mental health history, institutional vs. community care, mental health law, autonomy, consent, capacity, best interests, equity mental health services, early intervention, access, POLICY, anti-psychiatry, equity, governance, data gathering, statistics, reporting, outcomes, services, secure provision, early intervention, crisis intervention, DSM V, commissioning, funding for mental health, education and training, sickness - welfare benefits - 'incapacity' review 'return to work'

The relative position of concepts above does not indicate priority.