Mental illness research in the Gulf Cooperation Council: a scoping review

Rapid growth and development in recent decades has seen mental health and mental illness emerge as priority health concerns for the Gulf Cooperation Council (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). As a result, mental health services in the region are being redefined and expanded. However, there is a paucity of local research to guide ongoing service development. Local research is important because service users’ experience of mental illness and mental health services are linked to their sociocultural context. In order for service development to be most effective, there is a need for increased understanding of the people who use these services. This article aims to review and synthesize mental health research from the Gulf Cooperation Council. It also seeks to identify gaps in the literature and suggest directions for future research. A scoping framework was used to conduct this review. To identify studies, database searches were undertaken, regional journals were hand-searched, and reference lists of included articles were examined. Empirical studies undertaken in the Gulf Cooperation Council that reported mental health service users’ experience of mental illness were included. Framework analysis was used to synthesize results. Fifty-five studies met inclusion criteria and the following themes were identified: service preferences, illness (symptomology, perceived cause, impact), and recovery (traditional healing, family support, religion). Gaps included contradictory findings related to the supportive role of the Arabic extended family and religion, under-representation of women in study samples, and limited attention on illness management outside of the hospital setting. From this review, it is clear that the sociocultural context in the region is linked to service users’ experience of mental illness. Future research that aims to fill the identified gaps and develop and test culturally appropriate interventions will aid practice and policy development in the region

Using the nominal group technique to involve young people in an evidence synthesis which explored 'risk' in inpatient mental healthcare

Background In this paper we demonstrate how our application of the nominal group technique was used as a method of involving young people with previous experience of using inpatient mental health services in an evidence synthesis. Methods Nominal group technique is an approach to group decision-making that places weight on all participants having an equal opportunity to express a view, and to influence decisions which are made. It is an effective way to enable people who might otherwise be excluded from decision-making to contribute. Results In this study, the focus of the evidence synthesis was significantly shaped following using the nominal group technique in our stakeholder advisory group meeting. The young people present in the group invited the research group to think differently about which ‘risks’ were important, to consider how young people conceptualised risk differently, focussing on risks with long term impact and quality of life implications, rather than immediate clinical risks. Conclusions Using the nominal group technique with young people did offer a method of promoting the equality of decision making within a stakeholder advisory group to an evidence synthesis project, but care needs to be taken to invite sufficient young people to attend so they can be proportionally represented

Prioritizing young people's emotional health support needs through participatory research

Introduction Youth mental health is a global concern. Emotional health promotes mental health and protects against mental illness. Youth value self-care for emotional health, but we need better understanding of how to help them look after their emotional health. Participatory research is relevant, since meaningful engagement with youth via participatory research enhances the validity and relevance of research findings and supports young people's rights to involvement in decisions that concern them. Aim We aimed to develop a participatory approach for involving youth in research about their emotional health support preferences. Method Our team included a young expert-by-experience. We developed a qualitative, participatory research design. Eleven youth (16-18 years) participated in focus groups, followed immediately by a nominal group exercise in which they analysed the data, thus enhancing methodological rigour. Results This process highlighted youth perspectives on self-care strategies for emotional health. Discussion and Implications for Practice: Our simple participatory research approach generated trustworthy and credible findings, which accurately reflect youth perspectives and are consistent with the literature, endorsing our method. Young people said that they want reassurances of quality and safety when accessing digital mental health resources. These findings can inform future development of youth-oriented digital mental health resources

The future of mental health nursing education in the United Kingdom: Reflections on the Australian and New Zealand experience

This paper provides a debate related to how proposed changes to preregistration nurse preparation in the United Kingdom (UK) may impact on the future of undergraduate mental health nursing workforce. In the first instance we set out the proposed changes and the underlying reasoning provided for these changes. We compare the proposals in relation to the present curricula and possible outcomes of mental health nursing education in the UK. Our discussion also considers if there are lessons to be learned from the Australian and New Zealand where nursing education underwent similar changes during the 1990s. We offer a critique of the underlying political, economic and ideological reasons for these radial changes to nursing education with due consideration of lessons learned by others

Reciprocity Membership. A potential pathway towards recovery from mental illness in a Middle Eastern context

While recovery has become a popular framework for mental health services, there is limited understanding of its applicability outside of Western countries. In fact, recent studies in non-Anglophone populations suggest that recovery is contextually dependent and that implementation of mainstream recovery models risks imposing inappropriate values. We used classic grounded theory to explore the main concerns of mental health service users in a Middle Eastern context and the strategies they use to resolve those concerns. The theory of ‘reciprocity membership’, a process involving ongoing mutual exchange with a group or community, was developed. Reciprocity membership becomes balanced when an individual is satisfied with their ‘contribution to’ the group, the ‘acknowledgement from’ other group members, the ‘expectations of’ the group, and their ‘alignment with’ the values of the group. Balance among these conditions is appraised by a sub-process called ‘valuing’, and developed or maintained by two further sub-processes called ‘positioning’ and ‘managing relationships’. Balanced reciprocity membership seems to be associated with recovery. This study is the first in-depth exploration of people’s experience of mental illness in a Middle Eastern context; findings provide evidence for a novel potential pathway towards recovery

Developing a model of mental health self-care support for children and young people through an integrated evaluation of available types of provision involving systematic review, meta-analysis and case study

Background The mental health of children and young people (CYP) is a major UK public health concern. Recent policy reviews have identified that service provision for CYP with mental health needs is not as effective, responsive, accessible or child-centred as it could be. Following on from a previous National Institute for Health Research (NIHR) study into self-care support for CYP with long-term physical health needs, this study explored self-care support’s potential in CYP’s mental health. Objectives To identify and evaluate the types of mental health self-care support used by, and available to, CYP and their parents, and to establish how such support interfaces with statutory and non-statutory service provision. Design Two inter-related systematic literature reviews (an effectiveness review with meta-analysis and a perceptions review), together with a service mapping exercise and case study. Setting Global (systematic reviews); England and Wales (mapping exercise and case study). Participants (case study) Fifty-two individuals (17 CYP, 16 family members and 19 staff) were interviewed across six sites. Main outcome measures (meta-analysis) A measure of CYP’s mental health symptomatology. Data sources (literature reviews) MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, All Evidence-Based Medicine (EBM) Reviews, Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC). Review methods Titles and abstracts of papers were screened for relevance then grouped into studies. Two independent reviewers extracted data from studies meeting the inclusion criteria. A descriptive analysis and meta-analysis were conducted for the effectiveness review; descriptive analyses were conducted for the perceptions review. These analyses were integrated to elicit a mixed-methods review. Results Sixty-five of 71 included studies were meta-analysable. These 65 studies elicited 71 comparisons which, when meta-analysed, suggested that self-care support interventions were effective at 6-month [standardised mean difference (SMD) = −0.20; 95% confidence interval (CI) −0.28 to −0.11] and 12-month (SMD = −0.12; 95% CI −0.17 to −0.06) follow-ups. However, judged against Cochrane criteria, the studies were mostly low quality. Key elements of self-care support identified in the perceptions review were the acquisition of knowledge and skills, peer support and the relationship with the self-care support agent; CYP also had different perceptions from adults about what is important in self-care support. The mapping exercise identified 27 providers of 33 self-care support services. According to the case study data, effective self-care support services are predicated on flexibility; straightforward access; non-judgemental, welcoming organisations and staff; the provision of time and attention; opportunities to learn and practise skills relevant to self-care; and systems of peer support. Conclusions Mental health self-care support interventions for CYP are modestly effective in the short to medium term. Self-care support can be conceptualised as a process which has overlap with ‘recovery’. CYP and their families want choice and flexibility in the provision of such interventions and a continued relationship with services after the nominal therapy period. Those delivering self-care support need to have specific child-centred attributes. Future work Future work should focus on under-represented conditions (e.g. psychosis, eating disorders, self-harm); the role of technology, leadership and readiness in self-care support; satisfaction in self-care support; the conceptualisation of self-care support in CYP’s mental health; and efficacy and cost-effectiveness

Work-related stress in a humanitarian context: a qualitative investigation

There is a paucity of research into the subjective stress-related experiences of humanitarian aid workers (HAWs). Most studies investigating stress in HAWs focus on trauma and related conditions or adopt a quantitative approach. This interview-based study explored how HAWs (n=58) employed by a United Nations aligned organisation perceived the transactional stress process. Thematic analysis revealed eight main themes. An emergency culture was found where most employees felt compelled to offer an immediate response to humanitarian needs. Employees experienced a strong identification with humanitarian goals and reported high engagement. The rewards of humanitarian work were perceived as motivating and meaningful. Constant change and urgent demands resulted in work overload. Managing work-life boundaries and receiving positive support from colleagues and managers helped buffer perceived stress, work overload and negative health outcomes. The practical implications of the results are discussed and suggestions made in light of current research and stress theory