Publications by year
In Press
Owens CV, Carter M, Shenton D, Byng R, Quinn C (In Press). Engaging Without Exposing: Use of a Fictional Character to Facilitate Mental Health Talk in Focus Groups with Men Who Have Been Subject to the Criminal Justice System.
Qualitative Health Research Full text.
2020
Owens C, Fox F, Redwood S, Davies R, Foote L, Salisbury N, Williams S, Biddle L, Thomas K (2020). Measuring outcomes in trials of interventions for people who self-harm: qualitative study of service users' views.
BJPsych Open,
6(2).
Abstract:
Measuring outcomes in trials of interventions for people who self-harm: qualitative study of service users' views
. Background
. Patients often have very different ideas from clinicians about what they want treatments to achieve. Their views on what outcomes are important are not always reflected in trials.
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. Aims
. To elicit the views of people who self-harm on the most commonly used outcome measures and to identify the outcomes that matter to them.
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. Method
. We conducted in-depth interviews with 18 people with histories of self-harm, recruited from hospital and community settings. We conducted thematic analysis using a framework approach and used visual mapping to arrive at our final analysis and interpretation.
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. Results
. Participants' accounts contained a number of challenges to the validity and meaningfulness of current trial outcome measures. Five broad issues emerged: (a) relationship between frequency and severity of self-harm; (b) behavioural substitution; (b) self-management skills; (d) the role of self-harm as survival tool and affect regulator, and (e) strategic self-presentation. We show how these affect the visibility and measurability of commonly used outcomes. The outcomes that mattered to participants focused on positive achievements in three domains: (a) general functioning and activities of everyday living; (b) social participation, and (c) engagement with services. Participants conceptualised these as both measures and means of sustained improvement.
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. Conclusions
. Our findings suggest that current self-harm trial science rests on flawed assumptions about the relationship between mental states and behaviours and about our ability to measure both. Greater understanding of the outcomes that matter to people who self-harm is needed to inform both intervention development and trial design.
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Abstract.
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2019
Dunn BD, Widnall E, Reed N, Owens C, Campbell J, Kuyken W (2019). Bringing light into darkness: a multiple baseline mixed methods case series evaluation of Augmented Depression Therapy (ADepT).
Behaviour Research and Therapy,
120, 103418-103418.
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Brand SL, Quinn C, Pearson M, Lennox C, Owens C, Kirkpatrick T, Callaghan L, Stirzaker A, Michie S, Maguire M, et al (2019). Building programme theory to develop more adaptable and scalable complex interventions: Realist formative process evaluation prior to full trial.
Evaluation,
25(2), 149-170.
Abstract:
Building programme theory to develop more adaptable and scalable complex interventions: Realist formative process evaluation prior to full trial
© the Author(s) 2018. Medical Research Council guidelines recognise the need to optimise complex interventions prior to full trial through greater understanding of underlying theory and formative process evaluation, yet there are few examples. A realist approach to formative process evaluation makes a unique contribution through a focus on theory formalisation and abstraction. The success of an intervention is dependent on the extent to which it gels or jars with existing provision and can be successfully transferred to new contexts. Interventions with underlying programme theory about how they work, for whom, and under which circumstances will be better able to adapt to work with (rather than against) different services, individuals, and settings. In this methodological article, we describe and illustrate how a realist approach to formative process evaluation develops contextualised intervention theory that can underpin more adaptable and scalable interventions. We discuss challenges and benefits of this approach.
Abstract.
Dunn BD, Widnall E, Reed N, Taylor R, Owens C, Spencer A, Kraag G, Kok G, Geschwind N, Wright K, et al (2019). Evaluating Augmented Depression Therapy (ADepT): Study protocol for a pilot randomised controlled trial.
Pilot and Feasibility Studies,
27, 63-63.
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Owens C, Derges J, Abraham C (2019). Intervening to prevent a suicide in a public place: a qualitative study of effective interventions by lay people.
BMJ Open,
9(11), e032319-e032319.
Abstract:
Intervening to prevent a suicide in a public place: a qualitative study of effective interventions by lay people
ObjectivesMany suicides take place in public locations, usually involving jumping from high places or use of transport networks. Previous research has largely focused on the effectiveness of physical barriers at frequently used locations. There have been no studies of human intervention to prevent suicides in public places. The aim of this study was to identify the core components of an effective intervention by a member of the public.Design and methodsWe conducted in-depth qualitative interviews with people who have either been prevented by a stranger from taking their own life in a public location (n=12) or intervened to prevent a stranger from taking their own life in a public location (n=21). Collectively, the two groups narrated 50 incidents of suicide rescue. We analysed interview transcripts using inductive thematic analysis.ResultsSuicidal people typically displayed no visible distress, describing themselves as being dissociated or ‘in a bubble’. Intervention was seen to involve three main tasks: ‘bursting the bubble’ (reconnecting with self, others and everyday world); moving to a safer location, and summoning help. We show how interveners accomplished these tasks in a range of ways, using both verbal and non-verbal communication and different degrees of restraint.ConclusionsThis is the first empirical study to examine the role of passing strangers in preventing suicides in public places. It shows that no specialist skills are needed. Interveners were ordinary people, distinguished only by a high level of social awareness, combined with a readiness for social action. The findings also suggest that people do not need a script and should not be afraid of saying ‘the wrong thing.’ What interveners said was much less important than how they made the suicidal person feel, namely safe, connected and validated (‘I matter’). Interveners did this simply by being themselves, responding with authenticity, calmness and compassion. Members of the public need to be encouraged to recognise and reach out to those who may be at risk of suicide in public locations, but should be prepared for a prolonged and intense encounter that may leave them with troubling emotions.
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Russell G, Kapp SK, Elliott D, Elphick CM, Gwernan-Jones RC, Owens C (2019). Mapping the autistic advantage from the accounts of adults diagnosed with autism:. A qualitative study.
Autism in Adulthood,
1.2 Full text.
2018
Kirkpatrick T, Lennox C, Taylor R, Anderson R, Maguire M, Haddad M, Michie S, Owens C, Durcan G, Stirzaker A, et al (2018). Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial.
BMJ Open,
8(2).
Abstract:
Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial.
INTRODUCTION: the 'Engager' programme is a 'through-the-gate' intervention designed to support prisoners with common mental health problems as they transition from prison back into the community. The trial will evaluate the clinical and cost-effectiveness of the Engager intervention. METHODS AND ANALYSIS: the study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either: (a) the Engager intervention plus standard care (intervention group) or (b) standard care alone (control group) across two investigation centres (South West and North West of England). Two hundred and eighty prisoners meeting eligibility criteria will take part. Engager is a person-centred complex intervention delivered by practitioners and aimed at addressing offenders' mental health and social care needs. It comprises one-to-one support for participants prior to release from prison and for up to 20 weeks postrelease. The primary outcome is change in psychological distress measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure at 6 months postrelease. Secondary outcomes include: assessment of subjective met/unmet need, drug and alcohol use, health-related quality of life and well-being-related quality of life measured at 3, 6 and 12 months postrelease; change in objective social domains, drug and alcohol dependence, service utilisation and perceived helpfulness of services and change in psychological constructs related to desistence at 6 and 12 months postrelease; and recidivism at 12 months postrelease. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action and look for unintended consequences. An economic evaluation will estimate the cost-effectiveness. ETHICS AND DISSEMINATION: This study has been approved by the Wales Research Ethics Committee 3 (ref: 15/WA/0314) and the National Offender Management Service (ref: 2015-283). Findings will be disseminated to commissioners, clinicians and service users via papers and presentations. TRIAL REGISTRATION NUMBER: ISRCTN11707331; Pre-results.
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Quinn C, Denman K, Smithson P, Owens C, Sheaff R, Campbell J, Porter I, Annison J, Byng R (2018). General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study.
BMC Fam Pract,
19(1).
Abstract:
General practitioner contributions to achieving sustained healthcare for offenders: a qualitative study.
BACKGROUND: Offenders frequently have substantial healthcare needs and, like many other socially marginalised groups, often receive healthcare in inverse proportion to their needs. Improved continuity of healthcare over time could contribute to addressing these needs. General Practitioners need to be able to support people with complex social and medical problems, even in systems that are not specifically designed to manage individuals with such degrees of complexity. We aimed to examine offenders' perspectives on factors that contributed to, or worked against, creating and sustaining their access to healthcare. METHODS: from a sample of 200 participants serving community or prison sentences in South West (SW) and South East (SE) England, who were interviewed about their health care experiences as part of the Care for Offenders: Continuity of Access (COCOA) study, we purposively sampled 22 participants for this sub-study, based on service use. These interviews were transcribed verbatim. A thematic analytic approach initially applied 5 a priori codes based on access and different components of continuity. Data were then examined for factors that contributed to achieving and disrupting access and continuity. RESULTS: Participants described how their own life situations and behaviours contributed to their problems in accessing healthcare and also identified barriers created by existing access arrangements. They also highlighted how some General Practitioners used their initiative and skills to 'workaround' the system, and build positive relationships with them; feeling listened to and building trust were particularly valued, as was clear communication. Limitations faced by General Practitioners included a lack of appropriate services to refer people to, where the offender patients would meet the access criteria, and disagreements regarding medication prescriptions. CONCLUSIONS: General Practitioners can make a positive contribution to supporting access to healthcare for an under-served population by facilitating more flexible and less formal access arrangements, by using their relationship skills, and by problem-solving. General Practitioners should recognise their potential to transform people's experience of healthcare whilst working in imperfect systems, particularly with vulnerable and marginalised groups who have complex medical and social needs.
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Perry-Young L, Owen G, Kelly S, Owens C (2018). How people come to recognise a problem and seek medical help for a person showing early signs of dementia: a systematic review and meta-ethnography.
Dementia (London),
17(1), 34-60.
Abstract:
How people come to recognise a problem and seek medical help for a person showing early signs of dementia: a systematic review and meta-ethnography.
Evidence suggests that there is usually a long delay between noticing first signs of dementia and seeking medical help. We conducted a systematic review of what people experience and how they make decisions during this time, and used a meta-ethnographic approach to synthesise the findings. Screening and quality assessment resulted in nine studies eligible for inclusion. People with dementia mainly report experiencing memory lapses, while carers focus on more subtle changes in personality. People respond to these changes in one of three ways: 1) they discount them as normal; 2) they reserve judgement as to their cause and significance, or 3) they misattribute them. Pivotal events can finally trigger help seeking. Active reflection and seeking of further evidence may lead to earlier recognition of the possibility of dementia and the need to seek help; it also reduces the risk of a pivotal event. Public education should aim to improve recognition of more subtle signs and to encourage repeated evaluation and reflection.
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Wright K, Dodd A, Warren FC, Medina-Lara A, Taylor R, Jones S, Owens C, Javaid M, Dunn B, Harvey JE, et al (2018). The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study.
Trials,
19(1).
Abstract:
The clinical and cost effectiveness of adapted dialectical behaviour therapy (DBT) for bipolar mood instability in primary care (ThrIVe-B programme): a feasibility study.
BACKGROUND: in bipolar spectrum disorder, some individuals experience ongoing, frequent fluctuations in mood outside of affective episodes. There are currently no evidence-based psychological interventions designed to address this. This feasibility study is a phase II evaluation of a dialectical behavioural therapy-informed approach (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). It seeks to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme. METHODS/DESIGN: Patients will be randomised 1:1 to either treatment as usual only (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points will be at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point for the candidate primary outcome measures. We aim to recruit 48 individuals meeting diagnostic criteria for a bipolar spectrum disorder and reporting frequent mood swings outside of acute episodes, through primary and secondary care services and self-referral. To evaluate feasibility and acceptability, we will examine recruitment and retention rates, completion rates for study measures and feedback from participants on their experience of study participation and therapy. DISCUSSION: Proceeding to a definitive trial will be indicated if the following criteria are met: (1) trial participation does not lead to serious negative consequences for our participants; (2) any serious concerns about the acceptability and feasibility of the trial procedures can be rectified prior to a definitive trial; (3) follow-up data at 9 months are available for at least 60% of participants; (4) at least 60% of patients in the ThrIVe-B arm complete treatment. TRIAL REGISTRATION: ISRCTN, ISRCTN54234300. Registered on 20 July 2017.
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2017
Owens C, Charles N (2017). Development and evaluation of a leaflet for concerned family members and friends: 'It's safe to talk about suicide'.
Health Education Journal,
76(5), 582-594.
Abstract:
Development and evaluation of a leaflet for concerned family members and friends: 'It's safe to talk about suicide'
© the Author(s) 2017. Objectives: Significant others can play a key role in suicide prevention, but little attention has been given to the resources they may need in order to do so effectively. Based on previous qualitative research and working in partnership with suicide prevention charities, we developed a simple educational leaflet to help family members and friends recognise and respond to a possible suicidal crisis. We disseminated 15,000 copies through a wide range of community agencies within one English local authority. This paper describes the development, distribution and evaluation of the leaflet. The aim of the evaluation was to assess how the distribution strategy was working, whether the leaflet was regarded as useful and acceptable, how it was being used and whether there were any concerns about its content. Design: Interview study. Methods: We conducted two rounds of semi-structured telephone interviews with every agency on the distribution list and in-depth qualitative interviews with a purposefully selected sub-sample. Results: the leaflet was seen as filling an important gap. It was eagerly embraced by staff in frontline agencies, who passed it on to clients, used it for their own personal/professional development and to support clients or colleagues, or used it as a teaching aid. No concerns were raised about its content. Conclusion: Findings reveal a deep-seated fear of talking about suicide among frontline staff. They were using the leaflet in ways we had not anticipated, demonstrating lateral thinking and a real commitment to suicide prevention in agencies that are not typically associated with it.
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Malone KM, McGuinness SG, Cleary E, Jefferies J, Owens C, Kelleher CC (2017). Lived Lives: a Pavee Perspective. An arts-science community intervention around suicide in an indigenous ethnic minority.
Wellcome Open Research,
2, 27-27.
Abstract:
Lived Lives: a Pavee Perspective. An arts-science community intervention around suicide in an indigenous ethnic minority
Background: Suicide is a significant public health concern, which impacts on health outcomes. Few suicide research studies have been interdisciplinary. We combined a psychobiographical autopsy with a visual arts autopsy, in which families donated stories, images and objects associated with the lived life of a loved one lost to suicide. From this interdisciplinary research platform, a mediated exhibition was created (Lived Lives) with artist, scientist and families, co-curated by communities, facilitating dialogue, response and public action around suicide prevention. Indigenous ethnic minorities (IEMs) bear a significant increased risk for suicide. Irish Travellers are an IEM with social and cultural parallels with IEMs internationally, experiencing racism, discrimination, and poor health outcomes including elevated suicide rates (SMR 6.6). Methods: an adjusted Lived Lives exhibition, Lived Lives: a Pavee Perspective manifested in Pavee Point, the national Traveller and Roma Centre. The project was evaluated by the Travelling Community as to how it related to suicide in their community, how it has shaped their understanding of suicide and its impacts, and its relevance to other socio-cultural contexts, nationally and internationally. The project also obtained feedback from all relevant stakeholders. Evaluation was carried out by an international visual arts research advisor and an independent observer from the field of suicide research. Results: Outputs included an arts-science mediated exhibition with reference to elevated Irish Traveller suicide rates. Digital online learning materials about suicide and its aftermath among Irish Travellers were also produced. The project reached its target audience, with a high level of engagement from members of the Travelling Community. Discussion: the Lived Lives methodology navigated the societal barriers of stigma and silence to foster communication and engagement, working with cultural values, consistent with an adapted intervention. Feedback from this project can inform awareness, health promotion, education and interventions around suicide and its aftermath in IEMs.
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2016
Owens C (2016). "Hotspots" and "copycats": a plea for more thoughtful language about suicide.
Lancet Psychiatry,
3(1), 19-20.
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Owens C, Charles N (2016). Implementation of a text-messaging intervention for adolescents who self-harm (TeenTEXT): a feasibility study using normalisation process theory.
Child Adolesc Psychiatry Ment Health,
10Abstract:
Implementation of a text-messaging intervention for adolescents who self-harm (TeenTEXT): a feasibility study using normalisation process theory.
BACKGROUND: There are few interventions that directly address self-harming behaviour among adolescents. At the request of clinicians in Child and Adolescent Mental Health Services (CAMHS) in England and working with them, we redeveloped an adult SMS text-messaging intervention to meet the needs of adolescents under the care of CAMHS who self-harm. METHODS: We used normalisation process theory (NPT) to assess the feasibility of delivering it through CAMHS. We planned to recruit 27 young people who self-harm and their clinicians, working as dyads and using the intervention (TeenTEXT) for 6 months. RESULTS: Despite strong engagement in principle from CAMHS teams, in practice we were able to recruit only three clinician/client dyads. of these, two dropped out because the clients were too unwell. We identified a number of barriers to implementation. These included: a context of CAMHS in crisis, with heavy workloads and high stress levels; organisational gatekeeping practices, which limited the extent to which clinicians could engage with the intervention; perceived burdensomeness and technophobia on the part of clinicians, and a belief by many clinicians that CAMHS may be the wrong delivery setting and that the intervention may have better fit with schools and universal youth services. CONCLUSIONS: User-centred design principles and the use of participatory methods in intervention development are no guarantee of implementability. Barriers to implementation cannot always be foreseen, and early clinical champions may overestimate the readiness of colleagues to embrace new ideas and technologies. NPT studies have an important role to play in identifying whether or not interventions are likely to receive widespread clinical support. This study of a text-messaging intervention to support adolescents who self-harm (TeenTEXT) showed that further work is needed to identify the right delivery setting, before testing the efficacy of the intervention.
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Owens C, Hansford L, Sharkey S, Ford T (2016). Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data.
Br J Psychiatry,
208(3), 286-291.
Abstract:
Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data.
BACKGROUND: Presentation at an accident and emergency (A&E) department is a key opportunity to engage with a young person who self-harms. The needs of this vulnerable group and their fears about presenting to healthcare services, including A&E, are poorly understood. AIMS: to examine young people's perceptions of A&E treatment following self-harm and their views on what constitutes a positive clinical encounter. METHOD: Secondary analysis of qualitative data from an experimental online discussion forum. Threads selected for secondary analysis represent the views of 31 young people aged 16-25 with experience of self-harm. RESULTS: Participants reported avoiding A&E whenever possible, based on their own and others' previous poor experiences. When forced to seek emergency care, they did so with feelings of shame and unworthiness. These feelings were reinforced when they received what they perceived as punitive treatment from A&E staff, perpetuating a cycle of shame, avoidance and further self-harm. Positive encounters were those in which they received 'treatment as usual', i.e. non-discriminatory care, delivered with kindness, which had the potential to challenge negative self-evaluation and break the cycle. CONCLUSIONS: the clinical needs of young people who self-harm continue to demand urgent attention. Further hypothesis testing and trials of different models of care delivery for this vulnerable group are warranted.
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Quinn C, Brand S, Owens C, Byng R (2016). Synthesizing Multiple Qualitative Data Sets and Refining the Results in Complex Settings: Power and Paradigms.
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2015
Owens C, Sharkey S, Smithson J, Hewis E, Emmens T, Ford T, Jones R (2015). Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study.
Health Expect,
18(1), 81-94.
Abstract:
Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study.
BACKGROUND: Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa. AIM: We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice. METHODS: We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction. RESULTS: the young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators. CONCLUSIONS: Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities.
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Sweeney L, Owens C, Malone K (2015). Communication and interpretation of emotional distress within the friendships of young Irish men prior to suicide: a qualitative study.
Health Soc Care Community,
23(2), 150-158.
Abstract:
Communication and interpretation of emotional distress within the friendships of young Irish men prior to suicide: a qualitative study.
The potential for young men in crisis to be supported by their lay networks is an important issue for suicide prevention, due to the under-utilisation of healthcare services by this population. Central to the provision of lay support is the capability of social networks to recognise and respond effectively to young men's psychological distress and suicide risk. The aim of this qualitative study was to explore young men's narratives of peer suicide, in order to identify how they interpreted and responded to behavioural changes and indications of distress from their friend before suicide. In-depth qualitative interviews were conducted during 2009/10 with 15 Irish males (aged 19-30 years) who had experienced the death by suicide of a male friend in the preceding 5 years. The data were analysed using a thematic approach. Through the analysis of the participants' stories and experiences, we identified several features of young male friendships and social interactions that could be addressed to strengthen the support available to young men in crisis. These included the reluctance of young men to discuss emotional or personal issues within male friendships; the tendency to reveal worries and emotion only within the context of alcohol consumption; the tendency of friends to respond in a dismissive or disapproving way to communication of suicidal thoughts; the difficulty of knowing how to interpret a friend's inconsistent or ambiguous behaviour prior to suicide; and beliefs about the sort of person who takes their own life. Community-based suicide prevention initiatives must enhance the potential of young male social networks to support young men in crisis, through specific provisions for developing openness in communication and responsiveness, and improved education about suicide risk.
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Byng R, Howerton A, Owens CV, Campbell J (2015). Pathways to suicide attempts among male offenders: the role of agency.
Sociol Health Illn,
37(6), 936-951.
Abstract:
Pathways to suicide attempts among male offenders: the role of agency.
Suicide is common among offenders, who are at increased risk of homelessness, unemployment and mental illness and are prone to impulsivity. Release from prison is a particularly vulnerable time. This qualitative study investigated the views of 35 offenders in South-West England prior to and after release from prison, enquiring into their previous suicide attempts and how they saw their future. Semi-structured interviews were analysed thematically, comparing individuals who had made one, more than one, and no suicide attempts. Multiple attempters were often in despair and enmeshed in substance misuse, with little control over their lives. Most of those with one-off or no previous attempts portrayed themselves as having more mastery. One-off attempters described using particularly violent means. The role of different types of agency in pathways to and from suicide is discussed. Iterational agency, the selective reactivation of past patterns of behaviour, appeared to dominate in individuals who were choosing between further suicide attempts and substance use. Projective agency, having a more future orientation, appeared more prominent in some single attempters and in those individuals with plans to escape crime and social exclusion.
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Owens CV, Hardwick RJL, Charles NT, Watkinson G (2015).
Preventing suicides in public places: a practice resource. London, Department of Health.
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2014
Owens C, Roberts S, Taylor J (2014). Utility of local suicide data for informing local and national suicide prevention strategies.
Public Health,
128(5), 424-429.
Abstract:
Utility of local suicide data for informing local and national suicide prevention strategies.
OBJECTIVES: the practice of 'suicide audit' refers to the systematic collection of local data on suicides in order to learn lessons and inform suicide prevention plans. Little is known about the utility of this activity. The aim of this study was to ascertain from Directors of Public Health in England how they were conducting suicide audit and what resources they were investing in it; how the findings were being used, and how the process might be improved. STUDY DESIGN: E-mail survey. METHODS: a questionnaire was sent to all 153 Primary Care Trusts (PCTs) in England prior to their dissolution in 2013. Simple descriptive statistics were performed in an Excel database. RESULTS: Responses were received from 49% of PCTs, of which 83% were conducting a regular audit of deaths by suicide. Many had worked hard to overcome procedural obstacles and were investing huge amounts of time and effort in collecting data, but it is not clear that the findings were being translated effectively into action. With few exceptions, PCTs were unable to demonstrate that the findings of local audits had influenced their suicide prevention plans. CONCLUSIONS: in the light of fresh calls for the practice of suicide audit to be made mandatory in England, these results are worrying. The study suggests that there is a pressing need for practical guidance on how the findings of local suicide audits can be put to use, and proposes a framework within which such guidance could be developed.
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2013
Cox GR, Owens C, Robinson J, Nicholas A, Lockley A, Williamson M, Cheung YTD, Pirkis J (2013). Interventions to reduce suicides at suicide hotspots: a systematic review.
BMC Public Health,
13Abstract:
Interventions to reduce suicides at suicide hotspots: a systematic review.
BACKGROUND: 'Suicide hotspots' include tall structures (for example, bridges and cliffs), railway tracks, and isolated locations (for example, rural car parks) which offer direct means for suicide or seclusion that prevents intervention. METHODS: We searched Medline for studies that could inform the following question: 'What interventions are available to reduce suicides at hotspots, and are they effective?' RESULTS: There are four main approaches: (a) restricting access to means (through installation of physical barriers); (b) encouraging help-seeking (by placement of signs and telephones); (c) increasing the likelihood of intervention by a third party (through surveillance and staff training); and (d) encouraging responsible media reporting of suicide (through guidelines for journalists). There is relatively strong evidence that reducing access to means can avert suicides at hotspots without substitution effects. The evidence is weaker for the other approaches, although they show promise. CONCLUSIONS: More well-designed intervention studies are needed to strengthen this evidence base.
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2012
Owens C, Lambert H (2012). Mad, bad or heroic? Gender, identity and accountability in lay portrayals of suicide in late twentieth-century England.
Cult Med Psychiatry,
36(2), 348-371.
Abstract:
Mad, bad or heroic? Gender, identity and accountability in lay portrayals of suicide in late twentieth-century England.
Suicide research has relied heavily on the psychological autopsy method, which uses interviews with the bereaved to ascertain the mental health status of the deceased prior to death. The resulting data are typically interpreted within a clinical diagnostic framework, which reinforces psychiatric assumptions concerning the ubiquity of mental illness amongst those who take their own lives. The ways in which informants reconstruct the past and the meanings they attach to events preceding the suicide are rarely examined. This paper uses qualitative methods to analyse the narratives given by bereaved people in an English psychological autopsy study, in order to understand how they made sense of a family member's suicide. Some clear differences between the portrayal of male and female suicides emerged. The paper discusses the gendering of agency and accountability in relation to the differential medicalisation of male and female distress in the UK, and suggests that a preoccupation with mental illness in suicide research may have obscured other culturally normative understandings of self-accomplished death.
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Mcloughlin AB, Malone KM, Owens C, Kelleher C (2012). SUICIDE IN THE CHILDREN OF IRELAND FROM 2003-2008: a MIXED METHOD STUDY.
IRISH JOURNAL OF MEDICAL SCIENCE,
181, S446-S446.
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Owen G, Belam J, Lambert H, Donovan J, Rapport F, Owens C (2012). Suicide communication events: lay interpretation of the communication of suicidal ideation and intent.
Soc Sci Med,
75(2), 419-428.
Abstract:
Suicide communication events: lay interpretation of the communication of suicidal ideation and intent.
Previous research has shown that a majority of people communicate their suicidal ideas and intent prior to the act of suicide, but very little is known about the way in which these suicide communication events are interpreted by relatives, friends and significant others. A suicide communication event (SCE) is defined as a set of circumstances in which a person expresses suicidal feelings, thoughts, intentions or plans, either directly or indirectly, in interaction with other people in their social environment. In a qualitative study conducted in 2008-9 we collected narratives from people bereaved by suicide. Here we examine these narratives using an analytic framework derived from communication pragmatics and face-work theory. We analysed 14 cases of completed suicide drawn from coroner's case files in London, Southwest England and South Wales. We found that the SCEs described were potentially face-threatening situations requiring face-saving strategies, which often resulted in off-record, indirect, ambiguous, humorous and euphemistic communications. Listeners frequently found it difficult to judge the meaning and intention of utterances referring to suicide. The outcome was often misunderstanding and closure of the communication, limiting the possibility of further support and referral for professional help. SCEs are important elements of the suicide process and we conclude that better understanding of how they occur and the challenges they pose for significant others may provide a basis for strengthening public involvement in suicide prevention. We draw our findings together in a model that could inform public awareness campaigns designed to improve the way people communicate with each other about suicide and distress.
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Sharkey S, Smithson J, Hewis E, Jones R, Emmens T, Ford T, Owens C (2012). Supportive interchanges and face-work as 'protective talk' in an online self-harm support forum.
Communication and Medicine,
9(1), 71-82.
Abstract:
Supportive interchanges and face-work as 'protective talk' in an online self-harm support forum
Within a context of concern about inappropriate advice-giving online, we examined how young people who self-harm behave online, and how professionals might engage with them. We use Discourse Analysis to focus on participant interactions (posts) from a forum's crisis/support rooms, and highlight the prevalence of disclaimers, hedges, questions and tags in the young people's online interactions. We use the concept of facework as a framework to help understand interactions in the forum SharpTalk. The findings demonstrate the use of a range of mitigation devices, and suggest that the young people orientate to a 'protective' line in their supportive interactions. These findings echo Goffman's (1967) 'supportive interchanges' in that the young people's online interactions may help to preserve face, in an emotionally complex setting, whose vulnerable members also need 'protective' and sensitive support. Taking this 'line' may enable members to create a more open and trusting context for support, and to remain in a forum which they find both helpful and challenging. In light of concerns about online support, the findings provide a new perspective on online peer-support for young people who self-harm. © Equinox Publishing Ltd.
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2011
Byng R, Weyer Brown C, Sheaff R, Samele C, Deggan C, Owens C, Harrison D, Smithson P, Wright C, Annison J, et al (2011). Care for Offenders; Continuity of Access (COCOA). NIHR Service Delivery and Organisation Programme.
Sharkey S, Jones R, Smithson J, Hewis E, Emmens T, Ford T, Owens C (2011). Ethical practice in internet research involving vulnerable people: lessons from a self-harm discussion forum study (SharpTalk).
J Med Ethics,
37(12), 752-758.
Abstract:
Ethical practice in internet research involving vulnerable people: lessons from a self-harm discussion forum study (SharpTalk).
The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: participant usernames specific to the study, a closed website, private messaging facilities, a direct contact email to researchers, information about forum rules displayed on the website, a 'report' button for participants, links to online support, and a discussion room for forum moderators. This experience with SharpTalk suggests that an approach to ethics, which recognises the relational aspects of research with vulnerable people, is particularly useful for internet-based health research. The solutions presented here can act as guidance for researchers developing proposals and for ethics committees reviewing them.
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Smithson J, Sharkey S, Hewis E, Jones RB, Emmens T, Ford T, Owens C (2011). Membership and boundary maintenance on an online self-harm forum.
Qual Health Res,
21(11), 1567-1575.
Abstract:
Membership and boundary maintenance on an online self-harm forum.
In this article we explore how young adults became members and sustained membership in an online self-harm support forum, SharpTalk. We take a discursive approach to consider resources young people used to establish themselves, how others responded to their attempts, and how membership categories were developed and applied. Participants displayed expectations about appropriate ways of discussing self-harm, and about responses and advice. New posters made reference to other self-harm sites, provided biomedicalized narratives of their "story," and asked for help in particular ways. Participants were active in shaping interactions on the forum, requesting input from site moderators, and challenging each other both on perceived infringements of posting content, and on style of posting pertinent to membership. On the SharpTalk site, perceived deviance in posting behavior, and also the giving of health care advice, were most commonly addressed by other young people who self-harmed, rather than by the site moderators. We consider implications for creating sites that enable young people who self-harm to become members and sustain membership, and therefore access support.
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Jones R, Sharkey S, Ford T, Emmens T, Hewis E, Smithson J, Sheaves B, Owens C (2011). Online discussion forums for young people who self-harm: User views.
Psychiatrist,
35(10), 364-368.
Abstract:
Online discussion forums for young people who self-harm: User views
Aims and method: to explore what young people who self-harm think about online self-harm discussion forums. SharpTalk was set up to facilitate shared learning between health professionals and young people who self-harm.We extracted themes and illustrative statements from the online discussion and asked participants to rate statements. Results: of 77 young people who participated in the forum, 47 completed the questionnaire. They said they learned more about mental health issues from online discussion forums than from information sites, found it easier to talk about self-harm to strangers than to family or friends, and preferred to talk online than face-to-face or on the telephone. They valued the anonymity the forums provided and reported feeling more able to disclose and less likely to be judged online than in 'real life'. Clinical implications: Mental health professionals should be aware of the value of anonymous online discussion forums for some young people who self-harm, so that they can talk about them and assess their use with their patients. Declaration of interest: None.
Abstract.
Smithson J, Sharkey S, Hewis E, Jones R, Emmens T, Ford T, Owens C (2011). Problem presentation and responses on an online forum for young people who self-harm.
DISCOURSE STUDIES,
13(4), 487-501.
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Owens C, Owen G, Belam J, Lloyd K, Rapport F, Donovan J, Lambert H (2011). Recognising and responding to suicidal crisis within family and social networks: qualitative study.
BMJ,
343Abstract:
Recognising and responding to suicidal crisis within family and social networks: qualitative study.
OBJECTIVE: to shed light on the difficulties faced by relatives, friends, and colleagues in interpreting signs of suicidality and deciding whether and how to intervene. DESIGN: Qualitative study of completed suicides, based on in-depth interviews with multiple informants. SETTING: London, southwest England, and south Wales. PARTICIPANTS: 31 lay informants (one to five for each case), including parents, partners, siblings, friends, and colleagues of 14 cases of suicide in which the deceased was aged 18-34 and was not in contact with secondary mental health services. RESULTS: Informants described both intellectual and emotional barriers to awareness and intervention within the family and social network. They reported that signs and communications of distress were often oblique and difficult to interpret, that they may have disregarded warning signals and focused instead on positive signs, and that, even when they were aware that something was seriously wrong, taking any action at all involved considerable personal risks. CONCLUSIONS: As the suicidal process unfolds, significant others are faced with a highly complex task. Their proximity to the suicidal person and their emotional investment in the relationship make it difficult for them to see what is happening, to say anything to the person or to other members of the network, or to seek help outside the network. Efforts to strengthen the capacity of lay people to play a role in preventing suicide are urgently needed and should be informed by a thorough understanding of these difficulties. They should highlight the ambiguous nature of warning signs and should focus on helping people to acknowledge and overcome their fears about intervening.
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Owens C, Sharkey S (2011). Safety and privacy in online research with young people who self-harm. In Alderson P, Morrow V (Eds.) The ethics of research with children and young people: a practical handbook, London: Sage.
Jones R, Sharkey S, Smithson J, Ford T, Emmens T, Hewis E, Sheaves B, Owens C (2011). Using Metrics to Describe the Participative Stances of Members Within Discussion Forums.
JOURNAL OF MEDICAL INTERNET RESEARCH,
13(1), 212-226.
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2010
Owens C (2010). Interventions for self-harm: Are we measuring outcomes in the most appropriate way?. British Journal of Psychiatry, 197(6), 502-503.
Owens C, Farrand P, Emmens T, Darvill R, Hewis E, Aitken P (2010). Involving service users in intervention design: a participatory approach to developing a text-messaging intervention to reduce repetition of self-harm. Health Expectations, 14, 285-295.
2009
Owens C, Owen G, Lambert H, Donovan J, Belam J, Rapport F, Lloyd K (2009). Public involvement in suicide prevention: understanding and strengthening lay responses to distress.
BMC Public Health,
9Abstract:
Public involvement in suicide prevention: understanding and strengthening lay responses to distress.
BACKGROUND: the slogan "Suicide prevention is everyone's business" has been used in a number of campaigns worldwide in recent years, but most research into suicide prevention has focused on the role of medical professionals in identifying and managing risk. Little consideration has been given to the role that lay people can play in suicide prevention, or to the resources they need in order to do so.The majority of people who take their own lives are not under the care of specialist mental health services, and around half have not had recent contact with their general practitioner. These individuals are not known to be 'at risk' and there is little or no opportunity for clinical intervention. Family members and friends may be the only ones to know that a person is troubled or distressed, and their capacity to recognise, assess and respond to that distress is therefore vitally important. This study aims to discover what the suicidal process looks like from the point of view of relatives and friends and to gain insight into the complex and difficult judgements that people have to make when trying to support a distressed individual. METHODS/DESIGN: the study uses qualitative methods to build up a detailed picture of 15-20 completed suicides, aged 18-34. Data are gathered by means of in-depth interviews with relatives, friends and others who knew the deceased well. In each case, as many informants as possible are sought using a purposive snowballing technique. Interviews focus on the family and social network of the deceased, the ways in which relatives and friends interpreted and responded to his/her distress, the potential for intervention that may have existed within the lay network and the knowledge, skills and other resources that would have helped members to support the distressed individual more effectively. DISCUSSION: the study will inform interventions to promote public mental health awareness and will provide a basis on which to develop community-focussed suicide prevention strategies.
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Owens C, Lloyd-Tomlins S, Emmens T, Aitken P (2009). Suicides in public places: findings from one English county.
Eur J Public Health,
19(6), 580-582.
Abstract:
Suicides in public places: findings from one English county.
Little is known about where suicides take place. We collected data from coroners' files on all suicides and undetermined deaths in one large English county from 2000 to 2004. The data show that >30% of suicides occurred in public places. A quarter of these involved jumping from a height and nearly a quarter involved car exhaust poisoning. Several sites were associated with multiple methods of suicide. Identifying and managing high-risk locations should be an important part of an overall suicide prevention strategy and is best tackled at local level.
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2008
Owens C, Ley A, Aitken P (2008). Do different stakeholder groups share mental health research priorities? a four-arm Delphi study.
Health Expect,
11(4), 418-431.
Abstract:
Do different stakeholder groups share mental health research priorities? a four-arm Delphi study.
BACKGROUND: Despite considerable investment in research priority setting within diverse fields of healthcare, little is known about the extent to which different stakeholder groups share research priorities. Conflicting priorities may jeopardize stakeholder engagement in research. OBJECTIVE: to identify the research priorities of different stakeholder groups within mental health care and examine the extent and nature of agreement between them. DESIGN: Using a Delphi technique, we conducted parallel consultation processes within four different stakeholder groups. Each group process consisted of three rounds. SETTING AND PARTICIPANTS: the study was carried out within a mental health and learning disabilities trust in southern England. Participants were recruited from the following groups: mental health service users (34), informal carers (26), mental health practitioners (35) and service managers (23). FINDINGS: There were striking differences between the four groups in respect of their ability and willingness to make priority decisions. These differences notwithstanding, there was considerable overlap in respect of their research interests. All groups identified and attached high importance to issues relating to the promotion of independence, self-esteem and recovery. The quality of in-patient care, the place of psychological therapies and the relationship between physical and mental health also emerged across the board. CONCLUSIONS: the confluence of four different stakeholder groups around a number of clear themes is highly encouraging, providing a framework within which to construct a research agenda and suggesting that mental health research can be built on solid partnerships.
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Owens C, Lambert H, Lloyd K, Donovan J (2008). Tales of biographical disintegration: how parents make sense of their sons' suicides.
Sociol Health Illn,
30(2), 237-254.
Abstract:
Tales of biographical disintegration: how parents make sense of their sons' suicides.
Suicide research relies heavily on accounts provided by bereaved relatives, using a method known as the psychological autopsy. Psychological autopsy studies are invariably quantitative in design and their findings reinforce the medical model of suicide, emphasising the role of mental illness. They largely ignore the meanings that narrators attach to events, the nature of the sense-making task and the influences bearing upon it. This study drew on psychological autopsy data but used qualitative analytic methods. Fourteen semi-structured interviews with the parents of young men aged 18-30 who had taken their own lives form the basis for this paper. Some parents represent their sons as victims who were cruelly destroyed by external forces, while others portray them as agents of their own destruction. Either way, their narratives are dominated by moral rather than medical categories and by questions of personal accountability. We show how the parents use the interview to perform a complex reconstructive task, striving to piece together both their son's and their own shattered biographies and repair damage to their moral identities. We argue that their stories represent survival tools, enabling them not only to make sense of the past but also to face their own future.
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2007
Owens C (2007). Guidance on action to be taken at suicide hotspots. Translated into Japanese. Tokyo, National Institute of Mental Health.
Howerton A, Byng R, Campbell J, Hess D, Owens C, Aitken P (2007). Understanding help seeking behaviour among male offenders: qualitative interview study.
BMJ,
334(7588).
Abstract:
Understanding help seeking behaviour among male offenders: qualitative interview study.
OBJECTIVE: to explore the factors that influence help seeking for mental distress by offenders. DESIGN: Qualitative study based on in-depth interviews with prisoners before and after release. SETTING: One category B local prison in southern England. PARTICIPANTS: 35 male offenders aged 18-52, a quarter of whom had been flagged as being at risk of self harm. RESULTS: Most respondents reported that they would not seek help from a general practitioner or other healthcare professional if experiencing mental distress. When followed up after release, none had sought medical help despite the fact that many had considerable emotional problems. Many participants were hesitant to seek help because they feared being given a formal diagnosis of mental illness. Some of these men feared the stigma that such a diagnosis would bring, whereas others feared that a diagnosis would mean having to confront the problem. Lack of trust emerged as the most prominent theme in prisoners' discourse about not seeking help from health professionals. Distrust towards the "system" and authority figures in general was linked to adverse childhood experiences. Distrust directed specifically at healthcare professionals was often expressed as specific negative beliefs: many perceived that health professionals (most often doctors) "just don't care," "just want to medicate," and treat patients "superficially." Those men who would consider going to a general practitioner reported positive previous experiences of being respected and listened to. CONCLUSIONS: Distrust is a major barrier to accessing health care among offenders. Like most people, the respondents in this study wanted to feel listened to, acknowledged, and treated as individuals by health professionals. By ensuring that a positive precedent is set, particularly for sceptical groups such as ex-prisoners, general practitioners and prison doctors may be able to encourage future help seeking. Information specifically designed for prisoners is needed to help to de-stigmatise mental illness, and preparation for release should include provision of information about access to health and social services. Awareness training for health professionals is recommended: trust might be fostered in this population by seemingly trivial gestures that indicate respect.
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2006
Owens C (2006). Guidance on action to be taken at suicide hotspots. Leeds, National Institute for Mental Health in England.
2005
Owens C, Lambert H, Donovan J, Lloyd KR (2005). A qualitative study of help seeking and primary care consultation prior to suicide.
Br J Gen Pract,
55(516), 503-509.
Abstract:
A qualitative study of help seeking and primary care consultation prior to suicide.
BACKGROUND: Many suicides may be preventable through medical intervention, but many people do not seek help from a medical practitioner prior to suicide. Little is known about how consulting decisions are made at this time. AIM: to explore how distressed individuals and members of their lay networks had made decisions to seek or not to seek help from a medical practitioner in the period leading up to suicide. DESIGN OF STUDY: Qualitative analysis of psychological autopsy data. SETTING: One large English county. METHOD: Semi-structured interviews with close relatives or friends of suicide victims were conducted as part of a psychological autopsy study. Sixty-six interviews were transcribed verbatim and analysed using a thematic approach. RESULTS: Relatives and friends often played a key role in determining whether or not suicidal individuals sought medical help. Half the sample had consulted in their final month and many were persuaded to do so by a relative or friend. of those who did not consult, some were characterised as help-resisters but many others had omitted to do so because no-one around them was aware of the seriousness of their distress or considered it to be medically significant. A range of lay interventions and coping strategies was identified, including seeking non-medical help. CONCLUSION: Greater attention needs to be given to the potential role of lay networks in managing psychological distress and preventing suicide. A balanced approach to suicide prevention is recommended that builds on lay knowledge and combines medical and non-medical strategies.
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Hounsell J, Owens C (2005). User researchers in control: rhetoric and reality of user-led research. Mental Health Today, 29-32.
2004
Owens C, Lloyd KR, Campbell J (2004). Access to health care prior to suicide: findings from a psychological autopsy study.
Br J Gen Pract,
54(501), 279-281.
Abstract:
Access to health care prior to suicide: findings from a psychological autopsy study.
Previous research has suggested that progress towards suicide reduction targets may be achieved by improving the ability of general practitioners to recognise and treat mental illness. Using data from a study of suicide completers who were not in contact with specialist mental health services, we found that the rate of detection and treatment of mental health problems in primary care was high. The major barrier to receipt of care for mental health problems prior to suicide was non-consultation. The study also shows that detection and management in primary care does not necessarily result in prevention of suicide. Implications for public education, access to primary care services and the potential for suicide prevention are considered.
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Owens (2004). The glass-walled asylum: a description of a lay residential community for the severely mentally ill. Journal of Mental Health, 13(3), 319-332.
2003
Owens C, Booth N, Briscoe M, Lawrence C, Lloyd K (2003). Suicide outside the care of mental health services: a case-controlled psychological autopsy study.
Crisis,
24(3), 113-121.
Abstract:
Suicide outside the care of mental health services: a case-controlled psychological autopsy study.
BACKGROUND: Three-quarters of people who commit suicide are not in contact with mental health services at the time of death. No previous UK study has focused specifically on this group of suicides. AIMS: to identify the characteristics of people who commit suicide while outside the care of mental health services. METHOD: a case-control study was conducted in SW England involving 100 individuals who committed suicide while not in contact with mental health services and 100 age-sex matched controls drawn from the living population. Data were collected by means of semistructured interviews with key informants and from medical records. RESULTS: Key predictors of suicide were previous attempted suicide, social and interpersonal problems, current mental illness, past mental illness, and previous contact with specialist services. However, nearly a third of cases (32%) appeared to have no current mental disorder. CONCLUSION: This group is distinguished by a markedly lower rate of mental illness than has previously been recorded. The findings highlight the difficulty of identifying individuals outside specialist mental health care who are at risk of suicide and therefore support the continued development of broad population-based measures rather than the targeting of high-risk groups.
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2000
Lloyd KR, Booth NJ, Owens CV (2000). A case control study of suicide amongst persons not involved with mental health services.
EUROPEAN PSYCHIATRY,
15, 270S-270S.
Author URL.
Booth N, Owens C (2000). Silent suicide: Suicide among people not in contact with mental health services. International Review of Psychiatry, 12(1), 27-30.
1999
Owens C, Goble R, Pereira Gray D (1999). Involvement in multiprofessional continuing education: a local survey of 24 health care professions.
Journal of Interprofessional Care,
13(3), 277-288.
Abstract:
Involvement in multiprofessional continuing education: a local survey of 24 health care professions
Multiprofessional education is becoming recognised increasingly widely as the way forward for the health professions. A survey was conducted within one English health authority, namely North and East Devon, to determine how much of it was actually taking place at post-qualifying level. Unlike previous surveys, which have mostly been addressed to educational providers, this was sent to individual workers in all the established health professions and sought to measure the extent of actual involvement within each profession, along with attitudes towards learning in a multiprofessional context. Nearly three-quarters of those who replied had been involved in some form of multiprofessional education during a specified 12-month period, although levels of involvement varied greatly between professions, with some professions having markedly better access to opportunities than others. A key finding was that a number of professions are effectively excluded from multiprofessional education. Considerable interest in learning in a multiprofessional setting was found at all levels and amongst all groups of health professionals, and there was a clear demand from all professions for more opportunities, especially in the field of counselling and communication skills.
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