Evaluation of The Practitioner Online Referral and Treatment Service (PORTS): the first 18 months of a state-wide digital service for adults with anxiety,depression, or substance use problems

ABSTRACT

The Practitioner Online Referral and Treatment Service (PORTS) is a new digital mental health service (DMHS) providing assessment, treatment, and consultation across Western Australia, for adults with anxiety, depression, or substance use problems, and experiencing financial hardship or geographical disadvantage. From July 2017 to December 2018, a total of 2,527 individuals were referred to PORTS. Of these, 150 (6%) did not give consent for their results to be analysed. Of the remaining 2,377 patients, 615 (26%) could not be contacted to confirm the referral, 596 (25%) received assessment or information from PORTS, 427 (18%) were referred to another service, and 739 (31%) commenced treatment at PORTS. Almost half (47%) of patients were from areas with significant socio-economic disadvantage. Those referred by another mental health service were more likely to engage in treatment than those referred by a General Practitioner (GP). Overall outcomes were excellent, with large effect sizes (Cohen’s d: 1.1–1.4), from assessment to post-treatment and 3-month follow-up, reliable deterioration was low, and GP and patient satisfaction was high. These results indicate that the PORTS DMHS model is a promising method for engaging primary care patients with anxiety and depression, including those experiencing financial and geographical disadvantage.     

Harm inflation: Making sense of concept creep

ABSTRACT

“Concept creep” is the gradual semantic expansion of harm-related concepts such as bullying, mental disorder, prejudice, and trauma. This review presents a synopsis of relevant theoretical advances and empirical research findings on the phenomenon. It addresses three fundamental questions. First, it clarifies the characterisation of concept creep by refining its theoretical and historical dimensions and presenting studies investigating the change in harm-related concepts using computational linguistics. Second, it examines factors that have caused concept creep, including cultural shifts in sensitivity to harm, societal changes in the prevalence of harm, and intentional meaning changes engineered for political ends. Third, the paper develops an account of the consequences of concept creep, including social conflict, political polarisation, speech restrictions, victim identities, and progressive social change. This extended analysis of concept creep helps to understand its mixed implications and sets a multi-pronged agenda for future research on the topic.     

Humour is serious: Minority group members’ use of humour in their encounters with majority group members

This article adds to the social psychological literature on how minority group members seek to manage their interactions with majority group members. Specifically, it focuses on minority group members’ use of humour in interactions where they anticipate or actually experience prejudice. The data on which our analysis is based originate from interviews conducted with Roma in Hungary (N = 30). Asked about their interactions with majority group members, interviewees reported using humour as a means to (a) manage embarrassment; (b) gather information about the other's intergroup attitudes; and (c) subvert taken-for-granted understandings of social relations. The humour involved was diverse. Sometimes it entailed the telling of (Roma-related) jokes. Sometimes it involved the exaggerated performance of roles and identities that ironised majority–minority social relations. The significance of humour as a tool for minority group members to exert some control over their interactions with majority group members is discussed.     

The Building of Epistemic Trust: An Adoptive Family’s Experience of Mentalization-Based Therapy

ABSTRACT

Recently, theorists have posited the development of epistemic trust – the trust in others as reliable sources of information – as an essential aspect of the therapeutic relationship and a mechanism of therapeutic change. Epistemic trust is likely to be disrupted in adoptive children and families and Mentalization Based Treatment (MBT) aims to explicitly promote its development. Therefore, this study aims to investigate how epistemic mistrust is addressed and how epistemic trust is established within the MBT framework. This single-case, exploratory study reports data from in-depth interviews with one adoptive family, which were analyzed qualitatively using Interpretative Phenomenological Analysis. Two superordinate themes are reported: pre-therapy factors contributing to epistemic mistrust and factors contributing to the development of epistemic trust. The findings highlight two critical elements in establishing epistemic trust: the use of certain clinical skills that help build a secure base within therapy and the possibility of trust being transferred from and to other professionals/systems beyond therapy. Hence, this study informs a deeper understanding of how epistemic trust may be built in therapeutic work with adopted children and identifies possible clinical approaches that may be used by clinicians working with this client group.