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SInQUE Team Profile

Professor Gill Mezey

Professor and Honorary Consultant Forensic Psychiatrist, St Georges University of London and South West London NHS Mental Health Trust.

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Dr Sarah White

Statistician, Population Health Research Institute, St Georges University of London.

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Professor Helen Killaspy

Professor of Rehabilitation Psychiatry, University College London.

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Dr Brynmor Lloyd Evans

Senior Lecturer in Mental Health and Social Care, Division of Psychiatry, University College London.

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Professor Sarah Payne

Professor in Health Policy and Gender, School for Policy Studies, University of Bristol.

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Jenny Bousfield

Research Assistant, Division of Population Health Research Institute, St Georges University of London.

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Isobel Harrison

Research Associate, Division of Psychiatry, University College London.

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The SInQUE

The SInQUE (Social Inclusion Questionnaire User Experience) was developed by the team in 2012 to assess experiences of social inclusion in mental health service users. The SInQUE may be used by both clinicians and researchers in mental health. It was first piloted on individuals with a diagnosis of Schizophrenia (Mezey et al 2012). The pilot identified problems specifically in relation to social integration and work/educational participation in this group, which appeared to become more severe, the longer the person had been ill (Killaspy et al 2014).

The SInQUE examines social inclusion across 5 different domains, which cover the following topics.

PRODUCTIVITY

Includes paid employment, voluntary work, and educational courses/training.

SOCIAL INTEGRATION

Includes friendships, family and intimate relationships, living situation, relationships within the wider community, religious/cultural, and social and leisure activitie.

CONSUMPTION

E.g. savings, debt, investments, personal possessions and financial circumstances.

ACCESS TO SERVICES

E.g. access to and use of GP/dentist, travel & life insurance.

POLITICAL ENGAGEMENT

Includes voting/campaigning & other civic duties.

The SInQUE Study

August 2015 - November 2017

In 2015 the team was awarded funding by the NIHR/SSCR to validate the SInQUE and to further explore associations between mental disorder and social exclusion and factors that exacerbate or ameliorate social inclusion.

SInQUE Study Flowchart

AIMS AND OBJECTIVES

  • To investigate the concurrent, convergent and discriminant validity and test-retest reliability of the SInQUE as a measure of social inclusion for individuals with severe mental health problems.
  • To describe and compare experiences of social inclusion in individuals across a range of different diagnostic groups.
  • To investigate, quantitatively and qualitatively, factors positively and negatively associated with social inclusion in individuals with severe mental health problems.
  • To undertake preliminary development work for an intervention to promote social inclusion in individuals with severe mental health problems.

METHOD

This study has two parts:

  • Quantitative survey of social inclusion among mental health service users and their unaffected siblings.
  • Qualitative interviews with mental health service users to explore experiences of social inclusion.

Findings from the study may be used to inform the development of interventions to promote social inclusion for people with severe mental health problems.

Participants will be recruited from secondary community mental health services in South West London and St Georges NHS Mental Health Trust and Camden and Islington NHS Foundation Trust. These will include adult community teams (e.g. Recovery Teams/Community Mental Health Teams/Community Rehabilitation Teams and Forensic Community Teams).

Quantitative

We have recruited 192 mental health service users with a primary diagnosis of a psychotic disorder: n=106); common mental disorder (n=49); and personality disorder (n=37).

Measures

Interviews consisted of several standardized questionnaires and the collection of socio-demographic variables and clinical history.

Service user participants: Socio-demographic data (age, ethnicity, civil status); diagnosis; age of onset of illness; past contact with psychiatric services, including hospital admissions, both voluntary and compulsory; past forensic history (charges or convictions); current treatment from mental health services including contact with community statutory services, access and use of any personalised budget, and support from non-statutory services including supported accommodation, substance misuse and employment services; access and use of primary and secondary physical health care services.

Measures included:

  • Social Inclusion Questionnaire User Experience (SInQUE: Mezey et al 2013).
  • Discrimination and Stigma Scale (DISC -12: Thornicroft et al 2009, Brohan et al 2013).
  • Brief Psychiatric Rating Scale (Overall and Gorham 1962, Ventura et al, 1993).
  • Manchester Short Assessment of Quality of Life (MANSA: Priebe et al 1999).
  • Camberwell Assessment of Need Short Appraisal schedule (CANSAS: Slade et al 1999).
  • UCLA Loneliness Scale (Hays & DiMatteo, 1987).

Inclusion criteria:

  • Able to speak and understand English.
  • Age 18-67 i.e. working age.
  • At least one inpatient admission.
  • Primary diagnosis of: psychosis (schizophrenia, bipolar affective disorder or schizoaffective disorder); common mental disorder (depression, anxiety, obsessive compulsive disorder); or personality disorder (emotionally unstable/borderline personality disorder or antisocial personality disorder).
  • At least 3 months since last admission and receiving care in the community from secondary mental health services.

A sub- sample of 30 participants, divided between the three diagnostic groups, were asked to complete the SInQUE on a second occasion, between 5 and 10 days after the first, to assess test-retest reliability of the measure.

In order to account for socio-economic and cultural factors, which may impact on social inclusion but which may be unrelated to the person's mental health problem, we have recruited 28 unaffected siblings to complete the SInQUE.

Qualitative

Service users

We recruited a sub-sample of 15 service users, from participants in the quantitative study, to participate in in-depth, semi-structured interviews about their experiences of social inclusion and to seek their views on potential interventions to improve social inclusion. Participants were purposively sampled to reflect a range of diagnoses and demographic characteristics.

Staff Focus Groups

We recruited staff from services included in the study to participate in four focus groups (two in each participating Trust), exploring possible interventions to promote social inclusion.

Sibling Focus Group

Sibling participants from the quantitative interviews participated in a focus group exploring their view on social inclusion and possible interventions.


Advisory group

Members of the Research Team; three mental health service users representatives; Dr Jed Boardman (Centre for Mental health); Dr Sarah Byford (Health Economist , KCL).

PPI

The project has been discussed at the relevant local service user research groups, in South London this is the Peer Expertise in Education and Research (PEER) and in North London the Service User Research Forum (SURF), to obtain views and suggestions about the design of the project. PEER met monthly and SURF met quarterly.

Ethics Approval

Ethical approval has been granted by the London Bromley Research Ethics Committee - 15/LO/1778.

Dissemination

Publications

Mezey G, White S, Thachil A, Berg R, Kallumparam S, Nasiruddin O, Wright C, Killaspy H. (2013) Development and preliminary validation of a measure of social inclusion for use in people with mental health problems: the SInQUE. Int J Soc Psychiatry, 59(5),501-7.

Killaspy H., White S. Lalvani N. Berg R. ; Thachil A. Kallumpuram S., Nasiruddin O. , Wright C. and Mezey G. (2014) International Journal of Social Psychiatry. The impact of psychosis on social inclusion and associated factors 60,2, 107-116.

Conference Proceedings/Abstracts /Posters

School for Social Care Research - Oral presentation of study at Annual Conference on 12th April 2017 www.sscr.nihr.ac.uk/sscr-annual-conference-2017/

EDINBURGH - Poster presentation of study at International Congress of the Royal College of Psychiatrists on 27th June 2017 www.rcpsych.ac.uk/traininpsychiatry/conferencestraining/internationalcongress2017.aspx

ENMESH Conference, Groningen - Oral presentations of quantitative and qualitative study findings in October 2017 https://enmesh2017groningen.com/

© St George's, University of London