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Burnout in mental health staff is acknowledged as a major problem. The purpose of this paper is to gain an understanding of mental health staff views on improving burnout and mental toughness in mental health staff.

Ten participants from two mental health rehabilitation units across the north-west of England took part in a Nominal Group Technique. Participants consisted of mental health workers from varied roles in order to capture views from a multidisciplinary team. The main question posed to the staff was “What strategies and techniques do you think could help improve burnout and mental toughness in mental health staff”.

The study revealed that the top three ideas to take forward to help improve burnout and mental toughness in mental health staff were improving the culture/organisation, improving staff wellbeing and education. Additionally, staff were highly motivated and enthusiastic about engaging in discussion about what could be done to improve their wellbeing and the importance of taking this forward.

This study is unique in involving mental health staff in discussing their ways of improving their mental health. It is also unique as it has found the nine strategies to do this and these could be used in targeted training for mental health staff.

The purpose of this paper is to draw upon a range of material to improve the understanding of disengagement with everyday life, by some individuals who have learning disabilities and mental health difficulties. Illustrative incidents from historical clinical cases are utilised, to consider whether this reframing may enhance the interpretation of presenting behaviours.

Key recurring themes within transpersonal literature were reviewed, relevant to adults with behaviour indicating a degree of disengagement from everyday life. These were grouped into Physical Realm, Psychosocial Realm and Realm of Being. Illustrative examples of behaviour are reviewed and re-interpreted within this framework.

These examples generated plausible interpretations for the presenting behaviours within this framework of the Three Realms. These interpretations support a fresh understanding of the quality of the individual's inner experience. This paper suggests a potential framework to consider the way in which some individuals may experience a different quality of consciousness than the usual.

Use of the Three Realms for behaviour interpretation should result into a more empathetic and client-centred approach that could reduce the need for aversive approaches, lessening risk for the client and any employing organisation. The identification of behaviours that signal participation in the Realm of Being could be defined and evaluated with the potential to be used to inform the nature and content of the support provided.

This paper, rooted in clinical examples, offers an original synthesis with reasons to include the immaterial realm in the perspective of the human condition. This could benefit people with substantial episodes of disconnection from the Physical Realm and everyday culture and those who support them.

This paper aims to present the distinctive roles and perspectives of the members of a multidisciplinary team supporting a man with multiple diagnoses who was under Section by the Mental Health Act.

The management of risk for this man with intellectual disability, mental illness and a degenerative neurological condition was particularly complex due to his self‐harming and impulsivity. Each specialist clinician (nurse, speech and language therapist, psychiatrist) reflects on their role as a member of a team approach. The perspective of the man himself is represented, although he was unable to give a consistent descriptive self report.

For people with mental illness and intellectual disability the capacity to understand and retain information about their condition may be limited and variable. The paper discusses the multiple ethical issues in attempting to preserve a modified autonomy and in decision making around best interests.

Supporting someone with dysphagia presents specific challenges to staff teams due to the everyday and familiar nature of mealtimes. When the person is unable to understand and refuses to comply with guidelines outlining restrictions to mealtime choices, the staff's role in safeguarding is particularly complex. The paper considers how to mitigate against risks to mental and physical health.

In cases of self harm the care team is challenged to respect autonomy and maintain quality of life whilst ensuring safety of the individual. The paper discusses maintaining professional integrity when considering compromise.