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There is evidence that novel psychoactive substances (NPS) are commonly used by people with severe mental illness. The purpose of this paper is to undertake a scoping survey to explore the inpatient mental health workers’ perceptions of NPS use by consumers.

A cross-sectional online survey of mental health professionals is used in the study. The participants were opportunistically recruited through social media and professional networks.

A total of 98 participants (of 175 who started the survey) were included in the analysis. All reported that some patients had used NPS prior to admission. Over 90 per cent of participants reported observing at least one adverse event relating to NPS use in the previous month. The majority of participants reported that patients had used NPS during their inpatient admission. Three quarters were not clear if their workplace had a policy about NPS. Most wanted access to specific NPS information and training. The participants reported that they lacked the necessary knowledge and skills to manage NPS use in the patients they worked with.

Whilst the authors are cautious about the generalisability (due to methodological limitations), the findings provide useful insight into the perceptions of inpatient staff regarding the extent and impact of NPS use including concerns regarding the impact on mental and physical health, as well as ease of availability and a need for specific training and guidance.

Mental health professionals require access to reliable and up-to-date information on changing trends in substance use. Local policies need to include guidance on the safe clinical management of substance use and ensure that NPS information is included.

To the best of the authors’ knowledge, this is the first survey of the perceptions of mental health staff working in inpatient mental health settings regarding NPS. The findings suggest that NPS is a common phenomenon in inpatient mental health settings, and there is a need for more research on the impact of NPS on people with mental health problems.

The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature.

This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers.

Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively.

The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge.

This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research.

The purpose of this study is to outline a process-oriented psychology informed view of the impact of ever-increasing acuity within an adult inpatient system and conceptualise how an integrated therapies team (ITT) can work with the chaos that this brings.

A reflective scientist-practitioner based approach was used over a two-year period.

Several factors lead to “chaos” in an inpatient unit, including societal inequality, the trauma and adversity it creates and the impact of this at a systemic, interpersonal and intrapersonal level. Chaos is one means of coping and can dominate inpatient working, whereas understanding the underlying distress is often marginalised. Developing an ITT can support working with chaos. The ITT holds the therapeutic perspective for the wider multi-disciplinary team (MDT) and therapeutic and facilitation skills are central to how it operates. Processing the chaos and working with the underlying distress is its overarching function.

Developing an ITT offers a robust structure for evolving inpatient MDT working to cope with increasing acuity in a psychologically informed way.

The chaos in question is often viewed as patients’ issue but from a collectivist perspective it is something that all members of society are responsible for.

To the best of the authors’ knowledge, this is the first paper to conceptualise the chaos on an inpatient ward as a process needed by the system as a way of coping and propose the addition of an ITT to inpatient working.

Sensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users and potentially avoid the necessity for coercive practices such as seclusion and restraint. Despite the growing use of this intervention, there has been limited research exploring the implementation of sensory modulation at an organisational level, both internationally and within the New Zealand context. The purpose of this study is to investigate the implementation of a sensory modulation programme in two New Zealand inpatient mental health services using an exploratory organisational case study design.

Organisational case study design methodology was used to explore the implementation of a sensory modulation programme in two New Zealand acute adult inpatient mental health services. This study explored how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation. Cases were described and examined the pattern of findings.

Strategies found to support implementation were identified at environmental, organisational, group and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility and leeway in staffing levels to support training attendance and responsiveness to crises.

The facilitators and strategies highlighted in this study may be used to support the design and implementation of future sensory modulation programmes in New Zealand and internationally.

The complexity of factors that influenced the implementation of the sensory modulation approach within an inpatient setting made determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.

The purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and alternatives to seclusion.

A questionnaire was circulated to mental health inpatient staff. Data from the Ministry of Health for seclusion numbers and rates for Ma¯ori and non-Ma¯ori were also collected.

The major barriers to reducing the use of seclusion related to staffing issues, a lack of management and medical support, and physical characteristics of the facility. Data from the Office of the Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion events, the number of patients secluded, and the percentage of total patients secluded. However, the percentage of Ma¯ori secluded compared to the total number of patients secluded showed little change from 2007 to 2013.

Further analysis of the nurse’s responses showed that four of the six least-used strategies incorporated Ma¯ori cultural approaches. The authors surmise that an inability to provide culturally sensitive care, either through staffing or education factors, may be implicated in the lack of change in the seclusion rates for Ma¯ori. This may also be pertinent to seclusion rates for indigenous peoples in other countries.

Over the past 15 years, mental health organisations have taken steps to move towards providing services that are more recovery-oriented. This review was undertaken to explore what is known about service users’ experience of services that have introduced a recovery-oriented approach to service provision. There is limited research evaluating consumers’ lived experiences of recovery-orientated care; a scoping review was chosen to provide an overview of the available research in this area (Munn et al., 2018). The purpose of this review was to summarize and synthesize current qualitative research exploring consumers’ experience of recovery orientated mental health care provision.

This scoping review was undertaken as outlined by Arksey and O'Malley (2005). The five steps consisted identifying the research question; searching for relevant studies; selecting the studies; charting the studies; and collating, summarising and reporting the findings.

Three key themes emerged from this review: translation of recovery policy to practice; ward environment; and recovery principles with five subthemes: engagement; not being listened to; shared decision-making; informational needs; and supportive and collaborative relationships. The themes and subthemes identified in each of the 18 studies are presented in Table 3.

This review highlights the different degree to which service users have received recovery-oriented recovery care. In the majority of cases, most service users reported few opportunities for nursing engagement, poor communication, inadequate information provision, a lack of collaborative care and mostly negative experiences of the ward environment. Because of the limited studies on mental health service users’ lived experiences of a recovery-oriented service, more clinical studies are needed and in different cultural contexts.

On hindsight, the authors should have included service users in this review process as consumer inclusion is progressively emphasised in mental health educational and research activities. This review highlights that not all studies have involved service users or consumers in their research activity.

Service users need relevant information in a timely manner to participate in decision-making regarding their treatment and care. This review found that either no information was provided to the service users or it was provided in a limited and fragmented manner. This review also found inpatients reported limited opportunities to have meaningful participation in decision-making about their care. These findings have important social implications, as greater consumer engagement in the design and delivery of mental health services will increase community trust in the care provided. This in turn has the potential to facilitate greater community engagement in preventative mental health care.

This is the first review to systematically synthesis consumers perspectives on the extent to which service providers are achieving the goal of implementing recovery-orientated practice into their service provision. Despite important policy changes, the findings of this review demonstrate that more work is needed to truly operationalise and translate these principles into practice.

To provide a summary of the principles, theories and basic components of a recently developed brief integrated motivational intervention (BIMI) for working with individuals experience co-ccurring severe mental health and substance use problems in inpatient settings, including the outcomes of a feasiblity randomised controlled trial (RCT). There are greater financial costs and a negative impact on functioning associated with psychiatric admissions for people who experience co-occurring severe mental heath and substance misuse problems. In addition, their engagement in treatment is often problematic.

The BIMI described was evaluated via a feasibility RCT that assessed whether the opportunity to discuss use of substances whilst on an inpatient ward represented an opportunity to engage inpatients in thinking about their use and the impact it has on their mental health.

The BIMI is delivered in short burst sessions of 15-30 minutes over a two-week period adopting a simple 3-step approach that can be delivered by routine ward staff. It incorporates an assessment of substance use, mental health and motivation followed by personalised feedback, a focus on increasing awareness of the impact on mental health and development of goals and a change plan. The intervention has been shown to lead to higher levels of engagement in clients exploration of substance use and the impact on mental health. Findings suggest both staff and inpatients found the intervention feasible and acceptable.

Routine ward staff were trained to deliver a brief intervention to inpatients during an acute hospital admission.

This paper aims to explore the roles of psychologists in seclusion in adult mental health services in Ireland, their perspectives on seclusion and its use in recovery-oriented practice and related professional practice issues.

A qualitative hermeneutic phenomenological study was conducted from a social constructivist perspective. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis.

Twenty-four themes were identified, which were clustered into four overarching themes. Participants viewed themselves and psychology in Ireland more broadly as peripheral to seclusion. They believed that seclusion possessed no inherent therapeutic value but viewed it as an uncomfortable and multi-faceted reality. Participants regarded seclusion and recovery as largely inconsistent and difficult to reconcile, and they perceived systemic factors, which had a pervasive negative impact on seclusion and recovery in practice.

The findings highlight the perceived complexity of seclusion and its interface with recovery, and the need to conscientiously balance conflicting priorities that cannot be easily reconciled to ensure ethical practice. The findings suggest psychologists are well-suited to participate in local and national discussions on using seclusion in recovery-oriented practice.

This study offers a unique insight into psychologists’ perceptions of seclusion and considers the implications of these views. Participants’ nuanced views suggest that psychologists can make valuable contributions to local and national discussions on these topics.

The purpose of this paper is to conduct a systematic search of the peer-reviewed qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties, to appraise the quality of the existing literature and synthesise findings. Background: seclusion is a controversial intervention for the short-term management of unsafe behaviours in inpatient mental health services. There has been some sporadic interest in service users’ experiences of this.

Systematic literature review and meta-synthesis: data sources – databases MEDLINE, EMBASE, CINAHL and PSYCINFO were searched in July 2015; review methods – the Joanna Briggs Institute’s Qualitative Assessment and Review Instrument tools for critical appraisal and data extraction were used to review papers and synthesise findings.

A small number of papers were found, which were of mixed quality.

The existing research is limited in both quantity and quality. Although most participants from the existing research described seclusion as mostly negative with the potential for causing iatrogenic harm, some described more positive experiences, often in the context of compassionate interactions with staff.

There are high rates of emotional, behavioural and psychiatric problems (Cooper et al, 2007) in the learning disability population. This paper describes the Mental Health in Learning Disabilities (MHiLD) service for adults with learning disabilities in four South London boroughs. This service has been in operation in two South East London boroughs from 1982, and was extended to a third in 1999 and a fourth in 2006.