Search results

This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk.

Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears.

Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges.

To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care.

The authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.

Sensory modulation intervention involves using calming and grounding sensory stimuli to support coping with distress and intense emotions. Evaluating the impact of sensory modulation is challenging in inpatient settings due to the numerous variables influencing outcomes in ward environments. This study aims to determine the impact of sensory modulation across all organisational levels including service users, staff confidence and attitudes, ward climate and seclusion events.

Organisational case studies were conducted in two Aotearoa New Zealand inpatient mental health services, using qualitative and quantitative data to explore the effects of a sensory modulation programme.

Results showed that sensory modulation enhanced staff knowledge and confidence in fostering therapeutic relationships and reducing restrictive practices, positively impacted ward climate and provided service users with sensory strategies to use in everyday life.

The findings captured the complexity of implementation and impact of sensory modulation programmes at individual, group and organisational levels. It is important to recognise the influencing factors and impact of sensory modulation across all levels of service delivery.

Organisational case study methodology offered a unique approach to evaluating the impact of sensory modulation within inpatient mental health services. Data analysis suggests that in addition to managing acute service user distress, sensory modulation impacts broader staff, team and service level outcomes.

Violence and aggression against mental health professionals is a global concern with well-documented consequences. In the UK, mental health care is increasingly delivered in the community, yet little research has explored practitioner experiences of workplace violence (WPV) outside of inpatient settings. This study aimed to explore how mental health professionals in a UK community mental health team (CMHT) perceive, experience and cope with WPV.

Face-to-face semi-structured interviews were conducted with ten multidisciplinary professionals based in a CMHT in a UK city. Data was analysed using interpretative phenomenological analysis.

Three interconnected themes emerged. WPV was accepted as inevitable: participants carried on working despite its impact, and feeling unheard by management they gave up on change, perpetuating the perceived inevitability of WPV. Peer support and organisational resources like debriefing, counselling and occupational health improved coping. Stigma and ideas of professional responsibility were barriers to access.

To mitigate against the negative consequences of WPV, CMHTs could offer peer support initiatives, improve communication and availability of organisational resources and involve staff in post-incident decision-making. Recommendations are made to shift the attitude of acceptance of WPV and encourage help-seeking.

Incidents of violence and aggression are a regular occurrence within adult forensic mental health inpatient settings and often lead to the use of restrictive practices such as seclusion. Such events are frequently attributed to the complexity of the patients. Research commonly focuses on patient’s characteristics and their association with seclusion use. Less attention has been centred on forensic mental health nurses’ attitudes to seclusion and the association of nursing staff characteristics.

A cross-sectional survey was undertaken using a standardised questionnaire, “Survey of Nurses’ Attitudes to Seclusion”. Responses were received from n = 147 nurses at a high secure forensic mental health hospital in the UK.

Key findings indicate that most participants believed seclusion should remain part of clinical practice. A correlation was identified between forensic mental health nurses’ attitudes to seclusion use and their characteristics: gender, age range, educational level and experience.

This paper presents novel information on seclusion reduction opportunities through modifiable workforce factors such as gender-sensitive rostering and staff training and development. Furthermore, recruitment and retention strategies should be prioritised so forensic mental health is perceived as an attractive career and a safe workplace.

The paucity of research in this area has prompted calls for further research to explore nursing staff characteristics and seclusion use. This is particularly important now due to the current global difficulty in the recruitment and retention of mental health nurses.

The development and implementation of a provider collaborative (PC) represents an ambitious and complex piece of work to be delivered across a geographical area for a vulnerable patient cohort. The UK East Midlands Children and Adolescent Mental Health Services (CAMHS) PC was established in April 2021, and the current study aimed to explore the views of a variety of staff members about its functioning over the first twelve months. Specifically, it explored whether the intended aims has been achieved and identified the challenges that it faced during its introduction.

Feedback was collected through in-depth qualitative interviews and surveys with frontline (n = 20) and senior staff (n = 19) that were conducted to explore the experiences of a variety of stakeholders within the collaborative.

Two main themes were identified – the achievement of the key aims and the barriers to success. A thematic analysis has shown that whilst the aim of the PC is well intentioned and is generally welcomed by the multiple stakeholders across the geographical region, it is clear that changes are required in order to ensure the inception of an efficient care service that is able to achieve the ultimate goal of providing the ultimate goal of “right care at the right time”.

This is the first study, to the authors' knowledge, to explore collaborative working in CAMHs services. The study involved staff feedback from Phases 1 and 2 of a 4-years-long evaluation. The findings demonstrate the overall aims are being met as well as identifying areas of concern; this, in turn, allows the authors to develop a series of recommendations to implement and improve collaborative working before assessing their impact in the subsequent phase.

The purpose of this service user narrative and viewpoint article is to describe interprofessional and interpersonal barriers to peer support on a men’s mental health ward over the course of a year from a lived experience perspective.

A reflective journal was kept and participant observation was conducted over the course of the year.

There is sometimes a fissure and binary of “Us” and “Them” on the ward. In other words, staff can sometimes perceive peer support workers to be “one of us” (a member of staff) or “one of them” (a service user). For service users, the opposite is sometimes true: “one of us” (a service user) or “one of them” (a member of staff). Peer support workers must bridge this gap and strive to be “one of us” with both these groups, which is no easy task. A good ward manager or peer team leader can smooth over interprofessional differences and support the peer worker in their efforts of care towards the recovery of people with mental health problems.

Little has been written on this topic in a mental health inpatient setting as most papers address community peer support work, which is very different from peer support in hospital. This paper addresses one of the first peer support pilot projects in hospital of its kind in NHS England so is quite innovative and perhaps even unique.

Institutional abuse is a worldwide phenomenon with the UK also subject to several high-profile abuse scandals perpetuated on people with learning disabilities and/or mental health conditions living within institutional settings. This study aims to provide a broad perspective of safeguarding practices within institutional care to inform practice and service development in this area.

A narrative overview was undertaken of a range of empirical evidence, discussion papers, enquiry reports, reports from regulatory bodies and professional guidance to explore safeguarding practices within institutional care for individuals with learning disabilities and/or mental health conditions.

A range of literature was identified that exposed and explored abuse in this context. Three key themes were identified: failings within institutional care; safeguarding issues and concerns; and good practice within institutional care. Whilst guidance is available, standards are explicit and protocols facilitate improvement potential in this area, a consistent message was that statutory recommendations for reform have not been effective.

This paper provides an important resource for practitioners and service providers involved in institutional care. An accessible overview of both the empirical evidence and grey literature on adult safeguarding within institutional settings is provided, along with a range of standards and resources that specify practice in these settings.

Obesity and associated morbidity and mortality are major challenges for people with severe mental illness, particularly in secure (forensic) mental health care (patients who have committed a crime or have threatening behaviour). This study aims to explore experiences of weight management in secure mental health settings.

This study used a mixed-methods approach, involving thematic analysis. A survey was delivered to secure mental health-care staff in a National Health Service (NHS) mental health trust in Northern England. Focus groups were conducted with current and former patients, carers and staff in the same trust and semi-structured interviews were undertaken with staff in a second NHS mental health trust.

The survey received 79 responses and nine focus groups and 11 interviews were undertaken. Two overarching topics were identified: the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. In addition, seven themes were highlighted, namely: medication, sedentary behaviour, patient motivation, catered food and alternatives, role of staff, and service delivery.

Secure care delivers a potentially “obesogenic environment", conducive to excessive weight gain. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact.

To the best of the authors’ knowledge, this is the first study to involve current patients, former patients, carers and multidisciplinary staff across two large NHS trusts, in a mixed-methods approach investigating weight management in secure mental health services. People with lived experience of secure services are under-represented in research and their contribution is therefore of particular importance.

The purpose of this service user paper and narrative is to highlight that peer support is not a continuous, easy or uniform process but given to disruption, fragmentation, breakdowns in relationships and hurdles. This is illustrated in a summary of the case of “Christopher”.

A reflective journal was kept, and participant observation was conducted for just under a year on the ward where Christopher was under Section.

Peer support can be given to fissure, breakages in relationships and discontinuity. This can negatively impact the mental health of peer support workers. With this in mind, it is vitally important to ensure that the people who take up this role are appropriately trained, supported and supervised. There needs to be a focus on “restorative” supervision and supervision by someone with experience of the peer support role as well as buddying between peer workers.

There is an abundance of literature and research on peer support in the community but little in the inpatient setting, making this paper novel and a contribution to understanding peer support on mental health wards.

The main aim of this paper is to provide a living tribute of lived expert by experience and researcher Andrew Voyce.

Andrew provided the author with a list of names of people he might approach to write a tribute on his behalf.

The accounts describe the influence that Andrew has had both as an educator and as a trusted colleague for the people approached.

In many ways, the voices of people with mental health problems have been marginalised. Few mental health journals, with only some exceptions, encourage lived experience contributions.

The mental health agenda continues to be dominated by professional groups. The remarkable individuals who continually battle with serious mental illness are often lost in official discourses.

Despite the fact that the topic of mental health is now much more in the public domain, research tells us that the most effective anti-stigma strategy is contact with sufferers.

The archivist Dr Anna Sexton co-produced one of the few mental health archives that only featured people with lived experience. Andrew was one of the four people featured in it. This account “showcases” the work of this remarkable man.