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The purpose of this paper is to consider the role of the Mental Health Act (MHA) 1983 in safeguarding adults at risk of abuse and neglect. The author has undertaken a thematic review of Safeguarding Adults Reviews (SARs) commissioned in England and Adult Practice Reviews (APRs) commissioned in Wales where the MHA 1983 was a central aspect to the review.

Reviews were included based on specific determinants, following analysis of SARs, APRs and executive summaries. This should not affect the credibility of the research, as themes were identified in conjunction with analysis of literature regarding use of the MHA in the context of adult safeguarding. Consequently, this review has been underpinned by evidence-based research in the area of study.

The interaction between statutes, such as the MHA 1983 and Care Act 2014, signify challenges to professionals, with variable application of mental health legislation in practice.

Lack of a complete national repository for review reports means that it is likely that the data set analysis is incomplete. It was noted that limitations to this research include the fact that Safeguarding Adults Boards in England may not publish SAR reports or may choose to publish an executive summary or practice brief instead of the full SAR report, therefore limiting the scope of disseminating learning from SARs, as this is difficult to achieve where the full report has not been published. The author aimed to mitigate this by undertaking comprehensive searches of Local Authority and SAB websites, in addition to submitting Information requests to ensure that this research encompassed as many relevant review reports as possible.

This is an important and timely topic for debate, given that the UK Government is proposing reform of the MHA 1983. In addition, existing thematic reviews of SARS tend to be generalised, rather than specifically focused on the MHA.

The purpose of this paper is to report on the use and content of written guidance produced by mental health services in England and Wales describing hospital leave for informally admitted patients.

Guidance on leave was requested from National Health Service (NHS) mental health trusts in England and health boards in Wales (n = 61) using a Freedom of Information submission. Data were analysed using content analysis.

In total, 32 organisations had a leave policy for informal patients. Policies varied considerably in content and quality. The content of policies was not supported by research evidence. Organisations appeared to have developed their policies by either adapting or copying the guidance on section 17 leave outlined in the Mental Health Act Codes of Practice for England and Wales (Department of Health, 2016; Welsh Government, 2016). Definitions of important terms, for example, leave and hospital premises, were either absent or poorly defined. Finally, some organisations appeared to be operating pseudo-legal coercive contracts to prevent informal patients from leaving hospital wards.

Research should be undertaken to explore the impact of local policies on the informal patient’s right to life and liberty.

All NHS organisations need to develop an evidence-based policy to facilitate the informal patient’s right to take leave. A set of national standards that organisations are required to comply with would help to standardise the content of leave policies.

To the best of the author’s knowledge, this is the first study to examine the use and content of local policies describing how informal patients can take leave from hospital.

The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. The initial data set was published in this journal in 2015 and has since been updated annually. The complete data set is available from the author. The second purpose is to reflect on the narratives about adult safeguarding and self-neglect by focusing on the stories that are told and untold in the reviews.

Further published reviews are added to the core data set, drawn from the national SAR library and the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the domains used previously, direct work, the team around the person, organisational support and governance. SAR findings and recommendations are also critiqued using three further domains: knowledge production, explanation and aesthetics.

Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. SAR findings emphasise the knowledge domain, namely, what is actually found, rather than the explanatory domain that seeks to answer the question “why?” Findings and recommendations appear to assume that learning can be implemented within the existing architecture of services rather than challenging taken-for-granted assumptions about the context within which adult safeguarding is situated.

A national database of reviews completed by SABs has been established (www.nationalnetwork.org.uk), but this data set remains incomplete. Drawing together the findings from the reviews nonetheless reinforces what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, there is little analysis that seeks to explain rather than just report findings.

Answering the question “why?” remains a significant challenge for SARs, where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. The challenge for SAR authors and for partners within SABs is to reflect on the stories that are told and those that remain untold or untellable. This is an exercise of power and of ethical and political decision-making.

The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper analyses the degree to which SARs answer the question “why?” as opposed simply to answering the question “what?” It also explores the degree to which SARs appear to accept or challenge the context for adult safeguarding. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practice, and on the choices they make about the stories that are told.

Using a mixed methodology comprising interviews, case file analysis and descriptive statistics, this study aims to examine the experiences of all 43 young people in Wales subject to secure accommodation orders between 1st April 2016 and 31st March 2018.

Children in the UK aged 10–17 years who are deemed to be at a significant level of risk to themselves or others may be subject to a secure accommodation order, leading to time spent in a secure children’s home (SCH) on welfare grounds. Following a rise in the number of children in Wales referred to SCHs for welfare reasons, this paper describes these young people’s journeys into, through and out of SCHs, giving insight into their experiences and highlighting areas for policy and practice improvements.

Findings indicate that improvements in mental health support and placement availability are key in improving the experiences of this particularly vulnerable group of young people throughout their childhood.

Other practical implications of the study’s findings, such as improvements in secure transport arrangements, are also discussed.

While the findings are limited by the reliance on self-report methods and the size of the study, namely, the small number of young people with experience of SCHs who were able to participate, the findings build on the existing knowledge base around children’s residential accommodation and provide new insights into how best to support these children.

This study aims to address this need. In the UK, people with dementia admitted to National Health Service mental health in-patient dementia assessment wards [dementia assessment wards] present as complex and experience a number of changed behaviours, such as excessive walking, agitation and aggression. The complexity of the presentation of dementia has been identified as underpinning pre-and post-admission to these care environments, but limited study has so far been conducted to explore the boundaries and meaning of complexity and its relationship to dementia assessment ward practice.

An online electronic survey of UK-based national dementia leaders was conducted in 2018. Nineteen completed questionnaires were returned, and mental health nurses comprised the largest sub-sample. Qualitative data of the free-text responses were analysed using manifest content analysis.

Four routes to admission to a dementia assessment ward were identified. Multiplicity of needs and interconnectedness were seen as important domains in uncovering the meaning of complexity. The importance of life story and formulation approaches were highlighted. Challenges uncovered included, better understanding changed behaviour and its relationship to complexity, the need for understanding the boundaries of complexity and making visible care practices on these specific wards.

Findings can be used to produce a heightened awareness about the meaning and function of complexity in dementia assessment wards. Policymakers and researchers need to increase the emphasis on this area of mental health and dementia care. Further training for the multidisciplinary team on formulation approaches could help to improve the evidence-base for practice.

Both authors have been involved as lay members in research and other activities for a number of years, ensuring they represent the views of members of the public. This chapter identifies what is, and what is not, patient and public involvement as well as highlighting the importance of involving members of the public in all aspects of the research process. Best practice is explored as identified in the UK Standards for Public Involvement 2019 and the UK Policy Framework for Health and Social Care Research 2020. The implications of the Mental Capacity Act and its wording on research matters are also considered. Case studies have been incorporated to highlight the impact of involving patients and members of the public in all aspects of the research process. These include the lessons learnt by researchers and lay members of the team. The aspiration is to move towards more collaboration between members of the public and researchers; therefore, we discuss co-production of research or community-based participatory research (CBPR). We highlight the need for a better partnership between researchers and members of the public. The benefits of this are explored along with the consequences for all involved.

The purpose of this study was to provide proof of concept and evaluate the project for the development of a forensic service in safeguarding adults at risk of harm who may have suffered a non-accidental injury as a result of physical abuse or neglect.

This pilot project arising from a Safeguarding Adults Review was designed using an iterative process. Opinion from all partners of the Safeguarding Adults’ Boards in two adjacent areas as well as using expert forensic advice from the Faculty of Forensic and Legal Medicine was sought.

All professionals recognised the need for a forensic service because at present decision-making around potential non-accidental injuries (NAI) may not be evidence based. The main barriers were seen as lack of knowledge and education combined with the area of work not being recognised as being needed and hence not commissioned. No similar service existed in England to aid the project being developed either academically or practically, other than reflecting what happens in children’s safeguarding.

The knowledge and skills as well as the resources developed for this project will aid safeguarding professionals to make more informed decisions when working with adults at risk of harm who have sustained a potential NAI.

This project has high originality with no other area in England offering a similar service or in the process of developing a service at present.

The impact of frontline robots (FLRs) on customer orientation perceptions remains unclear. This is remarkable because customers may associate FLRs with standardization and cost-cutting, such that they may not fit firms that aim to be customer oriented.

In four experiments, data are collected from customers interacting with frontline employees (FLEs) and FLRs in different settings.

FLEs are perceived as more customer-oriented than FLRs due to higher competence and warmth evaluations. A relational interaction style attenuates the difference in perceived competence between FLRs and FLEs. These agents are also perceived as more similar in competence and warmth when FLRs participate in the customer journey's information and negotiation stages. Switching from FLE to FLR in the journey harms FLR evaluations.

The authors recommend firms to place FLRs only in the negotiation stage or in both the information and negotiation stages of the customer journey. Still then customers should not transition from employees to robots (vice versa does no harm). Firms should ensure that FLRs utilize a relational style when interacting with customers for optimal effects.

The authors bridge the FLR and sales/marketing literature by drawing on social cognition theory. The authors also identify the product categories for which customers are willing to negotiate with an FLR. Broadly speaking, this study’s findings underline that customers perceive robots as having agency (i.e. the mental capacity for acting with intentionality) and, just as humans, can be customer-oriented.

The purpose of this paper is to interrogate and develop the conceptualisation of discriminatory abuse in safeguarding adults policy and practice beyond the current interpersonal definition. The paper draws on Safeguarding Adults Reviews (SARs) that refer to discriminatory abuse or safeguarding practice with adults who have care and support needs and protected characteristics.

A search of the national network repository of SARs identified 27 published reviews for inclusion. The contents were thematically analysed to understand how discrimination was experienced in these cases. Fricker’s “Epistemic Injustice” theory was adopted as a conceptual framework, informing the analysis of findings.

Evidence from SARs provides a challenge to the interpersonal emphasis on language and behaviour in national policy. Although the reviews acknowledge that interpersonal abuse occurs, a close reading spotlights practitioner and institutional bias, and inattention to social, structural and contextual factors. The silence on these matters in policy provides a narrow frame for interpreting such abuse. This suggests significant potential for epistemic injustice and signals a need to acknowledge these social, structural and contextual factors in safeguarding practice.

Discriminatory abuse is an under-researched and under-utilised category of abuse in safeguarding adults practice. The paper adopts Fricker’s theory of “Epistemic Injustice” to highlight the silencing potential of current policy approaches to discriminatory abuse to suggest a more inclusive and structural framing for safeguarding practice with those targeted due to their protected characteristics.

Large numbers of nursing students and the COVID-19 pandemic made it necessary to relieve the pressure on UK hospitals to host clinical placements. One hospital innovated by providing a virtual placement online, immediately before an in-person placement. The purpose of this study is to evaluate the participant responses to the online virtual placement.

This was a pilot study evaluated after the placement, including a student survey (25 responses), four semi-structured interviews with students and four with staff in spring 2021.

High levels of approval of the innovation were recorded among both students and staff. Students were pleased to be taught by clinical experts, though some found it difficult to study at home and some found the hours long. High satisfaction levels may reflect the pandemic context: the placement reduced social isolation and the sense of education being interrupted. Participating students were in their final year of study, and the placement took place in the second year of the pandemic, so mutual familiarity and well-developed information technology skills may have made the innovation more acceptable.

The innovation has value and should be maintained post-pandemic to increase mental health in-person placement capacity and scaffold student learning.

This study added new knowledge to understanding about the utility of virtual placements in mental health nursing education.