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There is a proportion of psychiatric service users whose needs are not met by existing models of care. This can lead to a reliance on acute and crisis services. These service users may be considered high intensity users (HIUs). The purpose of this research is to evaluate the Crisis Plus model, an intervention designed to better support HIUs in the community and reduce dependency on acute and crisis services.

Forty-seven HIUs were involved in Crisis Plus. The core intervention of Crisis Plus was an Anticipatory Management Plan (AMP), produced in collaboration with service users, their families and their care coordinators. AMPs were shared with relevant services and attached to electronic patient notes to ensure a uniform, psychologically informed approach to care.

HIU service use was compared pre and post-AMP. On average, number of inpatient admissions, number of days spent on the ward, accepted psychiatric liaison referrals and accepted home treatment team (HTT) referrals decreased significantly.

Crisis Plus has taken a collaborative, proactive approach to engage HIUs, their families and the services that care for them. Crisis interventions that emphasise collaborative working and service user agency are key.

The provision of dedicated psychological support to HIUs and their professional and personal network is crucial to reduce reliance on acute and crisis care. Crisis Plus is unique in that it instigates co-production and active consultation with HIUs and services to improve clinical outcomes, in addition to reducing NHS expenditure.

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.

This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services.

A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having “major” relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes.

There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery.

This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English.

This review makes a unique contribution, highlighting that, to the best of the authors’ knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary.

Service users’ voice is at the forefront of movements within psychiatry that look to create more humanising care. Although genuine co-production of knowledge is limited by the power differential intrinsically functional to the health care setting, the arts have the potential to create collaborative environments and equalise relationships. The purpose of this case study is to describe and discuss the design and pilot evaluation of creative writing workshops in a forensic mental health ward as an innovative method for humanising care.

A creative writing intervention focussing on everyday experiences was implemented in a forensic mental health ward and involved four residents and four mental health professionals working together. Interviews were conducted with the four mental health professionals as part of a service evaluation. Transcripts were analysed using thematic analysis.

Two themes emerged from the analysis of interviews with mental health professionals: “a new way of learning about each other” and “imagining beyond the staff-resident relationship”. The authors discuss the intervention’s benefits in terms of its potential to foster mutuality and empathy beyond the illness narrative.

Creative writing can be used to engage patients and mental health professionals to jointly share everyday experiences and identities beyond illness.

The creative writing workshops present an innovative approach concerning the use of creative arts for humanising care through mutuality.

This preliminary investigation aims to examine the psychological impact of the COVID-19 pandemic on patients and staff within a high secure service.

To discern the connection between COVID-19-related distress and multiple factors, the study involved 31 patients and 34 staff who completed assessments evaluating coping strategies, resilience, emotional reactivity, ward atmosphere and work-related aspects.

Results demonstrated that around a third of staff (31.2%) experienced COVID-19-related distress levels that met the clinical cut-off for possible post-traumatic stress disorder. Emotional reactivity, staff shortages, secondary traumatic stress and coping strategies were all positively correlated with COVID-19-related-distress. Resilience was negatively associated with distress, thus acting as a potential mitigating factor. In comparison, the prevalence of distress among patients was low (3.2%).

The authors postulate that increased staff burdens during the pandemic may have led to long-term distress, while their efforts to maintain minimal service disruption potentially shielded patients from psychological impacts, possibly lead to staff “problem-focused coping burnout”. This highlights the need for in-depth research on the enduring impacts of pandemics, focusing on mechanisms that intensify or alleviate distress. Future studies should focus on identifying effective coping strategies for crisis situations, such as staff shortages, and strategies for post-crisis staff support.

The authors postulate that the added burdens on staff during the pandemic might have contributed to their distress. Nonetheless, staff might have inadvertently safeguarded patients from the pandemic’s psychological ramifications by providing a “service of little disruption”, potentially leading to “problem-focused coping burnout”. These findings underscore the imperative for further research capturing the enduring impacts of pandemics, particularly scrutinising factors that illuminate the mechanisms through which distress is either intensified or alleviated across different groups. An avenue worth exploring is identifying effective coping styles for pandemics.

This paper aims to provide a living tribute to the mental health activist and international trainer Peter Bullimore.

Peter provided a list of people to who he wanted to provide tributes. Jerome approached all these people. All agreed.

Several people from around the world attest to the influence that Peter’s teaching and personality have had on their clinical practice and on their lives.

The disappearance of an Open Mind has left a shortage of journals, which welcome the user perspective. Mental Health and Social Inclusion have always championed the voice of people with lived experience. These are selected tributes to one man’s work in the field of mental health.

These accounts provide insights into the work of a remarkable individual.

Students of the mental health professions are mainly exposed to work produced by their peers. The history of mental health is filled with the stories of professionals, not the people who have used services.

Historically accounts of psychiatry are written by mental health professionals. Service user or lived experience accounts are often written from the perspective of the person’s story of illness and recovery. There are comparatively few, which celebrate the additional achievements of specific individuals with lived experience.

The risk of aggression is higher among people with psychiatric disorders. This study aims to determine the association of aggression with schizophrenia, bipolar disorder (BD) and major depressive disorder (MDD) in patients referred to Shahid Beheshti Teaching Hospital in Kerman.

This was a cross-sectional study of 518 patients diagnosed with schizophrenia, BD and MDD who met the inclusion criteria and were compared with a comparison group. All participants completed the Buss–Perry Aggression Questionnaire (BPAQ). Independent samples t-test and Pearson correlation coefficient were used to investigate the relationship between the score of BPAQ and other variables. The Beck Depression Inventory (BDI-13), Young Mania Rating Scale (YMRS) and Positive and Negative Symptom Scale (PANSS) were completed by MDD, BD and schizophrenia patients, respectively.

The mean score of total aggression and its components in the comparison group was significantly (P-value = 0.001) lower than that of the other groups. However, no significant difference was observed between the three schizophrenia, MDD and BD groups. The total aggression score of BPAQ had a significant positive correlation with BDI-13 and YMRS and a significant negative correlation with the PANSS score. Single patients with schizophrenia and people in the comparison group with lower education levels had a higher total aggression score.

Suffering from BD, MDD and schizophrenia, especially in single patients with a lower education level, is associated with physical and verbal aggression, anger and hostility, which emphasizes the need for periodic examination and screening of aggressive behaviors in these patients.

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.

Clinical staff working in mental health services experience high levels of work-related stress, burnout and poor well-being. Increased levels of stress, burnout, depression and anxiety and poorer mental well-being among health-care workers are associated with more sick days, absenteeism, lower work satisfaction, increased staff turnover and reduced quality of patient care. Virtual reality (VR) relaxation is a technique whereby experiences of pleasant and calming environments are accessed through a head-mounted display to promote relaxation. The purpose of this paper is to describe the design of a study that assesses the feasibility and acceptability of implementing a multi-session VR relaxation intervention amongst mental health professionals, to improve their relaxation levels and mental well-being.

The study follows a pre–post-test design. Mental health staff will be recruited for five weeks of VR relaxation. The authors will measure the feasibility and acceptability of the VR relaxation intervention as primary outcomes, alongside secondary outcomes evaluating the benefits of VR relaxation for mental well-being.

The study aims to recruit 20–25 health-care professionals working in both inpatient and specialist community mental health settings.

Research indicates the potential of VR relaxation as a low-intensity intervention to promote relaxation and reduce stress in the workplace. If VR relaxation is shown to be feasible and acceptable, when delivered across multiple sessions, there would be scope for large-scale work to investigate its effectiveness as an approach to enable health-care professionals to de-stress, relax and optimise their mental well-being. In turn, this may consequently reduce turnover and improve stress-related sick leave across health-care services.

The purpose of this study is to describe participation in decision-making among service users with severe mental illness.

Service users want to participate in decision-making and in the planning of their care. There are widely known methods, such as shared decision-making, that could be used to facilitate service user participation. Three focus group interviews were conducted with the participation of 14 persons with mental illness and/or substance abuse who were service users at two Swedish Homes for Care and Residence (HVB). Data were analyzed by qualitative content analysis.

Two themes emerged: service users’ involvement in decisions is hampered by the professionals’ approach and adequate information and experience of participation means greater empowerment.

Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve the decision process, research on these matters is limited.

This study reveals that there is a need of more systematic decisional support, such as shared decision-making, so that service users can be seen as important persons not only in guidelines and policy documents but also in clinical practice.

The findings indicate that service users do not participate in decisions systematically, although policies, guidelines and laws providing that service users should be offered an active part in decision-making with regard to their care and treatment.

Although it is known that service users would like to have more influence, and that methods like shared decision-making are recommended to empower service users and improve their decision process, research on these matters is limited. The findings indicate that service users do not participate in decisions systematically, even though policies, guidelines and laws are in place stipulating that service users should be offered an active part in decision-making with regard to their own care and treatment. The results of this project bring improvement opportunities to light.