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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 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.

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.

This paper aims to provide an example of patient-led co-production.

Using the six principles of co-production to frame the activities undertaken during the author’s relationship with a community mental health nurse.

The paper describes the benefit of a collaborative support group for the three lived experienced participants and a mental health nurse.

Small support groups like the one described in this paper can be established effectively through the process of co-production between people with lived experience and mental health professionals working in partnership.

Co-production is usually used with groups of stakeholders working together in an equitable way to design or deliver a new service; this paper, however, seeks to demonstrate how the process can be effectively used when the project is patient-led within the context of a therapeutic relationship.

This study aims to examine nurses’ motivation for leadership and explore important challenges nurses face in leadership positions.

Semi-structured interviews were conducted with 20 nurses in leading positions. Thematic analysis was used to analyse the data.

Nurse leaders are recruited from clinical settings, and the transition process from clinical nurse to leader is demanding. Their motivation for leadership seems to be in human values and caring for others. Lack of strategic focus might be a challenge. Nurses in leadership positions emphasize the importance of good relationships with the staff and require an increased focus on strategic leadership.

Studies have revealed the frustration associated with the role of a nursing leader. According to an evaluation of a clinical leadership development programme, nurses were found to be inadequately prepared for their roles. They had not experienced positive role models, they felt overwhelmed and they regarded colleagues and nursing management structures as unsupportive. There is a need for further research into effective measures to strengthen nurse managers.

The role of leaders has changed over time. There are now increasing requirements and objectives with regard to laws, action plans, improvement projects and cost-effectiveness. A nurse leader has both many tasks and great responsibility. Good leadership relies on skilled nurse leaders meeting statutory requirements in patient care and delivering good quality and patient-safe services. Engaging in process-oriented guidance, such as mentoring, is one way to become more aware of oneself as a professional leader (Mathena, 2002).

By identifying and understanding the specific challenges that nurse leaders face, this study can contribute to the development of interventions and strategies to improve leadership practices, thereby enhancing organizational effectiveness.

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.

This paper contributes to a dialogue about the psychoanalytic concept of free association and its application in the context of qualitative research interviewing. In doing so, it also adds to wider discussion regarding the relationship between clinical psychoanalysis, psychoanalytic psychotherapy and qualitative research.

Critical consideration of different perspectives on the application of free association in the qualitative research interview, extending earlier work addressing this issue. Differences and similarities in the way the concept of free association is articulated are examined regarding its framing in psychoanalysis and psychoanalytically oriented psychotherapy.

Whether researchers see themselves as borrowing, applying or drawing inspiration from free association, there is scope for muddling distinct ways of viewing it as it is conceived in psychoanalysis.

Considerations are outlined for researchers interested in psychoanalytically informed methods to be mindful of.

The purpose of this study is to describe peer support work in a men’s mental health unit from a lived experience and service user’s perspective. The intertwining of process (a lived experience perspective) and subject (the therapeutic value of peer support) leads to greater knowledge and insight into peer support for people with mental health problems.

This service user narrative draws on the extracts from a reflective journal of interactions and conversations with people with mental health problems as well as feedback from service users and staff about the value of peer support. These methods allow a first-person, service user’s, reflective and narrative account of peer support work.

Peer support work, particularly hearing voices sessions, are found to be highly therapeutic and worthwhile. They promote insight and create feelings of safety and hope in what can sometimes be a frightening and hostile ward environment. Peer support provides emotional and practical support. Sharing stories and experiences of mental illness with people leads to trust, feelings of being valued, heard and accepted as well as better experiences of care and being seen as a person first. Due to their shared experiences, peer support workers are able to befriend people with mental health problems on the ward. Peer support work bridges the gap and vacuum of care between people with mental health problems and staff. It compensates for understaffing to provide more holistic and person-centred care and support.

Lived experience/ service user perspectives and narratives on peer support are rare, particularly in a hospital setting. This article provides a rich, perhaps overlooked and hidden narrative on the nature of peer support work. People with mental health problems, like Ben, are often excluded from society, health and social care, education, employment and research. This narrative opens up a pathway to understanding peer support from a service user perspective.