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1 – 10 of 742Joseph Lloyd Davies, Ruth Bagshaw, Andrew Watt, Paul Hewlett and Heidi Seage
This study aims to understand the perceived causes and consequences of weight gain within a secure psychiatric inpatient service in South Wales.
Abstract
Purpose
This study aims to understand the perceived causes and consequences of weight gain within a secure psychiatric inpatient service in South Wales.
Design/methodology/approach
A purposive sample of 12 staff members were interviewed. These interviews were transcribed verbatim and analysed using thematic analysis.
Findings
Three themes were identified, these were increasing demand for integrated physical health care, unhealthy lifestyles and weight gain viewed as a symptom of poor mental health.
Originality/value
It is a unique insight into the factors that contribute to obesity in a Welsh secure unit and adds to current understanding of the challenges of improving weight management services within this sector.
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Elanor Lucy Webb, Annette Greenwood, Abbey Hamer and Vicky Sibley
Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The…
Abstract
Purpose
Forensic health-care workers are frequently exposed to behaviours that challenge and traumatic material, with notably high levels in developmental disorder (DD) services. The provision of support is key in alleviating distress and improving work functioning. This paper aims to incite clarity on whether staff in DD services are more likely to access trauma support. The prevailing needs and outcomes for this population are also explored.
Design/methodology/approach
Data was extracted retrospectively from a database held by an internal trauma support service (TSS) for staff working in a secure psychiatric hospital. Overall, 278 permanent clinical staff accessed the TSS between 2018 and 2020, 102 (36.7%) of whom worked in an adult DD forensic inpatient service.
Findings
Staff working in DD services were over-represented in referrals to the TSS with a greater number of referrals per bed in DD services than in non-DD services (0.94 vs 0.33). DD staff were comparatively more likely to access support for non-physical, psychologically traumatic experiences. Psychological needs and outcomes following support were comparable between staff across services.
Practical implications
The findings highlight the more frequent need for trauma support of staff in forensic inpatient DD settings. Embedding a culture of safety and openness, and establishing appropriate and responsive models of staff support reflect key priorities for inpatient DD health-care providers, for the universal benefit of the organisation, workforce and service users.
Originality/value
This study offers novel insight into levels of access to support for staff working with people with DDs.
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Rebecca Brewer, Lucy Pomroy, Michelle Wells and Joanne Ratcliffe
The purpose of this paper is to provide wider research evidence for the use of the Short Dynamic Risk Scale (SDRS) in risk management with individuals who have an Intellectual…
Abstract
Purpose
The purpose of this paper is to provide wider research evidence for the use of the Short Dynamic Risk Scale (SDRS) in risk management with individuals who have an Intellectual Disability (ID) and reside in a secure psychiatric inpatient setting. The outcomes are supportive of previous research, showing that outcomes on the SDRS are related to maladaptive behaviours recorded for individual with ID.
Design/methodology/approach
All participant data taken from the hospital healthcare reporting system were entered into a PASW database. The ratings for each of the SDRS and Short-Term Assessment of Risk and Treatability (START) items were entered and totalled, with a separate total score for the SDRS with the additional three items. In order to capture the behavioural monitoring data, average severities weightings of each of the Overt Aggression Scale-modified for neuro-rehabilitation (OAS-MNR) categories for the three weeks following completion of the individual’s SDRS were calculated and recorded. In addition, average severity weightings reflecting the presence of sexualised behaviour (St Andrew’s Sexual Behaviour Assessment (SASBA) in the subsequent three weeks following SDRS completion was included. Using the most recent START assessment completed allowed for analysis of the predictive ability of the START of the same behavioural data.
Findings
A series of Spearman’s correlations were run to determine the relationship between outcomes on the SDRS and engagement in risk behaviours as rated by the OAS-MNR scales. There was a moderate positive correlation between all 11-items of the SDRS and OAS-MNR recordings. A series of Spearman’s correlations were conducted to determine the relationship between outcomes on the START Vulnerability items and engagement in risk behaviours as rated by the OAS-MNR scales. There was a weak negative correlation between all individual START vulnerability item ratings and OAS-MNR recordings.
Research limitations/implications
The current pilot study provides wider research evidence for the use of the SDRS in risk management with individuals who have an ID and reside in a secure psychiatric inpatient setting.
Originality/value
This paper compares outcomes on the START and SDRS in relation to an individual’s risk recordings to support identification of whether either have practical and clinical utility. To the authors’ knowledge, this has not been completed before.
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Alessandra Girardi, Elanor Lucy Webb and Ashimesh Roychowdhury
Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the…
Abstract
Purpose
Self-harm is a cause of concern for health-care professionals. The Short-Term Assessment of Risk and Treatability (START) is a short-term assessment instrument used to rate the likelihood of risk behaviours, including self-harm. As result of the assessment, interventions that are implemented to reduce the risk of self-harm may reduce the strength of the predictive validity of a risk assessment tool. The aim of this study was explore the impact of risk management interventions on the capacity of START to predict self-harm. It was predicted that the interventions would weaken the ability of START to predict self-harm in patients who received the intervention.
Design/methodology/approach
Secondary analysis of routinely collected data in a large sample of women in an inpatient secure care setting. Demographic and clinical information, self-harm episodes, safety management interventions and START assessments were extracted and used to build an anonymous database.
Findings
START significantly predicted self-harm in those with and without the safety management intervention. However, the strength of the predictive validity was smaller in those who received the intervention compared to those without.
Practical implications
The results suggest that the implementation of safety management interventions needs to be taken into account when assessing future risk of self-harm.
Originality/value
To the best of the authors’ knowledge, this is the first study to explore the impact of safety management interventions on the predictive validity of START in a large sample of women.
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Geoffrey L. Dickens and Laura E. O’Shea
The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to…
Abstract
Purpose
The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups.
Design/methodology/approach
A cross-sectional survey design of n=45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice.
Findings
HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, respectively.
Research limitations/implications
This was an exploratory survey and results should be verified using larger samples.
Practical implications
Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may overvalue historical factors. They believe that recent violent behaviour is important in risk formulation; however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified.
Social implications
It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention.
Originality/value
Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice.
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Patrick Callaghan and Andrew Grundy
The purpose of this paper is to examine empirical, epistemological and conceptual challenges and clinical narratives in the application of risk assessment and management in mental…
Abstract
Purpose
The purpose of this paper is to examine empirical, epistemological and conceptual challenges and clinical narratives in the application of risk assessment and management in mental health.
Design/methodology/approach
The authors used a narrative review of empirical, conceptual and clinical literature.
Findings
The worldwide prevalence of violence in mental health settings remains high. Risk assessment and management approaches, while well intentioned as an attempt to reduce harm and increase people’s safety, have negligible effect on both. They are invariably individual centric, ignore wider environmental, societal and behavioural influences that foment violence and have a stigmatising effect on people using mental health services. They also reinforce the myth that people who are mentally unwell threaten society and that through current risk assessment and management approaches, we can minimise this threat.
Research limitations/implications
There is a need to reconsider the study and application of violence risk assessment in mental health.
Practical implications
The practice of risk assessment and management in mental health is marred by an overuse of risk assessment measures that are limited in their predictive efficacy. As a result, they have little value in preventing, reducing and/or managing harm. The language of risk punishes and stigmatises service users and reinforces the image of menace. An alternative language of safety may nourish and protect. A collaborative approach to safety assessment based upon recovery-focussed principles and practices may fuse professionals and service users’ horizons. Combining service users’ self-perception, professionals’ sound clinical judgement, assisted by electronically derived risk algorithms and followed by evidence-based risk management interventions, may lessen the threat to service users, reduce harm and transform the practice of violence risk assessment and management.
Social implications
Risk appraisals discriminate against the small number of people who have a mental illness and are risky, an example of preventive detention that is ethically questionable. On the basis of the limitations of the predictive efficacy of actuarial measures, it is ethically dubious to subject people to interventions with limited benefits. Risk assessment processes tend to reinforce stigma by classifying individuals as risky, sanctioning society’s prejudices and fear through scientific authority.
Originality/value
The increasing focus on risk assessment and management to tackle violence in mental health is fraught with empirical, conceptual and practical concerns; the authors have suggested ways in which these concerns can be addressed without compromising people’s safety.
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Kristina Brenisin, Mc Stephen Padilla and Kieran Breen
Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into…
Abstract
Purpose
Transition from inpatient mental health care to community living can be very difficult, as people are at an increased risk of suicide, self-harm and ultimately readmission into hospital. There is little research conducted exploring peer support workers’ (PSWs) lived experiences that could provide insight into the key transitions of care, particularly the support required after discharge from inpatient mental health care. The purpose of this paper is thus to provide a particular insight into what it feels like being discharged from psychiatric care from a PSW’s perspective, how may support be improved post-discharge and what factors might impact the potential for readmission into inpatient care.
Design/methodology/approach
A qualitative, phenomenological approach was adopted to explore and describe PSWs’ lived experiences of transitioning from psychiatric care. Four PSWs who were employed by a UK secure mental health facility were recruited. PSW is a non-clinical role with their main duty to support patients, and they were considered for this type of the study for their experience in negotiating the discharge process to better carry out their job as a PSW.
Findings
After being discharged from psychiatric care, PSWs experienced issues that had either a negative impact on their mental wellbeing or even resulted in their readmission back into inpatient psychiatric care. This study identified three inter-related recurrent themes – continuity of support, having options and realisation, all concerning difficulties in adjusting to independent community life following discharge. The findings of the study highlighted the importance of ensuring that service users should be actively involved in their discharge planning, and the use of effective post-discharge planning processes should be used as a crucial step to avoid readmission.
Research limitations/implications
A deeper insight into the factors that impact on readmission to secure care is needed. The active involvement of service users in effective pre- and post-discharge planning is crucial to avoid readmission.
Practical implications
Mental health professionals should consider developing more effective discharge interventions in collaboration with service users; inpatient services should consider creating more effective post-discharge information care and support packages. Their lived experience empowers PSWs to play a key role in guiding patients in the discharge process.
Originality/value
This is the first study, to the best of the authors’ knowledge, to explore what it feels like being discharged from inpatient mental health care by interviewing PSWs employed at a forensic mental health hospital by adopting a phenomenological approach. This paper offers a deeper insight into the transition process and explores in detail what support is needed post discharge to avoid potential readmission from PSWs’ perspectives.
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Ernest Gralton, Victor Udu and Shan Ranasinghe
There has been a significant expansion of secure psychiatric service provision in the UK, but little discussion about the most appropriate principles on which to base these…
Abstract
There has been a significant expansion of secure psychiatric service provision in the UK, but little discussion about the most appropriate principles on which to base these services. There is longstanding tension between security and treatment that can be difficult to resolve. Solution‐focused ideas may provide a bridge between these two issues, by improving multi‐disciplinary working and providing an appropriate relationship style that optimises the delivery of care to forensic patients.
Jessica Holley, James Tapp and Simon Draycott
Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical…
Abstract
Purpose
Coercive practices – which are used as means to manage violent/aggressive behaviour in secure forensic settings – have come under scrutiny in recent years due to their paradoxical effects on provoking further service user aggression and violence. Previous research has found relationships between increased service user aggression with both service users’ interpersonal styles and perceptions of staff coercion (i.e. staff limit setting). This paper aims to investigate whether forensic service users’ levels of interpersonal sensitivity to dominance increase levels of self-reported anger and rates of aggression towards staff through perceptions of staff coercion.
Design/methodology/approach
In a cross-sectional quantitative study design, 70 service users were recruited from one high and two medium secure forensic hospitals. Standardised measures were completed by service users and recorded incident data was collected within the past year. Correlation and mediation analyses were run to investigate the relationship between study variables.
Findings
A significant relationship was found between service users’ interpersonal sensitivity to dominance and self-reported rates of anger, where forensic service users’ who had higher levels of interpersonal sensitivity to others’ dominance were likely to report higher rates of anger. No significant relationships were found between all other study variables.
Practical implications
The findings from this study contradict previous research where coercive practices may not necessarily increase rates of aggression towards staff but, in the context of service users’ interpersonal sensitivities to dominance, it may be more useful to consider the way in which coercive practices are implemented.
Originality/value
There is a gap in the literature, which looks at the way in which forensic service users perceive coercive practices in relation to their interpersonal sensitivities and whether this too has an impact upon service user aggression.
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