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Accessible Summary: What is already known about this topic?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates.No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. What this paper adds to existing knowledge?: It appears feasible to use the HIP to profile and compare physical health‐related risks in people with SMI across different international settings.The HIP tool identified significant differences in areas of risk across the four countries. What are the implications for practice?: The HIP could be used to identify unique clusters of health promotion needs in different countries.Use of HIP health checks may support implementation of individualized interventions. Introduction: To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim: To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method: An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results: Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion: This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi‐national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice: It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mindful yoga combines yoga techniques with the mindfulness‐based stress reduction approach.Previous studies on mindful yoga have reported improvements in depression for working‐age adults, but no studies have been conducted with older people. What the paper adds to existing knowledge?: Mindful yoga may be a safe and acceptable intervention to improve the mental and physical health of older adults with depression.The beneficial therapeutic ingredients of mindful yoga, included calmness, being non‐judgmental, letting go and seizing the day. What are the implications for practice?: Single‐sex mindful yoga groups may be more acceptable for some people.Well‐conducted feasibility studies comparing mindful yoga with an alternative group‐based approach are necessary. Introduction: Mindful yoga combines yoga techniques with the mindfulness‐based stress reduction approach. Previous studies on mindful yoga have reported improvements in depression for working‐age adults, but no studies have been conducted with older people. Aims: To explore the experiences of older adults with depression participating in a mindful yoga group to establish whether the approach has potential as a future intervention for this client group. Method: This study adopted a qualitative descriptive method and used inductive content analysis. Eighteen in‐depth individual interviews were conducted with nine participants (each participant had one interview following the programme and another four weeks later). Results: Six main themes emerged: "improved physical status," "actively involved in the community," "positive psychological effects," "perceived therapeutic ingredients," "facilitators of practising mindful yoga" and "barriers to practising mindful yoga.". Discussion: Most participants reported benefitting from the programme. Two male participants expressed that exercises were too challenging and more suited to women, suggesting single‐sex groups may be more acceptable. Implications for practice: Mindful yoga may be an acceptable/useful intervention for older adults with depression, but future studies are required to establish its feasibility and potential efficacy. [ABSTRACT FROM AUTHOR]

Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced‐based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub‐recommendation with most in line with the NICE guidelines were restrictive interventions, de‐escalation, and improving service users' experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster‐based documents, and departmental practices. [ABSTRACT FROM AUTHOR]

Background: Although bedrail use may increase the risk of accidents among patients, bedrails are still extensively used in healthcare facilities. Therefore, the field calls for a review of bedrail use in practice. Objective: This report examined the prevalence and implications of bedrail use in rehabilitation facilities in Hong Kong. The findings are compared with the current state of bedrail use worldwide. Design and methods: This work is a cross-sectional, observational study. A secondary analysis was conducted on the database of a prospective trial. Bilateral bedrail use was observed in two Hong Kong rehabilitation hospitals. Logistic regression was performed to examine the factors associated with bedrail use. Results: A total of 3,384 restraint observations were made. The bedrail rate was 31.34%, which revealed that bedrail use was the second most commonly used physical restraint. The fall history (OR: 2.84), cognitive impairment (OR: 0.91) and functional dependency (OR: 0.79) of patients were significant predictors of bedrail use, p <.05. Conclusion: This study examines bedrail prevalence through direct observation, which is the preferred method for examining bedrail use in practice. We found that actual bedrail use is higher than the numbers reported in previous studies in Hong Kong. In addition, our research reveals that bedrails are commonly used for vulnerable patients. This finding highlights the need to change nurses' beliefs on bedrail use through education. The management of these health facilities should also aim to create an institutional environment that promotes the reduction of bedrail use. Implementation strategies on restraint reduction should also fit the culture of the organisation and local nursing practices, as well as the staff's values. Impact Statement: This study provides preliminary information about the widespread use of bedrails in Hong Kong and other countries. The research also introduces effective ways to achieve the reduction of bedrail use. [ABSTRACT FROM AUTHOR]

Media often stigmatize severe mental patients (SMPs) by portraying them as dumb, sluggish, or violent. Conversely, TV documentaries, as a particular media genre, have the potential to destigmatize SMPs by entrusting them with an authentic presence and a direct voice. Illuminated by Couldry’s (2010) discussion on voice and drawing on narrative analysis, this article examines the evolving and joint endeavor of media and mental hospitals in systematically destigmatizing SMPs and in promoting the rehabilitation mode of mental health care in Hong Kong. From 1989 to 2011,Hong Kong Connectionsproduced three documentaries. Shifting the narrative from “whom to blame” to “nothing to fear,” the documentaries establish a destigmatization agenda jointly formulated by the media and mental hospitals. SMPs’ voices steadily increase in length and prominence in the narrative’s temporal line, yet they are strictly orchestrated within the sealed narrative that is subject to the institutional interest of promoting the rehabilitation mode of mental health care in Hong Kong. The voice/narrative inequality between SMPs and mental institutions leads to the “dependent destigmatization” that indicates a dependent power relation between SMPs and powerful institutions. [ABSTRACT FROM PUBLISHER]

Background: Many studies have affirmed that psychiatric advanced practice nurses (APNs) perform multifaceted roles. However, only a limited amount of research has been conducted on their perceptions of the performance of their roles. Aim: To explore the lived experiences of psychiatric APNs concerning the performance of their roles. Design: Data were collected from individual semi-structured interviews and analysed using the interpretative phenomenological analysis method. Methods: The study was conducted in a hospital cluster in Hong Kong. Thirteen psychiatric APNs were purposively recruited. Results: Three themes were discerned, namely, 'We are different', 'Who am I?', and 'I am who I am'. Conclusions: The findings can help psychiatric APNs and nurse administrators to better understand the needs of the role-bearers (APNs) and to develop strategies to support the development of advanced psychiatric nursing practices in Hong Kong and worldwide. [ABSTRACT FROM AUTHOR]

Kwai Chung Hospital has undergone the deinstitutionalisation process with a number of projects, beginning with a pilot to test the case management model and psycho-education for the care of people with chronic mental illness, followed by a RCT (randomised control trial) study which confirmed the efficacy of case management, and the Intervention for Frequent Readmitters project which confirmed the efficacy of assertive community treatment for a group of patients who had problems living in the community. Since 2010, the hospital has adopted the recovery movement that involves shifting its paradigm, altering its environment, training staff, and developing recovery practices and peer support for the betterment of living for the people it serves. [ABSTRACT FROM AUTHOR]

Background: Service user participation in direct service provision and evaluation has been developing in the western world in the past 20 years. However, this recovery-based care model is relatively new in Asia. Aim: To understand the views and perceptions of the service users and of psychiatric nurses about the recruitment of peer specialists in a regional psychiatric unit in Hong Kong. Method: A qualitative study using probe questions to understand the above issues in the form of focus group discus- sion. A total of 13 psychiatric nurses and 16 mental health service users were recruited from a regional psychiatric unit for the study. Results: Content analysis based loosely on grounded theory has identified several important themes. While service users are generally enthusiastic about the potential contribution of peer specialists in a service setting, they are much concerned about rejection and discrimination by the psychiatric staff. Psychiatric nurses are also sceptical about the involvement of peer specialists in the delivery of service, although for an entirely different set of reasons. In view of the divergent views of the service users and the psychiatric nurses, a second round of focus group discussion was conducted seven months later to understand whether the themes distilled were consistent with their views expressed in the first round of focus group discussion. Conclusion: It is encouraging is that, for those psychiatric nurses who worked with volunteer service users in the pilot scheme of 'expert user participation', there was a change in view towards positive acceptance about peer specialist involvement in service delivery. The study provides some insight into the potential obstacles to and opportunities in the implementation of peer specialist services in routine psychiatric services in Hong Kong. [ABSTRACT FROM AUTHOR]

We developed an integrated care pathway for the personalized care programme, a community mental health service using a multidisciplinary case management approach for patients with severe mental illness in Hong Kong, China. The pathway started from the point of referral to exit of service and covered acknowledgement of referral, triage and contact, and formulation, endorsement and review of individual service plan (ISP). The first audit showed a high compliance rate except endorsement of ISP. The improvement initiative was successful in raising the compliance rate. The integrated care pathway proved to be a useful tool in driving service development and continuous quality improvement. [ABSTRACT FROM AUTHOR]

A retrospective cohort of discharged patients from all public psychiatric hospitals in Hong Kong (1997-1999) was linked to suicide data from Coroner's court. Patients hospitalized shorter than 15 days had significantly lower suicide rates than longer stay patients. The results were fairly consistent across immediate/late post discharge periods, gender, age, diagnoses, and narrow/wide definitions of suicide. This finding was opposite of what has been reported in the literature. Short hospitalization carried different suicide risks in different service settings. [ABSTRACT FROM AUTHOR]

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