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Accessible summary What is known on the subject? Personal experiences of self-injury and staff reactions have been published., What this paper adds to existing knowledge? There is an absence of a detailed account of the interpersonal processes surrounding self-injury within a specific helping relationship., This paper is the first to explore the in-depth relationship between self-injury and shame., What are the implications for practice? This research identifies a cycle of shame in which people come to expect negative responses from others, which further reinforce their negative beliefs and supports a continuing cycle of harm., Mental Health Nurses may work with clients to understand the interpersonal processes and consequences of their self-injury in the helping relationship., Abstract Introduction Literature on self-injury has recognized the impact on the relationship between clients and staff. Rationale There is an absence of a detailed account of interpersonal processes surrounding self-injury. Aim A Bricolage qualitative research approach was carried out in the United Kingdom that explored the interpersonal processes surrounding self-injury. Method Three pairs of clients and staff were interviewed about an incident of self-injury. The interviews were thematically analysed and then synthesized producing a deeper exploration of the relationship between the client and staff. Findings An interpersonal trigger followed by anger and shame, resulted in self-injury to 'numb' these experiences. Discussion Self-injury is conceptualized as a safety behaviour to avoid shame and anger and then as a maintenance cycle that traps the client in a reinforcing and rejecting relationship. Staff interviewed were able to reflect with the clients and help them reframe these experiences. Implications for practice Mental Health Nurses can work with clients to understand their own interpersonal cycles of self-injury. They can then reflect on their own roles in this process and avoid reinforcing the clients' negative beliefs. What the study adds to international evidence This is the first international paper to explore the interconnection between the client and a professional helper in their lived experiences of self-injury. [ABSTRACT FROM AUTHOR]

ABSTRACTThe roles of Na+ and K+ (Rb+) uptake were further studied in a NaCl-tolerant strain of Ceratopteris richardii containing the stl2 mutation by direct comparison with the wild-type strain. In addition to Na+ tolerance, stl2 also confers tolerance to Mg2+ and sensitivity to K+. In addition to higher K+ (Rb+) uptake at concentrations commonly associated with low-affinity K+ transport, stl2 maintained higher uptake down to 0·1 mol m–3 Rb+. Up to a 25-fold excess of Na+ had little effect in either genotype on K+ (Rb+) uptake at low concentrations, i.e. 0·2 and 0·5 mol m–3 RbCl. Pretreatment with K+ (20 mol m–3) inhibited uptake of K+ (Rb+) in the wild type, whereas concurrent inclusion of K+ inhibited uptake of Rb+ more in stl2. In the absence of K+, Na+ uptake (0·01–60 mol m–3) was nearly identical in the wild type and stl2. K+ inhibited Na+ uptake more effectively in stl2 than the wild type, especially at 60 mol m–3 Na+. Greater inhibition of K+ uptake in stl2 occurred with MgCl2 or TEA (tetraethylammonium chloride) preincubation or with simultaneous inclusion of Al3+ (Al2SO4). The higher effective velocity of K+ uptake at a wide range of concentrations and the enhanced selectivity for K+ and against Na+ contribute to the preservation of higher cytosolic K+ and lower Na+ under salinity stress. [ABSTRACT FROM AUTHOR]

Many attempts to reduce the stigmatization of people with mental illness have often been predicated, based on the desire to persuade the public that people with mental illness are ‘ill’ in the same way as people with medical conditions. This paper presents one aspect from the findings of a study that examined the ways in which lay people perceived mental health and illness. Data are drawn from the discussion of the roles and experiences of different non-mental health professionals who cared for and about people they met in their everyday employment. In this paper, we argue that central to these roles is the importance of listening to people in an arena which is non-statutory and without judgment. We demonstrate that people use popular sectors when they are unsure of the problem they have, or they are reluctant to refer themselves to the professional sector. The paper presents narrative extracts illustrating the emotional labour operating in each participant's role and the extent to which they provide support for their client's emotional and psychological well-being. The implications for mental health nursing are discussed in relation to working with and alongside people experiencing mental distress, in relation to ‘ordinary human qualities’. [ABSTRACT FROM AUTHOR]

Accessible summary This paper discusses the use of story telling (sometimes referred to as narrative) as a research method and how by doing this those volunteering to participate in this type of research might find it therapeutic. The paper considers the personal characteristics and skills of the mental health nurse and how these can be transferred from using them therapeutically in clinical practice to the research encounter and what the implications of doing this might be. The paper specifically looks at: •similarities between narrative research and therapy; • what might motivate people to participate in research; • what happens during story telling or narrative; • the importance of looking after the participant and self as a researcher; • the importance of ensuring it is the participant's voice that is heard. Narrative inquiry as a qualitative research method appears to be growing in popularity among mental health nurses. This paper argues that there are a number of parallels between narrative inquiry and psychotherapy, and mental health nurses familiar with the practice of therapeutic engagement need to be mindful of these when using this approach to research. The symbiotic relationship between those engaged in narrative inquiry and those engaged in psychotherapeutic practice is explored in order to provide greater understanding of some of the ethical issues involved and how new researchers, supervisors and practitioners might better respond to the complexities inherent in using narrative inquiry which may itself be therapeutic. Our focus for this paper is the tensions experienced by the mental health nurse while working as a researcher when the research encounter provides a trigger that would normally elicit a therapeutic response for both participant and nurse. Using a selection of psychoanalytic theories and principles this paper explores the relationship between the processes of psychotherapy and narrative inquiry. This discussion paper is based on the authors' own research experiences of using narrative inquiry to explore a number of sensitive issues and many years of supervisory relationships with students and practitioners alike. [ABSTRACT FROM AUTHOR]

In the UK, there have been calls to develop gendered specific mental health services for women in an attempt to ensure privacy and dignity are achieved as and when women come into contact with services. This is a largely rhetorical policy objective. There are more fundamental factors affecting women's experience of mental health services that need addressing. This paper explores these issues in the context of mental health care for women who have been 'given' the diagnosis of borderline personality disorder (BPD). Borderline personality disorder effects 2% of the adult population, 75-90% of those diagnosed being women. This diagnosis continues to present considerable conceptual and therapeutic challenges for all of those involved in mental health services and it remains a categorical label that evokes a wide range of conscious and unconscious responses in mental health nurses. The paper argues that mental health nurses need to recognize the defence mechanisms involved in working with individuals who are often difficult to work with. It is only when mental health nurses can embrace and acknowledge the person in the context of their life, that the pejorative and disabling consequences of the BPD label can be eliminated, ensuring the individual's story is heard and not that which is often a pre-constituted account accompanying this diagnosis. [ABSTRACT FROM AUTHOR]

Childhood sexual abuse is an international public health problem. Research suggests similar prevalence rates in both Western and non-Western societies. The long-term consequences of child sexual abuse include wide ranging mental health problems in adult life. Psychiatric services and, in particular, counselling has been highlighted as being the most helpful to those who have experienced child sex abuse. This evidence base should be informing mental health nursing education and practice. However, we argue there is a divergence between the discourse of evidence-based theory and practice reality. The aim of this paper is to explore the preparedness of mental health nurses to work with adults who have experienced sexual abuse during their childhood. It is the first part of a three-part research project and reviews the literature relating to how (and if) mental health nurses are prepared to work with those who have sexual abuse histories. An important issue considered in this review is the impact upon patient/nurse relationships as a consequence of the nurse themselves being survivors of sexual abuse. We argue that a number of conflicting discourses need to be addressed, if mental health nurses are to be appropriately prepared to offer cogent, sensitive care to those in their care who are shackled to their past sexual abuse through the confines of their current mental illness. [ABSTRACT FROM AUTHOR]

Despite the United Kingdom's recent governmental mental health policy directives aimed at strengthening professional collaboration and increasing service user involvement, the prevailing mental health care culture remains steeped in a discourse of treatment and care, control and compliance and professional expertise. Drawing upon the data collected during the two phases of a 2-year national evaluation undertaken for the English National Board for Nursing, Midwifery and Health Visiting, the perceptions of a group of mental health service users in relation to their experiences and contact with the multi-professional team are explored. A series of metaphorical descriptions were developed with these service users drawn from their experience. These begin to illuminate a realistic way of thinking about how teams are set up, how and why they carry out their various roles, and the need to think in non-professional terms about the relationships that are developed with service users. A hierarchy of power was noted that was congruent with the outcomes of other studies. However, there was also a concurrent acknowledgement of the 'usefulness'(to the individual service user) of each of the professional group members. This appeared to have been constructed alongside the power hierarchy and serves to illustrate how individual service users sought to find an accommodation within the social system they were placed in. This paper argues however, that the use of metaphors, as a form of shared communication, can be an effective first step in working towards this objective. Working in the way described here can allow for a greater shared understanding of what each group is experiencing and help ensure that future service development reflects a broader view of the mental health care world. [ABSTRACT FROM AUTHOR]

International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new 'illness' of 'gender identity disorder'. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice. [ABSTRACT FROM AUTHOR]

This paper had its genesis in a national project, sponsored by the English National Board for Nursing, Midwifery and Health Visiting, to explore team working within mental health practice. The project extended over a 2-year period and utilized various methods of data collection. However, this paper focused on data, from the national survey and informal interviews (based in eight regions), that addressed specific issues within the practitioner group. Of the 800 questionnaires sent out 26% were returned. Fifty-three percent of the returns were from practitioners, 14% user/carers and 33% educationalists. Our focus was that of the practitioners. This group had a response rate of 50% (i.e. 50% of the surveys sent out to practitioners were returned). A content analysis of 100 interviews was used to triangulate the data. Whilst the original brief was to explore team working the survey also highlighted data that indicated a common understanding of what mental health practitioners do and what they say they do and that, although there was a commonality of vocabulary, different practices existed between and within regions. This is the focus of this paper. We argue, from our findings, that different practice is a result of 'habitus'. Whilst practitioners reported that they subscribe to a national agreement of meaning, there is a rhetoric-reality gap: that which is said to be done is not what is, in fact, practised. At the local level we argue that working within the habitus (educationally) can address the rhetoric-reality gap. However, we recommend further studies in order to explore how working within the habitus can address this matter across regions. [ABSTRACT FROM AUTHOR]

SKIDMORE D., WARNE T. & STARK S. (2004) Journal of Psychiatric and Mental Health Nursing 11, 348–356 Mental health practice and the rhetoric–reality gap This paper had its genesis in a national project, sponsored by the English National Board for Nursing, Midwifery and Health Visiting, to explore team working within mental health practice. The project extended over a 2-year period and utilized various methods of data collection. However, this paper focused on data, from the national survey and informal interviews (based in eight regions), that addressed specific issues within the practitioner group. Of the 800 questionnaires sent out 26% were returned. Fifty-three percent of the returns were from practitioners, 14% user/carers and 33% educationalists. Our focus was that of the practitioners. This group had a response rate of 50% (i.e. 50% of the surveys sent out to practitioners were returned). A content analysis of 100 interviews was used to triangulate the data. Whilst the original brief was to explore team working the survey also highlighted data that indicated a common understanding of what mental health practitioners do and what they say they do and that, although there was a commonality of vocabulary, different practices existed between and within regions. This is the focus of this paper. We argue, from our findings, that different practice is a result of ‘habitus’. Whilst practitioners reported that they subscribe to a national agreement of meaning, there is a rhetoric–reality gap: that which is said to be done is not what is, in fact, practised. At the local level we argue that working within the habitus (educationally) can address the rhetoric–reality gap. However, we recommend further studies in order to explore how working within the habitus can address this matter across regions. [ABSTRACT FROM AUTHOR]

The United Kingdom is currently experiencing a recruitment and retention crisis in its nursing workforce. Mental health care is a particular problem area. Widening access to health and social care careers is a challenge for educational and health care organizations. This discussion paper examines the congruence between an educational programme aimed at developing Mental Health Assistant Practitioners' and the organizational responses to the subsequent opportunities for practice innovation within mental health care services. Whilst the 'learning while working' philosophy of the educational programme has been enthusiastically embraced by many health care organizations, the change in management required for using these assistant practitioners in service innovation appears beset by organizational, cultural and professional concerns. Not least of which are the often ambiguous concepts of the role and purpose of being a mental health nurse. This paper argues that if current mental health nurses are unclear about their role it is oxymoronic to establish the mental health assistant practitioners. [ABSTRACT FROM AUTHOR]

This article examines the rhetoric and reality of clinical governance in the United Kingdom using the analogy of the New Year pantomime. The authors argue that processes to improve the quality of health care services provision have been in place for many years. Although the terms and language used to describe these processes have, over time, changed, the task remains the same. Clinical governance is the latest in a long list of such changes. The tensions involved in working towards achieving centrally driven targets and performance standards whilst at the same time addressing the huge modernization agenda are explored through managerial and clinical experiences. Whilst the clinical governance approach has undoubtedly achieved improvements, the sustainability of these is questioned. Organisational responses to the current system are explored and a glimpse into the future is given, as the present structures and processes change in 2004. The authors argue that practitioners and managers, who may have survived the current arrangements, might have considerably more difficulty in doing so in the future. [ABSTRACT FROM AUTHOR]

The roles of K+ uptake and loss in the salinity response of the wild type and the salt-tolerant mutant stl2 of Ceratopteris richardii were studied by measuring Rb+ influx and loss and the effects of Na+, Mg2+, Ca2+ and K+ -transport inhibitors. In addition, electrophysiological responses were measured for both K+ and Rb+ and for the effects of Na+ and NH4+ on subsequent K+ -induced depolarizations. stl2 had a 26-40% higher uptake rate for Rb+ than the wild type at 0.5-10 mol m-3 RbCl. Similarly, membrane depolarizations induced by both RbCl and KCl were consistently greater in stl2. In the presence of 0-180 mol m-3 NaCl, stl2 maintained a consistently greater Rb+ influx than the wild type. stl2 retained a greater capacity for subsequent KCl-induced depolarization following exposure to NaCl. Five mol m-3 Mg2+ decreased Rb+ uptake in stl2; however, additional Mg2+ up to 40 mol m-3 did not affect Rb+ uptake further. Ca2+ supplementation resulted in a very minor decrease of Rb+ uptake that was similar in the two genotypes. Tetraethylammonium chloride and CsCl gave similar inhibition of Rb+ uptake in both genotypes, but NH4cl gave substantially greater inhibition in the wild type than in stl2, NH4Cl resulted in a greater memberane depolarization in the wild type and the capacity for subsequent depolarization by KCl was markedly reduced. stl2 exhibited a higher K+ -dependent loss of R+ than wild type but, in the absence of external K+, loss of R+ was equivalent in the two genotypes. Since constitutive K+ contents are nearly identical, we conclude that high K+ influx and loss exact a metabolic cost that is reflected in the inhibition of gametophytic growth. Growth inhibition can be alleviated by reduced supplement K+ or by treatments that slightly reduce K+ influx, such as moderate concentrations of Na+ or Mg2+. We propose that high throughput of K+ allows maintenance of cytosolic K+ under salt stress and that a high uptake rate for K+ results in a reduced capacity for the entrance and accumulation of alternative cations such as Na+ in the cytosol. [ABSTRACT FROM AUTHOR]

Introduction In the UK, almost 50% of illness diagnosed among working age adults is mental distress, depression and chronic anxiety being the two most prevalent illnesses. However, only 24% of those diagnosed receive appropriate interventions within the National Health Service (NHS). In light of this, third sector organisations, such as MIND, are left to fill the gap in providing therapeutic care. This paper reports on an evaluative study of what Mind offers as opposed to statutory services from a service user perspective. Aim An exploration of the differences in mental health care between statutory and non-statutory organisations. Objectives To identify how service users experienced MIND's counselling service. To establish the benefits and disadvantages of mental health care within statutory and non-statutory services. To identify the impact of mental health care from non-statutory services. Method This qualitative research project, adopted a case study approach. Using one to one narrative interviews, data from 12 participants, five males and seven females were collected. Following transcription, each narrative was analysed individually, with thematic analysis being used across all 12 interviews. Results Six themes were identified; mindful of the gap; easing like sunday morning; magic moments; love is in the air; lighting up a future and changing the status quo. Conclusion Mind plays a significant role in enabling those with psychological problems to move towards building a better future. Findings suggest statutory services can learn important lessons from non-statutory organisations not least how best to provide cohesive, collaborative and compassionate mental health care for those in distress. [ABSTRACT FROM AUTHOR]

EmrE is a multidrug transporter that utilises the proton gradient across bacterial cell membranes to pump hydrophobic cationic toxins out of the cell. The structure of EmrE is very unusual, because it is an asymmetric homodimer containing eight α-helices, six of which form the substrate-binding chamber and translocation pathway. Despite this structural information, the precise oligomeric order of EmrE in both the detergent-solubilised state and in vivo is unclear, although it must contain an even number of subunits to satisfy substrate-binding data. We have studied the oligomeric state of EmrE, purified in a functional form in dodecylmaltoside, by high-resolution size-exclusion chromatography (hrSEC) and by analytical ultracentrifugation. The data from equilibrium analytical ultracentrifugation were analysed using a measured density increment for the EmrE–lipid–detergent complex, which showed that the purified EmrE was predominantly a dimer. This value was consistent with the apparent mass for the EmrE–lipid–detergent complex (137 kDa) determined by hrSEC. EmrE was purified under different conditions using minimal concentrations of dodecylmaltoside, which would have maintained the structure of any putative higher oligomeric states: this EmrE preparation had an apparent mass of 206 kDa by hrSEC and equilibrium analytical ultracentrifugation showed unequivocally that EmrE was a dimer, although it was associated with a much larger mass of phospholipid. In addition, the effect of the substrate tetraphenylphosphonium on the oligomeric state was also analysed for both preparations of EmrE; velocity analytical ultracentrifugation showed that the substrate had no effect on the oligomeric state. Therefore, in the detergent dodecylmaltoside and under conditions where the protein is fully competent for substrate binding, EmrE is dimeric and there is no evidence from our data to suggest higher oligomeric states. These observations are discussed in relation to the recently published structures of EmrE from two- and three-dimensional crystals. [Copyright &y& Elsevier]

This paper offers a discussion of team-working in mental health. It is based upon a 2-year study funded by the English National Board for Nursing, Midwifery and Health Visiting. The authors advocate that team-working should be studied situationally. The paper begins therefore by highlighting contextual tensions and paradoxes that create potential problems for effective team-working. It is argued that team-working is better caught as opposed to being taught. This involves a layered reading of vignettes and case studies, as well as 'hands on' experiences of team-working. Such an approach foregrounds for inspection the complexities and dilemmas of policy, models of practice and team-working patterns. As a result, the students build their own evidence-base, which is not built on the ideal (or optimal) but is located in the real everyday habitus of individuals in healthcare settings. This, the authors feel, is more likely to shift terms such as team-working, partnerships and so on, from merely remaining a healthy rhetoric. [ABSTRACT FROM AUTHOR]

As part of an ENB educational evaluation of teamworking in mental health, a report-and-respond survey was used as one of five data collection methods. This instrument disseminated earlier findings back to the participants and invited further comments. This article discusses the usefulness of this type of survey as a data collection tool and presents the findings of the survey which was administered to service professionals, educationalists, students, users and carers involved in mental health throughout England. The findings show that when groups of professionals are working within increasingly tight financial constraints and increased workloads, multiprofessional teamworking can be scarce in reality. These tensions present issues for nurse education and training at both pre- and postregistration levels in relation to the teaching of, for and about effective teamwork. [ABSTRACT FROM AUTHOR]

In order to identify physiological components that contribute to salinity tolerance, we compared the effects of Na+, Mg2+ and K+ salts (NaCl, Na2SO4, MgCl2, MgSO4, KCl and K2SO4), Ca2+ (CaSO4), mannitol and melibiose on the wild type and the single-gene Nacl-tolerant mutants stl1 and stl2 of Ceratopteris richardii, Compared with gametophytic growth of the wild type, stl2 showed a low level of tolerance that was restricted to Na+ salts and osmotic stress. stl2 exhibited high tolerance to both Na+ and Mg2+ salts, as well as to osmotic stress. In response to short-term exposure (3 d) to NaCl, accumulation of K+ and Na+, Ca2+ supplementation (1.0 mol m-3) ameliorated growth inhibition by Na+ and Mg2+ stress in wild type and stl1, but not in stl2. In addition, under Na+ stress (175 mol m-3) wild-type, stl1 and stl2 gametophytes maintained higher tissue levels of K+ and lower levels of Na+ when supplemented with Ca2+ (1.0 mol m-3) stl2 gametophytes were extremely sensitive to K+ supplementation. Growth of stl2 was greater than or equal to that of the wild type at trace concentrations of K+ but decreased substantially with increasing K+ concentration. Supplementation with K+ from 0 to 1.85 mol m-3 alleviated some of the inhibition by 75 mol m-3 NaCl was similar at 0 and 1.85 mol m-3 K+ supplementation. Although K+ supplementation above 1.85 mol m-3 did not alleviate inhibition of growth by Na+ in any genotype, stl2 maintained greater relative tolerance to NaCl at all K+ concentrations tested. [ABSTRACT FROM AUTHOR]

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman, or degrading treatment, and having the right to liberty, security, respect, and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature, findings revealed that restraint can be a form of abuse, it's inappropriate use often being a consequence of fear, neglect, and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike. [ABSTRACT FROM AUTHOR]