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Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self‐reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality. [ABSTRACT FROM AUTHOR]

Restrictive interventions (RI), such as physical restraint, seclusion, and rapid tranquilization, can have negative psychological effects on service users; however, there has been little investigation regarding their effects on women. The aim of this paper was to explore women's experiences of RI within UK inpatient mental health services. Twenty women accessing inpatient mental health services participated in semi‐structured interviews. Using thematic analysis (TA), three primary themes were reported from women's experiences: (1) powerlessness, (2) dehumanization, and (3) relationships and communication. Clinical recommendations included ensuring gender‐awareness and trauma‐informed care training is mandatory for all mental health staff, for RI training to include awareness of gender differences, and for policies to be reviewed with regard to women being invasively searched and ensuring sanitary products are safely available for women within seclusion. Directions for future research include investigating the experiences of RI for women from minority ethnic groups and exploring important moderators and mediators in the relationship between RI and re‐traumatization for women. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this discursive paper was to explore the development of co‐production and service user involvement in UK university‐based mental health research and to offer practical recommendations for practitioners co‐producing research with service users and survivors, informed by an overview of the key literature on co‐production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co‐written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co‐production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co‐production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co‐produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process. [ABSTRACT FROM AUTHOR]

The aim of the present qualitative, systematic review was to identify and summarize qualitative research that focussed on mental health nurse prescribing, synthesize findings, and outline key themes discerned. In November 2016, a systematic search was conducted for primary studies of the electronic databases PubMed, Excerpta Medica, (Embase), Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO. Of the 101 papers identified through the search strategy, 12 qualitative studies met the review inclusion criteria. These studies included perspectives from nurses, doctors, and patients/clients regarding their attitudes about, and experiences of, nurse prescribing. Three themes emerged from the review: (i) patient-centred care; (ii) professional role; and (iii) professional support. Nurse prescribers embrace a patient-centred approach, providing timely and effective medication management. Adequate education and continuing professional development inclusive of clinical supervision enable competency development in nurse prescribing, supportive professional relationships, and patient safety. Further research is necessary to establish safety and demonstrate enhanced clinical outcomes from mental health nurse prescribing. [ABSTRACT FROM AUTHOR]

In healthcare settings, there is an emotional cost to caring which can result in compassion fatigue, burnout, secondary trauma, and compromised patient care. Innovative workplace interventions such as the Schwartz Rounds offer a group reflective practice forum for clinical and non‐clinical professionals to reflect on the emotional aspects of working in health care. Whilst the Rounds are established in medical health practice, this study presents an evaluation of the Rounds offered to mental health services. The Rounds were piloted amongst 150 mental health professionals for 6 months and evaluated using a mixed‐methods approach with standardized evaluation forms completed after each Round and a focus group (n = 9) at one‐month follow‐up. This paper also offers a unique six‐year follow‐up of the evaluation of the Rounds. Rounds were rated as helpful, insightful, and relevant, and at six years follow‐up, Rounds were still rated as valuable and viewed as embedded. Focus groups indicated that Rounds were valued because of the opportunity to express emotions (in particular negative emotions towards patients that conflict with the professional care‐role), share experiences, and feel validated and supported by colleagues. The findings indicate that Schwartz Rounds offer a positive application in mental healthcare settings. The study supports the use of interventions which provide an ongoing forum in which to discuss emotions, develop emotional literacy, provide peer support and set an intention for becoming a more compassionate organization in which to work. [ABSTRACT FROM AUTHOR]

International efforts to minimize coercive practices include the US Six Core Strategies© (6CS). This innovative approach has limited evidence of its effectiveness, with few robustly designed studies, and has not been formally implemented or evaluated in the UK. An adapted version of the 6CS, which we called 'REsTRAIN Yourself' (RY), was devised to suit the UK context and evaluated using mixed methods. RY aimed to reduce the use of physical restraint in mental health inpatient ward settings through training and practice development with whole teams, directly in the ward settings where change was to be implemented and barriers to change overcome. In this paper, we present qualitative findings that report on staff perspectives of the impact and value of RY following its implementation. Thirty‐six staff participated in semi‐structured interviews with data subject to thematic analysis. Eight themes are reported that highlight perceived improvements in every domain of the 6CS after RY had been introduced. Staff reported more positively on their relationships with service users and felt their attitudes towards the use of coercive practices such as restraint were changed; the service as a whole shifted in terms of restraint awareness and reduction; and new policies, procedures, and language were introduced despite certain barriers. These findings need to be appreciated in a context wherein substantial reductions in the use of physical restraint were proven possible, largely due to building upon empathic and relational alternatives. However, yet more could be achieved with greater resourcing of inpatient care. [ABSTRACT FROM AUTHOR]

A high proportion of psychiatric inpatients experience Restrictive Practice (RP) during admission. Numerous reports have highlighted adverse effects on patients and staff. However, qualitative research focussed on experience, impact, and coping mechanisms of healthcare staff in the UK is limited. Therefore, this study explored psychiatric healthcare staff experience of RP on inpatient wards in the UK. Eight semi‐structured, audio‐recorded interviews, of ~60 min, were conducted via telephone/Skype and transcribed verbatim. A critical realist epistemology was used to thematically analyse data. Three themes were identified: the coexistence of accountability, power and subjection; impacts on the individual and professional relationships, and coping with difficult experiences and emotions. Restrictive practice can negatively affect staff experience, working relationships, and wellbeing. Opportunities for support could mediate adverse effects. Future research could further explore coping mechanisms and organizational factors contributing to negative staff experiences. [ABSTRACT FROM AUTHOR]

Some women with severe perinatal mental health difficulties in England are cared for by acute home treatment services, known as Crisis Resolution Teams (CRTs), which provide short‐term home‐based treatment for adults experiencing a mental health crisis. Intensive home treatment has been trialed in a number of countries, but it is not known how well suited it is to the needs of perinatal women. This qualitative study aimed to explore how women and practitioners experience the provision of intensive home treatment for perinatal mental health problems. Semi‐structured interviews were conducted with women who had received intensive home treatment in the perinatal period (n = 15), and focus groups were held with practitioners working in CRTs or in specialist perinatal mental health services (3 groups, n = 25). Data were analysed thematically. Women commonly found intensive home treatment problematic, experiencing it as intrusive and heavily risk‐focused, with poor staff continuity and little tailoring to the perinatal context. However, women valued emotional support when provided, particularly when it had a perinatal focus, sometimes based on practitioners sharing their own experiences. Some women also appreciated avoiding hospital admission, but choice was often limited. Practitioners reported a lack of perinatal training among CRT staff and described difficulties tailoring treatment to perinatal women's needs. Currently, intensive home treatment, as offered by CRTs, may not be well suited to women with perinatal mental health difficulties. Findings suggest a need to develop community crisis responses that are better tailored to the needs of this population. [ABSTRACT FROM AUTHOR]

Globally, the exodus of individuals who have been forced to flee their home and seek refuge in countries of safety has led to a refugee crisis. The United Kingdom (UK) has engaged with the United Nations High Commissioner for Refugees (UNHCR) in playing a significant role in the long‐term resettlement of refugees, half of whom are children and young people. One initiative of such humanitarian resettlement is the Gateway Protection Programme (GPP). To date, there is a dearth of studies investigating aspects of acculturation that affect the mental health of young refugees resettled under the UNHCR humanitarian programme. This study aimed to explore aspects of acculturation that could enhance the mental health of GPP young refugees several years after resettlement. Using narrative research, a purposive sample of 31 GPP young refugees, who had a minimum of three‐year stay in the UK, were recruited from local refugee community organizations. Data were collected through a multi‐method design combining focus group discussions (FGDs) with visual arts‐based narrative research (VABNR) and analysed thematically. Three overarching themes emerged: People and places; Its nearly all new to me; and Finding self. This study contributes important knowledge regarding the mental well‐being of young people who have engaged in a resettlement programme and offers valuable information for policymakers and mental health professionals working with GPP young refugees. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate a mentoring programme embedded in a work‐based personal resilience enhancement intervention for forensic nurses. This qualitative study formed part of a wider mixed‐methods study that aimed to implement and evaluate the intervention. Twenty‐four semistructured interviews were carried out with forensic nurse mentees and senior nurse mentors; these explored their experiences of the mentoring programme and any benefits and challenges involved in constructing and maintaining a mentor–mentee relationship. Qualitative data were analysed thematically using the Framework Method. Four key themes relating to the initiation and maintenance of mentor–mentee relationships were identified: finding time and space to arrange mentoring sessions; building rapport and developing the relationship; setting expectations of the mentoring relationship and the commitment required; and the impact of the mentoring relationship for both mentees and mentors. Study findings highlight the benefits of senior nurses mentoring junior staff and provide evidence to support the integration of mentoring programmes within wider work‐based resilience enhancement interventions. Effective mentoring can lead to the expansion of professional networks, career development opportunities, increased confidence and competence at problem‐solving, and higher levels of resilience, well‐being, and self‐confidence. [ABSTRACT FROM AUTHOR]

It is increasingly being recognized that individuals who access acute mental health services are at risk of sexual assault. Assaults may be perpetrated by other patients but also by staff working in mental health environments, although this latter group remain largely under‐researched. Following a reported professional sexual assault and review of an acute inpatient mental health setting in the UK, the overall aim of this study was to explore the mechanisms and structures that were put into place following the investigation and in so doing examine the wider questions of sexual safety in acute mental health settings. A qualitative approach was utilized and involved interviews with clinical staff (n = 8). Thematic analysis was used to analyse the data resulting in four main themes: 'Feeling betrayed': The relational context of the ward environment'; 'Doing what we were meant to be doing': Quality of leadership'; 'Covering yourself': Safeguarding practice; 'The subtleties of abuse': Complexities of safeguarding '. The findings of the study highlight the need for clear organizational structures of support, a clearer understanding of 'sexual safety', and education and training which explicitly addresses recognition and complexity of sexual violence. [ABSTRACT FROM AUTHOR]

Abstract: The effects of mental health nurses’ own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses’ lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six‐phase approach. The analysis revealed the broad context of nurses’ experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses’ lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses’ mental illness could be much broader than the effect of workplace stress. [ABSTRACT FROM AUTHOR]

Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, 'is restraint a necessary evil?', contained subthemes fitting into two ideas represented in the quote: 'it never is very nice but...it's a necessary evil'. It 'never is very nice' was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is 'never very nice', it is a 'necessary evil' when used as a last resort due to safety concerns. Mental health-care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff. [ABSTRACT FROM AUTHOR]

The aim of the present study was to measure the subjective well-being of a group of 225 UK registered mental health nurses (MHN) using three survey measures, and to identify whether certain demographic and workplace factors correlated with subjective well-being measure scores. An online survey incorporating the subjective well-being questions used by the Office for National Statistics, the Satisfaction with Life Scale, and the Warwick Edinburgh Mental Well-Being Scale was administered to members of two professional bodies for MHN. There was good consistency between the three subjective well-being measures, each demonstrating that UK MHN had a relatively low subjective well-being. Apart from the Office for National Statistics question, 'Overall, to what extent do you feel the things you do in your life are worthwhile?', demographic and workplace factors did not correlate with subjective well-being measure scores, although the characteristics of being male, living alone, and being aged 40-49 years were associated with lower mean scores on all three measures. The findings of the exploratory study suggest that a similar study should be undertaken with a larger representative population of MHN, and that qualitative research should explore why and how UK MHN have relatively low subjective well-being. The limitations of this study, namely the response rate and sample representativeness, mean that the results of the present study must be tested in further research on the MHN population. [ABSTRACT FROM AUTHOR]

A qualitative study of staff and service users' views of recovery was undertaken in a UK high secure hospital working to implement recovery practices. 30 staff and 25 service users participated in semi-structured interviews or focus groups. Thematic analysis identified four broad accounts of how recovery was made sense of in the high secure environment: the importance of meaningful occupation; valuing relationships; recovery journeys and dialogue with the past; and recovery as personal responsibility. These themes are discussed with an emphasis on service user strategies of cooperation or resistance, respectively advancing or impeding progress through the system. In this context the notion of cooperation is, for many, commensurate with compliance with a dominant medical model. The policy framing of recovery opens up contemplation of treatment alternatives, more participatory approaches to risk management, and emphasise the value of relational skills, but may not elude the overarching bio-psychiatric episteme. [ABSTRACT FROM AUTHOR]

The creative arts can be used to support stakeholders of mental health services to communicate and share their lived experience. Digital storytelling is one method that has been used to capture people's lived experience. In this scoping review, we were interested in mapping how digital storytelling has been used in mental health, and to identify gaps in the literature. Nine databases were searched to identify peer reviewed literature published between January 2000 and August 2015; 15 articles were included in the review. The articles were categorized across four broad areas: educational interventions, learning skills, learning about other people's lived experience, and learning about personal lived experience. We identify that while digital storytelling has potential as a participatory process to promote mutual understanding of and empathy towards lived experiences in mental health, there is a dearth of research in this area. More research is needed on the use of digital storytelling in mental health to determine its effectiveness in progressing a recovery orientation in service provision that is built on solidarity and a social justice agenda. [ABSTRACT FROM AUTHOR]