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Psychiatric decision units have been developed in many countries internationally to address the pressure on inpatient services and dissatisfactory, long waits people in mental health crisis can experience in emergency departments. Research into these units lags behind their development, as they are implemented by healthcare providers to address these problems. This is the first‐ever national survey to identify their prevalence, structure, activities, and contextual setting within health services, in order to provide a robust basis for future research. The response rate was high (94%), and six PDUs in England were identified. The results indicated that PDUs open 24/7, accept only voluntary patients, provide recliner chairs for sleeping rather than beds, and limit stays to 12–72 hours. PDUs are predominantly staffed by senior, qualified mental health nurses and healthcare assistants, with psychiatry input. Staff:patient ratios are high (1:2.1 during the day shift). Differences in PDU structure and activities (including referral pathway, length of stay, and staff:patient ratios) were identified, suggesting the optimal configuration for PDUs has not yet been established. Further research into the efficacy of this innovation is needed; PDUs potentially have a role in an integrated crisis care pathway which provides a variety of care options to service users. [ABSTRACT FROM AUTHOR]

The life expectancy of people with severe mental illnesses is substantially reduced, and monitoring and screening for physical health problems is a key part of addressing this health inequality. Inpatient admission presents a window of opportunity for this health-care activity. The present study was conducted in a forensic mental health unit in England. A personal physical health plan incorporating clearly-presented and easily-understood values and targets for health status in different domains was developed. Alongside this, a brief physical education session was delivered to health-care staff ( n = 63). Printed learning materials and pedometers and paper tape measures were also provided. The impact was evaluated by a single-group pretest post-test design; follow-up measures were 4 months' post-intervention. The feasibility and acceptability of personal health plans and associated resources were examined by free-text questionnaire responses. Fifty-seven staff provided measures of attitudes and knowledge before training and implementation of the physical health plans. Matched-pairs analysis indicated a modest but statistically-significant improvement in staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative. Inpatient admission is a key setting for assessing physical health and promoting improved management of health problems. Staff training and purpose-designed personalized care plans hold potential to improve practice and outcomes in this area, but further support for such innovations appears necessary for their uptake in inpatient mental health settings. [ABSTRACT FROM AUTHOR]

This study aimed to implement and evaluate a work‐based personal resilience enhancement intervention for forensic nurses. A mixed methods design consisting of surveys, interviews, and a case study approach, whereby the experiences of a group of nurses were studied in relation to their experiences of an intervention programme to enhance personal resilience, was utilized. Nurses working on forensic inpatient wards were invited to participate. Senior nurses were recruited as mentors. Data were collected via pre‐ and post‐programme surveys to evaluate nurses' levels of resilience. Post‐programme interviews were undertaken with nurses and mentors to explore their experiences of the programme. Descriptive statistics of survey data examined changes in nurses' resilience levels pre‐ and post‐intervention. Free‐text survey data and interview data were analysed thematically. The SQUIRE 2.0 checklist was adhered to. Twenty‐nine nurses participated. Levels of personal resilience (M = 4.12, SD = 0.60) were significantly higher post‐programme than pre‐programme (M = 3.42, SD = 0.70), (t49 = 3.80, P = 0.000, 95% CI = 0.32, 1.07). Nurses felt the programme had a marked impact on their personal resilience, self‐awareness, confidence, and professional relationships. The benefits of the programme demonstrate the advantages of providing a nurturing environment for nurses to consolidate their resilience levels. Findings demonstrated that resilience enhancement programmes can increase nurses' levels of resilience and confidence and improve inter‐professional relationships. Our findings are important for clinicians, nurse managers, and policymakers considering strategies for improving the workplace environment for nurses. The long‐term impact of resilience programmes may improve nurse retention and recruitment. [ABSTRACT FROM AUTHOR]

Abstract: In response to pressures on mental health inpatient beds and a perceived ‘crisis in acute care’, Crisis Resolution Teams (CRTs), acute home treatment services, were implemented nationally in England following the NHS Plan in the year 2000: an unprecedentedly prescriptive policy mandate for three new types of functional community mental health team. We examined the effects of this mandate on implementation of the CRT service model. Two hundred and eighteen CRTs were mapped in England, including services in all 65 mental health administrative regions. Eighty‐eight percent (n = 192) of CRT managers in England participated in an online survey. CRT service organization and delivery was highly variable. Nurses were the only professional group employed in all CRT staff teams. Almost no teams adhered fully to government implementation guidance. CRT managers identified several aspects of CRT service delivery as desirable but not routinely provided. A national policy mandate and government guidance and standards have proved insufficient to ensure CRT implementation as planned. Development and testing of resources to support implementation and monitoring of a complex mental health intervention is required. [ABSTRACT FROM AUTHOR]

In the present study, the superior factorial structure of the Health of the Nation Outcome Scales (HoNOS) was investigated. The aims of the study were to test the fit of our new four-factor/subscale structure within and across a wide range of clinical populations compared to competing structures, and to identify any clinical populations where the HoNOS might require modification in order to improve its psychometric properties. Ordinal confirmatory factor analysis was performed for four competing HoNOS subscale structures using a national sample of 80 161ratings taken at the point of referral to mental health services in England. A new four-factor structure with good/acceptable internal consistency for each of the factors/subscales demonstrated a significantly better fit to the data for 21 of the 24 data groups compared to three competing subscale models. A new four-factor/subscale structure was shown to be the most generalizable subscale structure currently available for HoNOS. However, although superior to other factorial structures, the statistical fit was less than optimal for some clinical populations. Therefore, we would recommend that additional items relevant to all mental health patients are identified and added to the HoNOS in order to allow the development of a single, more generalizable subscale structure, and a much improved version of the HoNOS. [ABSTRACT FROM AUTHOR]

Incontinence is associated with mental illness and neuroleptic medications but diagnosis and treatment is often poor or non-existent. Problems of incontinence are compounded in secure psychiatric services for women by poor health, obesity, and a sedentary lifestyle. Addressing the physical health of this group necessitates a more accurate picture of the nature, incidence, and management of incontinence. A point-in-time survey of 108 women who agreed to be interviewed (93%) covered presence, frequency, and nature of incontinence, and information on management case note data was used to gather demographic and previous medical history, comparisons were made between patients with and without problems of incontinence. Findings indicate a problem of incontinence in 48% of women with a dominance of problems of stress and urge enuresis. Of modifiable factors that contribute to enuresis, the current study highlighted the contribution of obesity, smoking and clozapine medication. A further finding was the preference for managing rather than treating problems of incontinence. Actions to improve the detection and treatment of this problem are described. [ABSTRACT FROM AUTHOR]

This study examined the antecedents to administration of pro re nata ( PRN) psychotropic medication on acute psychiatric wards, with a particular focus on its use in response to patient aggression and other conflict behaviours. A sample of 522 adult in-patients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2 weeks of admission. Two-thirds of patients received PRN medication during this period, but only 30% of administrations were preceded by patient conflict (usually aggression). Instead, it was typically administered to prevent escalation of patient behaviour and to help patients sleep. Overall, no conflict behaviours or further staff intervention occurred after 61% of PRN administrations. However, a successful outcome was less likely when medication was administered in response to patient aggression. The study concludes that improved monitoring, review procedures, training for nursing staff, and guidelines for the administration of PRN medications are needed. [ABSTRACT FROM AUTHOR]