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Open Dialogue is a need‐adapted approach to mental health care that was originally developed in Finland. Like other need‐adapted approaches, Open Dialogue aims to meet consumer's needs and promote collaborative person‐centred dialogue to support recovery. Need‐adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need‐adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need‐adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need‐adapted mental health care to ensure they deliver these interventions as intended and in an evidence‐based fashion. [ABSTRACT FROM AUTHOR]

Mental health inpatient units are complex and challenging environments for care and treatment. Two imperatives in these settings are to minimize restrictive practices such as seclusion and restraint and to provide recovery‐oriented care. Safewards is a model and a set of ten interventions aiming to improve safety by understanding the relationship between conflict and containment as a means of reducing restrictive practices. To date, the research into Safewards has largely focused on its impact on measures of restrictive practices with limited exploration of consumer perspectives. There is a need to review the current knowledge and understanding around Safewards and its impact on consumer safety. This paper describes a mixed‐methods integrative literature review of Safewards within inpatient and forensic mental health units. The aim of this review was to synthesize the current knowledge and understanding about Safewards in terms of its implementation, acceptability, effectiveness and how it meets the needs of consumers. A systematic database search using Medline, CINAHL, Embase and PsychInfo databases was followed by screening and data extraction of findings from 19 articles. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of empirical articles, and the Johanna Brigg's Institute (JBI's) Narrative, Opinion, Text‐Assessment and Review Instrument (NOTARI) was used to undertake a critical appraisal of discussion articles. A constant comparative approach was taken to analysing the data and six key categories were identified: training, implementation strategy, staff acceptability, fidelity, effectiveness and consumer perspectives. The success of implementing Safewards was variously determined by a measured reduction of restrictive practices and conflict events, high fidelity and staff acceptability. The results highlighted that Safewards can be effective in reducing containment and conflict within inpatient mental health and forensic mental health units, although this outcome varied across the literature. This review also revealed the limitations of fidelity measures and the importance of involving staff in the implementation. A major gap in the literature to date is the lack of consumer perspectives on the Safewards model, with only two papers to date focusing on the consumers point of view. This is an important area that requires more research to align the Safewards model with the consumer experience and improved recovery orientation. [ABSTRACT FROM AUTHOR]

This article aims to draw attention to increasing genericism in nurse education in the United Kingdom, which sees less specialist mental health education for mental health nursing students and offers opposition to such direction. In 2018, the Nursing and Midwifery Council produced the 'Future Nurse' standards which directed changes to pre‐registration nurse education. This led to dissatisfaction from many mental health nurses, specifically regarding reduced mental health content for students studying mental health nursing. Concerns have been raised through public forum and evolved into a grassroots national movement 'Mental Health Deserves Better' (#MHDeservesBetter). This is a position paper which presents the perspective of many mental health nurse academics working at universities within the United Kingdom. Mental health nurse academics collaborated to develop ideas and articulate arguments and perspectives which present a strong position on the requirement for specialist pre‐registration mental health nurse education. The key themes explored are; a conflict of ideologies in nursing, no parity of esteem, physical health care needs to be contextualized, the unique nature of mental health nursing, ethical tensions and values conflict, implications for practice, necessary improvements overlooked and the dangers of honesty and academic 'freedom'. The paper concludes by asserting a strong position on the need for a change of direction away from genericism and calls on mental health nurses to rise from the ashes to advocate for a quality education necessary to ensure quality care delivery. The quality of mental health care provided by mental health nurses has many influences, yet the foundation offered through pre‐registration education is one of the most valuable. If the education of mental health nurses does not attend to the distinct and unique role of the mental health nurse, standards of mental health care may diminish without assertive action from mental health nurses and allies. [ABSTRACT FROM AUTHOR]

This article is based on a larger research project, which investigates the effectiveness of a culturally appropriate model, namely ūloa, when working with Tongan people. Ūloa is a communal method of fishing in Tonga, which includes all members of the community. A previous paper described the three phases of ūloa: presenting the concept to health providers and community groups; phase two amended the model based on phase one. This paper reports on phase three and findings related to the increased awareness of ūloa model within the mental health services and to raise awareness of how to work with Pacific people and adjust the health service to suit the needs of this population to test its effectiveness. Using reflexive thematic analysis, results highlighted a number of patterns both across the groups, described as napanapangamālie (harmony, balance), ngāue fakataha (working together/oneness), and toutai (fisher). These findings continue to support that the conventional biomedical approach employed in the mental health services overlooks elements of Tongan constructions of mental illness and the intersections between Tongan and biopsychosocial themes. Care that is based only on the 'medicine' rather than bringing the spiritual aspect into care planning (fake leaves) will not serve the needs of the Tongan community. [ABSTRACT FROM AUTHOR]

ABSTRACT The stepped care model (SCM) is a patient‐centred approach to mental health care, offering a range of services from least to most intensive, tailored to individual needs. This scoping review examines the adoption, effectiveness, challenges and implications associated with applying SCM within primary mental health service delivery. Evidence from global sources suggests the model is viable, effective and useful. This review explores the literature available, clarifies fundamental concepts and identifies existing knowledge gaps. The literature search included CINAHL, MEDLINE, PsycINFO, Scopus, the Federation University library, Google and Google Scholar databases. A systematic keyword‐based search using terms like “stepped care model,” “mental health,” and “primary care”; and a combination of keywords and subject headings, were used. The search strategy was refined by considering factors such as relevance, publication date, objectives and outcomes. This strategy yielded 20 papers compiled in this review. They include randomised controlled trials and cross‐sectional studies. The review supports SCM adoption in primary mental health care but acknowledges the need for further research. Key inclusions of the review include cost‐effectiveness, diverse diagnoses, efficacy and the model's structural configuration. Clear treatment details, delivery methods, intervention durations and chronological sequences are essential. This systematic approach enhances generalisability across different SCM models and areas, strengthening reliable inferences. In summary, the SCM holds promise for enhancing mental health service delivery. However, there is a need to further examine the factors that determine its effectiveness and understand the different ways in which SCM is implemented. Such inquiry forms the foundation for implementing and advancing mental health care services in Australia and internationally. [ABSTRACT FROM AUTHOR]

Dialectical Behaviour Therapy (DBT) programmes are often the only available treatment for people diagnosed with borderline personality disorder and were rapidly converted to online delivery during the COVID‐19 pandemic. Limited research exists surrounding how the major elements of DBT are delivered in an online environment. This scoping review considered the operationalization of online delivery of DBT and its effectiveness. EBSCO host databases were searched using free text. Of 127 papers, 11 studies from 2010 to 2021 investigating online DBT for any clinical population were included in the review. A narrative synthesis of papers selected was undertaken. Seven articles reported results from five clinical trials (n = 437). Most adaptations mirrored face‐to‐face programmes although there was considerable variation in how therapy was facilitated. Attendance was reported to be greater online with comparable clinical improvements to face‐to‐face for those who remained in therapy. Additional challenges included managing risk, therapist preparedness and technology difficulties. Online delivery of DBT programmes is feasible and may be more accessible, acceptable and as safe and effective as face‐to‐face delivery. However, mirroring face to face delivery in an online environment may not be the most effective and efficient way to adapt DBT to online provision. Research is needed to identify areas which require further adaptation. [ABSTRACT FROM AUTHOR]

Abstract: Long psychiatric hospital stays are unpopular with services users, harmful, and costly. Economic pressures alongside a drive for recovery‐orientated care in the least restrictive contexts have led to increasing pressure to discharge people from hospital early. Hospital discharge is, however, complex, stressful, and risky for service users and families. This rapid literature review aimed to assess what is known about early discharge in acute mental health. Searches were conducted in nine bibliographic databases, reference lists, and targeted grey literature sources. Fourteen included papers focused on early discharge in mental health, a population over 18 years with a mental health condition, and reported outcomes on therapeutic care or service delivery. Quality appraisal was undertaken using The Mixed Method Appraisal Tool. The meta‐summary of the literature found that early discharge was neither provided to all inpatients nor limited to the Crisis Resolution and Home Treatment (CRHT) service model internationally. Early discharge interventions required collaborative working and discharge planning. It was not associated with unplanned readmissions and had a small effect on length of stay. Most studies reported service outcomes, whereas health outcomes were underreported. Professionals and service users were positive about early discharge and service users asked for peer support. Carers preferred hospital or day hospital care suggesting their need for respite. Limitations in the scope, detail, and quality of the evidence about early discharge leave an unclear picture of the components of early discharge as an intervention, its effectiveness, cost‐effectiveness, or outcomes. [ABSTRACT FROM AUTHOR]

Abstract: This review aimed to synthesize the evidence on the likelihood of harm and mortality on medical and surgical inpatient wards for people with severe mental illness (SMI). From 937 results identified through database searching, and a further 10 papers identified through citation searching and hand searching, 11 papers met the criteria for inclusion in the final review. This review did not find strong evidence for higher in‐hospital mortality in people with SMI. There was evidence that adverse events are higher in people with SMI. A higher likelihood of emergency instead of planned care, and poorer access to treatment were identified as potential contributing factors to these adverse events. In addition, service users with SMI were more likely to have a longer length of stay, associated with a higher cost of care. The severity of the mental illness increased the likelihood of harm or death, and people with schizophrenia were more likely than people with other mental illnesses to experience these adverse outcomes. There is evidence that people with SMI are provided with lower‐quality health care, whereas higher‐quality, better‐planned care is required to overcome the inequalities in access faced by this vulnerable population. [ABSTRACT FROM AUTHOR]

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer‐reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002–2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high‐quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries. [ABSTRACT FROM AUTHOR]

From the author's experience in reviewing abstracts for conference presentations, nurses do not find it easy or straightforward to write an abstract, nor do they appear to fully understand its aim and purpose. The aim of this paper is to provide a clear understanding of the role of the abstract in the context of conference presentations and to provide a practical tool to guide nurses through the process of writing an abstract for a conference presentation in terms of both the structure and the content. Tips on what to avoid when writing an abstract are included. [ABSTRACT FROM AUTHOR]

The diagnosis of borderline personality disorder (BPD) has been found to carry stigma and poor hope of recovery. More recently, it has been regarded as a treatable condition through psychotherapy. Despite this, patients often experience lengthy hospitalizations, limited access to treatment, and poor outcomes. This paper describes the experiences of psychiatric nurses working with people diagnosed with BPD in acute mental health in‐patient settings in Ireland. Seven nurses were interviewed, and the transcripts were analysed using a reflective and inductive approach. Overall, the nurses did not feel confident that their interventions were effective or valued by the wider service or patients. The nurses articulated their invidious professional circumstances, whereby they were required to act in ways, which ran counter to their vision of therapeutic or recovery‐focused work. These views and perceptions that in‐patient care is often ineffectual are widely echoed in the literature. We contend that the effect of this circumstance for these nurses approaches moral distress. The nurses were aware of more effective methods of care and treatment for BPD but perceived that they were unable to influence the culture of in‐patient care. [ABSTRACT FROM AUTHOR]

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one‐year post‐implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four‐step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes. [ABSTRACT FROM AUTHOR]

As mental health nurses acquire and utilize knowledge for practice, both emotion and learning become interrelated, interactive, and interdependent aspects of personal functioning and professional practice. Emotion and learning in combination are powerful sources of meaning and direction. This paper explores how, in addressing these important aspects of ‘becoming’ and ‘being’ a mental health nurse with students, the medium of painting was used to facilitate the exploration of their self in relation to others encountered in recent clinical practice. Broad principles of psychoanalytic theory are used in analysing the experiences depicted in the student paintings, and their explanatory accounts, in order to explore the emotionality of mental health nursing and the complexities of addressing this within current educational processes. What is revealed is that in the uncertainties of everyday clinical and educational practice, working and learning in the place between knowing and not knowing can give rise to unconscious defence mechanisms being used to achieve emotional homeostasis. This paper argues that while working and learning in this hinterland can sometimes be experienced as being threatening and anxiety provoking, it is also a place for personal and professional development and growth. The tutor's role in facilitating such opportunities for growth is seen as being crucial. However, this will require tutors to actively engage in critical reflection in and on their educational practice in order to better understand and use their authentic self in more effectively supporting the student. [ABSTRACT FROM AUTHOR]

This paper presents the second part of the findings of an Australian study examining the implementation of clinical supervision in a rural mental health service. A qualitative, exploratory approach was adopted, which included the auditing of relevant documentation and interviews with the nurses who oversaw the implementation process. Within this organization, implementation happened through five stages. The first two stages (preimplementation) were described in Part 1 of this paper. Part 2 describes stages 3–5, including: the strategic plan; implementing the strategic plan; and reflecting on the past and moving forward. The implementation model developed as a result of this research is presented in Part 3. The main findings from these stages included: the role of the implementation committee; the need for a strategic approach; the necessity of education and training; the ongoing importance of assessing organizational culture and considering the sustainability of clinical supervision. [ABSTRACT FROM AUTHOR]

Remarks such as ‘she's manipulative’ and ‘he's right off’ are familiar to psychiatric nurses. This paper critiques the language nurses use in acute inpatient psychiatry services, highlighting the diverse discourses implicated in nurses’ writing and speaking about patients. Based on a review of the literature, this paper examines ethnographic studies and discourse analyses of psychiatric nurses’ oral and written language. A prominent debate in the literature surrounds nurses’ use of standardized language, which is the use of set terms for symptoms and nursing activities. This review of spoken descriptions of patients highlights nurses’ use of informal and local descriptions, incorporating elements of moral judgement, common sense language and empathy. Research into written accounts in patient files and records show nurses’ use of objectifying language, the dominance of medicine and the emergence of the language of bureaucracy in health services. Challenges to the language of psychiatry and psychiatric nursing arise from fields as diverse as bioscience, humanism and social theory. Authors who focus on the relationship between language, power and the discipline of nursing disagree in regard to their analysis of particular language as a constructive exercise of power by nurses. Thus, particular language is in some instances endorsed and in other instances censured, by nurses in research and practice. In this paper, a Foucauldian analysis provides further critique of taken-for-granted practices of speech and writing. Rather than censoring language, we recommend that nurses, researchers and educators attend to nurses’ everyday language and explore what it produces for nurses, patients and society. [ABSTRACT FROM AUTHOR]

Due to their propensity for acting out with antisocial behaviours, angry men are often regarded as having antisocial personality disorder with little hope for treatment success. Whilst not denying the difficulties in working with angry men, this paper looks to challenge some of the received wisdom in this area. Antisocial personality disorder is compared with borderline personality disorder and the many similarities, including the association with childhood trauma, course of illness, symptoms and rates of occurrence, are discussed. Differences between the two groups may be associated with the internalization or externalization of anger. Some issues related to bias in diagnosis are raised, as is the universal hopelessness implied in the literature related to treatment of antisocial personality disorder. Some issues related to engaging traditional men are discussed. In this paper the term 'traditional men' is used to describe men who value stoicism, self-reliance, strength, work, status and aggression highly whilst denying any vulnerability and exhibiting restricted emotionality. There is a need to reframe the diagnosis in order to recognize the associated behaviours as being an adult manifestation of complex childhood trauma. Further, there is a need for treatment directed towards altering ongoing patterns of retraumatization which characterize the lives of these men. A case study is included to demonstrate a number of the issues involved in working with angry men. These include issues of connection, boundaries, safety and utilization of the general practitioner in setting up a containing structure. The case study is used to illustrate that when issues of connection and anger containment are positively addressed, good therapeutic outcomes are possible. [ABSTRACT FROM AUTHOR]

Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty‐two nurses were recruited from one Australian forensic mental health service. Data were collected using semi‐structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high‐risk patient cohort. [ABSTRACT FROM AUTHOR]

Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community‐based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer‐reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals’ experiences of such tensions in the context of decision‐making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision‐making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users’ subjective experiences in the decision‐making process to challenge the definition of people with mental health problems as risky. [ABSTRACT FROM AUTHOR]

People from Egypt have cultural belief systems about mental illness and its causes that are at variance from Anglo-Saxon-derived understandings that predominate in Australian psychiatry. These differences in understanding can affect how mental health services are experienced and accepted by this cultural group. This paper is a review of the literature on Egyptians’ beliefs about mental illness and how families in Egypt cope with a relative with mental illness. Because of limited literature on Egyptians’ experience with mental illness in Australia, this paper will be used to shed some light on the way in which people experience mental illness and communicate this suffering in the Australian context, based on what has been known to occur in Egypt. The Zar cult and related practices focusing on belief in the evil eye, magic, and evil possession will be explored. Historical and contemporary mental health care systems in Egypt, and the influence of education and religion are discussed. In order to provide culturally sensitive care, nurses need to be aware of possible influences on belief systems about mental illness. This paper has the potential of helping nurses to gain a deeper understanding of cultures that differ from theirs and to provide care to clients and their families based on respect for the others’ beliefs, values, and practices. [ABSTRACT FROM AUTHOR]

Collaborative research activities are increasingly being used across health-care settings and are viewed as a positive way to achieve mutual outcomes. However, interagency or intersectoral research programmes are not without problems. They are, at best, challenging and complex activities that require enormous commitment of resources, expertise and insight from all stakeholders. This paper uses the example of an actual collaborative research project to illustrate factors that can impair collaboration and in turn negatively impact on intersectoral research outcomes. It is anticipated that an honest description of those events and issues that adversely affected the programme presented here, and examination of the associated literature, will serve as a guide to others embarking on similar collaborative endeavours. This paper does not attempt to provide a full review of the comprehensive range of literature about collaboration and collaborative research; rather, it presents some key themes identified as having the potential to impact on the success of collaborative research projects. Key themes acknowledged by the authors as influencing the progress of the research project highlighted here are communication, environment, politics and power, and organizational culture. [ABSTRACT FROM AUTHOR]

Policy changes within the mental health system are creating an increasing expectation that service providers increase the opportunities for consumer and carer participation in the planning, delivery and evaluation of mental health services. If they are to reflect this change in philosophy, researchers have an obligation to ensure the involvement of consumers and carers, above and beyond involvement as a participant in all relevant mental health research. This paper describes the establishment and function of a reference group, established to guide and assist with the conduct of a research project examining the experiences of consumers and carers with psychiatric disability support services. The formation and operation of, and the valuable contribution made by, the reference group is discussed. [ABSTRACT FROM AUTHOR]

Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes. Findings highlight the complexities of the researcher role and benefits of using an ethnographic approach to explore mental health triage patterns. Insider participant observation brings many challenges but also, in this study, enabled the researcher to uncover some roles and processes underpinning triage decisions in mental health services. [ABSTRACT FROM AUTHOR]

Mental health nurses have historically been pessimistic about and often unsym­pathetic towards clients diagnosed with borderline personality disorder. By the time these clients reach adult mental health services their behaviours are often difficult to manage and they often suffer significant re-victimization by health services. Questions need to be raised about how best to avert the consolidation of the problems associated with the disorder. This paper explores the concept of‘borderline pathology’ in children and adolescents and examines the best available evidence for utilizing an early identification and intervention model for children and adolescents who exhibit this constellation of symptoms. [ABSTRACT FROM AUTHOR]

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well-being throughout their lives, compared to non-Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme 'supports along the road to recovery'. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients' mental health needs. These insights may inform service review, workforce development, and further research. [ABSTRACT FROM AUTHOR]

The active engagement of clients in mental health services offers far greater chances of successful outcomes. When clients do not actively engage in treatment, their risk of becoming part of the population of ‘high users’ is greater. The ‘high users’ consume a disproportionate share of health resources, which may prevent other potential clients from accessing services. Engagement can be particularly challenging in crisis situations, which is how many clients attracting psychotic diagnoses first enter the service. New Zealand Māori bring a transcendent quality to the idea of ‘respect for Other’, which would make it sacrilegious to overpower Other in most situations. This paper reviews a growing body of literature indicating how we might integrate an enhanced respect or reverence of Other into clinical practice. This includes the idea of engaging more frequently with the social network when building rapport with an individual is particularly challenging. There is some evidence that services adopting this kind of approach are more economical. [ABSTRACT FROM AUTHOR]

There is growing recognition and understanding of the inextricable interrelationship between physical and mental health. In mental health care, the physical health of consumers is now acknowledged as a serious problem requiring urgent action. This issue is undoubtedly related to negative symptoms and the lifestyle of people with mental illness. Much of the burden is also clearly linked with the detrimental side effects of psychotropic medications and deficits in the knowledge, skill, and confidence of mental health clinicians in relation to physical health matters. This paper highlights the problem of physical health in mental health care and presents recommendations to address this issue. The benefits of exercise on mental health in particular are explored. The authors argue that mental health nurses must play an active role in health promotion, primary prevention, and the early detection and management of physical health problems in all areas of clinical practice. [ABSTRACT FROM AUTHOR]

Nursing handover is an established practice that involves an interchange of information between nurses to inform of the condition of patients. It is essential to nursing practice in terms of continuity and quality of patient care. However, there is a lack of agreement about the quality, content, and process of handover and, in particular, a lack of information specific to mental health contexts. This paper reports the results of exploratory research of the practice and beliefs about verbal nursing handover within an inpatient mental health rehabilitation setting. Qualitative data were obtained from audiotaped handovers and interviews with nurses and analysed using content analysis. Handovers were found to lack structure and content, be retrospective, problem-focused and inconsistent. The findings were fairly consistent with the literature and would likely be applicable across nursing settings; however, the need to appraise nursing handover in unique contexts was also revealed. The study raised questions about how nursing handover reflects the goals and philosophies of mental health rehabilitation and whether nursing handover is an activity fully integrated with the focus of mental health rehabilitation. [ABSTRACT FROM AUTHOR]

The routine use of standardized instruments to measure consumer outcomes is now part of mental health policy throughout Australia. However, it has been broadly criticized for (i) not involving consumer input into the design of instruments; and (ii) not reflecting the aspects of care and treatment considered beneficial for recovery by consumers themselves. The importance of the concept of recovery is increasingly considered in the literature. Despite this, there is a paucity of research describing the effectiveness of services in promoting recovery from the perspective of consumers of mental health services. The aim of this study is to explore consumer perspectives in relation to the factors that promote and impede recovery, and the principles that ideally should underpin the evaluation of services. Focus group interviews were conducted with consumers of mental health services (n = 16) from one rural and one metropolitan mental health service in Victoria, Australia. This paper presents Part 1 of the findings, pertaining to aspects of mental health services that enhance recovery. Two main themes arose during the data analysis process: (i) treatment; and (ii) support and social connectedness. Various treatment strategies, including medication and spiritual involvement, were considered helpful. However, support from both staff and peers emerged as a more important and influential factor. [ABSTRACT FROM AUTHOR]

Family carers of people with a severe mental illness play a vital, yet often unrecognized and undervalued role in Australian society. Respite care services can assist these family carers in their role; however, little is known about their access to these services. The paper addresses this knowledge gap. An exploratory field study was conducted throughout the eastern suburbs of Sydney, Australia, to identify and examine the factors influencing the use and provision of respite services for older carers of people with a mental illness. Semistructured, in-depth interviews, and structured self-completed questionnaires were conducted with older family carers, mental health care professionals, and respite care service providers. Additionally, relevant documents (local policies, strategic plans and reports on respite care) were reviewed. It was found that current respite services are problematic for older family carers of Australians with a mental illness, signalling the need for concerted efforts by carers, health professionals, and service providers to improve access. Changes to respite provision and utilization are recommended. [ABSTRACT FROM AUTHOR]

There is increasing emphasis on enhancing consumer and carer participation in the planning and provision of mental health services. However, health professionals, consumers, and carers have different perceptions about what constitutes optimal care; identifying, negotiating, and meeting their respective needs can be challenging. The aim of the paper is to highlight the challenges of facilitating carer participation in daily practice and emphasize the broader issues that would benefit from more extensive discussion among health professionals. By examining the strategies used to enhance consumer participation, there is the potential to avoid many of the mistakes of the past and create a flexible and responsive framework to increase carer involvement. The authors anticipate that this discussion will resonate with many clinical staff as well as carers themselves. Identifying barriers to carer participation opens the way to promoting collaboration and enhancing care. [ABSTRACT FROM AUTHOR]

The aim of this paper is to report on findings identifying some of the difficulties encountered by the multidisciplinary team in the development and implementation of a care pathway for patients diagnosed with schizophrenia. Policy direction has shifted towards greater team working and blurring of professional boundaries. Moreover, there is greater need to deliver care according to set standards and for patients to reach particular outcomes of care. Care pathways are relatively new for psychiatry and will potentially uncover tensions within the team. Data were collected by participant observation and semistructured interviews over a period of 12 months on an acute psychiatric unit. The care team developed the care pathway and the process of development and implementation was observed through action research. Cross-sectional indexing was used to analyse the data, and themes were developed using interview and observational data collection methods. Clinicians argued strongly for clear role boundaries but also defended their perceived control over health care from other professions. The findings indicate that designing a care pathway for people with schizophrenia may produce conflicting perceptions from the team. Conflict may arise through professions being unwilling to accept plurality over roles, which may hinder progress in meeting the needs of patients. The findings also counter the impression that care pathways can be implemented with little impact on the team. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a qualitative study to identify factors that influence Asian communities’ access to mental health care and how mental health care is delivered to them. Semistructured interviews were completed with Asian community members/leaders and health-care professionals. Content analysis identified major themes. Participants also completed a demographic data sheet. The research aimed to provide health professionals with an increased understanding of the values and beliefs held by people from Asian communities regarding the cause and treatment of mental illness. Data analysis identified six main themes that influenced Asian communities’ access to mental health care and how mental health care is delivered to them. They were: shame and stigma; causes of mental illness; family reputation; hiding up; seeking help; and lack of collaboration. The findings highlighted that people from Asian communities are unwilling to access help from mainstream services because of their beliefs, and that stigma and shame are key factors that influence this reluctance. The findings also highlight that the mental health needs of refugee women are significant, and that they comprise a vulnerable group within Australian society. [ABSTRACT FROM AUTHOR]

Preceptorship is a valuable strategy largely underestimated in its ability to influence nursing students' attitudes and beliefs about mental health nursing. As a model, it has the potential to influence nursing practice, enhance clinical learning, promote recruitment and retention, and generate a more collaborative approach for nursing student supervision. The relationship is usually for a fixed and limited timeframe where the preceptor inspires and supports the growth and development of the student nurse, and encourages role socialization into the profession (Morton-Cooper & Palmer 2000). The challenge for mental health services is to achieve success in the provision of effective preceptorship, ensure positive and rewarding clinical experiences for nursing students, and improve recruitment and retention rates for the service. These aims are substantially more difficult to achieve in the absence of quality education, training and support for preceptors. This paper describes the use of preceptorship training to address recruitment issues in a rural service, particularly the need for effective preceptorship at undergraduate level, which has been shown to have an impact on the willingness of new nursing graduates to enter the mental health nursing field. The design and delivery of the training programme is outlined, including details of the program evaluation and its subsequent impact on psychiatric nurses' approach to and practice of preceptorship. Finally, the broader issue of the value of training nurses in larger groups, enlisting a critical mass of preceptors within an individual mental health service, is discussed. [ABSTRACT FROM AUTHOR]

Routine‘outcome measurement’ is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people's recovery journeys or provide information that can usefully inform care. Indeed,in its implementation nurses may be required to collude in practices or account for practice in ways which run counter to the personal recovery paradigm. Nurses should view a focus on outcomes as an opportunity for critical reflection as well as to seek ways to account for recovery stories in meaningful ways. [ABSTRACT FROM AUTHOR]

Nursing Clinical Development Units have become popular as a framework for the facilitation of the professional development of nursing and to contribute to improved outcomes for consumers of health care services. An exploratory evaluation of the Nursing Clinical Development Unit program implemented by the Centre for Psychiatric Nursing Research and Practice was undertaken using a qualitative approach. This paper focuses on the findings relating to outcomes. A number of positive outcomes were identified including: changes within nursing practices; the development of more positive attitudes by nurses,a greater focus on research utilization and evidence-based practice; and an increase in professional development activities,including conference presen­tations. Despite these positive findings,the need for more structured evaluation and an increased emphasis on dissemination of findings was identified. [ABSTRACT FROM AUTHOR]

There is a general expectation for health service employees to present their work in oral or written format to showcase clinical ideas,innovations,service developments,and quality and research initiatives. This research note outlines the types of forums where work can be presented and highlights their relative merits. It is anticipated that this discussion will be of interest to clinicians,managers and researchers when considering where best to present their work. [ABSTRACT FROM AUTHOR]

This paper acknowledges the concept of the unconscious in psychiatric discourse and explores the importance of this for mental health nursing practice. Mental health nursing practice has always been strongly influenced by psychiatric discourse because of its dominance in the clinical setting. The most recent edition of the American Psychiatry Association's Diagnostic and Statistical Manual has signalled that the concept of the unconscious is re-emerging in psychiatric discourse. This re-emergence provides the opportunity for mental health nurses to re-affirm or develop their psychotherapeutic skills in the nurse−patient relationship. The psychotherapeutic relationship could focus on ways for the patient to find meaning in their lives that recognize and value difference and multiple ways of being. [ABSTRACT FROM AUTHOR]

ABSTRACT: Working with consumers is now a common expectation in contemporary mental health services. Yet health professionals may not entirely understand the difference between patient and consumer roles. Alternatively, they may feel they do not have the skills or resources to deal with people in roles other than patient or carer. Nor may they be able to separate out their personal experiences with particular consumers from the ideals and goals for effective consumer partnerships. This paper reviews a concept known as the politics of difference as well as the rise of the consumer movement in order to explore areas of difference between consumers and providers, to reexamine how power and marginalization practices occur. It reminds professionals that generalizing from one failed experience relating with a consumer is just as invalid as idealizing the current policy of consumer inclusion. Inviting, allowing, amplifying and improving the effectiveness of the consumer voice in mental health services today requires active commitment, educative processes and novel strategies to move beyond superficial relationships so that consumers and professionals work together to make enduring change. [ABSTRACT FROM AUTHOR]

PRN, or ‘as needed’, medications are administered frequently by mental health nurses in psychiatric inpatient settings to manage difficult and disturbed behaviour when other strategies fail. Research indicates that approximately 50% of psychiatric inpatients receive a PRN medication at some stage of their treatment. Although evidence indicates that traditional antipsychotics and benzodiazepines are equally effective in managing acute agitation and other psychotic symptoms, it has been recommended that benzodiazepines should be the first-line of action because they do not cause the serious side-effects that are common with the traditional antipsychotics. Unfortunately, research indicates that doctors and nurses are not taking advantage of the latest evidence to guide their practice. This paper reviews the limited research available in the area and makes recommen­dations for evidence-based practice. [ABSTRACT FROM AUTHOR]

There has been an apparent shift in majority opinion within psychiatry over the last 20 years on the nature of the relationship between mental illness and violence. Where once there was perhaps widespread scepticism, research, while sometimes producing conflicting results, appears ultimately to have led to the emergence of an almost universal consensus that there is a link. This paper will review the nature of the evidence for such a link between mental illness and violence and explore some of the newer suggestions about why mental illness may sometimes be related to violence [ABSTRACT FROM AUTHOR]

Consumer participation in health care is increasingly becoming an expectation of health services. While important progress has been made in the mental health area, the attitudes of mental health professionals towards consumers poses a severe limitation. Greater consumer involvement in the education of mental health professionals has been presented as a strategy to encourage the development of a greater acceptance of consumer involvement by health professionals. A consumer academic position has been introduced into the Centre for Psychiatric Nursing Research and Practice. An important aspect of this role concerns the education of postgraduate psychiatric/mental health nursing students, in order to provide a consumer perspective and encourage greater consumer participation. In order to determine the impact of this project a questionnaire was developed by the authors to measure attitudes to consumer participation and the role of the consumer academic. This paper presents the first stage of this study. The questionnaire was administered to students (n = 25) on the first day of the course. The findings suggest that most students favour a high level of consumer participation but that this is limited to specific areas of treatment planning and delivery. Furthermore, the students' demonstrate some level of ambivalence regarding the value and necessity of the consumer academic role. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic led to significant adaptations to healthcare. Provision of mental healthcare in a changing environment presented healthcare workers with unique challenges and demands, including changes in workload and expectations. To inform current and future healthcare service responses, and adaptations, the current review aimed to collate and examine the impact of the pandemic on mental healthcare workers (MHWs). We conducted a rapid systematic review to examine the overall impact of the COVID‐19 pandemic on MHWs. Searches were conducted in Ovid Medline and PsycInfo and restricted to articles published from 2020. Inclusion criteria specified articles written in English, published in peer‐reviewed journals, and that examined any outcome of the impact of COVID‐19 on MHWs; 55 articles fulfilled these criteria. Outcomes were categorized into 'work‐related outcomes' and 'personal outcomes'. Mental healthcare workers worldwide experienced a range of work‐related and personal adversities during the pandemic. Key work‐related outcomes included increased workload, changed roles, burnout, decreased job satisfaction, telehealth challenges, difficulties with work‐life balance, altered job performance, vicarious trauma and increased workplace violence. Personal outcomes included decreased well‐being, increased psychological distress and psychosocial difficulties. These outcomes differed between inpatient, outpatient and remote settings. The COVID‐19 pandemic significantly altered the delivery of mental healthcare and MHWs experienced both work‐related and personal adversities during the COVID‐19 pandemic. With the continuation of changes introduced to healthcare in the initial stages of the pandemic, it will be important to maintain efforts to monitor negative outcomes and ensure supports for MHWs, going forward. [ABSTRACT FROM AUTHOR]

This study applied a fa'afaletui cultural lens to an exploratory qualitative study examining Samoan families' experiences and engagement with a person‐centred care model employed in specific mental health services in Aotearoa. Six semi‐structured talanoa group discussions with families who had been previously or currently engaged with mental health services. In addition, a local stakeholder group was recruited to guide stages of the fa'afaletui. A total of 13 individual participants from six families participated. Participants consisted of four mothers, two fathers, five sisters, one son, and one husband. Five themes were identified: (i) Fa'atuatua ile Atua; Spiritual faith in God; (ii) It is a hush hush topic; stigma of mental illness; (iii) We are in the dark with our communication and dealings with the services; (v) Practice what you preach; clinical service delivery misaligned with the model of care; and (vi) Alofa (love) and fa'aaloalo (respect); enablers of positive experience. The findings overall highlight spirituality and religion as core to a Samoan's faith to foster resilience and healing when facing adverse mental health events with their family members. In addition, the need to build up capacity for Pacific staffed specialist services and Pacific model to achieve equity and holistic care for Samoans and other Pacific populations at risk of adverse mental health outcomes are recommended. [ABSTRACT FROM AUTHOR]

Unplanned hospital readmission rate is up to 43% in mental health settings, which is higher than in general health settings. Unplanned readmissions delay the recovery of patients with mental illness and add financial burden on families and healthcare services. There have been efforts to reduce readmissions with a particular interest in identifying patients at higher readmission risk after index admission; however, the results have been inconsistent. This systematic review synthesized risk factors associated with 30‐day unplanned hospital readmissions for patients with mental illness. Eleven electronic databases were searched from 2010 to 30 September 2021 using key terms of 'mental illness', 'readmission' and 'risk factors'. Sixteen studies met the selection criteria for this review. Data were synthesized using content analysis and presented in narrative and tabular form because the extracted risk factors could not be pooled statistically due to methodological heterogeneity of the included studies. Consistently cited readmission predictors were patients with lower educational background, unemployment, previous mental illness hospital admission and more than 7 days of the index hospitalization. Results revealed the complexity of identifying unplanned hospital readmission predictors for people with mental illness. Policymakers need to specify the expected standards that written discharge summary must reach general practitioners concurrently at discharge. Hospital clinicians should ensure that discharge summary summaries are distributed to general practitioners for effective ongoing patient care and management. Having an advanced mental health nurse for patients during their transition period needs to be explored to understand how this role could ensure referrals to the general practitioner are eventuated. [ABSTRACT FROM AUTHOR]

The article discusses biomedical approach to illness and disorders, and risk assessment/management practices have long dominated the delivery of mental health services. While there are numerous and widely used psychotherapeutic approaches, pharmacological treatment either alone or simultaneous with psychological therapies, remain the basis of treatment.

This article discusses insights arising from a Community of Practice (CoP) initiative within a mental health short stay inpatient unit adjacent to a major Emergency Department to explore how COVID‐19 has influenced engagement and support of people in mental distress. The present initiative was designed as a collaboration between the University of South Australia and SA Health. Community of Practice (CoP) is combined with a narrative review of current evidence to explain specific nursing care responses within an operating environment of pandemic‐induced fear and uncertainty. Meetings discussed the challenges associated with delivering mental health care for people experiencing mental health distress in the COVID‐19 context. Applying trauma‐informed principles to mental health care delivery was identified to be of relevance in the context of an ongoing pandemic. Humanizing nursing care and increasing people's sense of predictability and safety contributed to therapeutic engagement and support during COVID‐19. Factors discussed to mitigate the effects of safety measures include, for example, nuanced verbal and non‐verbal engagement of health workers with people in mental distress when wearing personal protective equipment (PPE). We highlight the need to 'humanise' nursing and openly communicating that both practitioners and people in distress are navigating special circumstances. The CoP participants additionally acknowledged that the experience of moral distress among frontline health workers needs to be addressed in future policy responses to COVID‐19. Person‐centred and trauma‐informed responses at the point of care might help to mitigate the pandemic short‐ and long‐term effects for both service users and frontline health workers. [ABSTRACT FROM AUTHOR]

ABSTRACT Insufficient priority is being given to meet the physical health-care needs of people with mental illness. Mental health nurses, as the largest professional group working in mental health care, have a pivotal role in improving the physical health and well-being of people with mental illness. Through health-promotion strategies, alongside recovery-focused support aimed at avoiding deteriorating physical health, mental health nurses can significantly contribute to improving the current rate of premature death experienced by people with enduring mental illness. Drawing from contemporary policy, alongside practical examples taken from the published literature, this paper considers what constitutes recommended best practice in dealing with the physical health-care needs of people with mental illness. The role that UK-based health-care policy plays in shaping care delivery that meets the needs of people with mental illness is explored and placed within the context of global health concerns. Recommendations are made on how mental health nursing can work to provide evidence for a reassertion that nurses are well placed to work across organizational and professional boundaries to deliver person-centred care and a holistic approach to population health and well-being. [ABSTRACT FROM AUTHOR]

Mental health consumers are sexual beings; however, their sexual desire, capacity, and ability to maintain previous sexual patterns can be altered by their illness or by the effects and side-effects of medications. The sexuality of consumers has been poorly addressed, and the limited evidence suggests that mental health nurses remain ambivalent to including sexuality in their care. This paper presents the findings of a research project investigating the practices of mental health nurses in assessing and supporting the sexuality of consumers. A qualitative, exploratory approach underpinned individual interviews with 14 mental health nurses from inpatient and community settings. The participants acknowledged the importance of sexuality; however, most were reluctant to enquire about consumer concerns and tended to either ignore the issue or refer it to another clinician. Four themes were identified: talking about or avoiding sexuality concerns with consumers; sexuality is not an important priority; refer to others, as talking about sexuality is not 'my' job; and sexuality is poorly addressed by others. It is important that barriers to the assessment and discussion of sexuality are identified, and measures are taken to overcome them. [ABSTRACT FROM AUTHOR]

Mental disorders are the second leading cause of disease burden among Australia's Indigenous people after cardiovascular disease. Yet Indigenous people do not access mental health services in proportion to their need. This paper explores the barriers and facilitators for Indigenous people seeking mental health services in Australia and identifies key elements in the development and maintenance of partnerships for improved service delivery and future research. The process of seeking help for mental illness has been conceptualized as four consecutive steps starting from recognizing that there is a problem to actually contacting the mental health service. We have attempted to explore the factors affecting each of these stages. While people in the general population experience barriers across all four stages of the process of seeking treatment for a mental disorder, there are many more barriers for Indigenous people at the stage of actually contacting a mental health service. These include a history of racism and discrimination and resultant lack of trust in mainstream services, misunderstandings due to cultural and language differences, and inadequate measures to reduce the stigma associated with mental illness. Further research is required to understand the mental health literacy of Indigenous people, their different perceptions of mental health and well-being, issues around stigma, and the natural history of mental illness among Indigenous people who do not access any form of professional help. Collaborations between mainstream mental health services and Aboriginal organizations have been promoted as a way to conduct research into developing appropriate services for Indigenous people. [ABSTRACT FROM AUTHOR]