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Accessible Summary What is known on the subject What the paper adds to existing knowledge What are the implications for practice Introduction Aims Method Results Discussion Implication for Practice Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long‐term work‐related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited. One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels. Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs. Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn‐out. Unexpectedly, staff who reported a more anxious attachment style were burnt‐out; however, there are limitations to this finding. Policies and practices in forensic settings should reflect the risk of STS and burnout. Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT). Secondary traumatic stress (STS) and burnout literature in inpatient forensic health care professionals (FHCPs) is limited, despite the psychological, physiological and organisational consequences.This study aimed to further this limited evidence base, investigating predictors of STS and burnout in FHCPs.98 healthcare professionals working in two UK forensic inpatient settings completed measures assessing: burnout, STS, psychological flexibility, coping style, attachment style and a demographic questionnaire recording length of service and the sex of staff.Results indicated high STS and moderate burnout levels. The main predictors of STS and burnout were poorer psychological flexibility and greater maladaptive coping styles, whereas lower burnout was predicted by greater adaptive coping styles and an anxious attachment style.This study has contributed towards a limited evidence base and indicates poorer psychological flexibility and greater maladaptive coping may be risk factors for STS and burnout in FHCPs, whereas greater maladaptive coping may be a protective factor.The findings suggest that interventions such as Acceptance and Commitment Therapy (ACT) and coping skills interventions, may offer protective benefits to inpatient forensic healthcare professionals. [ABSTRACT FROM AUTHOR]

Accessible Summary What is known on the subject? What does this paper add to existing knowledge? What are the implications for practice? Background Aim Methods Results Discussion Implications for Practice Relevance Statement Clinical guidelines and staff training recommend using de‐escalation over restrictive practices, such as restraint and seclusion Evidence suggests that restrictive practices continue to be used frequently despite training This suggests a lack of impact of existing staff de‐escalation training. The features of de‐escalation training that are acceptable to staff and perceived to be impactful A co‐designed and co‐delivered training session on a trauma‐informed approach to de‐escalation on mental health wards was acceptable and perceived to be impactful Those attending training particularly valued how lived experience was incorporated into the training content and co‐delivery The organizational and team context may need more consideration in adapting the training. De‐escalation training that adopts a trauma‐informed approach and considers the context of ward environments is acceptable to staff Co‐delivery models of training to tackle restrictive practice can be acceptable and impactful Further research will show how clinically effective this training is in improving outcomes for service users in ward contexts. Evidence suggests a discrepancy between recommended and routine practice in de‐escalation in mental health settings, suggesting a lack of impact of existing training.To investigate the acceptability and perceived impact of a co‐designed/delivered training intervention on a trauma‐informed approach to de‐escalation on mental health wards.Trainees were invited to complete the Training Acceptability Rating Scale (TARS) post‐training. Responses to the quantitative items were summarized using descriptive statistics, and open‐text responses were coded using content analysis.Of 214 trainees, 211 completed the TARS. The trainees rated the training favourably (median overall TARS = 55/63), as acceptable (median 33/36) and impactful (median 23/27). There were five qualitative themes: modules of interest; multiple perspectives; modes of delivery; moulding to context; and modifying other elements.The EDITION training was found to be acceptable and impactful, with trainees particularly valuing the co‐delivery model. Trainees suggested several ways in which the training could be improved, particularly around the need for further moulding of the intervention to the specific ward contexts/teams.We recommend co‐designing and co‐delivering staff training to mental health professionals that tackles restrictive practices.This research is relevant to lived experience practitioners who want to be involved in training mental health professionals around restrictive practices, demonstrating the value and importance of their voice. It is relevant to current providers of de‐escalation training, and to staff receiving training, outlining a novel, but acceptable and impactful, form of training on a key area of mental health practice. It is relevant to anyone with an interest in reducing restrictive practice via co‐delivered training. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Little is known about how mental health services can cause harm in ways other than medication, talking therapies, diagnosis and detention under the Mental Health Act.The outcomes of people who avoid seeking help from mental health services due to previous experiences of harm are not well known. What this article adds to existing knowledge?: I provide a first‐person perspective of experiences of harm within mental health services, how this impacted my care, the long‐term effects of the harm on my well‐being and my ongoing experiences of avoiding mental health services. What are the implications for mental health nursing?: Healthcare professionals should be aware of the multitude of ways service provision can harm patients, and how, unknown to professionals, patients may create an internal understanding of how to best navigate harmful service environments.Healthcare professionals should have a deeper understanding of the reasons why people may choose not to engage with mental health services, and what impact this may have on them. The recent announcement of the first ever statutory public inquiry into a UK mental health service indicates a growing recognition of iatrogenic harm in mental healthcare. Despite the potential for harm across all services and practices, restrictive practices, psychotherapy, diagnosis and psychiatric medications are often the only areas of mental healthcare given significant attention. While the topic is widely discussed in survivor communities, accounts of harm caused by the everyday workings of services, including team cultures, administrative processes and staff–patient interactions, are missing from academic literature. In this article, I describe my 10‐year journey through mental health services, and how everyday practices, cultures and staff behaviour deeply impacted my ability to receive appropriate care, replicated previously traumatic environments, and damaged my mental health. Taking steps to protect myself from further harm, I self‐discharged and am currently living as a 'service‐avoider'. The ongoing implications of this decision and the long‐term impacts of harm are discussed. [ABSTRACT FROM AUTHOR]