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Accessible Summary: What the paper adds to existing knowledge?: Personality disorder is a serious mental health condition affecting up to 52% of psychiatric outpatients and 70% of inpatients and forensic patients. People with a diagnosis of personality disorder have higher morbidity and mortality than those without.Service users and carers reported a lack of training for staff in the management of individuals with a diagnosis of personality disorder, particularly with regard to self‐harm and suicidal behaviours.Staff burnout creates barriers to compassionate person‐centred care for individuals with a diagnosis of personality disorder as staff struggled to accommodate the nature of the presentation when under significant emotional, psychological and professional strain caused by understaffing and lack of support. What are the implications for practice?: This paper adds new knowledge by informing services of ways to improve care provision from the perspectives of both carers and service users.A more holistic and less medicalised approach to the treatment of problems associated with a diagnosis of a personality disorder should be adopted, and personality disorder training introduced for all healthcare practitioners, to improve patient outcomes. Introduction: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out‐of‐area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high‐quality care. Aim: To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out‐of‐area placements. Method: Semi‐structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. Results: Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD. Discussion: Anti‐stigma interventions for staff, research on care provision and structural changes to services including more evidence‐based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. Implications for Practice: This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Home treatment teams help people in a mental health crisis to recover. The staff goes to the person's home, avoiding the need to go to the hospital and providing care in the person's environment.The teams have been created in our country in recent years, becoming part of the mental health care network. What this paper adds to existing knowledge?: The paper presents the functioning of a CRHTT, the type of care it provides, and the coordination with the rest of the care network. It also shows the clinical results obtained in the first two years since its creation, supporting the CRHTT's effectiveness in accompanying people with mental health crises and reducing the need for hospital care.The outstanding factors in the team operation were coordination fluidity with referral services (facilitating accessibility), a prolonged care time (about two months), and continuity of care during the CRHTT intervention (the same CRHTT professionals visited the user and the family at home) and upon discharge (CRHTT staff organized joint visits with the professionals who would care for the user and the family after home treatment).The CRHTT followed a person‐centered orientation based on horizontality and dialogue. The CRHTT fostered the inclusion of the family and social network in the treatment and a deep understanding of the crisis considering social determinants. What are the implications for practice?: Flexibility, approach to the person's environment, dialogue, shared decision‐making, and the inclusion of the family and social network in the treatment are central factors in CRHTT functioning. It helps the person regain control over their life and enhance their resources to face possible future crises.Training in crisis management, community mental health and family care, and teamwork (which implies joint home visits and co‐responsibility with the rest of the staff, user, and the family) are relevant for CRHTT professionals. Introduction: Crisis resolution and home treatment teams (CRHTTs) provide intensive home care to people in a mental health crisis, becoming an increasingly widespread alternative to hospital admissions. However, there are wide variations in service delivery, organization, and outcomes, and little literature on how these teams work in clinical practice and different settings. Aim: To share the organizational functioning, the therapeutic approach, and the outcomes obtained in a CRHTT in Catalonia, Spain. Method: A descriptive analysis of the functioning of a home treatment team, the characteristics of the people served, and the clinical results from November 2017 to December 2019 are presented. Results: One hundred and five people were served, with an average stay of 57 days. And 55.24% were women, and the mean age was 41. Most people could overcome the crisis at home, and 5.71% required hospital admission during home care. A statistically significant improvement was observed in the results of the GAF and HoNOS scales at admission and discharge. Discussion: Despite reduced staff, home care was an alternative to hospital admission for most people treated. Implications for Practice: Flexibility, teamwork, and collaboration with the social network are relevant factors when accompanying the recovery process at home. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Adult psychiatric services typically focus on the mental health needs of the client but they do not support his or her parenting role.Many authors highlight the importance of a non‐judgmental approach when providing support and care to clients with mental illness who are parents.Assessments frequently focus on the negative aspects while the strengths of these families were often overlooked.There is a lack of scientific literature exploring nurses' experiences when caring for parents with mental illness and their families. What this paper adds to existing knowledge: Trust is the basis that helps clients to be open to receiving care and answering parenting‐related questions. Therefore, without adequate professional‐client trust, some care and interventions addressed to parents with mental illness could be poorly received by the client.Tronto's phases of care facilitated the collection of data and exploration of mental health nurses' experiences of care. What are the implications for practice: Mental health nurses should be aware of the potential needs of these families, as described in the scientific literature, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique.Mental health nurses must take the person's environment into account (family, social and political aspects and different forms of stigma) since all these factors may influence how parents with mental illness receive and provide care. Introduction: Many authors highlight the importance of a non‐judgmental approach when providing care to parents with mental illness. However, assessments frequently focus on the negative aspects while the strengths of such families were often overlooked. Aim: To explore the lived experiences of mental health nurses who care for clients who are parents. Method: We conducted a qualitative phenomenological study. The main data collection technique was in‐depth interviews. Data were analysed according to Colaizzi model, subsequently, the main categories that arised were compared and related to the five phases of Tronto's care. Results: The main categories identified from the analysis of the interviews were: (1) individualized care, (2) continuity of care, (3) psychoeducation and counselling, (4) trust and (5) context of the client. Discussion: Trust is the basis that helps parents with mental illness to be open to receiving care and answering parenting‐related questions. Without trust, some interventions could be poorly received by the client. Implications for Practice: Mental health nurses should be aware of the potential needs of these families, so they can include them in their assessments. They also should consider the need to individualize each care since each situation of a family with parental mental illness is unique. [ABSTRACT FROM AUTHOR]

Accessible summary: What Is Known on the Subject?: There are significant issues recruiting nurses into mental health due to several reasons such as dilution of curriculum, and mental health being an unpopular career choiceTransition programs provide nurses entering mental health with orientation, academic and clinical skills, and knowledge. What the Paper Adds to Existing Knowledge?: Transition programs need to be nuanced to specialty areas (e.g. community) to ensure nurses are given the support necessary to remain working in the field.Many nurses choose to work in mental health due to a lived or personal experience and as such strengthening wellbeing supports for transitioning nurses is an important role in retention. What Are the Implications for Practice?: Tailored transition programs can help strengthen mental health nurse role clarity, and support staff retention.Transition programs should be a segue to formal postgraduate studies in mental health nursing to strengthen professional practice and retention of nurses. Introduction: Globally, there are consistent issues recruiting staff into the mental health nursing workforce. In Australia, recent efforts to expand the workforce include recruitment of a wider range of nurses in addition to new graduates into mental health transition‐to‐practice programs. Understanding the career motivations of nurses entering the field is an important element of recruitment and retention. Aim: To describe nurses' satisfaction with their mental health transition program and identify factors influencing their choice of mental health as a career. Methods: An online cross‐sectional survey with questions on program satisfaction and career choice was responded to by n = 55 enrolled and registered nurses in a mental health transition program. Results: Nurses reported overall high satisfaction with their program and identified increased time release for professional development and being supernumerary as necessary to support role development. Almost 25% of nurses reported personal experience of mental illness as an influence in choosing a mental health career. Discussion: Mental health transition programs are important in recruitment and retention and need to be tailored to the needs of a wide range of nurses and include support for staff wellbeing. Implications for Practice: Tailored transition programs can help strengthen role clarity, and support staff retention. [ABSTRACT FROM AUTHOR]

What Is Known about the Subject?: Immigrant, refugee and asylum seeker populations worldwide are at high risk of mental health issuesNational mental health policies call for recognising Australian society's multicultural characteristics to ensure adequate mental health services to CALD communitiesSeveral barriers exist for people from CALD communities in Victoria to access and utilise mental health servicesImproving mental health professionals' knowledge of mental health service provision and cultural responsiveness can enhance CALD community access to services. What Does this Paper Add to Existing Knowledge?: We analysed the perspectives of people from CALD communities in Victoria regarding their needs and experiences with mental health services. Participants reported diverse perceptions and understanding of mental health issues and servicesVarious challenges were identified regarding health service utilisation for the CALD community in Victoria, including language barriers, stigma towards mental health issues, mental health illiteracy, distrust and lack of familiarity with mainstream mental health services. These challenges were acknowledged by community members even after a long residence in AustraliaThe data generated on the beliefs about mental health issues and consequent help‐seeking behaviours highlight the importance of culturally sensitive targeted prevention and early intervention strategies and ongoing commitment to building mental health literacy in the wider community What Are the Implications for Practice?: The information from the study can be adapted for quality improvement and culturally responsive practicesThe strategies for effective service delivery drawn by this paper can be a comprehensive resource tool for mental health professionals, organisations and policymakersThe findings imply that CALD mental health service users and their families will likely benefit from improved service assessment and quality of mental health care and equity when MHNs undertake cultural competence training and bring that into their practice. Introduction: Victoria is one of the most multicultural states in Australia. Many CALD communities in Victoria may have encountered complicated migration journeys and complex life stressors during their initial settlement, leading to adverse mental health concerns. This diversity necessitates public policy settings to ensure equity and access in health services planning and delivery. While the MH policies and services take cultural diversity into account, there needs to be more implementation of those components of MH policies that relate to the particular needs of various CALD communities in Victoria. Even though mental health services prevent and address mental health issues, many barriers can impair CALD community access and utilisation of mental health services. Furthermore, the recent Royal Commission inquiry into the Victorian Mental Health system drives a renewed policy imperative to ensure meaningful engagement and cultural safety of all people accessing and utilising mental health services (Department of Health, 2023). Aim: This study focused on the perspectives of people from CALD communities in Victoria regarding their mental health service needs, understandings of and experiences with mental health services to prepare an education package for mental health nurses as part of a larger multi‐method research project. Method: A qualitative descriptive design was used to collect and analyse the perspectives of 21 participants in Victoria, using telephone interviews, followed by thematic analysis. Results: The themes and sub‐themes identified were: Settling issues; Perceptions of understanding of mental health issues (help‐seeking attitudes toward mental health issues; the need for CALD community education); perceived barriers to accessing and utilising mental health services in Victoria (socio‐cultural and language barriers; stigma, labelling and discrimination; knowledge and experience of accessing health facilities); experience with mental health services and professionals. Discussion: Community participation, mental health professional education and robust research regarding the mental health needs of CALD people are some of the recommended strategies to improve access and utilisation of mental health services in Victoria. Implications for practice: The current study can contribute to the existing knowledge, understanding, practice and quality improvement as it vividly portrays the issues of various CALD communities in Victoria. The findings of this study imply that CALD MH service users and their families are likely to benefit in terms of improved service assessment and quality of MH care and equity when MHNs undertake CC training and bring that into their practice. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: During the COVID‐19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. What the paper adds to existing knowledge?: This paper provides a unique insight into the experiences and impact that the COVID‐19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. What are the implications for practice?: By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike. Introduction: While evidence has emerged concerning the impact of COVID‐19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. Aim: This paper aimed to explore how COVID‐19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. Method: We investigated staff reports regarding the impact of the COVID‐19 pandemic on mental healthcare and mental health service users in the UK, using a mixed‐methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. Discussion: Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for Practice: Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the topic?: MHST represents transformation at the forefront of policing and mental health to people in crisis with the aim of providing a better and more efficient response.Current knowledge has largely focused on service development, informed by narratives of risk, and this study applies an alternative focus by considering the interplay in practice. What the paper adds to existing knowledge?: This paper adds to emerging work on mental health street triage, offering original insights into the interplay of police officers and mental health nurses in practice.The evidence presented shows how the dynamics between officers and nurses were informed by perceptions of trust, belonging and legitimacy which shaped decision‐making and outcomes.This study also reveals the impacts of leadership continuity and staff turnover to service efficacy and the potential of strategic "drift." What are the implications for practice?: Nurses who work in MHST operations should be prepared to share knowledge, learning and insight into how different mental health conditions present in practice and support the assessment of risk posed to officers.Alternative pathways available to detainment by police under the Mental Health Act should be identified and communicated to officers, both in the control room and in situ, to avoid unnecessary detentions.Strategies should be developed to extend the communication of mental health education and knowledge beyond those immediately involved in MHST to support the police to better respond to mental health. Introduction: The limited evidence on mental health street triage (MHST) is largely focused on service development and is overly police‐centric dominated by narratives of risk. This paper considers the interplay between officers and CPNs in practice situated within strategic and operational contexts, illustrating the importance of place to service developments and trust within practice. Aim: This study was conducted to compare the processes, experiences and perceptions of MHST in three sites in England. Method: Semi‐structured interviews were completed with 27 police and health service staff in strategic and operational roles over a three‐month period in three sites in England. Results: Four themes were identified: "Reducing and improving the use of mental health detainments," "Importance of local contexts and partnerships," "Enhancing officer confidence" and "Developing street triage." Discussion: Mental health street triage decision‐making and outcomes were influenced by issues of trust, belonging and legitimacy within the interplay between officers and nurses. Continuity and staff turnover influenced strategic and operational development. However, MHST was perceived to be an effective and cost‐saving model. Implications for practice: Mental health nurses are well positioned to lead awareness and education of officers in relation to mental health crisis response. Staff need to develop communication strategies that extend beyond those immediately involved in MHST. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Aggression towards caregivers is a global phenomenon in mental health care.Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub‐par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression.Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. What this paper adds to existing knowledge?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non‐coercive techniques do not work.Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. What are the implications for practice?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de‐escalating aggression as well as diminishing the use of coercive measures.Further primary research exploring the opportunities of non‐coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well‐being of healthcare workers is also needed. Introduction: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non‐coercive measures. Aim: The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. Method: A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. Results: Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. Discussion: In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non‐coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression‐tolerating" workplace. Implications for Practice: Three implications for practice were identified: (1) It is vital for residential units to agree on a broad‐based definition of aggression, (2) further primary research exploring the opportunities of non‐coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well‐being of healthcare workers also needs further study. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: Restraint has negative psychological, physical and relational consequences for mental health patients and care providers.Several countries have implemented seclusion and restraint (S/R) reduction programmes in which post‐incident reviews (PIRs) including patients and care providers are one of several strategies.Existing knowledge indicates that PIRs have the potential to contribute to S/R prevention, but knowledge of the patients' perspectives on PIRs is scarce. What the paper adds to existing knowledge?: The paper provides in‐depth knowledge about patients' experiences of being participants in PIRs after restraint events.Patients experience PIRs to result in being strengthened and developing new coping strategies.The paper reveals pitfalls when planning and conducting PIRs that make patients experience PIRs as meaningless, feel objectified or long for living communication and closeness.The patients' mental state, the quality of the relationships and the services' care philosophies, influence patients' experiences of PIRs as supporting their personal recovery processes or as continuation of coercive contexts. What are the implications for practice?: Patients' vulnerability during the PIRs must be acknowledged.Trusted persons or advocacy must support the patient in the PIR and thus reduce the power‐dependence imbalance.The PIR must be conducted in a supportive, non‐punishing atmosphere.Patients must influence planning for the PIR concerning time point and participants and themes to be discussed.The PIR forms should be extended to support the patients' empowerment and well‐being. Introduction: Post‐incident reviews (PIRs), including patients, nurses and other care providers, following incidents of restraints are recommended in mental health services. Few studies have examined patients' experiences and considerations concerning PIRs. Aim: The study aims to explore patients' perspectives on PIRs in relation to how they experience participation in PIRs and further view PIRs' potential for care improvement and restraint prevention. Method: We conducted a qualitative study based on individual interviews. Eight current and previous inpatients from two Norwegian mental health services were interviewed. Results: The patients experienced PIRs as variations on a continuum from being strengthened, developing new coping strategies and processing the restraint event to at the other end of the continuum; PIRs as meaningless, feeling objectified and longing for living communication and closeness. Discussion: PIRs' beneficial potential is extended in the study. The findings highlight however that personal and institutional conditions influence whether patients experience PIRs as an arena for recovery promotion or PIRs as continuation of coercive contexts. Implications for practice: We recommend patients' active participation in planning the PIR. PIRs should be conducted in a supportive atmosphere, including trusted persons, emphasizing and acknowledging a dialogical approach. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Advanced clinical practitioners (ACPs) are, typically, non‐medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities.Most ACPs are nurses and new ACP roles are increasingly being established around the world.The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainabilityResearch on mental health nursing ACP roles is sparse. What the paper adds to existing knowledge?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services.A wide range of mental health services were perceived as potentially benefiting from ACPs.Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. What are the implications for practice?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established.Some mental health nurses may require long‐term developmental pathways to help prepare them to take on a master's level course and then the ACP role. Introduction: Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim: To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method: Focus group and semi‐structured interviews. Participants were directors of nursing (n = 10) and other senior staff from roles important to workforce development (n = 10). Results: Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion: The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long‐term developmental pathways for staff. Implications for practice: Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities.Studies of nurse consultants in the United Kingdom have largely been non‐empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. What this paper adds to existing knowledge?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change.A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. What are the implications for practice?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors.The continued absence of robust evidence as to the clinical/cost‐effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint.Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Introduction: The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims: The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method: We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross‐sectional survey of post holder characteristics and semi‐structured interviews with directors of nursing. Results: Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0–12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion: Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice: Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The potential benefits of introducing technological innovation into all types of health services are recognized internationally.There are few studies exploring the use of technology in inpatient mental health settings, or the views of staff and patients regarding such developments."Early warning systems" are increasingly used in inpatient mental health services to detect physical deterioration in patients and prompt staff to take appropriate action. We have identified no peer‐reviewed publications concerning this development. What the paper adds to existing knowledge?: Using a questionnaire survey, this project gathered views from staff and patients on a planned change from a paper‐based "early warning system" to one using handheld electronic devices (tablets).This study adds to the existing evidence by reporting specific staff and patient concerns about a technological development in an inpatient mental health setting. Some patients were concerned about confidentiality of data entered onto tablets. Whilst were either positive or neutral in attitude to the planned change some staff raised concerns that electronic devices could be used as weapons, and also that patients or visitors might misinterpret their use. What are the implications for practice?: Views of staff and patients must be considered when introducing new technology into clinical practice, in order to make the change successful and sustainable. Inadequate or unclear information about the use and purpose of electronic devices may lead to misunderstandings as to their purpose and the security of their data, particularly in mental health settings.Further exploration across a range of services and countries would be useful in determining whether attitudes towards implementing similar technological change in mental health practice are commonly shared. Introduction: Technological innovation offers opportunities to improve mental health care; however, little evidence exists regarding attitudes of inpatient staff and patients to such changes. We present a survey of staff and patients prior to introduction of a digital version of the National Early Warning Score (eNEWS) system for identifying physical deterioration. Aim: To collate views of staff and inpatients related to prospective use of eNEWS, to inform the plan for implementation. Method: Paper questionnaires were distributed to both groups in six wards prior to eNEWS implementation. Two discussion groups were then held. Results: Eighty‐two staff and 26 inpatients completed questionnaires. Some inpatients expressed concerns about data confidentiality. Most staff were neutral or positive about the planned change, but raised possible safety risks and the risk of electronic recording being misinterpreted by patients. The implementation plan was modified in response to this information, principally by improving communication processes with patients. Discussion: This study adds to the existing evidence by reporting specific staff and patient concerns towards a form of information technology. Further evaluations would help determine the transferability of these findings. Implications for practice: Listening to patient and staff views about planned technological innovation is essential for effective implementation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mechanical restraint is a common practice in mental healthcare settings in Spain, despite controversy.Mechanical restraint is perceived as a negative experience for nurses and service users.Mechanical restraint damages the nurse–patient therapeutic relationship, which is essential in providing quality care and promoting recovery. What the paper adds to existing knowledge?: The negative experiences of service users and mental health nurses arising from use of mechanical restraint affects both parties involved and results in trauma.Using mechanical restraint can provoke a moral injury in mental health nurses which can negatively impact on the establishment of trust within the therapeutic nurse–patient relationship. What are the implications for practice?: Nurses must be aware of the negative effects that mechanical restraint use has on both their practice and their day‐to‐day lives.Post‐mechanical restraint debriefing is required to repair the damage to the trust aspect of the nurse–patient relationship.Involving service users in co‐producing a debriefing framework may be a way to rebuild trust through constructive dialogue. Introduction: Mechanical restraint is an intervention that causes harm to service users and nurses, yet continues to be used in many countries, including Spain. However, there is a lack of research exploring Spanish mental health nurses' experiences of using mechanical restraint. Aim: To describe the experiences of mental health nurses who have used mechanical restraint in practice. Methods: A qualitative descriptive methodology was used and a purposive sample of 10 Spanish mental health nurses were interviewed about their experiences of using mechanical restraint. Thematic analysis was then employed to analyse interview data. Results: Participants' experiences of using mechanical restraint were mostly negative. Three main themes arose from the analysis of interview transcripts, (i) symmetrical trauma, (ii) moral injury and (iii) broken trust. Discussion: The use of restrictive practices, which can be perceived as counter‐therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention. Implications for practice: Reducing or eliminating use of mechanical restraints should be a policy and practice priority due to the symmetrical harms it causes both nurses and service users. The trust aspect of the therapeutic nurse–patient relationship is a significant casualty when mechanical restraint is used, therefore involving service users in co‐production of post‐mechanical restraint debriefing can be an avenue for restoring this trust through dialogue. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Treatment and mental health care in familiar environments are beneficial for older people experiencing mental health issues. But there are not enough qualified and specialized nurses who can meet the complex needs of nursing home residents experiencing mental health issues.The University Hospital of Psychiatry Zurich, Switzerland, established an outreach interprofessional mental health service to foster the care for residents experiencing mental health issues in nursing homes. Based on existing studies, little can be said about whether nurses in nursing homes find these types of services helpful. What does this paper add to existing knowledge?: Nurses in nursing homes caring for residents experiencing mental health issues felt relieved by having inclusive support from the interprofessional mental health service. Nurses appreciated the mental health team and felt accompanied and more confident in their daily work.Results showed that nurses wanted to be included in the care and treatment processes and to work as partners on an equal footing with the mental health team. What are the implications for practice?: Outreach interprofessional mental health services for nursing homes should take into account nurses' views and professional experience, and value and respect their role as nurses.Outreach interprofessional mental health services for nursing homes should offer further training in psychiatric nursing, include an accessible contact person in the team, and develop clear processes and responsibilities. Introduction: Outreach interprofessional mental health services for nursing homes can increase the quality of care for residents experiencing mental health issues but research on how nurses in nursing homes experience such a service is lacking worldwide. Aim: To describe how nurses experience the involvement of an outreach interprofessional mental health team in the care for older people experiencing mental health issues in nursing homes and to identify barriers to and facilitators of interprofessional collaboration. Method: Qualitative descriptive analysis based on 13 semi‐structured interviews. Framework analysis and complex adaptive systems theory were applied. Results: One core theme with two main categories: Nurses experienced relief from burden through inclusive support provided by the mental health team. Main categories were feeling accompanied and confident as a nurse and partnership‐based collaboration. Discussion: Results showed for the first time that nurses felt supported by the mental health team and were encouraged to find new ways of coping with challenging situations. Implications for Practice: To empower nurses, mental health teams should take into account nurses' perceptions in the treatment process, value and respect their role as nurses, transfer knowledge in both formal and informal settings, establish a steady and reliable contact person, and define processes and responsibilities. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Family‐focused interventions in Adult Mental Health Services (AMHS) address the needs of families where a parent is diagnosed with a mental illness. One of these interventions is the "Let's Talk about Children" programme (Let's Talk) (Solantaus & Toikka, 2006 International Journal of Mental Health Promotion, 8(3), 37).There is limited implementation knowledge on family‐focused interventions.A body of research to better understand the transfer of evidence‐based interventions into everyday practice has identified multiple influencing elements. The Consolidated Framework for Implementation Research (CFIR) has combined these known elements from research into five domains of influence.Elements that influence the implementation of evidence‐based practice are inter‐related and need to be understood in combination.Understanding different stakeholder perspectives on implementation in real‐world settings helps to understand uptake, challenges and opportunities. What the paper adds to existing knowledge?: As the first study to document leadership's perspectives of implementing Let's Talk, this paper contributes to the evidence base on their role in implementing family‐focused practice models in mental health.There are specific roles of leadership that need to be addressed to support implementing Let's Talk in changing environments.Leadership's knowledge of Let's Talk and approach to change influences implementation.Questions are raised about the role the readiness of the parent and the impact that the dynamic process between the practitioner and parent has on implementing Let's Talk. What are the implications for practice?: Engaging leadership needs to address the influence of their different organizational roles in shaping implementation for Let's Talk.Further research is needed to understand the dynamic process between parent and practitioner that influences readiness for trialling Let's Talk. Introduction: Different stakeholder's perspectives are needed to understand challenges and opportunities in implementing and sustaining evidence‐based practices (EBP) in real‐world settings. Aim/Question: To identify leadership perspectives on key elements influencing the process of implementation of Let's Talk about Children (Let's Talk), a family‐focused practice for practitioners working with parents diagnosed with a mental illness. Method: Semi‐structured interviews were conducted with 16 service managers and implementation leads, to establish their views on key elements influencing implementation of Let's Talk during a randomized controlled trial. A thematic analysis applied both inductive and deductive approaches, using the Consolidated Framework for Implementation Research (CFIR). Results: Impacts to effective translation to practice were grouped into three broad themes with eight subthemes: inner and outer setting impacting organization, leadership affecting readiness and parent and practitioner readiness. Discussion: The findings suggest that specific roles for leadership are vital to implementation within an environment of constant change, and more attention is needed to understand the dynamics of parent and practitioner readiness for delivering Let's Talk. Implications for practice: Different leadership roles need to be engaged to sustain Let's Talk in changing real‐world environments. The dynamic processes between parent and practitioner are suggested to influence readiness and need further research. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: There is a move towards the use of new ways of delivering mental health care, particularly via an increased use of telephone therapies. Although some studies have noted the advantages of telephone‐delivered therapies (e.g., removing access barriers) and reported on equivalent therapeutic effects when compared to face‐to‐face, there are concerns about how telephone‐based therapy adversely affects the therapeutic relationship. What the paper adds to existing knowledge: It contributes new knowledge regarding psychological practitioners’ experience and views about using telephone‐based therapies and how this affects the therapeutic relationship. What are the implications for practice: This paper provides data about the new practitioner workforce (IAPT Psychological Wellbeing Practitioners) and adds to a growing area of research regarding their clinical role. It has relevance for mental health nursing, because health services internationally and across the professions are exploring how telehealth can improve health care. This paper suggests that mental health services need to focus on what type of therapeutic relationship their practice facilitates and on offering transparency to service users. It concludes that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to focus on what facilitates and inhibits deeper therapeutic closeness and connection. Abstract: Introduction: Over‐the‐telephone (OTT)‐delivered psychological therapies as an alternative method to face‐to‐face (F2F) are becoming more prevalent in mental health care. Research suggests a range of benefits of OTT use in therapy, but there are growing concerns about its consequences for the therapeutic relationship. This paper presents new knowledge regarding psychological practitioners’ experience and views of OTT work and its potential effects on the therapeutic relationship in the context of the UK's Increasing Access to Psychological Therapy (IAPT) programme. Aim: This paper presents IAPT practitioners’ experiences and views of OTT work and its potential effects on the therapeutic relationship. Methods: Completed questionnaires (exploring OTT versus F2F work) which were distributed to IAPT practitioners revealed a concern about the therapeutic relationship in OTT. To explore this further, nine in‐depth semi‐structured interviews with PWPs were conducted and the findings from this qualitative study are reported here. Results: Practitioners noted OTT use facilitated access and flexibility for service users; however, they expressed some concern over the adverse effect of OTT on the therapeutic relationship. Discussion: Although a working alliance was possible OTT, this research suggests the type of therapeutic relationship formed OTT in a “low contact–high volume” service such as IAPT needs to be better defined. By addressing this, dissonance which might arise between practitioner aims and the aims of IAPT can be reduced. This research also contributes to wider debates regarding mental health care and its provision in the UK. Implications for practice: This paper concludes that mental health services need to focus on what type of therapeutic relationship their practice facilitates and to offer transparency to service users. The findings suggest that telephone work in IAPT can accommodate a working alliance, but not other types of therapeutic relationship, which practitioners and service users hoped for. Services need to offer a more nuanced understanding of the concept of a therapeutic relationship and focus on what facilitates and inhibits deeper therapeutic closeness and connection. [ABSTRACT FROM AUTHOR]

Accessible summary A number of studies have highlighted issues around the relationship between service users and providers. The recovery model is predominant in mental health as is the recognition of the importance of person-centred practice. The authors completed an in-depth search of the literature to answer the question: What are service users' experiences of the mental health service?, Three key themes emerged: acknowledging a mental health problem and seeking help; building relationships through participation in care; and working towards continuity of care., The review adds to the current body of knowledge by providing greater detail into the importance of relationships between service users and providers and how these may impact on the delivery of care in the mental health service. The overarching theme that emerged was the importance of the relationship between the service user and provider as a basis for interaction and support., This review has specific implications for mental health nursing. Despite the recognition made in policy documents for change, issues with stigma, poor attitudes and communication persist. There is a need for a fundamental shift in the provider-service user relationship to facilitate true service-user engagement in their care., Abstract The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host ( Academic Search Complete, MEDLINE, CINAHL Plus Full- Text), Psyc INFO, Psyc ARTICLES, Social Sciences Full Text and the United Kingdom and Ireland Reference Centre for data published between 1 January 2008 and 31 December 2012 was completed. The initial search retrieved 272 609 papers. The authors used a staged approach and the application of predetermined inclusion/exclusion criteria, thus the numbers of papers for inclusion were reduced to 34. Data extraction, quality assessment and thematic analysis were completed for the included studies. Satisfaction with the mental health service was moderately good. However, accessing services could be difficult because of a lack of knowledge and the stigma surrounding mental health. Large surveys document moderate satisfaction ratings; however, feelings of fear regarding how services function and the lack of treatment choice remain. The main finding from this review is while people may express satisfaction with mental health services, there are still issues around three main themes: acknowledging a mental health problem and seeking help; building relationship through participation and care; and working towards continuity of care. Elements of the recovery model appear to be lacking in relation to user involvement, empowerment and decision making. There is a need for a fundamental shift in the context of the provider-service user relationship to fully facilitate service users' engagement in their care. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Recurrent depressive episodes involve significant morbidity, suicide risk and recurrent hospitalizations.In both major depressive disorder and bipolar disorder, there are significant impairments in functioning following resolution of acute symptoms. What this paper adds to existing knowledge?: This paper provides an in‐depth qualitative understanding of the subjective experience of cognitive impairment following a depressive episode in a recurrent mood disorder.It identifies descriptions of two types of experience (being stuck and being preoccupied with one's thoughts) that led to impairments in concentration, memory, organization and decision‐making. What are the implications for practice?: Mental health nurses need to develop an awareness of the impact of cognitive difficulties in the process of recovery from recurrent mood disorders.Mental health nurses need to provide knowledgeable reassurance, information and interventions to people who experience cognitive difficulties to provide a framework of understanding that promotes recovery. Introduction: People who experience recurrent depressive episodes often have ongoing cognitive problems that impact on their functional recovery. These cognitive difficulties have been identified as impacting on social, interpersonal and occupational functioning and can result in vulnerability to relapse. Aim: The aim of this qualitative study was to explore participants' subjective experiences of cognitive impairment after discharge from mental health services following treatment for recurrent depression. Methods: The study was designed as a qualitative study in order to best capture participants' subjective experiences. Data were collected by semi‐structured interviews and were analysed using a process of thematic analysis. Results: Twenty participants took part in this study. All participants described experiences of either 1) "being stuck"; or 2) "being preoccupied with own thoughts"; however, all participants described the experiences in the third theme: "it stops you living to your potential." Implications for practice: In order to promote recovery in a meaningful way, mental health nurses need to provide information about and strategies for managing cognitive difficulties associated with recurrent mood disorders. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: The practices of mental health nurses in the administration of repetitive transcranial magnetic stimulation (rTMS) treatments for depression in outpatient clinic are crucial for patient outcomesTo date, most research has focused directly on procedural aspects of treatment delivery with limited focus on the delivery of holistic care and treatment.There is a lack of best practice guidance based on the experiences of those involved in clinical delivery to inform and improve rTMS practices What this paper adds to existing knowledge?: This study provides unique insights into service and personalized non‐treatment factors associated with rTMS delivery that may reduce stress and improve the experiences of rTMS patientsIt reviews and updates understanding of the factors that contribute to the delivery of effective rTMS. What are the implications for practice?: The need to apply findings for the development of best practice guidanceFactors to improve practice include (a) rTMS machine demonstrations; (b) constructive, individualized, friendly, and therapeutic conversations; (c) a relaxing, comfortable, 'homely' physical environment; (d) long term supportive management; and (e) careful engagement of nursing and support staff. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Current policy advocates for the participation of family carers in care planning., Caring for a person with a mental illness requires a significant commitment from families to support their relative's recovery., What this paper adds to existing knowledge? The evidence of family involvement in care planning is generally fraught with conflicting experiences related to different requirements between mental health professionals, families and service users., Confidentiality remains contentious at a practice level in terms of information sharing and decision-making., There is a requirement and need for a shared understanding around care planning between families and mental health professionals., What are the implications for practice? The provision of written information pertaining to families regarding confidentiality is required at service level., Educational workshops concerning care planning and treatment options should be provided for service users, families and mental health professionals., Further research into effective service-wide strategies that explore with families how their engagement can be positively fostered in mental health services is warranted., Abstract Introduction Mental health service policy stipulates that family carers be involved in care planning. Aim To identify families' experiences of care planning involvement in adult mental health services. Method An integrative review where electronic databases and grey literature were searched for papers published between 01 January 2005 and 10 February 2016. Results Fifteen papers met the inclusion criteria. Thematic analysis generated three themes: (1) families' experience of collaboration, (2) families' perceptions of professionals and (3) families' impressions of the care planning process. Collaborative decision-making is not regularly experienced by families with an 'us' and 'them' divide, perpetuated by a lack of communication, confidentiality constraints and a claim of 'insider knowledge' of service users. When involved, families perceive care planning to be uncoordinated and that their lived experiences are not always appreciated. Discussion Families need to be valued, empowered and engaged in care planning and the partnership distance be addressed. Accommodating the views of family, service user and professionals is preferable but not always possible. Our findings suggest that the key element for professionals is to value all 'insider knowledge' where possible. Implications for Practice Services should develop written information on confidentiality for families and facilitate open communication concerning their involvement in care planning. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject?: Care continuity is considered to be a cornerstone of modern mental health care. As community mental health services have become increasingly fragmented and complex, the crucial criterion for best quality care has become the degree to which treatment delivered by separate services and professionals is continuous and well coordinated. However, clarification of the key elements of continuity has proved challenging and a consensus has not been reached., Recent research has shown significant levels of variation in the quality of care coordination across England and Wales, with potentially detrimental consequences for individuals., What this paper adds to existing knowledge?: Studies on care continuity identified in this review are grouped into three categories: studies defining concepts of care continuity, studies providing models of continuity and studies describing development of questionnaires about care continuity., There are many similarities and parallels between concepts of continuity described in the studies under review. Therefore, there is potential for developing a consensus on the nature of care continuity as a multidimensional concept. The priority placed upon the patient's experience of care continuity is identified as a major focus in these studies., What are the implications for practice?: A consensus on the nature of care continuity would benefit both theory and practice in mental health nursing., It would provide a firmer foundation for new research seeking to improve continuity for people using services, and enable mental health nurses working as care coordinators to have a better understanding of the elements of their role that are most effective., Abstract Introduction The increased complexity of community mental health services, and associated fragmentation of traditional dividing lines between services, has underscored the centrality of care continuity and coordination in modern mental health care. However, clarification of the key features of the care continuity concept has proved difficult and a consensus has not been reached. Aim/Question This review draws together and critically examines latest evidence concerning concepts, models and scales based on a multidimensional understanding of care continuity. Method Databases ASSIA, PubMed, MEDLINE and Cochrane were searched for papers dating from January 2005 to July 2016, of which 21 articles met the inclusion criteria. These were subjected to quality appraisal based on CASP and COSMIN checklists. Studies were grouped into three thematic categories describing concepts, models and scales of care continuity. Results/Discussion Synthesis indicated correspondence between independent, multidimensional models of care continuity, providing greater clarity regarding the essential features of the concept. Association, although not causation, between care continuity factors and health outcomes is supported by current evidence. Implications for practice Clarification of care continuity in mental health services may enable nurses working as care coordinators to develop a better understanding of key elements of their role, and provide guidance for future service development. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: The conceptual components of mental health recovery have been proposed, however, the barriers to their sustainability within the context of internal and external stressors require further exploration.Within their emerging adult role, young people will experience the personal challenges that will directly impact their understanding of their recovery, which will be different from other age groups. What the paper adds to existing knowledge?: Findings revealed recovery is understood as an uncharted, timely and personal process of engaging and transcending pain. Perceived barriers to mental health recovery and the internal dynamics experienced within the process have been explored.Recovery in young adulthood involved the reclaiming of their active and purposeful life force. It acquires real‐life relevance when applied to the social and cultural factors that provide meaning in life for young adults. What are the Implications for practice?: This research will impact how mental health nurses understand the catalytic effects of personal, social and cultural meaning of suffering in young adults' actualization of mental health recovery.Findings have significance for practice as the process of mental health recovery must not be presented as a clinical pathway, but understood as a personalized strategy of individual wellness in young adulthood. Introduction: Within their emerging adult role, young people will embark on employment, form intimate relationships and live independently. This indicates that how recovery is experienced and actualized in young adulthood may be different from other age groups. Aim/Question: To explore young adult service user's perspectives of mental health recovery in Northern Ireland. Method: Semi‐structured individual qualitative interviews were analysed using a Gadamerian‐based hermeneutic method and interpreted using a novel theoretical framework. The sample comprised 25 participants with an average age of 28 years. Findings: Five key themes evolved: Services: A Losing Battle Straight Away; From your Foundations to a Step in the Dark; Let Go of the Pain not the Experience; Surviving Out of the Ashes Recovery; and Needs to be More than a Word. Discussion: The main findings were that recovery involved the reclaiming of their active and purposeful life force. It is suggested that young adults have developed an explanatory model of "use that stuff you wanna bury" to transform an illness narrative to a wellness strategy. Implications for Practice: This research has implications for mental health nursing so the process of mental health recovery is not presented as a clinical pathway, but a personalized strategy of individual wellness. [ABSTRACT FROM AUTHOR]

Accessible summary What is known about the subject? This paper describes crisis resolution/home treatment (CRHT) teams, which are part of mental health services in the United Kingdom. CRHT is expected to assist individuals in building resilience and work within a recovery approach., What this paper adds to existing knowledge? This paper arises from an interview with one individual, Dale, as part of a larger study exploring service users' experiences of CRHT. It adds to the body of narrative knowledge in CRHT through Dale's co-authorship of this paper, reflecting on his original interview 4 years later, with co-authors providing critical interpretation of his experience, in turn supported by cognate literature., What are the implications for practice? Implications for practice are considered, themselves mediated through Dale's own descriptions of how CRHT interventions impacted upon him. These impacts are analysed with respect to three themes: Resilience, Recovery and Power., It is centrally contended that clinicians need to more clearly comprehend three core matters. First, what resilience 'is' for service users as well as the complex process through which these individuals move in developing resilience. Second, the distinction that service users might make between 'recovery' and 'functionality', and how this in turn can impact on individuals both in personal and socioeconomic sense. Finally, the mechanics of power within CRHT contexts and how these interpersonal dynamics can affect the relationship between service user and clinician in practice., Abstract Introduction and Aim The central purpose of this paper, part of a larger study exploring the experiences of Service Users (SUs) with CRHT, is to emphasise the importance of the SU voice itself within the domain. Following an interrogation of the historical contexts of CRHT. Method This paper uses interpretative phenomological approach around detailed thematic examination of an extended, semi-structured with a single SU: Dale. Moreover, four years after the interview was originally conducted, Dale was himself invited to reflect upon, and critically re-evaluate, his initial participation as a co-author of this paper. In this way, a genuinely participant-centred narrative on experiences with CRHT could be generated. Implications for Practice This resulted in Dale describing what 'crisis' meant to him, and his personal journey within that crisis. Although framing some experiences as negative, he primarily argues that the CRHT team was very personable, affirming his personal values and beliefs, and encouraging him to use coping skills that he had utilised effectively in prior periods of crisis. Analysis highlights three major themes permeating Dale's narrative: Resilience, Recovery and Power. It is contended that this analysis begins to demonstrate implications for practice and highlight that (and how) CRHT clinicians might more clearly engage with what resilience 'is' for SUs, and also the complex process through which these individuals move in developing it. Equally, it is proposed that practitioners should be mindful of the distinction that SUs might make between 'recovery' and 'functionality', and how this in turn can impact on individuals both in personal and socio-economic sense. Finally, the mechanics of power within CRHT contexts are foregrounded, and how these interpersonal dynamics can affect the working relationship between SU and clinician. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: People with mental disorders have increased risk of dying from diabetes and cardiovascular diseases compared to the general population. Diabetes and cardiovascular diseases are preventable by improved lifestyle regarding smoking, alcohol consumption, physical activity and dietary behaviours.Forensic mental health service users are treated for longer periods of time compared to non‐forensic mental health service users, giving the opportunity to affect the lifestyle for a substantial period of time. What the paper adds to existing knowledge: This review gathers existing research on forensic mental health service users' lifestyle regarding smoking, alcohol consumption, physical activity, and dietary behaviours and factors influencing it. The lifestyle was found to be unfavourable with many patients being smokers, having problematic alcohol consumption, being physically inactive and eating a diet of poor nutritional value and rich in calories. Therefore, it seems likely that an unfavourable lifestyle is one reason for the excess mortality from diabetes and cardiovascular diseases.Smoking cessation and improving dietary habits was perceived difficult, but nicotine replacement and practical advice was suggested to support a change. What are the implications for practice: The treatment period gives an opportunity to improve the lifestyle of forensic mental health service users to prevent diabetes and cardiovascular diseases in this high‐risk group.We recommend a holistic approach, when planning the prevention activities, since activities that are perceived fun are more likely to succeed. Introduction: People with mental disorders have increased risk of dying from diabetes and cardiovascular diseases, both of which can be prevented by lifestyle. Aim: To review existing research, in order to investigate the characteristics of, and factors that influence forensic mental health service users' (FMU) health behaviours. Method: We searched PubMed, CINAHL, PsycInfo and Scopus for primary research on FMU's health behaviours regarding smoking, alcohol consumption, physical activity and dietary behaviours, and factors that influence them. Results: We found 13 eligible studies. The findings consistently indicated the presence of unfavourable health behaviours in FMU: Smoking, problematic alcohol consumption, physical inactivity and a high‐calorie diet of poor nutritional value. Changing smoking and dietary habits was perceived as difficult, but nicotine replacement and practical advice were suggested to support change. Discussion: The existing research on FMU's health behaviours is sparse. In particular, there is a lack of research on factors that influence health behaviours. From our findings, it seems likely that FMU's unfavourable health behaviours contribute to their increased risk of dying from diabetes and cardiovascular diseases. Implications for practice: FMU's health behaviours should be improved to prevent diabetes and cardiovascular diseases in this high‐risk group. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The experience of hearing distressing voices is commonly reported by service users with a diagnosis of first‐episode psychosis, but their access to formal conversations about voices in the form of psychological therapies can be limited.Service users within Early Intervention in Psychosis (EIP) services can benefit from informal opportunities to talk about their voice hearing experiences. However, they can be reluctant to engage with these conversations.Little is known about the experiences of EIP practitioners as they try to engage service users in conversations about their voices. What does the paper add to existing knowledge?: Despite EIP Services specializing in the treatment of the symptoms of psychosis such as voice hearing, practitioners can still be reluctant to initiate and continue informal conversations about voices. What are the implications for practice?: EIP practitioners may benefit from the introduction of interview guides and brief interventions to assist them with the initiation and continuation of conversations about voices. Introduction: Hearing voices is a common and distressing symptom of first‐episode psychosis. Formal and informal conversations about voices are helpful, but service users within Early Intervention in Psychosis (EIP) Services can be reluctant to discuss their voice hearing experiences. There is currently no literature that explores the experiences of EIP practitioners as they try to facilitate conversations about distressing voices. Aim/Question: A qualitative methodology was used to investigate how EIP practitioners work with service users who hear voices. Ten practitioners were interviewed, and interviews were analysed using template analysis. Results: Two themes that offer novel insights are presented: "starting a conversation about voices" and "continuing the conversation about voices." Discussion: Starting and continuing a conversation about voices was considered important but not all practitioners were confident in this respect. The initiation and continuation of these conversations may need to be systematically supported. Implications for practice: To support the initiation of informal conversations, a standardized interview guide for voice hearing could be introduced and systematically utilized. The continuation of these conversations could be supported by practitioners being given the opportunity to receive training in and the opportunity to deliver brief symptom‐specific therapies for distressing voices. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Existing literature provides insight into the general experience of carers of people with a mental illness. Previous studies have found that carers experience a range of emotions when looking after their relatives with a mental illness. However, experiences of carers as they engage with the healthcare system is largely absent from the literature., What this paper adds to existing knowledge? This paper identified the experiences of carers when their relatives are experiencing a crisis or acutely unwell. Carers found themselves in the middle between mental health services and their relatives., Strategies employed by carers to ensure their relatives receive adequate care were identified from this study. This paper identified how carers needed to become more assertive in order to receive adequate care for their relatives, and this finding has implications for any future carer education., What are the implications for practice? The participants identified the need to work more collaboratively with carers of people with a mental illness as they seek treatment for their relatives in order to achieve better health outcomes for the patients. Improved health service engagement of carers was seen by participants to assist them to better care for their relative., The study also found that there needs to be a clearer definition as to what constitutes mental health crisis and how carers are able to intervene during this period. Services could provide clear information concerning crisis services and in particular triage., Abstract Aim The literature reporting experiences of relatives of people with mental illness regarding their interactions with mental health services identifies many commonalities. However, the actual experience of carers engaging the services and understanding healthcare systems remains a gap in the literature. The aim of this study was to explore the experiences of carers (of people with a severe mental illness) in a major area mental health service in Victoria Australia as they fulfil their caring role while negotiating support for their relative. A carer is defined as a family member or significant other who is the primary individual who provides informal care for a person with severe mental illness and may or may not be in receipt of income supplement for such a role. Specifically this study has a focus on the experience of the carer when negotiating care needs or admission with a mental health service. Method A qualitative descriptive approach was used with five focus groups as a means of data collection. Ethical approval for the study was obtained from both the hospital and universities ethics committees. Results Key themes identified using thematic analysis are presented in the words of the carers and include: 'Juggling' between services; We became assertive and If only they would listen. Often carers were advocating for their relative and needing to negotiate between services (police and crisis assessment teams) to gain any form of assessment or intervention. Carers often spent a great deal of time on the phone to services only to be told that their relative was 'not sick enough' to access care or that no response would occur without another service also being involved. Discussion Our research highlights the importance of working collaboratively with informal carers and acknowledging their valuable contribution to the care of their relatives with a severe mental illness. It is very important that adequate support is given to carers especially during the period when their relatives are experiencing a crisis. An understanding of their experiences ensures a more family focused approach towards care. The study findings should enable the healthcare team to focus attention on the issues which are most pertinent to carers. Nurses are advocates not only for the patient but also for their families. Relevance statement Carers supporting a person who experiences mental illness can often find themselves in difficult and emotionally challenging situations such as at times of crisis and admission to mental health services. The fourth and latest Australian National Mental Health Plan (2009-2014) acknowledged these concerns and highlighted the need to recognize the role of carers in promoting well-being and recovery of the relative with a mental illness. The plan acknowledges that families are often best placed to recognize signs of relapse in their family members with a mental illness and discharge planning should include the involvement of family members (Commonwealth of Australia, ). To achieve best care outcomes for consumers, mental health nurses need to recognize the role of the carer and collaborate in care planning. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Religion plays important role in recovery from mental illness.Religion can have both positive and negative effects on recovery. What does this paper add to existing knowledge?: It is conceivable for Black African service users (BASUs) to engage with the mainstream mental health services at the onset of their symptoms.BASUs see mental illness and recovery through the lens of religion. They mostly use Pentecostalism and traditional African healing systems to aid their recovery.The mainstream mental health system and the traditional African healing system exist in harmony for BASUs who are open to simultaneously access both services. What are the implications for practice?: There is a need to recognize that most Black Africans have unique ways of practising their Christianity. Thus, broad changes are needed in the services to support religious coping tailored to the individual persons in their recovery journey.There is a need for service providers and healthcare professionals to integrate Pentecostalism and traditional African healing systems into the recovery processes. It should equally be recognized that such changes could trigger confusion, dilemmas and paradoxes.Service providers and healthcare professionals must build partnership and collaborative working with cultural practitioners and the clergy from the Black African communities to facilitate recovery and address any misunderstandings. Introduction: Religion is an important impetus for recovery. However, there has been little work examining the role of religion in recovery for Black African service users (BASUs) in England. Aim: The aim of this study was to explore how religion influences recovery from mental illness for BASUs in England. Method: Twelve Black African service users were purposively selected and interviewed using face‐to‐face semi‐structured interviews. Data were analysed using interpretative phenomenological analysis (IPA). Results: The study generates fascinating insights that BASUs views about mental illness and recovery are influenced by Pentecostalism and traditional African healing systems. Discussion: The participants' perceptions of their mental illness experiences and recovery which are characterized by the pragmatism of Pentecostalism and cultural beliefs are consistent with what is reported in the literature. Implications for practice: The findings of the study show that broad changes are needed to accommodate the religious coping of BASUs in their recovery journey. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint.Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan.However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. What this paper adds to existing knowledge?: This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended.Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients.Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. What are the implications for practice?: To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients.Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. Introduction: An international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited. Aims: To evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care. Methods: Mixed methods—quality ratings and interviews with relatives and nurses. Results: Positive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour. Discussion: The potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed. Implications for practice: Mental health professionals implementing PBSPs should engage with relatives and patients, gain organizational commitment and ensure that those involved understand fully the positive behaviour support approach. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Supportive observations is the practice of closely monitoring patients who are acutely unwell in order to keep them safe.There are no formal guidelines for nursing staff on what to observe during observations. What this paper adds to existing knowledge?: A consensus of expert opinion suggests that the clinically meaningful behaviours in supportive observations focus on six factors: agitation, self‐harm and suicide, violence, negative influence, disengagement and positive behaviour. What are the implications for practice?: These aspects of patient presentation should be a part of the decision‐making discussions about observations. The Mersey Care Supportive Observations Recording Tool that emerged from this consensus may assist with recording the relevant information. Introduction: Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim: To develop expert consensus on the important aspects of patient presentation that inform clinical decision‐making about observations and to develop a recording tool from this consensus. Method: A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results: The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self‐harm and suicide, violence, negative influence, disengagement and positive behaviour. Subthemes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion: These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice: Consensus items should be recorded in observations records and be considered in decision‐making about observations. The MSORT may aid observations recording. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women.Immigrant women are less likely to have their care needs met as they face multiple barriers to care at both individual and system levels.To date, most PPD research has focused on individual barriers to care, with limited research examining organizational and system level barriers and the uniqueness of immigrant women's post‐partum health experiences. What this paper adds to existing knowledge?: This study provides unique insights into immigrant women's perceptions of what influences their post‐partum mental health and ability to access services for PPD.Factors contributing to immigrant women's PPD included several social determinants of health, particularly a lack of social support and limited knowledge about PPD and available services.Most helpful services acknowledge women's concerns, build trust, enact cultural competence and help with system navigation.Assessment approaches and organizational wait times created barriers to accessing care. What are the implications for practice?: Relationship building by providers is foundational to effective care for immigrant women with PPD.Findings highlight the need for mental health practitioners to improve cultural competence when working with diverse ethno‐cultural communities and for more effective assistance with system navigation, service integration and timely, flexible and accessible services.Findings have implications for the development of healthy public policy to address perinatal mental health issues amongst immigrant women. Introduction: Immigrant women in Canada are at greater risk for post‐partum depression (PPD) than native‐born women yet face multiple barriers to care at individual and system levels. Aim: To explore factors that contribute to PPD and health service accessibility, and the role of health services in supporting immigrant women with PPD. Methods: A qualitative interpretive descriptive design was used. Individual interviews were conducted with 11 immigrant women who had delivered a baby within the previous year and had experienced PPD. Inductive thematic content analysis was conducted. Results: Factors contributing to immigrant women's PPD included several social health determinants. Services were most helpful and accessible when providers acknowledged women's concerns, allowed time to build trust, provided culturally competent care and helped with navigating services. Assessment approaches and organizational wait times created barriers to care. Discussion: Immigrant women with PPD see relationship building by providers as foundational to providing effective support, enhancing coping and facilitating access to services. Improved communication with diverse ethno‐cultural communities and assistance with system navigation, service integration and timely, accessible services are needed. Implications for Practice: Findings can inform health service delivery models and the development of healthy public policy to address perinatal mental health issues amongst immigrant women. [ABSTRACT FROM AUTHOR]

Accessible summary: What is already known about the topic?: Newly qualified nurses often feel overwhelmed by the challenges of the work environment and struggle to transition into healthcare work environments.Nurses require opportunities during the transition period to develop both competence and confidence in their ability to practise independently. What the paper adds to existing knowledge?: Newly qualified mental health nurses experience fear during their adaptation period, especially when they perceive mental healthcare users as dangerous and the working environment as risky, with little concern for their safety.Nurses new to the mental health environment learn from accepting responsibility, taking on challenges and making adjustments, in order to develop confidence as mental healthcare professionals. What are the implications for practice?: Nursing management should ensure a safe and supportive mental healthcare environment. The potential for and consequences of negative stereotyping of patients among mental health nurses should be acknowledged and addressed as it may hinder the smooth adaptation of newly qualified nurses.Although stressful experiences can help mental health nurses to develop confidence and skills to manage future demanding situations, newly qualified nurses need to be given appropriate support and debriefing to ensure challenging situations do not "go the wrong way" and decrease confidence levels. Introduction: Much has been written about the experiences of newly qualified nurses in their first year of employment, yet not much has been heard from the perspectives of newly qualified nurses working in mental health facilities. Aim: To explore and describe the adaptation process of newly qualified nurses working in public mental health facilities in South Africa. Method: Following a qualitative descriptive design, 11 newly qualified nurses in their first 6–18 months of employment were purposively selected from three public mental health facilities in South Africa. Data collected through unstructured individual interviews were thematically analysed. Results: Four themes emerged from the analysis: fear related to the mental healthcare environment; self‐doubt upon meeting the expectations of the inter‐professional team; ways to adjust to the challenges; and confidence as mental healthcare professionals. Discussion: During the adaptation process newly qualified nurses working in mental health facilities need support to overcome their initial fears and develop self‐confidence in both managerial and therapeutic realms. Implications for practice: Management of mental healthcare facilities needs to be cognisant of the importance of creating a supportive and safe environment that discourages negative stereotyping of patients and fosters newly qualified nurses' adaptation. [ABSTRACT FROM AUTHOR]

Accessible summary The therapeutic relationship is pivotal to mental health nursing, but very little is known about how it is experienced in adult eating disorder services., This paper reports on a research project that sought to discover how the therapeutic relationship is experienced between care workers and women with anorexia nervosa in an adult eating disorder service., Both care workers and women spoke of a relationship that had similarities to the mother-daughter relationship, that it felt therapeutic and that it was in keeping with a professional and compassionate nursing approach., These findings provide new insight. Maternalism is seen as a positive, nurturing and transient relationship that ensures the safety of the person and promotes recovery and transition to eventual independence., Abstract This paper reports on a UK interpretative phenomenological research study that aimed to explore the lived experience of the relationship between women with anorexia and their care workers in the context of a specialist eating disorder ( ED) unit. Here, the concept of maternalism as a phenomenon occurring within the therapeutic relationship in specialist ED units is discussed. Consideration is given to the parallel roles of the health care worker whose duty it is to protect, preserve life and to promote health and that of a mother/guardian. Although seemingly simplistic, the comforting, soothing and nurturing techniques that are used by the workers to diffuse distress and help the person feel cared for have many similarities to 'mothering'. Hence, a maternalistic approach that provides a sense of security and nurturing can be a compassionate way to facilitate hope and a route out of their anorexia into recovery, in the same way that good parenting can facilitate maturation and independence. [ABSTRACT FROM AUTHOR]

Accessible summary?: What is known on the subject: Analysis of co‐production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co‐production as a concept is open to multiple interpretations. Core components of co‐produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. What this paper adds to existing knowledge?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co‐production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co‐trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co‐trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. What are the implications for practice?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues’ mental health needs should be established and refined during co‐produced working. Negotiating personal disclosure and professional role identity must be explored further in both co‐production research and practice. Abstract: Introduction: Co‐production between service users and clinicians is a desirable element of recovery‐oriented practice in mental health, but the effect of co‐production on clinicians has not been explored thoroughly. Aim: To explore the meaning of co‐production for clinicians based on their experience of co‐production in a Recovery College. Method: Thematic analysis of eight semi‐structured interviews with clinicians who have co‐produced and co‐delivered workshops with a Recovery College Peer Trainer. Results: The “meaning of co‐production” had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians’ experience of co‐production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion: Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co‐produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice: Engaging in co‐produced educational workshops can alter clinicians’ perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Mental health nurses are affected by interpersonal, practice‐related and organizational factors that can increase workplace stress and reduce their physical and mental health and well‐being. Resilience programmes are a strength‐based preventative approach to supporting individuals to overcome workplace adversities. What the paper adds to existing knowledge?: This qualitative inquiry is the first study to report mental health nurses' perspectives and experiences on a workplace resilience programme. Strengthening mental health nurses' resilience through a resilience programme involved a process of understanding resilience, and applying resilience strategies such as positive self‐talk, managing negative self‐talk, detaching from stressful situations, being aware of and managing emotions, and showing more empathy, to address workplace challenges. To address the range of resources needed to support mental health nurses' resilience, a social–ecological approach to workplace resilience can be used to promote resource provision at individual, work unit, organizational and professional levels. What are the implications for practice?: Resilience programmes are one resource for addressing the impacts of workplace stressors on mental health nurses. Organizational barriers and risks to staff well‐being need to also be addressed to build a resilient workforce. Incorporating resilience strategies into clinical supervision or reflective practice models may help sustain beneficial outcomes following a resilience programme and support resilient practice. Abstract: Introduction: Mental health settings are potentially high‐stress workplaces that can lead to nurses' poorer health and well‐being. Resilience programmes are a strengths‐based preventative approach for promoting mental health and well‐being in the face of adversity; however, there is no prior research on mental health nurses' perspectives on resilience programmes. Aim: To explore the perspectives of mental health nurses participating in a mental health service‐initiated resilience programme (Promoting Adult Resilience). Method: An exploratory qualitative inquiry was undertaken. Multiple qualitative data: open‐ended responses and semi‐structured interviews and focus groups, were thematically analysed. Results: Twenty‐nine registered nurses from a metropolitan mental health service participated. Four main themes were as follows: being confronted by adversity; reinforcing understandings of resilience; strengthening resilience; and applying resilience skills at work. Discussion: This is the first study to report mental health nurses' perspectives on a resilience programme. Resilience programmes can help improve nurses' self‐efficacy and ability to realistically appraise stressful situations and to moderate their emotional responses to others. Implications for practice: It is recommended resilience programmes are provided to promote nurses' well‐being and resilient practices. To build a resilient workforce, the wider barriers and risks to staff well‐being need to be addressed at a unit, organizational and professional level. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: User involvement, when people who have accessed services become actively involved in aspects of mental health care, can sometimes be “tokenistic” and not well thought through. Users are often involved in their own care, and asked for feedback, but are less likely to be meaningfully involved in developing services and training staff. What this paper adds to existing knowledge?: To implement meaningful involvement, it is important to know why some users choose to devote time to such activities. User representatives in this study, involved in a UK mental health service, wanted to help people in a similar position and give something back to those that helped them. As people started involvement activities, such as interviewing staff, they gained confidence and felt part of something that was making a difference. After being supported by staff to explore opportunities, representatives become more independent and some moved to different, sometimes salaried, roles. Some representatives did not feel valued or supported. Staff often controlled opportunities, and many users missed out on being involved. What are the implications for practice?: Staff need to understand and receive training on involvement. The definition of involvement should be agreed by users and staff together, and outcomes of involvement activities must be fed‐back to users on a regular basis. There should be dedicated involvement workers in services, to support individuals and integrate involvement into the system. It is important to consider how to make involvement accessible to more mental health service users. Abstract: Introduction: Despite guidance promoting user involvement, meaningful involvement continues to be debated within services. To effectively implement involvement, it is important to acknowledge why users devote time to such activities. Aim: This study explores user representatives' experiences of involvement, including motivations and personal benefits. Method: Thirteen user representatives involved in activities such as staff training and interviews were recruited from a UK National Health Service mental health Trust during 2015. Themes within semi‐structured interviews were developed using constructivist grounded theory analysis. Memo‐writing, process and focused coding, and core categories supported development of the conceptual framework of being a user representative. Findings: Being a user representative was inextricably linked to wellness, yet staff governed opportunities. Making a difference to others and giving back were initial motivating factors. Experiences depended on feeling valued, and the theme of transition captured shifts in identity. Discussion: User representatives reported increased confidence and well‐being when supported by staff. However, involvement triggered mental health difficulties and identified the need for regular monitoring and reflection of involvement activities and practice. Implications for practice: Services should consider coproduction, where users and staff agree together on involvement definitions. Dedicated involvement workers are crucial to supporting individual well‐being and monitoring involvement. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coping with parental mental illness in families can be challenging for both children and parents. Providing evidence‐based family interventions to families where a parent has a mental illness can enhance the relationships in the family. Although psychiatric research has shown that evidence‐based family interventions may improve the communication and understanding of parental mental illness, there is a lack in this area of research from an everyday clinical context. What does this paper add to existing knowledge?: Our study reinforces the fact that parents with mental illnesses are searching for support from psychiatric services in order to talk to their children about their illness. The finding that under‐age children comply when they are told by their parents to join an intervention in psychiatric services supporting the family is something not observed earlier in research. This study once more illuminates the fact that partners of a person with parental mental illness are seldom, in an obvious way, included in family support interventions. What are the implications for practice?: Psychiatric services, and especially mental health nurses, have an important task in providing families with parental mental illness with support concerning communication with their children and in including the “healthy” partner in family support interventions. Abstract: Introduction: Although research has shown that evidence‐based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context. Aim: This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services. Method: Five families with children aged 10–12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed. Results: In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child‐rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support. Implications for practice: Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners. [ABSTRACT FROM AUTHOR]

Accessible summary What Is Known on the Subject? Psychiatric day hospital (DH) treatment has been offered since the 1930s and is appropriate for individuals experiencing intense psychiatric symptoms without requiring 24-hour inpatient care., No empirical research has examined the specific purpose of DH treatment from the perspectives of healthcare providers within these programs., What This Paper Adds To Existing Knowledge? This study was the first to address the question of the purpose and function of DH treatment from the outlook of frontline workers within this setting, and confirmed anecdotal observations that DH treatment provides an alternative to intensive psychiatric care, and also operates as 'bridge' between these intensive services and purely outpatient treatment., Additional information emerged, such as the importance of the name of DH programs avoiding connotations of illness, the benefits and skills that draw patients to these programs, and challenges that staff and patients experience within DH programs (e.g. short length of treatment, barriers to treatment access)., What Are the Implications for Practice? This information can enhance curriculum development within these settings. For example, given the importance of skill building, it is essential to integrate the provision of skill building and coping strategies within these settings., In addition, given that the name of the setting can impact staff (and perhaps service users as well), ensuring that the name of such program highlight wellness and recovery may enable a different type of therapeutic community to develop within these settings., Abstract Introduction Despite the benefits of psychiatric day hospitals ( DH), research has not addressed staff perspectives of these programs' effectiveness and barriers. Aim To elucidate staff perceptions of Adult Mental Health DH programs at two hospitals in Canada, allowing for improved programming, enhanced structure and increased understanding of DH settings within the continuum of care. Method Twenty-five DH staff members completed semi-structured qualitative interviews. Two independent coders applied content analysis to achieve data saturation. Results Four major themes emerged: (1) program purpose and function, (2) what is in a name, (3) perceived patient motivation, and (4) room for improvement. Discussion Findings highlighted the importance of a multidisciplinary team delivering education and skill-focused interventions. Services were cited as 'bridging' different mental health settings. Challenges included barriers to treatment access and inadequate length of treatment. Implications for Practice Understanding the function and purpose of this treatment service may enhance service delivery by enabling programs to integrate identified key ingredients. Providers can also note treatment duration and consider how to best use that time. Finally, language used within a DH setting appears to impact staff delivering services, and may also alter patients' understanding of the services they will receive and purpose of the program. [ABSTRACT FROM AUTHOR]

Introduction: Sexual health is essential to the overall health. People suffering from severe mental illness (SMI) experience a deterioration in their sexual health. These patients and their caregivers seem unwilling to engage in a dialogue concerning sexual health within the context of mental health care. Aim: The study investigated nurses' and care assistants' beliefs and attitudes regarding the sexual health of people with SMI on the psychiatric care pathway. Methods: Twenty semi‐structured interviews were conducted with nurses and care assistants. Data were subject to a thematic analysis. Results: Three main themes emerged: (1) The formalization of the care approach towards people with a SMI in hospitals; (2) the place given to sexual health in psychiatry units; (3) nurses and care assistants are not equipped to deal with patients' sexual health. Discussion: Caregivers consider that sexual health is a fundamental right and an indicator of good health. They nevertheless believe that the psychiatric hospital remains a place of acute care where sexual health is not considered. Implication for Practice: This research justifies that it is necessary to question the representations of nurses and care assistants before implementing a tailored intervention that integrates the consideration of sexual health into the holistic care of the patient on the psychiatric care pathway. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject The introduction of PSWs within mental health services has grown substantially both internationally and locally; however, no recognized studies have focused on the evolvement of this role within a Northern Ireland ( NI) context., Research is increasingly focusing on service users' and PSWs perspectives on mental health service provision. Despite this, few studies exist which exclusively report staff views in relation to the PSW role., What the paper adds to existing knowledge Results of the current study identified varying perspectives on the peer role. Some participants believed that the PSW role was tokenistic; others opposed these views, highlighting the value of this role. Clearly defined job descriptions and the importance of ensuring the PSW is a cohesive part of the team and not an 'add on,' was identified as imperative to avoid tokenistic practice., Provision of a flexible working environment, both sensitive and responsive to the peers' own mental health needs, was identified as significant in order for the peer to fulfil their role successfully., Implications for practice Services introducing PSWs within teams should engage with nursing staff at all organizational levels in the role development process to minimize the risk of tokenism, for example, the PSW role not integrated or valued within teams., Clearly defined job/role specifications for PSWs should be devised to ensure that both the PSW and the mental health nursing team have a shared understanding regarding this role., Abstract Aim Peer support worker ( PSW) roles are gaining recognition internationally as a valuable component in mental health service delivery. The aim of this study was to explore the views of mental health voluntary sector staff regarding the emergence of this role. Method A qualitative research design was used. A purposive sample was employed. Semi-structured interviews were undertaken with 10 staff members in various positions in two voluntary mental health organizations. Interview transcripts were analysed thematically. Results Views varied on the PSW role with some participants stating that it was tokenistic, whereas others highlighted the value of its contribution. Participants' expressed concerns regarding professional boundaries and organizational cultural challenges that PSWs may encounter in their role. The provision of reasonable adjustments was recommended as an integral support mechanism. Conclusion Successful integration of the PSW requires careful consideration of the role, the workplace environment and the unique needs of the peer, to prevent the role becoming constrained and diluted. Implications for practice The PSW role may impact the traditional delivery of mental health nursing services. It is therefore essential that nurses are cognizant of these potential challenges to successfully facilitate the integration of PSWs in practice. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Around the world, recovery has become a focus in mental health policy. The participation of people accessing mental health services (consumers) and carers of such individuals in decision-making related to services forms part of this recovery orientation and studies suggest positive outcomes following such participation., However, little is known about consumer and carer desires at the earliest stages of development of new services., What this paper adds to existing knowledge? Consumers and carers desire changes to how mental health services are provided., Many factors affect consumer and carer experiences, including language use, physical design of spaces, accessibility, consideration of individual needs, practical help and how well care is continued from hospital to community settings., Carers may feel sidelined in treatment and be distressed as a result. They wish to be respected and involved in recovery., Consumers and carers wish for focus on broader health, with care taken to address physical health, psychological needs, social needs and treatment of the whole person rather than just an illness., What are the implications for practice? Consumers and carers desire partnership with professionals in recovery. Tokenistic participation should be avoided., Flexibility in how services are provided and less formality may help engage consumers and carers. Specifically, professionals may help by linking consumers and carers to services that address practical needs., Professionals should communicate with carers to draw on their expertise about the individual accessing the mental health service and help carers understand how they can assist the individual's recovery., Abstract Introduction Recovery-oriented mental health policies recognize consumer and carer participation in service decision-making as essential, but little is known about the views of these individuals in the earliest stages of service development. Aim This study sought consumer and carer perspectives addressing the establishment of a mental health research, treatment and teaching facility in their region. Methods Two 2-hr focus groups were conducted, with separate groups held for mental health consumers ( n = 9) and carers ( n = 9), respectively. Discussions pertained to mental health literacy, gaps in current services, desires for an ideal facility (in terms of physical design and services offered) and what would help in recovery. Results Inductive thematic analysis was used to generate three themes: care outside of consultations, carer involvement in recovery and holistic approaches to mental health care. Consumers desired a facility that could cater to individual needs. Carers felt excluded in recovery and unable to provide effective support. Both groups preferred holistic approaches to mental health, expressing ambivalence towards medication and hospitalization. Discussion Consumers and carers have many needs that conventional practices may not meet. Implications for practice They have clear desires for equal partnership in recovery and for transformation of conventional treatment methods. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery., At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members., What this paper adds to existing knowledge? This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland., In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy., What are the implications for practice? Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment., Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally., Abstract Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N = 1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? In the UK and internationally, the number of looked after children is increasing year on year., Mental health problems among looked after children are significantly higher than in the general population, and the uptake of mental health services for these children is low., There is a poor prognosis for children with untreated mental health problems; this is further compounded if the child is within the care system., What does this paper add to existing knowledge? This study adds to our understanding of foster carers' experiences of the mental health needs of looked after children and demonstrates some of the challenges associated with accessing appropriate and timely mental health services., New knowledge derived from this research is that the barriers to accessing Child and Adolescent Mental Health Services (CAMHS) are not at the time of initial referral as previously reported, but later, once within the mental health system with long waiting times experienced particularly for specialist services., This study provides new insights into the experience of being a foster carer and the levels of support and resources needed that directly relate to the viability of the placement., The majority of the foster carers interviewed were from a Black and Minority Ethnic (BME) background, previously under-represented in this research area., What are the implications for practice? A number of areas in current CAMHS provision need addressing with a focus on accessibility, consultation and support for foster carers. Waiting times need to be addressed, and improved communication with other agencies is also highlighted., CAMHS nurses are well placed to develop and deliver a comprehensive care package to foster carers, offering more tailored support to them whilst enabling the children and young people in their care to access and engage more effectively with mental health services., Abstract Introduction Despite well-documented vulnerabilities to mental health problems among the increasing population of looked after children, there continues to be poor uptake and utilization of Child and Adolescent Mental Health Services ( CAMHS). Aim To elicit views of foster carers regarding the mental health needs of children and adolescents in their care and their experiences of accessing mental health services. Methods A grounded theory approach and semistructured interviews with ten foster carers. Results The experience of being a foster carer was the core category, with three major themes: (1) foster carers' psychological understanding of challenging behaviour; (2) barriers to accessing CAMHS; (3) the importance of support. Discussion A key finding of this research is that barriers to accessing CAMHS were not experienced at the point of referral, but once within the mental health system. The foster carers demonstrated a proactive approach to accessing services but expressed a need for more support structures related directly to the viability of the placement. Implications for practice Mental health nurses have a pivotal role in providing a more responsive and needs-led service for this population; professional support to foster carers to include facilitating peer support; and clinical interventions for the looked after children. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Problematic parent-child relationships have been identified as one of the main predictors of adolescents' mental health problems, but there are few existing interventions that address this issue., The format and delivery method of existing interventions for parents are relatively inaccessible for parents with full-time jobs and families living in rural areas., What does this paper add to existing knowledge? The newly developed 'Stepping Stone' culturally specific web-based intervention, which is intended to help Korean parents of adolescents to acquire both knowledge and communication and conflict management skills, was found to be feasible and well-accepted by parents., This study enabled us to identify areas for improvement in the content and format of the intervention and strategies. This will potentially increase effect sizes for the outcome variables of parents' perception and behaviours., What are the implications for practice? This web-based intervention could be delivered across diverse settings, such as schools and community mental health centers, to increase parents' knowledge of adolescent's mental health and allow for early detection of mental health problems., Mental health nurses working in schools may spend a significant amount of time addressing students' mental health issues; thus, this web-based intervention could be a useful resource to share with parents and children. In this way, the mental health nurses could facilitate parental engagement in the intervention and then help them to continue to apply and practice the knowledge and skills obtained through the program., Abstract Introduction There is a need for accessible, culturally specific web-based interventions to address parent-child relationships and adolescents' mental health. Aims This study developed and conducted a preliminary evaluation of a 4-week web-based intervention for parents of adolescents aged 11 to 16 years in Korea. Methods We used a two-group, repeated measures, quasi-experimental study design to assess the feasibility of developing and implementing a web-based intervention for parents. Descriptive statistics, chi-square and t tests, and mixed effect modeling were used for data analysis. Results The intervention and 1-month follow-up survey were completed by 47 parents in the intervention group and 46 parents in the attention control (AC) group. The intervention was found to be feasible and well-accepted by parents. Discussion This culturally specific web-based intervention is a useful tool for knowledge dissemination among large numbers of parents. Areas for improvement in the content and format of the intervention and strategies to elicit significant parent-child interactions are provided. Implications for practice and conclusion The intervention could be disseminated in collaboration with mental health nurses working in schools to facilitate parents' participation. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Nurses play an important role in monitoring and supporting patients and their relatives at the end of life., To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity., The limited literature available indicates that palliative care for psychiatric patients needs to be improved., What this paper adds to existing knowledge? This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision., Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders., Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses., What are the implications for research and practice? Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group., Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored., Abstract Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? UK mental health policy dictates user involvement in mental health care planning., Service users report feeling marginalized in the care planning process., Ongoing dissatisfaction with care planning involvement suggests a failure to translate policy into practice over time., What this paper adds to existing knowledge? Service user involvement should no longer be regarded as a nebulous concept., Ten key criteria underpin service user satisfaction with care planning involvement., Five criteria characterizing the process of care planning involvement are prioritized by service users., What are the implications for practice? Service users can conceptualize and describe meaningful user involvement. Service user requests, summarized through a 10C framework of care planning involvement, provide a clear structure for practice improvement., Abstract Background Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited. Question How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process? Methods In 2013, we conducted five focus groups ( n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services ( n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse. Discussion The process of care planning, centred on the user-clinician relationship, is key to user involvement. Implications for Practice Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? The time of discharge from a mental health hospital can be challenging for mental health service users, with high rates of readmission in the immediate months following discharge., Although some research exists that explores service users' perspectives of being discharged, little evidence exists that explores the processes influencing or used by service users' to adapt to the transition from in-patient acute mental health service., What this papers adds to existing knowledge? The findings of this grounded theory study demonstrates the strategies service users used to managed their own, as well as their social audiences, preconceived expectations arising from their new identity as 'psychiatric patients' following their discharge from hospital., While there is a move to develop recovery-orientated mental health services, key indicators of recovery-oriented practices were often absent from service users' experiences of service provision., What are the implications for practice? Nurses and other mental health professionals need to recognize their contribution to the architecture of stigma that transcends the physical structures of hospital or ward and are entrenched within attitudes, interactions and practices., The findings of this study can provide guidance to those working with service users and help them to understand the complexities of their experiences when using mental health services, which go far beyond the management of their symptoms., Abstract Introduction Following a period of hospitalization, the transition to home can result in increased vulnerability and a source of stress for mental health service users. Readmission rates have been suggested as one indicator of the success of the transition from hospital to community care. Despite knowledge of some of the factors that impact on service users following discharge, no coherent model or theoretical framework could be located in the literature, which explains or aides an in-depth understanding of the transition from hospital to community for service users. Aim The aim of this study was to develop a grounded theory that explored service users' experiences of going home from hospital. Method This qualitative study used grounded theory, and a total of 35 interviews were conducted with 31 service users. Results The core category was 'Managing Preconceived Expectations', which had seven subcategories, describes how the participants were negatively perceived by themselves and others following their admission and discharge from hospital. Implications for Practice This theory presents the strategies that the participants used to manage this new identity. This theory demonstrates that although there has been a move to adopt recovery-orientated services, key indicators of recovery were often absent for service users being admitted and subsequently discharged. [ABSTRACT FROM AUTHOR]

Accessible summary Clinical leadership is important for the strength of mental health nursing as a profession, particularly in utilizing clinical-based opportunities for the professional development of new graduates and nursing students., To date, there has been limited research examining the attributes of nurses considered by their colleagues to be clinical leaders. This study presents the views and experiences of mental health nurses who deliver care, about what they identify as important for effective clinical leadership., Clinical teaching and role modelling are two fundamental roles of effective clinical leaders; they are underpinned by the attributes of professionalism, honesty, willingness to share knowledge and approachability., Additional research is needed to consider the applicability of these roles and attributes across larger samples of nurses in mental health settings., Abstract Clinical leadership is acknowledged as important to the nursing profession. While studies continue to identify its significance in contributing to positive outcomes for consumers, the role that clinical leadership has in enabling and supporting professional development in mental health nursing is poorly understood. This study utilized a grounded theory methodology to explore the characteristics clinicians consider important for clinical leadership and its significance for mental health nursing in day-to-day clinical practice. Individual face-to-face, semi-structured interviews were conducted with nurses working in mental health settings. Participants described the important role that clinical leaders play in enabling professional development of others through role modelling and clinical teaching. They describe how nurses, whom they perceive as clinical leaders, use role modelling and clinical teaching to influence the professional development of nursing staff and undergraduate nursing students. Attributes such as professionalism and honesty were seen, by participants, as enablers for clinical leaders in effectively and positively supporting the professional development of junior staff and undergraduate nurses in mental health nursing. This paper examines clinical leadership from the perspective of mental health nurses delivering care, and highlights the important role of clinical leaders in supporting professional development in mental health nursing. [ABSTRACT FROM AUTHOR]

Accessible summary Creative and imaginative approaches to mental healthcare education are known to help students explore emotions, empathy and others' experiences, as well as address ambivalence and ambiguity., Very few studies in mental health nursing education specifically utilise photography as a participatory pedagogic tool, with even fewer utilising photography to explore understandings of culture, values and diversity., Photography makes visible complex, collaborative forms of learning and previously unidentified, unarticulated ideas about culture and values., Photography as a critical pedagogic method helps develop critical, politicized understandings of culture and values., Abstract Increasing culturally diverse populations means complex and conflicting values have become a common feature in mental health nursing. In education the need to critically examine such topics necessitates creative and engaging pedagogy, and visual methods are readily acknowledged as such. Yet while many studies advocate and demonstrate the value of art-based methods in student learning, very few studies in mental health nursing specifically utilize photography as a participatory pedagogic tool, and fewer still use photography to explore understandings of culture, values and diversity. In this paper, we discuss a qualitative study where mental health nursing students used photography to create images in order to explore their own and often dominant culture and attendant values. Findings suggest that photography makes visible situated, relational and collaborative learning, and surfaces previously unidentified, unarticulated ideas about culture and values. These practices mimic important processes central to mental health nursing practice and contemporaneous understandings of diverse cultures. We argue that photography provides an important resource with which to unearth subjugated knowledge, promote critical understandings of culture and values, and thereby help address inequalities in mental health care. [ABSTRACT FROM AUTHOR]

Accessible summary The Chief Nursing Officer's Review of mental health nursing was published in 2006. This paper reports an evaluation of the implementation of the Review in mental health trusts., There was widespread acceptance of the Review, but actions to implement the Review varied., The lack of an evidence-based implementation plan and a lack of strategic nursing leadership in many mental health trusts hampered the implementation., The Review recommendations may become widespread by a systematic policy implementation plan from the centre, supported by local leadership in practice., Abstract This study is an evaluation of the implementation of the Chief Nursing Officer for England's Review of mental health nursing in mental health trusts (MHTs). The authors employed instrumental case studies in six MHTs. The results showed evidence of acceptance of the Review and some evidence of subsequent actions to implement the Review recommendations, but these were not widespread. A lack of an evidence-based implementation plan hampered the implementation as did an apparent lack of strategic nursing leadership in many MHTs. In conclusion, the vision for mental health nursing reported in the Chief Nursing Officer Review prompted various changes, directly and indirectly, among mental health nurses and the development of areas of good practice in education, practice and leadership. The positive changes evident in some areas may become widespread by a systematic policy implementation plan from the centre, supported by local leadership in practice. [ABSTRACT FROM AUTHOR]

This paper reports on an evaluation of a 'social participation' improvement project in a mental health care and care for the intellectually disabled setting. The main research question is how sociality (i.e. clients' social lives) was constructed and what consequences this had for the project and for the clients. We undertook a dual approach: investigating the predefined outcomes and analysing the improvement processes in terms of how these processes construct sociality. As to the predefined outcomes, clients' social networks were not widened, but clients felt significantly less lonely at the end of the project. In a bottom-up analysis of data gathered on the improvement processes, we articulated two ways of constructing sociality: individualization, in which clients had to verbalize their wishes (verbalization) and to act upon them more actively (enterprising); and normalization, in which a good social life was one embedded in 'normal' community. We argue that this (explorative) way of conceptualizing change corresponds with some of the quantitative findings but also brings to light aspects that would have gone unnoticed by using only the predefined outcomes. Therefore, a mixed methods approach in studying effectiveness is a fruitful addition to the quality improvement literature. [ABSTRACT FROM AUTHOR]