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Introduction: People with a borderline personality disorder (BPD) diagnosis or symptoms may experience emotional crises which necessitate use of the emergency department (ED). No existing reviews focus specifically on experiences of consumersa, carersb and clinicians in relation to ED presentations by people diagnosed with BPD. Aim/Question: The aim of this study was to synthesise knowledge on consumer, carer and clinician experiences of BPD in the ED. Method: An integrative review methodology was chosen as it best captures the complexity of varied perspectives and emergent phenomena from diverse literature sources. EMBASE, CINAHL, PsycInfo and Medline were searched for papers published before 16 February 2022. Results: Nine papers met the inclusion criteria (five qualitative, one quantitative, one mixed methods and two letters to the editor). Key themes were barriers to timely and adequate care, and stigmatising attitudes and practices towards people diagnosed with BPD. Negative attitudes were perceived to perpetuate harmful outcomes and further ED visits. Discussion: Predominantly negative ED experiences were expressed by clinicians, consumers and carers. Further work is needed in ED models of care and staff education to improve the experience of care for consumers, carers and clinicians alike. Implications for Practice: Opportunities for change will exist through co‐designed innovation, education, advocacy and leadership. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Emergency departments (ED) are key settings to support and manage suicidal crisis; thus, ED staff are often the first point of contact for people in suicidal crisis. Despite this, some ED staff receive little training and/or education on how to best support such patients. What the paper adds to existing knowledge: Previous research focuses on one staffing role (e.g. triage nurses) whereas this paper includes staff working across the ED pathway. Administrative staff have often been excluded from research, despite representing a key part of the clinical pathway and being a person's initial contact with the ED.Overall findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. Staff also perceive there to be a negative ED culture, which often leads to poor attitudes towards suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention.Findings build upon previous research to highlight key challenges different staff face along the clinical pathway and the implications this can have on a patient's journey and follow‐up care provided. What are the implications for practice?: Findings are of particular importance and relevance to ED managers, and more broadly NHS England. Negative ED culture, poor staff attitudes and confidence can have a detrimental impact on both staff health and wellbeing, as well as a patient's journey throughout the ED, resulting in repeat presentations and absconding as appropriate support is not received.Policymakers need to consider staff burnout and lack of resources in mental health care strategies, and training programmes should be developed to improve culture and confidence among ED staff and managers to improve care for people attending EDs in suicidal crisis. Introduction: Emergency departments (EDs) are often the first point of contact for people in suicidal crisis. Yet, previous work has tended to focus on only one type of staffing role, failing to account for different staff perspectives along the clinical pathway. Aims: To explore and synthesise the perspectives of ED administrative (i.e. receptionists), medical (triage nurses) and mental health staff (liaison psychiatrists) working with people presenting in suicidal crisis. Method: Qualitative study guided by thematic analysis of semi‐structured interviews with 23 ED staff across six EDs in Cheshire and Merseyside, England. Results: Findings demonstrate that staff experience a lack of confidence, training and burnout due to regularly supporting people in suicidal crisis. The main challenges reported are an increase in working pressures, unavailability of resources and staff retention. Discussion: Staff felt unequipped to deal with suicide‐related presentations. Organisational support is perceived to be lacking, with increased staffing pressures and poor service availability. This lack of support was linked to job dissatisfaction. Implications for Practice: Findings are of particular relevance to individual EDs and NHS England. Addressing the challenges staff are reporting can have positive implications for staff wellbeing, as well as a patient's experience and journey throughout the ED. [ABSTRACT FROM AUTHOR]

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?: Psychiatric hospitals have input from a range of professionals, including Clinical Psychologists.Most evidence used to guide what Clinical Psychologists do is based on their work with individuals rather than staff teams.Some evidence shows working with staff teams is important, but most of this is based on interviews rather than measuring the impact using numbers and statistics.The current study aimed to investigate the effectiveness of staff‐level interventions provided by a Psychology team within a psychiatric inpatient setting. What the paper adds to existing knowledge?: Training sessions were effective at increasing staff levels of confidence and understanding in psychological approaches, and the perceived usefulness of the session to their practice.Case discussion sessions were effective at increasing staff levels of understanding a service user, compassion towards the service user, perceived opportunities for change with the service user, their perceived skills to work with the service user and their perception of the usefulness of the session to their practice.Reflective practice sessions were effective at providing a space for learning, sharing ideas and reflecting.Other interventions were highly valued by nursing staff. What are the implications for practice?: Staff‐level interventions are effective and valued by mental health nursing staff and should be considered in allocation of psychology resources.Interventions improved staff psychological thinking which could positively impact service user experience.There is potential for people with lived experience to participate in these interventions, which could facilitate the therapeutic relationship and reduce restrictive practices. Introduction: The role of Psychologists in psychiatric inpatient settings is well established and involves intervention at various levels; however, quantitative exploration of the effectiveness of staff‐level interventions is lacking. Aim: The aim of the study was to examine the effectiveness of a variety of staff‐level interventions provided by a Psychology team within a psychiatric inpatient setting. Methods: The evaluation used a mixed methods approach incorporating pre–post quantitative data and post‐intervention feedback. Additional data were collected via survey. Key Findings: Results indicated all staff‐level interventions were effective in achieving their aims and were highly valued by staff. Qualitative data supported the quantitative findings and showed tentative suggestion of a change to clinical practice. Discussion: Indirect psychology provision was found to significantly impact a range of staff attitudes and was highly valued by the staff team, supporting previous qualitative findings in psychiatric inpatient settings. Further quantitative evidence of the impact of staff‐level interventions should be sought. Implications: Staff‐level interventions are effective and valued by mental health nursing staff and should be considered in allocation of psychology resources. Furthermore, there is potential for people with lived experience to participate in these interventions, which could facilitate the therapeutic relationship and reduce restrictive practices, however this requires future research. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Most health professionals working in psychiatric care will experience adverse events (AE) such as service user suicide or violence, during their careerNorway lacks measures to capture potential iatrogenic injuries, such as risk assessment measures, to evaluate patient records for AEs in both inpatient and outpatient psychiatric clinics in hospitals What the paper adds to existing knowledge: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translationWe have incorporated the understanding of health professionals and service users; to bring together the lifeworld of the patient with the professional definition of AEs, triggers and risk areas of AEs in a psychiatric context. The service users' experiences resulted in modifications to the tool. What are the implications for nurses: Applying the 'Global Trigger Tool—Psychiatry' in Norway and Sweden can help mental health nurses to prevent iatrogenic harm and reduce the occurrence of AEs through the identification of potential triggers.Implementing 'Global Trigger Tool—Psychiatry' might help mental health nurses to improve patient safety in Norway and Sweden. Introduction: There is little consensus on cross‐cultural and cross‐national adaptation of research instruments. Aim/Question: To translate and validate a Swedish research tool (GTT‐P) to detect iatrogenic adverse events in psychiatric health care by involving service users and health professionals in the process. Method: The GTT‐P, designed to identify events in patient records that were triggers for adverse events, was translated to Norwegian using a cross‐cultural adaptation approach. This involved two focus groups with clinical staff, one of which involved service users, and a joint discussion at a Dialogue Conference to generate consensus on the definition of the triggers of potential adverse events identifiable in patient records. Results: We highlight both the differences and commonalities in defining the nature of risks, the adverse events and the triggers of such events. The Dialogue Conference resulted in three modifications of the tool, based on service users' experiences. Service user involvement and co‐production was essential for both the translation and adaptation of the research instrument. Discussion: We have described an approach to the validation of a research tool between different national contexts; a process that went beyond language translation. This approach enables a more nuanced understanding of potential risks within a psychiatric context as it engages differences in the care delivery. Applying the GTT‐P in hospital‐based psychiatric care might help to identify processes that need to be changed in order to promote patient safety and a safer work environment for mental health nurses. Implications for practice: When translating and validating the GTT‐P from Swedish to Norwegian, we have considered the knowledge and experiences of both service users and health professionals. The application of the GTT‐P can promote greater patient safety in hospital settings. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The principles of personal recovery are primarily applied in outpatient and community settings as these settings provide continuity of care and recovery‐based community programs supporting consumers' recovery journey.A range of healthcare professionals are involved in the care of people within mental health in‐patient units, including nurses, psychiatrists, psychologists, occupational therapists and social workers.The integration of recovery‐oriented care in mental health inpatient units may be impaired by a lack of confidence among mental health professionals. What this paper adds to existing knowledge?: Developing hope and a safe place is an integral part of recovery‐oriented practice within mental health inpatient units.Instilling connectedness is a relevant recovery principle; however, there may be greater barriers in mental health settings which traditionally prioritise safety and risk mitigation practices to prevent perceived harmful behaviours.Staff workload and inadequate understanding of recovery concepts present challenges to promoting recovery‐oriented care in everyday practice.Using strength‐based practice is critical in promoting a safe space for consumers by providing psychosocial interventions and person‐centred care. What are the implications for practice?: The provision of recovery‐oriented practice requires adopting a collaborative approach that places a strong emphasis on the involvement of consumers and their families.Empowering mental health professionals to believe that recovery‐oriented practice is possible in mental health inpatient units is crucial.Mental health professionals need to create a safe environment and positive relationships through respect and empathy for consumers and their family members. Introduction: Recovery‐oriented practice underpins an individual's personal recovery. Mental health nurses are required to adopt a recovery‐oriented approach. Globally, a paucity of literature exists on mental health professionals' experience of recovery‐oriented practice in mental health inpatient units. Aim: The aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery‐oriented care in mental health inpatient units by appraising and synthesising existing qualitative research. Method: Three databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist. Results: Ten qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery‐oriented care. Discussion: Mental healthcare professionals perceived the principles of recovery‐oriented care to be positive and include: therapeutic space, holistic care and person‐centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice. Implications for Practice: Recovery‐oriented practice must underpin consumer and family engagement, treatment choices and continuity of care to facilitate consumer's personal recovery. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Negative attitudes towards mental illness lead to the formation of stigma. Stigma prevents the recovery of people diagnosed with mental illness.There is evidence of stigmatic attitudes towards mental ill health among mental health professionals.Anti‐stigma initiatives, such as education and training, may be effective in enhancing or maintaining positive attitudes towards mental illness among mental health professionals. What this paper adds to existing knowledge?: Education and training that is designed and delivered around a specific mental health diagnosis or condition appears an appropriate strategy that could benefit mental health professionals to develop a deeper appreciation and understanding of mental ill health and its impacts on individuals.Consumer involvement in the education and training of mental health professionals regarding the stigma of mental illness is recommended; however, this is an under‐explored area of investigation.There is a weak evidence base regarding the long‐term sustainability of effects from anti‐stigma education and training. This should be addressed via further research in future. What are the implications for practices?: Anti‐stigma initiatives can support mental health professionals to develop stigma‐free, recovery‐oriented practices in their work. Further, such initiatives can improve the provision of evidence‐based quality care for the consumers, facilitating their recovery. Introduction: Despite an increasing focus on stigma, evidence shows prejudicial attitudes towards mental illness among mental health professionals still exist. It is suggested that anti‐stigma initiatives can aid in enhancing the attitudes of mental health professionals. However, research on initiatives targeting stigma of mental illness among mental health professionals is limited. Aim: To identify and analyse scientific literature pertaining to the effectiveness of anti‐stigma initiatives regarding mental ill health among mental health professionals. Method: A systematic literature review was performed using the databases MEDLINE, CINAHL, PsycINFO, PubMed, Scopus, Google Search engine and Google Scholar. The papers were limited to English language, published in peer‐reviewed journals with full‐text articles available and published between the years 2008 and 2020 to understand the most recent trends in the attitudes of mental health professionals including nurses. The Population, Intervention, Comparison and Outcome (PICO) strategy was used to identify papers meeting the inclusion criteria. Results: A total of 439 papers were identified. However, papers not meeting the inclusion criteria were excluded from selection. Three appraisers reviewed the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. Finally, eight unanimously accepted papers were included in the systematic review. Several effective anti‐stigma initiatives were identified through the review, and these had positive impacts on mental health professionals' attitudes towards mental illness, for at least a short period. It was identified that contact‐based interventions are relevant and effective although the involvement of consumers and caregivers in the design and delivery of interventions was not explicitly addressed in detail in studies included in the review. Education strategies tailored for specific mental illness may be more appropriate, rather than approaches that refer to mental illness in general. Conclusions: This review shows the evidence of pessimistic attitudes towards mental illness persists among mental health professionals. Anti‐stigma initiatives identified in the selected papers were effective in changing these attitudes. Future research should be focused on the effectiveness of contact‐based interventions and understanding the longer‐term effects of the interventions among homogeneous groups. Full consideration of the varying level of clinical experience and expertise in mental health should guide the development and implementation of anti‐stigma initiatives in this context. Implications for practice: Anti‐stigma interventions can have a positive impact on mental health professionals' knowledge, attitudes and supportive caring for people diagnosed with mental illness. Such anti‐stigma interventions may meaningfully support stakeholders to address the impact of negative attitudes on the physical and mental health status of people diagnosed with mental illness. With sustained leadership, effort and reinforcement, it is possible to create workplace cultures that prioritize stigma‐free and recovery‐oriented behaviours and practices within mental health services. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: Although sexual violence is prevalent, incidents of stranger rape remain statistically uncommon.Societal stigma and myths surrounding sexual violence are widespread.An individual's experience in the immediate aftermath and beyond can be shaped by the perception/s of sexual violence which are held and expressed by those they come into contact with. What this paper adds to existing knowledge?: This paper adds to the limited literature base and the population and practical‐knowledge gap around a specific form of sexual violence.This paper also demonstrates the need for reflection and discussion in minimizing blame that can unconsciously be shifted onto survivors in the form of myths and stereotypical views of sexual violence. What are the implications for practice?: Perceptions may be held around sexual violence, and by extension about the survivor, which may impede engagement and the building of trust within a therapeutic relationship.Myths that are synonymous with rape and all forms of sexual violence can be held by professionals, and lead to blame, negative judgement and lack of empathy towards survivors.Given the prevalence of sexual violence, this paper is applicable across all health and social care settings, and in particular mental health nursing professionals who may be more likely to meet people who have experienced sexual trauma. Introduction: This narrative illustrates the lived experience of a specific form of sexual violence (stranger rape) and its resulting implications as experienced by the second author, which is discussed under the following headings: your body as a crime scene, how lived experience compares to the myth of the 'real rape' and the wellbeing and health consequences arising from the experience. [Correction added on 5 September 2022, after first online publication: The preceding paragraph has been corrected in this version.] Aim: In their capacity as mental health nurses, the authors invite readers to consider the spoken, or more likely unheard stories of sexual violence, which are unfortunately commonplace among those who access mental health services. Implications for Practice: For professionals holding the privileged position of hearing these stories, there is a need to be reflective as to how fear, and personal or professionally held myths and stigmatizing views of sexual violence, and by extension views towards the survivor, are carried into therapeutic spaces, and the implications these can have. Practical suggestions as to how to discuss and manage disclosure of sexual violence in the context of trauma informed care are also provided. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mentalizing is the capacity to understand both one's own and other people's behaviour in terms of mental states, such as, for example, desires, feelings and beliefs.The mentalizing capacities of healthcare professionals help to establish effective therapeutic relationships and, in turn, lead to better patient outcomes. What this paper adds to existing knowledge?: The personal factors positively associated with the mentalizing capacities of healthcare professionals are being female, greater work experience and having a more secure attachment style. Psychosocial factors are having personal experience with psychotherapy, burnout, and in the case of female students, being able to identify with the female psychotherapist role model during training. There is limited evidence that training programmes can improve mentalizing capacities.Although the mentalization field is gaining importance and research is expanding, the implications for mental health nursing have not been previously reviewed. Mental health nurses are underrepresented in research on the mentalizing capacities of healthcare professionals. This is significant given that mental health nurses work closest to patients and thus are more often confronted with patients' behaviour compared to other health care professionals, and constitute a large part of the workforce in mental healthcare for patients with mental illness. What are the implications for practice?: Given the importance of mentalizing capacity of both the patient and the nurse for a constructive working relationship, it is important that mental health nurses are trained in the basic principles of mentalization. Mental health nurses should be able to recognize situations where patients' lack of ability to mentalize creates difficulties in the interaction. They should also be able to recognize their own difficulties with mentalizing and be sensitive to the communicative implications this may have. Introduction: Mentalizing capacities of clinicians help to build effective therapeutic relationships and lead to better patient outcomes. Few studies have focused on factors associated with clinicians' mentalizing capacities and the intervention strategies to improve them. Aim: Present a systematic review of empirical studies on factors associated with healthcare professionals' mentalizing capacities and the effectiveness of intervention programmes designed to improve these capacities. Method: Following PRISMA‐guidelines, a systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library and CINAHL. Results: Out of a systematic search with 1537 hits, 22 studies were included. Personal factors positively associated with mentalizing capacities of healthcare professionals are being female, greater work experience and having a more secure attachment style. Psychosocial factors are having personal experience with psychotherapy, burnout, and in the case of female students, being able to identify with the female psychotherapist role model during training. Evidence that training programmes improve mentalizing capacities is limited. Discussion: Mental health nurses are underrepresented in research on mentalizing capacities of healthcare professionals and training programs to improve these capacities are practically absent. Implications for Practice: For mental health nurses, training in basic mentalizing theory and skills will improve their capacities in building effective working relationships with patients. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Many studies have investigated the attitudes of mental health nurses towards a range of targets. These targets are person‐oriented (for example groups of people with a similar mental health diagnosis) or practice‐oriented (for example practices such as seclusion or restraint).It is thought that attitudes contribute to the practice of mental health nurses because research suggests attitudes have a role in shaping behaviour. What the paper adds to existing knowledge?: To date, research about mental health nurses' attitudes has examined different attitudes in isolation from one another. By demonstrating a lack of connectedness across studies this paper highlights the need for new theory‐informed approaches to attitudinal research.By standardizing measurements across different studies this review demonstrates that the most negatively appraised attitudinal targets—indicated by large proportions of respondents who appraise negatively—concern people with diagnoses of borderline personality disorder, substance misuse, and acute mental health presentations. What are the implications for practice?: Significant numbers of mental health nurses may have attitudes, especially towards people with borderline personality diagnoses and those who misuse substances, that may not be concordant with good practice.There is insufficient evidence about what the actual implications this has for practice because the body of relevant research lacks coherence, interconnectedness and a grounding in contemporary theoretical developments.Training programmes that focus on attitudinal change need to be more rigorously evaluated. Introduction: Attitudes are considered integral to mental health nursing practice. Aims: To comprehensively describe the (i) measured attitudes of UK mental health nurses towards people and practice; (ii) effectiveness of interventions to change attitudes; and (iii) relationships between their attitudes, other variables/constructs and practice. Methods: Using systematic review methodology, multiple databases (CINAHL, Scopus, PsycINFO, Web of Science Core Collection, Google Scholar) were searched. Eligible studies involved measurement of UK‐based mental health nurses' attitudes with multi‐item scales. Studies were quality appraised, mean (SD) attitudinal data were standardized, and other results converted to standardized effect sizes. Results: N = 42 studies were included. Negatively appraised attitudinal targets were people with a borderline personality disorder diagnosis, substance misuse, and acute mental health presentations. Educational interventions were associated with immediate increases in positive appraisals but sustainability was poorly evidenced. There was very limited study of attitude‐practice links. Discussion: This review identifies priority attitudinal targets for action but also demonstrates that future work must consider the interconnectedness of attitudes and their relationship with practice. Implications for Practice: Priority areas for consideration are attitudes to borderline personality disorder, substance misuse and mental health co‐morbidity. Addressing disparities between nurses' attitudes and those of service users is important. More robust research is required into the effectiveness of interventions to change attitudes and into attitude‐practice links. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Suicide prevention is an international healthcare priority.There is an urgent need to use approaches that are helpful and follow research evidence.Safety planning is now widely used in suicide prevention; however, it was developed for use with adults, and little is known about its effectiveness for children/young people. What the paper adds to existing knowledge?: This systematic scoping review brings together all research evidence since 2008 that reported how effective safety planning is for children/young people.Findings highlight that when healthcare professionals help children/young people who are suicidal, they need to ensure that the safety plan is completed collaboratively with healthcare professionals and children/young people and that it is appropriate for their age and development.There is also need for healthcare professionals to better recognize and respond to the needs of parents/carers who are caring for a child/young person with suicidal ideations/behaviours. What are the implications for practice?: There is some research indicating that safety planning is effective for use with children/young people, but such evidence has primarily been obtained from females and there is need for more evidence from male study populations. Further research on its use is needed for certain groups of children/young people including those who are care experienced, or identify as lesbian, gay, bisexual and transgender.This review highlighted that healthcare professionals need specific training before they deliver safety planning for children/young people.It was identified that parents/carers have additional needs and should be involved in safety planning. An additional resource specifically for parents/carers should be developed. Introduction: Suicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people. Aim: To synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations. Inclusion criteria: The review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc), any geographical location or social economic status and inclusivity around the method of delivery. Methods: A systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre‐registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA‐ScR checklist. Data analysis and presentation: Fifteen studies were reported during 2008–2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub‐groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement. Discussion and implications for practice: Further research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Mental health nursing staff may experience psychological stress and burnout. Exercise provision for mental health staff may improve staff physical and mental wellbeing and mitigate against psychological burnout.Existing research suggests the provision of exercise equipment for mental health nursing staff may improve staff attitudes towards physical activity and staff confidence in motivating physical activity amongst patient groups they care for, although more research is needed, and research investigating the attitudes of mental health staff towards such initiatives is warranted. What this paper adds to existing knowledge?: Access to fitness facilities in the workplace for mental health staff was endorsed.Logistical and practical concerns (i.e. shower access, time) were noted as barriers to implementation of fitness facilities in the workplace for staff use.Mental health staff expressed desire to have access to varied gym equipment at work What are the implications for practice?: The introduction of fitness facilities in the workplace environment for staff use was actively endorsed by mental health professionals, suggesting such initiatives may be warranted in mental health settings. However, barriers to successful implementation were noted and are worth considering in preparation for trialling provision of exercise equipment for staff use. Introduction: Exercise equipment for mental health staff may improve staff wellbeing, mitigate against stress and improve staff attitudes towards physical activity. This said, there is a lack of researching investigating the attitudes of mental health staff towards the provision of fitness facilities in the workplace. Aim: The study investigated staff attitudes towards being offered exercise bikes in the workplace. Method: Three focus groups and one individual interview were conducted with 12 healthcare professionals. Data were subject to a thematic analysis. Results: Three themes were identified. (1) 'This sounds like a good idea', which reflected positive views in the provision of exercise in the workplace for staff use. (2) 'I'm not sure it would work because ...', which reflected implementation concerns including not having access to shower facilities and time constraints. (3) 'Balancing choice', which reflected participant's desire to have access to varied gym equipment. Discussion: The introduction of fitness facilities in the workplace for staff use was endorsed. However, implementation barriers were noted. Implications for Practice: This research provides justification for the exploration of the feasibility and benefits of providing exercise equipment for mental health staff in the workplace but presents implementation barriers that are worth considering before trialling provision of exercise equipment. [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: Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under‐prepared.The single frontline service approach is time‐intensive and risks a coercive pathway to care.The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal. What the paper adds to existing knowledge: Police and ambulance staff struggled keeping up with the mental health demand, reporting inadequate mental health training, little enjoyment and negative experiences when trying to access help from other services.Most mental health staff had adequate mental health training and enjoyed their work, but many experienced difficulties getting help from other services.Police and ambulance staff found it hard to work with mental health services. What are the implications for practice: The combination of limited training, poor interagency referral processes, and difficulties accessing support from mental health services means that when police and ambulance services attend mental health crises alone, distress may be heightened and prolonged. Enhanced mental health training for first responders and more streamlined referral processes may improve process and outcomes.Mental health nurses have key skills that could be utilized in assisting police and ambulance staff who attend 911 emergency mental health calls.New models such as co‐response teams, whereby police, mental health clinicians and ambulance staff respond conjointly should be trialled and evaluated. Introduction: First responders are increasingly called to assist people experiencing mental health crises but little research exists canvassing multi‐agency perspectives of such work. Aim/Question: To understand the views of police officers, ambulance and mental health staff attending mental health or suicide‐related crises in Aotearoa New Zealand and to discover how they experience current models of cross‐agency collaboration. Methods: A descriptive cross‐sectional survey involving mixed methods. Quantitative data were analysed using descriptive statistics and free text by content analysis. Results: Participants included 57 police officers, 29 paramedics and 33 mental health professionals. Mental health staff felt adequately trained, but only 36% described good processes for accessing inter‐agency support. Police and ambulance staff felt undertrained and unprepared. Accessing mental health expertise was considered difficult by 89% of police and 62% of ambulance staff. Discussion: Frontline services struggle managing mental health‐related 911 emergencies. Current models are not working well. Miscommunication, dissatisfaction and distrust exist between police, ambulance and mental health services. Conclusion: The single‐agency frontline response may be detrimental to service users in crisis and under‐utilizes the skills of mental health staff. New ways of inter‐agency cooperation are required, such as co‐located police, ambulance and mental health nurses responding in partnership. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Individuals experiencing mental illness make up a significant portion of the world's population.Individuals with mental illness experience higher rates of morbidity and die on average at least a decade earlier than individuals without mental health disorders. What this paper adds to existing knowledge?: Issues of stigma, diagnostic overshadowing, premature closure, inadequate workup, fear and lack of training negatively impact the care of individuals with mental illness.Issues impacting the care of individuals experiencing mental illness cross geographic and care setting boundaries. What are the implications for practice?: Partnerships between physical and mental health practitioners are needed to thoroughly assess and accurately diagnose symptoms experienced by individuals with mental illness.Educational interventions can help prepare practitioners to care for individuals with mental illness.Nurses can better advocate for effective patient care by learning about the phenomenon of diagnostic overshadowing and calling attention to its occurrence. Introduction: Individuals with mental illness experience significantly higher overall rates of morbidity and mortality than counterparts without mental illness. Misdiagnosis of symptoms emanating from physical illnesses as psychiatric in nature presents one important cause. Aim: This integrative review explores research on healthcare professionals' misattribution of physical health symptoms to patients' comorbid psychiatric issues and seeks to identify unifying themes, shared causes, and possible strategies for addressing the issue. Method: This review uses Whittemore and Knafl's 2005 integrative review methodology coupled with vetted quality appraisal tools. Results: Following a systematic search of allied health, medical, psychological, sociological and general literature, 24 publications employing qualitative, quantitative, mixed and synthesis research methodologies were selected. Each study was appraised according to design, and relevant data were extracted. Discussion: Themes of stigmatization, diagnostic overshadowing, incomplete medical examination, insufficient training, and fears experienced by providers and patients emerged. Implications for Practice: Increased partnering between physical and mental health practitioners, continuing education, and improving patient–provider communication are key to providing equitable care. Nurses play primary roles in empathizing with patients, advocating for appropriate care and educating others on the dangers of misattributing physical symptoms to psychiatric cause. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Anti‐, peri‐ and post‐natal depression negatively affect the relationship between mothers and their children.At least half of cases of anti‐, peri‐ and post‐natal depression were missed and underdiagnosed by healthcare professionals (HCPs) including doctors, nurses and midwives.Previous qualitative studies considered women's experiences relating to anti‐, peri‐ and post‐natal depression separately from studies looking at the views of HCPs.There is a lack of research in Middle Eastern countries, despite the high prevalence of anti‐, peri‐ and post‐natal depression. What does this paper add to existing knowledge?: This is the first qualitative study investigating the experiences of both HCPs and service users regarding anti‐, peri‐ and post‐natal depression from the Middle East perspective, particularly in Oman.This study revealed that anti‐, peri‐ and post‐natal depression has been neglected in primary healthcare systems in Oman.The study explored many barriers and facilitators which have been identified by both HCPs and patients in identifying and managing anti‐, peri‐ and post‐natal depression in the primary healthcare system. What are the implications for practice?: Nurses, midwives and doctors should develop an empathic screening procedure that allows for the discussion of mental health concerns and help‐seeking behaviours with their patients.Training nurses and midwives in motivational interviewing, routinely screening mothers with any depressive symptoms, as well as providing public education programmes to increase mental health awareness, resources and access to a variety of mental healthcare alternatives, could be successful in recognizing and managing anti‐, peri‐ and post‐natal depression. Introduction: Anti‐, peri‐ and post‐natal depression is known to affect the relationship between infants and their mothers adversely. Previous studies have identified barriers and facilitators, reported by women and HCPs, related to the identification and management of anti‐, peri‐ and post‐natal depression. However, these studies considered the experiences of women separately from those of the healthcare professionals, even though their experiences of anti‐, peri‐ and post‐natal depression are interconnected. Additionally, there is a lack of research among people living in the Middle East, including Oman, which has one of the highest rates of anti‐, peri‐ and post‐natal depression globally. Aim: This study aimed to explore the views and experiences of HCPs and service users relating to anti‐, peri‐ and post‐natal depression from the Middle East perspective. Method: A qualitative descriptive study using semi‐structured interviews was conducted. This study took place at the Family Medicine and Community Clinic at the University Hospital and three selected primary healthcare centres in Muscat, between May 2020 and February 2021. Purposive sampling was used: 15 HCPs with 2–20 years of clinical experience in anti‐, peri‐ and post‐natal primary care and 13 pregnant patients plus 2 post‐birth patients were interviewed. Audio‐recordings were transcribed verbatim, and the anonymized transcripts were then entered into the qualitative data management software, NVIVO 12. Results: A thematic approach was used to analyse the data. Four themes were identified in the data, namely: (1) making sense of anti‐, peri‐ and post‐natal depression; (2) how to deal with anti‐, peri‐ and post‐natal depression; (3) barriers to addressing anti‐, peri‐ and post‐natal depression in primary anti‐, peri‐ and post‐natal care settings and (4) bridging the gap: facilitators in detecting and managing anti‐, peri‐ and post‐natal depression. Conclusions: Improving the identification and management of anti‐, peri‐ and post‐natal depression in primary healthcare systems will require a whole‐system approach with interventions at the patient, practice and comprehensive primary care team levels. Implications for Practice: The findings suggest implications for improving the identification and management of anti‐, peri‐ and post‐natal depression including an increased emphasis on mental health by enhancing the routine screening of mothers during the anti‐, peri‐ and post‐natal period, clearer referral systems, improving resources, providing training with regard to mental health and improving communication skills. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The impacts of racism on health are well documented and are greater for mental than for general health.Mental health professionals are well positioned to help dismantle racism and structural barriers compromising optimal patient care. What the paper adds to existing knowledge: We describe a systematic and orderly way to identify factors that contribute to entrenching racism as the status quo or that help to uproot it.By incorporating a racial equity lens, we can better understand daily racism and inform the optimal antiracist actions most relevant to an inpatient psychiatric setting. What are the implications for practice?: Our two‐domain/six‐theme model may serve as a rubric for individuals to engage in structured self‐reflection, for organizations in auditing or programmatic evaluation, or as scaffolding for difficult but frequently elided conversations.The unique strengths of a mental health environment can be harnessed toward the elimination of racism and racist practices in clinical care and in the workplace Introduction: It is well documented that racism plays a role in health care access and outcomes. However, discussions about racism in the inpatient psychiatric workplace are generally avoided. To address this gap, we incorporated a racial equity perspective into a qualitative study to better understand daily racism, its impact on patients and staff, and to inform optimal antiracist actions most relevant to inpatient psychiatric settings. Aim/Question: We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. Methods: We conducted semistructured interviews using a purposive sample of 22 individuals in an acute child psychiatric inpatient service. We analysed transcripts using thematic analysis guided by a constructivist grounded theory conceptual framework. Results: We identified two countervailing processes: (1) Entrenching—factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating and (2) Uprooting—factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements into a '6P' model along a temporal sequence around sentinel racist events. For each of the six components we describe: Contributing Factors, Emotional Reactions, and Behavioural Responses as reported by participants. Implications for Practice: Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. The two‐domain/six‐theme model we developed can serve as a rubric for individuals or milieu‐based inpatient settings serving patients of any age to engage in structured self‐reflection, auditing, program evaluation, or as scaffolding for difficult but frequently elided conversations. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal.●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. What the paper adds to existing knowledge: ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking.●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. What are the implications for practice: ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues.●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. Introduction: Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim: To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods: Qualitative exploratory research methods were employed. In‐depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results: Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions: These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice: Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: People diagnosed with a personality disorder might be more likely to have physical health problems and be admitted to the hospital. Treatment in hospitals might be complicated by mental health crises or self‐injury, and barriers to NHS care may increase the risk of developing further illness with serious consequences.Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Thirteen clinicians working in mental health liaison in the general hospital were interviewed as part of a sequence of research studies. What this paper adds to existing knowledge: This study identified unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in general hospitals. People with a "personality disorder" diagnosis were discriminated against and over‐ and under‐medicated.Mental health liaison clinicians reported limited understanding and skills among general hospital clinicians. People working in general hospitals were fearful of the "personality disorder" diagnosis. Poor care was accepted because general hospital clinicians did not consider themselves to be "mental health trained." What are the implications for practice?: Clinicians working in mental health liaison need credible knowledge of mental and physical health and medicines.Capability, influence, and high‐level interpersonal skills are needed to successfully work across mental health services and the general hospital.More advanced and consultant‐level nursing roles in more mental health liaison teams are needed to strengthen this specialist workforce. Introduction: Literature on "personality disorder" and the general hospital has to date primarily focused on emergency departments. Research on how general hospital inpatient wards respond to people diagnosed with a "personality disorder" has been long overdue. Aim: Qualitative telephone interviews were undertaken to explore the views and perspectives of clinicians working in mental health liaison in this final strand of a mixed methods explanatory sequential study. Method: Participants were recruited via social media and professional networks by snowball sampling. Data were analysed using a framework approach. Results: Four themes were identified: knowledge, understanding, skills, and discriminatory practice; alliances, diplomacy, care, and treatment of people diagnosed with a "personality disorder"; achieving parity of esteem in a disparate healthcare system; and organizational stress, mismatched expectations, and service led decision‐making. Discussion: There were unjust and avoidable differences in the care and treatment received by people diagnosed with a "personality disorder" in the general hospital. People were discriminated against and routinely over‐ and under‐medicated. Implications for practice: Clinicians working in mental health liaison need capacity for partnership working, clinical capability spanning mental and physical health, credibility and influence and high‐level interpersonal skills to address the entrenched discrimination of people diagnosed with a "personality disorder." [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Intellectual disability (ID) involves problems with general mental abilities and affects intellectual functioning and adaptive functioning.People diagnosed with ID present higher levels of functional disability, which means they usually have difficulty or the inability to independently perform basic activities of daily living.Little to no attention has been paid to the issues of the mental health of people diagnosed with ID. Specifically, healthcare workers' experiences of caring for patients with IDPD have been neglected. What does the paper add to existing knowledge?: The findings increase our understanding and partially address the knowledge gap regarding the situations and circumstances faced by healthcare workers in caring for patients diagnosed with intellectual disability co‐occurrent with psychiatric disorders (IDPD).In cases of insufficient staffing, healthcare workers may be forced to ignore the individualized needs of patients so as to facilitate management.Healthcare workers may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. They adapt by adjusting their expectations of their patients. What are the implications for practice?: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them.The government department responsible for the management of ID patient care institutions should be able to regularly monitor the overall staffing and quality of care in these institutions. Introduction: When intellectual disability co‐occurs diagnosed with psychiatric disorders (IDPD), the impact of the burden of illness on the affected individuals, their caregivers, their family and friends, and the services that provide for them is particularly high. The issues of the mental health of people diagnosed with ID have received little, if any, attention. One specific area of neglect is healthcare workers' experiences of caring for patients diagnosed with IDPD. Aim: The aim of this study was to understand healthcare workers' experiences of caring for patients diagnosed with IDPD. Methods: A qualitative descriptive research approach and semi‐structured interviews were used in this study. We interviewed 15 participants who had experience in caring for patients diagnosed with a dual diagnosis of IDPD. Findings: Four themes were found, as follows: (1) Negative impacts of insufficient staffing on the quality of care, (2) Constantly worrying about harmful incidents, (3) Discovering effective ways to provide individual patient care and (4) Adjusting expectations and attitudes towards patients. Participants' experiences revealed that they perceived the importance and effectiveness of providing individualized care for IDPD patients. However, when staffing is insufficient, they may be forced to ignore the individualized needs of patients so as to facilitate management. They may also feel frustrated by not being able to anticipate or deal with patients' unexpected problem behaviours or accidents. In addition, they adapt by adjusting their expectations of the patients. Discussion: The findings from this research help to fill the knowledge gap in our understanding of healthcare workers' experiences of and their perspectives on caring for patients diagnosed with IDPD. Implications for Practice: Healthcare administrators need to understand the difficulties faced by staff in caring for patients diagnosed with IDPD, arrange appropriate in‐service education to increase the healthcare workers' knowledge and skills in caring for patients diagnosed with IDPD, and create warm and supportive environments for them. The government department overseeing the management of institutions providing ID patient care should be empowered to conduct regular monitoring of the overall staffing and quality of care in such institutions. [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?: Smoking is more common among people with serious mental illness, and it contributes to a reduced life expectancy.Several Western countries have successfully introduced smoke‐free policies in inpatient mental health units.There is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. What the paper adds to existing knowledge?: We surveyed mental health professionals working in Qatar's main mental health service to determine support for and attitudes towards a proposed total smoking ban in psychiatric wards.Most staff who completed the survey supported an inpatient smoking ban. However, further analysis, both quantitative and qualitative, showed markedly ambivalent attitudes, that is staff simultaneously held attitudes that supported and opposed a smoking ban.Professionals who did not support a ban were more likely to have not received smoking cessation training in the last 5 years, to be a psychiatrist rather than a nurse or allied mental health professional, to be current smokers and to be a Middle Eastern and North African national. What are the implications for practice?: Further staff training is necessary to achieve more consistent attitudes that support a total smoking ban and increase the likelihood of successful implementation.The attitudes in this study showed similarities and differences to those reported for mental health professionals in Western countries. This highlights that local research is necessary to help shape training and successfully implement smoke‐free policies. Introduction: Despite the fact that patients with serious mental illness (SMI) have high rates of smoking and an increased standardized mortality, there is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. Aim: To assess support for, and attitudes towards, a proposed total smoking ban in psychiatric wards among mental health clinicians in Qatar. Method: Cross‐sectional survey of mental health professionals working in Qatar's primary mental health service. Results: The response rate was 68% (353/520). Support for a ban was assessed with a single‐item question; 73% of respondents supported a ban with opposition significantly (p <.05) associated with being a current smoker, a Middle Eastern and North African (MENA) national, a psychiatrist versus a mental health nurse or allied health professional and not receiving smoking cessation training in the last 5 years. A 21‐item questionnaire assessed attitudes to a total smoking ban. It showed marked ambivalence with multiple linear regression identifying MENA nationality, male gender and current smoking status as independent variables influencing attitudes. The most strongly held attitude supporting a ban was concern about passive smoking and against a ban was concern it may increase patient agitation. Qualitative data confirmed ambivalent views. Discussion: The results show similarities and differences to research from other countries suggesting that cultural factors influence some attitudes to smoke‐free policies. Implications for Practice: Staff support and smoking cessation education are necessary to achieve more consistent staff attitudes to support smoke‐free policies. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject: As‐needed medication is commonly used for psychiatric inpatients' acute psychiatric and physical symptoms. Both patients and staff can initiate such medication.Earlier studies have focused on what and how as‐needed medication has been used for psychiatric reasons. Little is known about how patients participate in planning, administration and evaluation of as‐needed medication and its alternatives. Nursing documentation provides an insight into these practices. What this paper adds to existing knowledge: Long‐term inpatients have an active role in initiating as‐needed medication. However, patients and staff may have divergent opinions on the need for medication.Alternatives to medication are mostly proposed by staff, and the feedback on as‐needed medication events is usually provided from nurses' point of view. What are the implications for practice: Patients' views on decision‐making and evaluation should be noticed and documented more.Patient participation can be promoted by planning as‐needed medication and its alternatives beforehand. Introduction: Pro re nata (PRN) medication is unscheduled and used for acute physical and psychiatric symptoms. Previous studies have focused on the what and how of psychotropic PRN administration. Initiators of PRN events and occasions in which PRN was denied have rarely been studied. Thus, knowledge of patient participation in PRN is fragmented. Aim: We aimed to describe and explain long‐term psychiatric inpatients' participation in relation to planning and initiation of, as well as decisions and feedback on their PRN medication treatment. Methods: We retrieved data from patients' (n = 67) nursing documentation in a Finnish forensic psychiatric hospital in 2018. Data were analysed using statistical methods. Results: All patients were prescribed PRN, and they initiated half of the 8,626 PRN events identified, in a 1‐year period. Non‐pharmacological strategies were rarely (6%) documented, and most of them were initiated by staff (76%). Feedback on PRN was usually from a nurse's viewpoint (71%). Nurses' feedback was positive (80%) more often than patients' (50%). Discussion: Patient participation needs to be recognized throughout the PRN process. Future research could continue to explore patient participation in planning and evaluating their PRN medication. Implications for practice: Patients participate in PRN by requesting medication. Their participation can be developed by supporting patients to communicate their choice of non‐pharmacological methods, take the initiative for medication when needed and disclose their viewpoint on the effects of PRN. [ABSTRACT FROM AUTHOR]

Introduction: Globally, healthcare regulatory bodies require providers of academic programs to involve service users in the design and delivery of education, yet concrete and tested directions for operationalising this are lacking. Service users' involvement in education is often passive, ad‐hoc and tokenistic, with limited input at the program development level. Aim: To explore the co‐design processes and outcomes of a collaborative revision of an Australian post‐registration mental health nursing curriculum. Method: Using qualitative case study design, the experiences and collaborative practices of five stakeholders (one mental health service user, two carers and two academics) co‐designing a post‐registration mental health nursing curriculum were explored. Results: Commonly identified barriers to meaningful involvement were overcome through planning and collaborative execution of the group's work. Participants reported a strong sense of successful collaboration in reviewing the curriculum, trusting relationships and mutual respect. Discussion: While it was possible to support and augment stakeholder knowledge in the context of post‐registration education, co‐design processes were ultimately bound by the university's relatively inflexible bureaucratic context. Implications for Practice: To ensure effective stakeholder collaboration beyond classroom teaching, mental health nurse academics must prepare service users for the role, explaining the language and practices of the tertiary health education and nursing context. As part of co‐design processes, organisational mandates must be explored and negotiated, and mutual clarity regarding expectations and roles must be established. A Design Thinking approach can support meaningful engagement of stakeholders in curriculum development. [ABSTRACT FROM AUTHOR]

Introduction: Humanised care refers to the holistic approach to the person, considering their bio‐psycho‐social and behavioural dimensions. It becomes more complex when the person has mental health problems that may affect his or her will, cognition and relationship to the world. The literature on the humanisation of mental health is scarce and only offers the view of professionals. Aim: To analyse the concept, values and strategic initiatives of humanised care in acute psychiatric units from the perspective of persons with mental health problems, carers and professionals. Method: Qualitative grounded‐theory approach. Data were collected through focus groups and in‐depth interviews among persons with mental health problems, carers and professionals. Results: Thirteen focus groups and three in‐depth staff interviews were performed, with a total of 61 participants. Humanised care is defined as quality care of an individualised, ethical and safe nature, empowering persons/carers to involve them in their health process, helping them resist the stigma of mental illness through a therapeutic relationship, bond and communication. Formal training, teamwork and effective communication are required. Six values and strategic initiatives were identified. Discussion: Each value and strategic initiatives acquires full meaning when connected with the rest. Without this interconnection, humanised care would be impossible. [ABSTRACT FROM AUTHOR]

Background: Medication self‐management (MSM) is considered an important aspect of pharmacotherapy and plays an essential role in the treatment of various illnesses. To date, research into the willingness and attitude of psychiatric healthcare providers toward MSM in patients diagnosed with schizophrenia or bipolar disorders during hospitalization is lacking. Aim: The aim of this study was to identify healthcare providers' willingness to MSM and assess their attitude, conditions, benefits, and ability toward it during hospitalization. Methods: A multicenter, quantitative cross‐sectional observational design was used to study psychiatric healthcare providers' attitude to MSM during hospitalization in patients diagnosed with schizophrenia or bipolar disorders. Results: In this study, 173 healthcare providers, of which 147 were nurses and 26 psychiatrists, participated. During hospitalization, 86% of the healthcare providers were willing to MSM. Regularly evaluating patients' ability regarding MSM during hospitalization was seen as an important condition (94%). Psychiatrists were significantly less convinced that MSM during hospitalization has a positive impact on adherence when compared to nurses (respectively 54% vs. 77%, p =.009). Discussion: Most healthcare providers indicated that they were willing to MSM in patients diagnosed with schizophrenia or bipolar disorders during hospitalization under specific conditions. [ABSTRACT FROM AUTHOR]