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Why you should read this article: • To understand the complexity of the needs of people with delirium superimposed on dementia • To enhance your knowledge of second-generation activity theory • To recognise the consequences of the separation of physical health and mental healthcare. Background: Delirium superimposed on dementia (DSD) affects the physical, mental and cognitive well-being of the person. The separation of physical health and mental health means that the care of people with DSD is at odds with the multifaceted aetiology and presentation of the condition. There is a lack of research on DSD from a mental health perspective. Aim: To explore UK mental health nurses’ experiences of providing care for people with DSD. Method: Individual semi-structured interviews were conducted with seven mental health nurses from one NHS trust in England. Participants’ experiences were considered through the lens of second-generation activity theory. Data were analysed using framework analysis. Findings: Six themes were identified: awareness of guidance and tools; guidance or tools as ‘paper exercises’; knowing the patient; the multidisciplinary team; care burden; and mental health versus physical health. Conclusion: When providing care for people with DSD, mental health nurses use their skills in knowing patients as individuals. However, this aspect of ‘knowing’ cannot be readily translated into the use of a numerical scoring tool. An integrated approach is required to support the care of people with DSD. [ABSTRACT FROM AUTHOR]

This literature review aims to discover the factors that influence staff working on psychiatric intensive care units (PICUs) to implement seclusion. Identifying these factors may help to reduce the use of seclusion and improve client care. A comprehensive search of available publications was undertaken, with relevant articles analysed and discussed. The main factors identified were staff and service-user characteristics, with an increase in shift workload, aggression on both sides and client-to-staff ratio contributing to an increased use of seclusion. Environmental factors also played an important part, with smaller unit size leading to lower rates of seclusion. A re-evaluation of the design and layout of PICUs may enable a decrease in the use of seclusion. In addition, increasing the number of staff working on a unit might improve issues such as organisation, staff confidence and the ability to adopt alternative de-escalation techniques. This review shows that further study is needed in this area, particularly on the different health professional roles in a PICU. [ABSTRACT FROM AUTHOR]

The research available on the use of positive risk-taking in clinical practice is surprisingly limited. The purpose of this article is to highlight the limitations and make recommendations about how risk-taking could shape future practice in mental health services. A search of databases including CINAHL and PsycINFO for papers that included the keywords recovery, risk management, positive risk-taking and risk management found that mental health practitioners were keen to promote positive risk-taking with patients to enable their recovery. Barriers to this included a culture of blame should a negative outcome arise, and the need for more support and guidance from management. As positive risk-taking has been shown to be an important part of successful recovery, there is a need for more research to support its application in clinical practice. [ABSTRACT FROM AUTHOR]

Mental health providers are increasingly turning to body-worn cameras to tackle violence and aggression towards staff. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the psychological benefits of massage therapy • To read about barriers and facilitators to introducing seated chair massage in forensic mental health settings • To consider the value of introducing seated chair massage in your own clinical setting Massage therapy has recognised psychological benefits, yet it is rarely used in forensic mental health settings. In 2022, ten-minute sessions of seated chair massage – where recipients remain fully clothed – were offered to patients and staff at a secure forensic mental health and learning disability service in the UK. This article is a service evaluation of the impact of providing these sessions. Seated chair massage was found to have overwhelmingly positive effects in the short term and the authors concluded that it is a low-risk, boundaried and appropriate complementary therapy intervention for patients in forensic mental health settings. Their findings challenge the view that these settings are essentially 'no touch' environments. The article outlines barriers and facilitators to introducing seated chair massage in a forensic mental health service, which may be useful to other teams considering developing a similar service. [ABSTRACT FROM AUTHOR]

Delirium is a common condition experienced by people in hospitals and long-term care settings. Opportunities to prevent and treat it are often not taken, however, according to the National Institute for Health and Care Excellence (NICE). It has updated its guidance and is urging the NHS and providers of long-term care to do more to meet people's needs. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the differences between psychiatric intensive care, low secure and locked rehabilitation units • To understand how service provision in psychiatric intensive care, low secure and locked rehabilitation units has changed since 2006 • To gather information on the types of interventions offered by the different psychiatric intensive care facilities Psychiatric intensive care can take place in a variety of settings, including psychiatric intensive care units (PICUs), low secure units (LSUs) and locked rehabilitation units (LRUs). These units have a range of referral, admission and discharge care pathways, staffing profiles and core interventions. The aim of this service evaluation was to compare present provision in PICUs and LSUs with results from the first national survey of PICUs and LSUs in 2006. The service evaluation also aimed to define the role of LRUs. The authors used a cross-sectional, 'census day' questionnaire with six-month follow-up design. Overall, 111 NHS units participated in the evaluation. Results included that PICUs were smaller and usually had a mixed-sex distribution of service users; LSUs mostly comprised single-sex facilities; and LRUs mostly comprised single-sex units with a significantly longer mean length of stay than the other types of unit. PICUs primarily cared for service users exhibiting acute behavioural disturbance, first-episode psychosis or psychotic crisis and, compared with the other types of unit, more often used high-dose medication and electroconvulsive therapy. [ABSTRACT FROM AUTHOR]

The Mental Health Act white paper for England and Wales, informed by the Independent Review of the Mental Health Act 1983, is out for consultation. [ABSTRACT FROM AUTHOR]

This section offers health-related news briefs in Great Britain as of May 2015 including the appointment of Steven Michael as chair of the NHS Confederation Mental Health Network, the launch of a paper on the use of personal budgets in mental health care and the under reporting of suicides.

This section offers news briefs on mental health services in Great Britain as of September 2013, including the publication of guidance to help professionals recognise signs of domestic abuse in patients, a briefing paper that calls on commissioners to improve services for people with mental health and drug or alcohol problems, and a self-help guide produced by Public Health Wales for people affected by suicide or an unexplained death.

Background Restrictive interventions (RIs) are defined as the use of deliberate acts that restrict a person's movement, liberty or freedom to act independently. RIs such as seclusion and physical intervention are practices commonly used to manage violence and aggression. Aims To investigate the frequency and rationale for use of RIs at an NHS inpatient service. Methods A service evaluation was carried out for six inpatient wards that offer adult and later-life services. Data were collected from patient incident and adverse events reports and from electronic patient records. Results There were 424 incidents of physical intervention and 184 incidents of seclusion reported. The use of physical intervention was more frequent between 10am and 12pm, when personal care was carried out. Physical and non-physical assaults were most commonly reported as the reasons for use of RIs. Conclusion Analysing the frequency and the rationale for the use of RIs has enabled changes to be made to practice and how staff are trained. It is hoped that other services will reflect on their use of RIs to improve practice. [ABSTRACT FROM AUTHOR]

Three decades of encouraging and supporting mental health nurses worldwide to improve wards has seen a pioneering nurse win a prestigious award. [ABSTRACT FROM AUTHOR]

Many cognitive behaviour therapy (CBT) trained mental health professionals seek non-mandatory accreditation with the British Association for Behavioural and Cognitive Psychotherapies (BABCP), despite self-regulation of talking therapies being a divisive issue. This raises the question: what views do CBT-trained mental health professionals have towards BABCP accreditation and what motivates them to become accredited? This qualitative study recruited seven postgraduate CBT-trained mental health professionals from NHS Greater Glasgow and Clyde during 2015. Individual semi-structured interviews were completed and verbatim transcripts produced. Thematic analysis revealed the value participants place on accreditation, and that an absence of motivating factors and barriers during the application process means that not all CBT therapists become accredited. [ABSTRACT FROM AUTHOR]

Background Core values represent a framework of guiding principles that can improve team cohesion and efficiency in an organisation. Aim To determine how well a medium secure hospital in South Wales is adhering to its identified core values from the perspectives of staff and patients. Method Focus groups were used to uncover areas of good practice in line with the organisation's core values and possible areas for improvement. Findings The core values are regularly demonstrated in the organisation with the perceived benefits of enhanced clinical care and strong cohesion among the staff. Conclusion Strategies to improve value driven performance include increased staff, collaborative risk assessment and management, and equal training opportunities for staff of all grades, qualified and unqualified. It is hoped that this project may encourage other services to think proactively about their potential core values. [ABSTRACT FROM AUTHOR]

A healthy and valued workforce is vital for safe and compassionate mental healthcare. That was my take-home from the recent senior leadership symposium on advancing and sustaining the mental health nursing workforce. [ABSTRACT FROM AUTHOR]

The Institute of Mental Health has been delivering accredited peer support training since 2009. The training is based on the values of recovery that each trainer, with lived or professional experience, strives to model in everything they deliver. Since 2009, the team has refined its approach by debating with and learning from as many people involved in peer support as possible. The growing demand for training in all areas of recovery has led the team to offer other courses, as well as consultancy and bespoke support for organisations hoping to employ peer support workers. This article describes the training team's values, achievements and reflections accumulated over five years of learning. [ABSTRACT FROM AUTHOR]

The article reports on an approach introduced by Barnet, Enfield and Haringey Mental Health National Health Service Trust in London, England known as the enablement programme to improve outcomes for people needing to improve their mental well-being.

The very nature of working in conflict zones makes former soldiers vulnerable to symptoms of post-traumatic stress disorder (PTSD). The culture of the military can also mean that personnel do not seek help and can endure symptoms for years. The two main treatments recommended for veterans diagnosed with PTSD--group therapy and exposure to trauma--have been shown to reduce PTSD symptoms. Even though these are recommended, veterans are not receiving evidence-based treatments due to the lack of training and reduced numbers of healthcare staff. There are high dropout rates from treatment because of the stigma of mental illness and because veterans feel that healthcare professionals do not understand them. Also, in some cases, veterans cannot be treated if they are experiencing a comorbid mental health problem or addiction. It is recommended that more research is carried out with veterans who are diagnosed with PTSD. The combination of treatments and treatment specific to the era in which the veteran served might further improve recovery from symptoms. It may also be beneficial to develop an intense educational programme for health professionals about the military and their needs. [ABSTRACT FROM AUTHOR]

This section offers news briefs on mental health practice in Great Britain. An evaluation of youth justice liaison and diversion pilot scheme has been published by the Department of Health. The Mental Health Foundation called for the revision of the Mental Capacity Act to enable health and social care staff to make decisions. A contact, help, advice and information network (CHAIN) by the National Health Service (NHS) provides online mutual support for health and social care workers.

The article explores the effectiveness of the adopted practice of zero tolerance by the British National Health Service (NHS) as a strategy to tackle violence against healthcare workers in London, England. It evaluates and determines the critical failures in the implementation of zero tolerance. It also probes on the apparent reasons behind the adoption of the NHS in England.

This article reviews a personalised care package scheme, in which mental health service users in Skegness are allocated previously agreed amounts of money depending on their personal circumstances and needs. The scheme is judged to be successful but is limited by the amount of time it takes and by the involvement of a distant budget holder. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented about the National Health Service (NHS) Mental Health Implementation Plan 2019/20-2023/24, with topics mentioned such as NHS England, Royal College of Nursing (RCN), and RCN mental health forum chairperson Ed Freshwater.

The author assesses the prevalence of job stress in mental health nurses and other healthcare staff of the British National Health Service (NHS). He discusses the importance of building staff resilience as an activity for dealing with stressors in the clinical environment. He also explains the need to review the workload of community mental health nurses.

The NHS in England and Wales is facing a tough winter, no matter what the weather will be. But the situation is going to be especially challenging this year because there are 7,600 nursing and midwifery vacancies in mental health services, which equates to one in ten posts being unfilled. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including mental health care in Great Britain, suicide prevention conferences, and smoking cessation.

The article examines the responses of service user groups and professionals to the spending plans of British Chancellor George Osborne in December 2010. The Department of Health mentions that the money that would be saved by the efficiency measures proposed by Osborne will be reinvested to meet the increasing demand for health care services. The measures include the need for enhancing the productivity of the workforce as well as the application of best practice throughout the National Health Service.

The author commends Jim Mackey, chief executive of the British National Health Service (NHS) Improvement, for revealing the state of finances and the workforce in NHS mental health services. He praises Mackey for being honest and for announcing to an audience of senior staff that funding was short and that there are challenges to workforce planning. He also acknowledges the tough job that people in top posts in government agencies have to do.

An introduction is presented in which the editor discusses an article within the issue concerning the shortage of hospital beds at mental health service institutions in Great Britain.

The article reports on a petition by mental health nursing student Beth Byrom in 2015 to call for British politicians' commitment to protect the National Health Service (NHS).

The article reports on the call for experts on mental health to help the British National Institute for Health and Care Excellence (NICE) in producing a guidance on safe nurse staffing levels in 2015.

The article discusses a report published by the leading economists to demonstrate the need to make cognitive behaviour therapy (CBT) commonly available for reducing mental illness in Great Britain. Lord Laynard, an economist states that NHS can reduce its spending on physical healthcare for providing psychological therapy. The extension and implementation of Improving Access to Psychological Therapies (IAPT) has been recommended for enhancing mental health of the country.

The article announces that Care UK, an independent care provider in Great Britain, has received a contract worth 53.2 million pounds for primary healthcare services in eight prisons in the north east of England.