Search

Adopting a children's rights perspective, a critique and analysis underpinned by documentary research methodology was undertaken in order to assess the extent to which the government's Green Paper (Department of Health and Social Care and Department of Education, 2017. Transforming children and young people's mental health provision: a green paper. Available at: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (accessed 7 December 2017)) addresses the mental health and well-being needs of refugee children and young people in England and Wales, identifying strengths, limitations and challenges for future policy and practice. Findings suggest that there is much of potential benefit to refugee children and young people's future mental health and well-being. However, a paradigm shift, explicit in implications, scale and time frame, will be required, if the Green Paper is to achieve those changes in attitudes, practice and service delivery which it anticipates. We argue that this Green Paper's overarching challenge is that it is premised on Western-centric models in its understanding of the experiences of refugee children and young people, and management of trauma and mental health. It fails to recognize the meanings and significance of culture, and of diversity and difference, and the need to invest in all communities in facilitating engagement and support for children and young people's mental health issues.

Background: The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm., Aim: To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services., Design: Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services., Setting: Global (systematic reviews); England and Wales (service map; case study)., Data Sources: Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites., Methods: A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'., Results: A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems., Limitations: Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn., Conclusions: There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research., Future Work: Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility., Study Registration: This study is registered as PROSPERO CRD42018106219., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research ; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

Purpose: For over 15 years, Mental Health First Aid™ (MHFA) has successfully been delivered in Wales, United Kingdom, with growing interest in the MHFA programme and increasing course attendees. Trainers, aware of the need for support, know the importance of MHFA being accessible for different communities and learner groups. MHFA has always focused on increasing mental health literacy. One marginalised group, with lower mental health literacy than the general population, is Deaf people, a group with increased risk of mental health problems. This paper aims to provide insights about why Deaf people are twice as likely as hearing people to experience mental health problems. Design/methodology/approach: During this paper, the authors have used four focal points i) exploring situational contexts for Deaf people; ii) reasons why Deaf individuals are at greater risk of mental health problems; iii) the authors explore a project, "Hear Deaf", and implementation of MHFA Wales by Deaf MHFA trainers; and iv) initiatives to influence and impact on policymakers. Findings: During the project, nine MHFA courses were delivered to Deaf communities across different locations in Wales, often with information and advertisements circulated directly to Deaf communities through Deaf clubs, resulting in 120 Deaf people trained. The authors conclude with their own reflections as a researcher and an MHFA who work predominantly with Deaf communities. Originality/value: This paper provides a discussion on the specific risks for Deaf people around mental health and the importance of mental health promotion programmes for Deaf communities. Further research is needed regarding the impact of MHFA on Deaf populations. [ABSTRACT FROM AUTHOR]

Background: Little is known about the effectiveness of, and implementation complexities associated with, service delivery models for children and young people (CYP) experiencing 'common' mental health problems such as anxiety, depression, behavioural difficulties and self-harm. This paper outlines how a model for high-quality service design for this population group was developed by identifying available services, their effectiveness, cost-effectiveness and acceptability, and the barriers and enablers to access. Methods: Sequential, mixed-methods design, combining evidence syntheses (scoping and integrative reviews of the international literature) with primary research (a collective case study in England and Wales). Data from these two elements were collaboratively synthesised in a subsequent model-building phase. Results: The scoping review yielded a service model typology. The integrative review found effectiveness evidence only for four models: collaborative care (the only service model to also have cost-effectiveness evidence), outreach approaches, brief intervention services and an organisational framework called 'Availability, Responsiveness and Continuity'. No service model seemed more acceptable than others. Three case study themes were identified: pathways to support; service engagement; and learning and understanding. The model-building phase identified rapid access, learning self-care skills, individualised support, clear information, compassionate and competent staff and aftercare planning as core characteristics of high-quality services. These characteristics were underpinned by four organisational qualities: values that respect confidentiality; engagement and involvement; collaborative relationships; and a learning culture. Conclusions: A consistent organisational evidence-base for service design and delivery in CYP's mental health spanning many years appears to have had little impact on service provision in England and Wales. Rather than impose – often inflexible and untested – specific local or national models or frameworks, those commissioning, designing and delivering mental health services for CYP should (re)focus on already known, fundamental components necessary for high-quality services. These fundamental components have been integrated into a collaboratively produced general model of service design for CYP with common mental health problems. While this general model is primarily focused on British service provision, it is broad enough to have utility for international audiences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the use and content of written guidance produced by mental health services in England and Wales describing hospital leave for informally admitted patients. Design/methodology/approach: Guidance on leave was requested from National Health Service (NHS) mental health trusts in England and health boards in Wales (n = 61) using a Freedom of Information submission. Data were analysed using content analysis. Findings: In total, 32 organisations had a leave policy for informal patients. Policies varied considerably in content and quality. The content of policies was not supported by research evidence. Organisations appeared to have developed their policies by either adapting or copying the guidance on section 17 leave outlined in the Mental Health Act Codes of Practice for England and Wales (Department of Health, 2016; Welsh Government, 2016). Definitions of important terms, for example, leave and hospital premises, were either absent or poorly defined. Finally, some organisations appeared to be operating pseudo-legal coercive contracts to prevent informal patients from leaving hospital wards. Research limitations/implications: Research should be undertaken to explore the impact of local policies on the informal patient's right to life and liberty. Practical implications: All NHS organisations need to develop an evidence-based policy to facilitate the informal patient's right to take leave. A set of national standards that organisations are required to comply with would help to standardise the content of leave policies. Originality/value: To the best of the author's knowledge, this is the first study to examine the use and content of local policies describing how informal patients can take leave from hospital. [ABSTRACT FROM AUTHOR]

WHAT IS KNOWN ON THE SUBJECT?: 'Leave' is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge. Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective. While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The leave policies of NHS mental health services in England and Wales are highly inconsistent. The extent to which policies are consistent with guidance differs depending on which service is providing care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is very likely that, because of inconsistencies between services and policies, practice also differs. Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey. Policymakers need to revisit leave policies in light of evidence from this study., Abstract: INTRODUCTION: Considerable guidance is available about the implementation of leave for detained patients, but individual mental health services are free to determine their own policies., Aim: To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation., Method: A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave-related terms were extracted and analysed., Results: Fifty-seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain-level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance., Discussion: Mental health professionals are inconsistently supported by the policy in their leave-related practice. This could potentially contribute to inconsistent practice and leave-related patient outcomes., Implications for Practice: To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs., (© 2023 The Authors. Journal of Psychiatric and Mental Health Nursing published by John Wiley & Sons Ltd.)

Background: Growing evidence of mental disorders among people going through the criminal justice system suggests the potential benefit of courts adding a Mental Health Treatment Requirement (MHTR) when sentencing an offender to a Community Order (sentence) in England and Wales. Although available since 2003, MHTRs have not been widely used, and there is little evidence on outcomes. Aim: To conduct the first large‐scale evaluation of mental health outcomes of people with an MHTR as part of their community sentence across multiple sites in England and Wales. Methods: Data were collected from 14 sites in England and Wales about individuals who were given an MHTR as part of a community sentence. They were assessed before and after this. During the MHTR, they received a psychotherapeutic intervention by assistant psychologists in a primary care framework. Measures of psychological distress (Clinical Outcomes in Routine Evaluation—Outcome Measure), anxiety (Generalised Anxiety Disorder‐7) and depression (Patient Health Questionnaire) were completed before the MHTR was implemented and after completion. Results: Where paired sample t‐tests and Wilcoxon signed ranked tests were used, with samples ranging between 309 and 447 individuals, clinically significant changes were obtained for all measures. Most individuals (63%) were identified as experiencing a reliable change in at least two out of the three scales. Finally, a negative linear relationship, between measures at the start of the intervention and reliable change, was identified with higher pre‐measures, indicating that more initial distress, anxiety and/or depression were associated with more sizeable changes. Conclusions: This paper provides the first substantial evidence in support of the MHTR within a primary mental healthcare framework as an effective pathway to reduce mental health problems among individuals under probation supervision as part of a sentence after conviction for a criminal offence. This supports the expansion of the provision across England and Wales. Future research should take account of the non‐completers and explore the relationship between the MHTR, mental health improvements and reoffending. [ABSTRACT FROM AUTHOR]

This paper examines the role of the police in mental health work. It explores whether the calls to 'defund the police' can be the basis for fundamental reforms of mental health services and the police role. The paper outlines the roots of the calls to ' defund the police' situating the perspective in the wider Black Lives Matter movement (BLM). The wider BLM movement seeks to overturn long standing racial and social injustices, including the disproportionate use of force against black citizens and racial biases within the Criminal Justice System. It goes further in that BLM calls for a shift in funding from policing towards an investment in welfare and community services. These calls are captured in the phrase 'defund the police'. These calls have highlighted the police role in mental health, particularly, the police response to citizens in mental health crisis. The paper examines the police role in mental health work, highlighting the historic impact of policies of deinstutionalisation and more recently austerity and welfare retrenchment. In calling for this policy shift, campaigners have highlighted the need to significant investment in mental health services. The police role in mental health services increased because of the failings of community care (Cummins, 2020a). Police officers have increasingly become first responders in mental health crises. The paper, focusing on England and Wales, uses 'defund the police' perspective as a lens to examine long standing areas of concern. Police involvement in mental health emergencies is inevitably stigmatizing. There are also concerns from the police. This is an area of police demand that has grown of austerity and the wider retrenchment in public services. Police officers often feel that they lack the skills and knowledge required to undertake their role in mental health work. In addition, there is frustration generated by poor interprofessional working. Police officers on an organizational and individual level feel that they are often left ' picking up the pieces '. There is a wide recognition that mental health services are failing to provide appropriate responses to those in crisis (Wessley, 2018). As well as being an issue of human rights and social justice, these failures place vulnerable people at increased risk. All aspects of police work involve contact with people experiencing mental health problems. People with mental health problems are first and foremost human beings who should be treated with dignity and respect. They are also citizens, family members, carers and work colleagues. Having acknowledged that core value perspective, if we accept that police officers will be involved in mental health work, we should seek to limit their role as far as is possible. The paper concludes that it is likely that there will be always be some form of police involvement in mental health–related work. However, there is a need to limit this as far as possible. [ABSTRACT FROM AUTHOR]

Background: Children and young people's (CYP) mental health is a major public health concern internationally and the recent Covid-19 pandemic has amplified these concerns. However, only a minority of CYP receive support from mental health services due to the attitudinal and structural barriers they and their families encounter. For over 20 years, report after report has consistently highlighted the shortcomings of mental health services for CYP in the United Kingdom and attempts to improve services have been largely unsuccessful. The findings reported in this paper are from a multi-stage study that aimed to develop a model of effective, high-quality service design for CYP experiencing common mental health problems. The aim of the stage reported here was to identify CYP's, parents' and service providers' perceptions of the effectiveness, acceptability and accessibility of services. Methods: Case studies were conducted of nine different services for CYP with common mental health problems in England and Wales. Data were collected using semi-structured interviews with 41 young people, 26 parents and 41 practitioners and were analysed using the Framework approach. Patient and Public Involvement was integrated throughout the study with a group of young co-researchers participating in data collection and analysis. Results: Four key themes defined participants' perceptions of service effectiveness, acceptability and accessibility. Firstly, open access to support with participants highlighting the importance of self-referral, support at the point of need and service availability to CYP/parents. Secondly, the development of therapeutic relationships to promote service engagement which was based on assessment of practitioner's personal qualities, interpersonal skills and mental health expertise and underpinned by relational continuity. Thirdly, personalisation was viewed as promoting service appropriateness and effectiveness by ensuring support was tailored to the individual. Fourthly, the development of self-care skills and mental health literacy helped CYP/parents manage and improve their/their child's mental health problems. Conclusions: This study contributes to knowledge by identifying four components that are perceived to be central to providing effective, acceptable and accessible mental health services for CYP with common mental health problems irrespective of service model or provider. These components could be used as the foundations for designing and improving services. [ABSTRACT FROM AUTHOR]

Wales is a small country, with an ageing population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the UK. This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.

Purpose This paper provides an overview of transitions across forensic child and adolescent mental health services in England and Wales. The purpose of this paper is to delineate the national secure services system for young people in contact with the youth justice system.Design/methodology/approach This paper reviews findings from the existing literature of transitions across forensic child and adolescent mental health services, drawing attention to present facilitators and barriers to optimal transition. The authors examine the infrastructure of current services and highlight gaps between child and adult service continuity and evaluate the impact of poor transitions on young offenders’ mental health and wellbeing.Findings Young offenders experience a broad range of difficulties, from the multiple interfaces with the legal system, untreated mental health problems, and poor transition to adult services. Barriers such as long waiting lists, lack of coordination between services and lack of transition preparation impede significantly smooth transitions.Research limitations/implications The authors need to develop, test and evaluate models of transitional care that improve mental health and wellbeing of this group.Practical implications Mapping young offenders’ care pathway will help to understand their needs and also to impact current policy and practice. Key workers in forensic services should facilitate the transition process by developing sustainable relationships with the young person and creating a safe clinical environment.Originality/value Transition of care from forensic child and adolescent mental health services is a neglected area. This paper attempts to highlight the nature and magnitude of the problems at the transition interface in a forensic context. [ABSTRACT FROM AUTHOR]

Purpose: South Wales Police Mental Health (MH) Triage service was initiated to meet the Welsh Government MH priority of early intervention to prevent MH crisis. Community Psychiatric Nurses, based in the control-room, provide advice to police and control room staff on the management of MH-related incidents. The purpose of this paper is to evaluate the first 12 months of operation (January-December 2019). Design/methodology/approach: Service evaluation of the first 12 months of operation (January–December 2019). Data were analysed in relation to: MH incidents; repeat callers; Section (S)136 use/assessment outcomes. Police, health staff and triage service users were interviewed and surveyed to capture their opinions of the service. Findings: Policing areas with high engagement in triage saw reductions in S136 use and estimated opportunity costs saving. Triage was considered a valuable service that promoted cross agency collaborations. De-escalation in cases of mental distress was considered a strength. Access to follow-on services was identified as a challenge. Practical implications: Triage enables a multi-agency response in the management of MH-related incidents. Improving trust between services, with skilled health professionals supporting police decision-making in real time. Originality/value: There is a gap in the research on the impact of police-related MH triage models beyond the use of S136. This project evaluated the quality of the service, its design and the relationship between health, police and partner agencies during the triage process. Multi-agency assessment of follow-up is needed to measure the long-term impact on services and users. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature.Design/methodology/approach This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers.Findings Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively.Research limitations/implications The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge.Originality/value This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a viewpoint on what needs to be done to develop competent residential services for people with intellectual disabilities and challenging behaviour. Design/methodology/approach – This article draws on previous accounts of the actions required. Whilst these have been available for decades and are still valid, they have not been fully implemented, hence the theme of "Back to the future". Findings – The need to continue developing small-scale, community-based services that have a clear value base and are committed to taking person-centred action is highlighted. The paper focuses on the need to enhance service quality through the dissemination and implementation of Positive Behavioural Support and discusses some key issues regarding this with reference to recent work in Wales. Originality/value – This paper makes a timely contribution to the current debate and highlights some practical actions and tools developed in Wales that may be of wider interest. [ABSTRACT FROM AUTHOR]

Background: Mentally disordered offenders may suffer discrimination on the basis of mental disorder, or on the basis of being offenders, or both., Aims: The aim of this paper is to outline a framework for examining discrimination affecting mentally disordered offenders. It is argued that there should be systematic comparisons between offenders with mental disorder and nonoffenders with mental disorder in order to identify and characterise specific failures to ensure equivalence of mental health care; and systematic comparisons between offenders with mental disorder and offenders without mental disorder in order to identify how mental disorder may constitute a barrier to forms of support and constructive intervention available to other offenders., Methods: A critical review was conducted of official documents presenting criminal justice and mental health policy for England and Wales, principally since 2012, together with reports of inspectorate and oversight bodies and relevant research studies., Findings: There is evidence that offenders with mental disorder may not be able to access mental health care equivalent to that for nonoffenders with mental disorder. There is also evidence that they may not be able to access interventions available to other offenders. Further disadvantage may arise in the criminal courts since, in England and Wales, if inpatient care is required, the powers of criminal courts to effect hospital admission under Part III of mental health legislation are weakened by the statutory requirement of information that places are available. This is discriminatory against offenders with mental disorder insofar as forms of court disposal for other offenders are not prevented by the capacity of criminal justice agencies., Conclusions and Implications: The review supports the need for systematic comparisons to identify forms of disadvantage and discrimination experienced by mentally disordered offenders in relation to both mental health and criminal justice policies services., (© 2019 John Wiley & Sons, Ltd.)

Background: Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care., Methods: A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method., Results: For service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent., Conclusions: There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning. This paper arises from a larger study published by National Institute for Health Research (Simpson A, et al, Health Serv Deliv Res 5(26), 2017).

This paper uses data produced by the Ministry of Justice to look for trends in the numbers of various categories of patients detained under the Mental Health Act in England and Wales between 2003 and 2016. Specifically, we have focussed on patients detained with Ministry of Justice restrictions in place. The number of 'restricted' patients, who are largely detained in secure psychiatric hospitals, has risen substantially during this period. If this trend continues, there will be the need for further expansion of secure psychiatric beds in the years ahead. Factors driving the increased number of restricted patients are discussed in this paper.

Background:The Mental Health Act Commission (MHAC) is a body which monitors the care and treatment of patients compulsorily detained in hospital in England and Wales. It does this through listening to their views and by observing the conditions in which they are held; this direct exposure to the experience of service users contrasts with other models of quality assurance which rely mainly on secondary data. Aims: This paper reviews the work of the Commission, focusing on its visiting role and methodology. Methods: The paper is based on published and unpublished literature, drawing also on personal experience as a member of the MHAC. Results: It argues that textual data tend to be privileged over talk because of the need for evidence-based recommendations and that patients' views are for this reason relatively neglected in Commission reports. The paper highlights ambiguities in the role of the Commission and identifies two divergent goals, firstly protection of legal rights, secondly audit and inspection. Conclusions: The paper finds that it has been difficult for the MHAC to reconcile these goals. While it has successfully raised standards of compliance with the Mental Health Act, it has been less successful in tackling wider issues of quality of care. There is a risk that its user-centred approach may be lost as a result of changes in regulatory structures. [ABSTRACT FROM AUTHOR]

Professional identities are important in defining workers' roles, and are concerned with attributes relating to those roles and how they are performed. Evidence shows mental health nurses undertake many different roles as part of their work. Yet, the roles of mental health nurses are insufficiently understood by healthcare staff, service users, and nurses themselves. Mental health nursing work has been deemed invisible and lacking in role clarity. Poor understandings about professional identity of mental health nurses result in difficulties recruiting to the profession, nurses lacking confidence articulating the value of their work, with misunderstandings apparent with service users about the specific role of mental health nursing in their care. The primary focus of this study, conducted in Wales, United Kingdom, was to examine how talk about mental health nursing was handled by participants from multiple perspectives. Data consisted of 17 individual interview transcripts with mental health nurses and 13 interview transcripts from mental health service users, and three focus groups with nursing students. Participants' talk was analysed using thematic analysis. This paper reports how participants described mental health nursing work to have significant role overlap with other multidisciplinary team members. Participants highlighted that mental health nurses often have an 'in the middle' label because the complexity of their work can be hard to describe. The implications are pertinent for nurses because if they are considered to be in a liminal position, they risk being perceived as neither one role nor another, resulting in nurses struggling with professional identities and role confidence. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the content of local policies on engagement and observation written by National Health Service (NHS) organisations in England and Wales. Design/methodology/approach: Engagement and observation policies were obtained from all (n = 61) NHS mental health trusts in England and health boards in Wales via a Freedom of Information Act 2000 request. Data were analysed using content analysis. Findings: All organisations had a specific policy referring to either "observation and engagement" or "observation". The policies varied considerably in quality, length, breadth and depth of the information provided. Significant variations existed in the terminology used to describe the different types of enhanced observation. Inconsistencies were also noted between organisations regarding: which members of the clinical team could initiate, increase, decrease and terminate observation; who could undertake the intervention (for example students); and the reasons for using it. Finally, despite rhetoric to the contrary, the emphasis of policies was on observation and not engagement. Research limitations/implications: This research has demonstrated the value of examining local policies for identifying inconsistencies in guidance given to practitioners on the implementation of engagement and observation. Further research should be undertaken to explore the impact of local policies on practice. Practical implications: Local policies remain variable in content and quality and do not reflect contemporary research. There is a need to produce evidence-based national standards that organisations are required to comply with. Originality/value: To the best of the author's knowledge, this is the first research in 20 years examining the local policy framework for the implementation of engagement and observation. [ABSTRACT FROM AUTHOR]

This paper aims to contribute to the prevention of future domestic homicide by analysing 141 domestic homicide reviews (DHRs) in England and Wales. All publicly available DHRs (n = 141) were retrieved from Community Safety Partnership websites in England and Wales in June 2016. Utilising a mixed methods approach, we designed templates to extract quantitative and qualitative data from DHRs. Descriptive statistics were generated by SPSS. 54 DHRs were analysed qualitatively, using N‐Vivo for data management. The findings revealed that perpetrators were aged: 16–82 years; with a mean average age of 41 years. Victims' ages ranged from 17 to 91 years old; with a mean average age: 45 years. Perpetrators' mental health was mentioned in 65% of DHRs; 49% of perpetrators had a mental health diagnosis. Healthcare services, in particular, mental health services, were most likely to be involved with perpetrators. 'Movement' was identified as a key contextual feature of the 54 DHRs analysed qualitatively and this was found to interact with risk assessment, language barriers and housing problems. In conclusion, domestic violence and abuse risk assessments need to be informed by the knowledge that domestic abuse occurs across the age span. Mental health settings offer an opportunity for intervention to prevent domestic homicide. Domestic Homicide Reviews can provide valuable material for training practitioners. [ABSTRACT FROM AUTHOR]

Dementia Care Mapping™ is widely acknowledged as the gold standard observational method that can support the introduction of person centred care into a variety of settings (http://www.bradford.ac.uk/health/dementia/dementia-care-mapping/). It encourages care staff to think about how the person with dementia is experiencing the care provided and the care setting. It has been shown to raise care staff awareness sufficiently to bring about improvements in care. In this paper, we describe a programme of work in North Wales that seeks to find innovative ways to use Dementia Care Mapping™, in acute mental health admission wards for people affected by dementia, and we set out some of those innovations. [ABSTRACT FROM AUTHOR]

This paper aims to capture some of the issues raised by those working on the development of mental health services in the prison environment. Each establishment in England and Wales will be different in terms of prison category and prisoner status, but its principle aim will be the same: to follow the strategic plans for the development of mental health services outlined in the National Service Framework. The purpose of the paper is to begin to facilitate and promote further open discussion of the development of services in prisons in order to improve clinical care. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to report on the role of an action researcher in a study investigating the change process in a health service context where a new assessment clinic was developed to manage the excessive waiting list for that service. Background For effective organisational change in health, there is a suggestion that change agents need to be emotionally intelligent; recognising the emotional state of individuals, reconciling that with the organisational drivers and making an assessment of readiness for organisational change. Anxiety features throughout this literature and there is a suggestion that being aware of anxiety and managing anxiety is within the emotionally intelligent change agent's repertoire, but there is a gap in the literature that explains this relationship in detail. Methods Data were generated to investigate the discrete nature of the role of the action researcher during this organisational change that spanned two years, through three methods: participant observations in the field captured in field notes ( n = 72); observations of team meetings that had been recorded and transcribed ( n = 13); interviews with key informants pre- and postintervention ( n = 14); a reflexive diary one document of 8920 words ( n = 1). Findings The data illuminating the interaction between the action researcher and participants were synthesised into two broad themes: how the action researcher introduced anxiety into the system; how the action researcher facilitated the participants to tolerate change anxiety. Discussion/relevance to clinical practice The findings from this study can be applied in clinical practice where change in practice is planned. Part of the requirement of a change agent in the NHS might be to be sufficiently emotionally literate to understand anxiety in the participant system and manage it to effect change. [ABSTRACT FROM AUTHOR]

Objective. To elicit the barriers and facilitators experienced by social prescribing service providers when designing and delivering social prescribing services to support adult mental health. Design. Semistructured interviews were conducted with social prescribing service providers across England and Wales in the third sector. Data were analysed in accordance with the Theoretical Domains Framework (TDF) and Thematic Framework Analysis (TFA). Results. Twenty‐one providers (15 females and 6 males) from 17 social prescribing services agreed to participate. Nine analytical themes were identified across seven TDF domains associated with the design of services (e.g., skills and environmental context and resources). Thirteen analytical themes across nine TDF domains were associated with the delivery of services (e.g., beliefs about consequences and optimism). Key recommendations for future social prescribing services were increasing public knowledge of social prescribing; clearly communicating the role of a social prescriber to the public and professionals; providing training to providers on how to safely and effectively lived experiences; adopting a person‐centred approach, including use of person‐centred measures of mental health and well‐being; and strategies to address sustainability of social prescribing services. Conclusions. Service providers are an essential part of the design and delivery of social prescribing services. Person‐centred care, sustainable funding, and improved knowledge of social prescribing all warrant further research. Sustainable funding for social prescribing remains a salient policy‐level barrier. [ABSTRACT FROM AUTHOR]

Purpose: Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services. It has been gradually adopted as the risk evaluation and safety-planning technique for all seven health boards in Wales. The purpose of this paper is to examine the opinions of WARRN as used within these health boards. Design/methodology/approach: An online survey was disseminated to NHS clinicians in secondary mental health services to evaluate their perceptions of the use and effectiveness of WARRN. Data from 486 clinicians were analysed with both quantitative and qualitative methods. Findings: Results indicated that the overall impact of WARRN on secondary mental health care was very positive, with clinicians reporting increased skills in the domains of clinical risk formulation, safety-planning and communication, as well as increased confidence in their skills and abilities in these areas. Clinicians also reported that the "common-language" created by having all NHS health boards in Wales using the same risk assessment process facilitated the communication of safety-planning. Crucially, NHS staff believed that the safety of service users and of the general public had increased due to the adoption of WARRN in their health board and many believed that lives had been saved as a result. Originality/value: WARRN is perceived to have improved clinical skills in risk assessment and safety-planning across Wales and saved lives. [ABSTRACT FROM AUTHOR]

Background: Experiencing mental ill health adds a layer of complexity for individuals in touch with the justice system and for those responsible for working in the justice service with these individuals, such as frontline police officers. In England and Wales, there are three commonly used but not necessarily commonly designed or operated, mental health interventions associated with policing, Liaison and Diversion, Street Triage and specialist staff embedded in Police Contact Control Rooms. A fourth US designed model, Crisis Intervention Teams (CITs), is now attracting some interest in England and Wales, and these four are to be considered in this review. A fifth intervention, Mental Health Courts, was trialed but has now been abandoned in England and Wales and so has been excluded, but remains in use elsewhere. In recent years, there has been an increase in the level of investment related to these intervention options. This has largely been without an evidence base being available to aid design, structure, and consistency of approach. The review will address this gap and provide a systematic review of each of these options. This will provide a baseline of research evidence for those who commission and provide services for individuals experiencing mental ill health and who are in contact with the justice system., Methods: Twenty-nine relevant databases and sources have been selected which will be systematically searched to locate relevant studies. These studies have to meet the set inclusion criteria which require them to report an objective outcome measure(s) in respect of offending or mental health outcomes and to have an experimental or quasi-experimental design including a comparator group(s) or a pre/post comparison. The review will exclude PhD theses, papers in non-English languages and papers published prior to 1980. Keywords have been collected through canvassing experts' opinion, literature review, controlled vocabulary and reviewing the results of a primary scoping review carried out to aid the development of the PICO, composed of Population/Participants, Intervention/Indicator, Comparator/Control, and Outcomes. For the proposed review, the key elements of the PICO are the following: persons with mental health problems, symptoms or diagnoses who come into contact with the police; interventions involving partnership working between police and mental health nurses and related professionals to divert those with mental health problems away from criminal justice processes; comparisons with control groups or areas where such interventions have not been introduced; and outcomes concerning criminal justice and health outcomes. The results of the searches will be screened using the set criteria and the selected papers reviewed and analysed to allow findings regarding these interventions to be reported., Discussion: The objectives of the review are firstly to identify and report research on the relevant interventions, nationally and internationally and then secondly to consider, when possible, which interventions or aspects of those interventions are effective. This is judged with regard to changes in mental health status or service use and future offending behaviour. The approaches to be considered have gained a good deal of support and funding over recent years, and this review will provide a systematic review of the underpinning research evidence to inform future commissioning, service design and investment decisions.

Purpose The purpose of this paper is to review the Mental Health Foundation’s experiences designing, implementing and evaluating peer-focused self-management programmes. Through a discussion of barriers and good practice, it outlines ways to be successful in making such projects work to improve mental health and wellbeing among at-risk populations.Design/methodology/approach A total of 11 Mental Health Foundation programmes implemented over the past ten years were reviewed through reading manuals and publications and interviewing programme managers. Key data were extracted from each programme to analyse trends in aims, outcomes and recommendations.Findings Through a focus on peer-work, programmes taught individuals from a variety of societal sectors self-management skills to effectively deal with life stressors. Through sharing in non-judgmental spaces and taking ownership of programme design and content, individuals realised improvements in wellbeing and goal achievement.Practical implications Good practice, barriers and recommendations can be taken from this review and applied to future peer-focused self-management programmes. By better embedding quantitative and qualitative evaluations into programme development and implementation, programmes can add to the evidence base and effectively target needs.Originality/value This review lays out valuable experience on an innovative community service paradigm and supports the evidence on effectiveness of peer-focused self-management programmes with a variety of group populations. [ABSTRACT FROM AUTHOR]

Introduction: Early-life medical and surgical interventions in babies born preterm and/or with surgical conditions influence later life health and educational outcomes. Obtaining long-term outcomes post-discharge to evaluate the impact of interventions is complex, expensive, and burdensome to families. Linkage of routinely collected data offers a feasible and cost-effective solution. The NeoWONDER research programme aims to describe the short and long-term health and educational outcomes for babies born preterm and/or with surgical conditions and evaluate the impact of neonatal care and interventions on later health and educational outcomes. Methods and analysis: We will include babies who received care in neonatal units in England and Wales, born between 2007–2020 with a gestational age below 32 weeks (approximately 100,000), and/or born between 2012–2020 (all gestations) with any of six surgical conditions: necrotising enterocolitis, Hirschsprung's disease, gastroschisis, oesophageal atresia, congenital diaphragmatic hernia, and posterior urethral valves (approximately 8,000). A detailed list of surgical condition codes is shown in S3 File. We will obtain long-term health and education outcomes through linkage of the National Neonatal Research Database, which contains routine data for all babies admitted to NHS neonatal units, to other existing health and educational datasets. For England, these are: Hospital Episode Statistics, the Office for National Statistics, Mental Health Services Dataset, Paediatric Intensive Care Audit Network, National Pupil Database; and for Wales, the Secure Anonymised Information Linkage databank. Analysis will be undertaken on de-identified linked datasets. Outcomes of interest for health include mortality, hospital admissions, diagnoses indicative of neurodisability and/or chronic illness, health care utilisation; and for education are attainment (using national curriculum assessments), school absence and special educational needs status. [ABSTRACT FROM AUTHOR]

There has been a growth in managerialism of professionals in the Public Sector. This paper contributes to this debate by examining perceptions of senior managers in mental health services within Health Authorities, NHS Trusts and Local Authorities' Social Services departments in Wales. The paper explores how different professions responded differently to the growth of managerialism. The results suggest important differences and similarities between management in health and social services settings. [ABSTRACT FROM AUTHOR]

It cannot be assumed by healthcare providers that transgender people routinely receive care and treatment that is of the quality and sensitivity that should be expected. In particular there are concerns from within the transgender community that they experience discrimination and disrespect from both individual practitioners and the healthcare system as a whole. This causes an avoidance of contact that is undesirable for both users and providers of healthcare services. Older transgender people are vulnerable to a range of mental health problems and, like all elderly, increasingly to dementia; failure to access specialist services in a timely manner may result in unnecessary distress and potentially to crisis. This paper reports on the use of an appreciative inquiry approach towards identifying the opportunities for one health board in North Wales to work more closely with older members of the transgender community it serves. [ABSTRACT FROM PUBLISHER]

Writing the recent history of mental health services requires a conscious departure from the historiographical tropes of the nineteenth and twentieth centuries which have emphasised the experience of those identified (and legally defined) as lunatics and the social, cultural, political, medical and institutional context of their treatment. A historical narrative structured around rights (to health and liberty) is now complicated by the rise of new organising categories such as 'costs', 'risks', 'needs' and 'values'. This paper, drawing on insights from a series of witness seminars attended by historians, clinicians and policymakers, proposes a programme of research to place modern mental health services in England and Wales in a richer historical context. Historians should recognise the fragmentation of the concepts of mental illness and mental health need, acknowledge the relationship between critiques of psychiatry and developments in other intellectual spheres, place the experience of the service user in the context of wider socio-economic and political change, understand the impacts of the social perception of 'risk' and of moral panic on mental health policy, relate the politics of mental health policy and resources to the general determinants of institutional change in British central and local government, and explore the sociological and institutional complexity of the evolving mental health professions and their relationships with each other and with their clients. While this is no small challenge, it is perhaps the only way to avoid the perpetuation of 'single-issue mythologies' in describing and accounting for change.

This paper is one of a series written by members of the Mental Handicap Research Project at the University College of North Wales in connection with the All-Wales Strategy. Previous papers describe local arrangements for the planning of new services and discuss in general terms issues concerning partnership and participation. This paper describes modes of parental participation in the planning of new, services for the mentally handicapped. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of mental disorders among women in prison is recognised worldwide. In England and Wales, successive governments and independent reports have argued that the equivalent of community care in prisons is acceptable but that some mental health assessment units (MHAUs), staffed by professional clinicians, should remain. These have not been researched.Aims: This paper aimed to explore patterns of use of a MHAU in a women's prison in England and to test the hypothesis that it was being used only, as intended--to hold women pending transfer to a health service hospital or in a bona fide crisis.Methods: Anonymised data on all women transferred to one MHAU between 1 January 2008 and 31 August 2010 were obtained from the prison files and subjected to descriptive analysis.Results: Less than a third of these women were transferred to an outside hospital; this group stayed longest in the unit. An overlapping group of 52% of the women was under a special assessment, care in custody and teamwork protocol because of suicide or serious self-harm risk. Thus, 188 (68%) admissions fulfilled national protocol criteria for MHAU admissions. Two in five women admitted were released or returned to ordinary prison locations. Nevertheless, over 80% of the women were known to external mental health services, and 64 (30%) were so unwell on arrival in prison that they were transferred directly to the MHAU. Over a third of admissions were of women admitted more than once during the 32 months of study, and this was significantly more likely after release from prison directly to the community.Conclusions: Our hypothesis was not sustained, and it seems unlikely that this prison MHAU is unique in being used outside its strict remit. A shift from studying the epidemiology of mental disorder in prisons to the epidemiology of mental health needs could benefit this vulnerable group and the wider community alike. [ABSTRACT FROM AUTHOR]

The article titled "The omnipresence of risk and associated harms in secure and forensic mental health services in England and Wales" has been retracted by the Editors in Chief due to multiple overlaps with previously-published research by different authors. The author's agreement to this retraction is not stated. The online version of the article includes the full text of the retracted article as Supplementary Information. [Extracted from the article]

Purpose: Stemming from substantial criticism during the late twentieth and early twenty-first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions., Design/methodology/approach: This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service., Findings: While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed., Originality/value: Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future.

Background: When an individual is detained in hospital it is important that they maintain contact with their family, friends and communities as these can be helpful for their well-being and recovery. Maintaining these relationships is also important to unpaid carers (family or friends), but they can be strained by carers' instigation of, or compliance with, the involuntary detention. Section 17 of the Mental Health Act (1983) in England and Wales allows for temporary leave from hospital, from an hour in the hospital grounds to going home for a few days. However, carers are not always involved in decisions around statutory s.17 leave, even where they are expected to support someone at home. This study aimed to explore how practice can be improved to better involve and support carers around s.17 leave. Methods: Semi-structured interviews and focus groups were held with 14 unpaid carers and 19 mental health practitioners, including four Responsible Clinicians, in three sites in England in 2021. The research explored views on what works well for carers around s.17 leave, what could be improved and the barriers to such improvements. Transcripts were analysed using reflexive thematic analysis. Results: Three themes were identified in the analysis: the need for carer support and the challenges surrounding provision; challenges with communication, planning and feedback around s.17 leave; and inconsistency in involving carers around s.17 leave. Permeating all themes was a lack of resources presenting as under-staffing, high demands on existing staff, and lack of time and capacity to work and communicate with carers. Conclusion: Implications include the need for more funding for mental health services for both prevention and treatment; staff training to increase confidence with carers; and standardised guidance for practitioners on working with carers around s.17 leave to help ensure consistency in practice. The study concluded with the production of a 'S.17 Standard', a guidance document based on the research findings consisting of 10 steps for practitioners to follow to support the greater involvement and support of carers. [ABSTRACT FROM AUTHOR]

Objectives: Independent healthcare, most of it NHS-funded, provides a significant and growing proportion of inpatient mental healthcare in the UK, but information about patients in these providers is limited. This paper examines differences in the profiles of mental health inpatients in NHS and independent providers in England and Wales, and assesses whether current information systems are adequate for monitoring patient flows and care, given the plurality of service provision. DESIGN DATA: from the national censuses of inpatients in mental health services in England and Wales in 2006 and 2007 were analysed to examine differences in demographic and other characteristics between inpatients in NHS and independent providers., Setting: All NHS and independent providers of inpatient mental health services in England and Wales in 2006 and 2007., Main Outcome Measures: Patients in independent providers were younger, 60% were on low/medium secure wards (compared with 16% in the NHS), they were 44% more likely to be detained and referrals were predominantly from NHS inpatient services. For all ethnic groups, ratios of detention on admission were higher in independent providers., Conclusions: This analysis highlights differences between inpatients in NHS and independent providers of mental health services. We also highlight the inadequacy of current information systems for monitoring care, and the urgent need for standardized data across all NHS-commissioned mental healthcare, irrespective of whether it is publicly or privately provided. This is especially important in view of the increases in independent sector provision, and the specialist nature of their services. Such information is critical for commissioners, regulators of health and social care, and other audiences for monitoring patient flows, the quality of care provided, usage of the Mental Health Act 2007 and compliance with equality legislation.

This paper ethically analyses arising out the proposed changes to the Mental Health Act for England and Wales. It looks in particular at thea shift in philosophy that the author claims has occurred with the proposals away from rights-focused principles to more utilitarian or outcome-focused principles. It gives examples of these changes and explores its their consequences.

The concept of 'whole system' working is fundamental to contemporary policy and consequently to practice and service development within UK mental health services. This paper reports on an exploratory study of the meaning of the 'whole system' to staff working within adult mental health services in North Wales, conducted within a broader practice development project. A focus group was used to collect data from a multiprofessional group drawn from two acute inpatient wards, Community Mental Health Teams (CMHTs) and an assertive outreach team. Thematic analysis generated three themes central to effective whole system working in adult mental health services. Discussion on the efficacy of the whole system gave rise to an understanding that this whole system varies in its effectiveness in responding to people with differing clinical presentations. Furthermore, it appears that under certain circumstances, the whole system may work to shift responsibility in order to manage worker's anxiety more adroitly than, for example, working creatively to respond to people's needs. The paper concludes that whilst by no means exhaustive or complete, these three themes enable critical reflection, discussion and identification of practice development challenges that may facilitate more effective whole system working and better services in North Wales and possibly in other settings.

This paper presents findings from a pilot research project to explore the significance and availability of mental health services in the medium of Welsh in Wales, UK. Based on small-scale research with Welsh-speaking mental health service users this article argues that being bilingual can be a significant factor in the complex biopsychosocial matrix that underpins mental health problems amongst Welsh speakers. It also argues that the destructive effects of linguistic oppression, and the difficulties of second language communication for mental health service users, are such that an appropriate health and social care response in Wales involves providing services in a user's preferred language. Service users' views about the current state of bilingual service provision in Wales are presented, which suggests that insufficient attention is being paid to the linguistic needs of Welsh speakers. Eight principles are proposed for mental health service policy and practice in Wales.

Purpose – The purpose of this paper is to describe the development and delivery of a self-management and peer support intervention for people with severe mental health diagnoses. Design/methodology/approach – There was a gap in the provision of a self-management intervention designed and delivered by people with psychiatric diagnoses. In total, 24 people with the experience of severe mental ill-health took part in developing the model and course materials for a new self-management intervention. A three-stage intervention was designed: two-day training, six follow-up sessions, and on-going peer support. Findings – Between 2009 and 2012, over six hundred participants across Wales were trained. In total, 35 of the new courses and 27 of the Bipolar UK courses have been delivered. Currently, 15 peer support groups are still meeting regularly and many people are receiving on-going support. At present, the effectiveness of the intervention is being evaluated; data are being collected at baseline, and at six and 12-month follow-up. Originality/value – Most self-management strategies developed in the past have been focused on physical health conditions and developed and delivered by clinicians. This new self-management intervention is based on the needs and experiences of the target beneficiaries. It was developed and is being delivered by people who have a psychiatric diagnosis, and have come through the training themselves. [ABSTRACT FROM AUTHOR]

This paper examines the role of approved mental health professional (AMHP) which was introduced by the Mental Health Act 2007. It outlines the scope and functions of the role and explores the likely impact on the nursing profession. While the expansion of the role does offer opportunities for career progression and enhancing professional autonomy and status, it must be accompanied by a corresponding increase in resources and training, to enable nurses to fully harness the AMHP role. This expansion will inevitably bring with it increased legal responsibility and accountability and the extent to which mental health/learning disability nurses will be willing to shoulder that remains to be seen. [ABSTRACT FROM AUTHOR]

Background: Concerns have been raised about inpatient mental health care. An accreditation model can improve compliance with standards associated with improved quality of health care. Aims: To explore the effects of a standards-based, peer review, accreditation model on standards of care in acute inpatient wards and explore how staff achieved change. Method: Quality of care was assessed by independent peer review against evidence-based standards in an accreditation process. Staff from the 11 wards receiving subsequent accreditation were interviewed to find out what processes had enabled accreditation. Results: Sixteen wards enrolled: four achieved immediate and 11 subsequent accreditation. The most common reasons for initial failure of accreditation were lack of psychological therapies or 1:1 time for patients, and presence of ligature points. Ward staff perceived the accreditation process improved communication, gave power to negotiate for resources, clear guidance how to practice, rewarded good practice and led to additional unrelated improvements in care. Conclusions: Acute wards need to attend to basic safety and provide talking treatments (both formal psychotherapy and basic time spent with patients). An accreditation, peer-reviewed, standards-based process can enable staff to feel confident about improvements in the quality of care. [ABSTRACT FROM AUTHOR]

Accessible summary • This paper will inform mental health service users and carers on how a University in Wales established a service user and carer-led research group. • The group's primary aim will be to undertake its own service user and carer-led research projects. • Mental health service users have undergone empowerment and research training at a University in Wales. This is an important initiative because it is the first service user and carer-led research group in Wales. • This paper is co-authored by a mental health service user and includes transcripts of service users’ stories written in their words. Service user and carer involvement in research has been gaining momentum in recent years. However, this involvement to date has primarily been as research respondents or ‘subjects’ in research studies. A group of mental health service users at a University in Wales underwent empowerment and research training to enable them to become active participants in the research process; this training was a necessary step to equip mental health service users with the skills to become independent researchers and to carry out service user-led research. We included transcripts from mental health service users on their views of the empowerment and research training received. We are not reporting, in this paper, on the findings from a research study rather it aims to inform readers how a service user and carer-led research group has been established in Wales. The group has two purposes: (1) to train service users in research methodologies, and thus for them to gain essential research skills; and (2) to undertake their own service user and carer-led research projects thereby implementing the research skills they have acquired from the training. The latter is a primary aim of the group; a future paper will report on its development. [ABSTRACT FROM AUTHOR]

Psychiatric nursing in prisons has received criticism from within and outside the profession in recent years. In England and Wales this amongst other issues has prompted a review of forensic health care by the United Kingdom Central Council for Nursing, Midwifery & Health Visiting (UKCC). The status of forensic psychiatric nursing as a specialty has also been disputed in the literature and the role of nurses working in this field is seen by some to be more about social control than caring. These arguments are set in the present situation of increasing numbers of mentally ill individuals in the prison system and a crisis in the availability of beds in secure units, a situation that is paralleled throughout the western world. The standard expected of health care services in prisons is equivalence with the service the public receives from the National Health Service (NHS). The number of prisoners needing transfer to hospital has increased during the last decade, resulting in competition for a limited number of suitable beds. The effect on health care centres (HCCs) in English prisons is that they now must provide long-term care for seriously mentally ill prisoners. This paper outlines the development of British psychiatric services in prisons. It then describes the HCC in Her Majesty's prison (HMP) Belmarsh and reports on recent radical changes in the management structure of this service. The aim of these changes is to produce a clinical environment in which psychiatric nurses can deliver high quality care in an area beset with difficulties for clinicians and managers and to further progress towards the goal of equivalence. These advances have been achieved through a shift of emphasis in management structure that increases the number of clinical posts and minimizes administrative and security-based responsibilities held by clinical grades. We conclude that although external contracts are necessary, much can be achieved through internal review and changes in policy.

A shortage of medium secure psychiatric beds is widely recognized, but there is little data on patients referred for admission but not accepted. This paper examines the relationships between assessed need for and admission to medium security. The method used was interview survey with principal clinical assessors of patients assessed for admission to medium secure units in England and Wales in the first half of 1999. A stratified random sample totalling 418 patients from 34 medium secure units, including 98% of relevant beds nationally was used. Factors associated with being assessed as needing medium security (but not necessarily being admitted) included having features of acute schizophrenia, non-compliance with treatment, a history of sexually inappropriate behaviour, and being referred because of self-harm. A 'grave' current offence and a history of recent or many past custodial sentences were also important. For patients seen in prison, NHS or community services, just under a fifth of those assessed as needing medium security (especially long term) were not admitted, and just under a quarter of those admitted needed low or no security. It was concluded that the match between need for and admission to medium security is poor. Insufficient range of provision leads to inappropriate use of medium secure beds. [ABSTRACT FROM AUTHOR]

The ultimate objective of the All Wales Strategy--Mental Illness, is to produce a community based mental health service led by multidisciplinary community mental health teams. This paper is based upon a report commissioned by the Welsh Office Social Services Inspectorate based upon a review of progress in the implementation of the strategy through scrutiny of County Joint Plans and meetings with County Joint Planning Teams. In general, we found that community multidisciplinary teamwork was not well developed throughout Wales. Insufficient attention was being paid to issues of staff development and the capacity to monitor and evaluate service developments. The need for a baseline assessment of current performance by health and social services authorities seemed inescapable, if the impact of the strategy is to be reliably and validly assessed.

The Mental Health Act 1983 substantially modified Guardianship, a previously little used facility for the compulsory care of mentally ill and mentally handicapped people in the community. This paper describes the results of a survey of information based on the annual returns from Local Authorities to the Department of Health and Social Security, and examines the impact of the new legislation upon the use of Guardianship in psychiatric practice. Although the number of Guardianship Orders in force remains relatively small compared to hospital admissions, recent trends indicate a significant increase in its application to people with a mental illness, and a decline in its use for people with a mental handicap. Despite the overall increase in use, the Regional differences of cases in England remain essentially unchanged and reflect the differing attitudes and policies of Local Authorities towards Guardianship Orders.