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

Accessible summary: What is known on the subject?: Traumatic brain injury (TBI) has been linked to poor outcomes in terms of mental health, specifically, PTSD, depression and alcohol abuse.A lack of research evidence exists relevant to exploring the presence and implications of TBI in the police in the UK and globally, despite the elevated risk of physical and emotional trauma specific to policing. What does the paper add to existing knowledge?: The rate of traumatic brain injury is highly prevalent in a small sample of police officers.Traumatic brain injury is a major source of post‐concussion symptoms (physical, cognitive and emotional deficits) in police officers, which, in general, are associated with greater mental health difficulties and drinking alcohol to cope. What are the implications for practice?: Traditional mental health treatments should be supplemented with elements of concussion care to address any cognitive, emotional and physical issues due to head injury.Interventions should be made more accessible to those suffering from a mild brain injury. This can be done through regular reminders of appointments, pictograms and by providing a concrete follow‐up. Introduction: Police officers have a high risk of injury through assaults, road traffic incidents and attending domestic calls, with many officers developing post‐traumatic stress disorder (PTSD) as a consequence. Traumatic brain injury (TBI) is a common injury in populations involved in conflict and has been extensively linked to mental health difficulties. However, current research has not explored the frequency and sequelae of TBI in police populations, despite the elevated risk of physical and emotional trauma specific to policing. Aim: To explore self‐reported TBI, PTSD, post‐concussion symptoms, depression and drinking to cope in a small sample of UK police, to determine the frequency of these conditions and their relationships. Method: Measures of TBI, mental health, and drinking alcohol to cope were administered to 54 police officers from a Midshire Police Constabulary. Results: Mild TBI with loss of consciousness was reported by 38.9% of the sample. TBI was associated with increased post‐concussion symptoms (PCS). PCS were associated with greater severity of PTSD, depression and drinking to cope. Discussion: Exploring TBI in the police could identify a major factor contributing towards ongoing mental health difficulties in a population where, based on previous research, the implications of TBI should not be overlooked, highlighting the need for further research in this area. Implications for Practice: This research spans to identify the importance of routine assessment and increasing awareness within mental health services. Mental health treatments should be made amenable to a population with potential memory, planning and impulse control deficits. Further work in mental health services is needed to understand the level of ongoing issues that are due to post‐concussion symptoms and those that are due to other mental health difficulties, such as PTSD, thereby educating patients on the association between TBI and emotional difficulties. A graduated return‐to‐work plan should be developed to enable a safe transition back to work, whilst managing any ongoing symptoms. [ABSTRACT FROM AUTHOR]

Purpose – The aim of this paper is to highlight the challenges in evaluating psychological input into acute wards using more traditional methods; and also to provide an example of how it is possible to evaluate such services capturing outcomes at multiple levels. Design/methodology/approach – Data were gathered from multiple levels including staff, patients and the wider organisation mainly using self report questionnaires. The paper looks at the impact on satisfaction, service utilisation, development of recovery principles, quality of therapeutic environment and alliance with treatment teams following the introduction of a dedicated psychology team. Findings – The results show positive trends in patient experiences of the ward environment, alliance with treating teams and staff recovery principles, along with reduced readmission rates and length of stay in hospital. Qualitative data demonstrate the value of the service to both staff and patients. Research limitations/implications – Much of the data do not meet the criteria for more sophisticated statistical analysis. Originality/value – The paper provides an example of evaluation of a contemporary model of service delivery for which there is currently a limited evidence base and looks to stimulate current thinking on the practice of mental health service delivery. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: To date, improvements on U.K. acute mental health wards have been difficult to sustain. The barriers to change may be context dependent. Mental health wards are volatile workplaces with service user violence/aggression, frequent staff and patient changes, and ongoing service improvements.The evidence suggests that burnout affects staff perceptions of barriers to change, and ward climate affects burnout. As two potentially important, independent predictors of staff perceptions of barriers to change, the impact of ward climate and burnout on how staff regard changes should be considered. What the paper adds to existing knowledge?: Elements of ward climate such as high numbers of incidents and temporary staff independently worsened mental health staff perceptions of barriers to change, in addition to negative impacts from burnout and occupational status.How staff perceived ward climate was also linked their perceptions of barriers to change; however, burnout was no longer a significant consideration with these variables.Staff with low job satisfaction and high interaction anxiety also had low confidence regarding changes. Staff with low job satisfaction were also demotivated towards changes. What are the implications for practice?: Ward climate is clearly an important factor in how nurses view organizational changes. In this study, nurses' perceptions of barriers to change were worse if they viewed ward climate negatively, or if temporary staff and incident numbers were high.Staff perceptions of ward climate and barriers to change should be assessed, ahead of service changes.Developing change strategies based on such information is likely to produce better implementation outcomes. Specifically, targeting staff confidence and motivation (which are barriers to change) may improve how staff regard their ward climate. Introduction: To create successful change programmes for mental health wards, it is necessary to understand which aspects of ward climate prevent change. Question: Does ward climate influence mental health nurse's perceptions of barriers to change? Method: Random‐effects models were used to test whether the following ward climate variables influenced the outcome measure "staff perceptions of barriers to change" (VOCALISE) and its subscales (powerlessness/confidence/demotivation): (a) Perceptions of ward climate (VOTE: subscales included work intensity/job satisfaction/interaction anxiety). (b) Ward climate indicators (incidents/detention under the Mental Health Act (2007)/staffing/bed pressure). As known predictors of VOCALISE, burnout (Maslach Burnout Inventory) and occupational status were included in the models. Results: Perceptions of ward climate (VOTE), incidents, temporary staff, occupational status and burnout significantly and negatively affected perceptions of barriers to change (VOCALISE). Staff with low job satisfaction (VOTE) and high interaction anxiety (VOTE) also had low confidence (VOCALISE). Staff with low job satisfaction (VOTE) were also demotivated (VOCALISE). Discussion: Ward climate is an important predictor of how staff regard service changes in mental health wards. Implications for practice: Staff perceptions of ward climate and barriers to change should be assessed ahead of service changes to identify pressures that impede progress and lower morale. [ABSTRACT FROM AUTHOR]

Background: Service user demand and service changes, from hospital based, to community and hospital mix, within acute adult mental health services, focus the need for psychologically informed, holistic, approaches. Aims: (1) Describe and report feasibility of a psychologically led Intensive Support Programme (ISP) to meet this need. (2) Present results of a pilot evaluation of this programme. Method: ISP was implemented in four acute mental health services of the Southern Health NHS Trust, available to both inpatient and outpatient acute services. Evaluation of the service one month after data collection, illustrates operation and level of uptake across different professional roles. The programme was evaluated by assessing psychological distress (CORE-10) and confidence in self-management (Mental Health Confidence Scale) of participating service users before and after intervention. Results: The service evaluation demonstrated extensive roll out of this programme across acute services of an extensive NHS Trust. Repeated measuret-tests demonstrated significant decrease in distress (p < 0.0005) and significant increase in confidence in self-management of mental health (p < 0.0005). Conclusion: Evaluation shows that ISP can be delivered in routine care in an acute mental health service and results in improvement in self management skills and facilitation of recovery. [ABSTRACT FROM PUBLISHER]

Accessible summary People diagnosed with borderline personality disorder (BPD) can raise anxiety in health professionals and constitute a high proportion of psychiatric inpatients in generic settings., Mentalization-based therapy (MBT) is an evidence-based psychological treatment effective in the treatment of people diagnosed with BPD, but this has been used and evaluated only in specialist settings., Mentalization-based treatment skills training (MBT-S) is a new and compact 2-day workshop which aims to provide mental health professionals with MBT skills for use in generic health-care settings and has never been evaluated., This study assesses staff nurse perceptions of the impact of MBT-S on their practice when working with people with a diagnosis of BPD in the generalist setting of acute mental health wards., Staff nurses perceived MBT-S as a straightforward but empowering skill set which also contributed to attitudinal change to people diagnosed with BPD. MBT-S promoted empathy as a response to instances of self-harm which removes the potential of a vicious cycle of iatrogenic harm., Staff found MBT-S to be flexible in its structured or 'off the cuff' usability, a desirable attribute in acute mental health where people diagnosed with BPD primarily present in crisis and not for long-term structured treatment., Abstract People diagnosed with borderline personality disorder ( BPD) are highly prevalent in acute mental health wards, with staff nurses identifying a challenge in working with people who can be significantly distressed. This has contributed to a negative stereotype verging on stigmatization. Mentalization-based therapy ( MBT) is a psychological therapy which has been shown to be of benefit to people with a diagnosis of BPD, yet it has been utilized and evaluated only in partial hospitalization and outpatient settings. Despite this, most people diagnosed with BPD will continue to be treated in generic inpatient settings such as acute mental health. Mentalization-based therapy skills training ( MBT- S) is a new and cost-effective 2-day workshop aiming to provide generalist practitioners with MBT skills for use in generic settings. This study aimed to capture staff perceptions of the impact of MBT- S on their practice when working with people with a diagnosis of BPD in acute mental health. Through two focus groups, this study assessed the perceptions of nine staff nurses. An interpretive phenomenological approach was utilized in data analysis. Participants found the approach easy to grasp, improving of consistency between staff and flexible in its use in planned or 'off the cuff' discussions. MBT- S promoted empathy and humane responses to self-harm, impacted on participants ability to tolerate risk and went some way to turning the negative perception of BPD through changing the notion of patients as 'deliberately difficult'. Staff felt empowered and more confident in working with people with a diagnosis of BPD. The positive implication for practice was the ease in which the approach was adopted and participants perception of MBT- S as an empowering skill set which also contributed to attitudinal change. In acute mental health environments, which may not have the resources to provide long-term structured treatments to patients, MBT- S could be viewed as ideal as participants applauded its flexibility. The promotion of empathy also sees a move away from iatrogenic damage caused by unhelpful responses to self-harm. In the context of wider research, this study shows that staff nurses find the MBT- S skill set valuable in the generic inpatient setting of acute mental health. [ABSTRACT FROM AUTHOR]