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Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de-escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular., (© 2022 John Wiley & Sons Australia, Ltd.)

Objective:: The aim of this study was to assess the outcomes for people following intervention by a police-mental health co-responder team., Method:: Individuals seen by the co-responder team were followed for 2 weeks to monitor subsequent emergency department presentations and inpatient admissions., Results:: Of the 122 people who had direct contact with the co-responder team, 82 (67.2%) remained at their residence, 35 (28.7%) were transported to the emergency department (ED) and 5 (4.1%) were taken into custody by police. The 82 people who remained at home following initial assessment were followed-up for 2 weeks. During this time 10 (12.2%) presented to ED and 3 of these (3.7%) were subsequently admitted to hospital., Conclusions:: Interventions provided through the co-responder team were capable not only of resolving the immediate crisis for the majority of people, but were also likely to divert people away from ED and inpatient treatment in the immediate term.

Objective: To consider incidents relating to absences without permission from authorised leave from a security hospital., Method: A retrospective audit over a 10-year period of all critical incidents relating to leave from the High Security Inpatient Services, Brisbane, Australia., Results: There has been a low incidence of patients absenting themselves without permission from leave. Of the 12 patients who went absent without permission over the 10-year study period, only one patient was reported to have committed an offence and no patient seriously self-harmed., Conclusions: Attention to patient selection and risk management strategies have been effective in minimising the risk to patients and to the community as a direct result of absences without permission from authorised leave.

Aim: To evaluate the effectiveness of a benchmarking initiative in facilitating quality improvement and reform in extended care mental health services., Method: Individual interviews and focus group discussions were conducted with 84 staff in 22 extended care mental health services that had previously participated in a State-wide benchmarking exercise in Queensland, Australia., Results: Staff reported positive outcomes from participation in the benchmarking exercise. Information derived from benchmarking provided a different perspective on the strengths and weaknesses of individual services and an opportunity to learn from peer services. Staff in 86% of the services identified issues that needed to be addressed and 64% of services had implemented one or more service improvement projects in response to shortcomings identified through the benchmarking exercise., Conclusions: The collection and reporting of performance data through a process of benchmarking was successful in facilitating service improvement in most of the participating facilities. Engaging services in all stages of the process was considered useful in converting benchmarking data into knowledge that was able to be applied at the local service level.

Background: Benchmarking of performance indicators in the mental health field is gaining currency in Australia as a strategy for improving service quality., Aim: To engage mental health service providers in the collection and evaluation of performance data., Methods: Three separate rounds of data collection involving high secure, extended treatment, and medium secure services were carried out between 2003 and 2005. Twenty-five core indicators were identified and these were used to assess service inputs, processes, outputs and outcomes., Results: Differences in casemix, clinical practice and local business rules gave rise to variation in service performance. The benchmarking exercise led to the implementation of quality improvement initiatives., Conclusions: It is possible and useful to collect and evaluate performance data for mental health services. While services appear similar enough to benchmark, information related to both casemix and service characteristics needs to be included in benchmarking data to understand the factors that produce differences in service performance.

Objective: To report on the development, testing and psychometric properties of a brief consumer satisfaction measure for use with psychiatric inpatients., Method: Focus group discussions with inpatients were used to develop a pool of items related to satisfaction with hospital stay. A second cohort of 72 inpatients was invited to rate the 51 items that emerged for importance in contributing to satisfaction. Mean importance scores highlighted 20 items that were subsequently framed into neutrally worded statements. A draft questionnaire comprising these statements was introduced, on a trial basis, in a range of inpatient facilities., Results: Factor analysis of 356 completed questionnaires yielded three factors comprising a staff-patient alliance; doctor/treatment issues; and an environmental component. Psychometric properties include good response variability and high internal consistency., Conclusions: The Inpatient Evaluation of Service Questionnaire addresses many of the shortcomings of existing satisfaction measures. It was developed through extensive consumer involvement, it is simply worded, easy to score and appears to perform well with acute and rehabilitation inpatients.

Dear Editor, Australia is introducing novel staffing approaches to public mental health services, including increased availability of Peer Support Workers (PSWs) and Non-Government Organisation (NGO) partnerships.[1],[2] While consistent with contemporary Australian mental health policy frameworks, these changes have been subject to limited research.[3] Transitional residential rehabilitation services, such as the Community Care Units (CCUs), have been a focus of these staffing innovations. Our re-analysis suggests that clinical staffing model CCUs may work with consumers experiencing more severe impairment than those operating the integrated staffing model. [Extracted from the article]

Objective:The aim of this study was to identify, at the time of admission, predictors of aggression in adults admitted to acute mental health care. Method:Adult patients (n = 350) consecutively admitted to the National Institute of Mental Health (NIMH) in Sri Lanka were assessed for a wide range of dispositional, historical, contextual and clinical factors associated with inpatient violence. Clinical factors were assessed using the Brief Psychiatric Rating Scale (BPRS), and risk of aggression using the Brøset Violence Checklist (BVC). All 350 patients were followed for 72 hours post-admission and observed for aggression using the Overt Aggression Scale. Results:Fifty-nine patients (16.8%) met criteria for aggression. Those in the aggressive group were younger, single and had caused harm to others or damaged property in the two weeks prior to admission. Aggressive patients were also more likely to exhibit symptoms of psychopathology (higher scores on the hostility-suspiciousness subscale of BPRS) and to have a higher total score on the BVC at the time of admission, than other patients. Conclusions:Of all of the risk factors considered at the time of admission, the BVC total score was the strongest predictor of aggression following admission. Indeed, the BVC was a more robust predictor of aggression in the post-admission period than a history of aggression preceding admission and psychopathology as measured by the BPRS. The finding supports the use of structured risk assessments for monitoring the risk of aggression in patients during the initial 72 hours post-admission. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to assess the utility of six measures of consumer outcomes: the Behaviour and Symptom Identification Scale, the Mental Health Inventory (MHI), the Medical Outcomes Study 36-Item Short-Form Survey, the Health of the Nation Outcome Scales, the Life Skills Profile (LSP) and the Role Functioning Scale previously recommended for the routine assessment in Australian mental health services. Method: Consumers and service providers were invited through focus group discussions and surveys to describe the perceived utility of these selected measures. Results: All six measures were rated favourably. The qualitative and quantitative findings suggest that the MHI elicited the most positive results of the consumer measures. No observer-rated scale was clearly preferred. Conclusion: The qualitative feedback obtained indicated that process and context issues may be as important to the successful use of routine instruments for the measurement of consumer outcomes in clinical practice as the choice of instrument. [ABSTRACT FROM AUTHOR]

To evaluate forensic and secure mental health services (FSMHS) staff’s confidence in managing workplace aggression, identify associated factors, and explore their workplace aggression prevention training needs.Through an online survey, staff rated their experience of workplace aggression, perceived effectiveness of current training, and confidence in responding to workplace aggression, and described training needs. Stepwise multiple regression was used to identify associated factors with statistical significance. Thematic analysis was used to generate themes describing their training needs.The staff perceived current training as low-to-medium in effectiveness, mirroring their confidence in managing workplace aggression. Nurses experienced more workplace aggression compared to other professions. Staff working at High Security perceived current training as less effective compared to those working at Medium Security or Low Security. Qualitative findings underscored the necessity for improved training content, methods, and supportive strategies.Recommendations for enhancing training include: tailoring training to FSMHS settings; equally focussing on both non-physical and physical intervention techniques; providing more scenario-based hands-on practice opportunities; delivering training in a reasonable trainer-trainee ratio; prioritising nurses and High Security staff and integrating other professions into the training framework; and implementing strategies that support staff, consumers, and environment to ensure training effectiveness and applicability. [ABSTRACT FROM AUTHOR]