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Background. Paramedic students frequently face various stressful and challenging situations as they work in emergency medical settings. Currently, research studies on utilizing meditation courses as a part of the curriculum to improve the mental health of paramedic students in Korea are lacking. Methods. For this quasiexperimental study, a nonequivalent group pretest and post-test research design was used. The study sample comprised 55 paramedic students from two similar-sized universities in different locations: 27 in the experimental group and 28 in the control group. The experimental group participated in an eight-week meditation course, while the control group did not receive any interventions during the same time period. Results. The results indicated that compared with the control group, the experimental group had significantly decreased anxiety ( p = 0.047 ) and stress levels ( p = 0.044 ) and improved sleep quality ( p = 0.041 ). The change in depression levels did not significantly differ between the groups ( p = 0.419 ). Conclusions. The inclusion of a meditation course within college curriculums for paramedic students is feasible and may benefit students in terms of stress, anxiety, and sleep quality.

Providing therapist‐guided cognitive behaviour therapy via the Internet (ICBT) has advantages, but a central research question is to what extent similar clinical effects can be obtained as with gold‐standard face‐to‐face cognitive behaviour therapy (CBT). In a previous meta‐analysis published in this journal, which was updated in 2018, we found evidence that the pooled effects for the two formats were equivalent in the treatment of psychiatric and somatic disorders, but the number of published randomized trials was relatively low (n=20). As this is a field that moves rapidly, the aim of the current study was to conduct an update of our systematic review and meta‐analysis of the clinical effects of ICBT vs. face‐to‐face CBT for psychiatric and somatic disorders in adults. We searched the PubMed database for relevant studies published from 2016 to 2022. The main inclusion criteria were that studies had to compare ICBT to face‐to‐face CBT using a randomized controlled design and targeting adult populations. Quality assessment was made using the Cochrane risk of bias criteria (Version 1), and the main outcome estimate was the pooled standardized effect size (Hedges’ g) using a random effects model. We screened 5,601 records and included 11 new randomized trials, adding them to the 20 previously identified ones (total n=31). Sixteen different clinical conditions were targeted in the included studies. Half of the trials were in the fields of depression/depressive symptoms or some form of anxiety disorder. The pooled effect size across all disorders was g=0.02 (95% CI: –0.09 to 0.14) and the quality of the included studies was acceptable. This meta‐analysis further supports the notion that therapist‐supported ICBT yields similar effects as face‐to‐face CBT.

The field of psychiatry is hampered by a lack of robust, reliable and valid biomarkers that can aid in objectively diagnosing patients and providing individualized treatment recommendations. Here we review and critically evaluate the evidence for the most promising biomarkers in the psychiatric neuroscience literature for autism spectrum disorder, schizophrenia, anxiety disorders and post‐traumatic stress disorder, major depression and bipolar disorder, and substance use disorders. Candidate biomarkers reviewed include various neuroimaging, genetic, molecular and peripheral assays, for the purposes of determining susceptibility or presence of illness, and predicting treatment response or safety. This review highlights a critical gap in the biomarker validation process. An enormous societal investment over the past 50 years has identified numerous candidate biomarkers. However, to date, the overwhelming majority of these measures have not been proven sufficiently reliable, valid and useful to be adopted clinically. It is time to consider whether strategic investments might break this impasse, focusing on a limited number of promising candidates to advance through a process of definitive testing for a specific indication. Some promising candidates for definitive testing include the N170 signal, an event‐related brain potential measured using electroencephalography, for subgroup identification within autism spectrum disorder; striatal resting‐state functional magnetic resonance imaging (fMRI) measures, such as the striatal connectivity index (SCI) and the functional striatal abnormalities (FSA) index, for prediction of treatment response in schizophrenia; error‐related negativity (ERN), an electrophysiological index, for prediction of first onset of generalized anxiety disorder, and resting‐state and structural brain connectomic measures for prediction of treatment response in social anxiety disorder. Alternate forms of classification may be useful for conceptualizing and testing potential biomarkers. Collaborative efforts allowing the inclusion of biosystems beyond genetics and neuroimaging are needed, and online remote acquisition of selected measures in a naturalistic setting using mobile health tools may significantly advance the field. Setting specific benchmarks for well‐defined target application, along with development of appropriate funding and partnership mechanisms, would also be crucial. Finally, it should never be forgotten that, for a biomarker to be actionable, it will need to be clinically predictive at the individual level and viable in clinical settings.

Evolutionary biology provides a crucial foundation for medicine and behavioral science that has been missing from psychiatry. Its absence helps to explain slow progress; its advent promises major advances. Instead of offering a new kind of treatment, evolutionary psychiatry provides a scientific foundation useful for all kinds of treatment. It expands the search for causes from mechanistic explanations for disease in some individuals to evolutionary explanations for traits that make all members of a species vulnerable to disease. For instance, capacities for symptoms such as pain, cough, anxiety and low mood are universal because they are useful in certain situations. Failing to recognize the utility of anxiety and low mood is at the root of many problems in psychiatry. Determining if an emotion is normal and if it is useful requires understanding an individual's life situation. Conducting a review of social systems, parallel to the review of systems in the rest of medicine, can help achieve that understanding. Coping with substance abuse is advanced by acknowledging how substances available in modern environments hijack chemically mediated learning mechanisms. Understanding why eating spirals out of control in modern environments is aided by recognizing the motivations for caloric restriction and how it arouses famine protection mechanisms that induce binge eating. Finally, explaining the persistence of alleles that cause serious mental disorders requires evolutionary explanations of why some systems are intrinsically vulnerable to failure. The thrill of finding functions for apparent diseases is evolutionary psychiatry's greatest strength and weakness. Recognizing bad feelings as evolved adaptations corrects psychiatry's pervasive mistake of viewing all symptoms as if they were disease manifestations. However, viewing diseases such as panic disorder, melancholia and schizophrenia as if they are adaptations is an equally serious mistake in evolutionary psychiatry. Progress will come from framing and testing specific hypotheses about why natural selection left us vulnerable to mental disorders. The efforts of many people over many years will be needed before we will know if evolutionary biology can provide a new paradigm for understanding and treating mental disorders.

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals’ health, well‐being, and social functioning. Long‐lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self‐awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability for or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. SUDs are treatable, and evidence of clinically significant benefit exists for medications (in opioid, nicotine and alcohol use disorders), behavioral therapies (in all SUDs), and neuromodulation (in nicotine use disorder). Treatment of SUDs should be considered within the context of a Chronic Care Model, with the intensity of intervention adjusted to the severity of the disorder and with the concomitant treatment of comorbid psychiatric and physical conditions. Involvement of health care providers in detection and management of SUDs, including referral of severe cases to specialized care, offers sustainable models of care that can be further expanded with the use of telehealth. Despite advances in our understanding and management of SUDs, individuals with these conditions continue to be stigmatized and, in some countries, incarcerated, highlighting the need to dismantle policies that perpetuate their criminalization and instead develop policies to ensure support and access to prevention and treatment.

Most acute phase antipsychotic drug trials in schizophrenia last only a few weeks, but patients must usually take these drugs much longer. We examined the long‐term efficacy of antipsychotic drugs in acutely ill patients using network meta‐analysis. We searched the Cochrane Schizophrenia Group register up to March 6, 2022 for randomized, blinded trials of at least 6‐month duration on all second‐generation and 18 first‐generation antipsychotics. The primary outcome was change in overall symptoms of schizophrenia; secondary outcomes were all‐cause discontinuation; change in positive, negative and depressive symptoms; quality of life, social functioning, weight gain, antiparkinson medication use, akathisia, serum prolactin level, QTc prolongation, and sedation. Confidence in the results was assessed by the CINeMA (Confidence in Network Meta‐Analysis) framework. We included 45 studies with 11,238 participants. In terms of overall symptoms, olanzapine was on average more efficacious than ziprasidone (standardized mean difference, SMD=0.37, 95% CI: 0.26‐0.49), asenapine (SMD=0.33, 95% CI: 0.21‐0.45), iloperidone (SMD=0.32, 95% CI: 0.15‐0.49), paliperidone (SMD=0.28, 95% CI: 0.11‐0.44), haloperidol (SMD=0.27, 95% CI: 0.14‐0.39), quetiapine (SMD=0.25, 95% CI: 0.12‐0.38), aripiprazole (SMD=0.16, 95% CI: 0.04‐0.28) and risperidone (SMD=0.12, 95% CI: 0.03‐0.21). The 95% CIs for olanzapine versus aripiprazole and risperidone included the possibility of trivial effects. The differences between olanzapine and lurasidone, amisulpride, perphenazine, clozapine and zotepine were either small or uncertain. These results were robust in sensitivity analyses and in line with other efficacy outcomes and all‐cause discontinuation. Concerning weight gain, the impact of olanzapine was higher than all other antipsychotics, with a mean difference ranging from –4.58 kg (95% CI: –5.33 to –3.83) compared to ziprasidone to –2.30 kg (95% CI: –3.35 to –1.25) compared to amisulpride. Our data suggest that olanzapine is more efficacious than a number of other antipsychotic drugs in the longer term, but its efficacy must be weighed against its side effect profile.

Increased public concern over policing and the psychological impact of trauma-associated events by first responders have highlighted a critical need to improve the availability of mental health and wellness resources for law enforcement officers. The national Officer Safety and Wellness Group prioritized mental health, alcohol use, fatigue, and body weight/poor nutrition as targets for safety and wellness initiatives. Departmental culture will need to change from silence and fear-driven hesitancy to a culture of openness and support. Increased education, openness, and support for mental health will likely reduce stigma and improve access to care. Psychiatric–mental health nurse practitioners and other advanced practice nurses who wish to work with law enforcement officers should be aware of the specific health risks and standards of care that are summarized in this article. [ Journal of Psychosocial Nursing and Mental Health Services, xx (x), xx–xx.]

Occupational stressors are causing unprecedented levels of stress, depression, and suicide among our nation's farmers, and little is known about how farmers view their personal stress and potential stress-relieving strategies. The current study used a descriptive qualitative approach to conduct focus groups comprising farmers and farm family members ( N = 26). Participants were recruited using a snowball approach based on the investigators' connections to farming communities. Preliminary analysis indicates that primary stressors are: lack of control over many aspects of farming and the public's lack of understanding/appreciation for farming. In addition, two communities identified high levels of anticipatory stressors. Despite these stressors, they continue to farm because of their love for farm life and their generational connection with the land. To decrease farmer stress, participants suggested educating the public about farm life and the impact farming has on the general public, creating social groups for farmers to talk to each other, and sharing the farmer story. [ Journal of Psychosocial Nursing and Mental Health Services, xx (x), xx–xx.]

Psychotherapy is well-established as an effective treatment for major depressive disorder (MDD). However, many individuals with MDD in rural areas of the United States do not have access to psychotherapy. Self-management (SM) strategies are now the standard of care for chronic medical conditions and may be a viable alternative for individuals without access to psychotherapy. The current article describes the implementation of a 13-week pilot project to integrate digital cognitive-behavioral therapy (dCBT) SM programs into routine psychiatric advanced practice nurse (APN) telehealth appointments in the rural United States. Eight participants completed the project. The project did not meet the benchmark of 20 participants to improve access to treatment; however, one half ( n = 4) of participants reported clinically significant improvement in MDD symptoms over 6 weeks. For clients without access to psychotherapy, dCBT SM programs can be effective in improving individual client outcomes when implemented by APNs in routine telehealth appointments. [ Journal of Psychosocial Nursing and Mental Health Services, xx (x), xx–xx.]

Alcohol use disorder (AUD) accounts for high rates of global deaths, disability, and health care spending. Naltrexone is an opioid antagonist used to reduce alcohol cravings. Despite demonstrated safety and efficacy, naltrexone is highly under-utilized in a variety of health care settings. The current quality improvement (QI) project aimed to increase knowledge and prescribing behaviors of naltrexone. A chart review of a purposive convenience sample was performed to determine the impact of the intervention. Staff participants completed a pre/posttest and a post-module survey. The primary objectives of the QI project were to increase the number of patients with AUD discharged with a prescription for naltrexone by 5% and achieve 50% staff participation in the online module, pre/posttest, and post-module survey. [ Journal of Psychosocial Nursing and Mental Health Services, xx (x), xx–xx.]

Purpose Digital mental health interventions (DMHIs) are promising alternatives to traditional face-to-face psychological interventions to improve psychological outcomes in various chronic health conditions. However, their efficacy among people with diabetes is yet to be established. Therefore, this narrative review aims to identify the importance and need for evidence-based research on DMHIs targeting the psychological outcomes in people with diabetes. Design/methodology/approach Using a narrative review approach, this study highlights the technological advancements in diabetes health care and identifies a need for developing DMHIs for people with diabetes. Findings DMHIs are promising for improving psychological outcomes in people with diabetes. However, there is a need for further rigorous, controlled and high-quality diabetes-focused studies, to make firm conclusions on the effectiveness and appropriateness of DMHIs for patients with diabetes. This review also suggests that DMHIs based on psychological theories and studies with higher quality methodologies are also needed. Originality/value This review highlights the contemporary literature on diabetes and related technological advancements. The findings of this study serve as a basis of the improvement of policy on digital mental health services for people with diabetes, to impact the global burden of the disease.

Anxiety disorders are among the most common mental health conditions affecting pediatric populations. The Diagnostic and Statistical Manual of Mental Disorders , 5th edition, recommends objective measurement of pediatric anxiety for evaluation of symptomatology and treatment response. The objective of the current review was to summarize recommendations and resources for measuring pediatric anxiety, and to quantify and characterize use of outcome measures for generalized anxiety in pediatric psychiatry. These findings represent an essential step toward understanding how and to what extent anxiety rating scales are used in pediatric psychiatry and where quality improvement initiatives may be needed. Education, training, and further research are warranted to optimize use of measurement-based care for generalized anxiety in pediatric psychiatry settings and to determine which scales are optimal for use in this context. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (5), 11–16.]

The immune system is central to brain health and longevity, yet with age, infection, injury, or chronic stress, the immune system can trigger persistent central nervous system inflammation that impairs brain functioning. This brief review investigates psychopharmacological treatments that have anti-inflammatory effects in the context of immune system dysregulation in the aging brain. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (5), 7–10.]

In the current study, we conducted one-on-one interviews with primary care providers (PCPs) and family care partners (FCPs) and held focus groups with interdisciplinary adult day service center (ADSC) staff to understand the perspectives of care providers across community settings regarding early warning signs of acute illnesses in persons living with dementia (PLWD). We used content analysis to analyze qualitative data. Warning signs of acute illnesses in PLWD fell into one of five categories, including new onset changes in (a) physical functions, (b) moods or behaviors (psychological), (c) social interactions, (d) speech, or (e) appearance. FCPs ( n = 11) focused on physical changes, whereas ADSC staff ( n = 33) emphasized changes in speech and social interactions in addition to the other categories. Although ADSC staff and PCPs ( n = 22) focused on changes in functions and moods, each group described these changes differently. ADSC staff possess rich information that can be used to identify acute changes in PLWD and describe a broader range of warning signs compared to PCPs and FCPs. FCPs may benefit from further training in distinguishing between normal disease progression and acute illness. Future research should focus on the implementation of standardized tools across community-based care providers to simplify the identification and reporting of early warning signs in PLWD. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (5), 35–43.]

The current cross-sectional study aimed to examine the relationship between social support, fear, and psychological distress among frontline nurses during the coronavirus disease 2019 (COVID-19) pandemic. Participants from 20 wards for adult patients from public and private hospitals in Indonesia were recruited. The Fear of COVID-19 Scale, Job Stress Scale, and Perceived Social Support Questionnaire were used to measure outcomes of interest. Questionnaires were completed by a total of 211 nurses. High risk working unit, higher fear score, younger age, less working experience, and less social support were significant influences on nurses' psychological distress. Social support as a modifiable factor is a potential target for intervention strategies to manage psychological issues among nurses. Findings can help policymakers and managers better understand how to support frontline nurses' psychological health and maintain well-engaged nursing staff. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (5), 53–58.]

Purpose The changing clinical landscape in psychiatry, both before and after the pandemic, has impacted students’ direct contact with psychiatric patients. It is imperative, therefore, that medical education keeps pace with evolving clinical pathways to ensure that clinicians are always appropriately trained not just for common presentations but also for low-prevalence, high-risk situations. Simulated-based training is well established. However, it is not without its limitations, many of which could be overcome with the use of virtual simulation. This study aims to analyse the use of virtual simulation within medical education to train clinicians in psychiatric assessments. Design/methodology/approach A scoping review was undertaken with a comprehensive literature search of the six most relevant online peer-reviewed databases, including PubMed, PsycINFO, CINAHL, Medline, EMBASE and Cochrane. All published papers in English that discussed simulation in teaching psychiatric assessments were included. Findings Virtual patients can be used for educational, diagnostic and therapy purposes attributable to advances in speech-recognition technology. Virtual simulations are well received and positively affect clinicians’ knowledge and skill development. Educational faculties should consider using virtual simulation technologies to improve learning outcomes. Further studies should enhance the fidelity and quality of virtual assessment simulation situations, mainly focusing on the virtual patient’s empathy, gesturing and body language to enable this evidence-based tool to be used effectively and efficiently for the benefit of future patient care. Originality/value The changing clinical landscape in psychiatry, both before and after the pandemic, has impacted students’ direct contact with psychiatric patients. This scoping review has reviewed the use of virtual simulation-based education to train clinicians for psychiatric assessments. To the best of the authors’ knowledge, this work has not been conducted before.

Purpose One of the recommendations in process-based cognitive therapies suggests that functional analysis created by the clinician should be supported by empirical data collected through daily sampling. It enables the computing of a dynamic network of psychological processes and symptoms supporting clinical decisions but also therapeutic progress monitoring. However, the experience sampling solutions available in the market do not enable the automatic creation of this kind of network; thus, the use of this approach in clinical practice is practically impossible without advanced statistical skills and significant time investment. The purpose of the present paper is to describes a protocol of a research project based on a participatory approach aiming to create a solution enabling therapists not only to set up a personalized daily sampling for their patients and collect the data but also providing a fully automated visualization of the network adapted for therapeutic purposes. Design/methodology/approach The project will require creating a platform for therapists where they can set up monitoring and receive dynamic networks visualization, creating an experience sampling application for patients connected to the platform and creating an optimal data visualization system that will enable therapists to accurately and quickly interpret the network. A series of participatory workshops, qualitative and quantitative studies are described. Findings The presented studies will enable us to evaluate the ergonomy of use of both platform and app in laboratory and ecological settings along with the evaluation of network interpretation accuracy. Originality/value To the best of the authors’ knowledge, this is the first participatory design protocol for creating a solution that might enable clinicians to use a dynamic network approach in their everyday clinical practice. The challenges and opportunities of creating this kind of mHealth solution are discussed.

Objective. This study aims to explore the mediation role of perceived stress between nonrestorative sleep (NRS) and emotional distress, as well as the moderation role of resilience among NRS, perceived stress, and emotional distress in university students. Method. We recruited 851 students from the Be Resilient to Nursing Career program (BRNC, registration number: NFYKDX002) in June 2022. Nonrestorative sleep scale (NRSS), 10-item perceived stress scale (PSS-10), 10-item Kessler psychological distress scale (K10), and 10-item Connor–Davidson resilience scale (CD-RISC-10) were administered through a paper questionnaire. Latent profile analysis and moderated mediation analysis were performed. Results. Three profiles of perceived stress were identified: high ability-low stress (24.5%), middle ability-high stress (65.0%), and low ability-middle stress (10.5%). The mediation role of perceived stress between NRS and emotional distress was significant (SE = 0.025; 95% confidence interval = −0.369, −0.269). The moderation role of resilience among NRS, perceived stress, and emotional distress was not significant. Conclusion. Heterogeneity exists in freshmen students’ perceived stress. Perceived stress plays a significant mediating role between NRS and emotional distress, while resilience cannot significantly moderate the associations among NRS, perceived stress, and emotional distress. The trial is registered with ChiCTR2000038693.

Background/ObjectivesMoving into a nursing home is often an unavoidable life event for older people living with dementia. It is associated with negative emotions and outcomes. Research capturing their perspectives is scarce. This study aims to identify how older people living with dementia perceive a potential life in a nursing home and to understand their (future) care wishes.Materials and methodsThis study is part of the European TRANS-SENIOR research network. The study followed a qualitative phenomenological methodology. Semi-structured interviews with 18 community-dwelling older people living with dementia were conducted between August 2018 and October 2019 (METCZ20180085). A stepwise interpretive phenomenological analysis was performed.ResultsThe majority of community-dwelling older people feared the idea of potentially moving to a nursing home. The participants associated a possible move with negative perceptions and emotions. Additionally, this study emphasized the importance of knowledge of current and past experiences with care when identifying the participant's wishes. They wanted to remain (a) individuals, who are (b) autonomous and have (c) social contacts if they would move to a nursing home.Discussion/ImplicationsThis study showed how past and current care experiences can educate/inform healthcare professionals on the future care wishes of older people living with dementia. The results indicated that listening to the wishes, and life stories of people living with dementia could be a way of identifying 'a suitable time' to suggest a move to a nursing home. This could improve the transitional care process and adjustment to living in a nursing home.

Purpose The aim of this research is to gain an insight into the attitudes that therapists, both qualified and trainee, have towards the use of artificial intelligence (AI)/machine therapy in therapeutic practice. The paper also aims to gain an insight into attitudes towards machine therapy and the potential of developing a therapeutic alliance with a machine therapist. Design/methodology/approach A short questionnaire was developed to gauge therapists and trainee therapists’ attitudes towards machine therapy. The questionnaire included a scenario for participants to read and then respond to questions on the therapeutic alliance using questions based upon those asked on the working alliance short inventory scale. At the end of the questionnaire, there was also the opportunity for participants to respond to an open-ended question. Findings It is evident from the responses that there is a clear reservation about the use of AI technology within the therapeutic setting. In spite of this reticence, many participants recognised the potential and are open to the possibilities this technology can bring. It was notable that the therapists largest concern was about the potential to create a strong bond with a machine therapist. Originality/value This paper presents findings on therapists’ attitudes towards AI use within therapeutic practice and machine therapy. Whilst limited in scope, it provides a yardstick for considering the way that attitudes towards these emerging technologies might change in the future.

Purpose. Individuals with attention deficit and hyperactivity disorder (ADHD) have experienced exacerbated symptoms and negative effects during the pandemic on both physical and mental health. However, the leading global news websites did not cover the vulnerabilities and special needs of individuals with ADHD in the context of the neurodiversity approach. I argue that both cnn.com and bbc.com did not incorporate the neurodiversity approach aiming to increase acceptance and inclusion of the differences without viewing them as deficits. Methods. The present study explores online news media portrayal of ADHD during the COVID-19 pandemic through content analysis between March 2020 and October 2022. The news articles mentioning ADHD (64 from bbc.com and 56 from cnn.com) were analyzed. Results. Findings show that ADHD was dominantly framed as a medical issue, far from the neurodiversity perspective. Only 13 news articles among 64 (approximately 20%) on bbc.com and 4 among 56 (less than 10%) on cnn.com incorporated the neurodiversity approach that would benefit both individuals with ADHD and the whole society during the pandemic. Practice Implications. The findings show a need for more awareness of neurodiversity in the news media and a broader coverage of ADHD-related neurodiversity during the pandemic.

Purpose New patient safety frameworks are being implemented to improve the impact of incident reporting and management across the National Health Service (NHS) in England. This study aims to examine the current practices in this domain of patient safety in a sample of mental health trusts, a setting in which limitations in the current practice of serious incident management have been reported. The authors present key recommendations to maximise the opportunities to improve current incident reporting and management practice. Design/methodology/approach Ethical approval for the study was granted. A Web-based questionnaire was designed to examine current practices concerning incident reporting and management. It was refined based on consultation. Patient safety incident managers within mental health trusts in England were recruited. Twenty-nine mental health trusts responded, from a total of 51. The questionnaire study data were analysed in Statistical Package for the Social Sciences. Findings Current approaches used to report and manage incidents have been established and variation in practice demonstrated. A key finding for attention is that the training and education that investigators of serious incidents receive falls short of the recommended minimum national standard of 15 h, with a sample mean of 10.3 h and median of 8.0 h. Originality/value Recommendations at a local and national level are presented, which, if implemented, can maximise the impact of incident reporting and management practices in mental health trusts. Future qualitative research is indicated, to understand the perceptual experience and meaning behind the findings across a wider group of stakeholders.