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Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post-registration physical health-care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post-registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation., (© 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.)

Background: Violence and aggression is common in mental health care and physical restraint is used frequently. Control and restraint (general services) (C&R (GS)) and Strategies in Crisis Intervention and Prevention (SCIP) are often used. There had not been any study evaluating the outcomes of the different approaches of restraint method., Aim: To compare the effectiveness of C&R (GS) and SCIP., Method: A retrospective cohort study design was employed to compare the rates of disturbed incidents. The patients admitted to C&R (GS) and SCIP wards were investigated to study the effectiveness of the two approaches of physical restraint., Results: The study suggests that C&R (GS) achieved better outcomes than SCIP. Patients exposed to SCIP had longer hospitalisation, were involved in higher rate of incidents of disturbed behaviour; had lower survival and higher failure probabilities and a higher relative hazard ratio., Conclusions: There is a need to debate the evidence base of the various approaches currently used in physical intervention in the management of disturbed behaviour by mental health services providers. The better outcomes demonstrated by C&R (GS) challenges the current trend in and the value of mental health practice.

Background: Despite the high prevalence of co-morbid substance use among mental health service users (dual diagnosis), very few mental health workers in the UK have had training and/or clinical experience to equip them to deliver targeted interventions to this client group., Method: In a randomised controlled trial of training for dual diagnosis interventions, 79 case managers from 12 community mental health teams in South London were randomly allocated to either receive training and follow-up supervision (experimental group) or no training and supervision (control group). Baseline measures of attitude, self-efficacy and knowledge were collected prior to randomisation, and were repeated at 18 months post-training. An intention to treat analysis of follow-up data (adjusted for baseline score for that outcome and team) was performed., Results: At 18 months post-training, the AAPPQ (The Alcohol and Alcohol Problems Perception Questionnaire) total score was did not differ significantly between the two groups (adjusted difference 7.43 [95% CI -0.86 to 15.71], p = 0.08). There were significant differences in favour of the experimental group on 2 of the 6 subscales of the AAPPQ: 'adequacy of knowledge and skills in working with alcohol" (adjusted difference 3.598 [95% CI 1.03 to 6.16], p = 0.007) and "self-esteem in working with alcohol" (adjusted difference 3.00 [95% CI 0.46 to 5.54], p = 0.021). In addition there were significant improvements for the experimental group on "Knowledge About Dual Diagnosis" (adjusted difference 2.00 [95% CI 0.80 to 3.22], p = 0.002) and "Self-Efficacy Scale" (adjusted difference 13.55 [95% CI 8.00 to 26.86], p = 0.001). The effect of membership of teams was added to the analysis of covariance and this changed the results for only one variable: "self-esteem working with drinkers" was no longer significant., Conclusion: A brief training course in dual diagnosis interventions had a significant effect on secondary measures of knowledge and self-efficacy that was detectable at 18 months post-training. Improvements in attitudes towards working with drinkers and drug users in mental health settings failed to reach statistical significance. Future research should explore the effects of dose of dual diagnosis training, and the successful integration of skills gained into routine care., Trial Registration: ISRCTN98891022 14th March 2007.

Background: There is equivocal evidence of the effectiveness of adherence therapy in improving treatment adherence and clinical outcomes for people with schizophrenia., Aims: To evaluate the effectiveness of adherence therapy in improving quality of life for people with schizophrenia., Method: A 52-week, single-blind, multicentre randomised controlled trial of the effectiveness of adherence therapy. Participants were individually randomised to receive eight sessions of adherence therapy or health education. Assessments were undertaken at baseline and at 52-week follow-up., Results: Adherence therapy was no more effective than health education in improving quality of life., Conclusions: This effectiveness trial provides evidence for the lack of effect of adherence therapy in people with schizophrenia with recent clinical instability, treated in ordinary clinical settings.

Aims: The aim of this review was to assess whether restraint and seclusion are safe and effective interventions for the short-term management of disturbed/violent behaviour. Staff and service user perspectives on the use of these interventions were also considered. The review was undertaken as part of the development process for a national guideline on the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings and emergency departments in the United Kingdom., Method: An exhaustive literature search was undertaken. Systematic reviews, before and after studies, as well as qualitative studies were included. Searches were run from 1985 to 2002., Findings: Thirty-six eligible studies were identified. However, none were randomised controlled trials. Most of the included studies had many limitations, such as small sample sizes, confounders not adequately accounted for, potential selection bias, poorly reported results, and lack of clarity as to whether mechanical restraints were used. This review must therefore be viewed as a mapping exercise, which illustrates the range and quality of studies that have been undertaken in this area to date., Conclusions and Implications for Practice: Insufficient evidence is available to determine whether seclusion and restraint are safe and/or effective interventions for the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings. These interventions should therefore be used with caution and only as a last resort once other methods of calming a situation and/or service user have failed.

Background: Non-compliance attenuates the efficacy of treatments for physical and mental disorders., Aims: To assess the effectiveness of a medication management training package for community mental health nurses (CMHNs) in improving compliance and clinical outcomes in patients with schizophrenia., Method: Pragmatic randomised controlled trial. Sixty CMHNs in geographical clusters were assigned randomly to medication management training or treatment as usual. Each CMHN identified two patients on their case-load who were assessed at baseline and again after 6 months by a research worker. The primary efficacy outcome of interest was psychopathology, measured using the Positive and Negative Syndrome Scale (PANSS)., Results: Nurses who had received medication management training produced a significantly greater reduction in patients'overall psychopathology compared with treatment as usual at the end of the 6-month study period (change in PANSS total scores: medication management -16.62, treatment as usual 1.17; difference -17.79; 95% CI -24.12 to -11.45; P<0.001)., Conclusions: Medication management training for CMHNs is effective in improving clinical outcomes in patients with schizophrenia.

Phobias are anxiety disorders that can have a significant impact on a person's lifestyle, due to the distress and symptoms suffered. This article discusses the characteristics, assessment and treatment of the three classified phobias, as well as self-help interventions.

Objective: Implementation of the National Mental Health Strategy has important implications for education and training of the Australian mental health workforce. This paper discusses relevant developments in the United Kingdom that may provide some lessons for Australia., Method: A review was undertaken of a number of specific clinical education and training programs for mental health workers in the United Kingdom which have been subjected to published evaluation., Results and Conclusions: A finite mental health resource base dictates that education and training activity should: (i) be evaluated; (ii) target those clients most in need; (iii) include evidence-based approaches such as assertive community treatment, medication management, cognitive-behaviour therapy and family interventions; and (iv) prepare mental health workers in the core competencies needed to implement these approaches. Two programs, developed in the United Kingdom, which meet these criteria are presented as examples of best practice: the nurse therapy model established by Isaac Marks; and the Thorn initiative established in association with the Institute of Psychiatry, London and the University of Manchester.

The Thorn Initiative started life as an educational programme focusing on community psychiatric nurses. From the beginning its teaching has been multidisciplinary and at present its students come from a variety of backgrounds. This article describes the rationale for the initiative and describes its progress and impact on those who experience severe mental health problems and their families.

This article discusses the characteristics of people with obsessive compulsive disorder (OCD), their assessment, treatment and the increasing importance of self-help.

In 1995 the Sainsbury Centre for Mental Health commissioned a major review of all specialist mental health training. The current, largely uni-disciplinary approach to training was felt to be failing to equip professionals with the necessary skills for today's multi-disciplinary, integrated, community-based service, where users and their carers expect an equal partnership and sharing of information. Kevin Gournay and Susannah Strong outline the findings and recommendations of the review, and its implications for mental health nurse education, which make a case for its separation from the rest of the nursing profession.

This study aimed to compare the ability of practice nurses in two groups of general practices to detect psychological distress in patients attending their clinics. Practice nurses in Britain are employed directly by general practitioners (GPs) and carry out their duties mainly in treatment rooms in GP's practices. The number of practice nurses has increased rapidly since the mid-1970s; recent estimates put the total between about 15000 and 18000. Most psychiatric disorders that come to medical attention do so initially within a primary care setting. In Britain, 98% of the population is registered with a GP and 70% of these people will consult their doctor in a given year. In the early 1990s the WHO found a 24% prevalence of current mental disorder in users of general health care. A further 9% of patients had significant and/or disabling symptoms but did not reach the threshold criteria for a confirmed diagnosis of mental disorder. Although published reports of surveys of practice nurses have shown varying degrees of involvement in mental health care, it is thought to be important that they become agents of detection of mental health problems because these nurses are in contact with a wide range of vulnerable people. Armstrong (1994) found that informants in a survey thought that practice nurses needed additional training in three main areas of mental health care: recognition followed by appropriate referral and on-going care of people with depression and anxiety; primary prevention of depression; and care in the community for people with serious long-term mental illness. The study briefly reported here measured practice nurses' detection of mental health problems. Results showed that practice nurses detect about 23% of those identified as cases using the General Health Questionnaire (GHQ). Testing of agreement between nurses and patients using Cohen's (1960) kappa showed a low level of agreement between nurses and patients concerning psychological distress.

A cognitive behavioural model of body image is presented with specific reference to body dysmorphic disorder (BDD). We make specific hypotheses from the model for testing BDD patients in comparison with: (i) patients with "real" disfigurements who seek cosmetic surgery; (ii) subjects with "real" disfigurements who are emotionally well adjusted; and (iii) healthy controls without any defect. There have been no randomised controlled trials of treatment for BDD and therefore the model has clear implications for the development of cognitive behavioural therapy. This was evaluated in a pilot controlled trial. Nineteen patients were randomly allocated to either cognitive behaviour therapy or a waiting list control group over 12 weeks. There were no significant pre-post differences on any of the measures in the waiting list group. There were significant changes in the treated group on specific measures of BDD and depressed mood. Cognitive behaviour therapy should be further evaluated in a larger controlled trial in comparison with another psychological treatment such as interpersonal therapy and pharmacotherapy.

The role of the nurse in the management and treatment of manic depression comprises social, psychological and pharmacological interventions. Achieving a balance is crucial to the management of this serious disorder and nurses are ideally placed to help in this.

A clinical standards advisory group spent more than two years developing a protocol for assessing standards of care for people with a diagnosis of schizophrenia. The results of its site visits have major implications for nursing practice. There is a clear need for attention to be paid to physical health, medication management and the greater involvement of users and carers. Training in psychosocial interventions needs to be developed as a matter of urgency.

Anxiety states affect millions of people in the UK and as such constitute a major public health problem. Specialist mental health nurses can provide very effective treatments for a range of some of the most severe of these conditions. However, because of the prevalence of anxiety, all nurses should know something of their nature and management.

Recent research using brain imaging and molecular biological methods has clarified our knowledge about the cause of schizophrenia. The picture emerging is of a group of illnesses with their origins in neurodevelopmental abnormalities. The most severe forms of schizophrenia are accompanied by defects in memory and attention. There are several implications of this new knowledge for nursing. Our current nursing models are less than adequate and represent outdated and discredited theory. Additionally we must consider new ways of working with people who have what are essentially brain diseases. However, it is also clear that social and psychological factors are crucial in determining outcome and quality of life for people with schizophrenia and their families. The Thorn Programme, which trains nurses in case management and various psychosocial interventions, exemplifies the way forward for mental health nursing and such developments will secure a place for the profession in the services of the future.

The aim of this study was to investigate the community psychiatric nursing (CPN) process with non-psychotic patients and to relate various constructs of the initial assessment interview to final patient outcome. The overall purpose of the research was to provide future directions for CPN training. This study used a repeated measures design, assessing patients at pre- and post-intervention on various scales to obtain outcome data. These clients were referred by general practitioners to community psychiatric nurses working in primary health care settings. The first contact session was video recorded (n = 8). Process measures were derived from these recordings using two independent expert raters using several process measures. Anxiety, depression and 'psychiatric caseness' indices all related to various process constructs (R(s) > or = 0.69). These results are based on correlations of a small sample, and the evidence suggests that a poor initial interview has a negative weighting on patient outcomes. This first interview may be related to the CPN skill base. CPN training may need to incorporate a module on structured assessment techniques. This study concludes that it is possible to conduct action research successfully within this field.

The review of mental health nursing recommends a shift of focus to serious mental illness. To meet the challenge, mental health nurses need to acquire skills in case management and psychosocial interventions. There have been some excellent developments in nursing education and practice, including the Thorn programme. However, there are still several areas in which action is needed. Pre-registration training needs an urgent and radical overhaul. Today's generation of CPNs should abandon their work with patients with neuroses and be helped to acquire expertise in case management and medication monitoring. Lecturing staff also need to undergo change to a more clinically-focused role and abandon some redundant ideologies.

The potential benefits to psychiatric nursing of the new science of health economics are explored in this article, which stems from more extensive research carried out by the authors. It is suggested that an analysis of the relationship between costs and clinical outcomes of community psychiatric nursing interventions will enable an objective ratification of the costs and benefits of treatment to emerge. The new discipline must be incorporated into evaluative research processes to allow psychiatric nursing to have an influence over future changes in health care provision.

There are no systematic studies of the failure of psychiatric nursing interventions and few very such studies in the psychological/psychiatric outcome literature. This study reports a controlled study of exposure treatment with agoraphobic clients who were treated by nurse therapists and psychologists. This includes an analysis of the four categories of treatment failure (i.e. treatment refusers, treatment dropouts, failures and relapsers). The analysis consisted of an examination of the outcome data of clients who met a priori criteria for the categories of failure and an examination of questionnaire responses. The results have implications for psychiatric nursing practice, particularly with regard to preparation for treatment. Additionally, the results indicate that much more research needs to be carried out on treatment methods and that exposure alone produces a significant but limited effect. Finally, the paper suggests that outcome research is a priority in psychiatric nursing.

This study examines, using a randomised control trial, the question of the optimum base for exposure treatment with agoraphobic clients. The results have relevance for community psychiatric nurses and nurse behaviour therapists working with such problems and indeed for other behavioural practitioners. While the results confirm the already extensive evidence for the efficacy of exposure in vivo for agoraphobic clients, the results show that in general there is no difference between outcome of treatment delivered from the patient's own home and the out-patient clinic. There are, however, a small number of clients who will not attend psychiatric out-patient clinics for treatment but who will subsequently do well with home-based treatment. The reasons for the experimental findings and implications for psychiatric nurses are discussed.

A formulation of agoraphobia is presented in personal construct theory terms. It is hypothesized that the construing of agoraphobics and their spouses is characterized by low cognitive awareness of constructs concerning interpersonal conflict and lack of tenderness; by dilemmas in which the ability to go out implies possible infidelity; and by low self-esteem in the agoraphobic and high self-esteem in their spouse. Evidence in support of these hypotheses is provided by a repertory grid study comparing agoraphobics, non-agoraphobic neurotics, spouses of both client groups, and normal subjects. Features of construing of agoraphobic and spouse are shown to be predictive of the agoraphobic's response to behaviour therapy, and therapeutic improvement to be associated with some reconstruction in the above areas. The role of mutual validation of constructions between agoraphobic and spouse in the maintenance of agoraphobic behaviour is discussed, as are implications for the treatment of agoraphobia.