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Aim To explore attitudes and confidence in professional competence of home nurses concerning depression and to evaluate the capacity of a minimal intervention in helping home nurses to detect depression in patients and their family caregivers. Background Long-term ill patients have an elevated risk to develop comorbid depression, as do their family caregivers. However, most primary care providers have little training to detect patients at risk. A minimal intervention to help home nurses detect symptoms of depression was therefore evaluated. Design Quasi-experimental field study with pre-measures, postmeasures and follow-up measures. Methods From the Fall of 2012-Spring of 2013, home nurses ( N = 92) in three regions in Antwerp (Belgium) were assigned to a 1-hour intervention (consisting of information, skill training and discussion; N = 63) or to a control condition ( N = 29). The Depression Attitude Questionnaire and the Morris Confidence Scale were completed before the intervention and 3 and 7 months afterwards. For 3 months, the number of detections of depression in patients in each region was monitored. Findings No significant changes were found in attitude or confidence in professional competences, except for a decline in the role attitude for home nurses in the intervention group. Home nurses who followed the intervention did detect significantly more depressed patients compared with controls. Conclusion These findings suggest that a minimal intervention can allow home nurses to be more responsive to symptoms of depression in patients and their family caregivers. The implications of these findings are discussed and suggestions for future research are made. [ABSTRACT FROM AUTHOR]

Abstract: Background: Community facilitators (CFs), such as teachers, nurses and social workers, are well placed as gatekeepers for depression and suicidal behavior, but not properly prepared to provide preventive and supportive services. The current study aimed: (1) to improve CFs’ attitudes toward depression, knowledge on suicide, and confidence to detect suicidal behavior in four European countries and (2) to identify specific training needs across regions and CF groups. Methods: A standardized training program was provided to 1276 CFs in Germany, Hungary, Ireland, and Portugal. Attitudes toward depression, knowledge about suicide, and confidence in identifying suicidal persons were assessed before training, after training, and at three to six months follow-up. Additionally, several participants’ characteristics were registered. Results: At baseline, CFs showed relatively favorable attitudes toward depression, but limited knowledge on suicide, and little confidence to identify suicidal behavior. Basic skills strongly differed across CF groups and countries. For example, in Germany, carers for the elderly, nurses, teachers, and managers were most in need of training, while in Portugal pharmacists and the clergy appeared to be important target groups. Most importantly, the training program improved the competencies of CF groups across countries and these improvements were sustained after three to six months. CFs with low basic skills benefited most of the training. Limitations: The observed training effects could be influenced by other external factors as our results are based upon a pre–post comparison with no control group. Conclusions: Gatekeeper trainings in community settings are successful in improving knowledge, reshaping attitudes, and boosting the confidence of gatekeepers. The most effective strategy to achieve the preferred objectives is to target those CF groups that are most in need of training and to tailor the content of the training program to the individual needs of the target group. [Copyright &y& Elsevier]

Implementation is an emerging research topic in the field of health promotion. Most of the implementation research adheres to one of two paradigms: implementing interventions with maximum fidelity or designing interventions that are responsive to the needs of a local community. While fidelity and adaptation are often considered as contradictory, they are both essential elements of preventive interventions. An innovative program design strategy is therefore to develop hybrid programs that ‘build in’ adaptation to enhance program fit, while also maximizing the implementation fidelity. The present article presents guidelines for this hybrid approach to program implementation and illustrates them with a concrete psycho-educational group intervention. The approach, which is referred to as ‘empowerment implementation’ on the analogy of empowerment evaluation, builds on theory of implementation fidelity and community-based participatory research. To demonstrate the use of these guidelines, a psycho-educational course aimed at stress reduction and the prevention of depression and anxiety was implemented according to these guidelines. The main focus lies on how an intervention can benefit from adaptations guided by local expertise, while maintaining the core program components and still respecting the implementation fidelity. [ABSTRACT FROM AUTHOR]

Background Involvement of mental health-care patients in the decision-making processes is considered to be an ethical requirement. Health-care systems worldwide are increasingly emphasizing the value of participatory approaches. There is, however, no consensus on the definition of patient involvement. The literature is particularly inconsistent and lacks clarity. Objective The purpose of this article is to clarify the concept of patient involvement in mental health care (MHC), taking into account its multidimensional nature. Search strategy We searched the literature in online databases from January 1998 until August 2010 using synonyms of 'patient involvement', combined with the terms 'mental health(care)'. Data synthesis Based on 45 different descriptions found in the literature, we constructed a definition of patient involvement and we drew up a model identifying its determinants and outcomes. Results We propose a comprehensive model of patient involvement to be used in MHC. This model can serve as a guide for policy makers and field workers to shape policies to stimulate involvement. Discussion and conclusions There are three main problems in the literature concerning patient involvement. First, there is a proliferation of conceptualizations of the topic, leading to conceptual vagueness. Furthermore, there is a lack of quantitative data, and some aspects of involvement remain underexposed, such as the involvement of specific target groups and practical ways to shape the involvement processes. Involvement processes should be tailored to the specific target group and context. [ABSTRACT FROM AUTHOR]

Background: There is an increasing number of interactive web-based advance care planning (ACP) support tools, which are web-based aids in any format encouraging reflection, communication, and processing of publicly available information, most of which cannot be found in the peer-reviewed literature.Objective: This study aims to conduct a systematic review of web-based ACP support tools to describe the characteristics, readability, and quality of content and investigate whether and how they are evaluated.Methods: We systematically searched the web-based gray literature databases OpenGrey, ClinicalTrials.gov, ProQuest, British Library, Grey Literature in the Netherlands, and Health Services Research Projects in Progress, as well as Google and app stores, and consulted experts using the following eligibility criteria: web-based, designed for the general population, accessible to everyone, interactive (encouraging reflection, communication, and processing of information), and in English or Dutch. The quality of content was evaluated using the Quality Evaluation Scoring Tool (score 0-28-a higher score indicates better quality). To synthesize the characteristics of the ACP tools, readability and quality of content, and whether and how they were evaluated, we used 4 data extraction tables.Results: A total of 30 tools met the eligibility criteria, including 15 (50%) websites, 10 (33%) web-based portals, 3 (10%) apps, and 2 (7%) with a combination of formats. Of the 30 tools, 24 (80%) mentioned a clear aim, including 7 (23%) that supported reflection or communication, 8 (27%) that supported people in making decisions, 7 (23%) that provided support to document decisions, and 2 (7%) that aimed to achieve all these aims. Of the 30 tools, 7 (23%) provided information on the development, all of which were developed in collaboration with health care professionals, and 3 (10%) with end users. Quality scores ranged between 11 and 28, with most of the lower-scoring tools not referring to information sources.Conclusions: A variety of ACP support tools are available on the web, varying in the quality of content. In the future, users should be involved in the development process of ACP support tools, and the content should be substantiated by scientific evidence.Trial Registration: PROSPERO CRD42020184112; https://tinyurl.com/mruf8b43. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of this study was to obtain qualitative data to understand how type 2 diabetic patients with unregulated blood glucose levels (HbA1c >140 mg/dL) seek and use information sources for their diet. MethodsA descriptive, explorative study design was used with focus group interviews in the Brussels-Capital Region. Each interview was recorded, transcribed literally, and analysed thematically using a grounded theory approach. ResultsGPs were the most important information source in this study. GPs and other professionals were considered to be reliable sources of information by the patients. All patients received information passively at diagnosis. Patients that actively sought information differed in their search behaviour and reported they were not sufficiently informed. Some information sources remained unknown to the diabetic patients in this study. ConclusionDiabetic patients of the Brussels-Capital Region are not well informed about their diet. The main problem is how patients perceived the accessibility of information. Practice implicationsPublic health strategies are required to promote well-informed, proactive patients supported by healthcare teams. [ABSTRACT FROM AUTHOR]

Background Despite its public health significance, data about depression in general practice are often unavailable or incomplete. Objective To study half-year follow-up data on patients diagnosed by their GP with a new episode of mild or a first episode of moderate depression, specifically: (i) treatment continuation, (ii) remission and, in ongoing episodes, suicidal behaviour and inability to work and (iii) the match between treatments initiated and delivered as well as the determinants of actual delivery of non-pharmacological support initiated by the GP for patients with ongoing depression. Methods General practice-based data were collected on all patients aged ≥18 years who were diagnosed by their GP with a new episode of depression in Belgian sentinel general practices during 2008. Results Follow-up data were available for 900 of 1048 patients. Complete treatment dropout was found in 9%, treatment discontinuation in 40% and a GP visit ≤8 weeks preceding the follow-up in 51%. Of the latter 457 patients, 60% were still depressed. Among these, one suicide attempt was reported and 24% were unable to work for ≥1 month. While 91% of the patients who received psychoactive agents at diagnosis had actually taken them, and 62% of the referred patients actually received treatment from another caregiver, non-pharmacological support by the GP was delivered in only 43% of patients for whom it was initiated. Conclusions Half a year after diagnosis, half of patients continue to visit their GP and 60% of those patients remain depressed. The delivery of non-pharmacological GP support takes place for less than half of the patients for whom that intervention is initiated. Our follow-up findings reinforce the policy recommendations made by stakeholders, i.e. the introduction and reimbursement of a mental health consultation in family practice and integration of primary care psychologists. Quality improvement interventions may be a strategy to overcome premature discontinuation of non-pharmacological support by GPs. [ABSTRACT FROM PUBLISHER]

ABSTRACT: Background The suicide rate is a macro indicator of the population's psychosocial wellbeing and an evaluation criterion of the effectiveness of suicide prevention strategies. A high level of injury deaths of undetermined intent (UD) is usually discussed in connection with the validity of suicide statistics. An effort is made to develop a criterion to characterise the quality of suicide statistics.Methods Standardised rates of suicides (X60-X84) and UD (Y10-Y34) by the International Classification of Disease version 10 as an average for the past five available years were taken from the WHO European mortality database. Rate ratios were computed by dividing rates of UD by suicide rates. Results: There is considerable variation in suicide and UD rates among countries. The highest overall rates of UD were registered in Russia, Ukraine and Belarus, and the lowest in Greece, Spain and Italy. The EU-15 average UD rate of 1.97 and the rate ratio of 0.194 UD to suicides were combined into a '2-20 benchmark', in which the primary indicator is 2.0 UD cases per 100 000 and the secondary indicator is the proportion of UD to suicides 0.20 (20% ), which enables countries to be clustered according to the quality of suicide statistics. The following countries satisfied the benchmark: Greece, Norway, Spain, The Netherlands, Luxembourg, France, Austria, Italy, Romania, Hungary, Ireland and Finland. Conclusion This study used the developed '2-20 benchmark' in Europe to assess suicide registration quality in a particular country, to compare the relative position of countries, and to set a target for those European countries that have not yet achieved the benchmark. [ABSTRACT FROM AUTHOR]

This study explores the palliative care capacity of social workers in Flanders. First, it examines the frequency with which social workers in Flanders are currently performing palliative care tasks. Second, this study assesses their attitudes and competencies regarding the performance of these tasks. Third, as contextual factors also influence this performance, this study explores the level of appreciation experienced by social workers in Flanders. To achieve these objectives, a mixed-methods explanatory sequential design was used. Quantitative data were collected by distributing electronic survey questionnaires on QUALTRICS© to a theoretical sample of social workers in Flemish hospitals, community health clinics, nursing homes, home care, and health insurance services. A total of 499 social workers completed the survey in April and May 2021, of whom 352 met the eligibility criteria and were retained for analysis. Qualitative data were collected based on online focus groups between June and September 2021, in which a total of 24 social workers discussed the main survey results. Transcripts from the focus groups were analysed by using the framework method. The results indicate that the current palliative care capacity of responding social workers in Flanders is limited to tasks related to client assessment and referral, while their potential role extends beyond these tasks. With an expanded role, social workers would be better able to address the social dimensions of care, engage in politicising work, and, in turn, contribute to a holistic and multidimensional approach to palliative care. However, this study illustrates the need to increase the competencies and actual involvement of social workers in tasks associated with this expanded role. [ABSTRACT FROM AUTHOR]

Background: Mental health in the workplace is a growing concern for enterprises and policy makers. MENTUPP is a multi-level mental health intervention implemented in small and medium size enterprises from three work sectors in nine countries. This pilot study aimed to evaluate the feasibility, delivery, and instruments for the MENTUPP intervention to inform the planning of a clustered randomized controlled trial. Methods: We administered items from the Copenhagen Psychosocial Questionnaire and the Danish Work Environment Cohort Study measuring psychosocial workplace factors. The questionnaire was answered by 382 participants at baseline, of which 98 participants also answered after six months at follow-up. We calculated mean scores of 19 psychosocial factors at baseline and conducted repeated measures ANOVAs to assess differences in eight psychosocial factors at follow-up. We also examined whether outcomes differed between work sectors and job positions at follow-up. Results: The construction sector and workers with no or a lower leadership role reported more negative working environment factors at baseline. We observed a statistically significant decline in social support from colleagues and social community at work, and a marginally significant decline in justice at work. For the rest of the constructs, we did not observe statistically significant changes. Conclusions: We found significant differences in psychosocial work environment factors among work sectors and job positions at baseline. Contrary to our hypotheses, three psychosocial work environment factors decreased at follow-up. Possible explanations are the utilization of specific psychosocial factors as resources to cope with psychosocial stressors, high participant expectations that were not met by the intervention, insufficient time for structural changes, or the intervention prompting critical evaluations of the work environment. These findings will inform the design and implementation of the forthcoming clustered randomized controlled trial, where they will also be further investigated to validate their significance. [ABSTRACT FROM AUTHOR]

Background: In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons' needs.Methods: This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010-2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up.Results: A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model.Conclusions: The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the RUG-III case-mix, resources can be allocated to keep older persons at home longer, bearing in mind the complexity of care and the availability of services in the community. [ABSTRACT FROM AUTHOR]

Objective: To determine if and which types of organisational interventions conducted in small and medium size enterprises (SMEs) in healthcare are effective on mental health and wellbeing. Methods: Following PRISMA guidelines, we searched six scientific databases, assessed the methodological quality of eligible studies using QATQS and grouped them into six organisational intervention types for narrative synthesis. Only controlled studies with at least one follow-up were eligible. Results: We identified 22 studies (23 articles) mainly conducted in hospitals with 16 studies rated of strong or moderate methodological quality. More than two thirds (68%) of the studies reported improvements in at least one primary outcome (mental wellbeing, burnout, stress, symptoms of depression or anxiety), most consistently in burnout with eleven out of thirteen studies. We found a strong level of evidence for the intervention type "Job and task modifications" and a moderate level of evidence for the types "Flexible work and scheduling" and "Changes in the physical work environment". For all other types, the level of evidence was insufficient. We found no studies conducted with an independent SME, however five studies with SMEs attached to a larger organisational structure. The effectiveness of workplace mental health interventions in these SMEs was mixed. Conclusion: Organisational interventions in healthcare workers can be effective in improving mental health, especially in reducing burnout. Intervention types where the change in the work environment constitutes the intervention had the highest level of evidence. More research is needed for SMEs and for healthcare workers other than hospital-based physicians and nurses. [ABSTRACT FROM AUTHOR]

Background: People with dementia and their family caregivers often encounter challenges in engaging in advance care planning (ACP), such as a lack of information and difficulties in engaging in ACP conversations. Using a user-centred design, we developed two interactive web-based tools as part of an ACP support website to stimulate ACP reflection and communication: (1) the 'Thinking Now About Later' tool, with open-ended questions about 'what matters most', and (2) a digital version of the 'Life Wishes Cards', a card tool with pre-formulated statements that prompt reflection about wishes for future care. This study aimed to evaluate the use of and experiences with two web-based tools by people with dementia and their family caregivers. Methods: During an eight-week period, people with dementia and family caregivers were invited to use the ACP support website in the way they preferred. The mixed-methods evaluation of the ACP tools involved capturing log data to assess website use and semi-structured qualitative interviews to capture experiences. Analyses included descriptive statistics of log data and framework analysis for qualitative data. Results: Of 52 participants, 21 people had dementia and 31 were family caregivers. The 'Thinking Now About Later' tool and 'Life Wishes Cards' were accessed 136 and 91 times respectively, with an average session duration of 14 minutes (SD = 27.45 minutes). 22 participants actively engaged with the tools, with the majority using the tools once, and seven revisiting them. Those who used the tools valued the guidance it provided for ACP conversations between people with dementia and their family caregivers. Participants reported that people with dementia experienced barriers to using the tools on their own, hence family caregivers usually facilitated the use and participation of people with dementia. Some highlighted not knowing what next steps to take after completing the tools online. Conclusions: Although less than half the people used the ACP tools, those who used them found them helpful to facilitate communication between people with dementia and their family. Family caregivers of people with dementia played a crucial role in facilitating the use of the web-based tools. [ABSTRACT FROM AUTHOR]

Introduction: Integrated care is a valuable approach in creating a health care system that addresses the complex needs of people with chronic diseases. For integrated care to be successful, patient participation, i.e. the involvement of patients in decision making and active participation in care activities in partnership with professionals, is crucial. Patient participation can occur at the micro (i.e., individual), meso (i.e., organizational) and macro (i.e., policy) level of care. At all levels, participation can range from purely one-sided information exchange provided by professionals, to consultation of patients, to collaboration (also labelled as co-creation) where professionals and patients share power and responsibility in making decisions. While integration and patient participation appear to be two guiding principles in reorganizing health care systems, so far little is known on the actual contribution of patients with chronic diseases to the organization of integrated care. Hence, the objective of this study is to systematically review studies on patient participation in the development and evaluation of integrated care. Method: PubMed (Medline) and Web of Science databases were consulted to conduct a systematic literature review. We searched for papers on patient participation, integrated care and chronic diseases that were published between January 2003 and December 2016. After categorizing the general focus of the articles, the levels and degrees of patient participation that were described in the studies were reviewed. Results: As for the focus of the articles, most papers address patient participation in the creation and/or evaluation of integrated care initiatives or ICT facilitators to achieve integrated care. A small group of articles explores the perspectives of patients on integrated services and policies. Regarding the level of care in which patients are involved, most studies refer to patient participation at the meso level. Also, in some studies participation at the macro level is described. Concerning the degree of participation, in the majority of articles patients are consulted to express their views, yet this infrequently leads to the actual cocreation of integrated care initiatives. Discussion: Despite the importance of patient co-creation that has been articulated by the WHO, actual participation activities and practices in integrated care often comprise a limited degree of patient collaboration in decision making. Conclusion: In the field of research into integrated care, current practices of integrated care provide little opportunity for impact of patients with chronic diseases to collaborate in decision making on (re)designing and changing health care systems. [ABSTRACT FROM AUTHOR]

Palliative care is a holistic practice using a multidisciplinary approach in addressing multidimensional needs. Although the social aspects surrounding the end-of-life phase suggest a place for social work in it, the profession is often inadequately involved in daily practice. This contrasts strongly with the potential meaningful contributions of social workers in this field. To date, no comprehensive list of prerequisites for meaningful social work involvement in palliative care exists. This review aims to gain more insight on the prerequisites for meaningful social work involvement in palliative care and how to realise them in practice. It could therefore provide pathways for future intervention development in enhancing the involvement of social workers and maximising their contributions in palliative care. A scoping review methodology was used. A systematic selection of peer-reviewed articles ranged from 2000 to April 2021 – out of the electronic databases Web of Science, Scopus and Pubmed – was conducted. The 170 articles that met the eligibility criteria were analysed for relevant content using open and axial coding processes. The findings are reported according to the PRISMA-ScR checklist. The nine prerequisites listed in this review concern the level of individual social work capacities and the level of contextual factors structuring social work practices. A majority of articles have, however, focused on the level of individual social work capacities in a rather specialist view on palliative care. Future research should further address the contextual level of social work involvement in the broader practice of death, dying and bereavement. [ABSTRACT FROM AUTHOR]

Background: The attention of healthcare professionals is directed mainly towards the recipients of care and often insufficiently towards family carers. However, an effective collaboration between professionals and family carers is vital to provide quality palliative and end-of-life care. Such collaboration is under-studied in a palliative care context. Aim: This study aimed to investigate how family carers of people who live at home with a life-limiting chronic illness experience and perceive collaboration with different healthcare professionals in the last phase of life. Design: Face-to-face semi-structured interviews were conducted with the primary family carers of people with a life-limiting chronic illness. Interpretative phenomenological analysis was used to analyse the data. Setting/participants: A heterogeneous sample of 30 family carers of people with cancer, heart failure or dementia was recruited through a variety of care providers and services, in order to reflect the heterogeneity of caregiving in serious illness. Results: Five main themes emerged from interpretative phenomenological analysis that describe the quality of the collaboration between family carers and professionals: respecting family carers both as someone with care needs and as a member of the care team; the continuous availability and accessibility of healthcare professionals; the provision of information and communication including family carer issues; the coordination of care between all parties and contextual factors. The dominant experience by family carers was one of missed opportunities across these themes. Conclusions: This qualitative study about the experiences and perceptions of family carers of people with a chronic life-limiting illness living at home regarding the collaboration with different healthcare providers in the last phase life, showed that family carers experience a lot of possibilities, but perceive missed opportunities as well, for healthcare professionals to effectively collaborate with them for palliative care. [ABSTRACT FROM AUTHOR]

Aim The aims of the present study were: (i) to describe palliative care needs and symptoms of older adults anticipated to be in the last year of their life in Flemish nursing homes (Belgium); and (ii) to evaluate whether these needs differ between residents with and without dementia. Methods A cross-sectional study was carried out in 2014. Nurses and nursing assistants in 15 Flemish nursing homes (Belgium) completed the Palliative care Outcome Scale for 109 residents with palliative care needs. Results Pain, as well as other physical symptoms, was present in more than half of the nursing home residents according to caregivers. The most prominent needs occurred on psychosocial and spiritual domains, such as patient anxiety, support, finding life worth living and self-worth. Caregivers reported that residents with dementia experienced fewer physical symptoms apart from pain than did residents without dementia (coeffficient -0.73, 95% CI -1.18-0.84; P = 0.001. Furthermore, residents with dementia received higher scores on the items 'support' (coefficient 0.75; 95% CI 0.15-1.34, P = 0.015), 'life worthwhile' (coeffficient 0.58; 95% CI 0.090-1.07, P = 0.020) and 'self-worth' (coefficient 0.58, 95% CI 0.13-1.03, P = 0.012). Conclusions According to caregivers, residents with dementia experienced fewer other physical symptoms (e.g. nausea) than residents without dementia. This, however, might be a result of an underdetection of other symptoms in nursing home residents with dementia. Furthermore, most challenges in nursing homes lie within the spiritual and psychosocial domains of palliative care, particularly in people with dementia. These aspects should be integrated in the professional education of caregivers. Assessment tools might be of help to improve the identification of needs and symptoms. Geriatr Gerontol Int 2017; 17: 1501-1507. [ABSTRACT FROM AUTHOR]

Mental health and social care services networks aim to provide patients with continuity of care and support their recovery. There is, however, no conclusive evidence of their effectiveness. Since 2011, Belgium has been implementing a nation-wide reform of mental health care by commissioning service networks. Using a case–control design, we assessed the reform's effectiveness for continuity of care, social integration, quality of life, and re-hospitalization for 1407 patients from 23 networks. Greater reform exposure was associated with a slight improvement in continuity of care, but not with other outcomes. We concluded that service networks alone do not affect patient-level outcomes. [ABSTRACT FROM AUTHOR]

Background: Small and medium-sized enterprises (SMEs) face major financial losses due to mental health issues affecting employees at all levels but seldom apply programs to promote wellbeing and prevent mental health issues among employees. To support the development of a multi-country workplace-based mental health intervention for SMEs (MENTUPP), a multinational consultation study was conducted. The study aimed to examine the experiences and needs of SMEs concerning the promotion of employee wellbeing, and the prevention and management of non-clinical mental health problems in workplaces. Methods: A survey consisting of open and closed questions was designed to assess key informants' opinion about the acceptability, the use, and the implementation of interventions to promote wellbeing and prevent mental health issues in the workplace. Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations across the nine MENTUPP intervention countries (eight European countries and Australia) were invited to complete the survey. Data were collected via the online platform Qualtrics. Sixty-five of 146 informants responded, representing a 44.5% response rate. Descriptive statistics were used to analyse the quantitative data and qualitative data were analysed through thematic analysis. Results: Measures to create mentally healthy workplaces were most used in SMEs, while more specific mental health interventions, such as training staff on how to promote wellbeing, were hardly used. Managers lack resources to implement mental health interventions and are concerned about employees spending too much time on these interventions during working hours. Receiving information about the economic benefits of mental health interventions and hearing successful testimonials from other SMEs can persuade managers otherwise. Employees have concerns about confidentiality, discrimination and stigma, and career opportunities when using such interventions. Conclusions: The study identifies a variety of challenges, needs and possibilities related to implementing mental health interventions in SMEs. Employers need to be convinced that investing in mental health in the workplace is worth their time and money. This requires more studies on the (cost-)effectiveness of mental health interventions. Once employers are engaged, their knowledge and competencies about how to implement such interventions should be increased and privacy concerns of employees to participate in them should be addressed. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Seclusion and restraint still regularly occur within inpatient mental health services.The Council of Europe requires the development of a policy on for instance age limits, techniques and time limits.However, they only define the outer limits of such a policy by indicating when rights are violated. Within these limits, many choices remain open.Staff and service managers lack clarity on safe and humane procedures. Research literature provides limited and contradictory insights on these matters. What this paper adds to existing knowledge?: The study resulted in 77 best practice recommendations on the practical application of restraint and seclusion as last resort intervention in inpatient youth and adult mental health services, including forensic facilities.To our knowledge, this is the first study in which the development of recommendations on this topic is not only based on scientific evidence, but also on an analysis of European human rights standards and consensus within and between expert‐professionals and experts‐by‐experience. This approach allowed to develop for the first time recommendations on time limits, asking for second opinion, and registration of seclusion and restraint. What are the implications for practice?: The 77 recommendations encourage staff to focus on teamwork, safety measures, humane treatment, age and time limits, asking for second opinion, observation, evaluation and registration when applying seclusion and restraint as last resort intervention.The implementation of the best practice recommendations is feasible provided that they are combined with a broad preventive approach and with collaboration between service managers, staff (educators) and experts‐by‐experience. Under these conditions, the recommendations will improve safety and humane treatment, and reduce harm to both service users and staff. Introduction: Seclusion and restraint still regularly occur within inpatient mental health services. Professionals lack clarity on safe and humane procedures. Nevertheless, a detailed policy on for instance age limits, techniques and time limits is required. Aim: We developed recommendations on the humane and safe application of seclusion, physical intervention and mechanical restraint in inpatient youth and adult mental health services, including forensic facilities. Method: After developing a questionnaire based on a rapid scientific literature review and an analysis of human rights sources stemming from the Council of Europe, 60 expert‐professionals and 18 experts‐by‐experience were consulted in Flanders (Belgium) through a Delphi‐study. Results: After two rounds, all but one statement reached the consensus‐level of 65% in both panels. The study resulted in 77 recommendations on teamwork, communication, materials and techniques, maximum duration, observation, evaluation, registration, second opinion and age limits. Discussion: Combining an evidence, human rights and consensus‐based approach allowed for the first time to develop recommendations on time limits, asking for second opinion and registration. Implications for Practice: When combined with a preventive approach and collaboration between service managers, staff (educators) and experts‐by‐experience, the recommendations will improve safety and humane treatment, and reduce harm to service users and staff. [ABSTRACT FROM AUTHOR]

Background: Family carers have a prominent role in end-of-life care for seriously ill persons. However, most of the advance care planning literature is focused on the role of healthcare professionals. Aims: To investigate (1) what proportion of family carers discussed advance care planning with their relative and associated socio-demographic and clinical characteristics (2) what proportion received support from healthcare professionals for these conversations, (3) what type of support they received and (4) to what extent the type of support received was considered sufficient. Design/participants: Population-based cross-sectional survey in Belgium of bereaved family carers of persons with a serious chronic illness (N = 3000) who died 2–6 months before the sample was drawn, identified through three sickness funds. The survey explored support from healthcare professionals for family carers during the last 3 months of the patient's life. Results: Response rate was 55%. The proportion of family carers that engaged in an advance care planning conversation with their relative was 46.9%. Of these family carers, 78.1% received support from a healthcare professional, mostly by doing the advance care planning conversation together (53.8%). Of family carers receiving support from a healthcare professional, 57.4% deemed the support sufficient. Conclusion: Many family carers engage in advance care planning conversations with their dying relative. Healthcare professionals often support them by performing the advance care planning conversations together. More insight into how family carers can be supported to conduct these advance care planning conversations, both with and without involvement of healthcare professionals, is necessary. [ABSTRACT FROM AUTHOR]

An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported. [ABSTRACT FROM AUTHOR]