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The need to protect the physical health of people with mental illness is increasingly acknowledged. We conducted six focus groups with 14 patients and 12 mental health care professionals to explore their individual and mutual perspectives on health promotion in daily clinical practice. Three main themes: Health as a balancing act; Dilemmas for health promotion; and Ideals and responsibility for health promotion in clinical practice were identified using thematic analysis. We discuss how aligning mutual expectations and creating an authentic dialogue based on the identification of and respect for patients’ individual resources can support health promotion in clinical psychiatry.

Epidemiological evidence suggests that physical exercise, notably popular sports, is associated with reduced, mental health burden. This study explored participation in a supervised, group-based, outdoor cycling programme (10 &times, 10 km rides over a five-month period) for people with mental illness. We conducted two rounds of three audio-taped focus groups with people with mental illness (n = 25, mean age = 40 years) that focused on previous physical activity and motivation for enrolment (baseline), and on programme evaluation, including subjective wellbeing (after 10 weeks). Transcribed verbatim, the group discussions were analysed using systematic text condensation, which identified 12 categories and four themes: 1) Reinvigoration, (2) motivation through equal status, (3) group commitment without focus on illness, and (4) the value of cycling. Of particular interest was the potential for outdoor cycling to support unique non-stigmatising therapeutic relationships in a non-patient environment, outdoor sensory experiences, e.g., fresh air, wind, and rain, and feelings of personal mastery, equal status, solidarity, community, and healing. This study indicated that outdoor cycling performed in groups supervised by healthcare staff may support exercise self-efficacy and empower people with mental illness, potentially promoting long-term physical activity and participation. Future interventional studies examining the effectiveness of outdoor cycling complementary to conventional community mental healthcare services are warranted.

Background: The use of physical coercive measures, e.g. mechanical restraint (MR), in mental health care, is a major infringement on the psychiatric patient’s autonomy. MR can cause physical and mental harm but may be necessary to avoid putting an individual’s health at risk. The nursing staff is tasked with protecting the life and health of, not only the individual patient, but also other patients, and relatives. A situation can occur in which staff is obligated to use force, and occasionally MR, if a patient is very aggressive, violent, self-destructive, or suicidal. Although MR is legal, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment concluded, in three reports from 2002, 2008, and 2014 that no medical justification exists for applying instruments of physical restraint to psychiatric patients for days, and that doing so amounts to ill treatment. Following, the Government in Denmark decided in 2014, that the number of MR should be halved before 2020. This decision lead to development, and implementation of an array of more or less, evidence based preventive initiatives. In some regions, the development has been positive, reducing the numbers of MR episodes, but we do not know which initiatives has created this development. Aim: To examine which MR preventive factors/initiatives reduces the number of MR episodes. Methods: This study is designed as a nationwide, longitudinal, cluster, cross-sectional survey of preventive initiatives implemented in psychiatric units and the corresponding numbers of coercive episodes. Questionnaires will be used to gather data on preventive initiatives from the units’ once a year, over a period of three years, and data on coercive episodes will be accessed from the national database on coercion. A linear mixed-method model will be used to estimate the longitudinal effect of implementing the specific preventive initiatives. Results: The only data collected at the time of the conference will be from 2016, so descriptive data will be presented, together with data on coercive episodes.

Introduction: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice: Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.