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Medium secure mental health units (MSUs) provide a specialised secure environment to assist people recovering from mental illness where less restrictive care has been unsuccessful or been unable to provide safety for the person or the community. Internationally, it has been found that these units can be associated with prolonged admissions, posing ethical and resource issues. Objectives: This 'Realist Review' aimed to investigate the factors associated with length of stay and outcomes of medium secure care to help inform the development of a local secure care pathway. Method: The searches generated a total of 1570 entries across multiple search engines. Following removal of duplicates, application of inclusion/exclusion criteria and selection of articles, a total of 18 were reviewed in detail, including a further five articles obtained from references and the explored grey literature. Results: Several issues influenced not only admission to medium secure units, but also the outcomes. Many articles were retrospective studies relying on administrative data. The realist synthesis provides contextual data to inform program development. Conclusions: The existing literature, though variable in quality, was limited by the varied jurisdictions and contexts. However it may be useful to inform care pathways for the optimal use of medium secure beds. [ABSTRACT FROM AUTHOR]

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

Resting energy expenditure (REE) is lower than predicted in persons taking atypical antipsychotic medication, and weight management is a significant clinical challenge for some of them. However, to date there have been no published guidelines to assist clinicians in choosing appropriate prediction equations to estimate energy expenditure in persons taking atypical antipsychotic medications. The objectives of this study were to measure REE in a group of men taking the atypical antipsychotic clozapine and to determine whether REE can be accurately predicted for this population using previously published regression equations. REE was measured using indirect calorimetry via a ventilated hood on eight men who had completed at least 6 months of treatment with clozapine. Comparisons between measured REE and predicted REE using five different equations were undertaken. The commonly-used Harris-Benedict and Schofield equations systematically overestimated REE. Predictions of REE from other equations were too variable for clinical use. When estimating energy requirements as part of a weight-management program in men who have been taking clozapine for 6 months, predictions of REE from the equations of Harris-Benedict and Schofield should be reduced by 280 kcal/day. J Am Diet Assoc. 2005;105:612-615.

Objectives: Demand for places in postgraduate psychiatry training programmes has increased over recent years. All systems have capacity limits, and concerns have been raised regarding the sustainability of the current intake. This paper presents a modelling exercise to exploring the presence and strategies to resolve bottleneck in the Queensland training programme. Methods: Mathematical modelling based on the RANZCP training regulations and the characteristics of the accredited training programme. Results: A training bottleneck was identified which has been impacted by increased training intake, demand for Advanced Training certificates, and location factors. Conclusions: This investigation raises important questions regarding the future management of postgraduate training in psychiatry in Queensland that may be applicable more widely across Australia and New Zealand. In particular, it highlights the large impact that can result from even small incremental increases in trainees across varying levels of the postgraduate programme and the importance of limiting trainee intake in a manner proportional to the availability of mandatory terms. [ABSTRACT FROM AUTHOR]

Repeat presentations to the emergency department (ED) for non‐fatal suicidal behaviour (NFSB) are common in Australia and overseas. The challenges faced by mental health services in managing this sub‐group of patients have not been fully explored. In this qualitative study, we consider how case managers view frequent ED use by patients with NFSB. Individual interviews with case managers were audio‐recorded, transcribed verbatim, and subjected to thematic analysis. Four main themes emerged: a logical place to go; not a lot of benefit from an ED visit; focus on managing risk; and building a life outside of the ED. The case managers noted that patients with NFSB tend to have complex presentations that are challenging to address in the ED. The focus tends to be on assessment of risk with referral to community support agencies. The findings point to the need to identify more intensive care options that support patients to reduce their dependency on the ED. Insights gleaned from the study have implications for those working with NFSB patients. [ABSTRACT FROM AUTHOR]

Presentations to emergency departments (EDs) for non‐fatal suicidal behaviour (NFSB) are increasing in Australia and overseas. Our understanding of the factors contributing to this trend remains unclear. In this qualitative phenomenological study, we explored patient perceptions of their ED experience and the interventions provided. The study group comprised 10 adults who had had 3 or more presentations to the ED in a 12‐week period for NFSB. Individual interviews were conducted in person with participants and transcribed verbatim. Three broad themes emerged from analysis of the transcripts: ED – a safety net; 'treatment – what treatment!'; and maintaining ED dependence. The findings highlight a failure to understand the needs of those with NFSB and establish better ED treatment strategies and models of aftercare for this sub‐group of patients. The findings have implications for mental health nurses working with consumers in the ED and in broader case management roles. [ABSTRACT FROM AUTHOR]

Objectives: To examine the prevalence of metabolic syndrome and its association with clinical, demographic and lifestyle factors in patients with mental illness participating in residential rehabilitation.Methods: A physical health audit of all consumers ( n = 364) in publicly funded residential rehabilitation programs in Queensland was carried out in late 2016. Data collection focused on clinical, demographic and lifestyle factors associated with physical health.Results: Central obesity was identified in 80% of males and 89% of females and half of the patients (49.4%) met criteria for metabolic syndrome (MetS). The prevalence of MetS in Indigenous patients (66.1%) was 20% higher than the rate found in non-Indigenous patients (46.1%). Smoking, substance abuse, gender, Indigenous background, length of stay and rarely eating fruit and vegetables were individually associated with MetS.Conclusions: The prevalence of MetS in this cohort is almost double that of the general population, while the rate in Indigenous patients is among the highest reported for those with mental illness. Rehabilitation staff are encouraged to engage more fully in the monitoring of physical health status, sharing this information with consumers and primary care providers, and encouraging consumers to play a greater role in managing their physical health. [ABSTRACT FROM AUTHOR]

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

Objective: To examine the differences in the physical health of Indigenous and non-Indigenous patients with severe mental illness (SMI) undergoing psychiatric rehabilitation.Methods: An audit of the physical health of patients ( n = 361) in all publicly funded residential rehabilitation programs in Queensland was carried out in late 2014. Data collection focused on clinical and lifestyle factors associated with physical health.Results: The prevalence of smoking, substance use and type 2 diabetes in Indigenous patients was significantly higher than rates found in non-Indigenous patients. Metabolic syndrome was also significantly higher in indigenous patients, with 66% of Indigenous patients compared to 46% of non-Indigenous patients meeting criteria for metabolic syndrome.Conclusions: Patients with SMI in residential rehabilitation programs have poor physical health. Our findings underscore the need for clinicians to develop and evaluate interventions aimed at improving the metabolic profile of those with SMI in residential rehabilitation programs. Historical factors and cultural traditions need to be considered when designing lifestyle interventions for Indigenous patients. [ABSTRACT FROM AUTHOR]