Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research

Minimising the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management. Aim: To review research and explore what patients consider beneficial in risk management practice. Method: A mixed‐studies systematic review utilising PRISMA guidelines, alongside a convergent qualitative design to categorise findings. Results: 12 papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management. Discussion: Connectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family, and peers to widen input and supportive networks beyond clinical relationships. Implications for Practice: Risk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and risk management

A Review of Risk Matrices Used in Acute Hospitals in England.

In healthcare, patient safety has received substantial attention and, in turn, a number of approaches to managing safety have been adopted from other high-risk industries. One of these has been risk assessment, predominantly through the use of risk matrices. However, while other industries have criticized the design and use of these risk matrices, the applicability of such criticism has not been investigated formally in healthcare. This study examines risk matrices as used in acute hospitals in England and the guidance provided for their use. It investigates the applicability of criticisms of risk matrices from outside healthcare through a document analysis of the risk assessment policies, procedures, and strategies used in English hospitals. The findings reveal that there is a large variety of risk matrices used, where the design of some might increase the chance of risk misprioritization. Additionally, findings show that hospitals may provide insufficient guidance on how to use risk matrices as well as what to do in response to the existing criticisms of risk matrices. Consequently, this is likely to lead to variation in the quality of risk assessment and in the subsequent deployment of resources to manage the assessed risk. Finally, the article outlines ways in which hospitals could use risk matrices more effectively

Sexual health promotion programme: Participants' perspectives on capacity building

Objectives: The aim of this study was to evaluate a Health Service Executive (HSE) Foundation Programme in Sexual Health Promotion (FPSHP) with a specific emphasis on capacity building. Design: A mixed-method design using both quantitative and qualitative methods was used to collect the data. Setting: The FPSHP was delivered to staff working in health, education and community settings and was designed and facilitated by sexual health promotion staff who are part of the Irish HSE. Methods: A survey, designed by the researchers, as well as individual telephone interviews with past participants was used to evaluate the programme. Out of a possible 200 participants, 97 completed the questionnaire (response rate 49%), and a total of 22 telephone interviews were completed. Results: There was generally a high level of satisfaction with the FPSHP. Participants reported high levels of individual and intra-organisational capacity-building activities, but apart from networking, inter-organisational capacity-building activities were reported less frequently and tended to be ad hoc in nature. Satisfaction with the programme was high and so was the perception of its sustained impact. Motivation, satisfaction with the programme and attending of further training were strong predictors of reported sustained impact. Conclusion: Capacity building in sexual health promotion was affected positively by participation in the programme. Nonetheless, a greater emphasis on capacity building at an inter-organisational level needs to be considered. It is recommended that participants need to be motivated, guided and supported in the use of strategies to achieve this

Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: a narrative account

The views and opinions of people who use mental health services are being increasingly acknowledged in relation to rights-based, socially-inclusive, and recovery-oriented care. However, little is known of the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in this respect. The aim of the present study was to explore the experiences and needs of LGBT people in relation to mental health services. The study was an exploratory design utilizing mixed methods. Both quantitative and qualitative data were collected using a survey instrument (n = 125) and in-depth semistructured interviews (n = 20) with a sample of people who had completed the survey. This paper will report on the findings from the interview data. The data were thematically analysed, and the main themes that emerged included accessing services, treatment choices, mental health service experiences, and other supports. The findings inform the discussion, and recommendations are made in terms of future mental health practice, education, and research

"Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings.

What is known on the subject? Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. What this paper adds to existing knowledge? This manuscript provides readers with qualitative findings of mental health nurses’ (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. What are the implications for practice? This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. Abstract 4.1 Description The paper will report on the interview data of trained MHNs’ experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020—under review). 4.2 Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. 4.3 Aim To explore PSI-trained MHNs’ experiences of using PSI within Ireland. 4.4 Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. 4.5 Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs’ understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. 4.6 Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. 4.7 Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. 4.8 Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research