Training in cognitive behavioural interventions on acute psychiatric inpatient wards

There has been a drive towards addressing the types of care and therapeutic interventions available to people with serious mental illness, which is reflected in the latest government mental health policy initiatives. Recent evidence strongly supports the implementation of psychological and social interventions for people with psychosis, and in particular the use of cognitive behavioural techniques. Until now, the main focus has been on people living in the community. This study examines the delivery of psychosocial interventions training to qualified psychiatric nurses and unqualified staff on seven acute psychiatric admission wards in London, UK. The approach had the strength of on-site delivery, follow-up role modelling of the interventions and clinical supervision. Despite this, in some cases the training was less successful, mainly because of staffing and leadership weaknesses. The impact of training in these methods and the implications for mental health education and practice development are discussed

Violence, misconduct and schizophrenia: Outcome after four years of optimal treatment

Background: Aggressive behaviour in patients with schizophrenic disorders is an ongoing source of concern to community-based services. It has been suggested that optimal treatment may reduce the risk of serious misconduct. Objective: To assess prospectively aggressive and sexual misconduct in a cohort of patients receiving continued evidence-based community treatment. Method: Fifty patients with a DSM-IV diagnosis of a schizophrenic disorder were treated for 4 years with integrated biomedical and psychosocial strategies. The frequency and context of all aggressive and sexually inappropriate behaviour were assessed throughout. Correlations between an index of misconduct and demographic and clinical variables were examined. Results: Levels of serious misconduct were low at the start of the project and declined as treatment progressed. Close examination of predictors of misconduct supported larger epidemiological studies imputing persistent psychotic symptoms, personality disorders and substance use. Conclusion: The study supports the hypothesis that effective treatment reduces aggressive and sexual misconduct in schizophrenic disorders. © 2005 Economou et al; licensee BioMed Central Ltd