Exploring partnership: Reflections on an international collaboration.

yesThis article explores some of the challenges involved in a collaborative mental health partnership, drawing on the reflections of two project members from the Chainama College of Health Sciences in Zambia and the Leeds Metropolitan University in England. The aim of the project was to support the education and training of the mental health workforce in Zambia as services shift from institutional to community-based care. The discussion is located within Gray’s ‘three-pronged dilemma’ and debates concerning the internationalisation agenda in social work and higher education. The conclusion emphasises the benefits and tensions of partnership working between ‘developed’ and ‘developing’ countries

Collaborative research exploring mental health service user perspectives on acute inpatient occupational therapy

Introduction:User perspectives are important for understanding why people engage with occupational therapy during an admission for acute mental health issues, and can be used to inform service provision and development. Method: Twenty-two recent and current inpatients participated in six semi-structured individual interviews and three focus groups. Data from the two methods were initially subject to separate thematic analysis. Then a further stage of constant comparative analysis, of both data sets, generated the findings presented here. Findings: Three themes were identified: (1) ‘A tiny sort of world’ expressed experiences of being restricted; (2) ‘Relief’ indicated how occupational therapy offered relief from the ward and experiences of mental ill-health; and (3) ‘Something to do’ suggested specific purposes for engaging in occupation. These themes indicate how service users experience and value occupational therapy for different reasons at different times. The approach of occupational therapists to service users, valuing them as occupational beings, is a key aspect of their experience. Conclusion: The profession is challenged to design flexible opportunities for occupational engagement which simultaneously provide relief and distraction, address diverse occupational needs, and are feasible within the resource restrictions of acute mental health services

“It doesn’t mean I’m useless” How do young people experiencing psychosis contribute to their families and why are their contributions sometimes overlooked?

Purpose: Psychosis is often seen as a “burden” on families. and affected individuals frequently hold a negative view of themselves. This study explored the ways in which young adults who have experienced first episode psychosis (FEP) make a positive contribution within their families. Methods: Fifteen participants (seven young people with experience of psychosis and eight relatives) were interviewed separately. Their accounts were analysed using grounded theory methodology (Charmaz, 2006). Results: For many individuals, their experience had led to a catastrophic redefinition of their identity. However, they continued to contribute significantly both within their families and within their wider communities. The redefinition of identity sometimes appeared to create a ‘perceptual filter’ whereby both the person themselves and family members overlooked or minimised their contribution, focusing instead on being alert to signs of psychosis or illness. Conclusions: Shame and a focus on symptoms rather than achievements and contributions can significantly limit opportunities, expectations, and movement beyond an illness identity. It is important for clinicians to be aware of this and to help young people and their families to notice and value positive contribution, and so promote recovery, well-being and post-traumatic growth

Violence and under-reporting: Learning disability nursing and the impact of environment, experience and banding

This is the authors' version of an article published in the Journal of Clinical Nursing. The definitive version is available at www3.interscience.wiley.comThe study explores the implications of a survey into the discrepancy between actual and reported incidents of violence, perpetrated by service users, within the learning disability division of one mental health NHS Trust. Violence within the NHS continues to constitute a significant issue, especially within mental health and learning disability services where incidence remains disproportionately high despite the context of zero tolerance. A whole-population survey of 411 nurses working within a variety of settings within the learning disability division of one mental health NHS Trust. A questionnaire was administered to learning disability nursing staff working in community, respite, residential, assessment and treatment and medium secure settings, yielding a response rate of approximately 40%. There were distinct differences in the levels of violence reported within specific specialist services along with variation between these areas according to clinical environment, years of experience and nursing band. The study does not support previous findings whereby unqualified nurses experienced more incidents of violence than qualified nurses. The situation was less clear, complicated by the interrelationship between years of nursing experience, nursing band and clinical environment. The conclusions suggest that the increased emphasis on reducing violent incidents has been fairly successful with staff reporting adequate preparation for responding to specific incidents and being well supported by colleagues, managers and the organisation. The differences between specific clinical environments, however, constituted a worrying finding with implications for skill mix and staff education. The study raises questions about the relationship between the qualified nurse and the individual with a learning disability in the context of violence and according to specific circumstances of care delivery. The relationship is clearly not a simple one, and this group of nurses’ understanding and expectations of tolerance requires further research; violence is clearly never acceptable, but these nurses appear reluctant to condemn and attribute culpability

Attitudes to personality disorder of staff working in high and medium secure hospitals

The discourse surrounding personality disorder is largely negative, and the diagnosis is considered to be associated with a degree of stigma. This study aimed to investigate current staff attitudes to personality disorder in a high and a medium secure forensic-psychiatric hospital in the UK. Staff attitudes were assessed using the Attitude to Personality Disorder Questionnaire (Bowers & Allan, 2006). The questionnaire was completed electronically by 132 staff. Attitudes to personality disorder in the current study were significantly less positive than in comparable studies in similar settings. Having completed staff training surrounding personality disorder, and being from a non-nursing professional background, were the best predictors of positive attitudes to personality disorder. The findings of this study offer support to the pursuit of improving access to training in personality disorder in forensic settings

Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) Services: A qualitative study exploring professionals’ perspectives of working with this patient group

A high prevalence of people present to ‘Improving access to Psychological Therapies’ (IAPT) in England with common mental health disorders and co-morbid personality disorder. This group have sub optimal treatment outcomes in IAPT. Whilst new short-term treatment approaches are advocated, no solutions or guidance have been provided. This qualitative study explored IAPT healthcare professional (N=28) perspectives of working with people who present to IAPT with co-morbid personality disorder. Individual semi-structured interviews were digitally recorded, transcribed verbatim and analyzed using a framework analysis approach. Results identified a lack of skills and confidence in working with this patient group, restrictive service constraints and a treatment gap between the interface of primary and secondary services. Insight into acceptable adaptions to practice are identified which have transferable utility to a wider international audience who can identify people outside of specialist mental health services with common mental health disorders and co-morbid personality disorder traits

Qualified and Unqualified (N-R C) mental health nursing staff - minor differences in sources of stress and burnout. A European multi-centre study

<p>Abstract</p> <p>Background</p> <p>Unqualified/non-registered caregivers (N-R Cs) will continue to play important roles in the mental health services. This study compares levels of burnout and sources of stress among qualified and N-R Cs working in acute mental health care.</p> <p>Methods</p> <p>A total of 196 nursing staff - 124 qualified staff (mainly nurses) and 72 N-R Cs with a variety of different educational backgrounds - working in acute wards or community mental teams from 5 European countries filled out the Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPSS) and the Psychosocial Work Environment and Stress Questionnaire (PWSQ).</p> <p>Results</p> <p>(a) The univariate differences were generally small and restricted to a few variables. Only Social relations (N-R Cs being less satisfied) at Work demands (nurses reporting higher demands) were different at the .05 level. (b) The absolute scores both groups was highest on variables that measured feelings of not being able to influence a work situation characterised by great demands and insufficient resources. Routines and educational programs for dealing with stress should be available on a routine basis. (c) Multivariate analyses identified three extreme groups: (i) a small group dominated by unqualified staff with high depersonalization, (ii) a large group that was low on depersonalisation and high on work demands with a majority of qualified staff, and (iii) a small N-R C-dominated group (low depersonalization, low work demands) with high scores on professional self-doubt. In contrast to (ii) the small and N-R C-dominated groups in (i) and (iii) reflected mainly centre-dependent problems.</p> <p>Conclusion</p> <p>The differences in burnout and sources of stress between the two groups were generally small. With the exception of high work demands the main differences between the two groups appeared to be centre-dependent. High work demands characterized primarily qualified staff. The main implication of the study is that no special measures addressed towards N-R Cs in general with regard to stress and burnout seem necessary. The results also suggest that centre-specific problems may cause more stress among N-R Cs compared to the qualified staff (e.g. professional self-doubt).</p

Suicide in an ageing UK population: problems and prevention

Purpose Suicide can be an emotive, and at times, controversial subject. The purpose of this paper is to reflect on the social, health, personal, and cultural issues that can arise in later life and the potential reasons for suicide. It will analyse already recognised risk factors of suicide in older adults and focus on improving knowledge about the social meaning and causation of suicide for older people. It will also consider suicide prevention policies, their practice implications, and whether they are successful in protecting this potentially vulnerable cohort. Design/methodology/approach A synopsis of available literature in the form of a general review paper of suicide of older adults. Findings There is evidence that the ageing process often leads to a set of co-morbidities and a complex and diverse set of individual challenges. This in turn equates to an increased risk of suicide. There is no easy answer to why there is evidence of a growing number of older adults deciding that suicide is there only option, and even fewer suggestions on how to manage this risk. Social implications The entry of the “baby boom” generation into retirement will lead to the potential of an increase in both suicide risk factors and older adults completing suicide. This is on the background of a demographic surge which is likely to place additional pressures on already under-resourced, and undervalued, statutory and non-statutory services. Originality/value A literature search found very little information regarding older adults and suicide risk, assessment, treatment or prevention. </jats:sec