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

"They're Really PD Today": An Exploration of Mental Health Nursing Students' Perceptions of Developing a Therapeutic Relationship With Patients With a Diagnosis of Antisocial Personality Disorder

The therapeutic relationship is of particular importance when working with patients with antisocial personality disorder, but despite this, there is a paucity of literature exploring student nurses’ perceptions of developing a therapeutic relationship with such patients. Hence, this qualitative study explored the perceptions of second-year mental health nursing students of developing a therapeutic relationship with this patient group. Student nurses from a University in the Northwest of England participated in two focus groups, to compare the perceptions of a group of student nurses who had experience in secure settings (forensic hospital) with those who had not. Four key themes emerged: diagnosis, safety, engagement, and finally environmental influences. Both groups commented on looking beyond the diagnosis and seeing the person. The student nurses cited other staff in their clinical placement areas as hugely influential in terms of the development of their perceptions of patients with antisocial personality disorder and how to relate to them

Preventing suicides in public places: A practice resource

This practice resource is for those with responsibility for suicide prevention in local authorities and their partner agencies. It has been developed to help them contribute to the delivery of the national suicide prevention strategy for England, in particular area 3 of the strategy, ‘Reduce access to the means of suicide’. It replaces the ‘Guidance on action to be taken at suicide hotspots’ published in 2006 by the National Institute for Mental Health in England (NIMHE). It has a broader focus, includes learning from those who have tried to take their own lives in public places, draws on recent research and expert opinion, and provides examples of innovative practice from England and around the world. This document sits alongside PHE’s ‘Guidance for developing a local suicide prevention action plan’: www.gov.uk/government/publications/suicide-prevention-developing-a-local-action-planPublic Health Englan

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

Outcomes from a pilot psychological therapies service for UK military veterans

Aim: To evaluate the outcomes of participants attending a psychological therapies service for military veterans. Background: The UK Military Veterans’ Improving Access to Psychological Therapies Service (North West) (MV IAPT) provided a clinical psychological therapies service for military veterans. Outcomes of depression, anxiety and social adjustment were assessed after treatment in the service's pilot phase. Design: An observational, prospective cohort study examined changes in depression, anxiety and social adjustment during receipt of the service. Methods: Changes in depression (PHQ-9), anxiety (GAD-7) and social adjustment (WSAS) were examined in 952 veterans referred over 20 months from September 2011. Data were collected using the IAPT clinical information system plus additional fields. Changes for patients who completed treatment, remained in treatment and dropped out were compared. Results: Seven hundred and seven veterans received an initial assessment, from which 505 received two or more appointments. Of these, 156 completed treatments, 179 remained in treatment and 170 dropped out. The majority of veterans had been operationally deployed and were similar in risk characteristics to those in other military cohort studies. There were highly significant improvements on all measures (p<.01), with completers improving more and having higher rates of recovery from depression and anxiety than those remaining and drop outs. Recovery rates compared favourably with evaluations of general IAPT services and also exceeded reported natural recovery rates

The Recovery Orientation of a Farm Community for Severe Autism — Data from the DREEM-IT (Developing Recovery Enhancing Environment Measures — Italian Version)

Recent years have witnessed an increasing interest in the concept of ‘recovery’ in the field of mental health and psychiatry. Autism is a neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication skill, along with a restricted, repetitive, and stereotyped pattern of behavior and interests. The diagnosis is lifelong and can be a major impediment to independent living. It has been previously demonstrated that organized and structured forms of intervention, starting from early childhood and developing during all the different life stages, may improve outcome and quality of life in patients with autism. It is therefore conceivable that diverse forms of recovery (e.g. optimal level of motivation, skills, social involvement) may be possible in autism. There are no fully developed tools with which to evaluate the recovery orientation of a service, but the National Institute for Mental Health in England (NIMHE) has identified the Developing Recovery Enhancing Environments Measure (DREEM) as the most promising of an emerging group of recovery sensitive measures. This study explores the use of DREEM, as a tool to evaluate the effectiveness of recovery-based care in an Italian farm community center specifically designed for adult patients with autism and intellectual disability

Mental health care and resistance to fascism

Mental health nurses have a critical stake in resisting the right-wing ideology of British fascism. Particularly concerning is the contemporary effort of the British National Party (BNP) to gain credibility and electoral support by the strategic re-packaging of a racist and divisive political manifesto. Evidence that some public sector workers are affiliated with the BNP has relevance for nursing at a series of levels, not least the incompatibility of party membership with a requirement of the Professional Code to avoid discrimination. Progressive advances, though, need to account for deep rooted institutionalized racism in the discourse and practice of healthcare services. The anomalous treatment of black people within mental health services, alongside racial abuse experienced by ethnic minority staff, is discussed in relation to the concept of race as a powerful social category and construction. The murder of the mentally ill and learning disabled in Nazi Germany, as an adjunct of racial genocide, is presented as an extreme example where professional ethics was undermined by dominant political ideology. Finally, the complicity of medical and nursing staff in the state sanctioned, bureaucratic, killing that characterized the Holocaust is revisited in the context of ethical repositioning for contemporary practice and praxis

Eating disorder symptomatology and body mass index are associated with readers’ expectations about character behavior: evidence from eye-tracking during reading

Objective: Many theories have been put forward suggesting key factors underlying the development and maintenance of eating disorders, such as: unhealthy food-related cognitive biases, negative body attitude, and perfectionism; however, underlying cognitive processes associated with eating disorder symptomatology remain unclear. We used eye-tracking during reading as a novel implicit measure of how these factors may relate to eating disorder symptomatology. Method: In two experiments, we monitored women’s eye movements while they read texts in which the characters’ emotional responses to food-, body image-, and perfectionism-related scenarios were described. Participants’ eating disorder symptomatology was then assessed. Results: Both studies suggest that moment-to-moment processing of characters’ emotional responses to perfectionism-, and to a lesser extent, body image-related information was associated with participants’ eating disorder symptomatology, thus supporting theories in which these factors are key to developing and maintaining eating disorders

Staff attitudes towards inpatients with borderline personality disorder

This article discusses the negative attitudes of some nursing staff towards inpatients diagnosed with borderline personality disorder (BPD), from the perspective of a third-year mental health nursing student. Factors to support underlying nurses’ attitudes are considered, including stigma associated with BPD, the relationship between BPD and self-harm, clients being viewed as manipulative and nurses’ lack of optimism for client recovery. Work pressures, poor communication skills and time restraints also contribute to the poor care being delivered by some mental health nurses. The authors suggest ways to improve staff attitudes, based on recommendations in the literature. Further education relating to BPD is discussed, as well as the need for increased supervision of mental health nurses and more time for effective communication between nurse, client and the multidisciplinary team