Skellern Lecture and the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award 2015.

The author reviewed the literature published since 1972 concerning restraint and seclusion. The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.

This editorial presents a commentary on COVID-19 and mental health in Hong Kong. We outline the current measures being used to contain the outbreak and how the experience of the SARS epidemic may have influenced the response in Hong Kong. We also discuss the potential mental health ill-effects of the pandemic and its impact on mental health nursing locally.

Knowledge about the practice and roles of mental health nurses in New Zealand is currently limited. In a sociopolitical climate where the views of users of mental health services are increasingly incorporated into education and the planning and delivery of services, there is a need for research that reflects the perspective of users. In this study a qualitative descriptive methodology with focus group interviews was used to explore with users of mental health services, the attitudes, knowledge and skills that they need in mental health nurses. Users of mental health services valued the therapeutic work of mental health nurses, and identified positive attitudes towards users of mental health services as essential in mental health nurses. However, they did not consistently experience a therapeutic approach in their interactions with mental health nurses.

Would the real mental health nurse please stand up? The relationship between identification and professional identity

WHAT IS KNOWN ON THE SUBJECT?: Developing sex type is the process in which one develops behavioural attributes and personality characteristics socially defined as matching one's biological sex. "Psychological androgyny" means that a person should not be judged in terms of his or her traditional sex role. "Androgynous" sex type means that a person could have both female and male characteristics, depending on the circumstances. "Androgynous" sex-type individuals show higher capacity to deal with a variety of roles and a healthier and more adaptive behaviour than those with the same gender sex typing Previous studies focused on caring behaviours while examining the difference between female and male nurses but there are no studies on differences between female and male nurses in the mental health field in relation with sex types. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: From a theoretical point of view, our study adds important information on specific associations between sex types and caring in mental health nurses. Nurses with different sex type perform caring behaviours at different levels. "Androgynous" sex-type nurses perform caring behaviours at a higher level than others do. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our findings can contribute to raising awareness among head nurses and policy makers in the mental health field, of the differences between nurses, and among female and male nurses in mental health centres, regarding their caring behaviours. Understanding this association can assist in the recruitment and allocation of candidates in mental health nursing settings and later on, in developing appropriate instruction programs for these employees. ABSTRACT: Introduction Understanding differences in caring behaviours by sex is crucial in light of the need to encourage men to join the nursing profession. Aims To study the association between sex types and caring behaviours in female and male nurses in the mental health field. Methods Cross-sectional study including a convenience sample of 114 nurses in three mental health centres in Israel. Data were self-reported in a structured form including validated scales for the assessment of sex types and caring behaviours. ANOVA and linear regression tests were used were performed with SPSS version 21. All the analyses were 2-tailed, and p<0.05 was considered statistically significant. Results Androgynous female and male nurses displayed higher levels of caring than other sex types. Higher levels of caring were observed in female compared with male nurses overall (p=0.011) and in behaviours showing respect (p=0.020) and attentiveness to patients' needs and safety (p=0.002). Conclusion Our results suggest that different sex-typed female and male nurses in the mental health field display different levels of caring behaviours. Implications for Practice Our findings can help head nurses and policy makers in recruitment and allocation of nurses in mental health settings, as well as in developing educational programs for employees and nursing students.

WHAT IS KNOWN ON THE SUBJECT?: There is emerging evidence highlighting the counter therapeutic impact of the use of restraint and promoting the minimization of this practice in mental health care. Mental health nurses are often the professional group using restraint and understanding factors influencing their decision-making becomes critical. To date, there are no other published papers that have undertaken a similar broad search to review this topic. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Eight emerging themes are identified as factors influencing mental health nurses decisions-making in the use of restraint. The themes are: 'safety for all', 'restraint as a necessary intervention', 'restraint as a last resort', 'role conflict', 'maintaining control', 'staff composition', 'knowledge and perception of patient behaviours', and 'psychological impact'. 'Last resort' appears to be the mantra of acceptable restraint use, although, to date, there are no studies that specifically consider what this concept actually is. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These findings should be considered in the evaluation of the use of restraint in mental health settings and appropriate strategies placed to support shifting towards restraint minimization. As the concept of 'last resort' is mentioned in many policies and guidelines internationally with no published understanding of what this means, research should prioritize this as a critical next step in restraint minimization efforts. While mechanical and manual restraint as an institutional method of control within mental health settings may be perceived to seem necessary at times, there is emergent literature highlighting the potential counter-therapeutic impact of this practice for patients as well as staff. Nurses are the professional group who are most likely to use mechanical and manual restraint methods within mental health settings. In-depth insights to understand what factors influence nurses' decision-making related to restraint use are therefore warranted. To explore what influences mental health nurses' decision-making in the use of restraint. An integrative review using Cooper's framework was undertaken. Eight emerging themes were identified: 'safety for all', 'restraint as a necessary intervention', 'restraint as a last resort', 'role conflict', 'maintaining control', 'staff composition', 'knowledge and perception of patient behaviours', and 'psychological impact'. These themes highlight how mental health nurses' decision-making is influenced by ethical and safety responsibilities, as well as, interpersonal and staff-related factors. Research to further understand the experience and actualization of 'last resort' in the use of restraint and to provide strategies to prevent restraint use in mental health settings are needed.

Background: Mental health nurses play an important role in caring for patients with mental illnesses. In order to provide comprehensive mental health nursing care, it is important to establish periodic educational interventions about mental health and psychiatric nursing in any mental health institution. The presence of frequent educational programs can lead to improvements in mental health nurses' clinical competency. Aim: To evaluate the effectiveness of an educational intervention on the clinical competency of mental health nurses. Methods: A quasi-experiment study pretest and posttest with one group study design were conducted among 80 nurses in a large mental health hospital in Tabuk city, Saudi Arabia. Data were collected by using the clinical competence evaluation in mental health nurses scale to evaluate the effectiveness of an educational intervention on the clinical competency of mental health nurses by comparing the result of the pretest and posttest scores. Result &amp; Discussion: The total score for the pre-test was (74.83±14.25/Average), and then the score increased dramatically for the post-test (96.18±26.53/Good) also, the Wilcoxon signed-rank test indicated that Post-test (Mean rank=102) significantly higher than pre-test (Mean rank=59) (U=1480, p&lt;0.001). As a result of the current study, the program showed great effectiveness (p&lt;0.001) with an advantage for post-test. Conclusion: The collected data analysis revealed a statistically significant positive effect of educational programs on improving mental health clinical competency, hence, Healthcare organizations and senior decision-makers should develop well designed periodic mental health programs that involve nurses who have a master's and doctorate degrees in mental health nursing to enhance mental health clinical competency.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.

Editorial Call for Papers for Special Topical Issues of Archives of Psychiatric Nursing

Mental health problems and disorders account for 13% of the burden of disease across the world, and in high income countries the estimate increases to 23%, with such problems and disorders being the most common cause of disability and premature death (World Health Organization [WHO] 2004). Since the publication of Mental Health: New Understanding, New Hope (WHO 2001a), there have been concerted efforts internationally to promote mental health, reduce the burden of mental health problems, and increase the social inclusion (see Chapter 9) of people living with such problems (WHO 2001b). In the UK, since the 1999 National Service Framework (NSF) for Mental Health (Department of Health [DH] 1999) and other NSFs (DH 2001, DH/Department for Education and Skills 2004), mental health has become one of the government’s national health priorities (DH 2004b, 2006d). Within UK NHS mental health services, mental health nurses (MHNs) make up the largest proportion of the professional work- force, making them pivotal to the delivery of the NSF. Mental health nursing takes place in an increasingly wide variety of prac- tice contexts, and rapid developments in mental health and social care policy, research, and service delivery within the past ten years have impacted significantly upon the work of MHNs. There has been an increased emphasis on partnership working with service users and carers (NHS Executive 2000). The patient choice agenda is now central to service and care delivery (Care Services Improvement Partnership/National Institute of Mental Health in England 2005), and new roles, new ways of working, and new types of service have prolifer- ated (DH 2003a–c, 2005b). Staffing challenges within mental health services, together with further opportunities to extend nursing roles, raise important issues as to the most effective use of the resource of MHNs (DH 2006a, Sainsbury Centre for Mental Health [SCMH] 2005).

Mental health, mental illness, or some of each? The need for care with the use of language

Frontline Reports

Police Use of the Taser With People With Mental Illness in Crisis

I am pleased to report that at the beginning of 2009, almost 5 years into my editorship, at a time when most of the news is gloomy and quite naturally is concerned with the impact of the global economic meltdown, the JPMHN continues to make a significant impact in the world of mental health nursing. During 2008 JPMHN continued to expand and extend its boundaries, with this being the first year that 10 issues were published. In keeping with the trend for the past 4 years, the journal will again be increasing in size in 2009. Indeed, in a year of uncertainty and instability, the journal and its team had a number of things to celebrate. In December 2008 we celebrated the third JPMHN lifetime achievement award, honouring Professor Bryn Davis for 50 years of dedicated service to mental health nursing. The award was presented in London, UK in December, along with the Eileen Skellern Lecture, which this year was given by Professor Len Bowers. Previous winners of the lifetime achievement award include Jo Brand and Professor Phil Barker. Over the past 12 months there have also been a small number of changes to the editorial board including some additions to the board: Dr Alec Grant (University of Brighton UK); Dr Theo Stickley (University of Nottingham UK) and Dr Russell Ashmore (Sheffield Hallam University, UK). 2009 is the year that the JPMHN learns the outcome of its first impact factor rating, which we look forward to receiving. Whilst ISI ratings are not without their critics (myself included) and are only one indicator of quality and impact, they can provide a useful benchmark by which to measure the journals influence in certain areas. The international contribution to the journal grows year on year, with publications being submitted from 25 different countries across all continents in 2008. Ensuring access to the journal is also something that the JPMHN can be proud of as many developing countries (over 100) have research access to the journal free of charge through philanthropic programs provided by Wiley-Blackwell. At the annual full editorial board meeting, which was also held in December, the international board agreed a number of proposals for advancing the scope and aims of the journal. One of which focused on the appropriate inclusion of user and carer expertise in the management and development of the journal. Early this year a user/carer advisory board will be appointed and their contribution formalised through specified and agreed terms of reference. It is hoped that through regular facilitated meetings, the user/carer advisory board will be able to add value to what is already a highly acclaimed and committed board and further progress the journals potential to reach a wide audience of both professionals and mental health service users, as well as informed and interested public and media. In keeping with this aim readers will note that the original papers published in the journal, will in future, be supported by an ‘accessible summary’. Author's guidelines have been updated to reflect this new requirement and potential author's will find examples of accessible summaries in the guidance notes in order to assist in this process. A number of other changes have been made to the author guidelines, reflecting the expansion of the range of available contributions that authors can now make to the journal. For as important as it is to widen access to the knowledge and expertise contained within in the journal, it is just as important to widen and facilitate varied array of opportunities for writers to present their knowledge, expertise, views and opinions. To this end we would encourage our readership to re-visit the journal pages and particularly the guidance for authors. We are also happy to announce that JPMHN will soon be part of the Wiley-Blackwell Early View service. Articles will then be published on a regular basis online in advance of their appearance in a print issue. These articles are fully peer reviewed, edited and complete – they only lack page numbers and volume/issue details – and are considered fully published from the date they first appear online. The implementation of Early View for JPMHN represents our commitment to get manuscripts available to view as quickly as possible, reducing time to publication without sacrificing quality or completeness. This year we anticipate launching the new European section of the journal under a new Associate Editorship. A themed edition focusing on European issues in Mental Health Nursing will pull together recent policy, practice and research initiatives in a special issue. The section editors working on the journal provide excellent direction and support on the management of the journal itself, and in addition are available to answer specific questions, clarify author guidelines and of course to receive suggestions and ideas for improving the impact of the journal at all levels. We look forward to a challenging and in some ways frugal new year, but one that may also leave us fulfilled and stimulated in our desire for new knowledge and better understanding of ourselves in our daily human interactions.

Mental health and addiction services in the criminal justice system: Where do we sit?