Acute Inpatient Mental Health Services Research Articles

A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study.

Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. This study is registered as ISRCTN14470430. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

Safewards Impact in Inpatient Mental Health Units in Victoria, Australia: Staff Perspectives.

Introduction: Mental health professionals working in acute inpatient mental health wards are involved in a complex interplay between an espoused commitment by government and organizational policy to be recovery-oriented and a persistent culture of risk management and tolerance of restrictive practices. This tension is overlain on their own professional drive to deliver person-centered care and the challenging environment of inpatient wards. Safewards is designed to reduce conflict and containment through the implementation of 10 interventions that serve to improve the relationship between staff and consumers. The aim of the current study was to understand the impact of Safewards from the perspectives of the staff. Methods: One hundred and three staff from 14 inpatient mental health wards completed a survey 12 months after the implementation of Safewards. Staff represented four service settings: adolescent, adult, and aged acute and secure extended care units. Results: Quantitative results from the survey indicate that staff believed there to be a reduction in physical and verbal aggression since the introduction of Safewards. Staff were more positive about being part of the ward and felt safer and more connected with consumers. Qualitative data highlight four key themes regarding the model and interventions: structured and relevant; conflict prevention and reducing restrictive practices; ward culture change; and promotes recovery principles. Discussion: This study found that from the perspective of staff, Safewards contributes to a reduction in conflict events and is an acceptable practice change intervention. Staff perspectives concur with those of consumers regarding an equalizing of staff consumer relationships and the promotion of more recovery-oriented care in acute inpatient mental health services.

Police and clinician diversion of people in mental health crisis from the Emergency Department: a trend analysis and cross comparison study

BackgroundThe Northern Police and Clinician Emergency Response (NPACER), a combined police and clinician second response team, was created to divert people in mental health crisis away from the hospital emergency department (ED) to care in the community or direct admission to acute inpatient services. The aim of this study was to evaluate the NPACER by comparing trends in service utilisation prior to and following its inception.MethodsA retrospective comparison of electronic records was undertaken with interrupted time series analysis to assess the impact of NPACER on ED presentations over 27-months (N = 1776). Chi-squared tests were used to analyze service utilization; (1) in the six-months before and after the implementation of NPACER and (2) within the post NPACER period between times of the day it was operational.ResultsNPACER reduced the number of mental health crisis presentations to the ED. When the NPACER team was operational, 16 % of people in crisis went to ED compared with 100 % for all other times of the day, over a six-month period. The NPACER team enabled direct access to the inpatient unit for 51 people assessed at a police station and in the community compared with no direct access when NPACER was not operational.ConclusionsNPACER enabled reductions in presentations to the ED by diverting people to more appropriate and less restrictive environments. The model also facilitated direct admission to acute inpatient mental health services when people in crisis were assessed in the community or transported to a police station for assessment.

Acute Inpatient Mental Health Services: Building Foundations for Team Effectiveness

Aims Effective teamwork is vital for quality of care. The exchange of information, ideas and support, helps with patient safety, patient positive experience, and avoiding the detrimental effects of staff burnout. The aim of this study was to assess the development needs of a 44-member multidisciplinary acute inpatient mental health team and to improve team effectiveness. A wide range of questionnaires and activities developed by the NHS Leadership Academy, U.K., was used to focus on seven essential aspects of effective team working: Team Identity, Team Objectives, Role Clarity, Team Decision Making, Team Communication, Constructive Debate, and Inter-Team Working. Team reflection and positive challenging were used to promote critical thinking. The team's purpose and operating principles were defined and team objectives were agreed. Questionnaires identified Communication and Inter-Team Working as areas for development. On a scale of 1 (strongly disagree) to 5 (strongly agree), in areas showing need for improvement, scores were as follows: 3.2 (there is enough information to make decisions about work), 3.2 (effective communication between team members), 2.8 (well-managed time in meetings), 3.3 (planned outcomes achieved in meetings), 3.3 (decisions and actions clearly summarised in meetings), 3.3 (efficient working to resolve conflict with colleagues), and 2.9 (effective processes to quickly resolve difficulties amongst teams). Meeting processes were changed and time dedicated to care increased. Teams can improve by focussing on specific factors contributing to their development and effectiveness. Communication and inter-team relationships might be particularly challenging areas that may improve by changing team processes.

The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

Accreditation Models of Mental Health Care: A Systematic Review

Purpose: To identify accreditation models in mental health and their effects on performance of health plans and health facilities. Methods: We conducted a free search in Databases of PubMed , Scopus , EMBASE , PsycINFO and Google Scholar up to March 2014 ,searching for “mental health” and “accreditation” in keywords, titles , abstracts and all indexed fields . Inclusion criteria were English or Persian language of of the articles, and Presentig accreditation models in mental health (processes or effects). Exclusion criteria were manuals of accreditation ,guidelines of accreditation,revisions of standards and Interview with pioneers. Results: Seven models of accreditation in mental health were determined. They were Peer or professional accreditation, The Memory Services National Accreditation Programme (MSNAP), Accreditation of acute in-patient mental health services (AIMS), Psychiatric Liaison Accreditation Network (PLAN), Electroconvulsive Therapy accreditation Service (ECTAS), psychiatric intensive care unit (AIMS-PICU), JCAHO Mental Health Care Network .All models used self-review and external peer review in collection of related data. Five accreditation models clearly focused on Continous Quality Improvement projects. Conclusion: Upon results of this systematic review, it is concluded that there are various accreditation models in mental health care . there arent enough researches about accreditation impacts on community mental health . It is recommended that a study be conducted about accreditation effect on efficiency and effectiveness of health programs and mental health care.

Seclusion and its context in acute inpatient psychiatric care

In acute inpatient mental health services, patients commonly demonstrate extreme behaviours. A number of coercive practices, such as locked doors, enforced medication and seclusion, are used in these settings to...

Establishing family inclusive acute inpatient mental health services: a staff training programme in Somerset

In spite of policies advocating the involvement of families in the care of mental health service users in the UK there are few examples of training initiatives to bring this about. This article describes the delivery of a whole‐team training initiative to promote family inclusive working in all acute inpatient units in Somerset. The three‐day staff‐training programme is described and training outcomes are reported. Staff reported a significant increase in confidence in their skills for working with families, and a pre‐ and post‐training case note audit showed an increased consideration of the needs of families. This was accompanied by a modest increase in the average number of family meetings. Obstacles to family inclusive ways of working on inpatient units are described, and strategies to overcome these are discussed.

National review of NHS acute inpatient mental health services in England: implications for working with people with a dual diagnosis

Addressing the needs of people with a dual diagnosis is a core component of acute inpatient mental healthcare. In 2006/2007, the Healthcare Commission conducted a national review of NHS acute inpatient wards in England. The review included five indicators of particular relevance to working with people with a dual diagnosis. This paper provides an overview of the review process, reports the dual diagnosis findings and considers their implications for improving the care and treatment of people with a dual diagnosis in the inpatient setting.

Focus on inpatient units

Inpatient units, once the mainstay of mental health care and treatment, now tend to be viewed as a last resort, even as evidence of system failure. Irrespective of one’s views about the need for, or importance of, acute inpatient mental health services, it is evident that attitudes to this area of practice have changed. A hierarchy has emerged that places community care at the top and inpatient units towards the bottom of the pecking order. This presents an interesting divergence from the dynamics of the general health-care system, where Intensive Care, Critical Care and Coronary Care units are considered to represent the need for a higher level of nursing knowledge and skill. Why is this? In simple terms, these nurses provide care and treatment to people who are most ill and most in need. Is this not the same in acute inpatient units? Given the emphasis on the least restrictive environment and community care the answer is clearly yes. So why then do we place less value on the nursing work of inpatient units? I make this point not to suggest that inpatient nurses should be considered more skilled than their community colleagues, but rather to suggest that they should not be considered less skilled. Personally I oppose the notion of hierarchy within nursing practice. The value placed on nursing should reflect its contribution to positive outcomes for people who use the services, rather than less relevant factors such as the practice setting, nature of clientele or degree of autonomy. Suffice it to say that nursing in an inpatient unit requires skill, knowledge and expertise, which may be different to but is not lesser than the skills, knowledge and expertise required in other practice settings. We need to value and support our inpatient nurses for the important contribution they make within mental health services. With this in mind, I proudly introduce the December Edition of the International Journal of Mental Health Nursing with a focus on acute inpatient nursing. A guest editorial by Dr Margaret Grigg sets the scene for an exciting edition by calling for the elimination of restraint and seclusion, an issue that will hopefully be the springboard for passionate discussion and debate within the profession. The feature articles highlight the complexity inherent within the acute inpatient setting. We are alerted by Johansson and colleagues from Sweden to the environment of control that can so easily dominate nursing practice at the expense of therapeutic intervention. This issue of therapy versus control is further considered through the work of Whitehead and Mason who suggest that risk assessment and special observations may indeed lessen the need for more controlling interventions such as restraint and seclusion. Bowers and colleagues describe the negative impact of untoward events (such as suicide, homicide and assault) on both consumers and inpatient nurses and herald the need for an organizational response to limit the occurrence and minimize their impact. The work of Steinert and colleagues challenges the traditional medical model of leadership by describing a successful model of shared leadership between medicine and nursing in psychiatric hospitals in Germany. As mental health policy increasing acknowledges the importance of consumer participation in mental health services, McCann and colleagues explore the attitudes of nurses in inpatient settings to the role and functions of consumer consultants. Thomas and colleagues provide research evidence to support the value of nursing initiatives in reducing the use of PRN medication. For something completely different, but nevertheless important, Reilly and colleagues describe a quit smoking programme for inpatient staff. Given the disproportional number of people with mental illness who smoke, this initiative has significant implications for health promotion in mental health services. I hope you will agree that this Edition provides an important contribution to mental health nursing knowledge in relation to inpatient units. The articles provide interest, diversity and relevance for all nurses, regardless of practice setting. To the authors, reviewers and readers who again have contributed so much to the continued success of this journal, I sincerely thank you. I wish you all the best for Christmas and the New Year festivities and look forwards to working with you once again in 2007.

Accreditation of acute in-patient mental health services

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AIMS and its aims

Clinical Psychology Forum talks to John Hanna about the Accreditation for Acute Inpatient Mental Health Services (AIMS) project.

Professionalizing action research - a meaningful strategy for modernizing services?

This paper outlines how a specific action research approach can be used to secure practice development in services which have found sustained change difficult. For the purpose of this paper discussion focuses upon using professionalizing action research (a form of action research) to secure transformation in acute inpatient mental health services. This speciality has experienced long-term difficultly in meaningful practice change. Not limited to this context parallels can be made with other health and social care services requiring significant modernization. The aim is to critically discuss the use of professionalizing action research as an approach to sustainable change. clarifies whether this method is a suitable vehicle for change, which is ideally suited to services which have a poor record of practice development. A review of action research and practice development literature forms the basis of this paper. The literature is sourced through bulletin boards, electronic databases and the British Library Classification Scheme. Keywords searched are action research, team learning, managing change and practice development. Following definition; the components of professionalizing action research are analysed using the themes of educative base, problem focus, improvement and involvement. The educative base of professionalizing action research is collaborative reflective practice which is used to initiate meaningful change, rooted in everyday practice. The benefit of this is that change actions are based in real-time situations. The problem focus component of professionalizing action research is used to emphasize the views of service users and carers. This is positive in terms of the patient and public involvement agenda although this theme does emphasize limitations of the approach. The final components are involvement and improvement, these are debated as pluralistic notions and the implications of this are acknowledged. Reviewing the literature and theoretical application indicates the value of professionalizing action research as a process for modernization. The strength of the approach lies in the opportunity for team learning and change which is grounded in the context of services and pursued through collaboration.

The content of management of violence policy documents in United Kingdom acute inpatient mental health services.

The aim of the study was to examine the content of Trust policies concerning the prevention and management of violence in acute in-patient settings in order to establish their usefulness as guidance for staff in this difficult, complex, and controversial aspect of inpatient psychiatric care. Violence is a commonly encountered problem in inpatient psychiatric settings. There are legal requirements for workplaces in general and mental health care facilities in particular to develop safe systems of work based upon the findings of assessments of this risk. Policies have a key role to play in making explicit the responsibilities of both employer and employees, and specifying standards of acceptable practice. A cross-sectional survey methodology was used, which entailed examination of the content of management of violence policies that had been forwarded to the authors from 40 Trusts providing acute inpatient psychiatric care throughout England, Scotland, Wales, and Northern Ireland. Policies were found to vary widely in their content, and serious shortcomings were noted in the extent to which policies included information regarding their status and review, advice on the prevention of violence, the management of violent incidents, and postincident action. Further research is needed to tease out the extent to policies which are lacking in content, reflect shortcomings in the organizational approach to the prevention and management of violence by Trusts, and the extent to which such shortcomings result in harm being suffered by staff and/or patients. An alternative format for the presentation of management of violence policies is discussed, and items that should be included in inpatient units' management of violence policies are suggested.

Hyperkinetic circulatory disorder after closure of persistent ductus arteriosus.

In acute inpatient mental health services, patients commonly demonstrate extreme behaviours. A number of coercive practices, such as locked doors, enforced medication and seclusion, are used in these settings to control such behaviours. The aim of this report is to explore briefly some of the contemporary debates pertaining to seclusion. A perusal of the literature reveals a clarion call to end the practice of seclusion, without consideration of feasible alternatives. It is hoped that this brief report will encourage further evidence-based discussion and research initiatives on this important ethical topic.