Acute Inpatient Mental Health Settings Research Articles

Understanding organisational and nursing behaviour changes associated with a therapeutic engagement improvement tool in acute mental health inpatient settings: A qualitative analysis

BackgroundEnhancing the quality of therapeutic engagement between nurse and service user is related to positive impact on care, safety, and recovery outcomes. Achieving improved therapeutic engagement remains challenging in the acute mental health inpatient setting, characterised by complex social processes and contextual features that constrain behaviour change. The Therapeutic Engagement Questionnaire is an evidence-based tool co-produced with service users and nurses to improve therapeutic engagement. ObjectivesThe objectives of this quality improvement project were to identify the organisational and nursing behaviour changes associated with the Therapeutic Engagement Questionnaire and to understand the active behaviour change ingredients of the improvement tool and how they exert their influence. DesignA qualitative multi-site case study design in which data were collected from study site field notes and document review. SettingFour acute mental health inpatient case study sites in England. MethodsData referencing Therapeutic Engagement Questionnaire-linked behaviour change in project meeting field notes and documents from each study site were analysed using an inductive and deductive approach with thematic analysis. The Capability Opportunity Motivation-Behaviour model was employed as a theoretical framework. FindingsThe therapeutic engagement tool had the capacity to prompt behaviour change across all three components of the behaviour change model: Capability – through nurses sharing good therapeutic engagement practice and use of statements in the questionnaire to build nurses’ knowledge and skills; Opportunity – through organisational barriers being addressed and ward-level practice and culture changes; Motivation – through nurses’ awareness of their influence on service user recovery, nurses’ alertness to their therapeutic work, and connections between the therapeutic engagement tool and nursing core values. However, the tool did not accord with the values of some nurses, reported to be unmotivated by the recognition it gave their profession for contribution to service user recovery. In sites evidencing more prominent behaviour change, senior leader and ward-level agents of change played a valuable facilitative role. ConclusionThe therapeutic engagement tool had the potential to prompt behaviour changes at organisation and ward level and to the ways individual nurses therapeutically engage with service users, helping strengthen therapeutic engagement practice. Leadership at senior organisational and ward level was important to address contextual barriers to change. The project resulted in a conceptual framework to explain and understand the behaviour change techniques and functions linked to the therapeutic engagement tool. Longevity of the behaviour changes and their impact on service user quality of care requires future evaluation. Tweetable abstractA therapeutic engagement tool can prompt organisational and nursing behaviour change in acute mental health inpatient settings.

Patient-centered health care planning in acute inpatient mental health settings: a best practice implementation project.

The current project aimed to improve the quality of health care by promoting evidence-based practice (EBP) regarding mental health care planning (MHCP) for adult inpatients. The implementation of the best evidence in the process of developing and documenting nursing care plans is currently an important legal requirement that contributes to increasing the quality of care. This implementation project was based on the JBI evidence implementation approach and included a baseline audit of seven criteria, implementation of strategies, and a follow-up audit. The project was conducted in an acute psychiatric setting at a university hospital in Bucharest, Romania. The sample included 17 nurses and 30 ward patients. The baseline audit revealed low compliance (33%-37%) for criterion 3 (a comprehensive care plan) and criterion 4 (patient involvement); moderate compliance (55%) for criterion 1 (care plan for all patients); and increased compliance (97%-100%) for criterion 2 (assessment of patient's needs), criterion 5 (education of patients/caregivers), criterion 6 (providing a copy at discharge), and criterion 7 (education of professionals). As a result of implementing the most appropriate strategies, the maximum improvement (100%) was observed across all five audit criteria that were found to be deficient in the baseline audit. The development and implementation of strategies adapted to specific care need to play a key role in the implementation of EBP. In this case, educating nurses, facilitating nurses' access to EBP for care planning, and improving procedures proved effective in achieving maximum compliance with all the audit criteria.

Solving the shortage of psychiatric - mental health nurses in acute inpatient care settings.

This debate essay proposes possible remedies to the shortage of nurses in acute inpatient mental health settings and draws inspiration from a Journal of Psychiatric and Mental Health Nursing editorial, Glascott and McKeown (2022, 29, 767). The aim is to stimulate debate within the profession. The art and science of nursing continues to develop but staffing shortages in key areas undermine practice, leadership, academic and policy efforts to improve the quality of care for people attending services. This is a debate essay which draws on the authors' experience and presents ideas based on extant literature. Organisational, professional and wider societal challenges are explored. Practice-based solutions as well as recommendations for improving the terms and conditions of employment of nurses are made. Opportunities which may empower the nursing profession are promulgated. It is intended that this paper will provoke further discourse and may reflect the 'call to action' advocated by Glascott and McKeown (Journal of Psychiatric and Mental Health Nursing, 2022, 29, 767). While the focus is on acute inpatient mental health nursing, the ideas presented may have an application to wider nursing groups or a wider cadre of public sector workers.

Non-contact monitoring to support care in acute inpatient mental health

Background Averting incidents of patient self-harm is an ongoing challenge in acute inpatient mental health settings. Novel technologies that do not require continuous human visual monitoring and that maintain patient privacy may support staff in managing patient safety and intervening proactively to prevent self-harm incidents. Aim To assess the effect of implementing a contact-free vision-based patient monitoring and management (VBPMM) system on the rate of bedroom self-harm incidents. Methods A mixed methods non-randomized controlled before-and-after evaluation was conducted over 24 months on one female and one male acute inpatient mental health ward with the VBPMM system. The rates of bedroom self-harm, and of bedroom ligatures specifically, before and after implementation were investigated using quantitative methods. Qualitative methods were also used to explore the perceived effectiveness of the system and its acceptability. Results A −44% relative percentage change in bedroom self-harm incidents and a −48% relative percentage change in bedroom ligatures incidents were observed in the observational wards with the VBPMM system. Staff and patient responses gave insights into system acceptability and the ways in which these reductions may have been achieved. Conclusion The results indicate that using the VBPMM system helped staff to reduce self-harm incidents, including ligatures, in bedrooms.

A qualitative synthesis of patients' experiences of re-traumatization in acute mental health inpatient settings.

INTRODUCTION: Rates of re-traumatization among mentally ill-health patients have risen significantly over the past decade and clinical guidelines place mental health nurses at the heart of their care. To gather, analyse, and synthesize the evidence on people's experiences on re-traumatization in acute mental health inpatient settings. A systematic search for qualitative studies (CINAHL, MEDLINE, ASSIA, PsycINFO, and EMBASE) was conducted. Two authors independently assessed eligibility and appraised methodological quality using Joanna Briggs's quality appraisal tool and extracted data. The analysis followed the principles of interpretative synthesis. Fourteen papers were included for thematic synthesis. Three themes emerged: (1) Quality of staff interaction; (2) Specific interventions, (Sub-theme nature of symptoms); and (3) Nature of the environment. Our findings demonstrate that patients are experiencing re-traumatization in acute mental health inpatient settings and that there is little being done to prevent it from occurring. This study is the first to analyse the factors that contribute to re-traumatization and make recommendations to mental healthcare professionals to reduce the harmful practices in place in inpatient settings. It is suggested that training staff in trauma-informed care and allowing patients to be experts in their own care can reduce the rates of re-traumatization.

Patient characteristics and the use of seclusion in an adult forensic inpatient mental health service in Australia: a quantitative analysis and examination of clinical interventions

Background/Aims In Australia, national data indicate that the rate of seclusion use in public forensic mental health inpatient settings has almost tripled since 2008, with the number of patients being admitted to these settings being secluded more often but for shorter durations. The aim of this study was to describe and analyse the use of seclusion within an adult forensic mental health inpatient setting in Australia. The study also sought to compare and examine the characteristics of patients who experienced seclusion and those who did not. Methods This quantitative study was achieved by completing a retrospective case file audit. Data were collected on all patients admitted to the adult forensic mental health inpatient unit during a 6-month period (January to June 2016). Data were obtained from medical records including age, sex, ethnicity, primary and secondary diagnosis, referral source and previous admissions to acute and forensic mental health inpatient settings. Results During the 6-month study period, 117 admissions to the service occurred involving 109 patients. There were 61 seclusion events involving 20 (18%) patients. Data indicated that patient gender and diagnosis increased the likelihood of a seclusion event occurring. Conclusions Seclusion was used on a small number of patients who presented a high risk, specifically young, white men with a diagnosis of schizophrenia or a psychotic disorder and drug-related symptoms. Identifying patient characteristics that increase the risk of seclusion is important so that services can design early intervention strategies to enhance patient safety.

Patients' and staff members' experiences of restrictive practices in acute mental health in-patient settings: systematic review and thematic synthesis.

Recent guidance has called for the reduction of restrictive practice use owing to growing concerns over the harmful physical and psychological effects for both patients and staff. Despite concerns and efforts, these measures continue to be used regularly to manage challenging behaviour in psychiatric in-patient settings. To undertake a systematic review of patients' and staff members' experiences of restrictive practices in acute psychiatric in-patient settings. A systematic review and thematic synthesis was conducted using data from 21 qualitative papers identified from a systematic search across three electronic databases (PsycInfo, Embase and MEDLINE) and citation searching. The protocol for the review was pre-registered on PROSPERO (CRD42020176859). The quality of included papers was examined using the Critical Appraisal Skills Programme (CASP). Four overarching themes emerged from the experiences of patients: the psychological effects, staff communication, loss of human rights and making changes. Likewise, the analysis of staff data produced four themes: the need for restrictive practices, the psychological impact, decision-making and making changes. Patient and staff experiences of restrictive practices were overwhelmingly negative, and their use carried harmful physical and psychological consequences. Lack of support following restraint events was a problem for both groups. Future programmes seeking to improve or reduce restrictive practices should consider the provision of staff training covering behaviour management and de-escalation techniques, offering psychological support to both patients and staff, the importance of effective staff-patient communication and the availability of alternatives.

Crisis-focused Cognitive Behavioural Therapy for psychosis (CBTp) in acute mental health inpatient settings (the CRISIS study): protocol for a pilot randomised controlled trial

BackgroundCognitive Behavioural Therapy for psychosis (CBTp) has an established evidence base and is recommended by clinical guidelines to be offered during the acute phases of psychosis. However, few research studies have examined the efficacy of CBTp interventions specifically adapted for the acute mental health inpatient context with most research trials being conducted with white European community populations.AimsThe aim of this study is to conduct a pilot randomised controlled trial (RCT), which incorporates the examination of feasibility markers, of a crisis-focused CBTp intervention adapted for an ethnically diverse acute mental health inpatient population, in preparation for a large-scale randomised controlled trial. The study will examine the feasibility of undertaking the trial, the acceptability and safety of the intervention and the suitability of chosen outcome measures. This will inform the planning of a future, fully powered RCT.MethodsA single-site, parallel-group, pilot RCT will be conducted examining the intervention. Drawing on principles of coproduction, the intervention has been adapted in partnership with key stakeholders: service users with lived experience of psychosis and of inpatient care (including those from ethnic minority backgrounds), carers, multi-disciplinary inpatient clinicians and researchers. Sixty participants with experience of psychosis and in current receipt of acute mental health inpatient care will be recruited. Participants will be randomly allocated to either the crisis-focused CBTp intervention or treatment as usual (TAU).DiscussionFindings of this pilot RCT will indicate whether a larger multi-site RCT is needed to investigate the efficacy of the intervention. If the initial results demonstrate that this trial is feasible and the intervention is acceptable, it will provide evidence that a full-scale effectiveness trial may be warranted.Trial registrationThis trial has been prospectively registered on the ISRCTN registry (ISRCTN59055607) on the 18th of February 2021.

Knowledge, Attitude, Preparedness and Behavior of Nurses Towards Intimate Partner Violence in Mental Health Settings

Various studies have explored healthcare professionals’ knowledge, attitudes and preparedness towards intimate partner violence (IPV). However, there is a dearth of research, which focuses on nurses working in mental health settings. This study explored the knowledge and preparedness of nurses working in mental health settings to identify and manage IPV. The hypothesis developed for this study was: nurses have negative perceptions towards the management of IPV; and demographic characteristics influence the nurses’ perceptions towards IPV. A cross-sectional quantitative survey design was used. One hundred and nine nurses working within the acute in-patient and community mental health setting completed the Physicians Readiness to Manage Intimate Partner Violence Survey (PREMIS). The results of the study show that the participants lack competence in identifying potential victimized individuals and may not feel adequately prepared and knowledgeable to address IPV in their practice. However, they are willing to manage IPV and have identified the need of more competence in the area. These findings are similar to literature which involved populations other than nurses who work in mental health settings. Nurses in mental health settings need training on how to identify and manage IPV cases. Mixed methods research in this area is also recommended.

Places of safety? Fear and violence in acute mental health facilities: A large qualitative study of staff and service user perspectives.

To understand violence on acute mental health units according to staff and service user perspectives and experiences. The collateral damage of violence in acute inpatient mental health settings is wide-ranging, impacting on the health and wellbeing of staff and service users, and detrimental to public perceptions of people who are mentally unwell. Despite international research on the topic, few studies have examined psychiatric unit violence from both staff and service user perspectives. We conducted in-depth interviews with 85 people (42 staff, 43 service users) in four adult acute mental health inpatient units in New Zealand. We undertook a thematic analysis of perspectives on the contributing factors and consequences of violence on the unit. Both staff and service users indicated violence was a frequent problem in acute inpatient units. Four themes regarding the causes of violence emerged: individual service user factors, the built environment, organisational factors, and the overall social milieu of the unit. Staff often highlighted complexities of the system as causal factors. These included the difficulties of managing diverse service user illnesses within an inadequate and unsafe built environment whilst having to contend with staffing issues and idiosyncrasies relating to rule enforcement. In contrast, service users talked of their needs for care and autonomy not being met in an atmosphere of paternalism, boredom due to restrictions and lack of meaningful activities, enforced medication, and physical confinement as precipitants to violence. Two broader themes also emerged, both relating to empathy. Both staff and service users exhibited 'othering' (characterised by a profound lack of empathy) in relation to acutely unwell individuals. Explanations for violent behaviour on the unit differed between groups, with service users being more likely to attribute unwanted behaviour to contextual factors and staff more likely to 'blame' mental illness. The consequences of violence included stress, physical injury, and a culture of fear and stigma. Violence in acute inpatient mental health units in New Zealand is a significant, complex, and unresolved problem negatively impacting the therapeutic mission of these settings. Further in-depth qualitative investigations are urgently required into what is experienced as violence by service users, their view of how violence occurs, the role of fear and power relations, and the contributions of the built and organisational environment to all forms of violence to all unit users. A core function of the acute mental health unit is to offer a therapeutic environment for individuals at their most vulnerable. For this to happen, the unit must be a rewarding place to work, and a safe place to be.

Providing music therapy for people with dementia in an acute mental health setting.

As global figures for dementia are set to rise significantly, there has been a shift towards using non-pharmacological interventions such as music therapy to enhance the quality of life for people with the condition. Research into music therapy interventions for this patient group in acute mental health inpatient settings, however, is limited. This article describes a service evaluation that explored whether group music therapy was effective for people with dementia in such settings. Open group music therapy sessions were hosted weekly in two acute wards and the researchers examined the social and behavioural outcomes of participants pre and post-intervention. The results indicated that music therapy significantly improved patient outcomes following participation. The outcome measure developed for this service evaluation was found to be a reliable tool for measuring the effectiveness of music therapy on patient outcomes.

Safewards Secure: A Delphi study to develop an addition to the Safewards model for forensic mental health services.

Accessible SummaryWhat is known on the subject? The Safewards model has been introduced to forensic mental health wards with mixed results.Research has identified a need to consider the addition of factors that may be relevant to forensic mental health services to enhance the introduction of Safewards. What the paper adds to existing knowledge? This study elicits factors specific to forensic mental health settings missing from the original Safewards model, which have the potential to enhance nursing care, improve safety and improve adherence to Safewards in a forensic mental health setting. What are the implications for practice? This study provides the adaptation required in a forensic mental health setting to enhance the implementation of the Safewards model of care, originally developed to assist nurses to prevent and manage conflict and containment in acute general mental health settings.The development of Safewards Secure has incorporated perspectives from expert Safewards and forensic mental health nurse leaders and healthcare clinicians and is inclusive of consumer and carer perspectives to ensure the model is applicable and broadly acceptable. IntroductionSafewards is a model designed specifically for acute mental inpatient wards. Research investigating the introduction of Safewards has identified a need to consider factors relevant in forensic mental health services, such as offence and risk issues.AimTo identify adaptations needed to address gaps in the Safewards model to assist forensic mental health nurses to prevent and manage conflict and containment.MethodA Delphi study was employed to engage a group of international Safewards and forensic mental health experts (n = 19), to elucidate adaptation of the Safewards model.ResultsExperts identified necessary elements and reached consensus on key considerations for Safewards interventions. To ensure the Safewards Secure model was robust and developed on a platform of research, all items suggested by Delphi experts were cross‐referenced and dependent on empirical evidence in the literature.DiscussionThis study identified a number of key differences between civil and forensic mental health services, which informed the development of Safewards Secure, an adjunct to the original Safewards model.Implications for PracticeThe development of person‐centred models of nursing care adapted to specific settings, such as forensic mental health, provides a potential solution to preventing and managing conflict and containment, and improving consumer outcomes.Relevance StatementManaging conflict and containment in mental health services remains an ongoing challenge for mental health nurses. Safewards is a model of care designed for acute mental health inpatient settings to prevent conflict and containment. To date, there has been mixed results when introducing Safewards in forensic mental health settings, and reported reluctance and scepticism. To address these issues, this study employed a Delphi design to elicit possible adaptions to the original Safewards model. From this study, Safewards Secure was developed with adaptations designed for forensic services, to enhance the management of conflict and containment, assist implementation and improve consumer outcomes.

Key Components for the Delivery of Cognitive Behavioral Therapies for Psychosis in Acute Psychiatric Inpatient Settings: A Delphi Study of Therapists’ Views

Abstract Cognitive Behavioral Therapy for psychosis (CBTp) is a psychological therapy recommended for people with psychosis which can start in the acute phase. However, there is not consensus on how CBTp should be delivered in an acute mental health inpatient setting. This study aimed to gain consensus from therapists on how CBTp should be delivered in this context. A 2-stage Delphi study was conducted to establish consensus on what the core components are of inpatient CBTp from the perspective of therapists who are experts in the field. Forty-five therapists took part in 2 rounds of rating statements on the areas of engagement and feedback, assessment and model, formulation, change strategies, homework, and principles and values. A final list of 114 statements were included, which were rated as essential or important by ≥80% of respondents. The delivery of inpatient CBTp is dependent on several adaptations to traditional CBTp including indirect work, being more flexible with session content and delivery, and making adaptations to the restrictive environment. These recommendations could inform training, competency frameworks, and delivery of CBTp in inpatient settings.

Interventions to Improve Social Climate in Acute Mental Health Inpatient Settings: Systematic Review of Content and Outcomes.

Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits. This study aimed to identify and critically review research about the effectiveness of interventions for improving social climate in inpatient adult acute mental health settings. Systematic review reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive terms were used to search multiple electronic databases from inception to July 2019. Information about intervention type(s), complexity was extracted and study quality was assessed. Twenty-three papers met inclusion criteria of which 20 used a pretest-posttest study design and three employed randomized and/or controlled designs. Interventions were environmental/structural, operational/process-oriented and developmental/person-oriented in nature and they ranged in complexity. The Ward Atmosphere Scale was the most common outcome measure used. Following quality assessment, six studies were judged to be sufficiently robust in terms of quality, theory-base, user-inclusion, and outcomes evaluation to contribute credibly to the evidence base. Of these, four complex person- and process-oriented intervention studies and two less complex structural/environmental intervention studies resulted in positive outcomes. There is limited strong evidence that interventions positively influence measures of ward social climate in acute adult mental health settings. Such measures should not be the sole criterion of success when evaluating change. Decisions about implementing change to improve social climate should be informed by meaningful proxy measures including the views and preferences of service users and other stakeholders. Studies using stronger designs are required to establish the ability of interventions to improve social climate.

Nursing people diagnosed with Borderline Personality Disorder: 'We all need to be on the same hymn sheet'.

The diagnosis of borderline personality disorder (BPD) has been found to carry stigma and poor hope of recovery. More recently, it has been regarded as a treatable condition through psychotherapy. Despite this, patients often experience lengthy hospitalizations, limited access to treatment, and poor outcomes. This paper describes the experiences of psychiatric nurses working with people diagnosed with BPD in acute mental health in-patient settings in Ireland. Seven nurses were interviewed, and the transcripts were analysed using a reflective and inductive approach. Overall, the nurses did not feel confident that their interventions were effective or valued by the wider service or patients. The nurses articulated their invidious professional circumstances, whereby they were required to act in ways, which ran counter to their vision of therapeutic or recovery-focused work. These views and perceptions that in-patient care is often ineffectual are widely echoed in the literature. We contend that the effect of this circumstance for these nurses approaches moral distress. The nurses were aware of more effective methods of care and treatment for BPD but perceived that they were unable to influence the culture of in-patient care.

Association between suicide, external-cause and all-cause mortality and irregular mental health discharge among the US veteran population

Background Irregular hospital discharge is highly prevalent among people admitted to hospital for mental health reasons. No study has examined the relationship between irregular discharge, post-discharge mortality and treatment setting (i.e. mortality after patients are discharged from acute in-patient or residential mental health settings). Aims To understand the relationship between irregular discharge and mortality among patients discharged from acute in-patient and residential settings. Method A retrospective study was conducted in members of the US veteran population discharged from acute in-patient or residential settings of the US Department of Veterans Affairs between 2003 and 2018. Multivariate Cox proportional hazards were used to evaluate associations between irregular discharge and suicide, external-cause (as defined by ICD-10 Codes: V01-Y98) and all-cause mortality in the first 30-, 90- and 180-days post-discharge. Results There were over 1.5 million mental health discharges between 2003 and 2018. Patients with an irregular discharge were at increased risk for suicide, external-cause and all-cause mortality in the first 180 days after discharge. In the first 30 days after discharge, patients with irregular discharge had more than three times greater suicide risk than patients with regular discharge (adjusted hazard ratio (HR) = 3.41, 95% CI 2.21–5.25). Suicide risk was higher among patients with irregular discharge in the first 30 days after acute in-patient discharge (adjusted HR = 1.55, 95% CI 1.11–2.16). In both settings, the mortality risk associated with irregular discharge attenuated but remained elevated within 90 and 180 days. Conclusions Irregular discharge after an acute in-patient or residential stay poses a large risk for mortality soon after discharge. Clinicians must identify effective interventions to mitigate harms associated with irregular discharge in these settings.

Irregular hospital discharge from acute inpatient and residential mental health treatment settings in a large integrated healthcare system

ObjectiveIrregular discharge is a concern among mental health populations and associated with poor outcomes. Little is known about the relationship between irregular discharge and treatment setting. Because care processes differ between acute inpatient and residential settings, it is important to evaluate irregular discharge in these settings. MethodA retrospective study was conducted in patients with mental health conditions admitted to acute inpatient or residential mental health settings in the Department of Veterans Affairs, 2003–2019. Logistic regression and multivariate Cox proportional hazards were used to evaluate factors associated with irregular discharge risk in the first 90- days of admission. ResultsAmong 1.8 million discharges, 7.4% had an irregular discharge within 90- days of admission. Younger age was a central predictor of risk. Irregular discharge rates were four-fold higher in residential versus acute settings. When accounting for length of stay (LOS) across settings, there was a modest higher risk of irregular discharge from acute versus residential settings (HR = 1.06, 95% Confidence Interval 1.04–1.07). ConclusionsPatients are at high risk for irregular discharge from acute and residential settings when they are young. LOS is an important determinant of irregular discharge risk.. Interventions are needed to address drivers of irregular discharge.

A systematic review of the implementation of psychological therapies in acute mental health inpatient settings.

Research has demonstrated that psychological therapies are not routinely delivered in acute mental health inpatient settings despite being recommended by the National Institute for Health and Care Excellence (NICE) guidelines. This study aimed to identify the barriers and facilitators to implementing psychological therapies in acute mental health inpatient settings. A systematic review and narrative synthesis was undertaken. Primary studies were included if they examined the implementation of a NICE recommended psychological therapy in acute psychiatric inpatient settings and were of any study design. Four databases were searched for eligible studies (MEDLINE, CINAHL Plus, PsycINFO and Embase) and Google Scholar. A total of 16 studies (a mixture of both qualitative and quantitative methodologies) were included in the review, and the majority evaluated the implementation of Cognitive Behaviour Therapy. Overall, the literature was deemed to be of poor to moderate quality. The main barriers to the implementation of psychological therapy were the busy nature of the ward, multi-disciplinary professionals not being suitability trained and the acute nature of service users mental health difficulties. Facilitators to implementation included the adaptation of interventions to be specifically delivered in the acute inpatient setting, training of multi-disciplinary professionals, leadership support with the delivery of psychological therapies and prioritising the therapeutic relationship. There is a requirement for senior management to prioritise the implementation of psychological therapies and update clinical guidelines to describe modifications necessary to implement psychological therapies in acute inpatient settings. Future research should improve their methodological quality and continue to develop the evidence base of brief psychological therapies in acute inpatient settings.

The subjective experience of recovery from psychosis in an acute mental health inpatient setting

ABSTRACT Background: Experiences of recovery from psychosis have been well explored but not with service users in the acute stages of psychosis. This study aimed to explore the subjective experiences of recovery from psychosis from the perspective of service users receiving acute mental health inpatient care. Methods: Ten participants undertook a semi-structured interview examining their experiences of recovery from psychosis during acute mental health inpatient care. Data were analysed using Interpretative Phenomenological Analysis (IPA). Results: Five superordinate themes emerged: “My future is just being ripped out in front of me”: Living with psychosis is a struggle; “Would you want to be in here?”: Traumatic experience of being in hospital; “I know roughly why I got ill anyway and what caused this”: A journey towards reaching an understanding; Recovery/Rehabilitation/Recuperation: A process of evolution; and “You need all the help you can get”: Facilitators of Recovery. Conclusions: This study highlighted that mental health inpatient settings are not settings where everyone can be in recovery or approaching recovery. For some participants, recovery appeared to be an empty signifier, and is a word used by services but does not necessarily correspond with their experiences of mental health inpatient settings.

The evaluation of a highly specialist inpatient psychologist working with patients with high risk presentations in an acute mental health inpatient setting

Objective: To evaluate the function and impact of a highly specialist psychologist working with high risk patients in an acute mental health inpatient setting. The impact was examined on outcomes such as risk related incidents, re-admission, average length of stay, and use of restrictive practice.<br/> Method: A mixed methods service evaluation of a pilot project was undertaken to examine the impact of the specialist psychologist role on these outcomes over a 17-month period. Demographic and clinical data was collected for 18 patients who were seen by the psychologist. Routinely collected clinical data examining risk incidents, re-admission rates, average length of stay, and use of restrictive practice, were also used to evaluate outcome across the evaluation period (at baseline and six-month follow-up).<br/> Results: The specialist psychologist provided input to patients' care and undertook a variety of direct and indirect work and training. Examination of descriptive routine clinical data indicated a slight reduction in risk related incidents, readmissions, and average length of stay after the introduction of the psychologist role, however these were not statistically significant.<br/> Conclusion: These initial findings suggest the potential for outcome improvement, but further, more robust research is required to see if such a role can have a significant impact on outcomes.