Adult Inpatient Mental Health Research Articles

Rapid review of facilitating reflective practice groups with staff in adult inpatient mental health settings

ABSTRACT Reflective practice is poorly defined and often lacks distinction from other practices, such as clinical supervision. In the UK, the National Health Service (NHS) faces unparalleled challenges within the context of chronic underfunding, high staff attrition, and the recent global pandemic. Frontline staff are desperately trying to meet the demands of their roles and services are struggling to prioritise their professional development and wellbeing, further exacerbating these problems. This rapid review of the evidence sought to identify barriers and facilitators of Reflective Practice Groups (RPGs) within adult inpatient mental health services, using three databases. Two-hundred and one unique references were retrieved, yielding eight papers meeting the inclusion criteria. Barriers to facilitating RPGs included: practicalities; individual and team expectations; needs and competencies of facilitators; and organisational issues. Studies suggested solutions including facilitating RPGs off-ward to reduce disruptions and protect the space; increasing psychological safety by incorporating clear guidelines and expectations for attendees; and organisational support. The review highlighted universal challenges faced by healthcare professionals and organisations in facilitating and accessing RPGs. The review illustrates the paucity of research in this area, which may be due to nebulous definition and inconsistencies between different organisations. Implications for practice are discussed.

Domestic and Family Violence Screening and Response: A Prospective, Cross-Sectional, Mixed Methods Survey in Private Mental Health Clients.

Most domestic and family violence (DFV) research has focused on establishing prevalence and screening rates in public health and community samples. This study sought to address a gap in the literature by evaluating DFV screening and response practices in a private mental healthcare inpatient service and determining if clients of the service had unmet DFV needs. A prospective, convenience sample, mixed methods, cross-sectional survey of adult inpatient mental health consumers was employed. Sixty-two participants completed the Royal Melbourne Hospital Patient Family Violence Survey. Quantitative Likert-type and categorical responses were collated and analysed descriptively (count and percentage). Free-text responses were analysed using qualitative description within a content analysis framework. Sixty-five percent of participants had been screened for at least one DFV issue, on at least one occasion, with 35% not being screened, to their recall. Twenty-three percent reported disclosing DFV concerns, 82% felt very supported by the clinician's response to their disclosure, and 86% were provided with information they found helpful. Unmet needs were identified in 13% of participants, who had wanted to disclose DFV concerns but not feel comfortable to do so. No unscreened respondents disclosed DFV concerns, highlighting the need to uphold best practice guidelines for direct enquiry. Most disclosing clients were positive about the support they received. Indicated areas for improvement were screening rates, active follow-up, increasing psychology support levels and safety planning.

Exploring therapeutic engagement in Finnish adult acute inpatient mental health settings

Exploring therapeutic engagement in Finnish adult acute inpatient mental health settings

Physical activity in adult users of inpatient mental health services: A scoping review.

People with severe mental illness engage in considerably less physical activity than those without. They also experience premature mortality of around 10-25 years. A large proportion of these premature deaths are attributed to modifiable behaviours, including physical activity. The inpatient environment provides an opportunity to support people to become more physically active; however, there is limited evidence on which interventions are most successful and what contextual factors affect their delivery. A scoping review was conducted to help understand the extent and type of evidence in this area and identify research gaps. We included studies of physical activity correlates and interventions in adult inpatient mental health services published in peer-reviewed journals. Reviews, meta-analyses, and papers focusing on eating disorder populations were excluded. We searched the MEDLINE, CINAHL, PsycINFO, ASSIA and Web of Science databases for relevant studies published in English. We extracted data on study design, participant characteristics, intervention and control conditions, key findings, and research recommendations. We used a descriptive analytical approach and results are presented in tables and figures. Of 27,286 unique records screened, 210 reports from 182 studies were included. Sixty-one studies reported on correlates of physical activity, and 139 studies reported on physical activity interventions. Most intervention studies used a single-group, pre-post design (40%) and included fewer than 100 participants (86%). Ninety percent of interventions delivered physical activity directly to participants, and 50% included group-based sessions. The duration, type, frequency and intensity of sessions varied. Mental health was the most commonly reported outcome (64%), whereas physical activity was rarely an outcome (13%). Overall, there is a modest but growing body of research on physical activity in adult users of inpatient mental health services. More high-quality trials are needed to advance the field, and future research should target neglected intervention types, outcomes, populations and settings.

De-escalating aggression in acute inpatient mental health settings: a behaviour change theory-informed, secondary qualitative analysis of staff and patient perspectives

BackgroundDe-escalation is often advocated to reduce harm associated with violence and use of restrictive interventions, but there is insufficient understanding of factors that influence de-escalation behaviour in practice. For the first time, using behaviour change and implementation science methodology, this paper aims to identify the drivers that will enhance de-escalation in acute inpatient and psychiatric intensive care mental health settings.MethodsSecondary analysis of 46 qualitative interviews with ward staff (n = 20) and patients (n = 26) informed by the Theoretical Domains Framework.ResultsCapabilities for de-escalation included knowledge (impact of trauma on memory and self-regulation and the aetiology and experience of voice hearing) and skills (emotional self-regulation, distress validation, reducing social distance, confirming autonomy, setting limits and problem-solving). Opportunities for de-escalation were limited by dysfunctional risk management cultures/ relationships between ward staff and clinical leadership, and a lack of patient involvement in safety maintenance. Motivation to engage in de-escalation was limited by negative emotion associated with moral formulations of patients and internal attributions for behaviour.ConclusionIn addition to training that enhances knowledge and skills, interventions to enhance de-escalation should target ward and organisational cultures, as well as making fundamental changes to the social and physical structure of inpatient mental health wards. Psychological interventions targeting negative emotion in staff are needed to increase motivation. This paper provides a new evidence-based framework of indicative changes that will enhance de-escalation in adult acute mental health inpatient and PICU settings.

SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards

BackgroundAggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment...

Venous Thromboembolism (VTE) Risk Assessment in an Older Adult Mental Health Inpatient Ward

Venous Thromboembolism (VTE) Risk Assessment in an Older Adult Mental Health Inpatient Ward

EXERCISE PROGRAM WITHIN ADULT PSYCHIATRIC INPATIENT SERVICES FOR THOSE WITH DISORDERED EATING

INTRODUCTION & AIMS Over one million Australians live with an eating disorder, with 40 – 80% reported to undertake dysfunctional exercise practices (e.g., compulsive exercise, exercise dependence). Dysfunctional exercise can be the first symptom to appear and the last symptom to resolved in eating disorder patients, with 41% of eating disorders patients relapsing into dysfunctional exercise patterns 4 to 9 months post inpatient treatment. We evaluated an accredited exercise physiology led program implemented for adult mental health inpatients with disordered eating and exercise behaviours to support patient outcomes and safe exercise participation. METHODS Data was collected as part of service evaluation and included patient characteristics, session data (e.g., mood and enjoyment via Exercise Enjoyment Scale) and patient outcomes (e.g., Compulsive Exercise Test (CET); Exercise Dependence Scale (EDS-21)). Characteristics of the cohort was reported and compared to clinical cut-offs, along with program feasibility measures. RESULTS Between Sep 2022 and Nov 2023, 20 female patients engaged in the program (mean age= 26 years). Of those 15 were diagnosed with Anorexia Nervosa, 16 with a co-occurring Personality Disorder and 9 with a Trauma Related Disorder. EDS-21 results showed 56% were symptomatic, and 33% exercise dependent, with 80% also presenting with suicidal ideation/self-harm. Across 137 service interactions, patients engaged 65% of the time, and 25% of the time deemed inappropriate. Pre-session mood was low (mean= -2.13 ± 1.46) with an average post-session mood improvement of + 4.46 Session enjoyment was high (mean=3.6±1.20) and no adverse events were recorded. CONCLUSIONS & IMPLICATIONS Exercise supported by AEPs is safe for inpatients with disorder eating, with patients valuing engagement in services focused on supporting positive exercise relationships and behaviours. A tailored and evidence-based approach to exercise can improve acute mood of consumers.

Prevalence and variability of restrictive care practice use (physical restraint, seclusion and chemical restraint) in adult mental health inpatient settings: A systematic review and meta-analysis.

There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised. This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates. Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates. A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions. There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations. Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities. This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study. The protocol for this review has been registered to PROSPERO: CRD42022335167.

Physical activity following discharge from inpatient adult mental health settings

BackgroundPeople with severe mental illness are considerably less physically active than the general population and experience a premature mortality of 10–20 years, often attributed to modifiable behaviours, including physical activity. Inpatient environments provide opportunities for people with SMI to become more physically active, however evidence is limited on its sustainability following discharge to community settings. ObjectiveThis review aimed to summarise the published evidence relating to physical activity interventions following discharge from inpatient adult mental health settings. DesignMEDLINE, CINAHL, PsycINFO and AMED databases were searched to identify articles considering physical activity interventions taking place following discharge from an adult (>18) inpatient mental health setting, published after 2007. ResultsOf 3412 unique results, 5 studies were eligible for inclusion. Despite all included studies involving some transition between inpatient and community mental health settings, to-date no study has focused exclusively on physical activity interventions delivered following discharge from inpatient mental health settings. ConclusionsThis review has found insufficient evidence to guide the delivery of physical activity following discharge from inpatient mental health services. Future research is required to improve our knowledge of the optimal forms and delivery of physical activity interventions during this time, alongside quantifying the impact on readmission rates and clinical presentation.

Non-Qualified Staff's Experience of Suicidal Behaviour in Adult Mental Health Inpatient Services.

Suicide and attempted suicide of people receiving care in Adult Mental Health Inpatient Services (AMHIS) leads to significant emotions amongst mental health professionals, characterised by guilt and shame. A sense of responsibility occurs due to hospital being seen as a safe place. However, little is known about what it is like for 'non-qualified' staff. This study explored experiences of suicide and attempted suicide on 'non-qualified' staff in AMHIS. Semi-structured interviews explored ten staff's experiences. Participants were recruited online and transcripts were analysed using Reflexive Thematic Analysis. Four themes were identified; 'Direct personal impact', 'Unrealistic expectations', 'Attempting to contain the impact' and 'Acclimatisation'. Ten sub-themes outlined; responsibility for assessing risk, shame and protective strategies to aid acceptance. The results provide insight into the unique experience of non-qualified staff in AMHIS experiencing suicidal behaviour.

Trauma-Informed Care on mental health wards: the impact of Power Threat Meaning Framework Team Formulation and Psychological Stabilisation on self-harm and restrictive interventions.

The aim of this evaluation was to assess the impact of introducing a model of Trauma-Informed Care (TIC), comprising weekly Power Threat Meaning Framework (PTMF) Team Formulation and weekly Psychological Stabilisation staff training, to a National Health Service (NHS) adult acute inpatient mental health unit over a four-year period. A retrospective service evaluation design was employed to assess for differences in the number of incidents of self-harm, seclusion and restraint in the four-year period following the introduction of TIC, when compared to the year prior. Significant reductions were demonstrated in the monthly number of incidents of self-harm (p < 0.01; r = 0.42), seclusion (p < 0.05; r = 0.30) and restraint (p < 0.05; d = 0.55) following the introduction of TIC. Findings suggest that PTMF Team Formulation and Psychological Stabilisation training can contribute to significant reductions in self-harm and restrictive interventions (seclusion and restraint) on adult mental health wards. Qualitative interviews with staff and service users from the unit will support a better understanding of the mechanisms of this change. Further research, employing a randomised control trial design, could increase the validity and generalisability of findings. However, the ethical implications of withholding potentially beneficial practices from a control group would need to be considered.

Sensory modulation implementation strategies within inpatient mental health services: an organisational case study

PurposeSensory modulation is an emerging approach that aims to reduce distress and agitation in mental health service users and potentially avoid the necessity for coercive practices such as seclusion and restraint. Despite the growing use of this intervention, there has been limited research exploring the implementation of sensory modulation at an organisational level, both internationally and within the New Zealand context. The purpose of this study is to investigate the implementation of a sensory modulation programme in two New Zealand inpatient mental health services using an exploratory organisational case study design.Design/methodology/approachOrganisational case study design methodology was used to explore the implementation of a sensory modulation programme in two New Zealand acute adult inpatient mental health services. This study explored how key organisational and staff factors (including policies and practices related to de-escalation and seclusion reduction) influence sensory modulation implementation. Cases were described and examined the pattern of findings.FindingsStrategies found to support implementation were identified at environmental, organisational, group and individual staff levels. Aspects highlighted as being particularly important included taking an inter-professional approach in leadership and training, rostering flexibility and leeway in staffing levels to support training attendance and responsiveness to crises.Practical implicationsThe facilitators and strategies highlighted in this study may be used to support the design and implementation of future sensory modulation programmes in New Zealand and internationally.Originality/valueThe complexity of factors that influenced the implementation of the sensory modulation approach within an inpatient setting made determining the effectiveness of the approach challenging. However, the general principles and strategies identified in this study offer useful insights for the design and implementation of future sensory modulation programmes.

Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study

IntroductionPatients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted...

P17 National antimicrobial point prevalence survey in adult inpatient mental health facilities in Ireland

Abstract Background Antimicrobial use in mental health inpatient settings has not been extensively examined in Ireland. The Healthcare-Associated Infection and Antimicrobial Use in Long-Term Care Facilities (HALT) study 2016 found that Irish long-term care facilities caring for residents with psychiatric conditions had an antimicrobial prevalence rate of 7.7%, higher than the European average of 4.9%. National community antimicrobial prescribing guidelines are available at www.antibioticprescribing.ie. In addition, a preferred antibiotic initiative for community settings advocates prescribers to choose ‘Green’ (preferred) antibiotics over ‘Red’ (reserved) agents. Reserved agents are considered to have more adverse effects, drug interactions and potential for development of antimicrobial resistance. The patient safety implications of antimicrobial stewardship along with an ageing population, and potential drug–drug interactions between many antimicrobials and psychotropic medications prompted a review of antimicrobial use practices in mental health services. Methods A sample of adult inpatient mental health facilities (MHF) operated by the state's Health Service Executive (HSE) were surveyed by community antimicrobial pharmacists (AMPs) between November 2021 and January 2022. AMPs reviewed patients’ medication charts for systemic antimicrobial prescriptions in the previous 30 days in addition to medical notes and laboratory results (where available). Adherence to HSE National community antimicrobial guidelines and the systems and structures in place to support antimicrobial stewardship were assessed. Results In total, 1003 patients in 51 MHFs were surveyed. At the time of survey, 6.3% (n=66) patients were on a systemic antimicrobial and 15% (n=153) had received a systemic antimicrobial within the previous 30 days. Prophylaxis accounted for 50% of antibiotic use (3.3% of all patients), with the most common indication being the prevention of urinary tract infection (UTI) (58%). Prophylaxis duration exceeded six months in 61% of prescriptions. The median duration of treatment courses was seven days. The proportion of ‘Green’ (preferred) antimicrobials versus ‘Red’ (reserved) antimicrobials was 58% versus 38%. Co-amoxiclav, a ‘Red’ agent was the most commonly prescribed antibiotic for treatment of infection (31%). Adherence with choice of antimicrobial agent as per national antimicrobial guidelines was 76%; adherence of dosing regimen was 75% and adherence with recommended duration was 46%. The main themes for non-adherence with choice of agent were use of unnecessarily broad spectrum agents, nitrofurantoin prescribed in renal impairment and inappropriate formulation of nitrofurantoin chosen. Dipstick urinalysis was performed routinely (on admission and/or at designated intervals) for persons asymptomatic of UTI in 53% (n=27) of MHFs. Conclusions This PPS established antimicrobial use practices in HSE MHFs and identified opportunities for improvement relating to the safe and optimal use of antimicrobials. Key national recommendations from this survey were:

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.

Economic evaluation of a vision-based patient monitoring and management system in an acute adult and an older adult mental health hospital in England

Background and aims Patients on acute adult and older adult inpatient mental health wards are at an increased risk of accidental injuries and deliberate harm to self and others. A vision-based patient monitoring and management (VBPMM) system was designed by Oxehealth Limited to support ward staff to provide better and more efficient care and to reduce incidents. The VBPMM system uses an infrared-sensitive camera, installed in a patient’s room, that works with cleared medical device software to deliver contact-free vital sign and activity insights to clinical teams. Data from two studies undertaken at an English National Health Service (NHS) mental health trust were used to inform an early economic assessment of VBPMM implementation into acute adult and older adult mental health wards. Methods A cost calculator was used to compare the introduction of the VBPMM system as an adjunct to standard care versus standard care alone. Observational data were collected at two English NHS mental health trusts. Both compared data pre- and post-VBPMM implementation using a 12-month baseline period. The model estimated cost per occupied bed day, cost per patient, annual cost per average-sized ward, and total cost to NHS mental health trusts across England. Costs were modeled from an NHS perspective over a 12-month time horizon. Scenario analysis was conducted to test the uncertainty of results using statistical significance of key inputs. Results and conclusions This early analysis indicated that the VBPMM system is likely to be cost saving within both settings examined, with an estimated cost saving of £272 per acute adult mental health patient and £4,591 per older adult mental health patient. This translates to £22.3 and £63.3 million, respectively, across NHS mental health trusts in England every year. VBPMM, therefore, has the potential to augment standard care, leading to positive clinical outcomes and monetary savings.

Improving family engagement in an adult inpatient mental health service using an action research framework

AbstractFamily involvement in mental health treatment has been shown to improve outcomes for service users. This project used a whole system‐focused action research framework and involved service users, family members and healthcare professionals to develop ways to improve family engagement in an adult inpatient mental health service. Focus groups were conducted with two service users, two family members and four healthcare professionals to discuss their experiences of family involvement and develop initial ideas. A problem‐solving group, involving service users, family members and professionals, was used to develop the solutions. The project identified context‐specific solutions to improve family engagement, which included specific training for professionals working on the inpatient wards, questionnaires to facilitate conversations with families, and sharing information about mental health and the inpatient mental health service with families. These may be helpful for other adult inpatient services.

Creating a psychologically informed group: ‘Listening and joining in and offering little stories’

This article outlines the creation and delivery of a six-session psychologically informed group, ‘The Talking Group’, on an older adult inpatient mental health ward. We summarise the content of the sessions and explore the feedback received from people who attended the group. Thematic analysis identified themes from 175 responses which were collected from 93 participants between September 2018 – June 2020. Our findings demonstrated that although the overall feedback was positive and attendees continued to attend the group, there were also areas the group could be improved. We have summarised the improvement suggestions into ‘recommendation’ tables throughout the article, which we hope will provide some guidance for clinicians planning to develop groups in a similar context.

Clinical Audit and Reaudit of Driving Risk Assessment During Leave Risk Discussions Within an Adult Mental Health Inpatient Hospital

AimsAll detained patients should have a leave risk discussion carried out prior to commencement of home leave. Driving risk must be clearly discussed and captured during the assessment. Driving advice as per DVLA guidance must be documented in case notes and discharge summaries. The aim was to audit and reaudit the use and quality of the driving risk assessment during leave risk discussions within adult mental health inpatient wards at one site under the Tees, Esk and Wear Valleys NHS Foundation Trust. The authors hypothesise that compliance to local policies could be improved upon.MethodsStandards were set based on local policies. The audit was conducted across all adult acute inpatient wards within the identified mental health hospital. All inpatients who went on a period of home leave during their admission and ultimately discharged during the period from 1 April 2021 to 30 April 2021 (initial audit) and 1 October 2021 to 31 October 2021 (reaudit) were assessed. The data were collected using an audit tool. An Excel spreadsheet was used to collate data: specifically driving status of the patient, whether a leave risk discussion which captured driving risk was carried out, and whether DVLA advice was captured on discharge letters.Results48 patients (19 were drivers) during the initial audit and 27 patients (9 were drivers) during the reaudit met the inclusion criteria. For the initial audit, overall compliance for leave risk discussion (73%), specifically for driving risk assessment, did not meet target compliance. Only 5% of drivers were given written DVLA guidance on discharge letters. The reaudit showed a 100% compliance in the use and quality of leave risk discussion. 56% of patients had written confirmation of discussion on DVLA driving advice recorded on discharge summary.ConclusionThere has been significant improvement in the use and quality of leave risk discussion, and documentation of DVLA driving advice on discharge summary during the reaudit.The results were discussed at the Regional Audit meeting and the Inpatient Leadership Meeting. The following improvement plan was agreed and implemented: 1.Regular communication amongst Multi-Disciplinary Team (MDT) during Leave Risk Discussion. One healthcare professional assigned to inform patient of the advice and capture conversation on case notes.2.Junior doctor induction to reiterate importance of capturing DVLA advice on discharge letters.3.MDT to discuss driving risk and advice during discharge meetings. “Driving advice discussion” to be added to discharge meeting checklist.