Mental Health Clinical Practice Research Articles

Inspiring Careers in Mental Health: Piloting a Pipeline Program for Underserved High School Students.

Given mental health workforce shortages, academic psychiatry departments have a compelling interest in developing pipeline programs. This article examines a pilot program for high school students within an academic psychiatry department, assessing whether it successfully informs students about mental health career options and increases their interest in them. The authors recruited all program participants in 2022 and 2023 during data collection. The program served as an intervention, teaching participants about mental health career options, clinical practice, and client experiences via presentations from psychiatrists and other mental health professionals. Participants completed a pretest at the start of the two-week program and a posttest at the end. On both the pretest and posttest, participants rated their agreement with 22 statements relating to mental health career knowledge, attitudes, and interest. The authors analyzed the data using dependent means t tests. The program increased participants' knowledge of the roles and paths to pursuing different mental health careers. It also increased participants' belief that they could pursue a mental health career. The program improved some but not all measured attitudes toward mental health and mental health careers. In 2023, the program increased participants' likelihood of pursuing a mental health career. A pipeline program for underserved high school students delivered by an academic psychiatry department is feasible, and it was effective in changing attitudes and increasing the likelihood of pursuing a mental health career.

The impact of exercise on mental health: a narrative review

It has become increasingly clear that exercise not only improves physical health but also significantly affects mental well-being, presenting a non-pharmaceutical approach to manage various psychological conditions. This narrative review summarizes studies from the literature to understand the effects of exercise on mental health, particularly in depression, anxiety, and global psychological well-being. Results indicate that regular physical activity, including aerobic and resistance exercises, reduces depression and anxiety symptoms, improves mood, and enhances cognitive abilities. Theoretical models, such as the endorphin hypothesis and neurogenesis hypothesis, explain these benefits through mechanisms including endorphin release, reduced stress hormones, improved sleep, and neurogenesis. Evidence suggests that structured exercise programs can match the effectiveness of psychotherapy or medication with fewer adverse effects. The benefits of regular exercise have garnered attention from professionals, physicians, and policymakers, highlighting the necessity of incorporating exercise plans into mental health clinical practice. Additionally, this review advocates for more specific and personalized exercise interventions tailored to individual characteristics and preferences. It also aims to inform health and research agendas by specifying the optimal exercise type and intensity for eliciting desired benefits, and evaluating the potential for exercise interventions to sustain long-term psychological well-being.

Examination of self patterns: framing an alternative phenomenological interview for use in mental health research and clinical practice.

Mental disorders are increasingly understood as involving complex alterations of self that emerge from dynamical interactions of constituent elements, including cognitive, bodily, affective, social, narrative, cultural and normative aspects and processes. An account of self that supports this view is the pattern theory of self (PTS). The PTS is a non-reductive account of the self, consistent with both embodied-enactive cognition and phenomenological psychopathology; it foregrounds the multi-dimensionality of subjects, stressing situated embodiment and intersubjective processes in the formation of the self-pattern. Indications in the literature already demonstrate the viability of the PTS for formulating an alternative methodology to better understand the lived experience of those suffering mental disorders and to guide mental health research more generally. This article develops a flexible methodological framework that front-loads the self-pattern into a minimally structured phenomenological interview. We call this framework 'Examination of Self Patterns' (ESP). The ESP is unconstrained by internalist or externalist assumptions about mind and is flexibly guided by person-specific interpretations rather than pre-determined diagnostic categories. We suggest this approach is advantageous for tackling the inherent complexity of mental health, the clinical protocols and the requirements of research.

Ethical Dimensions of Digital Phenotyping Within the Context of Mental Healthcare

AbstractDigital phenotyping (DP) refers to the emerging field within digital (mental) health that involves the collection of data from individual’s digital devices (smartphones, wearable, Internet usage, etc.) to monitor and analyse their behaviours, activities and health-related patterns. That such ‘digital footprint’ data can be mined for behavioural insights is an intriguing idea, which has motivated an increasing amount of research activity, particularly in the field of digital mental health. Whilst of potentially revolutionary utility in (mental) healthcare, the idea of DP also raises a set of rich sociotechnical, ethical and philosophical considerations, and a cottage industry of sociotechnical and ethical critiques of DP has emerged, particularly within the humanities. Within this scene of early empirical investigation in the health/behavioural sciences on the one hand and general conceptual critiques from the humanities on the other, in this paper we instead explore a case for the potential utility of DP in circumstances of clinical mental health practice and examine its ethical dimensions in this context. After providing an explicatory framework for DP and making a case for it within this framework, we subsequently examine the ethical pros and cons of three topics pertaining to DP in clinical practice, namely (1) issues in psychometric assessment/testing, (2) the role and responsibilities of mental health practitioners with regard to DP technology, and (3) the value DP can afford clients in terms of self-awareness/empowerment and strengthening the therapeutic alliance with their clinician.

Optimizing Measurement Potential in Mental Health Clinical Practice: The Canadian Personal Recovery Outcome Measure (C-PROM) study

Optimizing Measurement Potential in Mental Health Clinical Practice: The Canadian Personal Recovery Outcome Measure (C-PROM) study

Nurses’ and patients’ perceptions of physical health screening for patients with schizophrenia spectrum disorders: a qualitative study

BackgroundDespite worldwide concern about the poor physical health of patients with schizophrenia spectrum disorders (SSD), physical health screening rates are low. This study reports nurses’ and patients’ experiences of physical health screening among people with SSD using the Finnish Health Improvement Profile (HIP-F) and their ideas for implementation improvements.MethodsA qualitative exploratory study design with five group interviews with nurses (n = 15) and individual interviews with patients with SSD (n = 8) who had experience using the HIP-F in psychiatric outpatient clinics. Inductive content analysis was conducted.ResultsTwo main categories were identified. First, the characteristics of the HIP-F were divided into the subcategories of comprehensive nature, facilitating engagement, interpretation and rating of some items and duration of screening. Second, suggestions for the implementation of physical health screening consisted of two subcategories: improvements in screening and ideas for practice. Physical health screening was felt to increase the discussion and awareness of physical health and supported health promotion. The HIP-F was found to be a structured, comprehensive screening tool that included several items that were not otherwise assessed in clinical practice. The HIP-F was also considered to facilitate engagement by promoting collaboration in an interactive way. Despite this, most of the nurses found the HIP-F to be arduous and too time consuming, while patients found the HIP-F easy to use. Nurses found some items unclear and infeasible, while patients found all items feasible. Based on the nurses’ experiences, screening should be clear and easy to interpret, and condensation and revision of the HIP-F tool were suggested. The patients did not think that any improvements to the HIP-F were needed for implementation in clinical settings.ConclusionsPatients with schizophrenia spectrum disorders are willing to participate in physical health screening. Physical health screening should be clear, easy to use and relatively quick. With this detailed knowledge of perceptions of screening, further research is needed to understand what factors affect the fidelity of implementing physical health screening in clinical mental health practice and to gain an overall understanding on how to improve such implementation.

Acculturation and Mental Health: A Scoping Review.

Background: Acculturative stress theory and the healthy immigrant paradox provide conflicting frameworks from which to study the mental health of immigrant groups. This scoping review aims to provide clarity on the mental health effects of acculturation. Review Question: How are anxiety, depression, and stress expressed in the adolescent and adult children of immigrants? Method: Considering various generational classifications, 1333 articles were screened and 25 articles were selected. This review highlights the presentation of cultural stress and its mental health effects in the children of immigrants ranging from 13 to 28 years of age. Conclusions: Social support is necessary as these children and young adults work to reconcile different worldviews. There is a need for a multifaceted approach to health care that incorporates the development of culturally appropriate responses to stressors. Collaboration among health practitioners growing in cultural competency can assist this population not only in the development of coping strategies, but also in self-actualization. The conflicting results found in this review suggest a need for more work in the area of acculturation stress, to grow the understanding of health practitioners within various cultural groups in order to transform mental health clinical practice.

Listening in Mental Health Clinical Practice

Abstract In mental health clinical practice, listening is viewed as a fundamental skill that clinicians should possess to support service users and enable recovery. Given its importance, this review sought to explore how listening is understood in mental health clinical practice. A scoping review was conducted to search for peer-reviewed articles reporting on literary and empirical studies. The search covered five databases (JSTOR, MEDLINE, Embase, CINAHL, Google Scholar) and the International Journal of Listening. A total of nineteen articles published from 2000 to 2022 were included for analysis. Thematic analysis was used to identify relevant themes. Findings showed that although listening was seen as critical to mental health treatment and care, little had been done to deconstruct the concept, examine the way it was practised and empirically verify its use. Further, listening was described and used differently, not only across different mental health professions but even within the same profession, between practitioners. This article will discuss these variations and how certain listening types can improve the therapeutic encounter. It will further look at whether listening can be regarded as a virtuous professional characteristic trait in achieving professional role responsibilities in social work.

Changing Mindsets to Create a New Mental Health Nursing Care Landscape

Perception of change is a real and profound out come of the recently ended COVID-19 pandemic. The course of this pandemic was unpredictable and subject to change with no clear end in sight. Thus, "uncertainty" became the only certainty in daily life. The realities of the pandemic necessitated that changes and adjustments be made in our physical, psychological, and emotional states as well as life and work styles, which tested everyone's resilience. Change interpreted through Buddha Siddhartha's "Theory of Dependent Origination" is normal and to be expected. The Buddha believed all "conditioned dharmas" in the world (things that can be seen with form) were not created from nothing and could not exist alone. Instead, they must have been formed through a combination of various causal conditions and, once these conditions disappear, must return again to nothingness. Thus, "All dharmas arise due to conditions, and all dharmas cease due to conditions (Sina Buddhism, 2017)". Because of this, the Buddha believed all things and all phenomena to be impermanent and changing (Master Sheng Yen, 2002). According to the Buddha, change is normal and impermanence is permanent. As such, the practice of mental healthcare has not been passively changed by the epidemic, but has always been changing continuously and proactively. The process of treating and restoring to health in patients with mental illness is actually a long and arduous journey, and mental health nurses play a very important role throughout this long process of recovery. We abandon the traditional treatment and care model that only focuses on mental disorders and symptoms, and instead adopt the concept of holistic healthcare (Mandal et al., 2020), which focuses on patient physical, psychological, social and spiritual aspects, helping them achieve whole person wellness (Swanson et al., 2019). Each patient should be regarded as a unique individual not only in terms of their disease diagnosis, symptoms, physical and mental states, understanding, and communications but also in terms of their socioeconomic status, family support, and social resources. Because of this, nursing care plans should not be institutionalized or mechanistic, but rather allow flexibility to address each patient's current condition. Through comprehensive and integrated care and consultation and interdisciplinary teamwork, the psychiatric and mental health nurses work hard to ensure every patient and family member who receives care is satisfied in terms of their physical, psychological, social, and spiritual needs. Another aspect of change is the adoption by mental health nurses of a more active, more professional, larger pattern, and broader vision of their professional services. After all, mental patients may not necessarily fully understand their needs. As mental health professionals, we can develop our professional sensitivity. Moreover, while devoting ourselves to helping patients move towards holistic health and providing holistic care for patients, we should also try our best to detect and pay attention to whether current mental-health-related policies, medical system norms, or usual modes of operation may be ignoring patient needs or increasing the obstacles encountered in the rehabilitation process. In addition, we should try to seek strategies to change the situation, advocate for the health and well-being of patients, and improve the quality and effectiveness of overall mental healthcare. In this issue, four professors respectively discuss issues related to mental health policy, clinical practice, community rehabilitation and employment support, and the expansion of the professional role and service field of mental health nursing. These authors share how the field and functions of mental healthcare can change and evolve along a positive path forward. They not only provide direction and light but also show the results of their efforts.

A smoking cessation intervention for people with severe mental illness treated in ambulatory mental health care (KISMET): study protocol of a randomised controlled trial

BackgroundSmoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands.MethodsA pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals.DiscussionThe results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system.Trial registrationNetherlands Trial Register, NTR9783. Registered on 18 October 2021.

Testing of the SVIP (Strengthened supervision during clinical practice in nursing education) model in clinical practice in mental health nursing – a qualitative study

Testing of the SVIP (Strengthened supervision during clinical practice in nursing education) model in clinical practice in mental health nursing – a qualitative study

Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis.

To present evidence-based guidelines for clinical practice regarding religiosity and spirituality in mental health care in Brazil. A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS, and Cochrane databases. A summary of recommendations and their levels of evidence was produced in accordance with Oxford Centre for Evidence-Based Medicine guidelines. The systematic review identified 6,609 articles, 41 of which satisfied all inclusion criteria. Taking a spiritual history was found to be an essential part of a compassionate and culturally sensitive approach to care. It represents a way of obtaining relevant information about the patient's religiosity/spirituality, potential conflicts that could impact treatment adherence, and improve patient satisfaction. Consistent evidence shows that reported perceptual experiences are unreliable for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful for distinguishing pathological and non-pathological anomalous experiences. Considering the importance of religiosity/spirituality for many patients, a spiritual history should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to differential diagnosis.

Translation and Validation of the Arabic Version of the Athlete Psychological Strain Questionnaire.

The international sports community is becoming more proactive in clinical mental health practice and research. An athlete-specific psychological distress screening tool can identify potential mental health illness. The Athlete Psychological Strain Questionnaire (APSQ) is a simple screening tool for detecting early signs of athlete-specific strain and related mental health concerns. We evaluated the internal consistency and reliability of the translated and culturally adjusted Arabic version of the APSQ (APSQ-Ar) with Arabic-speaking elite athletes. The final translation underwent standard forward and backward translation, an inspection by a team of experts, and then preliminary testing. The APSQ-Ar was cross-culturally validated and then assessed for internal consistency and reliability among (n = 98) Arabic-speaking athletes. There were no problems with the patients' understanding or interpretation of the items on the APSQ-Ar translation. The intraclass correlation value was .93 (95% confidence interval, .89-.95), and the mean difference was 2.4 with a minimal detectable change of 5.12, demonstrating strong test-retest reliability. Moreover, Cronbach alpha showed excellent internal consistency (.76). The APSQ-Ar was demonstrated to be good, reliable, and internally consistent. With APSQ-Ar, sports medicine professionals in Arabic-speaking countries will be able to identify psychological distress and symptoms in athletes and, as a result, provide them with mental health support.

Second-year undergraduate nursing students’ experiences with clinical simulation training in mental health clinical practice: A focus group study

AimThe aim of this focus group study was to investigate second-year undergraduate nursing students’ experiences with clinical simulation training as part of their clinical practice in acute mental health care. BackgroundThe quality of bachelor programmes in nursing has been criticised for lacking theoretical and experiential learning in the mental health modules. Novice nurses feel unprepared to care for patients with mental health challenges and graduate nurses are reported to lack the necessary knowledge and skills to manage patients with mental health issues confidently and competently. Clinical simulation training can facilitate the teaching of clinical and non-clinical skills simultaneously and is a highly suitable method within mental health care for addressing gaps in knowledge and skills in communicating with patients. Clinical simulation training may enhance nursing students' competence and thereby reduce the risk of adverse events and increase safety. However, we know little about undergraduate nursing students’ experiences with clinical simulation training as an integrated part of nursing students’ clinical practice in acute mental health wards. DesignExplorative qualitative focus group study. MethodThree focus group interviews were conducted using a semi-structured interview guide with second-year undergraduate nursing students from a university in Norway during spring 2020. In total, 14 students who had experienced clinical simulation training as part of their mental health clinical practice participated in the study. The collected data were analysed using systematic text condensation. ResultsClinical simulation training as part of the clinical practice increased the students’ preparedness, coping and self-awareness. Most of the participants had positive perceptions of the use of high-fidelity simulation-based learning. Furthermore, they highlighted three elements that increased the value of the training. First, the simulation felt authentic and increased their professional skills. Second, the standardised patient had clinical qualifications, which made the simulation feel authentic and close to realistic situations. Third, not having a former relationship with the person acting as the standardised patient enhanced authenticity. ConclusionClinical simulation training as part of clinical practice contributed to increasing the students’ self-awareness and in-depth reflection and to broadening their nursing competence. The present study lays the groundwork for future studies on clinical simulation training in mental health clinical practice for nursing students.

Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective.

Providing appropriate, timely intervention and care to people who present with mental health issues to an Emergency Department presents unique ongoing challenges, often affecting patient experiences and outcomes. To address such concerns, a Mental Health Liaison Nurse role, led by a Mental Health Nurse Practitioner, was introduced to a regional Emergency Department. This role provided integrated emergency-based mental health clinical practice, with positive findings reported in a recently published multi-site translational research project. With sound quantitative and qualitative evidence detailing the benefits of this role, the experiential perspective from a clinician working in this frontline space further confirms the importance of having access to such a position in leading cultural and systemic change. This discussion article identifies key processes that align current research with the clinical perspective. Such processes recognize the challenges of implementing a new role and moving forward from these to embed consistent clinical practices. The need to build sound internal and external stakeholder partnerships, effect change implementation, and assign recommendations to ensure sustainability of improved practice and processes are highlighted in this paper. This article is, therefore, designed to assist other advanced practice nurses, who may be embarking on a similar journey and want to influence organizational policy and practice.

Influence of Depression Literacy, Mental Health Beliefs, and Stigma on Help-seeking Behaviour: A Semi-Systematic Review

Despite having a mental health act and clinical practice guideline, Malaysian patients with depression frequently progress to severe disease with poor prognosis. Understanding the underlying factors which influence help-seeking behaviour using a patient journey approach can provide insights for designing effective interventions. The study aimed to determine the different stages of patients journey for depression including awareness, screening, diagnosis, treatment, adherence, and control using a semi-systematic review. The review was conducted through (i) structured keyword search in Embase, MEDLINE, and BIOSIS databases using OVID platform for English articles published between 2005 and 2021; and (ii) an unstructured search on websites of Google, Incidence and Prevalence Database, World Health Organization, and Malaysian Ministry of Health. Studies included in the semi systematic review were based on Malaysian patients aged ≥18 years at different journey stages for depression and publications from year 2005 to July 2021. Thesis abstracts, letters to the editor, editorials, and case studies, or articles representing smaller population subgroups were excluded. Three articles out of 1062 retrievals through structured search and two articles out of four retrievals through the unstructured search were included in the final synthesis. We have found that the prevalence of major depressive disease (2.3%), low initial screening (20%), diagnosis (50% to 60%) and adherence (30% to 40%), despite high awareness (76.9%) and initiation of treatment (75.3%). Low education level, ethnicity, stigma regarding mental health, and irrational prescription pattern of primary care physicians were associated with poor mental health help-seeking behaviour. Depression literacy can improve the help-seeking behaviour of the patients.

Comparison of capability and health-related quality of life instruments in capturing aspects of mental well-being in people with schizophrenia and depression.

There is increasing evidence that assessing outcomes in terms of capability provides information beyond that of health-related quality of life (HRQoL) for outcome evaluation in mental health research and clinical practice. To assess similarities and differences in the measurement properties of the ICECAP-A capability measure and Oxford Capabilities Questionnaire for Mental Health (OxCAP-MH) in people with schizophrenia experiencing depression, and compare these measurement properties with those of (a) the EuroQol EQ-5D-5L and EuroQol Visual Analogue Scale (EQ-VAS) and (b) mental health-specific (disease-specific) measures. Using data for 100 patients from the UK, measurement properties were compared using correlation analyses, Bland-Altman plots and exploratory factor analysis. Responsiveness was assessed by defining groups who worsened, improved or remained unchanged, based on whether there was a clinically meaningful change in the instrument scores between baseline and 9-month follow-up assessments. The two capability instruments had stronger convergent validity with each other (Spearman's rho = 0.677) than with the HRQoL (rho = 0.354-0.431) or the mental health-specific (rho = 0.481-0.718) instruments. The OxCAP-MH tended to have stronger correlations with mental health-specific instruments than the ICECAP-A, whereas the ICECAP-A had slightly stronger correlation with the EQ-VAS. Change scores on the capability instruments correlated weakly with change scores on the HRQoL scales (rho = 0.131-0.269), but moderately with those on mental health-specific instruments for the ICECAP-A (rho = 0.355-0.451) and moderately/strongly on the OxCAP-MH (rho = 0.437-0.557). Assessing outcomes in terms of capabilities for people with schizophrenia and depression provided more relevant, mental health-specific information than the EQ-5D-5L or the EQ-VAS. The ICECAP-A and the OxCAP-MH demonstrated similar psychometric properties, but the OxCAP-MH was more correlated with disease-specific instruments.

Exploring Characteristics of Homicide Offenders With Schizophrenia Spectrum Disorders Via Machine Learning.

The link between schizophrenia and homicide has long been the subject of research with significant impact on mental health policy, clinical practice, and public perception of people with psychiatric disorders. The present study investigates factors contributing to completed homicides committed by offenders diagnosed with schizophrenia referred to a Swiss forensic institution, using machine learning algorithms. Data were collected from 370 inpatients at the Centre for Inpatient Forensic Therapy at the Zurich University Hospital of Psychiatry. A total of 519 variables were explored to differentiate homicidal and other (violent and non-violent) offenders. The dataset was split employing variable filtering, model building, and selection embedded in a nested resampling approach. Ten factors regarding criminal and psychiatric history and clinical factors were identified to be influential in differentiating between homicidal and other offenders. Findings expand the research on influential factors for completed homicide in patients with schizophrenia. Limitations, clinical relevance, and future directions are discussed.

Incorporating Digital Interventions into Mental Health Clinical Practice: a Pilot Survey of How Use Patterns, Barriers, and Opportunities Shifted for Clinicians in the COVID-19 Pandemic.

Although many digital mental health interventions are available, clinicians do not routinely use them in clinical practice. In this pilot survey, we review the factors that supported the rapid transition to televisits during the COVID-19 pandemic, and we explore the barriers that continue to prevent clinicians from using other digital mental health interventions, such as mindfulness applications, mood trackers, and digital therapy programs. We conducted a pilot survey of mental health clinicians in different practice environments in the USA. Survey respondents (n = 51) were primarily psychiatrists working in academic medical centers. Results indicated that systemic factors, including workplace facilitation and insurance reimbursement, were primary reasons motivating clinicians to use televisits to provide remote patient care. The shift to televisits during the pandemic was not accompanied by increased use of other digital mental health interventions in patient care. Nine clinicians reported that they have never used digital interventions with patients. Among the 42 clinicians who did report some experience using digital interventions, the majority reported no change in the use of digital applications since transitioning to televisits. Our preliminary findings lend insight into the perspective of mental health clinicians regarding the factors that supported their transition to televisits, including institutional support and insurance reimbursement, and indicate that this shift to virtual patient care has not been accompanied by increased use of other digital mental health interventions. We contend that the same systemic factors that supported the shift toward virtual visits in the COVID-19 pandemic may be applied to support the incorporation of other digital interventions in mental healthcare.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41347-022-00260-8.

Developing and implementing a digital formulation informed risk management framework in mental health and learning disability services

PurposeRisk assessment is a fundamental part of clinical practice in mental health and learning disability services in the UK. Most services use a tool or framework to structure their clinical judgments, but there does not appear to be a consensus on which risk assessment tool should be used. This paper aims to describe the development, implementation and evaluation of an evidence-based formulation informed risk management (FIRM) framework in mental health and LD services.Design/methodology/approachThe development of FIRM and evaluation was based on the model for improvement, with an emphasis on co-production broken down into three distinct yet interdependent phases of co-production: co-design, co-create and co-deliver. Following the implementation of the FIRM framework, a post-implementation survey was distributed to a sample of clinical staff to capture experiences in the first three months post-implementation.FindingsThe three co-production stages were pivotal for successful implementation in clinical practice. The key ingredients for success seemed to be acknowledging human factors and varied responses to change, communication, engagement and involvement of stakeholders. Early evaluation post-implementation demonstrated the benefits in terms of confidence in use, formulation of risk, risk management and communication. Further quality improvement initiatives are underway to evaluate impact up to 12 months post-implementation and to improve the quality of FIRM in practice. Future research is planned to look at enhancing personalised risk assessment and management.Originality/valueThis paper describes and demonstrates the value of co-production with clinicians and stakeholders in service development. The FIRM has improved the clinical practice of risk assessment, formulation and management and use of digital technology.