Mental Facilities Research Articles

Analysis of a nursing survey: Reasons for compromised quality of care in inpatient mental health wards.

Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self-reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality.

A Foundation for a "Cheerful Society": The Korean War and the Rise of Psychiatry.

One of the most remarkable medical achievements of the Korean War was the development of psychiatry. During the Korean War, soldiers and prisoners of war (POWs) experienced "gross stress reaction" and manifested poor concentration and memory as well as clinical depression and social alienation. Rest and relaxation rotations served as the primary treatment for their conditions. Civilians also bore the brunt of the war's effects. Delusions of grandeur and megalomania appear to have been common among Koreans, but there were few mental health facilities to provide treatment and care. Out of the furnace of war, psychiatry emerged as a newly specialized field, and in the 1950s, Korea became the very place where military psychiatry training under the U.S. military laid the groundwork for civilian psychiatry. This essay aims to enrich the study of mental illness during and after the Korean War by providing a more detailed picture of the mental problems experienced not only by veterans and POWs, but also by civilians in Korea. Examining mental health issues from this period is challenging due to the scarcity of resources for delving into the minds of the civilians involved. Taking military psychiatry as a starting point, this essay goes beyond existing scholarship to discuss psychiatry-related responses to the Korean War, including the influence of military psychiatry on civilian psychiatry, the endeavors of medical professionals and government policies, and contemporary expressions of mental distress during and after the war.

Exploring the Impact of a Housing Support Service on Hospital Discharge: A Mixed-Methods Process Evaluation in Two UK Hospital Trusts

Delayed discharge from hospital is a global healthcare problem with negative impacts on patient outcomes and the wider health system. Delays to discharge can arise when a patient remains in hospital even when they are medically fit due to nonmedical reasons such as a lack of appropriate housing or social care. However, whilst several nonmedical interventions have been developed to facilitate timely hospital discharge, there remains a lack of evidence on their impact. This study reports on findings from a mixed-methods process evaluation of a newly integrated housing and health service in two United Kingdom- (UK-) based hospitals (one mental health hospital and one general hospital). The service involved housing support coordinators (HSCs) being based within hospitals and supporting inpatients with their housing-related needs. We employed qualitative interviews with service users and hospital/housing staff (N = 16) and routine data analysis (n = 488) to understand the impact of the service and any challenges to service delivery. Service users faced different housing barriers, for example: 28.3% experienced homelessness (n = 136) whilst 80 (16.4%) faced challenges with their accommodation no longer meeting their physical needs. Service users received support for a variety of issues such as assistance with medical priority applications, support to apply for social housing, and referral to other support services. Healthcare professionals at all levels credit the service for improving hospital discharge processes and reducing stress on clinical staff, enabling them to concentrate more effectively on clinical tasks. Key to success is experienced housing staff providing patient-centred support, being integrated within a multidisciplinary team with management and oversight from the health service, and the availability of appropriate housing stock and wider services to support people after discharge. Our findings indicate that other hospitals may benefit from implementing similar housing and health integrated services.

Perceptions of nurses working in mental health services regarding the recovery-oriented care approach: Findings from Africa.

The recovery-oriented care approach in mental health is recognised as the vision for mental health. People with a diagnosis of mental illness value the support and the individualistic approach emphasised in the recovery-oriented mental health care approach as they believe it facilitates their recovery. However, as a developing country, Botswana has a long way to go in availing mental health care resources to people with mental illness, let alone adopting new mental health approaches such as recovery. The study aimed to explore the perceptions of nurses working in mental health care facilities of recovery-oriented mental health care. Four mental health facilities from Botswana consented to participate in the study. A descriptive qualitative approach was utilised to explore nurses' views on how they perceive recovery from mental illness. Thirty nurses participated in the focus group discussions across the four study sites. All participants consented to participate and to be recorded. Tesch's (in Qualitative enquiry and research design: Choosing among five approaches. 3th ed. SAGE, 2013:198) thematic analysis was used for this study. Three main themes were identified in participants' perceptions of recovery-oriented care mental health: Recovery from mental illness is possible, the Meaning of recovery from mental illness and Factors facilitating recovery from mental illness. The study offers a perspective into how nurses perceive recovery-oriented approaches from a developing country and add to the gap existing in recovery-oriented mental health care approach from the African context.

Listening to the experts: person-centred approaches to supporting autistic people and people with an intellectual disability in the mental health system

SUMMARYDespite numerous UK government policies aimed at reducing the number of autistic people and people with an intellectual disability in mental health hospitals, little progress has been made, with many experiencing lengthy stays that offer little therapeutic benefit. Once admitted, people are at risk of restrictive interventions and significantly delayed discharge, resulting in trauma. This article draws on the cases of four people to illustrate the limitations of current mental health system approaches to the challenges experienced by autistic people and people with an intellectual disability. The importance of relational working and listening to people is explored, and we demonstrate how this can facilitate the provision of bespoke housing and care packages to enable a successful return to life in the community. Finally, we offer recommendations on the changes urgently needed to ensure that autistic people and people with an intellectual disability can live ordinary lives in their own homes, with timely and effective support from mental health services when needed, just like everyone else.

Factors Affecting Patient Satisfaction with Home Healthcare Services Provided by Taif Mental Health Hospital

Factors Affecting Patient Satisfaction with Home Healthcare Services Provided by Taif Mental Health Hospital

Nurses' Perceptions on How Recovery-Oriented Mental Health Care Can Be Developed and Implemented.

This study explored how nurses working in inpatient mental health units perceived the development and implementation of a recovery-oriented mental healthcare programme (ROMHCP). The recovery-oriented mental healthcare approach (ROMHCA) in mental health is regarded as the future of mental health services and has been implemented in different countries worldwide. However, regarding developing and implementing the recovery approach, Africa appears to have been left behind by the rest of the continents. The study used a qualitative approach to describe how a recovery-oriented mental healthcare approach could be developed. Thirty nurses who worked in Botswana's four inpatient mental health facilities consented and voluntarily participated in the study. Data were collected from February to mid-March 2022 through online focus group discussions and analysed using thematic analysis. The COREQ checklist was used to report the findings. Two main themes emerged as follows: (i) developing and implementing a recovery-oriented mental healthcare programme is possible and (ii) certain elements are required to develop and implement ROMHCP. The participants believed that people diagnosed with mental illness could recover from the illness and suggested how it could be achieved. They also contended that the programme's success would lie mainly with multisectoral support from policymakers, facilities, hospital personnel, patients, and the community. Clinical Relevance. ROMHCP has the potential to benefit people with mental illness in the country. In addition, it would allow nurses to improve their knowledge and skills in managing mental illnesses. Patient or Public Contribution. The patients and the general public did not contribute to the study's concept, design, and outcomes. However, the nurses working in mental health facilities volunteered to participate in the study.

Applying the theory of planned behaviour to understand mental health professionals’ intentions to work using a human rights-based approach in acute inpatient settings

Background There has been a shift to implement human rights-based approaches in acute mental health care due to increasing concerns around quality of care. National Health Service (NHS) Trusts have a legal duty to uphold a person’s human rights, therefore it is important to understand what any barriers might be. Using psychological theory may help to develop this understanding. Aim To test whether the theory of planned behaviour can be an effective model in understanding mental health professionals’ intentions to work using a human rights-based approach. Method Participants were recruited from two NHS Trusts in the North West of England. A cross-sectional, survey design was used to examine mental health professionals’ intentions to use human rights-based approaches. Results Multiple regression analyses were performed on the theory of planned behaviour constructs showing that attitude and subjective norm significantly predicted intention. Perceived behavioural control did not add any significant variance, nor any demographic variables. Conclusion There could be factors outside of the individual clinician’s control to fully work within a human rights-based framework on acute mental health wards. The theory of planned behaviour offers some understanding, however further development work into measuring human rights outcomes on acute mental health wards is needed.

Using polygenic risk scores to investigate the evolution of smoking and mental health outcomes in UK biobank participants.

Mendelian randomization studies report a bi-directional relation between cigarette smoking and mental disorders, yet from a clinical standpoint, mental disorders are the focus of treatment. Here, we used an event history framework to understand their evolution in the life course. Our objective was to estimate the relative contribution of genetic predispositions and self-reported smoking status (never, former, and present smoker) to hospitalizations for major depression, bipolar disorder, and schizophrenia. We calculated polygenic risk scores (PRS) for ever smoking, pack-years of smoking as a proportion of adult life, and neuroticism in 337,140 UK Biobank participants of white British ancestry. These PRS and self-reported smoking status were entered as explanatory variables in survival models for hospitalization. The estimated single nucleotide polymorphisms heritabilities (h2 ) were 23%, 5.7%, and 5.7% for pack-years, ever smoking, and neuroticism respectively. PRS pack-years and PRS neuroticism were associated with higher hospitalization risk for mental disorders in all smoking status groups. The hazard for mental health hospitalization was higher in both previous (HR: 1.50, CI: 1.35-1.67) and current (HR: 3.58, 2.97-4.31) compared to never smokers, after adjusting for confounders. Since genetic liabilities for smoking and neuroticism are fixed at conception and smoking initiation generally started before age 20, our results show that preventing smoking in adolescents probably prevents the development of mental disorders.

The Impact background Music Has on Meal Consumption of Residents in a Mental Health Facility

The Impact background Music Has on Meal Consumption of Residents in a Mental Health Facility

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.

Do Job Autonomy and Self-Efficacy Jointly Determine the Strain Outcomes of Nonphysical Workplace Aggression? Testing the Demand-Control-Person Model Across Two Samples of Healthcare Providers

ABSTRACT Workplace aggression is a widespread problem in healthcare organizations, bearing negative consequences for both workers and organizations. Drawing on the Demand-Control-Person (DCP) model, the current study investigated the joint moderating effect of job autonomy and self-efficacy on the relationship between nonphysical aggression by patients or their relatives and job burnout. A cross-sectional design based on two samples of healthcare providers was applied. The study sample included 217 nurses from a general hospital and 309 healthcare workers from a mental health hospital. Data were collected using self-reported questionnaires and analyzed using hierarchical multiple regression. A significant three-way interaction predicting depersonalization was revealed in both samples. Contrary to expectations, for employees with high self-efficacy beliefs, the association between nonphysical aggression and depersonalization was weaker under conditions of low, rather than high, job autonomy. Results further showed that the combination of low autonomy and high self-efficacy was associated with lower levels of depersonalization as nonphysical aggression increased, compared to the combination of low autonomy and low self-efficacy. The current results suggest the appraisal of both an external resource (job autonomy) and an internal resource (self-efficacy) as low may increase the risk for depersonalization in the face of high levels of nonphysical aggression by patients. They also suggest that self-efficacious employees may be better able to maintain an empathetic and positive attitude toward patients even when treated with disrespect when job autonomy is low and the burden of responsibility is relatively lighter.

Suicidal behavior in persons attended in out-of-hospital emergency services in Spain.

The aims of this study were to describe the use of health services by patients attended for suicidal behavior by out-of-hospital emergency services and to identify the variables associated with the repetition of this behavior in Spain. An analytical, observational, retrospective study was carried out. A total of 554 patients attended by the mobile teams of the Primary Care Emergency (mt-PCES) of the Malaga Health District (Spain), after being coordinated by the 061 Emergency Coordination Center (ECC) were analyzed. Of the total, 61.9% of the patients were women and the mean age was 43.5 years. Ninety-six percent (N = 532) of the patients attended by mt-PCES were transferred to hospital emergency services. Regarding clinical decision, of those transferred 436 persons (82%) were discharged home. Of the total sample 25.5% (N = 141) were referred to primary care, while 69% (N = 382) were referred to outpatient mental health care. Regarding follow up in the 6 months after being seen by emergency services, among those referred to a mental health facility, 64.4% (N = 246) attended the follow-up appointment while out of the total sample only 50.5% (N = 280) attended a follow-up appointment with an outpatient mental health service. Finally, it should be noted that 23.3% presented a relapse of suicidal behavior in the 6 months following index episode. The variables associated with repetition of suicidal behavior were older age, greater number of previous suicide attempts and having any contact with mental health services in the following 6 months. We believe that selective suicide prevention initiatives should be designed to target the population at risk of suicide, especially those receiving both out-of-hospital and in-hospital emergency services.

Truly Listening to Accounts of Mental Health Act Assessments: Reflections on my Practice

Abstract This article draws upon the experience of the author whilst undertaking a qualitative research study exploring service user experiences of being assessed for detention to a mental health hospital. Doing research as a social work practitioner is a growing area and a common motivation is to improve practice. This article brings a different way of reporting research, which is embedded in the reflective tradition of social work. It explores practitioner research and insider/outsider perspectives. Through reflection, the author examines in depth two participants’ narratives, how this impacted her as a mental health social worker and the changes in her practice. These assessments are complex pieces of social work with involuntary service users in a pressured setting and are a challenging area for practitioners to improve service user experiences.

Quality of life of inpatients in the mental health ward of Herat Regional Hospital: a cross-sectional study

Background: Quality of life is a vital parameter for assessing the impact of severe psychiatric conditions on patients, significantly influencing their overall well-being. This study aims to comprehensively examine and evaluate the quality of life among inpatients in the Mental Health Ward of Herat Regional Hospital. Methods: A cross-sectional study was conducted from September 23, 2022, to October 12, 2022, involving 147 inpatients from the Mental Health Ward of Herat Regional Hospital. Results: The study included 147 participants, with the majority (59.9%) falling within the 15-28 age range, and 20.4% were male. Among the respondents, 79.6% reported poor physical health, while 20.4% of hospitalized patients reported good mental health. Regarding gender, females (84.6%) exhibited worse physical health compared to males. Moreover, individuals with limited literacy (unable to read and write) had a lower physical health score (82.3%). Among unemployed participants, only 37.5% reported good physical health. Females (82.9%) also showed worse mental health compared to males, with a statistically significant correlation observed between gender and mental health. Conclusion: The quality of life of inpatients in the Mental Health Ward of Herat Regional Hospital was found to be lower in both physical and mental dimensions compared to hospitalized patients in other countries. Identifying factors contributing to the poor quality of life among patients is of paramount importance. Targeted interventions are needed to prevent morbidity and mitigate factors impacting the quality of life of these patients.

Capillary blood sampling for the determination of clozapine concentrations: analytical validation and patient experience.

Patients may be reluctant to start clozapine (CLZ) because of the frequent blood sampling needed for white blood cell monitoring, but also therapeutic drug monitoring of CLZ. Finger prick, instead of venepuncture, might lower the threshold to CLZ use. The aim of this study was to determine whether CLZ concentrations are the same in capillary and venous blood samples. Capillary blood was drawn by finger prick and collected in the Hem-Col tube. Paired capillary and venous blood samples were collected from inpatients and outpatients of a mental health institute. Patients were asked to rate pain, experience, and preference for blood sampling method. Passing-Bablok analysis of 40 paired samples showed that CLZ concentrations were statistically equal in capillary and venous samples {slope 0.96 [95% confidence interval (CI): 0.88-1.04], intercept -6.86 (95% CI: -30.75 to 24.13)}. Venepuncture was the preferred method based on the experience ( P = 0.009) and preference ( P = 0.043) items. In conclusion, CLZ concentrations were similar in venous and capillary blood samples. Venepuncture appeared to be preferred to finger prick for blood sampling. Our results emphasize the importance of consulting patients' individual preference for blood sampling method.

Perceived need for care and stigma experiences among individuals with methamphetamine-related admissions to inpatient mental health wards

BackgroundThere are gaps in our understanding of treatment needs among people who use methamphetamine. We examined the demographics, perceived treatment needs, barriers to accessing care, and stigma experienced by an inpatient sample of people who use methamphetamine.MethodsThis study surveyed a convenience sample of patients admitted to psychiatry wards with a history of methamphetamine use in Winnipeg, Canada, between May 1 and July 31, 2019. The Perceived Need for Care Questionnaire (PNCQ-9) was used to assess treatment needs and barriers to care, and the Substance Use Stigma Mechanisms Scale (SU-SMS) was used to assess enacted, anticipated, and internalized stigma. Prevalence rates of perceived need, stigma, and demographic variables were determined.ResultsA total of 103 potential participants were identified, with 34 completing the survey. The most common age group was 21–30 years of age (41.2%); an approximate equal number of men and women; and almost all were single and never married (91.1%). Rates of perceived need for care were very high across all treatment types, including 91% identifying a need for medication treatment for their mental health or substance use. Despite the majority receiving care across the seven types of care described in the PNCQ-9, most felt they did not receive enough care. Unmet need for care was therefore high in many categories, including rates of 87% for counselling and skills training. The most common barriers to having needs met were a desire to self-manage substance use, and not receiving care after asking for help. Almost all participants reported experiencing stigma (94%). Stigma from family was endorsed significantly more than stigma from health care providers (p = 0.005).ConclusionsThe average hospitalized person who uses methamphetamine in this sample is young, single, and has not completed any post-secondary education. High rates of perceived treatment need suggest an awareness of problems with methamphetamine, yet most interventions are perceived as inadequate. People who used methamphetamine felt highly stigmatized, particularly by their family members.Trial registration Registered with the Health Research Ethics Board at the University of Manitoba (Number HS22605 (H2019:072), renewed February 14, 2022).

Preliminary evaluation of a multidisciplinary pathway for people who self-harm in acute inpatient mental health care

Background/aims Inpatient mental health settings are required to provide biopsychosocial interventions to support service users who self-harm. This is important as self-harm has been associated with increased admissions and risk of suicide. A multidisciplinary self-harm pathway was developed in an acute inpatient mental health ward for adult women to help staff support patients who self-harm. The aim of this project was to evaluate the pathway in relation to service user distress, confidence in managing mental health, therapeutic alliances with the ward team and self-harm incidents on the ward. Methods Data were collected from the record-keeping systems and from questionnaires completed before and after the pathway was introduced. Results The pathway was well received by service users and contributed to improvements in distress, confidence and to more effective management of self-harm. Conclusions The self-harm pathway was found to be a useful framework within which to structure psychosocial interventions for self-harm and least restrictive practice.

Examining the factors that influence medication administration errors and the reporting of these among mental health nurses in the hospital setting: a systematic review

Background/Aims A medication administration error is defined as ‘any difference between what the patient received or was supposed to receive and what the prescriber intended in the original order’. Medication administration errors are associated with increased morbidity and mortality. They occur frequently in the mental health setting and pose a serious risk of patient harm. The factors leading to medication administration errors in the mental health care setting is under researched and the potential for mental health services to prevent harm from medication administration error is unknown. The aim of this study was to understand factors that influence medication administration errors, and the reporting of these, among mental health nurses in the mental health hospital setting. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (2015) checklist. A total of 3625 studies were identified, nine of which were included for final review. The CINAHL, Cochrane, EMBASE, Medline, Medline Ovid, Psych Info and PubMed databases were searched, as well as grey literature. Results Medication administration errors and their reporting are complex, multifaceted and show organisational and individual overlap. Heavy workload, staffing shortages, differing levels of experience, ward dynamics, lack of knowledge, interruptions, communication and patient interaction contributed to the occurrence of medication administration errors. Key factors included rationale on why not to report an error, lack of knowledge regarding how to report, what to report, as well as fear and stigma. Conclusions Many factors lead to the occurrence of a medication administration error or why they are not reported. More education is needed to help reduce medication administration errors. Further research may understand the behavioural patterns of mental health nurses and at-risk behaviour. This may help identify adequate interventions to reduce the risk of medication administration errors in this setting.

Latency, uncertainty, contagion: Epistemologies of risk-as-reform in crime forecasting software

A shift in crime analysis software used by municipal police departments in the US is currently underway from simpler predictive models to criminal ‘risk’ forecasting that uses data not specific to crime to direct police to areas with ‘environmental risk factors’ such as bars, transit stops and mental health facilities. Through analyses of interviews with developers, industry professionals and law enforcement as well as published statements, this article offers a detailed examination of how the function and premises of ‘data-driven’ policing are altered by this turn to epistemologies of risk. I argue that the latent presence of ‘disorder’ supplements visible aberrations of ‘order.’ Statistical indeterminacies are called upon to justify a range of police interventions, and a focus on arenas of contagion supplements the spatial logic of containment. These turns reveal that the paradigm of ‘risk’ participates in the cooptation by technocratic reform of critiques exposing the problematic geographies of policing. I therefore suggest a shift away from critique oriented by revealing spatial bias in purported objectivity and towards interventions in the operationalization of indeterminacy itself and the vision of public life that undergirds and is enacted by this software.