Inpatient Mental Health Settings Research Articles

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.

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.

A Picture of Health? A Review of the Quality of Physical Healthcare Provided to Adult Patients Admitted to a Mental Health Inpatient Setting

AimsTo identify and explore remediable factors in the clinical and organisation of the physical healthcare provided to adult patients admitted to a mental health inpatient setting.MethodsData from 291 clinical, 56 Trust-level and 224 Hospital-level organisational questionnaires were completed; 285 sets of case notes were peer reviewed; 168 service user and 79 carer surveys were reviewed to assess the care provided to patients aged 18 years and older who were admitted to a mental health inpatient setting in the UK for at least one week during 01/11/2018 to 31/10/2019, and who: •Had existing chronic obstructive pulmonary disease/ asthma/ cardiovascular disease/ diabetes•Had experienced a transfer to a physical health hospital•Died in the mental health inpatient setting or within 30 days of discharge•Specialist commissioned mental health services and suicides, homicides and self-harm related deaths were excluded from this study.ResultsThe report highlighted 5 key messages: 1.Assess patients for acute physical health conditions on arrival at a mental health inpatient setting and then undertake a detailed physical health assessment once the patient is admitted A detailed physical health assessment was not undertaken appropriately for 28/126 (22.2%) patients.2.Develop a physical healthcare plan for patients admitted to a mental health inpatient setting A plan for physical health observations was not documented for 48/217 (22.1%) patients.3.Formalise clinical networks/pathways between mental healthcare and physical healthcare Local care pathways or pre-existing arrangements with physical healthcare providers were used as part of the care plan for 71/291 (24.4%) patients.4.Involve patients and their carers/friends/family in their physical healthcare and use the admission as an opportunity to assess, and involve patients in their general health In 100/188 (53.2%) sets of notes reviewed, there was no record that the physical health review had been discussed with the patient's family/ carers.5.Include mental health and physical health conditions on electronic patient records and allow sharing across healthcare providers6.20/56 (35.7%) organisations reported that all elements of the clinical record were available in the electronic patient recordConclusionThe NCEPOD report provided an in-depth review of the quality of physical healthcare in mental health inpatient settings and found that there is room for improvement in physical healthcare of patients. Key aspects of care requiring improvement were treatment of long-term physical health conditions (62/119; 52.1%), documentation of physical health observations (61/119; 51.3%) and delays in identifying acute deterioration (19/119; 16.0%) patients.The report makes twelve recommendations for clinicians and management to implement in practice.

Sustaining a therapeutic environment within mental health in-patient settings during COVID-19. Results of a Delphi study

AimDevelop a strengths-based, person-centred, trauma-informed and recovery-oriented framework to mitigate any potential increase in conflict resulting from the implementation of C19 restrictions. BackgroundGuidance addressing the unique challenges posed by Covid-19 within mental health in-patient settings, including how to support those whose distress may present as behaviour that challenges including violence and self-harm, remains urgently needed. Methodology/approachA Delphi design involving four iterative stages was adopted. Stage 1 involved a review and synthesis of COVID-19-related public health and ethical guidance and a narrative literature review. A formative operational framework was then developed. Stage 2 sought to establish the face validity of the framework through engagement with frontline and senior staff in mental health services in Ireland, Denmark and Netherlands. Stage 3 investigated the content validity of the final framework through a plenary presentation and discussion of the framework at a scientific symposium of the European Violence in Psychiatric Research Group (EViPRG, 2020). Stage 4 sought expert appraisal of the framework using a structured evaluation completed by a panel of eighteen multidisciplinary experts from nine countries, including four academics, six clinicians and eight holding dual clinical/academic appointments to assess content validity. ResultsThe guidance adopts the widely advocated approach to support those whose distress may present as behaviour services find challenging in identifying the need for primary, secondary, tertiary and recovery measures. It emphasizes person-centred care while integrating specific Covid-19 public health requirements into service planning. It also aligns with contemporary best practice in in-patient mental health care, incorporating the principles of Safewards, the core values of trauma-informed care, and an explicit on recovery. ConclusionThe guidance developed has face and content validity.

Nurses' clinical decision-making in the use of rapid tranquillization in adult mental health inpatient settings: An integrative review.

Rapid tranquillization is a restrictive practice that remains widely used in mental health inpatient settings worldwide. Nurses are the professionals most likely to administer rapid tranquillization in mental health settings. To improve mental health practices, an enhanced understanding of their clinical decision-making when using rapid tranquillization is, therefore, important. The aim was to synthesize and analyse the research literature on nurses' clinical decision-making in the use of rapid tranquillization in adult mental health inpatient settings. An integrative review was conducted using the methodological framework described by Whittemore and Knafl. A systematic search was conducted independently by two authors in APA PsycINFO, CINAHL Complete, Embase, PubMed and Scopus. Additional searches for grey literature were conducted in Google, OpenGrey and selected websites, and in the reference lists of included studies. Papers were critically appraised using the Mixed Methods Appraisal Tool, and the analysis was guided by manifest content analysis. Eleven studies were included in this review, of which nine were qualitative and two were quantitative. Based on the analysis, four categories were generated: (I) becoming aware of situational changes and considering alternatives, (II) negotiating voluntary medication, (III) administering rapid tranquillization and (IV) being on the other side. Evidence suggests that nurses' clinical decision-making in the use of rapid tranquillization involved a complex timeline with various impact points and embedded factors that continuously influenced and/or were associated with nurses' clinical decision-making. However, the topic has received scant scholarly attention, and further research may help to characterize the complexities involved and improve mental health practice.

Brief admission—a promising novel crisis management method

Self-harm among children and adolescents is currently increasing and is strongly associated with suicide. 1 Griffin E McMahon E McNicholas F Corcoran P Perry IJ Arensman E Increasing rates of self-harm among children, adolescents and young adults: a 10-year national registry study 2007–2016. Soc Psychiatry Psychiatr Epidemiol. 2018; 53: 663-671 Crossref PubMed Scopus (81) Google Scholar Inpatient care in child and adolescent psychiatry has not yet evolved sufficiently to provide care that promotes the patient's autonomy and sense of self-determination, 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar but there are various restrictive ways to handle impulsive self-harm and suicidal behaviours. 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar Lengthy inpatient stays, coercive actions, and even forensic hospital admission have been used for life-saving purposes. 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar Given the need for better approaches, it is crucial to study alternative ways to handle crises to prevent iatrogenic damage. 3 Cha CB Franz PJ Guzmán EM Glenn CR Kleiman EM Nock MK Annual research review: suicide among youth—epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry. 2018; 59: 460-482 Crossref PubMed Scopus (258) Google Scholar Furthermore, coordinated treatment plans to prevent new crises by bridging the gap between inpatient and outpatient care are often obstructed by the different cultures of these care settings. To date, there are no standardised methods in child and adolescent inpatient care that ease or prevent self-harm without using coercive methods. New non-restrictive methods that reduce the need for lengthy constraining inpatient stays and promote continuity across inpatient and outpatient care are urgently required. 2 Griffiths R Dawber A McDougall T Midgley S Baker J Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: systematic review and narrative synthesis. Int J Ment Health Nurs. 2022; 31: 35-50 Crossref PubMed Scopus (2) Google Scholar Introducing brief admissions by self-referral in child and adolescent psychiatry: an observational cohort study in SwedenOur findings suggest that brief admissions can be successfully implemented in paediatric psychiatry and appear to be an effective crisis management method for adolescents, associated with reduced demand for emergency care. Future randomised controlled trials are warranted. Full-Text PDF

The Impact of Smoking Regulations on the Daily Routine of Patients within an Irish Mental Health Setting

A high prevalence of smoking has been reported among people receiving care within inpatient and forensic mental health services. An Irish inpatient mental health service introduced a “smoke free campus” policy in 2018. Six semi-structured interviews were completed with patients within this setting in 2019. Using thematic analysis, five themes were identified: Experience of stakeholder support, routine, experience of being an inpatient, the meaning of smoking, and the experience and perception of the smoking policy and governing bodies. The findings have implications for staff who work in mental health inpatient settings or who develop policies regarding smoking on hospital sites.

Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences.

Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes. Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults. Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training. Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.

The experiences of nurses following seclusion or restraint use and immediate staff debriefing in inpatient mental health settings.

The aim of this study is to explore nurses' experiences of seclusion or restraint use and their participation in immediate staff debriefing in inpatient mental health settings. This research was conducted using a descriptive exploratory design and data were gathered through in-depth individual interviews. The experiences of nurses following seclusion or restraint use and their participation in immediate staff debriefing were explored via teleconference, using a semi-structured interview guide. Reflexive thematic analysis was used to identify prevalent themes from the data. Interviews (n=10) were conducted with nurses from inpatient mental health wards in July 2020. Five themes emerged through the data analysis: (i) ensuring personal safety; (ii) grappling between the use of least-restrictive interventions and seclusion or restraint use; (iii) navigating ethical issues and personal reactions; (iv) seeking validation from colleagues and (v) attending staff debriefing based on previous experience. The themes were also analysed using Lazarus and Folkman's Transactional Model of Stress and Coping. Staff debriefing is a vital resource for nurses to provide and/or receive emotion- and problem-focused coping strategies. Mental health institutions should strive to establish supportive working environments and develop interventions based on the unique needs of nurses and the stressors they experience following seclusion or restraint use. Nurses in both frontline and leadership roles were involved in the development and pilot test of the interview guide. The nurses who participated in the study were asked if they can be recontacted if clarification is needed during interview transcription or data analysis.

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...

Staff responses to self-harm by children and young people in mental health inpatient settings: Experiences and views of children and young people, parents and staff.

This study aimed to understand the views of children and young people (CYP), parents and staff on how staff should respond to incidents of self-harm carried out by CYP in mental health inpatient settings. Semi-structured interviews were conducted with CYP (n = 6), parents (n = 5) and mental health professionals (n = 6) with experience of this issue. Data were analysed using reflexive thematic analysis. Two superordinate themes were identified: (1) The threshold for intervening; and (2) Interpersonal attributes of staff. There was general agreement among participants about the interpersonal skills that staff should possess to work safely and effectively with this population. There was disagreement between staff and parent participants about the appropriate threshold for using restrictive interventions to manage incidents of self-harm for this group. Our findings suggest that further work is needed to develop effective approaches for addressing self-harm in this population which are considered acceptable to all key stakeholders. The results of this study could be used to inform future intervention development.

What does a Peer Support Worker do in a Forensic Mental Health Clinic for Addicted Offenders?

IntroductionPeer support work can be an effective way to support patients and their participation in psychiatric treatment. Unlike in general psychiatry there is less experience with peer support work in forensic mental health inpatient settings. Characteristics different from general psychiatry, e.g., regarding patient structure and background, might lead to different tasks of peer support workers and subjects of conversation.ObjectivesWe aim to present an overview of tasks and conversation topics of a peer support worker in a forensic mental health setting for addicted offenders during an 12 month period. We address tasks on regular and irregular basis and the most frequent conversation topics.MethodsWe used the anonymized work documentation about weekly working activities and conversation notes of the peer support worker to extract information. Extracted data were thematically analyzed and clustered into themes for tasks and conversation topics.ResultsResults reveal several recurring and routine tasks, like joining ward rounds and changes of shift or leading a recovery patient group along with one-to-one conversations with patients according to their request. These topics were expanded by irregular tasks like group discussions for special occasions, e.g., after incidents. During one-on-one conversations, patients addressed topics, e.g., about their substance use history, thoughts and issues about their therapy or ways to achieve their goals in the future.ConclusionsPeer support is a well-accepted offer that can contain various different tasks in groups and in one-on-one settings as well. Although the peer support worker is seated on one ward, there are many requests from other wards, too. There also exists a broad range of conversation topics, some might be also present in general psychiatric wards and others that might be more unique to forensic settings. The broad range of tasks and acceptance of peer support make it necessary to provide corresponding resources like peer support staff and payment.Disclosure of InterestNone Declared

Exploring the use of body-worn cameras in acute mental health wards: A qualitative interview study with mental health patients and staff

BackgroundBody-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there is a dearth of research on their use in these settings, particularly when it comes to patient perspectives. ObjectiveThis study aimed to explore the perspectives of patients, mental health staff, and senior management on body-worn cameras to identify the possible impacts of this technology in inpatient mental health settings. DesignThis was an exploratory qualitative study. SettingWe undertook interviews online and in-person on a number of acute inpatient wards across five mental health hospitals in England. Participants were recruited in-person, online via social media, and through professional networks. ParticipantsThis study recruited 24 patients from acute wards, 25 staff from acute wards, six Mental Health Nursing Directors, and nine community-based patients. MethodsSemi-structured interviews were conducted online and in-person. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. ResultsThe subjective nature of how violence and aggression is defined shapes how staff and patients view the prospect of using body-worn cameras. Both staff and patients cited issues resulting from an underlying culture of mistrust in inpatient settings that leave staff and patients feeling unsafe. Body worn cameras may intensify power dynamics and undermine therapeutic relationships. Participants felt that engaging existing interventions and addressing systemic causes of violence and aggression should take priority over introducing body-worn cameras. ConclusionsThere is no indication that staff or patients believe body-worn cameras will deter violence and aggression on inpatient mental health wards. They may serve as a tool for safeguarding and staff training, but there are still unexplored ethical concerns about their use and a lack of evidence to support use of this technology to deter violence in NHS mental health settings. Tweetable abstractMental health patients & staff have complex perspectives on controversial body-worn camera technology @thekeiranwilson @unafoye @maddych4dwick @gbrennancafc @cityalan.

Understanding the implementation of ‘Making Every Contact Count’ (MECC) delivered by healthcare professionals in a mental health hospital: protocol for a pragmatic formative process evaluation

ABSTRACT Background ‘Making Every Contact Count’ (MECC) is a public health strategy supporting public-facing workers to use opportunities during routine contacts to enable health behaviour change. A mental health hospital in the North East of England is currently implementing a programme to embed MECC across the hospital supporting weight management (‘A Weight Off Your Mind’). Bespoke MECC training has been developed to improve staff confidence in discussing physical activity, healthy eating, and related behaviour change with service users. This article describes the protocol for a pragmatic formative process evaluation to inform the implementation plan for MECC and facilitate successful implementation of the bespoke MECC training at scale. Methods/Design An 18-month, mixed method pragmatic formative process evaluation, including qualitative research, surveys, document review and stakeholder engagement. This project is conducted within a mental health inpatient setting in the North East of England. Programme documents will be reviewed, mapped against MECC national guidelines, Behaviour Change Techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A cross-sectional survey (n = 365) and qualitative semi-structured interviews (n = 30) will be conducted with healthcare practitioners delivering MECC to assess capability, opportunity and motivation. Data collection and fidelity procedures will be examined, including design, training and delivery dimensions of fidelity. Interviews with service users (n = 20) will also be conducted. Discussion Anticipated outcomes include developing recommendations to overcome barriers to delivery of and access to MECC, including whether to either support the use of the existing MECC protocol or tailor the MECC training programme. The findings are anticipated to improve fidelity of MECC training within mental health inpatient settings as well as provide evidence for MECC training at a national level. We also expect findings to influence strategic plans, policy, and practice specific to MECC and inform best practice in implementing wider brief intervention programmes.

Decision-making and best practice when nasogastric tube feeding under restraint: multi-informant qualitative study.

Clinicians working in mental health in-patient settings may have to use nasogastric tube feeding under physical restraint to reverse the life-threatening consequences of malnutrition when this is driven by a psychiatric condition such as a restrictive eating disorder. To understand the decision-making process when nasogastric tube feeding under restraint is initiated in mental health in-patient settings. People with lived experience of nasogastric tube feeding under restraint and parents/carers were recruited via the website of the UK's eating disorder charity BEAT. Eating disorder clinicians were recruited via an online post by the British Eating Disorders Society. Semi-structured interviews were administered to all participants. Themes overlapped between the participant groups and were integrated in the final analysis. Two main themes were generated: first, 'quick decisions', with the subthemes of 'medical risk', 'impact of not eating' and 'limited discussions'; second, 'slow decisions', with subthemes of 'threats', 'discussions with patient', 'not giving up' and 'advanced directives'. Benefits and harms of both quick and slow decisions were identified. This research offers a new perspective regarding how clinical teams can make best practice decisions regarding initiating nasogastric feeding under restraint. In-patient mental health teams facilitating this clinical intervention should consider discussing it with the patient at the beginning of their admission in anticipation of the need for emergency intervention and in full collaboration with the multidisciplinary team.

An Exploratory Evaluation of the Impact and Acceptability of a Structured Reflective Practice Program Piloted with Staff in a Forensic Mental Health Setting

This study describes and examines the impact of a novel Reflective Practice program tailored to the multidisciplinary clinical workforce at an inpatient forensic mental health setting. Surveys assessing wellbeing, self-efficacy and reflective practice capacity were administered to all clinical staff prior to commencement of the Reflective Practice program, as well as six months post-implementation. Interviews were also conducted with key clinical stakeholders to obtain detailed feedback regarding the impact of the program across the organization following six-eight months of implementation. Staff who participated in post-implementation surveys reported significantly higher confidence in their work when compared to staff at baseline, while clinical stakeholders observed improvements in the cohesion of the multidisciplinary team. In spite of the limitations of the pragmatic study design and small sample size, results suggest the novel Reflective Practice program offers an acceptable model for adoption in an inpatient forensic mental health setting, with potential to improve the wellbeing, learning and morale of a forensic mental health workforce. The findings also highlight the need to support practice development and wellbeing in early career clinicians, where low confidence and high stress are predominant.

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:

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

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

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

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

Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review.

To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe (n = 26), Western Pacific (n = 8), Americas (n = 3) and South-East Asia (n = 1). In primary studies, ethnicity was reported according to migrant/national status (n = 16), mixed categories (n = 12), indigenous vs. non-indigenous (n = 5), region of origin (n = 1), sub-categories of indigenous people (n = 1) and religion (n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies (n = 20), multiple restrictive practices studied concurrently (n = 17), mechanical restraint (n = 8), rapid tranquillisation (n = 7) and manual restraint (n = 1). Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers' and clinicians' understanding of the issue. Further research in this field may improve mental health practice.