Inpatient Mental Health Settings Research Articles

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.

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

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

Nursing staff composition and its influence on seclusion in an adult forensic mental health inpatient setting: The truth about numbers

IntroductionResearch on the influence of nursing staff composition and use of seclusion in the forensic mental health inpatient settings is sparse. Nursing staff composition refers to staffing levels, roles, gender ratio and skill mix of the ward teams. Internationally, the rates of seclusion in some forensic mental health inpatient settings have increased over the past 10 years despite global efforts to reduce and eliminate its use. AimTo examine whether the use of seclusion in a forensic mental health inpatient setting can be attributed to staffing composition or to contextual factors such as day of the week, month or other clinical factors. MethodRetrospective data collection was conducted using seclusion data, daily ward reports and staff rosters. Data were collected for all shifts in the hospital over a six-month period. ResultsThree staffing variables were identified as having an influence on the use of seclusion: the number of registered nurses on duty, the presence of the shift coordinator and having a lead nurse on shift. DiscussionSenior nurse oversight and guidance are important factors in assisting staff to identify clinical deterioration and intervene early which may assist services reduce the use of seclusion. Implications for practiceAs staffing levels and composition are modifiable, the results of this study may assist nurse leaders to consider workforce improvements to reduce seclusion use.

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

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

APA’s Government, Policy, and Advocacy Update (September 2022)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (September 2022)Search for more papers by this authorPublished Online:25 Aug 2022https://doi.org/10.1176/appi.pn.2022.09.9.28Health Care Groups Release Statement Opposing Legislative Interference in CareJoined by more than 75 other organizations representing health care professionals, APA issued a statement emphasizing its opposition to all legislative interference in the patient-clinician relationship. The statement was made as the country’s health care system enters the post-Roe v. Wade era and abortion bans have gone into effect across the country.The wave of abortion bans “will harm patients, impair the integrity of the medical profession, and have a devastating and unquantifiable impact on the patients and clinicians it affects,” the statement reads. “People in at least half the states will now face a cruel choice between traveling hundreds of miles to receive abortion care (which is simply impossible for those who lack the resources, means, and opportunity) or being forced to continue with a pregnancy that may threaten their health, well-being, and future.”Clinicians practicing in those states will similarly face an untenable decision, the statement continues: risk criminal prosecution by providing evidence-based care or withholding safe and effective reproductive health care from patients in need.“More Than 75 Health Care Organizations Release Joint Statement in Opposition to Legislative Interference” APA Provides Comments on Patient Experience Survey for Mental Health SettingsThe Agency for Healthcare Research and Quality (AHRQ) is developing a version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, a tool for assessing patients’ experiences with health care, for use in inpatient mental health settings.Versions of the CAHPS survey are used in a variety of other health care settings and have been incorporated into federal quality and payment programs, such as the Centers for Medicare and Medicaid Services’ Merit-Based Incentive Payment System and the Hospital Value-Based Purchasing Program.APA responded to a request for information that AHRQ released, providing input and suggestions. For example, APA advised that in an inpatient mental health setting, the survey should address patient involvement in care, including questions such as, “Do you feel like staff listened to you and respected you?” APA also noted the benefits and limitations of a patient experience survey in an inpatient mental health setting. Many patients are admitted involuntarily or their illness may affect their insight about the need for hospitalization or understanding of survey questions. Nonetheless, these patients should be surveyed to help lead to targeted interventions to improve the experience of patients like them, APA advised.APA’s comments Medical Groups Sound Alarm on Lawsuit Threatening Preventive CareAPA joined 60 other organizations, including the AMA, in issuing a statement warning that a federal court case could cause millions of Americans to lose access to preventive services.Kelley v. Becerra, filed in the Northern District of Texas, “could significantly jeopardize the coverage of preventive health care services for millions of Americans with private health insurances,” the statement reads. The lawsuit questions the constitutionality of section 2713 of the Affordable Care Act, which requires insurers and group health plans to cover more than 100 preventive health services at no cost to patients.“Our patients cannot afford to lose this critical access to preventive health care services,” the statement reads. “Rolling back this access would reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable.”The news release APA Expresses Support for REDI Act, Suicide Prevention ActIn July, APA signed on to letters to Congress expressing support for two pieces of legislation that would address high student loan debts and suicide prevention.The Resident Education Deferred Interest (REDI) Act (S 3658/HR 4122) would allow borrowers to qualify for interest-free deferment on their student loans while completing a medical or dental internship or residency program.“This bill would prevent medical and dental residents from being penalized during residency and save them thousands of dollars in interest,” the letter reads. It was sent to leaders of the Senate Health, Education, Labor, and Pensions Committee and the House Committee on Education and Labor.Additionally, APA joined a letter to Sens. Jack Reed (D-R.I.) and Jerry Moran (R-Kan.), cosponsors of the Suicide Prevention Act (S 4448). The bill would expand data collection and surveillance of suicide attempts and other instances of self-harm in state and local health departments, “allowing for a more timely and accurate response to concerning public health trends,” the letter states.The Suicide Prevention Act would also create a grant program to fund suicide prevention programs in hospital emergency rooms. “Equipping emergency department staff with the tools and training needed to recognize suicide risk in patients and refer them for appropriate follow-up is vital in ensuring that patients are being treated swiftly and given the care they need,” the letter states. ■ ISSUES NewArchived

Staff Experiences of Implementing a Positive Behavioural Support (pbs) Model Within a Psychiatric Intensive Care Unit (PICU): a Qualitative Service Evaluation

Aim: Positive behaviour support (PBS) is a proactive, person-centred, approach for working with behaviours that are challenging to support. The use of PBS in educational and intellectual disability settings is widely recognised. However, surprisingly few papers have explored the use of PBS in inpatient mental health settings, and, even fewer, the perspective of staff members. This service evaluation aimed to explore staff perceptions and experiences of implementing a PBS model within one psychiatric intensive care unit (PICU). Method: Six members of PICU staff participated in qualitative, semi- structured, interviews to explore their experiences of implementing PBS in their clinical practice. All data was analysed using empirical thematic analysis. Results: Four themes were identified: The practice and principles of PBS, Changes for the better, for all, Emotional and practical challenges and Staff wellbeing and confidence. Conclusion: Staff had positive experiences implementing a PBS model in PICU settings, which appears to translate well to inpatient mental health care. Benefits of PBS were perceived in the ward environment, to patient care and in staff communication, confidence and wellbeing. However, these were dependent upon the availability of resources and support. To ensure sustainable success, the implementation of PBS in PICU settings requires ongoing organisational and leadership support to help staff feel able and confident to deliver model driven care.