Mental Health Services In Ireland Research Articles

Supporting children whose parent has a mental health problem: an assessment of the education, knowledge, confidence and practices of registered psychiatric nurses in Ireland

Health professionals, including nurses, stand accused of ignorance or oversight of children whose parent experience a mental health problem. Psychiatric nurses are in an ideal position to respond to children's needs and support their parents in a proactive and sensitive manner. The aim of this study was to explore psychiatric nurses' education, knowledge, confidence and practice with regard to the support needs of children whose parent has a mental health problem. This study employed a self-completion anonymous survey design with a sample of registered psychiatric nurses from one integrated mental health service in Ireland. The sample reported relatively low levels of education, knowledge, confidence and supportive clinical practice when it came to children whose parent has a mental health problem. There is an urgent need for education on family-focused care, and the development of guidelines and child focused services if the needs of parents and children are to be met.

A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness

There is increasing interest in the application of recovery principles in mental health services. We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in a community mental health service in Ireland. Eighty service attenders with severe and enduring illness characterized by significant ongoing disability were randomized into (1) a group receiving a programme of ICM and (2) a group receiving treatment as usual (TAU). Groups were compared before and after the programme for general psychopathology using the Brief Psychiatric Rating Scale (BPRS) (clinician rated) and How are You? scale (self-rated). The Functional Analysis of Care Environments (FACE) scale provided assessment of multiple functional domains. The overall group (mean age 44.5 ± 13.2 years; 60% male) had mean total Health of the Nation Outcome Scale (HoNOS) scale scores of 10.5 ± 4.6, with problems in social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p < 0.01) with higher baseline scores on the HoNOS social subscale and BPRS (p < 0.05). An analysis of covariance, controlling for these baseline differences, indicated greater improvement in BPRS scores (p = 0.001), How are You? scores (p = 0.02) and FACE domains for cognition, symptoms and interpersonal relationships (all p < 0.001) in the ICM group. The ICM group underwent greater changes in structured daily activities that were linked to improved BPRS scores (p = 0.01). A programme of ICM emphasizing recovery principles resulted in significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.

NVivo 8 and consistency in data analysis: reflecting on the use of a qualitative data analysis program

Qualitative data analysis is a complex process and demands clear thinking on the part of the analyst. However, a number of deficiencies may obstruct the research analyst during the process, leading to inconsistencies occurring. This paper is a reflection on the use of a qualitative data analysis program, NVivo 8, and its usefulness in identifying consistency and inconsistency during the coding process. The author was conducting a large-scale study of providers and users of mental health services in Ireland. He used NVivo 8 to store, code and analyse the data and this paper reflects some of his observations during the study. The demands placed on the analyst in trying to balance the mechanics of working through a qualitative data analysis program, while simultaneously remaining conscious of the value of all sources are highlighted. NVivo 8 as a qualitative data analysis program is a challenging but valuable means for advancing the robustness of qualitative research. Pitfalls can be avoided during analysis by running queries as the analyst progresses from tree node to tree node rather than leaving it to a stage whereby data analysis is well advanced.

Service user involvement in mental health practitioner education in Ireland

In recent years, there is an ever increasing call to involve people who use mental health services in the development, delivery and evaluation of education programmes. Within Ireland, there is very little evidence of the degree of service user involvement in the educational preparation of mental health practitioners. This paper presents the findings on service user involvement in the education and training of professionals working in mental health services in Ireland. Findings from this study indicate that in the vast majority of courses curricula are planned and delivered without consultation or input from service users. Currently the scope of service user involvement is on teaching, with little involvement in curriculum development, student assessment and student selection. However, there is evidence that this is changing, with many respondents indicating an eagerness to move this agenda forward.

A potential model for primary care mental health services in Ireland.

A high demand for the inclusion of psychosocial interventions for primary care mental health presentations has become more apparent in recent years. Current policies have proposed models of care highlighting principles required for a quality service. However, implementation has been slow to date. This article aims to inform the current debate relating to primary care service delivery models for mental health presentations and to contribute towards future planning initiatives. A narrative review of a range of policies and selected articles relevant to primary care mental health in an Irish context. The search produced four distinct themes: current service provision in Ireland; stakeholders' views; psychological care options; and potential service structures. Thereafter, a potential service delivery model is proposed. This formulated model employs a combination of elements from the reviewed themes to provide a clinically- and cost-effective, equitable and accessible service driven by service user and carer input. Although this review was selective in nature, the proposed potential model can complement future research agendas for more favourable primary care practice in Ireland. Recommendations are made for the planning of services including policy implementation procedures, training and communication.

Leadership and service user empowerment in mental health services in Ireland

Leadership and service user empowerment in mental health services in Ireland

Patient attitudes towards compulsory community treatment orders and advance directives.

The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan. Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI). Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan. With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.

P02-166 - Mental health policy and planning in Ireland

IntroductionAlthough the world is suffering from an increasing burden of mental disorders, budgets allocated for mental health in the majority of countries make up a relatively small proportion of total health expenditures.ObjectivesTo review the mental health situation in Ireland with regards to mental health Policy and Planning through review of relevant literature.AimTo assess the extent of mental health problems in Ireland and discuss the obstacles and priorities in Mental Health Policy and Planning to achieving good mental health in Ireland.MethodologyTo review available hardcopy and internet literature since WHO 2001 health report regarding current mental health situation, issues that are significant obstacles to implementation of mental health policy and what should be prioritised in order to achieve good mental health in Ireland.ResultsIn Ireland 24-25% of the population develop mental health problems at some point but only 7% of the health budget is allocated to mental health services. Mental health services are not equitable. There is a need for reorganisation of services and transitional funding. There are human resource shortages and lack of transparency and accountability especially around past expenditures.ResultsThe core problem with mental health services in Ireland is an increasingly shrinking budget with poor financial administration consistent with lack of or inadequate implementation of mental health policy. The stumbling block in mental health policy implementation is the lack of a clear authority with defined responsibility for overall mental health policy and budgetary matters.

Sources of Patients' Knowledge of the Adverse Effects of Psychotropic Medication and the Perceived Influence of Adverse Effects on Compliance Among Service Users Attending Community Mental Health Services

Noncompliance with medication has been a complex issue with patients with severe mental illness during the last few decades, and adverse effects of medication have been identified as a major contributor to noncompliance. To assess the sources of patients' knowledge of the adverse effects of their prescribed medicines and the perceived effects of their knowledge and experiences of adverse effects on their compliance with prescribed medicines. A cross-sectional survey of 500 patients attending outpatient psychiatric services in an urban adult mental health services in Ireland was carried out to assess parameters relevant to the objectives of the study. Of the 500 patients approached, 409 agreed to take part in the study, giving a response rate of 81.8%. Mean (SD) age was 41 (12) years, with 39% being males, and 74.9% having at least secondary education. Overall, 44% said they had learnt of adverse effects of their medication from multiple sources including physicians (52.31%), leaflets (54.2%), Internet (14.29%), books (13.02%), and chemist/pharmacist (11.34%). Of the patients, 46.2% reported that they have had concerns about taking their medication because of their knowledge of adverse effects, with females more likely to have such concerns than males. Moreover, 14.7% of patients reported that they had ever refused to take medication prescribed for them because of their knowledge of adverse effects, whereas 30.8% of patients reported that they had some time in the past stopped taking their medication because they had actually experienced adverse effects. Finally, when asked if they would have taken the medicines prescribed for them now if they were told initially of all the adverse effects, 50.60% answered "more likely," with a higher proportion of these being males. Physicians and information leaflets are the leading sources of patients' knowledge about adverse effects of medication. The knowledge of adverse effects of medication has a potential to affect compliance, and so it is essential for physicians to engage patients in a fuller communication about their illness and its treatment with medication including the management of potential adverse effects.

Operationalizing autonomy: solutions for mental health nursing practice

The new Mental Health Act (2001) became a law on 1 November 2006. The new Act, reflective of international legislative norms, outlines an agenda for the mental health services in Ireland which, in part, aims to maximize patient autonomy. This paper seeks to contextualize autonomy within nurse-patient interactions in the mental health care setting. The acceptance of autonomy as an unconditional principle, as outlined within traditional bioethics, is challenged. The paper draws on the social critique of normative ethics and suggests an alternative framework within which to operationalize patient autonomy. The authors conclude that a broader, more contextualized perspective on autonomy would more suitably inform mental health nursing. Narrative ethics and a framework of 'protective responsibility' are offered as an alternative to more traditional approaches. Practice-based initiatives to maximize patient autonomy and facilitate-reasoned ethical decision making are outlined.

Aggression and violence in mental health services: categorizing the experiences of Irish nurses

There is growing evidence that nurses in mental health services are likely to be victims of violence or aggression. One of the key difficulties in comparing international findings, however, has been that there has been an inadequate categorization of the types of incident to which staff are exposed. The current study aimed to identify the types of violent or aggressive incidents that staff in Irish Mental Health Services were exposed to within a 1-month long period. A cross-sectional study was undertaken with all nurses working in one of the Mental Health Services in Ireland, serving both an urban and rural population. Data were collected through a questionnaire (Scale of Aggressive and Violent Experiences) adapted from the Perceptions of Prevalence of Aggression Scale. The questionnaire was designed to collect data relating to both personal and professional demographics of the sample as well as experiences of aggressive or violent incidents respondents may have encountered in their work situation. There was a response rate of 31%. Data were analysed utilizing SPSS-11. Both descriptive and inferential analyses were undertaken. The relevant data were subjected to a series of one-way ANOVAS and chi-squared analysis. The findings suggest that nursing staff in this Mental Health Service experienced high levels of verbal aggression, with distinctions obvious between threatening and non-threatening aggression, suggesting discernment in terms of intentionality. Additionally, respondents encountered greater levels of covert or indirect violence or aggression than forms that were overtly directed towards staff. The implications are discussed in relation to both policy and practice.

The future of forensic mental health services in Ireland.

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Persistence of psychological problems in adolescence: a one year follow-up study.

To examine the prevalence and persistence of psychological problems in older adolescents. This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used. Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls. A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.

Immigration: new challenges for psychiatry and mental health services in Ireland.

Immigration: new challenges for psychiatry and mental health services in Ireland.

Mental Health Services in Ireland

Mental Health Services in Ireland

St. Brendan's and the Community: Mental Health Services in Ireland

1. In Ireland, the regional administrators--including the chiefs of nursing and psychiatry--have as their responsibility all of the related outpatient clinics, day hospitals, day care centers and community residences, including all levels of acuity. Discharge planning becomes easier than in the United States. 2. In Ireland, Assessment Units are unlocked, nurses are in uniform, there is no equivalent of a Master's prepared clinical specialist or an advanced level Nurse Practitioner, and residences are integrated into neighborhoods. 3. The majority of chief psychiatric nurses and officers and nurse tutors in Ireland are men. Teaching is not a top priority of staff nurses, and nurse tutors are not involved regularly with students on the wards.