Mental Health Care Staff Research Articles

Implementing culturally appropriate recovery approaches in mental health services: perspectives from the Irish Traveller community.

This study explores the perspectives of Irish Travellers, an ethnic minority group in Ireland, on the service improvements needed to implement culturally appropriate recovery approaches in mental health services. A community-based participatory research approach was employed. Seventeen Traveller peer researchers conducted thirteen qualitative participatory workshops and five individual interviews across Ireland. Eighty-seven adult members of the Traveller community (83% female, mean age = 33, 56.3% not in education or employment) were recruited through convenience sampling. Participatory thematic analysis was employed. Travellers' ideas about improvements in mental healthcare involve practitioners in creating a trusting environment, increasing representation of Travellers within mental healthcare staff and working in partnership with Traveller service users to co-produce strategies that are owned by the community. Study participants emphasised the importance of Traveller cultural awareness, strengthening trauma-informed care, and embedding an ethos of cultural humility within mainstream services. The findings indicate the need for increased collaboration between mental health service providers and non-mental health agencies, and a reorientation of care towards empowering Traveller service users to achieve their social aspirations and building a positive self-identity. This study demonstrates that implementing a recovery approach for Travellers requires a reorientation of services, in line with Travellers' definition of culturally appropriate mental healthcare. This study calls for an expanded mandate for mental health services beyond individual care and towards intersectoral action in addressing the social determinants of Travellers' mental health. This will help to shape an equitable and inclusive healthcare setting that promotes Travellers' mental health and recovery.

Sources of Distress for Secure Mental Healthcare Staff: A Cross-Sectional Study of the Impact of Personal and Occupational Problems on Psychological Wellbeing and Functioning

Despite a global drive to improve staff well-being in healthcare, distress and absenteeism continue to persist, posing consequences for patient care and organisational functioning. Current research and subsequent strategies implemented to remediate such problems have primarily focused on occupational experiences, disregarding the contribution of problems occurring outside of the workplace. The current study sought to establish the prevalence of work and non-work problems, and their respective impacts on several well-being outcomes, in this occupational group. Secondary analysis of data from a cross-sectional survey of 323 staff in a secure UK mental healthcare organisation was conducted. Exposure to non-work problems was pervasive across the sample (79.3%). Demographic discrepancies in exposure to types of problems were apparent, though number of problems reported was comparable across the sample. Number of non-work problems was a significant predictor of depression, anxiety, functional impairment, and complex post-traumatic stress disorder symptoms, when controlling for exposure to work problems. The findings implicate the need for a broader conceptualisation of distress in secure mental healthcare staff, who typically report exposure to several non-work problems, in the context of occupational challenges. Policy, practice and service implications are discussed, with consideration for the availability and modality of support offered to staff.

How can we measure psychological safety in mental healthcare staff? Developing questionnaire items using a nominal groups technique.

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psychological safety that is suitable for use in inpatient mental health settings. Edmondson (1999) is the most commonly used measure of psychological safety, but it was designed for use in general physical healthcare settings. As inpatient mental health settings are unique environments, transferability of knowledge from physical to mental healthcare settings cannot be assumed. We sought to develop questionnaire items that capture psychological safety among healthcare staff working in acute inpatient mental healthcare settings. We used the nominal group technique, a consensus method involving rounds of discussion, idea generation, and item rating/ranking to identify priorities. Twenty-eight stakeholders participated, including 4 who had lived experience of mental health problems, 11 academics and 18 healthcare professionals (8 participants identified with more than 1 category). The study involved a workshop with three parts: (i) an overview of current research and limitations of the Edmondson (1999) measure as outlined above, (ii) discussion on what items should be retained from the Edmondson (1999) measure, and (iii) discussion on what items should be added to the Edmondson (1999) measure. Twenty-one items were generated and retained to capture psychological safety in inpatient mental health settings. These measure professionals' sense of being valued by their team and organization, feeling supported at work, feeling physically safe and protected from physical harm, and knowing they can raise concerns about risk and safety. This is the first study to generate questionnaire items suitable for measuring staff psychological safety in mental health settings. These have been generated via a consensus method to ensure stakeholders' views are reflected. Further research is needed to evaluate factor structure, internal reliability, and convergent validity.

Understanding weight management in adult secure mental health services: findings from a mixed-methods study in Northern England

PurposeObesity and associated morbidity and mortality are major challenges for people with severe mental illness, particularly in secure (forensic) mental health care (patients who have committed a crime or have threatening behaviour). This study aims to explore experiences of weight management in secure mental health settings.Design/methodology/approachThis study used a mixed-methods approach, involving thematic analysis. A survey was delivered to secure mental health-care staff in a National Health Service (NHS) mental health trust in Northern England. Focus groups were conducted with current and former patients, carers and staff in the same trust and semi-structured interviews were undertaken with staff in a second NHS mental health trust.FindingsThe survey received 79 responses and nine focus groups and 11 interviews were undertaken. Two overarching topics were identified: the contrasting perspectives expressed by different stakeholder groups, and the importance of a whole system approach. In addition, seven themes were highlighted, namely: medication, sedentary behaviour, patient motivation, catered food and alternatives, role of staff, and service delivery.Practical implicationsSecure care delivers a potentially “obesogenic environment", conducive to excessive weight gain. In future, complex interventions engaging wide-ranging stakeholders are likely to be needed, with linked longitudinal studies to evaluate feasibility and impact.Originality/valueTo the best of the authors’ knowledge, this is the first study to involve current patients, former patients, carers and multidisciplinary staff across two large NHS trusts, in a mixed-methods approach investigating weight management in secure mental health services. People with lived experience of secure services are under-represented in research and their contribution is therefore of particular importance.

Investigating the impact of the COVID-19 pandemic on recovery colleges: multi-site qualitative study.

During the COVID-19 pandemic, mental health problems increased as access to mental health services reduced. Recovery colleges are recovery-focused adult education initiatives delivered by people with professional and lived mental health expertise. Designed to be collaborative and inclusive, they were uniquely positioned to support people experiencing mental health problems during the pandemic. There is limited research exploring the lasting impacts of the pandemic on recovery college operation and delivery to students. To ascertain how the COVID-19 pandemic changed recovery college operation in England. We coproduced a qualitative interview study of recovery college managers across the UK. Academics and co-researchers with lived mental health experience collaborated on conducting interviews and analysing data, using a collaborative thematic framework analysis. Thirty-one managers participated. Five themes were identified: complex organisational relationships, changed ways of working, navigating the rapid transition to digital delivery, responding to isolation and changes to accessibility. Two key pandemic-related changes to recovery college operation were highlighted: their use as accessible services that relieve pressure on mental health services through hybrid face-to-face and digital course delivery, and the development of digitally delivered courses for individuals with mental health needs. The pandemic either led to or accelerated developments in recovery college operation, leading to a positioning of recovery colleges as a preventative service with wider accessibility to people with mental health problems, people under the care of forensic mental health services and mental healthcare staff. These benefits are strengthened by relationships with partner organisations and autonomy from statutory healthcare infrastructures.

The differential and accumulative impacts of self and other sources of moral injury on well-being in mental healthcare staff

PurposeResearch has established the prevalence and relevance of moral injury in healthcare workers, though less attention has been paid to the different classes of potentially morally injurious events (PMIEs) experienced by this population and their impact. This exploratory study sought to examine the frequency of self- and other-generated PMIE classes and their associations with demographic characteristics and well-being outcomes among mental healthcare staff.Design/methodology/approachSecondary analysis of data drawn from two cross-sectional surveys of 267 frontline and leadership staff from mental healthcare settings in the UK was conducted. Responses on the Moral Injury Events Scale and the Short Professional Quality of Life Scale were extracted for analysis.FindingsBetrayal by others was most frequently endorsed (61.8%), whilst self-transgressions were least frequently reported (25.5%). After controlling for the number of PMIE classes experienced, betrayal significantly predicted secondary traumatic stress (p = 0.01) and burnout (p = 0.04). Additionally, other transgressions significantly predicted secondary traumatic stress (p = 0.008). The predictive effects of self-transgressions on burnout, secondary traumatic stress and compassion satisfaction were all nonsignificant after controlling for the number of PMIE classes experienced.Practical implicationsFindings highlight differences in the frequency and impact of self and other PMIEs experienced by healthcare professionals. Reducing cumulative exposure to differential PMIE classes appears to be of critical importance to improving occupational well-being in this group.Originality/valueTo our knowledge, this study is the first to explore the associations between PMIE classes and occupational well-being in a mental healthcare population, inclusive of frontline and leadership staff.

Protocol for an implementation study of group metacognitive therapy for anxiety and depression in NHS cardiac rehabilitation services in England (PATHWAY-Beacons).

Cardiac rehabilitation (CR) services aim to improve heart disease patients' health and quality of life and reduce the risk of further cardiac events. Depression and anxiety are common among CR patients but psychological treatments have usually had small effects. In contrast, the recent NIHR-funded PATHWAY trial found that group Metacognitive Therapy (MCT) was associated with improvements in anxiety and depression when added to CR and was more effective than usual CR alone. The next stage is to test implementation of MCT within the National Health Service through the creation of a network of CR beacon sites. The study will test the quality of data capture following addition of a new MCT data-field to the national audit of cardiac rehabilitation (NACR), examine level of adoption at sites, examine mental health outcomes benchmarked against usual CR and the PATHWAY data, examine the enablers and barriers to implementation and the expected resource requirements. The study has been registered: NCT05956912 (13th July, 2023). Beacon sites will be recruited as preliminary adopters of group MCT from NHS CR services in England. A national invitation for expressions of interest from CR services will be issued and those meeting eligibility criteria will be considered for inclusion. Two staff at each site will receive training in MCT, and mixed-methods will be used to address questions concerning the quality of patient data recorded, level of adoption at sites, the characteristics of patients attending MCT, the impact of adding MCT to CR on mental health outcomes, and patient, healthcare staff and commissioner views of barriers/enablers to implementation. Exploration of implementation will be informed by Normalisation Process Theory. The study will support development of an NHS roll-out strategy, assess the mental health outcomes associated with MCT, examine treatment fidelity in real-world settings, and evaluate revised data collection structures that can be used to assess the impact of national-level implementation. NCT05956912; 13th July 2023.

Experiences of clinical staff who work with patients who self-harm by ligature: An exploratory survey of inpatient mental health service staff.

Self-harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self-harm. Most fatal and non-fatal suicidal behaviours in inpatient settings are a result of ligature use. There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self-harm by ligature. Key issues related to self-harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self-harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self-harm by ligature. Working with self-harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self-harm by ligature, and unsupported after responding to a ligature incident. Training about self-harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self-harm, and acknowledgement of the emotional impact on staff. Support for staff members who respond to ligature incidents should be available for all staff members who respond to self-harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. INTRODUCTION: Self-harm by ligature is a common form of self-harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self-harm. We explored the experiences of clinical staff who work with patients who self-harm by ligature. A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. 275 staff members participated. Challenges most frequently reported about working with self-harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self-harmed by ligature. There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self-harm by ligature.

52 An Evaluation of Satisfaction with Emergency Department Care in Children and Adolescents with Mental Health Concerns

Abstract Background Increasingly, the emergency department (ED) is a vital safety net for children and adolescents with mental health concerns seeking crisis care. Evaluating patient and parent/caregiver experience and satisfaction with care is essential to improve the quality of mental health services provided. Objectives The primary objective was to evaluate total satisfaction with the delivery of ED mental health care in two paediatric EDs in Alberta, Canada (Stollery Children's Hospital and Alberta Children's Hospital). Secondary objectives included exploring aspects of ED mental health care (staff interpersonal skills, confidentiality/privacy, and patient-reported outcomes of care) associations with general satisfaction, patient and ED visit characteristic associations with total satisfaction score, and care experience themes. Design/Methods We enrolled patients <18 years of age presenting with a mental health concern—e.g., anxiety, disruptive behaviour, self-harm, depression, situational crisis—over a 12-month period (February 1, 2020—January 31, 2021). Satisfaction data were collected using the Service Satisfaction Scale, which includes quantitative and qualitative data on aspects of ED mental health care. ED visit (length of stay, mental health and psychiatry consultations, hospital admission) and patient (discharge diagnoses, age, sex) data were collected. We evaluated associations of general satisfaction with ED mental health care using Pearson’s correlation coefficient tests, and associations between total satisfaction score with patient and ED visit characteristics using multivariable regression analyses. Inductive thematic analysis of qualitative feedback identified satisfaction and patient experience themes. Results 646 participants were enrolled with most being Caucasian (71.2%; 460/646) and female (56.3%; 364/646); the median age was 13 years (IQR, 11-15 years). The most common discharge diagnosis was anxiety or stress-related disorders (39.5%; 245/620). Parents/caregivers and adolescents were most satisfied with confidentiality and respect in the ED and least satisfied with how the ED services helped reduce symptoms and/or problems. Greater satisfaction was reported for parents/caregivers whose child received care at Alberta Children’s Hospital (p=0.003). General satisfaction was strongly associated with the perceived amount of help received in the ED (r=0.85). ED visit characteristics associated with total satisfaction score included an evaluation by a mental health team member (p=0.004) and psychiatrist consultation (p=0.05). Written comments demonstrated satisfaction with ED provider attitudes and interpersonal skills and dissatisfaction with access to mental health and addictions care, wait time, and COVID-19. Conclusion The results reflect the need to improve the satisfaction with ED mental health care delivery, with a particular focus on enhancing access to care by appropriate mental health providers.

Planning for Change: Co-Designing Implementation Strategies to Improve the Use of Sensory Approaches in an Acute Psychiatric Unit

Implementing sensory approaches in psychiatric units has proven challenging. This multi-staged study involved qualitative interviews (n = 7) with mental health care staff in an acute psychiatric ward to identify the local factors influencing use of sensory approaches, and co-design implementation strategies with key stakeholders to improve their use. Using framework analysis, results revealed that the use of sensory approaches were hindered by: inadequate access to sensory resources/equipment; lack of time; lack of staff knowledge; and belief that sensory approaches are not effective or part of staff’s role. To address identified barriers a systematic theory-informed method was used to co-design implementation strategies to improve the use of sensory approaches.

Psychometric properties of the Italian version of the staff attitude to coercion scale: an exploratory factor analysis.

The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment. The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria). Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77. The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion.

The ethical imperative of trauma-sensitive care for electroconvulsive therapy (ECT)

Background The empirical literature on the lived experience of electroconvulsive therapy (ECT) is limited, divergent, and largely focused on the experiences of procedures, (adverse) effects, information provision, or decision-making. Aims This study aimed to investigate aspects related to the lived experience and meaning-making of people who have had ECT. Method In-depth interviews with 21 women (21–65 years old) were analyzed using interpretative phenomenological analysis (IPA). Findings A subgroup of nine participants described more negative experiences with ECT. A common factor for these participants was the experience of trauma that remained under-treated. The superordinate themes identified were a lack of trauma-based and recovery-oriented treatment. The rest of the sample (12) expressed more positive experiences with ECT. Conclusions This study suggests that exploring more broadly the impacts of ECT at the long term offers insights that can help design more person-centered services aligned to the needs of the treatment recipients. Educational modules for mental health care staff should include, besides knowledge on the methods’ effectiveness, additional evidence about treatment recipients’ subjective concerns and the relevance of trauma and recovery-oriented care models.

Predictors of Post-Traumatic Growth in a Sample of United Kingdom Mental and Community Healthcare Workers during the COVID-19 Pandemic.

Experiences of adversity can generate positive psychological effects alongside negative impacts. Little research to date has evaluated predictors of post-traumatic growth in mental or community healthcare workers during the COVID-19 pandemic. Following a survey of 854 community and mental healthcare staff in the United Kingdom in July to September 2020, multiple linear regression was used to determine the association between hypothesised risk and protective factors (personal, organisational and environmental variables) and total scores on the Post-traumatic Growth Inventory-Short Version. Positive self-reflection activities, black and minority ethnic status, developing new healthcare knowledge and skills, connecting with friends and family, feeling supported by senior management, feeling supported by the UK people, and anxiety about the personal and work-related consequences of COVID-19 each significantly independently predicted greater post-traumatic growth. Working in a clinical role and in mental healthcare or community physical healthcare predicted lower post-traumatic growth. Our research supports the value of taking an organisational growth-focused approach to occupational health during times of adversity, by supporting staff to embrace opportunities for personal growth. Valuing staff's cultural and religious identity and encouraging self-reflective activities, such as mindfulness and meditation, may help to promote post-traumatic growth.

Use of debriefing following restrictive practices in forensic psychiatric care

PurposeInpatient violence is a substantial problem in psychiatric wards and de-escalation is difficult. When managing instances of violence through verbal techniques fail, mental health-care staff may use restrictive practices. The Six Core Strategies and debriefing exist for managing violence and restrictive practices in different mental health settings. Debriefing is used to get patients’ views on restrictive practices, ensure proper patient care and strengthen the role of patients as experts. This study aims to provide new information on debriefing implementation and how debriefing was used among different patient groups in a forensic hospital.Design/methodology/approachQuantitative seclusion time and debriefing reports (n = 524) were examined with Poisson regression analysis. Fisher’s exact test was used to determine the associations between debriefing and seclusion/restraint.FindingsDebriefing (n = 524) was provided in 93% of violent episodes, which is an excellent result on an international level. There was significant variation in how often debriefing was used (p < 0.001) among different patient groups, i.e. dangerous, difficult-to-treat patients and criminal offenders whose sentences have been waived. Previous debriefing research has rarely specified what types of psychiatric patients have been subjected to seclusion or restraint.Practical implicationsThe implementation of debriefing requires multiprofessional work within the organization and wards.Originality/valueDebriefing seems to stimulate reflection at every level of a health-care organization, which fosters learning and can ultimately change clinical practices. The use of debriefing can strengthen the role of patients as well as professionals.

Predictors of Moral Injury in Secure Mental Healthcare Workers: Examining a Role for Violence and Restrictive Practices Through an Intersectional Lens

ABSTRACT Secure mental healthcare staff provide care in the context of exposure to violence and restrictive practices. Yet, despite recognition of the moral dilemmas afforded by these events, they are yet to be explored within a moral injury framework. The current study sought to explore the potentially morally injurious effects of violence and restrictive practices through an intersectional lens. A cross-sectional survey was completed by 222 secure mental healthcare professionals. Associations between exposure to violence, restrictive practices and moral injury were significant in white female participants only. When entered into a hierarchical regression, exposure to violence significantly predicted moral injury score for this group, and nullified the effects of restrictive practices. The findings position restrictive practices and exposure to violence as potential sources of moral injury for white female healthcare professionals. The implementation of strategies to reduce exposure to such events and their impacts in this occupational group are important priorities.

The introduction and development of a mental health integrated support unit within an English prison: clinical, care staff and operational officer perspectives

PurposeThere is clear evidence that prison can be detrimental to mental health and that wider society has tended to assume “out of sight, out of mind” for prisoners in mental distress. The lack of access to effective mental health care in prisons along with increasingly lower numbers of prison officers, or Operational Officers (OOs), has created a negative culture that requires the development of specialist services. With this comes a need to conduct evaluations, and investigations, into the roles of OOs and mental health-care staff. This study aims to report on a commissioned evaluation around the introduction and development of an HMP Mental Health Unit, named the integrated support unit (ISU), in the North of England. This study’s section of the wider evaluation focuses on the early team building, working practice and development of mental health registered nurses, other care staff and OOs within the ISU.Design/methodology/approachThree focus groups incorporating two professional groups took place on the ISU. The first of six Mental Health Workers (MHW) including Registered Mental Health Nurses and support workers; the second of two sets of two ISU dedicated OOs. The areas addressed within each of the groups concerned why staff wanted to work in the ISU, as well as how they would measure its potential success, and the necessary skills competencies and training they thought were required to prepare them to work in the area.FindingsOverall, the participants expressed an interest or enthusiasm for their work having actively chosen to work in the ISU. There was a strong sense of a wish for the unit to succeed; in fact, success was a motivating drive for all. Both OOs and MHW emphasised the importance of teamworking, autonomy and freedom as well as information sharing. Analysis also revealed many areas of practice that were challenging. The findings are optimistic for the development of such special units as evaluated here. The drivers for different professions along with their measures of success in the field are discussed in detail. The relationship, expectations, hopes and needs of both MHW and prison officers working in a multidisciplinary unit provide useful information to support both policy and practice in the field. The authors make recommendations around training regimes and how they can effectively coordinate the different symbiotic professional roles. The ISU is a new initiative in offender management within prisons and is reviewed as a model of mental health practice in prison settings.Practical implicationsThe value in recruiting to the ISU dedicated OOs, with committed interests in mental health. A continued emphasis on the ongoing development of team working, focussing on issues of risk, trust and treatment. The development (by nurses) of a formal/mandatory period of training for new OO’s prior to taking up a role on the ISU. For mental health nurses to embrace team leadership/educator roles in the areas of mental health awareness, team building and conflict resolution. To capture and formulate and develop the specific range of mental health interventions offered within the ISU.Originality/valueThe presented research explores and evaluates the introduction of a new mental health wing (ISU) for 11 patients in a Northern UK prison. It does this through the consideration of group discussions with both MHW and OOs on this wing. This work is part of a larger study.

Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry: An exploratory, qualitative interview study with mental health care staff

IntroductionPatients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. MethodsStudy staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement. ResultsMost participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate. ConclusionsDespite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the “gap” between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.

Development of a model for shared care between general practice and mental healthcare: a protocol for a co-production study

IntroductionMental health illness represents one of the greatest health burdens in the world. It is well documented that treatment of these illnesses could be optimised through strengthened collaboration between general...

Improving assessments and follow-up for pediatric emergency department mental health visits

Background: Over the past decade, the number of children presenting to emergency departments (ED) with mental health (MH) concerns has increased substantially. EDs struggle to respond to this increase with approaches that comprehensively address patient needs. The lack of standardized processes to perform risk stratification, assess severity, and ensure access to follow-up care pose barriers to the provision of safe MH care. Our team addressed this gap by introducing an evidence-based care bundle to Alberta’s two pediatric EDs. This report presents the quality improvement (QI) approach used to ensure fidelity of implementation at one of the EDs. This initiative was funded by Alberta Innovates (Partnership for Research and Innovation in the Health System; PRIHS).&#x0D; Methods: We used the Model for Improvement to test and implement each bundle element: suicide risk screening (Ask Suicide-Screening Questions [ASQ]) at ED triage; a tool (HEADS-ED) to streamline and standardize MH assessments by ED-based MH nurse); and an urgent, single-session ‘Choice Appointment’ with a MH professional within 96 hours of the ED visit for patients lacking access to appropriate and timely MH follow-up care. The two ED-based bundle elements did not require additional resources or funding and are expected to reduce length of stay. The follow-up clinic option for ED patients without resources is intended to prevent crisis escalation and match patients with supports. Each new practice was introduced sequentially over a 2-week period. For each practice, we identified 1 to 2 improvement aims, developed key driver diagrams, and selected primary outcomes and measures. Each practice was implemented using Plan-Do-Study-Act (PDSA) cycles with initial tests of change starting small and becoming larger as learning accrued from previous cycles. Our QI team included families with lived experience, patient care and unit managers, nurse educators, frontline healthcare providers, content experts, and clinical leaders who supported staff and led change management strategies. A nurse was hired as a QI lead to support execution of PDSA cycles. We developed a sustainability plan which included embedding education regarding new practices in new healthcare staff orientation, having a measurement strategy to ensure that improvement was maintained, and planning for transition of responsibility for these processes to operational and medical leadership. &#x0D; Evaluation Methods: Primary aims included: 80% of targeted patients would receive the ASQ and HEADS-ED and 100% of children eligible for an Urgent, single-session ‘Choice Appointments’ would be offered it within 96 hours. We used clinical data from the electronic health record (Epic/Connect Care) as well as patient experience data collected via parent/caregiver surveys to determine if the aims for each practice were achieved. We included balancing measures to test whether changes in care in one part of the system introduced unintended consequences in other parts. We evaluated results for the primary aims using run charts to rapidly detect change according to established rules for detecting special cause. We discussed the results from each PDSA cycle in the context of existing healthcare resources to support implementation of each element of the bundle.&#x0D; Results: Tests of change to introduce suicide risk screening began February 1st, 2021. Performance was measured in weekly intervals. The median initial use of ASQ by triage nurses was with 77% of MH patients (686/901 patients), and over time, improved to 93% (319/350 patients), with special cause (shift) in noted September 2021. Tests of change to introduce the HEADS-ED tool began February 16th, 2021. Initial use of the HEADS-ED by MH nurses was 81% (440/555) and improved to 87% (201/227) with special cause (shift) noted August 2021. Urgent, single-session ‘Choice Appointments’ were offered to all patients who did not have timely and access to urgent follow-up with an existing mental healthcare provider with 89.1% having an appointment booked within 96 hours of the ED visit (139/156).&#x0D; Advice and Lessons Learned: Three plans were viewed as crucial to the success of this initiative: 1) a robust strategy to develop proposed changes based on best evidence combined with patient and staff engagement; 2) a comprehensive QI strategy to test, measure, and implement changes; and 3) regular communication and collaboration among ED staff, mental healthcare staff, patients/families, and hospital leadership. There were also lessons learned regarding what could have further enhanced project success: 1) enhanced communication strategies using multiple methods to ensure that project communications reached all stakeholders, including those not regularly present in the ED; 2) hiring the QI lead earlier to begin change management prior to bundle implementation; and 3) outlining a transition plan for clinical data management and bundle monitoring earlier to ease the QI transition to clinical leadership.

Psychological Factors Associated With Sexual Dysfunction in Men on Methadone Maintenance Treatment

Background: Psychological problems are common among drug users. However, a few studies have investigated the role of psychological factors, including depression, anxiety, and childhood trauma, on sexual dysfunction in MMT patients. Objectives: This study aimed to determine the prevalence of sexual dysfunction and the role of psychological factors, including anxiety, depression, and childhood trauma, on the sexual function of patients on MMT. Patients and Methods: In this cross-sectional study, 100 MMT patients were selected by convenience sampling among patients referring to Baharan Psychiatric Hospital, Zahedan, Iran. All participants completed self-report questionnaires, including the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Childhood Trauma Questionnaire (CTQ), and International Index of Erectile Function (IIEF-15). Statistical analysis was done with Pearson correlation coefficients, and stepwise linear regression models determined the predictors of sexual function. Results: Seventeen percent of participants reported various degrees of sexual dysfunction. Child sexual abuse and depression were significant predictors of sexual dysfunction. The regression analysis showed that 12% of the variance of sexual dysfunction (R2 = 0.12; F = 6.61; P &lt; 0.002) was predicted by an experience of childhood sexual abuse and depression. Conclusions: People on MMT suffer from psychological problems as the risk factors for sexual dysfunction. Thus, mental health care staff should consider psychological factors to prevent and treat sexual dysfunction.