Mental Implications Research Articles

Using Delphi method to address factors contributing to aggressive behaviour in mental health settings.

WHAT IS KNOWN ABOUT THE SUBJECT?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors. Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in-depth reflection in the light of the contribution of others. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nursing curricula should focus on nurses' communication skills and emotion regulation training. An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints. Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols ABSTRACT: Introduction Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut-off rate below 69.7% were included in the next round. Results Twenty-one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff-patient ratio in psychiatric wards. Discussion The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills.

When the wounds heal but the soul bleeds-A lived experience narrative.

WHAT IS KNOWN ON THE SUBJECT?: This paper acknowledges the profound and lasting impact of childhood abuse on substance use and homelessness. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: It underscores the inherent value and humanity of every individual, regardless of their struggles. That a comprehensive approach to mental health care, encompassing medication, therapy and a secure environment, is imperative. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Early intervention and recognising individuals who suffer in silence are paramount. Mental health nurses must have the courage to ask uncomfortable questions and truly hear the unspoken words. Mental health nurses should never underestimate the power of simply being present with someone during their darkest moments. This simple act can wield significant influence.

Escaping iatrogenic harm: A journey into mental health service avoidance.

WHAT IS KNOWN ON THE SUBJECT?: Little is known about how mental health services can cause harm in ways other than medication, talking therapies, diagnosis and detention under the Mental Health Act. The outcomes of people who avoid seeking help from mental health services due to previous experiences of harm are not well known. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: I provide a first-person perspective of experiences of harm within mental health services, how this impacted my care, the long-term effects of the harm on my well-being and my ongoing experiences of avoiding mental health services. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Healthcare professionals should be aware of the multitude of ways service provision can harm patients, and how, unknown to professionals, patients may create an internal understanding of how to best navigate harmful service environments. Healthcare professionals should have a deeper understanding of the reasons why people may choose not to engage with mental health services, and what impact this may have on them. ABSTRACT: The recent announcement of the first ever statutory public inquiry into a UK mental health service indicates a growing recognition of iatrogenic harm in mental healthcare. Despite the potential for harm across all services and practices, restrictive practices, psychotherapy, diagnosis and psychiatric medications are often the only areas of mental healthcare given significant attention. While the topic is widely discussed in survivor communities, accounts of harm caused by the everyday workings of services, including team cultures, administrative processes and staff-patient interactions, are missing from academic literature. In this article, I describe my 10-year journey through mental health services, and how everyday practices, cultures and staff behaviour deeply impacted my ability to receive appropriate care, replicated previously traumatic environments, and damaged my mental health. Taking steps to protect myself from further harm, I self-discharged and am currently living as a 'service-avoider'. The ongoing implications of this decision and the long-term impacts of harm are discussed.

Exploring individuals' experiences of hope in mental health recovery: Having a sense of possibility.

WHAT IS KNOWN ON THE SUBJECT?: Mental health recovery is acknowledged as a process of transformation and a way of living a meaningful life despite the presence of mental ill-health. Experiencing hope has been articulated as intrinsic to service users experience of a meaningful life. The social construction of mental illness and stigma are recognised as barriers to experiencing hope. Mental health professionals have responsibility to positively influence the experience of hope. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: Individuals in mental health recovery experience hope as the embodiment of having a sense of possibility in life. Individuals' sense of possibility in life is underpinned by a belief and confidence that they will be ok. This belief is informed by 'feeling safe' and 'feeling connected'. This article generates an increased understanding of the dynamic relational processes that unpin hope generation. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health stakeholders need to be more explicit in exploring 'hope' and uncovering its therapeutic potential. Mental health practitioners need skill in enabling individuals to feel safe and connected while understanding its role in cultivating hope. ABSTRACT: Introduction The experience of hope is widely acknowledged and empirically supported as a key catalyst of mental health recovery. Lived experience accounts of hope are critical in accessing data on what has been termed a nebulous concept. This article is the second presentation of data from this study and provides further context to improve understanding of hope and optimise its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative Interpretative Phenomenological Analysis (IPA) approach was used. Results This article explores the second of three experiential group themes: Hope as Having a sense of possibility 'I will be ok' which is informed by feeling safe and feeling connected. Discussion Having a sense of possibility is easier when basic needs are met and people feel connected to self, others and the universe. The use of creativity as a pathway to the imagination is positively experienced. The role of family, friends and healthcare professionals as hope reservoirs is critical. Finally, the framing of medication use emerged as significant. Implications for Practice It is important that all stakeholders appreciate the interpretation of hope and use the understanding and skill in harnessing its therapeutic potential.

Perceived implications of COVID-19 on physical, mental and social aspects of resident doctors in a tertiary care hospital.

The COVID-19 pandemic has put health care systems of many countries under major stress. Due to its high transmission capacity, it has spread across the globe at a rampant pace. India is one of the countries which has been severely affected by COVID-19. It has posed onerous tasks in front of doctors. Along with it, it has left physical, social and mental implications on well-being of doctors. The purpose of this study is to get an in-depth understanding about the implications of COVID-19 on physical, social and mental aspects of resident doctors in tertiary care hospital. We performed a qualitative study which involved in-depth interviews of resident doctors who have worked during the COVID-19 pandemic from general medicine department of tertiary care hospital. Interviews were then manually transcribed and analyzed. Data analysis by preparing transcript unveiled that doctors were constantly facing burnout and mental distress along with less social support. Our study also found that there was a shortage of resources and demonstrated poor doctor patient ratio which led to a decrease in efficiency of doctors. Our findings are not only confined to doctors facing burden but has also explored sanguine perceptions of resident doctors. While treating COVID-19 patients, resident doctors suffered a great setback. Providing them with mental aid, social support, ample resources and decreasing their work burden is recommended to effectively manage future pandemic.

Are Physical Activity Levels in Childhood Associated with Future Mental Health Outcomes? Longitudinal Analysis Using Millennium Cohort Study Data

The rising prevalence of mental health conditions among children and young adults accelerated by the COVID-19 pandemic emphasises the urgent need to address this issue effectively. A potential avenue for early diagnosis lies in physical activity patterns as individuals with mental health conditions often move less than the general population. This paper utilises Millennium Cohort Study data to investigate the relationship between childhood physical movement patterns, and mental distress and wellbeing outcomes in late adolescence. By controlling for a range of factors of both cohort members and their parents, the study employs well-adjusted logistic and linear regressions to assess the hypothesis. Objective physical movement data is collected with accelerometers, while mental distress is measured using the Kessler K6 scale and mental wellbeing using the Warwick–Edinburgh Mental Wellbeing Scale. The findings of the study suggest no significant association between raw physical movement and mental distress; however, there is suggestive evidence of a weak positive association with mental wellbeing. In addition, the study found that lower exercise levels at age 7 were associated with an increased likelihood of mental distress at age 17, highlighting the potential impact of exercise habits on mental health in adolescence. Overall, these findings suggest that raw physical activity data may be a better predictor of specific mental health outcomes, such as those assessed by the Strengths and Difficulties Questionnaire in similar studies. The paper offers recommendations for future research – such as using self-reported questionnaires to contextualise quantitative physical movement data – and a more comprehensive analysis of the cognitive and mental implications.

Knowledge Sharing: Antecedent and Consequences Literature Review

Knowledge dissemination is a core component of Knowledge Management (KM) that profoundly influences the efficacy of KM initiatives. Numerous scholarly research underscores the pivotal role of KM and its procedures in affording organizations a competitive advantage. External entities such as consumers, vendors, advisors, rivals, or newly-inducted employees' previous employers can be sources of knowledge. With the increasing emphasis on a knowledge-driven economy, disseminating knowledge has emerged as a high-efficiency organizational behaviour. Rapidly transmitting and sharing knowledge, compared to one's competitors, is perceived as a crucial competitive benefit. This article seeks to consolidate prior research insights regarding the influencers and consequences of knowledge dissemination within firms. This review was orchestrated in a tripartite manner: establishing a review methodology, undertaking the review, and elucidating the review findings. Cultivating a culture that values knowledge dissemination is critical to optimized knowledge management. Earlier research has delved into knowledge dissemination through lenses like technological, organizational, and individual behavioral facets. The precursors to knowledge dissemination encompass Technology, Behavioral and Motivational aspects, Incentive Mechanisms, Organizational Configuration, and Corporate Culture. Evidence-based research implies that knowledge dissemination exerts a spectrum of effects across individual, group, and organizational echelons. At the singular level, it influences efficacy, educational acquisition, innovation, and mental implications. In a group context, it affects group efficacy, innovative tendencies, and the overall environment. On an overarching scale, the knowledge exchange among staff members plays a role in determining organizational outcomes.

Untreated Major Depression During Gestation: The Physical and Mental Implications in Women and Their Offspring

While postpartum depression has been extensively studied and is a concern surrounding major depression in women, the effects of major depression during pregnancy alone should also be considered. The purpose of this review article was to explore in longitudinal fashion, from neonate to adulthood, the lasting physical and mental implications that depression during gestation can present in offspring. Consideration of various sources pulled from the OVID Medline database yielded findings consistent with negative associations between gestational depression and offspring outcomes. In mothers, gestational depression presents with physical implications, such as preeclampsia and preterm delivery, leading to low birth weight and neurodevelopmental complications in neonates. As the children grow older, these complexities manifest as socioemotional, behavioral, and linguistic development delays presenting as increased incidence in attention-deficit/hyperactivity disorder diagnoses, parental attachment issues, and lower emotional and verbal IQ. Research regarding adolescents and adults is sparse in comparison with that of earlier stages, but there are studies that examine the developmental outcomes of certain mood disorders, such as generational depression, in the offspring of birthing parents with prenatal depression. This review presents an extended timeline of the effects of gestational major depression in offspring, and it provides suggestions for future research regarding underlying biological explanations and certain risk outcomes.

Non-pharmacological intervention to reduce pain post-appendectomy: A rapid review of randomized controlled trial studies

Background: Appendicitis leads to post-appendectomy pain with significant physical and mental implications, necessitating non-pharmacological pain management approaches. Objective: This study aimed to determine which non-pharmacological interventions can effectively reduce postoperative pain following an appendectomy. Design: A rapid review study design was employed. Data Sources: The databases used were EBSCOhost-CINAHL and PubMed. The article search was conducted on March 14, 2022. Review Methods: The identified articles were described using PRISMA guidelines and sorted based on inclusion criteria. These criteria included patients with appendicitis aged 18-59 years who underwent appendectomy, non-pharmacological pain management interventions, studies utilizing the Randomized Controlled Trial (RCT) method, full-text articles available, English language, and articles published between 2012-2022. Studies involving pediatric and elderly appendectomy patients, as well as studies with insignificant results, were excluded. Results: Four articles were analyzed, revealing four types of interventions: Foot and Hand Reflexology (Massage), Lavender Aromatherapy and Almond oil (Aromatherapy), Inhalation aromatherapy with sweet-scented geranium essential oil, and Acupressure Le7. These interventions were then classified into two categories: aromatherapy-based interventions and neurostimulation-based interventions. All interventions were found to significantly reduce pain in appendectomy patients. Conclusions: Non-pharmacological therapies, such as lavender and almond oil aromatherapy, sweet-scented geranium aromatherapy, foot and hand reflexology, and Le7 acupressure, have demonstrated positive effects in reducing long-term pain after an appendectomy.

A Practical Green Infrastructure Intervention to Mitigate Air Pollution in a UK School Playground

Air pollution severely compromises children’s health and development, causing physical and mental implications. We have explored the use of site-specific green infrastructure (green barriers) in a school playground in Sheffield, UK, as an air-pollution-mitigation measure to improve children’s environment. The study assessed air quality pre-post intervention and compared it with two control sites. Nitrogen dioxide (NO2) and particulate matter <2.5 µm in size (PM2.5) concentration change was assessed via three methods: (1) continuous monitoring with fixed devices (de-seasonalised); (2) monthly monitoring with diffusion tubes (spatial analysis); (3) intermittent monitoring with a mobile device at children’s height (spatial analysis). De-seasonalised results indicate a reduction of 13% for NO2 and of 2% for PM2.5 in the school playground after two years of plant establishment. Further reductions in NO2 levels (25%) were observed during an exceptionally low mobility period (first COVID-19 lockdown); this is contrary to PM2.5 levels, which increased. Additionally, particles captured by a green barrier plant, Hedera helix ‘Woerner’, were observed and analysed using SEM/EDX techniques. Particle elemental analysis suggested natural and potential anthropogenic origins, potentially signalling vehicle traffic. Overall, green barriers are a valid complementary tool to improve school air quality, with quantifiable and significant air pollution changes even in our space-constrained site.

Is falling in love within the mental health system a problem? How to turn it into a chance for the care relationship.

INTRODUCTION: The care pathway within a mental health service can create situations of strong emotional impact, including physical attraction and falling in love. This may evolve in moments of impasse for the staff and sometimes compromise the success of therapeutic treatment. This article offers some evidence about how intervene in a situation such as a client falling in love with a nurse, avoiding transforming it into a problem. The fear of the nurse, maybe already inclined to blame themselves for what has happened, when he/she asks for supervision, is to feel judged also by the supervisor. This story teaches that to refer to figures from outside the team, as would usually be the case with supervision, may be replaced by enhancing the role composition already available in the residential community as a resource. The story was listened and enhanced thankyou to an exchange between M. and the community manager. From the analysis of the narratives co-produced by M., the former substance user, and the community manager, the elements that made it possible to transform a feeling of falling in love into an interaction of extended trust emerged. The non-judgmental and confidential context, but above all the training in interpersonal exchange, facilitated the client sharing very intimate and private experiences, which are usually hidden or denied. This made it possible to make the community responsible for the individual's experiences and to overcome the role impasse and the related identity dilemma. Neither nurses nor clients should be held accountable or blamed when these episodes occur. The strongest resource is sharing in the group and putting one's own experiences into play. Following the M. story, a targeted confrontation between team members and clients is an accessible and effective resource to respond to situations of strong emotional impact, falling in love being just one example; however, it can be effectively activated only through a collective taking charge of the individual's difficulties has already been implemented.

Holding Hope: Co-producing eating disorders education that integrates the lived experience voice to inform best practice.

WHAT IS KNOWN ON THE SUBJECT?: Eating Disorder (ED) education is predominating taught through a DSM-V diagnostic criteria and clinically focused lens devoid of lived experience expertise. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Current clinically focused ED education may be shaping health professional misunderstandings of EDs, influencing the therapeutic relationships between health professional and consumer which is key to the recovery process. Integrating the lived experience voice through co-produced, humanities-based ED education deepens understandings and honours the complexities of EDs by bringing a much-needed, alternate perspective to health professional learning, practice and research. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Reframing mental health education towards a more strengths-based, trauma-informed and recovery focused lens has the potential to upskill the health workforce in how to hold hope, space and learn to walk the fight with people living and recovering with an ED.

Getting help as a depressed dad: A lived experience narrative of paternal postnatal depression, with considerations for healthcare practice.

WHAT IS KNOWN ABOUT THE SUBJECT?: A significant proportion of fathers report experiencing depression after their baby is born Fathers are not offered regular support for their psychological well-being in the transition to parenthood despite an acknowledged need for such support WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Lived experience provides new insight into how one father experienced postnatal depression, including the role of his partner in help-seeking It explains the delayed presentation in help-seeking as resulting from healthcare practitioner language and attitudes, and gendered expectations around mental health and help-seeking in the context of fatherhood WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Mental health nurses should be aware that postnatal depression can affect fathers as well as mothers, and that it is necessary to support fathers in safe spaces and with appropriate language Planning care for depression in men should consider the recent birth of a child in order to provide effective care Clearer guidance is needed for supporting new fathers with postnatal depression ABSTRACT: Introduction Fathers are not universally supported with their perinatal mental health, but evidence shows that they suffer at a similar level to mothers. Aim This paper examines the journey of one father through his PND experience, his help seeking, and encounters in healthcare, in order to highlight the needs of a depressed father. Method The method is a father's lived experience narrative which has been written alongside a health visitor who highlights the relevance of the condition to healthcare practice. Results & Discussion The needs of fathers are unmet. They require support which considers their gender role expectations. Partners are key to their help seeking. Implications for practice The language and sensitivity used by nurses is key to encouraging fathers to share their depression and reduce stigma around the condition.

Female Reproductive Autonomy in Honduras: An Interdisciplinary Analysis of Associated Factors in the Early 21st Century

The presence of female reproductive autonomy, or the ability for a woman to make a well-informed decision, independently or with limited input from partners, about the number, spacing and timing of her children is a key determinant of female empowerment and independence. Understanding the intensity of a woman's reproductive role, and the entrenched social, physical and mental implications that underlie it, is key to bringing about gender equity. This study utilizes Demographic and Health Surveys (DHS) collected between 2005-2006 and 2011-2012 to draw attention to the factors associated with reproductive autonomy as they relate specifically to women in Honduras. Results from the longitudinal analysis, using logistic regression tests, reveal the predicted association between reproductive resources such as sexual education and contraceptives as well as social autonomy. Ultimately, higher rates of formal education are likely associated with key reproductive autonomy indicators such as desire for last birth, knowledge of the fertility period and independent decision-making around contraceptive use. Sexual health programs can coincide with increasing formal education resources. Implementing such programs in the later years of primary schools can facilitate an increase in sexual autonomy and health knowledge outcomes such as fertility knowledge.

Exploring individuals' experiences of hope in mental health recovery: An interpretative phenomenological analysis.

WHAT IS KNOWN ON THE SUBJECT?: The delivery of mental health recovery orientated acre is a requirement of mental health professionals and an acknowledged desired outcome for individuals presenting with mental health issues. Hope has been recognized as one of 5key processes of mental health recovery, and critically as the key catalyst of recovery. Mental health nurses are required to be competent in cultivating service user hope. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Novel exploration of how people described and made sense of the lived experience of hope in mental health recovery. Participants described hope as intrinsic to life in the context of its ability to cultivate desire and provide energy for life and living. Participants with experience of attempts to end life had a very clear concept of hope as missing at these times. Participants described the concept of hope as present but hidden to explain their survival through tortuous circumstances. The themes generated contribute to a greater understanding of the dynamic role and process of hope in mental health recovery. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Mental health practitioners need to be competent in understanding and cultivating hope as part of a person-centred approach, embedded in a therapeutic relationship. All stakeholders including service users, mental health nurses and educators need a more accessible reified dialogue of "hope" that harnesses its therapeutic potential. ABSTRACT: Introduction Mental health services have embraced the philosophy and practice of recovery. Research has confirmed hope as a micro-process of recovery. The lived experience of hope has received scant attention. This is required to improve understanding and optimize its therapeutic potential. Aim To explore how individuals describe and make sense of their experience of hope in mental health recovery. Method A qualitative interpretative phenomenological analysis (IPA) approach was used. The sample was accessed via email networks. Data were generated through semi-structured interviews and analysed using an IPA framework. Results Three superordinate themes emerged: "Without it we would wither up and die"-Hope as intrinsic to life; "I will be ok"-Having a sense of possibility and "Making it happen"-Moving forward. Individuals referenced hope by its absence when attempts were made to end life, and as present but hidden in tortuous circumstances. Discussion Individuals were more familiar with the concept of hopelessness, had a ready-to-hand vocabulary of "having no hope" and used this by default to inform what hope meant. Implications for Practice It is important that all stakeholders appreciate the context specific interpretation of hope and cultivate dialogue and understanding to harness its therapeutic potential.

Family dynamics in dementia care: A phenomenological exploration of the experiences of family caregivers of relatives with dementia.

WHAT IS KNOWN ON THE SUBJECT?: Several studies explore and describe the role of family dynamics in dementia care. However, few focus specifically on the diversity of family relationships that influence family caregivers' experiences of providing care to a relative with dementia. The role of family caregivers engaging in unpaid care of relatives with dementia is becoming more and more critical as the numbers of people living with dementia increase across the globe. Family caregivers are a diverse group of people as there are different categories of kinship relations and thus cannot be viewed as a single collective. They are linked intricately to their family and social support systems, however, they often experience limited family support, and tensions between family members can be a major source of stress. Hence, health professionals need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is unique in that it focuses on a range of family relationships in which a person with dementia finds themselves. It highlights that this network of complex connections influences the caregiving process. The study demonstrates the important role that siblings can play in sharing the caregiving load. However, this sharing is rarely balanced or fair and there is always someone in the family who carries the heaviest load. Communication between family members is frequently a challenge, with family members experiencing denial or an inability to understand the challenges encountered by the family caregiver. Most studies focus on the relationship between the family caregiver and the relative with dementia alone, rather than the family network of the family caregiver and how it influences the caregiving process. This study is unique as it focuses on family dynamics and the family network, particularly the range of family relationships in which family caregivers and their relative with dementia find themselves. Other studies tend to focus on a specific kinship category and the family network, such as an adult child, caring for their parent, but this study presents a wide variety of kinship categories to demonstrate the diversity of family caregiving contexts. The family caregivers in this study all highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The findings suggest the need for communication (training and therapeutic) interventions between family caregivers and other family members (secondary caregivers). Mental health nurses are often well positioned to offer the family caregiver the option to undertake such an intervention. The findings emphasize the diversity of family caregiving situations and argue that mental health nurses can assess the nature of the care situations and work with families on how best to address the needs of the relative with dementia and the main caregiver. However, tensions frequently exist between family members, some of which existed prior to the relative acquiring dementia and other tensions as a consequence of the relative acquiring dementia. Mental health nurses could assist as a mediator between family members in order to assist families to become more cohesive. ABSTRACT: Introduction This article explores the diverse nature of family caregivers, focusing on the different categories of kinship relations. Family caregivers are linked intricately to their families, but often experience limited family support, causing stress and tension between family members. Aim The article aims to explore the family relationships of family members caring for relatives with dementia in order to provide an insight into the role of such relationships on the caregiver relative with dementia dyad. Method A phenomenological, exploratory-descriptive design was used. Eight participants took part and data were obtained using collages and semi-structured interviews. Results A range of family relationship patterns was highlighted including sibling involvement in the caregiving process; spousal involvement in supporting a caregiver of a parent; and spousal involvement in caring for their spouse. Discussion The family caregivers highlighted the need or desire for effective support from the family network. Challenges of communication between family members and the caregiver were also evident and were framed within the existing family dynamic of each family. Implications for Practice Mental health nurses need to deepen their understanding of family relationships to enable them to provide effective advocacy and clinical support to family caregivers and assist families to become more cohesive.

Redefining help through peer support.

WHAT IS KNOWN ON THE SUBJECT?: Traditional mental health services are not meeting the needs of service users. Peer support is an alternative approach of providing support founded on relationship where there is respect and shared responsibility. Peer support relationships are mutual and reciprocal. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The experience of peer-led care can be transformative. A key aspect is the validation and valuing of lived experience and being seen as a person not as an illness. The nature and quality of relationships is paramount and needs to be based on equity. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Nurses have a key role to advocate and promote peer support services. Relationships need to be based on respect and "being alongside" service users in their recovery journey rather than trying to "fix the problem." ABSTRACT: Introduction Peer-led services provide an approach to support based on mutuality, respect and shared experience. Aim To provide an understanding of my experiences of receiving help from a peer-led service. Method Journaling experiences captured in detail the reality of my experiences at the time and were used to inform this paper. Results The Narrative describes entering a Peer-Led Acute Alternative Service when I was amid a mental health crisis and feeling broken. Here, relationships were based on connecting with others who have experienced similar struggles, being seen as an individual rather than a patient, treated with dignity and respect, being heard, having my feelings acknowledged rather than medicated and feeling understood. This created a shift in me to a place of healing and finding meaning in my experiences of mental distress which led to me training in peer support. Discussion Peer-led services can be a transformative experience which redefines the relationship and shifts the person from being a passive recipient of help to an active participant in their recovery. Choice and increased options for peer services as an integral aspect of services available for individuals on their mental health journey is critical.

Chicken or egg: A dual diagnosis narrative

WHAT IS KNOWN ON THE SUBJECT?: Dual diagnosis is a term used to describe persons who have a co-occurring mental health and substance misuse disorders. It is the cause of significant economic burden to health care, justice and educational systems. It is well reported that to date dual diagnosis is under-diagnosed and poorly treated within the confines of mental health services WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: It demonstrates that the need for service reform where all services are equipped with the necessary tools required to adequately support a person with dual diagnosis. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: The narrative provides a real-life, candid description of how trauma in early childhood can cause significant challenges when one becomes older. The narrative identifies the dangers of not diagnosing a dual diagnosis early, resulting in only treating half the presenting issues. This narrative also offers hope to individuals in current distress, as well as for those supporting such individuals, as it clearly demonstrates that with the right supports and encouragement, recovery is possible. ABSTRACT: Introduction Dual diagnosis describes when a person has two co-occurring disorders. It is often difficult to diagnose and this can lead to prolonged suffering on behalf of the individual. Aim To provide a lived experience narrative of the early recovery journey of a person with a dual diagnosis. Method This aim was achieved through the use of a narrative based methodology. Results The journey of life leading to a dual diagnosis and beyond is described under the following headings: Formative Years, Substance Misuse, When Life gives you Lemons, They Say Nothing lasts Forever, From the Ashes, Early Recovery and Luck or Fate? DISCUSSION: The narrative presented describes a first hand experience of the struggles leading to a dual diagnosis and how receiving the diagnosis has supported the recovery journey of the first author.

Communication and Social Inactivity During COVID-19 Lockdown in Hong Kong: Psychosocial Implications to Individuals With Aphasia, Their Primary Caretakers, and Healthy Adults

Purpose Hong Kong is among the first cities worldwide affected by COVID-19, with the first case confirmed on January 23, 2020, 7 weeks before the World Health Organization declared a pandemic on March 11, 2020. Although it has now been over a year since the onset of outbreak, there are still significant knowledge gaps on the short and long term impacts of COVID-19 on people with aphasia (PWAs) and their primary caretakers. With reference to a reshaped rehabilitation service plan to advocate for people facing disabilities and some pilot findings from an ongoing survey investigation in Hong Kong about PWAs' perspectives on the pandemic, this article aims to highlight the social inactivity and communication challenges posed to PWAs and healthy adults during lockdown. Conclusions The social isolation and mental implications among PWAs in Hong Kong subsequent to their limited opportunities to engage into social activities during the pandemic were evident. At the same time, one should not neglect the emotional and psychosocial impacts on PWAs' caretakers and other healthy adults. We encourage researchers from different parts of the world, especially developing and undeveloped countries, to explore and share current service delivery to PWAs and corresponding strategic plans to enhance clinical practices in this unprecedented difficult time.

Every Intervention Emerges from an Encounter: Translation and Contextualization as Treatments for Recurrent Depression.

WHAT IS KNOWN ON THE SUBJECT?: Psychiatric treatment is commonly seen as not treating the whole person, but as using technical fixes for symptoms. Both in treatment and when reading their medical files, lay people often feel personally disrespected. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We suggest that some practitioners are aware of their patients as humans: They respect the service user's understandings and relationships, including the one between patient and practitioner. Two mechanisms for bonding and building mutual respect (translation and contextualization) are described. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING?: Every intervention emerges from an encounter, and therefore, talk cannot merely be instrumental but must also be an exchange. Translation means that the service user understands the provider, and vice versa. Contextualization means that patients and practitioners interact not only in those roles, but as people with a broader history and network of relationships. Neither technical nor personal understandings are privileged, but used flexibly and as needed.