Psychiatric Staff Research Articles

Effects of dialectical behavior therapy skills training on outcomes for mental health staff in a child and adolescent residential setting.

Training in Dialectical Behavior Therapy (DBT) skills coaching is desirable for staff in psychiatric settings, due to the efficacy of DBT in treating difficult patient populations. In such settings, training resources are typically limited, and staff turnover is high, necessitating brief training. This study evaluated the effects of a brief training in DBT skills coaching for nursing staff working in a child and adolescent psychiatric residential program. Nursing staff (n = 22) completed assessments of DBT skill knowledge, burnout, and stigma towards patients with borderline personality disorder (BPD) before and after a six-week DBT skills coaching training. Repeated measure ANOVAs were conducted to examine changes on all measures from pre- to post- treatment and hierarchical linear regressions to examine relationships between pre- training DBT knowledge, burnout, and BPD stigma and these same measures post-training. The brief DBT skill coaching training significantly increased DBT knowledge (p = .007) and decreased staff personal (p = .02) and work (p = .03) burnout and stigma towards BPD patients (p = .02). Burnout indices and BPD stigma were highly correlated at both time points (p < .001); however, while pre-training BPD stigma significantly predicted post-training client burnout (p = .04), pre-training burnout did not predict post-training BPD stigma. These findings suggest that brief training of psychiatric nursing staff in DBT skills and coaching techniques can result in significant benefits, including reduced staff burnout and stigma toward patients with BPD-related problems, and that reducing BPD stigma may particularly promote lower burnout.

Psychiatrists' Attitudes Toward Non-Pharmacologic Factors Within the Context of Antidepressant Pharmacotherapy.

Recent meta-analyses of antidepressant clinical trials have suggested that up to 82% of response can be attributed to non-medication-related factors. The present study examines psychiatrists' attitudes regarding non-pharmacologic factors within the context of antidepressant pharmacotherapy. A web-based, 20-question cross-sectional survey was distributed to 101 staff psychiatrists and 48 post-graduate trainees in psychiatry at an academic hospital in Boston, MA. Demographics, practice characteristics, beliefs about non-pharmacologic factors affecting prescribing practices, perceived response and remission rates, and opinions about the need for further investigations in the psychopharmacology process were assessed. Overall completion rate was 53%. The final sample included 79 responses. The medians for clinician-perceived response rates (54%) and remission rates (33%) were in agreement with published rates. The reported median of the what portion of clinical outcomes is believed to be due to placebo effects (26%) was numerically lower than suggested by literature. The contribution of the active ingredients of medications was perceived to be significantly higher than the contribution of patient characteristics and clinician characteristics. A longer time since graduation from medical school was significantly associated with higher belief in the effect of the active ingredients of antidepressant medications and with less perceived importance of placebo effects. These findings suggest a discrepancy between empirical evidence and psychiatrists' beliefs on the impact of placebo effects on clinical outcomes. Educating antidepressant prescribers about the evidence based on psychosocial mediators of placebo effects' contribution to outcome may represent a promising strategy for improving clinical outcomes.

Recommendations for mental health professionals in the NICU.

This article describes recommended activities of social workers, psychologists and psychiatric staff within the neonatal intensive care unit (NICU). NICU mental health professionals (NMHPs) should interact with all NICU parents in providing emotional support, screening, education, psychotherapy and teleservices for families. NMHPs should also offer educational and emotional support for the NICU health-care staff. NMHPs should function at all levels of layered care delivered to NICU parents. Methods of screening for emotional distress are described, as well as evidence for the benefits of peer-to-peer support and psychotherapy delivered in the NICU. In the ideal NICU, care for the emotional and educational needs of NICU parents are outcomes equal in importance to the health and development of their babies. Whenever possible, NMHPs should be involved with parents from the antepartum period through after discharge.

What Health and Aged Care Culture Change Models Mean for Residents and Their Families: A Systematic Review.

A range of commercialized programs are increasingly being adopted which involve broad culture change within care organizations to implement person-centered care. These claim a range of benefits for clients; however, the published evidence for client and family outcomes from culture change is inconclusive and the evidence for these specific models is difficult to identify. The purpose of this review was to identify and evaluate the peer-reviewed evidence regarding consumer outcomes for these subscription-based models. The review followed the Joanna Briggs Institute procedure. The review considered peer-reviewed literature that reported on studies conducted with health and aged care services, their staff, and consumers, addressed subscription-based person-centered culture change models, and were published in English up to and including 2015. The review identified 19 articles of sufficient quality that reported evidence relating to consumer outcomes and experience. Resident outcomes and family and resident satisfaction and experiences were mixed. Findings suggest potential benefits for some outcomes, particularly related to quality of life and psychiatric symptoms, staff engagement, and functional ability. Although residents and families identified some improvements in residents' lives, both also identified problematic aspects of the change related to staff adjustment and staff time. Outcomes for these models are at best comparable with traditional care with limited suggestions that they result in poorer outcomes and sufficient potential for benefits to warrant further investigation. Although these models may have the potential to benefit residents, the implementation of person-centered principles may affect the outcomes.

Job Satisfaction Among Swedish Mental Health Nursing Staff: A Cross-Sectional Survey

ABSTRACTThere is limited amount of empirical studies concerning job satisfaction in inpatient psychiatric care. However, job satisfaction has several implications on public administration and management. The objective of this study is to identify factors having positive impact on job satisfaction among Swedish psychiatric nursing staff in an inpatient psychiatric clinic. The cross-sectional study is based on Herzberg’s motivation-hygiene theory. The survey was distributed among nursing staff at a psychiatric university hospital clinic in Western Sweden. Overall, job satisfaction was rated relatively high, and salary was rated the lowest of all factors investigated. Unlike the premises in Herzberg’s theory, salary showed a positive correlation with job satisfaction and not only in preventing dissatisfaction. Hospital managers must be attentive to salary levels and staff turnover. Psychiatric nursing personnel in Sweden lack competitive salaries, and hospital administrators should encourage nursing staff to improve relationships between staff and managers and establish good relationships among colleagues.

Post-Traumatic Stress, Trauma-Informed Care, and Compassion Fatigue in Psychiatric Hospital Staff: A Correlational Study

Assault of staff in psychiatric hospitals is a frequent occurrence, and studies indicate that hospital staff are at risk of developing post-traumatic stress disorder (PTSD). We performed a correlational study with a convenience sample of 172 staff in a psychiatric hospital and compared the rate of traumatic events (TEs), resilience, confidence, and compassion fatigue to PTSD symptoms (PTSS). Regression analyses identified two variables that were unique predictors of PTSS: (1) trauma-informed care (TIC) meeting attendance and (2) burnout symptoms. Severe TEs, age, and compassion satisfaction also contributed to the model. Attention to these factors may help reduce PTSS in psychiatric staff.

Implementing digital interventions in psychiatric outpatient units: a qualitative analysis of staff attitudes

Background Up to one-third of patients in psychiatry use alcohol or drugs at a level that is problematic. A national survey of outpatient psychiatric clinic directors and staff in Sweden was carried out on guidelines and practices regarding screening, brief intervention and referral to treatment (SBIRT) for their patients, showing that national recommendations to offer SBIRT for problematic substance use (PSU) are not systematically followed[1]. The objective of this research is to investigate whether implementation of digital interventions for PSU in psychiatry could be a way of increasing treatment access for patients and supporting staff in offering treatment.

Exploration of the Effectiveness and Acceptability of a Professional Mindfulness Retreat for Psychiatrists

Mindfulness has a growing evidence base demonstrating its efficacy for mental health patients; however, less is known about its usefulness for psychiatric staff. This study aimed to evaluate the effectiveness of a newly developed mindfulness retreat designed for psychiatrists. Twenty-two consultant psychiatrists, two middle grade doctors and two trainees attended a mindfulness retreat designed by a consultant psychiatrist with long-term experience in mindfulness meditation, in collaboration with a Zen Master. The retreat lasted 2 days, was part silent and involved a range of mindfulness exercises, including meditation and mindful walking. Teaching was provided around establishing one’s own regular practice, as well as how to teach patients to do the same. Questionnaires were distributed to participants before the retreat, immediately after and at 1-week follow-up to evaluate the retreat efficacy. Results illustrated that the retreat significantly increased perceived mindfulness and therapeutic alliance and significantly reduced burnout. This was further supported by a thematic analysis of retreat feedback which identified themes of individual development and retreat experience. The mindfulness retreat appeared to be an effective and acceptable intervention for psychiatrists. Further large-scale evaluation is required.

Well-Being and Safety Among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity.

Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual's stress reactivity. At a large public psychiatric hospital, an online survey was completed by 323 clinical care staff, of whom 69.5% had experienced physical assault in the previous 12months. Staff well-being (depression, anger, and physical health) and staff safety concerns were adversely affected by conflicts with other staff members and by individual reactivity to social conflict and to assault. To improve staff well-being, in addition to safety protocols, interventions should target staff relationships, personal health maintenance practices, and individual coping skills for dealing with adverse workplace experiences.

How do Psychiatric Staffs Approach Religiosity/Spirituality in Clinical Practice? Differing Perceptions among Psychiatric Staff Members and Clinical Chaplains

The present study examined the perception of contemporary German psychiatric staff (i.e., psychiatrists, psychotherapists and nurses) regarding their approach towards religious/spiritual issues in their clinical practice, and how clinical chaplains perceive attitudes and behaviors towards religiosity/spirituality of other psychiatric staff members. To answer these questions, two separate studies were conducted to include psychiatric staff and clinical chaplains. Curlin et al.’s questionnaire on Religion and Spirituality in Medicine: Physicians’ Perspectives was the main instrument used for both studies. According to the self-assessment of psychiatric staff members, most contemporary German psychiatric staff members are prepared and open to dealing with religiosity/spirituality in therapeutic settings. To some extent, clinical chaplains agreed with this finding, but their overall perception significantly differs from the staff’s own self-rating. Our results suggest that it may be helpful for psychiatric staff members and clinical chaplains to exchange their views on patients regarding religious/spiritual issues in therapeutic settings, and to reflect on how to apply such findings to clinical practice.

Finding a voice – the feasibility and impact of setting up a community choir in a forensic secure setting

This study reports on the feasibility and impact of running a choir for forensic psychiatric inpatients, staff and members of the local community, within the confines of a medium secure psychiatric unit. The choir ran between October and December 2013. Eight weekly workshops and a final concert performance were evaluated through participant observation and focus groups held with the participants. Between 12 and 16 male and female patients attended each workshop and the final concert. All participating patients had received a diagnosis of schizophrenia, schizo-affective disorder or personality disorder, all had committed serious violent or sexual offences and all were legally detained and receiving treatment in a forensic medium or low secure ward, under the Mental Health Act (England and Wales). Considerable benefits were reported by patients, as well as by the participating community choir members and staff. Primary benefits reported by patients included the following: improved happiness and well-being; increased confidence and self-esteem; greater emotional connectedness and reduced sense of stigma. Participating staff also reported increased feelings of well-being and happiness, greater tolerance and more positive perceptions of the functioning and capabilities of forensic psychiatric patients. The longer term benefits of music participation on the mental health and social functioning of forensic psychiatric patients require further investigation.

Reducing or Increasing Violence in Forensic Care: A Qualitative Study of Inpatient Experiences

Semi-structured interviews with 13 forensic psychiatric inpatients that had decreased their assessed risk of violence were analyzed using interpretive description. The main contribution from this study is a detailed description of patients' own strategies to avoid violence. Participants described having an ongoing inner dialog in which they encouraged themselves, thereby increasing their self-esteem and trying to accept their current situation. An unsafe and overcrowded ward with uninterested and nonchalant staff increased the risk of aggressive behavior. In the process of decreasing violence, the patients and the forensic psychiatric nursing staff interacted to create and maintain a safe environment.

Incidence and risk factors of workplace violence on psychiatric staff.

A study by Hesketh et al. found that 20% of psychiatric nurses were physically assaulted, 43% were threatened with physical assault, and 55% were verbally assaulted at least once during the equivalent of a single work week. From 2005 through 2009, the U.S. Department of Justice reported that mental health occupations had the second highest average annual rate of workplace violence, 21 violent crimes per 1,000 employed persons aged 16 or older. An evaluation of risk factors associated with patient aggression towards nursing staff at eight locked psychiatric units. Two-hundred eighty-four nurses in eight acute locked psychiatric units of the Veterans Health Administration throughout the United States between September 2007 and September 2010. Rates were calculated by dividing the number of incidents by the total number of hours worked by all nurses, then multiplying by 40 (units of incidents per nurse per 40-hour work week). Risk factors associated with these rates were analyzed using generalized estimating equations with a Poisson model. Combining the data across all hospitals and weeks, the overall rate was 0.60 for verbal aggression incidents and 0.19 for physical aggression, per nurse per week. For physical incidents, the evening shift (3 pm - 11 pm) demonstrated a significantly higher rate of aggression than the day shift (7 am - 3 pm). Weeks that had a case-mix with a higher percentage of patients with personality disorders were significantly associated with a higher risk of verbal and physical aggression. Healthcare workers in psychiatric settings are at high risk for aggression from patients.

Resource use and financing of guideline-adherent psychotherapeutic inpatient care

The financing of psychiatric psychotherapeutic care in Germany is determined by the German psychiatric staffing regulations which are unchanged since 1991. Psychotherapy was established after 1991 as an effective and indispensable treatment of mental and behavioral disorders. The aim of this study was to empirically investigate the use of psychiatrists' and psychologists' working time for psychotherapy in guideline-adherent hospital care. A further aim was to compare these results to the resources defined by the German psychiatric staffing regulations and in the new prospective payment system for psychiatry and psychosomatics in Germany. University hospitals for psychiatry and psychotherapy were asked to retrospectively provide data of patients for which guideline-adherent care was possible. Participating institutions provided both data describing the staff time utilization of psychotherapeutic services provided by psychiatrists and psychologists and patient classifications according to the German psychiatric staffing regulations and the new prospective payment system for psychiatry and psychosomatics. Resources defined by the German psychiatric staffing regulations covered a mean of only 71 min of psychotherapy per patient and week while the actual mean intensity of psychotherapeutic care provided by the participating hospitals was 194 min per patient and week. The associated use of staff time was 102 min per patient and week. Both figures increased during an inpatient episode. The resources defined by the German psychiatric staffing regulations covered only 70 % of medical and psychological personnel. The current configuration of the new prospective payment system for psychiatry and psychosomatics covered only 59 % of staff time. The results of this study provide another unambiguous recommendation to adjust the out-dated German psychiatric staffing regulations to the current evidence and S3 guidelines for psychiatric psychotherapeutic hospital care. In particular, more resources are required for the provision of psychotherapeutic care.

Guideline-adherent psychiatric-psychotherapeutic hospital care: Normative definition of staff required using the example of depression

Unipolar depression is of high relevance in German inpatient treatment. An effective psychiatric psychotherapeutic hospital treatment also requires sufficient staff for carrying out psychotherapeutic treatment. The aim of this study was to define the staff requirements for guideline-adherent psychiatric-psychotherapeutic inpatient treatment of depression on the basis of a weekly treatment schedule for a 5-week admission period. A further aim was to compare the staff required with the resources defined by the German psychiatric staffing regulations (Psych-PV). The weekly schedule was normatively defined on the basis of the current evidence for treatment efficacy and effectiveness. The staff required was calculated on the basis of the weekly schedule. The time for psychotherapy defined by the Psych-PV was calculated using the treatment classification provided by a large nationwide database. Regarding psychotherapy, 280 min per week is regarded as necessary and usually sufficient according to the current evidence. The results showed clearly higher requirements of working time of psychiatrists and psychologists than those defined by the Psych-PV. In particular, the Psych-PV allows only 72 min for psychotherapy per patient and week and only a limited amount of direct patient contact with psychiatrists. The figures provided impressively show that the Psych-PV does not allow effective guideline-adherent hospital treatment within a reasonable length of hospital stay. Despite its evidential effectiveness, psychotherapeutic treatment cannot be sufficiently provided under the current financing circumstances.

A Primer for Working in Campus Mental Health: A System of Care.

This article provides a framework for residents and staff psychiatrists new to student mental health, outlining the issues particular to practicing on a college campus. Treating students on campus often entails more case management than standard community treatment, and it demands that the psychiatrist think beyond the individual patient and diagnosis to understand the context in which patients are living and studying. While some students are adequately treated with psychotherapy and medication, many have issues concerning academic progress, interpersonal relationships, housing, and finances that require institution-specific knowledge and active guidance. To know your patient is to understand the student experience and therefore, the best way to know your patient is to understand your institution. The Substance Abuse and Mental Health Services Administration defines system of care as “a spectrum of effective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life” [1]. First described in 1986 as a way to better meet the needs of children with mental health challenges [2], the widely accepted system of care approach is team-oriented and based on principles of shared ownership, with all players working together in the best interest of the patient. The system of care approach has been useful in ensuring that primary and secondary school students’ needs are adequately met to allow successful school completion [3, 4]. The same approach can also help students in higher education. A campus setting naturally exemplifies a system of care by offering a wide array of services of individualized care, with stakeholders including “policy makers, service providers, agency administrators, technical assistance providers, family members, advocates, leaders in cultural competence, researchers, and others” [1]. While team-based collaboration can be challenging in large institutional settings (such as colleges and universities) containing multiple autonomous divisions with competing interests, this approach provides an effective framework in which to manage the complex mental health of our students. Using the system of care framework, we describe components of post-secondary education along the traditional eight overlapping dimensions: education services, health services, mental health services, substance abuse services, social services, vocational services, recreational services, and conduct and justice services (Fig. 1). This framework provides a way of conceptualizing a student’s education, breaking it down into component parts. We begin each section with a brief psychiatric referral scenario, illustrating why that particular dimension may be important, in addition to psychiatric services.

If You Label Me, Go with Your Therapy Somewhere! Borderline Personality Disorder and Stigma

Introduction Borderline personality disorder is associated with numerous symptoms that interfere with interpersonal relationships. Both mental health professionals and the general population often think negatively about patients suffering from this disorder, which may worsen the creation and maintenance of the supporting therapeutic relationship. Method Research and review articles were identified using the Web of Science, Medline and Scopus. Keywords were represented byterms 'borderline”, 'stigma”, 'internalized stigma”, 'therapy”, 'treatment”, 'psychotherapy” and 'psychosocial treatment”. Results Psychiatric staff´s opinions on the patients with personality disorders are strongly judgemental and stereotypic. Mental healthprofessionals stigmatize the patients with borderline personality disorder even more frequently than the general population does. The rule is that there is a conviction about incurability of the disorder, manipulative nature of self-mutilation or other symptoms, and thestrong traits of the patient are overlooked. The considerable percentage of medics tries to avoid the contact with these patients. Thesereactions partly arise from the patient’s real maladaptive behaviour; however they are partly the result of prejudice, negative stereotypes and unprocessed countertransference. Negative attitudes of medics lead to the marginalization of patients with borderline personality disorder within the health care system. Conclusion The health professionals often negatively and stereotypically evaluate the patients with borderline personality disorder, which can lead to an increase of maladaptive symptoms and worsening of treatment effectiveness in these patients.

Burnout in early course psychosis caregivers: the role of illness beliefs and coping styles.

In occupational settings, burnout is a common response to chronic exposure stressors and has been frequently documented in formal caregivers (i.e. paid psychiatric staff). However, the literature is limited on reports of burnout among informal caregivers and particularly within early psychosis groups. The current study sought to investigate reports of burnout in carers of young adults treated within a specialist early psychosis service and links with key appraisals reported about the illness and coping. Seventy-two carers completed the Maslach Burnout Inventory along with self-report measures of coping styles and illness beliefs. Seventy-eight per cent of carers reported high burnout in at least one of the three key burnout markers (i.e. emotional exhaustion, depersonalization or low personal accomplishment). Seven per cent of carers met full criteria for high burnout across all the three domains. A carer's belief about the negative consequences of the illness for themselves was a significant predictor of emotional exhaustion and depersonalization. Low personal accomplishment was linked to a carer's less optimistic beliefs about the illness timeline and fewer reports of adaptive coping. The results provide preliminary support for the importance of asking carers in the early illness phase about their experiences of caregiving. Targeted assessment may serve as a helpful tool to identify and intervene with carers in need of additional support with stress management, use of adaptive coping strategies, and balanced recovery focused information about psychosis.

‘Simulation-based learning in psychiatry for undergraduates at the University of Zimbabwe medical school’

BackgroundThe use of simulated patients to teach in psychiatry has not been reported from low-income countries. This is the first study using simulation teaching in psychiatry in Africa. The aim of this study was to introduce a novel method of psychiatric teaching to medical students at the University of Zimbabwe and assess its feasibility and preliminary effectiveness. We selected depression to simulate because students in Zimbabwe are most likely to see cases of psychoses during their ward-based clinical exposure.MethodsZimbabwean psychiatrists adapted scenarios on depression and suicide based on ones used in London. Zimbabwean post-graduate trainee psychiatrists were invited to carry out the teaching and psychiatric nursing staff were recruited and trained in one hour to play the simulated patients (SPs). All students undertaking their psychiatry placement (n = 30) were allocated into groups for a short didactic lecture on assessing for clinical depression and then rotated around 3 scenarios in groups of 4–5 and asked to interview a simulated patient with signs of depression. Students received feedback from peers, SPs and facilitators. Students completed the Confidence in Assessing and Managing Depression (CAM-D) questionnaire before and after the simulation session and provided written free-text feedback.ResultsPost-graduate trainers, together with one consultant, facilitated the simulated teaching after three hours training. Student confidence scores increased from mean 15.90 to 20.05 (95% CI = 2.58- 5.71) t (20) = 5.52, (p > 0.0001) following the simulation teaching session. Free-text feedback was positive overall with students commenting that it was “helpful”, “enjoyable” and “boosted confidence”.ConclusionsIn Zimbabwe, simulation teaching was acceptable and could be adapted with minimal effort by local psychiatrists and implemented by post-graduate trainees and one consultant, Students found it helpful and enjoyable and their confidence increased after the teaching. It offers students a broader exposure to psychiatric conditions than they receive during clinical attachment to the inpatient wards. Involving psychiatry trainees and nursing staff may be a sustainable approach in a setting with small number of consultants and limited funds to pay for professional actors.

Association between stigmatisation and experiences of evidence-based practice by psychiatric rehabilitation staff in Japan: a cross-sectional survey

Background: Mental health professionals are one of the groups holding harmful stigmatisation towards people with mental illness.Aims: To investigate the association between the performance of evidence-based practice (EBP) and the staff’s level of stigmatisation in Japan.Methods: The study enrolled 179 staff members in psychiatric day-care, psychiatric community outreach teams, and psychiatric rehabilitation teams at 14 psychiatric hospitals. The Positive Attitudes Scale (PAS), the Japanese-language version of the Social Distance Scale (SDSJ) and the Recovery Attitude Questionnaire (RAQ) were employed as outcome measures. Scores on each scale were compared between participants who performed EBPs and those who had never performed EBPs.Results: Approximately 40% of the staff engaged in at least assertive community treatment, supported employment or family psychoeducation. The staff who performed EBPs had significantly higher scores on PAS (MD, 7.09; 95% CIs, 4.09–10.09) and RAQ (MD, 1.30; 95% CIs, 0.36–2.25) but lower scores on SDSJ (MD, −2.41; 95% CIs, −3.50 to −1.32) than those who never performed EBPs. Multivariate analyses found that EBP experience was associated with a low level of staff stigmatisation after controlling for confounders.Conclusion: The findings suggest that an individual EBP experience is associated with their reduced stigmatisation.