Role Of Mental Health Services Research Articles

Fertility by Design: Integrating IVF, Biopsychosocial Tenets, and Counseling

Women's health is a vast and complex field, encompassing diverse experiences and challenges throughout the pregnancy lifecycle. Despite advanced medical facilities in the United States, pregnancy-related mortality rates remain higher than in other countries, with alarming disparities affecting minority populations. This article explores the multifaceted landscape of infertility, focusing on women in heterosexual partnerships pursuing in vitro fertilization (IVF). In exploring the biological, psychological, and social dimensions of women's health in the context of IVF, this article employs the biopsychosocial model as a systemic framework to comprehend the comprehensive nature of the IVF process. It delves into the challenges faced by individuals and couples, emphasizing the vital role of mental health services in promoting overall wellbeing.

Children and adolescents as perpetrators of stalking: an overview

PurposeStalking is considered a public health priority with a range of adverse outcomes. This paper aims to explore existing literature on children and adolescents as perpetrators of stalking, with a focus on rates of stalking and victim and perpetrator characteristics associated with stalking.Design/methodology/approachA review of research where stalking was engaged in by those 18 years old and younger was conducted, where 17 manuscripts met criteria for review.FindingsThis review found a prevalence of young people engaging in stalking of between 5.3% and 36%. Considerations including demographics, typologies, prior relationship characteristics, stalking and pursuit tactics, cyberstalking and a brief consideration of the impact are given.Practical implicationsLiterature considering perpetration remains thin, and future research should seek to move towards a widely acceptable definition of stalking, as well as considering effective interventions for early intervention, and to consider the role of mental health services in supporting perpetrators and victims, who may not always be mutually exclusive groups.Originality/valueThis paper extends previous literature reviews; the authors understand this to be original work that contributes to a gap in the literature.

Assessing professionalism in mental health clinicians: development and validation of a situational judgement test.

Situational judgement test (SJT) scores have been observed to predict actual workplace performance. They are commonly used to assess non-academic attributes as part of selection into many healthcare roles. However, no validated SJT yet exists for recruiting into mental health services. To develop and validate an SJT that can evaluate procedural knowledge of professionalism in applicants to clinical roles in mental health services. SJT item content was generated through interviews and focus groups with 56 professionals, patients and carers related to a large National Health Service mental health trust in England. These subject matter experts informed the content of the final items for the SJT. The SJT was completed by 73 registered nurses and 36 allied health professionals (AHPs). The primary outcome measure was supervisor ratings of professionalism and effectiveness on a relative percentile rating scale and was present for 69 of the participating nurses and AHPs. Personality assessment scores were reported as a secondary outcome. SJT scores statistically significantly predicted ratings of professionalism (β = 0.31, P = 0.01) and effectiveness (β = 0.32, P = 0.01). The scores demonstrated statistically significant incremental predictive validity over the personality assessment scores for predicting supervisor ratings of professionalism (β = 0.26, P = 0.03). These findings demonstrate that a carefully designed SJT can validly assess important personal attributes in clinicians working in mental health services. Such assessments are likely to represent evidence based, cost-effective tools that can support values-based recruitment to mental health service roles.

Exploring the role of dietitians in mental health services and the perceived barriers and enablers to service delivery: A cross-sectional study.

Mental health is a rapidly evolving area of practice for dietitians. The role of dietitians in supporting the physical health of consumers experiencing mental illness is becoming more widely recognised given the importance of lifestyle interventions for physical health. The present study aimed to explore the dietitian role in mental health services as well as identify barriers and enablers to service delivery. This was a cross-sectional survey of dietitians currently employed in any capacity in public and private mental health services. An online survey comprised of questions pertaining to four domains, including demographics, role and service provision, experience and supervision, barriers/challenges and drivers/enablers was completed and included closed and open-ended responses. In total, 48 responses were included. The mean ± SD age of respondents was 36.1 ± 10.9 years (range 23-67 years) with the majority working in inpatient settings. The top three tasks respondents reported conducting were individual consultations (n = 47; 98%), group programs (n = 23; 48%) and multidisciplinary team meetings. Barriers included a lack of awareness from others regarding a dietitian's role in mental health, and a lack of specific tools for nutrition screening. More training, resources and increased evidence base to guide practice would enable better service provision. The present study provides insights regarding the possible drivers and barriers to effective service provision for dietitians working in mental health services focusing on the local contexts of respondents. The findings highlight the importance and value of working collaboratively within a multidisciplinary team.

Navigating advanced nurse practitioner roles in UK mental health services: a scoping review

Background: The advanced nurse practitioner (ANP) role is becoming increasingly prominent in the provision of mental health services, both in the UK and globally. Understanding the experiences associated with these roles is crucial for their effective implementation in practice. This article presents a scoping review that systematically searches and synthesises existing literature on the experiences of ANP roles in mental health services in the UK. Methods: A comprehensive search of databases including CINAHL, MEDLINE, Web of Science, PsychNet, and Google Scholar was conducted to identify relevant peer-reviewed publications and grey literature that had been published between 2010 and 2022. The Patterns, Advances, Gaps, Evidence for Practice, Research recommendations (PAGER) framework was employed to analyse the findings and identify key themes. Findings: The review findings reveal important insights into the experiences of ANP roles in mental health services, highlighting the significance of role understanding, opportunities and challenges. Key themes identified include the need for clear governance, role clarity, support from colleagues and managers, professional development opportunities, and the impact of role implementation on the provision of person-centred care and physical healthcare. Conclusion: ANP roles in mental health services offer opportunities to enhance the provision of person-centred care, improve physical healthcare delivery and provide professional development and career pathways for nurses. However, challenges such as role understanding, planning and support need to be addressed to ensure successful implementation. Further research examining patient experiences, measures to support improved planning and role clarity, and the professional development and career pathways of ANPs would contribute to advancing the field and facilitating the effective future implementation of ANP roles in mental health services in the UK and beyond.

Mental Health Service Staff on Sharing Lived Experience in the Workplace

ABSTRACT Over the past three decades, “lived experience” designated roles in mental health services in Australia have increased. However, the lived experience of staff in roles not designated in this way is often hidden or unacknowledged. This qualitative study included 33 participants employed in a range of roles at two Victorian mental health services, including 10 social workers. Interviews explored staff perspectives regarding the sharing of lived experience by staff with colleagues and supervisors. Concept analysis identified conflicting ways of thinking about lived experience, which influenced when and how staff shared and how they responded to sharing by other staff. These findings suggest the need to explicitly address the purpose and value of sharing lived experience in the mental health workplace, to better support staff and service users. Recommendations for social workers and their colleagues, working at all levels of the mental health system, are provided. IMPLICATIONS The perspectives and experiences of mental health service staff suggest room for improvement in the valuing and inclusion of staff with lived experience, which may have benefits for service-user experiences of support. Promoting the value of sharing lived experience to reflective-practice and service reform is consistent with core social work values and, thus, the responsibility of all social workers, supervisors, and educators.

“I Need Help”: A Study of Spiritual Distress Among People Diagnosed With Bipolar Disorder in Malaysia

Introduction: Little is known about spiritual distress in people with bipolar disorder, inclined to maladaptive coping. Given the contextual influence of religion on Malaysians, this study explores the phenomenon of spiritual despair and recovery, as experienced by a group of people with bipolar disorder. Method: A qualitative one-to-one interview was conducted on 25 participants of multi-religious background and diagnosed with bipolar disorder recruited from two psychiatric clinics in Kuala Lumpur, Malaysia. All interviews were audio-taped and transcribed verbatim. The interview data were analysed using a thematic analysis approach. Results: This paper presents the theme of ‘Restoring hope, meaning, and purpose’ with three subthemes; 1) experiencing spiritual despair, 2) engaging in spiritual meaning-making, and 3) orienting the spiritual life. The finding captured the participants’ experience of having despair in God over the ‘fated experience’ (takdir) and they abandoned religious practice during the period. However, participant narratives also indicate the possibility that their spiritual despair can be mitigated, endured, or transformed through the support of family members. The participants also highly recommended that spirituality may be combined with medical interventions, such as medication prescribed by their psychiatrist. Conclusion: This study highlights the importance of supportive families in advancing towards religious-spiritual pathways and the advantages of medical interventions in controlling bipolar symptoms during their spiritual despair. This study favours extending the role of mental health services in providing sessions for the users to voice out their spiritual concerns.

Decentralisation and community stakeholders’ engagement for better mental health services development in the conflict-affected regions of Ukraine

Purpose The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on community stakeholders’ perception of their problems and solutions that communities can create to achieve better mental health coverage. Design/methodology/approach A series of roundtables (RTs) (4 RTs, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities’ representatives/stakeholders from the East of Ukraine (Lugansk region, a government-controlled area) during the year 2021. Participants (health, mental health, social care workers and administration representatives) were provided with the opportunity to discuss mental health services’ development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered for review by participants. Findings Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Awareness-raising interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination and collaboration problems; infrastructure, physical accessibility and financial problems; mental health and primary health-care workforce shortage and lack of competencies; low awareness of mental health and available services and high stigma; war, crises and pandemic-related problems. Communities stakeholders foresaw seven domains of action: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative and health care); mental health advocacy and lobbying led by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing services by combining efforts and budgets of neighbouring communities. Research limitations/implications The study has potential limitations. Participants of the roundtables were mostly appointed by local authorities, so some of them didn`t have a motivation for mental health services development. Service users were involved only from the facilitators` side, not from the side of communities; therefore, it was impossible to include their view of problems and solutions. Obtained data were limited to the opinion of local professionals, administration workers and other local stakeholders. The human rights aspect was not clearly articulated in the tasks of the roundtables. Originality/value To the best of the authors’ knowledge, the paper is original in terms of its topic (connecting decentralisation and local stakeholders’ engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context).

Empowering teachers to screen, guide, and refer schoolchildren with behavioral and mental health problems. A pilot study to promote mental health in Iran.

BackgroundSchools are ideal for promoting the mental health of school-age children, but the teachers' current knowledge is insufficient to play an influential role in mental health services at schools. Fortunately, however, teachers have a high sense of responsibility, interest, and talent to receive knowledge and the ability to participate in this field. This study aimed to examine whether a protocol focused on the role of teachers could identify, guide, and care for school-age children with behavioral and mental health problems.MethodThe current research was a “before and after” pilot quasi-experimental study conducted in three elementary, secondary, and high schools. The main intervention consisted of a 5-h workshop based on a ready-to-use booklet for teachers conducted separately in each school. A total of 58 teachers and 872 school-age children were included using a judgmental sampling technique.ResultsThe pre-and post-workshop mean scores of teachers' knowledge about common mental disorders in school-age children were 6.21 ± 4.58 and 12.50 ± 7.27, respectively. According to the Strengths and Difficulties Questionnaire (SDQ), the teachers made 127 referrals, of whom 102 school-age children had problems. Consultants diagnosed 114 school children who reflected 90% of all teachers' recommendations needing psychological care and counseling. Finally, only 50 diagnosed school-age children were followed up and attended therapy sessions at counseling centers. The sensitivity and specificity of this brief intervention in detecting school-age children with psychological problems were respectively 80.3 and 98.0%.ConclusionsThis study's results support teacher empowerment training's effectiveness in identifying and guiding school-age children needing mental health care. Psychological counseling programs in schools in various quantitative and qualitative dimensions, including responding to school-age children's needs and psychological problems, should be adequately evaluated, and appropriate measures should be taken to promote mental health services. Collaboration between health systems and the education department will increase the effectiveness of mental health programs' promotion and drug abuse prevention. These pilot data lead the way to designing scientifically sound follow-up studies that will concretely ascertain the benefit of this program.

Health, Well-Being, and Quality of Life After COVID-19: A Mixed-Methods Study

Abstract Date Presented 04/02/2022 This study aimed to find the impacts of coronavirus disease 2019 (COVID-19) on the health, well-being, and quality of life of survivors. The findings of this study indicate that many of the mental and social impacts of COVID-19 on survivors of the virus may be related to the pandemic and related restrictions as opposed to the virus itself. Given the increased need for mental health services as a result of COVID-19, OTs may establish a new role in mental health services as well as community health promotion. Primary Author and Speaker: Lia McLoughlin Additional Authors and Speakers: Lindsey Curtin, Angela Butler, Nicole Weick, Christopher Gray Contributing Authors: Catherine Cavaliere, Michael Pizzi

Fifty ways to leave your treatment: First-person accounts of factors that helped actualize the choice to disengage from mental health services.

Objective: To investigate which factors and processes facilitated disengagement from mental health services (MHS). Method: The study adapted the narrative approach to the life stories method. We interviewed 13 women and 10 men who were diagnosed with a serious mental illness (SMI) for which they were hospitalized and used medication in the past but disengaged from MHS and were no longer engaged in any mental health treatment for at least a year. Results: Data analysis of the factors and processes that facilitated disengagement revealed three main factors, each overarching several subthemes: (a) Factors Related to Personal Resilience and Motivation; (b) Factors and Processes Related to Interpersonal Relationships; and (c) Using External Resources. Conclusions and Implications for Practice: Disengagement from MHS is not necessarily a problem that needs a solution but rather-in some cases-a legitimate choice that may actually represent healthy reasoning and an important step toward recovery. These findings emphasize the need for a broader and more flexible conceptualization of the potential role of MHS in the recovery process. Such an approach challenges the widespread notion that disengaging from MHS is a negative course of action and suggests that-for some-it is a significant and meaningful life choice that can empower individuals. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

‘Defunding the police’: A consideration of the implications for the police role in mental health work

This paper examines the role of the police in mental health work. It explores whether the calls to ‘defund the police’ can be the basis for fundamental reforms of mental health services and the police role. The paper outlines the roots of the calls to ‘ defund the police’ situating the perspective in the wider Black Lives Matter movement (BLM). The wider BLM movement seeks to overturn long standing racial and social injustices, including the disproportionate use of force against black citizens and racial biases within the Criminal Justice System. It goes further in that BLM calls for a shift in funding from policing towards an investment in welfare and community services. These calls are captured in the phrase ‘defund the police’. These calls have highlighted the police role in mental health, particularly, the police response to citizens in mental health crisis. The paper examines the police role in mental health work, highlighting the historic impact of policies of deinstutionalisation and more recently austerity and welfare retrenchment. In calling for this policy shift, campaigners have highlighted the need to significant investment in mental health services. The police role in mental health services increased because of the failings of community care ( Cummins, 2020a ). Police officers have increasingly become first responders in mental health crises. The paper, focusing on England and Wales, uses ‘defund the police’ perspective as a lens to examine long standing areas of concern. Police involvement in mental health emergencies is inevitably stigmatizing. There are also concerns from the police. This is an area of police demand that has grown of austerity and the wider retrenchment in public services. Police officers often feel that they lack the skills and knowledge required to undertake their role in mental health work. In addition, there is frustration generated by poor interprofessional working. Police officers on an organizational and individual level feel that they are often left ‘ picking up the pieces’ . There is a wide recognition that mental health services are failing to provide appropriate responses to those in crisis ( Wessley, 2018 ). As well as being an issue of human rights and social justice, these failures place vulnerable people at increased risk. All aspects of police work involve contact with people experiencing mental health problems. People with mental health problems are first and foremost human beings who should be treated with dignity and respect. They are also citizens, family members, carers and work colleagues. Having acknowledged that core value perspective, if we accept that police officers will be involved in mental health work, we should seek to limit their role as far as is possible. The paper concludes that it is likely that there will be always be some form of police involvement in mental health–related work. However, there is a need to limit this as far as possible.

An Exploratory Survey of Mental Health Social Work in Europe.

This article reports on an exploratory study comparing mental health social work (MHSW) in Europe. There has been very limited previous research comparing approaches to MHSW in Europe and so the aim of the study was to develop a better understanding of the similarities and differences between and, where relevant, within countries (referred to as jurisdictions). An online survey was distributed mainly through existing European networks and social media to seek information on the role, nature, extent and context of MHSW in a range of European jurisdictions. Conducted during the COVID-19 pandemic, there were 158 responses from 10 jurisdictions. Data were analyzed using thematic analysis. From this analysis, four main themes were identified, relating to: role; law, policy and education; the distinctive contribution made by MHSW; and the key challenges for MHSW. The study demonstrates that MHSW, although it is described and provided in different ways and is confined by a range of factors, plays an important role in mental health services across jurisdictions. There are also interesting differences between contexts, especially in the balance of therapeutic, legal and specialist/generic approaches, some of which reflect the World Health Organisation’s vision and objectives for mental health. Lastly, the study illustrates a need and provides a valuable basis for further comparative and collaborative work to define MHSW and enhance the contributions it makes.

A qualitative study of perceptions of senior health service staff as to factors influencing the development of Advanced Clinical Practice roles in mental health services.

WHAT IS KNOWN ON THE SUBJECT?: Advanced clinical practitioners (ACPs) are, typically, non-medical healthcare professionals, who possess advanced clinical skills, a master's level qualification and evidence of leadership, management and research abilities. Most ACPs are nurses and new ACP roles are increasingly being established around the world. The views of senior staff towards new mental health nursing roles in organizations are likely to influence their introduction and sustainability Research on mental health nursing ACP roles is sparse. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper uniquely provides specific information as to factors perceived by senior staff as affecting the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs. Establishing role clarity for MHN ACPs is perceived as being as essential to successful introduction of the role, as has been found for other specialities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participants identified a need for early engagement with service users and professions about new ACP roles and for processes that can evaluate ACP roles once they established. Some mental health nurses may require long-term developmental pathways to help prepare them to take on a master's level course and then the ACP role. ABSTRACT: Introduction Advanced clinical practice (ACP) roles are increasingly being developed internationally. Identifying factors perceived as affecting the development of ACP can support effective implementation. Aim To understand the views of senior health service staff as to factors influencing the development of ACP roles in mental health services. Method Focus group and semi-structured interviews. Participants were directors of nursing (n=10) and other senior staff from roles important to workforce development (n=10). Results Content analysis suggested seven categories: understanding the role and national guidelines, attitudes to the role, learning from implementing other roles, understanding prerequisites for development, challenges, opportunities and future support/actions. Prerequisites for success would include early engagement with stakeholders. Medical attitudes towards ACP roles were perceived as generally more positive than previously. Discussion The study provides unique information regarding perspectives of senior staff regarding the implementation of ACP roles in mental health services. A wide range of mental health services were perceived as potentially benefiting from ACPs, with the importance of role clarity being highlighted and long-term developmental pathways for staff. Implications for practice Successful Implementation of ACP roles may require clear role definition, early engagement with stakeholders and processes to evaluate role outcomes.

College Student Perspectives of Telemental Health: a Review of the Recent Literature.

Purpose of ReviewWe review the recent literature regarding college student experiences with and attitudes toward telemental health (TMH). We examine their perspectives of the advantages and drawbacks to this form of mental healthcare and their willingness to engage in TMH.Recent FindingsCollege students view TMH as convenient, accessible, easy to use, and helpful. TMH helps to overcome the barrier of stigma associated with seeking mental health treatment. Despite positive reviews, many students find a lack of customization or connection to the provider to be drawbacks to some forms of TMH. Willingness to engage in TMH varies based on prior experience with mental health treatment, ethnicity, and severity of symptoms.SummaryThe recent literature highlights the potential for TMH to play a key role in mental health services for college students. It also highlights some of its shortcomings, which are indicative of the continued need for in-person services. Future studies should continue to track college student perspectives toward and utilization of TMH.

Stigma, mental illness, and COVID-19 from a frontline clinician perspective: a way to go against the grain?

A well-known insidious obstacle for patients with mental illness is stigma, linked to feelings of incomprehensibility, incurability, and dangerousness. The COVID-19 pandemic represented a relevant additional barrier for these patients, which contributed to their marginalization, quality of life reduction and diminished treatments feasibility. As part of a cross-sectional multidisciplinary project conducted in the psychiatric service of Biella, a northern Italy province, preliminary data were collected by frontline clinicians during the COVID-19 first wave regarding the vicious cycle that may have been created between stigma and psychiatric patients in COVID-19 time. Therefore, we tried to frame the observed changes not in the dual literature paradigms stigma-mental illness or stigma-social consequences in COVID-19 time, but in the mental illness-stigma-COVID-19 three-way paradigm. The protection of this vulnerable segment of population, including a rapid access to COVID-19 vaccination, needs to be recognized as a real public health priority. The role of mental health services in providing information and activating supportive interventions for patients with mental illness is also crucial. Particularly, a multidisciplinary therapeutic team including mental health providers, general practitioners, hospital physicians, and social services would be needed to ensure adequate networks and cares continuity. Actions to contrast stigma can be arduous and exhausting because they must counteract the gravitational pull of customs, prejudices, and ingrained cultural beliefs, and may therefore appear to be moving in an “unnatural” direction, like the water in Escher’s lithograph entitled “Waterfall”. Nevertheless, there is no less strenuous way to go against the grain.

“Own Goodness and Service for Others” A Motivation to Serve People with Mental Disorders: Systematic Review

Volunteers have an important role in mental health services. Volunteers are present among the stigma and discrimination against people with mental disorders. To understand the motivation of volunteers in caring for people with mental disorders. A systematic review was conducted by collecting the results of scientific publications. The data bases used were ProQuest, PubMed, Sincedirect, and Springer link. Searching was carried out using the keywords of motivation, volunteers and mental disorders. Determination of the number of articles and articles contained in the review was determined by using PRISMA methods. Eight articles were found using the inclusion criteria for the article. Volunteer’s motivation was for their own goodness and service for others. Motivation of own goodness was divided into personal growth, altruism and self-existence. Motivation to serve others was to help others and contribute to society. There was strong evidence that volunteers had good motivation in improving the health status of people with mental disorders.

“Own Goodness and Service for Others” A Motivation to Serve People with Mental Disorders: Systematic Review

Volunteers have an important role in mental health services. Volunteers are present among the stigma and discrimination against people with mental disorders. To understand the motivation of volunteers in caring for people with mental disorders. A systematic review was conducted by collecting the results of scientific publications. The data bases used were ProQuest, PubMed, Sincedirect, and Springer link. Searching was carried out using the keywords of motivation, volunteers and mental disorders. Determination of the number of articles and articles contained in the review was determined by using PRISMA methods. Eight articles were found using the inclusion criteria for the article. Volunteer’s motivation was for their own goodness and service for others. Motivation of own goodness was divided into personal growth, altruism and self-existence. Motivation to serve others was to help others and contribute to society. There was strong evidence that volunteers had good motivation in improving the health status of people with mental disorders.

The nurse consultant in mental health services: A national, mixed methods study of an advanced practice role

WHAT IS KNOWN ON THE SUBJECT?: Internationally, systematic reviews have identified evidence of equal or improved clinical outcomes comparing advanced practitioner treatment with medical treatment as usual, across a range of specialities. Studies of nurse consultants in the United Kingdom have largely been non-empirical. Most studies specifically related to nurse consultant roles in mental health services are case studies or reports of views on this role. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The study demonstrates that nurse consultant numbers vary over time and by clinical specialty. This is influenced by the value invested in the role by local nursing leadership and by national policy change. A lack of role clarity affects the uptake and sustainability of advanced practice roles internationally and is also an issue for the nurse consultant role in England's mental health services. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Successfully introducing advanced practice nursing roles in mental health services requires role clarity and support from local nurse directors. The continued absence of robust evidence as to the clinical/cost-effectiveness of nurse consultant roles in mental health settings places an onus on individual posts to generate data to justify the role at a time of financial constraint. Detailed post holder characteristics reported in this paper provide a basis for future comparison with other advanced practice roles in mental health services and other specialties nationally and internationally. Abstract Introduction The nurse consultant is an advanced practice role providing expert clinical practice, consultancy and professional leadership. To date, few studies have examined this role within mental health services and none have described the professional characteristics of post holders. Aims The main aims of the study were to identify changes in nurse consultant numbers in mental health services, identify post holder characteristics and factors influencing number of posts. Method We used a triangulated mixed methods approach comprised of a longitudinal examination of national workforce data, a national cross-sectional survey of post holder characteristics and semi-structured interviews with directors of nursing. Results Of 58 mental health organizations, 51 (88%) responded, identifying 123 nurse consultant posts, and a range of 0-12 posts per organization. One in 229 mental health nurses and 1 in 186 learning disability nurses were nurse consultant. An average of 40% of nurse consultants' work time was reported as being in clinical practice. Themes identified as important in relation to role sustainability were cost and value, contribution of individual post holders, role clarity and domains of work. Discussion Nurse consultants are represented to a greater extent in the mental health service workforce than in nursing generally, but their roles often lack clarity. Attitudes of local professional leaders and national policies are likely to affect post numbers. Implications for practice Developing and sustaining nurse consultant roles requires role clarity and active support from nurse leaders. Roles need to demonstrate their value to the clinical systems in which they work.

Co-production and involuntary psychiatric settings

Purpose The purpose of this paper is to examine whether the popular policy assumption of co-production is feasible in secure psychiatric settings. Design/methodology/approach The assumptions of co-production are listed and then used as a basis for an immanent critique to test the feasibility described in the purpose of the paper. An explanatory critique exploring consumerism in the welfare state then follows. These forms of critique are derived from the philosophy of critical realism. Findings A distinction is made between the co-production of knowledge about mental health services and the actual co-production of those services. It is concluded that the former has emerged but the latter is not feasible, given the limitations on citizenship imposed by psychiatric detention. Research limitations/implications Evidence for the co-production of mental health services (rather than the co-production of knowledge about those services) remains sparse. Practical implications The contradictions about citizenship created by the existence of mental health legislation and the social control role of mental health services requires ongoing honest reflects by mental health professionals and those responsible for the development of mental health services. Social implications As described above, mental health legislation pre-empts confidence in the co-production of mental health services. Originality/value Whilst there is a small literature on co-production and mental health services, alluded to at the outset, this paper uses immanent and explanatory critiques to deepen our understanding of the topic.