Work In Mental Health Services Research Articles

Investigating a multi-session virtual reality relaxation intervention for mental health staff: protocol for a feasibility and acceptability study

PurposeClinical staff working in mental health services experience high levels of work-related stress, burnout and poor well-being. Increased levels of stress, burnout, depression and anxiety and poorer mental well-being among health-care workers are associated with more sick days, absenteeism, lower work satisfaction, increased staff turnover and reduced quality of patient care. Virtual reality (VR) relaxation is a technique whereby experiences of pleasant and calming environments are accessed through a head-mounted display to promote relaxation. The purpose of this paper is to describe the design of a study that assesses the feasibility and acceptability of implementing a multi-session VR relaxation intervention amongst mental health professionals, to improve their relaxation levels and mental well-being.Design/methodology/approachThe study follows a pre–post-test design. Mental health staff will be recruited for five weeks of VR relaxation. The authors will measure the feasibility and acceptability of the VR relaxation intervention as primary outcomes, alongside secondary outcomes evaluating the benefits of VR relaxation for mental well-being.FindingsThe study aims to recruit 20–25 health-care professionals working in both inpatient and specialist community mental health settings.Originality/valueResearch indicates the potential of VR relaxation as a low-intensity intervention to promote relaxation and reduce stress in the workplace. If VR relaxation is shown to be feasible and acceptable, when delivered across multiple sessions, there would be scope for large-scale work to investigate its effectiveness as an approach to enable health-care professionals to de-stress, relax and optimise their mental well-being. In turn, this may consequently reduce turnover and improve stress-related sick leave across health-care services.

A bite of dark chocolate? Black humour in mental health services.

Black humour permits expression of what may otherwise be unspeakable and is observed and used by staff working in mental health services. The aim of this study was to identify how humour, particularly black humour, was perceived by different health professionals in psychiatric practice. Participants were invited to complete a survey. Data was collated and statistically analysed by a biostatistician. Chi square and univariate tests were performed to identify associations between categories. The sub-question relating to the benefits of black humour was analysed. Main findings were that the majority of staff perceived black humour to be beneficial in psychiatric practice (n = 564 of 710 total; 79.4%), particularly if they used general and black humour with patients, families and colleagues. Those who observed black humour being used collegially about patients and families were more likely to find black humour beneficial; and even those uncomfortable with black humour being used by colleagues were more likely to see the benefits of black humour. Black humour was perceived to be beneficial in mental health settings when used mindfully, sensitively and in context. Further study with patients and relatives may shed light on how widely the perception of benefit is shared.

Fear, loss and disconnection: the emotional impact of the Covid-19 pandemic upon staff working in mental health services and how the organization can help – a psychoanalytic perspective

ABSTRACT This paper describes the work of a psychoanalyst working within NHS mental health services in the UK . The central contribution of a psychoanalytic approach within psychiatric care in offering a committed attempt towards understanding the patients’ presentation, rather than treatment primarily aimed at symptom control, is described. Beyond this, the specific contribution of psychoanalytic ideas in establishing a containing framework for staff, and how this strengthens the capacity of the organisation as a whole to contain anxiety and to metabolize complex projective processes is outlined. Examples are given with clinical illustrations of activities which enhance this capacity in ordinary times. The author then turns to the impact of the covid-19 pandemic upon staff and patients, describing how fear, threat and experiences of multiple losses have permeated all areas of our lives and activated primitive defences. The pandemic starkly revealed profoundly disturbing questions about our assumptions and habits, adding to the intensity and multi-layered quality of the anxieties evoked . Urgent attention has been drawn to our deeply problematic relationship with the natural world, our own habitat, and indefensible social inequities have been crudely exposed. Staff have been caught between their own fear, the need to contain increased disturbance in their patients, already struggling with fragmented and disordered states of mind, and pressures from an organisation under intense strain. The capacity of mental health staff to act as containers for their patient’s distress has been profoundly challenged and compromised. This paper outlines how the pandemic has highlighted the crucial role of the organisation as a container for anxiety and in supporting staff to do their work in mental health care. In order to strengthen this capacity during the crisis, the author describes how ideas derived from psychoanalytic principles were developed into guidance for NHS Mental Health Trusts during the early days of the pandemic . This guidance was adopted nationally by the Royal College of Psychiatrists and is summarised in this paper.

How is physical healthcare experienced by staff, service users, and carers in adult community mental health services in a south London mental health trust? A service evaluation.

Adults with a serious mental illness (SMI) are at greater risk of physical health morbidity and premature death than the general population, largely as a result of preventable physical health issues. Staff working in mental health services have a role to play in addressing these inequalities, but little is known about how they perceive their role and how this impacts on their practice. Understanding this better would enable services to improve their approach and support better health outcomes for SMI patients. A service evaluation was undertaken to investigate how physical healthcare is approached within adult community mental health teams (CMHTs) at a South London (UK) Mental Health Trust. This was a prospective, cross-sectional evaluation design. Interviews and focus groups were conducted with clinical staff, service users and carers (non-professional caregivers e.g., family or friends, of adults living with an SMI), to understand their experiences and to identify key barriers and facilitators to supporting physical healthcare support for adults with SMI. Thematic analysis was conducted to identify key themes which were classified into five main categories. 50 participants took part in the study, 38 were clinical staff, eight were service users and four were carers. We found staff widely recognised the importance of supporting physical healthcare. However, there was variability in how staff approached physical healthcare in routine practice, and differences in how physical healthcare is experienced by service users and carers. Staff were keen to engage in changes to the way physical healthcare is delivered in CMHTs. However, they sought clearer guidance on their roles and responsibilities, and wanted to better understand the rationale for changes in community mental health practice, such as increased screening for physical healthcare. Service users and carers felt equally that the role of CMHTs in physical healthcare was unclear, which limited their ability to access it and understand the benefit for their overall care. Staff articulated gaps in leadership and training that impacted on their ability to implement the overall vision for physical healthcare within the Trust. Mental health staff recognise the role they play in supporting the physical health of adults living with SMI. This evaluation provides insight into common barriers and facilitators faced by staff, service users and carers when providing or accessing physical healthcare within adult CMHTs. These findings indicate a more comprehensive and better articulated approach to physical healthcare in mental health Trusts is needed to ensure service users and their carers understand what support is available and how to access it and to equip staff to provide and sustain that care in routine practice.

Analysis of changes in the national mental health nursing workforce in England, 2011-2021.

WHAT IS KNOWN ON THE SUBJECT?: Nurses work in mental health services around the world, constituting the largest professional group. Nurses have been identified as being potentially able to carry out a much wider range of functions than are typically allowed in practice, when provided with suitable training. There are long-term concerns regarding shortages of mental health nurses in England and many other countries. Workforce data is rarely subject to analysis in peer-reviewed journals. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a case study of the workforce patterns of a national mental health nurse (MHN) workforce overtime allowing comparison with other countries and specialities. MHN numbers reduced from 2011 to 2017, then increased to near the 2011 level by 2021, not meeting ambitious national plans for increasing numbers. The mental health nursing proportion of the total NHS nursing workforce decreased through this period. Advanced practice roles and skills are widely, but unevenly, distributed and are provided by a small proportion of nurses. The proportion of nurses working in community settings has increased to constitute more than half of all nurses for the first time. The ratio of support workers to nurses increased in inpatient settings and will continue to change. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Historical challenges in recruiting MHNs suggest that future plans to expand the profession are overly optimistic. To support the development of advanced practice roles and new skill sets, clearer research evidence of impact is required and clearer national guidance regarding best practice models. Good workforce data are essential to inform good workforce planning. ABSTRACT: Introduction Data regarding changes in characteristics of the MHN workforce is commonly cited in governmental publications, but is rarely analysed in peer-reviewed journals, despite ongoing concerns regarding high vacancy rates within mental health services. Aim The aim of the study was to characterize changes in the MHN workforce, implementation of new nursing roles/skills and alignment with national policy. Method Analysis of nationally published workforce data, peer-reviewed publications and governmental policy/planning documents. Results Nurse numbers declined from 2011 to 2017, subsequently returning to near 2011 levels, but remaining below national targets. Nurses in community settings increased to constitute more than half of all nurses, whilst inpatient numbers declined, although more slowly than bed numbers. The ratio between nurses and support workers changed due to more support workers in inpatient settings. New advanced skills and roles for nurses have increased, but are unevenly distributed, constituting a small proportion of the total workforce. Implications for Practice This paper provides a case study against which comparisons may be made with the nursing workforce in other countries and specialities. Even clear policy commitment to nursing growth may not deliver planned changes in numbers and introducing new roles may have uneven impact, especially in the absence of a robust evidence base.

Proceeding From Our Roots in the Dust: An Unfolding Ethics of Care Through the Arts (Étendre nos racines dans la poussière : une éthique des soins qui se déploie à travers les arts)

This theoretical essay invites a reimagining of ethics in art therapy, and a questioning of the reverence of ethical codes and standards in the care professions as universally beneficial. It explores how one may practice care work without replicating systemic violence. I begin exploring these broad quandaries by drawing from partial and situated knowledges (Haraway, 1988). This writing is informed by feminist analyses and theorizations of care ethics, and written from my subject position as a racialized cisgender woman working in mental health services and an art therapy training program in Tkaronto 1 . I begin with a discussion of the discourse of professional ethics and its idealization of masculine rationality and a top-down model of accountability to contemplate why people continue to experience oppressive and unethical treatment within human service systems despite deeply cemented directives to adhere to professional codes of ethics. I argue that it is necessary to center emotions and interdependence in confronting our complicity in oppression. I conclude by contemplating an ethics of foregrounding the arts to hold space for uncertainty, responsibility, and care.

Narrative review of the COVID-19, healthcare and healthcarers thematic series.

This review covers the thematic series of 22 papers selected from among manuscripts published by BJPsych Open concerning coronavirus disease 2019 (COVID-19) and healthcare. We report nine papers that cover concepts and epidemiology relating to the public and patients. We review 11 papers about the impact of COVID-19 on healthcare services and their staff in 15 countries. Two papers consider the psychosocial impact on staff working in mental health services in the UK. Most papers report cross-sectional analyses of data collected from convenience samples by self-reported surveys conducted at single times. They have limitations of generalisability, do not enable conclusions about diagnosis or causality, and many are likely to have attendant bias and noise. BJPsych Open published these papers to meet requirements for early indications of the mental health impact of COVID-19 on the public and on healthcare staff. They claim high prevalence of symptoms of anxiety, depression and post-traumatic stress. We contrast these findings with selected reports of studies with different methodologies published elsewhere. We emphasise the need for longitudinal clinical studies with refined sampling and methodological rigour. We identify several longitudinal research programmes; two in this series. We advocate tuning advice offered about caring for the public and healthcare staff to the realities of their circumstances and their perceptions of need in the context of findings from further longitudinal studies. We draw attention to the importance of the social, relationship and environmental circumstances of the public and healthcare staff in order to understand their distress and their risks of developing mental health disorders.

Overcoming Factionalism in Serious Mental Illness Policy Making: A Counter-Perspective

Overcoming Factionalism in Serious Mental Illness Policy Making: A Counter-Perspective

Mapping the Matrix: Understanding the Structure and Position of Social Work in Mental Health Services in England and Wales

Abstract Social work is one of the core professions within mental health services in the UK, though its position as local authority ‘outsider’ excludes it from health-based workforce planning, leaving the exact national composition of mental health social work shrouded in mystery. In the context of increasing demand and limited resources, this lack of clarity precludes effective use of the mental health workforce. This study aimed to map the provision of mental health social work across England and Wales. A cross-sectional design was used, with brief surveys issued to all local authorities and National Health Service trusts responsible for providing social work or mental health services. These surveys collected the number of mental health social workers in each agency and their employment contexts for subsequent descriptive statistical analysis. Responses were received from 96.6 percent of agencies, employing 6,584 social workers. Findings indicated that mental health social work varies widely across both nations, with little clear rationale for, or consistency in, how social work is structured within mental health services. While these findings establish the first robust framework for understanding the size and scope of mental health social work provision, further research is required to establish temporal and contextual understandings to inform future service planning.

Challenges for the non-clinical researcher working in mental health services

Mental health research aims to improve our understanding of illnesses, provide better preventative approaches, enhance diagnosis and treatment strategies, increase our understanding of biological markers of disorders, and progress our knowledge of co-morbidities between physical and mental health. A need exists to engage researchers in undertaking work in this field, however we rarely consider the barriers in place for a non-clinical researcher working in the mental health environment. This article aims to reflect on barriers to conducting research as a non-clinical researcher in a clinical mental health setting and to consider approaches to overcoming these barriers.

Feeling stuck: exploring experiences of junior doctors.

Staff working in mental health services provide care for individuals with a variety of difficulties, which can pose treatment challenges. Perceived lack of progress in patients can engender uncomfortable feelings within the clinician, such as frustration, 'heartsink' and 'feeling stuck'. The aim of this study was to explore the phenomenon of 'feeling stuck' amongst NCHDs in psychiatry. A total of 30 participants were recruited from three psychiatric hospitals to complete a 15-item questionnaire. The survey was designed to pursue a thematic analysis. Participants were asked to complete the survey anonymously, either online or paper version. The analysis was carried out by two researchers using open coding, with themes finalised through collective discourse. Three themes were elicited from the data. The central theme - 'causes of feeling stuck' - consisted of three subthemes (patient, doctor and system factors). Participants were adept at describing patient and system factors, but reflected on doctor factors, such as countertransference, less often and in less detail. Other themes, explored in less detail by respondents, were 'the experience of feeling stuck' and 'responses to feeling stuck', with participants tending to seek solutions to, rather than an understanding of, these feelings. Trainee psychiatrists can clearly identify the situations where they are 'stuck' with clinical interactions. In spite of clinical supervision and reflective practice groups, they desire further training in managing these scenarios. NCHDs would benefit from further training, using these 'stuck' interactions as material, to further develop their understanding of the underlying factors in both themselves and their patients.

Doing peer work in mental health services: Unpacking different enactments of lived experiences

ABSTRACT Mental health services are increasingly employing peer workers (PWs), individuals who have lived experiences with mental health problems, to support patients and be part of mental health care teams. While the employment of PWs continues to increase, little is known about how the function unfolds in practice. This paper explores the broader context in which the PWs navigate and the concrete outcomes and everyday issues that exist at the individual level. Methodologically, the paper draws on 22 interviews with PWs employed in the mental health services in Denmark. Theoretically, it combines Lipsky’s (1980) theory on street-level bureaucrats with sociological discussions concerning the lay-expert divide. The analysis shows that PWs experience both role ambiguity and goal uncertainty and that they use substantial discretion in determining the nature, amount and quality of their peer practices. This – combined with the PWs’ diverse lived experiences – calls for a heterogeneous understanding of peer work and therefore the analysis presents three categories of peer workers: PWs as (1) a representative of patients’ lifeworld, (2) an interdisciplinary professional and (3) an ‘expert by experience’. These categories display PWs different enactments of their lived experiences and reveal ambiguities tied to the lay-expert divide.

What makes us the same? What makes us different? Development of a shared model and manual of group therapy practice across art therapy, dance movement therapy and music therapy within community mental health care

Arts therapies draw upon many theories and models of practice, but lack consensus in shared factors of their provision. In preparation for a randomised controlled trial involving art therapy, dance movement therapy and music therapy, we used experiential and practice-based methods to develop a model and manual for mixed diagnosis arts therapies groups in community mental health care. Six arts therapists met over the course of a year to explore commonalities and differences in art, dance movement and music therapy groups. Arts-based and consensus methods were used to develop practice principles, which were expanded through workshops with arts therapists working in mental health services. A model, manual, training and adherence guide were produced, which incorporated role-play and video-based reflection. The model is underpinned by transdiagnostic and contextual psychotherapy theories. The manual outlines ten core principles, alongside 19 practice principles. Fourteen scenarios where therapists commonly intervene informed ongoing therapist training and development. This is the first model to describe practice across three types of arts therapies for mixed diagnosis groups in community mental health care. Whilst overall manual utility (including adherence) and effectiveness is yet to be assessed, the development methods may be informative for wider arts therapies groups and clientele.

COVID-19: What can we learn from shared experiences of social distancing within secure services?

COVID-19 is an infectious disease that has spread across the globe with a social, economic and psychological impact that will undoubtedly change the world in which we live. Those working in mental health services will have experienced major changes in working practices, including navigating the challenges of infection control, whilst caring for some of the most vulnerable members of our society. There have been a number of publications considering many of the practicalities of the COVID-19 challenges in mental health. However, deeper reflections of philosophical issues regarding our own shared experiences have not yet been well covered in the professional press. This commentary describes some experiences of working within a low secure forensic service at the beginning of the COVID-19 pandemic in the UK. It aims to explore some of the key themes arising from this unprecedented situation, proposing areas for reflection and shared learning within the mental health inpatient community.

A pilot study of brain injury in police officers: A source of mental health problems?

WHAT IS KNOWN ON THE SUBJECT?: Traumatic brain injury (TBI) has been linked to poor outcomes in terms of mental health, specifically, PTSD, depression and alcohol abuse. A lack of research evidence exists relevant to exploring the presence and implications of TBI in the police in the UK and globally, despite the elevated risk of physical and emotional trauma specific to policing. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The rate of traumatic brain injury is highly prevalent in a small sample of police officers. Traumatic brain injury is a major source of post-concussion symptoms (physical, cognitive and emotional deficits) in police officers, which, in general, are associated with greater mental health difficulties and drinking alcohol to cope. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Traditional mental health treatments should be supplemented with elements of concussion care to address any cognitive, emotional and physical issues due to head injury. Interventions should be made more accessible to those suffering from a mild brain injury. This can be done through regular reminders of appointments, pictograms and by providing a concrete follow-up. ABSTRACT: Introduction Police officers have a high risk of injury through assaults, road traffic incidents and attending domestic calls, with many officers developing post-traumatic stress disorder (PTSD) as a consequence. Traumatic brain injury (TBI) is a common injury in populations involved in conflict and has been extensively linked to mental health difficulties. However, current research has not explored the frequency and sequelae of TBI in police populations, despite the elevated risk of physical and emotional trauma specific to policing. Aim To explore self-reported TBI, PTSD, post-concussion symptoms, depression and drinking to cope in a small sample of UK police, to determine the frequency of these conditions and their relationships. Method Measures of TBI, mental health, and drinking alcohol to cope were administered to 54 police officers from a Midshire Police Constabulary. Results Mild TBI with loss of consciousness was reported by 38.9% of the sample. TBI was associated with increased post-concussion symptoms (PCS). PCS were associated with greater severity of PTSD, depression and drinking to cope. Discussion Exploring TBI in the police could identify a major factor contributing towards ongoing mental health difficulties in a population where, based on previous research, the implications of TBI should not be overlooked, highlighting the need for further research in this area. Implications for Practice This research spans to identify the importance of routine assessment and increasing awareness within mental health services. Mental health treatments should be made amenable to a population with potential memory, planning and impulse control deficits. Further work in mental health services is needed to understand the level of ongoing issues that are due to post-concussion symptoms and those that are due to other mental health difficulties, such as PTSD, thereby educating patients on the association between TBI and emotional difficulties. A graduated return-to-work plan should be developed to enable a safe transition back to work, whilst managing any ongoing symptoms.

Psychosocial factors and Burnout Syndrome among mental health professionals

Objective:to identify biopsychosocial factors at work associated with the Burnout Syndrome in mental health professionals.Method:a cross-sectional study with a quantitative approach conducted with a sample of 293 mental health service workers from the public network of a municipality in the inland of the state of São Paulo, Brazil. An instrument composed of three self-administered questionnaires was applied, namely: biosocial data form, the Job Stress Scale (JSS) and the Maslach Burnout Inventory (MBI- HSS). The data were analyzed through the application of the Chi-squared and logistic regression tests, with the adoption of a 5% significance level.Results:Burnout Syndrome prevalence was 7% with a predominance of nursing professionals and was associated with the work sector, the use of psychotropic drugs, low satisfaction with the manager and with the low control over the work activity. Among the professionals with Burnout Syndrome, twelve performed functions considered of high wear, six performed passive work and two were in low wear activity.Conclusion:low control was the main psychosocial factor at work associated with Burnout Syndrome, making it necessary to develop actions that promote worker autonomy and improve the management of stress-triggering psychosocial factors.

The unique contribution of older people with a lived experience of mental illness to the peer workforce: observations from older peer workers

Background: The development of peer work models that are integrated into health systems is at the heart of national and international reform agenda in mental health. Peer work differs from other mental health roles as it is provided by people who have a lived experience of mental illness and recovery and does not assume a medical model. Peer work in mental health services for older people is not well established and to address this gap we developed, implemented and evaluated a peer work model for older patients of a specialist mental health service.Method: The findings discussed in this paper are part of a broader evaluation and consist of qualitative observations made by the peer workers during focus groups. Three focus groups were conducted during the first year of the project to identify the peer workers’ perspectives, feelings and thoughts around the developing peer work model and how they were impacted by the work. Data collection and analysis was inductive and informed by grounded theory principles. Observations from peer workers are discussed in relation to the literature as well as observations made by the researchers during project implementation.Results: Analysis suggests that older peer workers have a level of maturity and experience with recovery that benefit the peer workforce in a number of ways namely (a) significant experience with recovery to draw on when helping others; (b) a well-established sense of identity and coping strategies that support wellbeing and (c) ability to cope with ambiguity and uncertainty inherent in peer work practice. We propose that having a strong sense of self or personal identity may be important in peer work, particularly as the peer work role is often challenged, questioned and unclear.Conclusion: Older peer workers provide a valuable contribution to the peer workforce and bring with them an array of strengths that can help overcome some of the common peer work implementation barriers.

Maximising resilience resources for mental healthcare staff

PurposeThe purpose of this paper is to investigate optimal resources to promote resilience in staff working in inpatient mental health services. The study also provides an example of card sorting methodology used as an efficient way to identify the most helpful resources for resilience.Design/methodology/approachIn total, 25 clinical staff participated in the study. A preliminary focus group and brief literature search identified resources used in two tasks. Two card sorting tasks identified resources participants found helpful vs unhelpful and abundant vs scarce, and resources they would find valuable to use more often.FindingsThe results indicate that most resources helpful to resilience and available to staff were personal resources (relating to positive outlooks or ways of working), whereas resources valuable to resilience but scarce in the working environment were organisational resources (relating to management or social workplace culture). Resources found to not be valuable to resilience were largely personal tangible resources (e.g. smoking, massages).Practical implicationsThe findings and method may be generalisable to other mental health services, giving insight into promoting resilience within individuals and organisations. This information could serve as guidelines to streamline the allocation of organisational resources to best promote resilience across various mental health settings.Originality/valueStaff resilience to working in mental health services contributes to high-quality, sustainable patient care. This study provides further insight into how personal and organisational resources are both vital to resilience in staff working in highly challenging environments.

지역사회 정신건강서비스 기관 종사자의 직무외상 경험이 외상 후 성장에 미치는 영향: 낙관성과 수퍼비전 기능의 조절효과를 중심으로

지역사회 정신건강서비스 기관 종사자의 직무외상 경험이 외상 후 성장에 미치는 영향: 낙관성과 수퍼비전 기능의 조절효과를 중심으로

Factors Associated with Satisfaction with a Community Mental Health Service

Abstract This study’s objective was to simultaneousy assess the factors associated with the satisfaction of 84 patients and 84 family members with treatment and the satisfaction of 67 professionals with the work performed in a mental health service. This is a quantitative cross-sectional study with a correlational design and multivariate data analysis. The participants responded to satisfaction scales and sociodemographic questionnaires. The results indicate that the following variables predicted the level of satisfaction: age at onset of psychiatric disorder; being supported by the professionals; receiving information about treatment; level of education; and years of work in mental health services. The results reveal that establishing a partnership with the families of patients is important to ensuringtheir satisfaction and treatment adherence, while the way the public health system manages the professionals’ careers has contributed to their dissatisfaction, requiring urgent reformulation.