The clinical skills of community psychiatric nurses working with patients who have severe and enduring mental health problems: an empirical analysis

Aims and MethodA retrospective survey to explore how consultant psychiatrists, senior house officers and community psychiatric nurses prioritised referrals to four sectorised community mental health teams.ResultsReferral outcomes appeared to be comparable for patients with psychoses, sub-threshold mental health problems and personality disorders. However, differences in the outcomes were apparent for patients with a primary diagnosis of drug/alcohol misuse, as well as for patients with affective disorders and neuroses.Clinical ImplicationsIt may be necessary to establish clearer, consistent boundaries in order to consolidate services for patients with severe mental health problems.

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Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

10.1177/1363459319874100 ◽

2019 ◽

pp. 136345931987410

Author(s):

Julie Høgsgaard Andersen ◽

Tine Tjørnhøj-Thomsen ◽

Susanne Reventlow ◽

Annette Sofie Davidsen

Keyword(s):

Mental Health ◽

Primary Care ◽

Young Adults ◽

General Practitioners ◽

Mental Health Problems ◽

Psychosocial Problems ◽

Health Problems ◽

Care Work ◽

Psychiatric Nurses ◽

Provision Of Care

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

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A nurse's journey through mental ill health

Practice Management ◽

10.12968/prma.2019.29.10.18 ◽

2019 ◽

Vol 29 (10) ◽

pp. 18-20

Author(s):

Jane Fisher

Keyword(s):

Mental Health ◽

Health Service ◽

Mental Health Problems ◽

Health Problems ◽

Perinatal Mental Health ◽

Psychiatric Nurse ◽

Personal Journey ◽

Community Psychiatric

Jane Fisher, a community psychiatric nurse, describes her experience of perinatal mental health problems after the birth of her third child, the treatment and interventions she received from the health service and her personal journey to recovery

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The psychotherapeutic practice and potential of mental health nurses: an Australian survey

Australian Health Review ◽

10.1071/ah19208 ◽

2020 ◽

Vol 44 (6) ◽

pp. 916

Author(s):

Richard Lakeman ◽

Andrew Cashin ◽

John Hurley ◽

Tom Ryan

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Clinical Skills ◽

Health Problems ◽

Policy Formation ◽

Stepped Care ◽

Vulnerable Groups ◽

Educational Preparation ◽

Psychotherapeutic Practice ◽

The Continuum

ObjectiveMental health nurses (MHNs) have a long, under-recognised, history of engaging in psychotherapeutic practice across the spectrum of mental illness and mental health problems. There is a need for a psychotherapeutic response for people with complex or serious mental health problems within the stepped care model and in response to increased need for psychotherapeutic responses to COVID-19 and natural disasters. This project sought to identify the educational preparation and self-reported competency of MHNs to clinically undertake psychotherapy across the continuum of care. MethodsSituated within a larger mixed-methods study exploring how MHNs practice psychotherapy, adapt it to routine care and envisage the future, this paper reports the findings from a survey of MHNs regarding their educational preparation, experience and competence in modalities of psychotherapy and the application of psychotherapy with specific clinical groups. ResultsIn all, 153 MHNs responded to a request to participate in the study. In this cohort, 86% of nurses had postgraduate qualifications specific to psychotherapy and 95% had worked for over 10 years in the mental health field and had hundreds of hours of training in psychotherapy. There was a high level of self-reported competence in working with people with serious mental health problems and at-risk or vulnerable groups. ConclusionsCurrently, MHNs are not recognised in federal funding arrangements to procure psychotherapeutic intervention for members of the Australian population who require it. MHNs ought to be recognised as independent providers based on both the psychotherapeutic skills they possess and their specialist clinical skills of working with people across the spectrum of mental health problems. Appropriately qualified MHNs need to be funded to use their skills in psychotherapy via access to appropriate funding arrangements, such as Better Access and the National Disability Insurance Scheme. What is known about the topic?MHNs do not appear to be recognised as having postgraduate knowledge and skills in psychotherapy and other psychotherapeutic interventions. This lack of recognition has resulted in the Australian public being unable to access subsidised specialist psychotherapeutic services by this highly experienced group. Most published commentary has been around the Mental Health Nurse Incentive Program, but, to date, scholarly work related to this program has not influenced public views and policy formation despite multiple favourable evaluations. What does this paper add?This study highlights that MHNs possess a largely unrecognised and valuable skill set in psychotherapy practice that they can adapt to work with people with complex needs. What are the implications to practitioners?MHNs possess skills and experience that, if recognised and funded, could be rapidly mobilised to improve consumer outcomes across the continuum of stepped care and in response to increased need during COVID-19.

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Community Psychiatric Nurse Teams: Intensive Support Versus Generic Care

The British Journal of Psychiatry ◽

10.1192/bjp.165.2.211 ◽

1994 ◽

Vol 165 (2) ◽

pp. 211-217 ◽

Cited By ~ 78

Author(s):

Matt Muijen ◽

Margaret Cooney ◽

Geraldine Strathdee ◽

Ray Bell ◽

Annette Hudson

Keyword(s):

Mental Health ◽

Outcome Measures ◽

Mental Health Problems ◽

Health Problems ◽

Management Approach ◽

Community Resources ◽

Psychiatric Nurse ◽

Process Of Care ◽

Community Psychiatric ◽

Aftercare Service

Background.This study evaluated whether a community psychiatric nurse (CPN) team providing a comprehensive aftercare service, using a case management approach, improves psychopathology and social functioning of the long-term mentally ill, and reduces hospital use compared with a generic CPN team.Method.Patients suffering from severe and persistent mental health problems were randomised to intensive aftercare or generic care after referral to the CPN manager. Each group contained 41 patients who were assessed at baseline and at 6, 12 and 18 months by an independent research psychologist. Outcome measures included the GAS, PSE, SAS, patient and relatives' satisfaction, number of admissions, and length of stay.Results.No difference between the groups was found on any of the outcome measures, despite the much higher number of contacts of the intensive (n = 52) versus generic CPNs (n = 13) and the much greater range of interventions.Conclusions.Intensive aftercare for people with persistent mental health problems was not found to be of greater benefit than generic CPN care. Many factors need to be considered for aftercare to be effective, including community resources, process of care, and staff training.

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Quality of Care and Cost-Containment in Managed Mental Health: Policy, Education, Research, Advocacy

Psychological Reports ◽

10.2466/pr0.1996.79.3f.1395 ◽

1996 ◽

Vol 79 (3_suppl) ◽

pp. 1395-1422 ◽

Cited By ~ 14

Author(s):

Richard H. Dana ◽

Michael G. Conner ◽

James Allen

Keyword(s):

Mental Health ◽

Health Policy ◽

Quality Of Care ◽

Cost Containment ◽

Mental Health Problems ◽

Health Care Cost ◽

Clinical Skills ◽

Mental Health Policy ◽

Health Problems

Managed mental health care cost-containment practices of risk-benefit analysis, provider usage, manipulation of supply and demand, gate keeping, medical necessity, and formulation have adversely affected quality of care. Improved mental health services are dependent upon redefining mental health problems and understanding inequities created by medicalization as means to limit access to services. This dilemma can be addressed by development of mental health policy, public education, and political advocacy. An immediate role for professional psychology is found in the creation of a research agenda that documents empirically supported interventions for specific mental health problems, mechanisms of effective and acceptable service-delivery, and identification of providers with demonstrated clinical skills, including cultural competencies.

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DAHAGA: An Islamic spiritual mindfulness-based application to reduce depression among nursing students during the COVID-19 pandemic

Belitung Nursing Journal ◽

10.33546/bnj.1494 ◽

2021 ◽

Vol 7 (3) ◽

pp. 219-226

Author(s):

Meidiana Dwidiyanti ◽

Badrul Munif ◽

Agus Santoso ◽

Ashri Maulida Rahmawati ◽

Rikhan Luhur Prasetya

Keyword(s):

Mental Health ◽

Nursing Students ◽

Mental Health Problems ◽

Comparison Group ◽

Health Problems ◽

T Test ◽

Psychiatric Nurses ◽

P Value ◽

Significant Difference ◽

Quasi Experimental

Background: The COVID-19 pandemic significantly impacts students’ mental health. Most of them may experience depression. Due to restrictions and social distancing during the pandemic, counseling may not be applicable in detecting the problems. Therefore, an Islamic spiritual mindfulness-based application called DAHAGA is created in order to detect and reduce depression. It is believed that this innovative app could reduce mental health problems among students.Objective: This study aimed to determine the effect of DAHAGA on reducing depression among nursing students during the COVID-19 pandemic in Indonesia.Methods: This was a quasi-experimental study with a comparison group pretest/posttest design conducted from May to June 2020. Seventy students were selected using convenience sampling, of which 35 were assigned in an experimental group and a comparison group. The validated Indonesian Version-Beck Depression Inventory-II (BDI-II) was used for data collection. Paired t-test and independent t-test were used for data analysis.Results: There was a significant effect of DAHAGA on depression (p < 0.001). The level of depression after intervention (mean 11.49, SD 4.49) was lower than it before the intervention (mean 17.20, SD 4.94). Additionally, there was a significant difference in depression level between the experimental and comparison groups after the intervention with a p-value of < 0.001. Conclusion: The DAHAGA is proven effective in reducing depression. Therefore, this study offers a new and innovative app that fits with the COVID-19 pandemic to help Muslim students maintain their health status. The findings also support Islamic spiritual mindfulness as a part of nursing interventions among psychiatric nurses to deal with mental health problems, especially depression.

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Survey of community mental health teams

Psychiatric Bulletin ◽

10.1192/pb.22.12.733 ◽

1998 ◽

Vol 22 (12) ◽

pp. 733-739 ◽

Cited By ~ 4

Author(s):

Natasha Mauthner ◽

Simon Naji ◽

Jill Mollison

Keyword(s):

Mental Health ◽

Community Mental Health ◽

Mental Health Problems ◽

Postal Questionnaire ◽

Psychiatric Nurses ◽

Team Size ◽

Needs Assessments ◽

Community Psychiatric ◽

Patient Groups

Aims and methodThe aim of the study was to describe community mental health teams (CMHTs) working In Scotland. Interviews, a focus group, and a postal questionnaire survey of Identified CMHTs were carried out.ResultsOf the 53 teams identified, 42 (79%) completed questionnaires. The average team size was 11 people. Community psychiatric nurses were in all teams, social workers and psychiatrists were in most, but psychologists were in only half. Needs assessments occurred in only 17% of teams. Fifty-one per cent of teams had open referral systems, and 38% of referrals comprised people with long-term mental health problems. Fifteen per cent of referrals were considered by teams to be inappropriate.Clinical implicationsAmbiguities about appropriate structures, patient groups and interprofessional and inter-agency working require further consideration and evaluation if CMHT care is to be optimally effective.

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