Self-injurious behaviour in forensic mental health care: a study into the prevalence and characteristics of incidents of self-injury

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Vivienne de Vogel ◽  
Nienke Verstegen
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Forensic Mental Health ◽  
Content Type ◽  
Self Injury ◽  
Forensic Psychiatric ◽  
The Impact

Purpose Incidents of self-injury by forensic psychiatric patients often have a deleterious impact on all those involved. Moreover, self-injurious behaviour is an important predictor for violence towards others during treatment. The aim of this study is to analyse methods and severity of incidents of self-injury of patients admitted to forensic psychiatry, as well as the diagnoses of self-injuring patients. Design/methodology/approach All incidents of self-injury during treatment in a forensic psychiatric centre recorded between 2008 and 2019 were analysed and the severity was coded with the modified observed aggression scale+ (MOAS+). Findings In this period, 299 incidents of self-injury were recorded, displayed by 106 patients. Most of these incidents (87.6%) were classified as non-suicidal. Methods most often used were skin cutting with glass, broken plates, a razor or knife and swallowing dangerous objects or liquids. Ten patients died by suicide, almost all by suffocation with a rope or belt. The majority of the incidents was coded as severe or extreme with the MOAS+. Female patients were overrepresented and they caused on average three times more incidents than male patients. Practical implications More attention is warranted for self-injurious behaviour during forensic treatment considering the distressing consequences for both patients themselves, supervisors and witnesses. Adequate screening for risk of self-injurious behaviour could help to prevent this behaviour. Further research is needed in different forensic settings into predictors of self-injurious behaviour, more specifically, if there are distinct predictors for aggression to others versus to the self. Originality/value Incidents of self-injury occur with some regularity in forensic mental health care and are usually classified as severe. The impact of suicide (attempts) and incidents of self-injurious behaviour on all those involved can be enormous. More research is needed into the impact on all those involved, motivations, precipitants and functions of self-injurious behaviour and effective treatment of it.

scholarly journals The familiar stranger of mental health

2020 ◽  
Vol 15 (4) ◽  
pp. 237-247
Author(s):  
Matthew Sydney Long
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health Facility ◽  
Health Care Professionals ◽  
Service User ◽  
Health Care Facilities ◽  
Mental Health Facility ◽  
Content Type ◽  
The Impact

Purpose This paper aims to contribute to the debate about the closure of institutional mental health-care facilities, from an experiential perspective of a former mental health inpatient, ongoing service user and campaigner for retention of such facilities. It argues that auto-ethnographic accounts of mental illness by those with multiple social identities can have a greater role in terms of future training of mental health-care professionals. Design/methodology/approach The paper offers an experiential account of the impact of mental health facility bed closures as a patient admitted to institutional mental health facilities; as a mental health campaigner, fighting for the provision of both places of safety and “safe space” within his own local community; and as an ongoing service user. The research is in the interpretivist tradition of social science in taking an auto-ethnographical methodological stance. Findings This paper is underpinned by two key theoretical notions. Firstly, Stuart Hall’s concept of the Familiar Stranger (2017) is used to explore the tensions of self-identity as the author SHIFTS uncomfortably between his three-fold statuses. Secondly, the notion of “ontological insecurity” offered by Giddens (1991) is used with the paper exploring the paradox that admission to a mental health facility so-called “place of safety” is in fact itself a disorientating experience for both patient and carer(s). Research limitations/implications No positivistic claims to reliability, representativeness or generalisability can be made. It is the authenticity of the account which the reader feels should be afforded primacy in terms of its original contribution to knowledge. Practical implications This paper should have practical use for those tasked with developing educational and training curriculums for professionals across the mental health-care sector. Social implications This paper implicitly assesses the political wisdom of the policy of mental health bed closures within the wider context of the deinstitutionalisation movement. Originality/value This paper is underpinned by original experiential accounts from the author as patient, campaigner for places of safety and onging service-user of mental health care provision.

The risk of risk management: adopting critical theories to explore clinical risk concerns in mental health care

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kris Deering ◽  
Jo Williams ◽  
Rob Williams
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Risk Management ◽  
Mental Health Care ◽  
Social Inclusion ◽  
Management Practices ◽  
Content Type ◽  
Clinical Risk ◽  
Critical Theories ◽  
The Impact

Purpose The purpose of this paper is to outline several critical risk theories and explore their application to risk concerns in mental health care. This will contribute to the on-going debate about risk management practices and the impact these might have on recovery and social inclusion. Notably, while risks like suicide can be therapeutically addressed, risk management may involve paternalistic practices that exclude the participation needed for recovery. Design/methodology/approach A viewpoint of key risk theories will be presented to provide a critical eye about some clinical risk concerns in mental health care. Implications for recovery and social inclusion will then be discussed alongside direction for practice and research. Findings Clinical concerns seemed to involve difficulties with uncertainty, holding onto expertise, and the othering of patients through risk. These concerns suggest the patient voice might become lost, particularly within the backdrop of clinical fears about blame. Alternatively, a relational approach to risk management could have merit, while patient expertise may develop understanding in how to improve risk management practices. Originality/value Clinical concerns appear more than managing potential harms; it can involve appraising behaviours around societal norms, explaining to an extent why mental illness might be addressed in terms of risks. While the points raised in the paper support existing findings about risk management, the underlying reasons drawing on the critical risk theories are less explored.

Improving continuity of forensic mental health care

2019 ◽  
Vol 21 (3) ◽  
pp. 180-189
Author(s):  
Vivienne de Vogel ◽  
Petra Schaftenaar ◽  
Maartje Clercx
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Best Practices ◽  
Mental Health Care ◽  
Focus Groups ◽  
Discharge Planning ◽  
Limited Capacity ◽  
Forensic Mental Health ◽  
Content Type ◽  
Forensic Care

Purpose Continuity of forensic mental health care is important in building protective structures around a patient and has been shown to decrease risks of relapse. Realising continuity can be complicated due to restrictions from finances or legislation and difficulties in collaboration between settings. In the Netherlands, several programs have been developed to improve continuity of forensic care. It is unknown whether professionals and clients are sufficiently aware of these programs. The paper aims to discuss this issue. Design/methodology/approach The experienced difficulties and needs of professionals and patients regarding continuity of forensic care were explored by means of an online survey and focus groups. The survey was completed by 318 professionals. Two focus groups with professionals (15 participants), one focus group and one interview with patients (six participants) were conducted. Findings The overall majority (85.6 percent) reported to experience problems in continuity on a frequent basis. The three main problems are: first, limited capacity for discharge from inpatient to outpatient or sheltered living; second, collaboration between forensic and regular mental health care; and, third, limited capacity for long-term inpatient care. Only a quarter of the participants knew the existing programs. Actual implementation of these programs was even lower (3.9 percent). The top three of professionals’ needs are: better collaboration; higher capacity; more knowledge about rules and regulation. Participants of the focus groups emphasized the importance of transparent communication, timely discharge planning and education. Practical implications Gathering best practices about regional collaboration networks and developing a blueprint based on the best practices could be helpful in improving collaboration between setting in the forensic field. In addition, more use of systematic discharge planning is needed to improve continuity in forensic mental health care. It is important to communicate in an honest, transparent way to clients about their forensic mental health trajectories, even if there are setbacks or delays. More emphasis needs to be placed on communicating and implementing policy programs in daily practice and more education about legislation is needed Structured evaluations of programs aiming to improve continuity of forensic mental health care are highly needed. Originality/value Policy programs hardly reach professionals. Professionals see improvements in collaboration as top priority. Patients emphasize the human approach and transparent communication.

Cultivating compassion through compassion circles: learning from experience in mental health care in the NHS

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Clark ◽  
Andy Bradley ◽  
Laura Simms ◽  
Benna Waites ◽  
Alister Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
National Policy ◽  
Well Being ◽  
Content Type ◽  
Team Members ◽  
Health And Social Care ◽  
Current Concerns ◽  
The Impact

Purpose This paper aims to discuss the importance of compassion in health care and experiences of Compassion Circles (CCs) in supporting it, placing this into the national policy context of the National Health Service (NHS), whilst focusing on lessons from using the practice in mental health care. Design/methodology/approach This conceptual paper is a discussion of the context of compassion in health care and a description of model and related concepts of CCs. This paper also discusses lessons from implementation of CCs in mental health care. Findings CCs were developed from an initial broad concern with the place of compassion and well-being in communities and organisations, particularly in health and social care after a number of scandals about failures of care. Through experience CCs have been refined into a flexible model of supporting staff in mental health care settings. Experience to date suggests they are a valuable method of increasing compassion for self and others, improving relationships between team members and raising issues of organisational support to enable compassionate practice. Research limitations/implications This paper is a discussion of CCs and their conceptual underpinnings and of insights and lessons from their adoption to date, and more robust evaluation is required. Practical implications As an emergent area of practice CCs have been seen to present a powerful and practical approach to supporting individual members of staff and teams. Organisations and individuals might wish to join the community of practice that exists around CCs to consider the potential of this intervention in their workplaces and add to the growing body of learning about it. It is worth further investigation to examine the impact of CCs on current concerns with maintaining staff well-being and engagement, and, hence, on stress, absence and the sustainability of work environments over time. Social implications CCs present a promising means of developing a culture and practice of more compassion in mental health care and other care contexts. Originality/value CCs have become supported in national NHS guidance and more support to adopt, evaluate and learn from this model is warranted. This paper is a contribution to developing a better understanding of the CCs model, implementation lessons and early insights into impact.

The 10th EAMHID International Congress: integrating different approaches in the neurodevelopmental perspective – the mental health care evolution timeline

2016 ◽  
Vol 10 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Marco O. Bertelli
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Full Range ◽  
Autism Spectrum ◽  
International Congress ◽  
Content Type ◽  
Interdisciplinary Approaches ◽  
The Impact

Purpose – The purpose of this paper is to provide a summary of main outcomes of the 10th EAMHID International Congress and a critical overview of some key contributions. Design/methodology/approach – A discussion on the impact of the neurodevelopmental perspective on mental health care achievements and failures in the field of intellectual disability (ID) and autism spectrum disorders (ASD). Findings – The considerable progress in the field of mental health care for people with ID that has been made in the last 30 years and that is reflected through the 350 papers presented in this Congress represents the continuation of the work of great pioneers, such as Frank Menolascino, Felix Platter or William I. Gardner, who have been honoured by the EAMHID in the naming of the congress rooms, and the dedication of the poster award. The neurodevelopmental perspective was confirmed to be the current most valued conceptual framework to explain relations across systems and to support multi-level, transnosographic, life-long, interdisciplinary approaches in the production of aetiological insight and good-quality intervention for mental health problems; on the other hand it might determine a premature abandonment of the traditional nosology and the appearance of very broad spectrum conditions covering the full range of psychopathology. Also psychopharmacology was extensively considered, with the explicit aim to raise the attention of researchers and clinicians on this neglected topic. Unfortunately, adults with ID/ASD are still deprived of the right to receive treatments that are based on strong evidence, as it is for the general population. Originality/value – This editorial outlines the second part of a special issue that offers a comprehensive and varied collection of papers from the contributions to the 10th International Congress of the EAMHID.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

Commentary on the harm reduction reference group of justice health and forensic mental health network and corrective services NSW, Australia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Julia Anne Silano ◽  
Carla Treloar ◽  
Thomas Wright ◽  
Tracey Brown ◽  
Colette McGrath ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Health Care ◽  
Harm Reduction ◽  
Reference Group ◽  
New South ◽  
Forensic Mental Health ◽  
Content Type ◽  
Health Network ◽  
South Wales

Purpose This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW). Design/methodology/approach By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee’s success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group’s audit were drawn by critically appraising the JHFMHN/CSNSW HRRG’s Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature. Findings The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings. Social implications Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large. Originality/value Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives.

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