Quality improvement in forensic mental health: the East London forensic violence reduction collaborative

Ward-based violence is the most significant cause of reported safety incidents at East London NHS Foundation Trust (ELFT). It impacts on patient and staff safety, well-being, clinical care and the broader hospital community in various direct and indirect ways. The contributing factors are varied and complex. Several factors differentiate the forensic setting, which has been identified as a particularly stressful work environment. Staff must constantly balance addressing therapeutic needs with robust risk management in a complex patient cohort. ELFT identified reducing inpatient physical violence on mental health wards as a major quality improvement (QI) priority. The aim was to use a QI methodology to reduce incidents of inpatient violence and aggression across two secure hospital sites by at least 30% between July 2016 and March 2018. Collaborative learning was central to this project. It sought to foster a culture of openness within the organisation around violence and to support service users and staff to work together to understand and address it. A QI methodology was applied in medium and low secure inpatient settings. A change bundle was tested for effectiveness, which included: safety huddles, safety crosses and weekly community safety discussions. Operational definitions for non-physical violence, physical violence and sexual harassment were developed and used. Reductions of 8% and 16.6% in rates of physical and non-physical violent incidents, respectively, were achieved and sustained. Compared with baseline, this equated to one less incident of physical and 17 less of non-physical violence per week averaged across seven wards. Three wards achieved at least a 30% reduction in incidents of physical violence per week. Five wards achieved at least a 30% reduction in incidents of non-physical violence per week. This collaborative brought significant improvements and a cultural shift towards openness around inpatient violence.

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OP0082-PARE THE EFFECT COVID-19 HAS ON THE MENTAL HEALTH OF PEOPLE LIVING WITH RHEUMATIC DISEASES. FROM DATA TO INTERVENTIONS.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.910 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 44-45

Author(s):

S. Mingolla ◽

A. Celano ◽

M. Santopietro

Keyword(s):

Mental Health ◽

Rheumatic Diseases ◽

Rare Diseases ◽

Psychological Impact ◽

Well Being ◽

Total Sample ◽

Support Service ◽

Health Condition ◽

National Association ◽

The Impact

Background:Covid-19 has had an important impact on the mental health conditions of over 5 million Italians suffering from one of the over 150 rheumatic diseases. In order to understand the psychological impact of the Covid-19 emergency and the restrictions imposed to counter it, the Italian National Association of People with Rheumatic and Rare Diseases – APMARR APS launched the research “Living with a rheumatic pathology”.Objectives:Gather data directly from Italian patients about the impact of the COVID-19 and consequent restrictions on their mental health and feelings; evaluate the most effective intervention to be implemented to face the pandemic by Patients organization.Methods:A qualitative-quantitative survey was carried out through a questionnaire administered throughout the national territory to a sample of N = 1,001 people. The people invited to complete the questionnaire were women (55,9%) and men (44,1%), aged 18-85 years (age 18-41=26,7%; age 42-65=64%; age >65=9,3%) with at least one rheumatic pathology. The questionnaire was made up of 39 questions, of which 29 were closed and 10 were open. For the administration of the questionnaires, the CAWI (Computer Aided Web Interview) methodology of on-line survey was used. The 1,001 interviews were carried out from 7 to 14 August 2020.Results:More than 4 out of 10 people (total sample 44.2%; male 60%, female 35,7%; age 18-41=39,1%; age 42-65=45,9%; age >65 = 50%) declared that the emergency period has somehow caused a worsening of their health condition. People declared that the deterioration of their health is due to the emergency period for the following reasons: 1) Psychological: such as stress and anxiety: “Too much stress and anxiety made the symptoms worse.”; “The stress of the quarantine affected my problem”; “Insomnia. Nervousness. General ailments. Depression. Strong stress” 2) Inability to perform physiotherapy and motor activities due to the lockdown 3) Postponement of examinations, visits and checks 4) remote working, in some cases described as harmful for people’s mental and physical health: “Due to Covid19 I had to do remote working and I worked even 12 hours a day including holidays to the detriment of my family life”.Furthermore, from January 31, 2020 a significant increase emerged in communication problems with rheumatology specialist compared to the period before the emergency due to Covid-19. The sharp increase may be due to the situation of severe psychological stress to which also the doctors were subjected in the emergency phase: people could not find the comfort of being empathically listened to.Conclusion:The research shows that the most frequent symptoms among people with rheumatic diseases were depression and high levels of anxiety due to strong emotional stress. Psychological malaise caused direct effects in worsening the symptoms of rheumatic disease as well as other related effects, for example, insomnia. The forced isolation due to the lockdown has made people lack the social support that is fundamental for the psychological well-being especially for those suffering from some chronic pathology. Starting from the data collected, APMARR promptly activated a completely free psychological support service with 6 professional psychologists, two of them specialized in emergency psychology. The service is accessible online and is still going on for all who are not able to overcome the anxiety and fear related to the pandemic and its evolution. Thousands of accesses to the service have been measured to date.References:S Mingolla1, A Celano1, M Santopietro2[1]NATIONAL ASSOCIATION OF PEOPLE WITH RHEUMATIC AND RARE DISEASES - APMARR APS[2]WeResearch. Ricerche di marketingDisclosure of Interests:None declared

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Virtual Body Ownership Illusions for Mental Health: A Narrative Review

Journal of Clinical Medicine ◽

10.3390/jcm10010139 ◽

2021 ◽

Vol 10 (1) ◽

pp. 139

Author(s):

Marta Matamala-Gomez ◽

Antonella Maselli ◽

Clelia Malighetti ◽

Olivia Realdon ◽

Fabrizia Mantovani ◽

...

Keyword(s):

Mental Health ◽

Clinical Care ◽

Well Being ◽

Narrative Review ◽

Future Research ◽

Body Ownership ◽

Surrounding Environment ◽

Wide Range ◽

Clinical Conditions ◽

Virtual Body

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of clinical conditions that influence people’s general and social well-being such as chronic pain, neurological disorders that lead to motor o perceptual impairments, psychological disorders that alter behaviour and social cognition, or physical conditions like eating disorders or present in amputees. It is known that an accurate perception of oneself and of the surrounding environment are both key elements to enjoy mental health and well-being, and that both can be distorted in patients suffering from the clinical conditions mentioned above. In the past few years, multiple studies have shown the effectiveness of VR to modulate such perceptual distortions of oneself and of the surrounding environment through virtual body ownership illusions. This narrative review aims to review clinical studies that have explored the manipulation of embodied virtual bodies in VR for improving mental health, and to discuss the current state of the art and the challenges for future research in the context of clinical care.

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Research watch: what really helps recovery in relation to severe mental health difficulties?

Mental Health and Social Inclusion ◽

10.1108/mhsi-11-2019-0037 ◽

2020 ◽

Vol 24 (1) ◽

pp. 6-12

Author(s):

Sue Holttum

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Design Methodology ◽

Support Service ◽

Health Condition ◽

Service Users ◽

Content Type ◽

Inpatient Settings ◽

Mental Health Difficulties

Purpose The purpose of this paper is to examine three recent papers on mental health services and how they support recovery following a diagnosis of a severe mental health condition. Design/methodology/approach A search was carried out for recent papers on mental health and recovery. The author selected three papers that seemed to advance understanding of not only whether, but also how recovery of a meaningful life may be best supported in mental health services. Findings One paper suggested how staff were able to support service users’ personal goals and focus on recovery in acute inpatient settings, and what got in the way. The author suggests practical ways to address the barriers. A second paper reported the testing of a new model for supporting staff in primary and secondary care to work together so that service users with a diagnosis of bipolar or schizophrenia were better supported to work towards valued goals. A third paper reviewed 40 studies of how people can experience positive change after a first diagnosis of psychosis, and how change happened. Originality/value By studying the issues in detail, all three papers show how improved support for recovery and inclusion can be implemented against the backdrop of many years of service shortcomings.

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An integrative review on patient inflicted violence among mental health nurses

Clinical Nursing Studies ◽

10.5430/cns.v7n1p62 ◽

2018 ◽

Vol 7 (1) ◽

pp. 62

Author(s):

Mohammed Hamdan Alshammari

Keyword(s):

Mental Health ◽

Health Care ◽

Workplace Violence ◽

Health Care Professionals ◽

Physical Violence ◽

Well Being ◽

Integrative Review ◽

Public Health Issue ◽

Global Public Health ◽

Mental Health Nurses

Workplace violence can be in the form of aggression, harassment or simply physical infliction of harm towards nurses. It can arise from many sources but primarily they are patient inflicted violence in different forms. It can be a physical violence, emotional or a combination of both. Incidence of violence towards health care professionals is a recognized global public health issue. Previous studies have already suggested that health care professionals, particularly nurses, have a higher risk of experiencing workplace violence than other professionals. This integrative review looked into the violence where patients are the primary source, as well as the types and impact of violence amongst psychiatric mental health nurses happening worldwide. Further, it looked into the nurses’ road to recovery from the experience of violence and what hospitals and facilities are advocating in stopping these events or at least minimizing the frequency of such acts. Published studies considered in this review found that nurses’ experienced physical pain, fear, anxiety, frustration, distress, resentment, apathy, job dissatisfaction and anger following the violent incident. Nurses after their exposure to a series of violence from their patients’ experience dramatic changes in their well-being.

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Occupational Stress and Mental Health Among Healthcare Workers Serving Socially Vulnerable Populations During the COVID-19 Pandemic

Frontiers in Public Health ◽

10.3389/fpubh.2021.782846 ◽

2021 ◽

Vol 9 ◽

Author(s):

V. Nelly Salgado de Snyder ◽

Alice P. Villatoro ◽

Marisol D. McDaniel ◽

Ana Sofia Ocegueda ◽

Deliana Garcia ◽

...

Keyword(s):

Mental Health ◽

Vulnerable Populations ◽

Healthcare Workers ◽

Well Being ◽

Safety Net ◽

The United States ◽

Lessons Learned ◽

Community Safety ◽

Vulnerable Groups ◽

Work Place

The purpose of this study was to analyze occupational and personal stressors, mental health indicators, perceived discrimination and help-seeking behaviors among healthcare workers and providers (HCWPs) serving socially vulnerable groups such as immigrants, refugees, farmworkers, homeless individuals, people living in poverty, and other disadvantaged populations in the United States (U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive approach, we gathered information between July and September 2020, from a sample of 407 affiliates of two national organizations of clinic-based HCWPs who worked at federally funded and community safety-net clinics. Informed consent was obtained from all participants who completed a self-administered online survey available in English and Spanish. Our results indicated that the HCWPs serving vulnerable groups in the midst of the pandemic experienced high levels of occupational and personal stressors as well as anxiety and depressive symptomology. Major occupational stressors were excessive workload, long working-hours, and institutional barriers to refer and follow-up on their clients' access to needed social services. High-rated personal stressors included sleep disorders, lack of and child-care, partner's loosing job, and other family related situations. Our findings suggest that HCWPs working with vulnerable populations need specialized interventions that bolster their mental health and well-being as the pandemic continues to unfold. We recommend implementing initiatives that encourage HCWPs' to be actively involved in clinic decisions regarding employee safety and protection as well as in management decisions to improve work place infrastructure and capacity to respond to the social needs of their clients. Lessons learned from the pandemic are useful tools in designing protocols for addressing the mental-health needs of HCWPs in health-care organizations that attend to socially underprivileged populations.

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Impact of COVID-19 and Partial Lockdown on Access to Care, Self-Management and Psychological Well-being among People with Diabetes: A Cross-sectional Study

10.22541/au.160770440.01726562/v1 ◽

2020 ◽

Author(s):

Ester Yeoh ◽

Sooon Guan Tan ◽

Yingshan Lee ◽

Ying Yee Low ◽

Su Chi Lim ◽

...

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Health Services ◽

Clinical Care ◽

Self Care ◽

Well Being ◽

Cross Sectional ◽

Disinhibited Eating ◽

Health Services Access ◽

The Impact

Background The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, diabetes self-care, behavioral and psychological impact of COVID-19 and partial lockdown in Singapore. Methods We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models. Results Among 301 respondents, 45.2% were women, majority were ethnic Chinese (67.1%), aged 40 to 49 years (24.2%), have Type 2 diabetes (68.4%) and on oral medications (42.2%). During the lockdown, nearly all respondents were able to obtain their medications, supplies (94%) and contact their doctors (97%) when needed. Respondents reported less physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β=11.44, p= 0.017), diabetes-related comorbidities (β= 3.98, p= 0.001) and Indian ethnicity (β= 7.73, p= 0.018) were significantly associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β= 2.71, p= 0.007) while mental health condition was associated with greater barriers to activities (β= 9.63, p= 0.033). Conclusion Health services access were minimally affected but COVID-19 and lockdown had mixed impact on self-care and management behaviors. Greater clinical care and attention should be provided to people with diabetes with greater number of comorbidities and previous mental health disorders during the pandemic and lockdown.

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Religion and psychiatry: research, prayer and clinical practice

BJPsych Advances ◽

10.1192/bja.2020.43 ◽

2020 ◽

Vol 26 (5) ◽

pp. 282-284

Author(s):

Christopher C. H. Cook

Keyword(s):

Mental Health ◽

Clinical Practice ◽

Mental Disorder ◽

Religious Coping ◽

Clinical Care ◽

Well Being ◽

Culturally Sensitive ◽

Careful Attention

SUMMARYReligious concerns, manifested in thought and behaviour, have a complex, bidirectional and sometimes conceptually overlapping relationship with mental health and mental disorder. Psychiatry, concerning itself with what is measurable in research, and with the relief of distress in clinical practice, has a different perspective on these complex interrelationships than does theology or religion. That which is transcendent, and therefore not measurable, is often important to patients, and sometimes distress may (theologically) be a sign of human well-being. The giving of careful attention to transcendence and distress may variously be conceived of as prayer, religious coping or clinical care. Applications of research to clinical practice, addressing as they do a sensitive and controversial boundary between psychiatry and religion, must therefore be patient centred and culturally sensitive.

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“Everybody’s responsibility”: Conceptualization of youth mental health in Kenya

Journal of Child Health Care ◽

10.1177/1367493518814918 ◽

2018 ◽

Vol 24 (1) ◽

pp. 5-18 ◽

Cited By ~ 2

Author(s):

Inge Tamburrino ◽

Elijah Getanda ◽

Michelle O’Reilly ◽

Panos Vostanis

Keyword(s):

Mental Health ◽

Young People ◽

Mental Health Problems ◽

Youth Mental Health ◽

Well Being ◽

Attribution Of Responsibility ◽

Contributing Factors ◽

Disadvantaged Area ◽

Middle Income ◽

Identity Resolution

There is increasing interest in providing resilience-building interventions in low- and middle-income countries (LMIC), but limited evidence on how young people and their carers process mental health and related supports. The aim of this study was to establish stakeholders’ conceptualization of youth mental health in a disadvantaged area of Kenya through focus groups with 7 young people aged 14–17 years and their parents, 9 teachers and 11 practitioners or community leads. The four identified themes related to definitions of both mental well-being and mental health problems; a range of contributing factors related to identity resolution, parenting, poverty and social media; attribution of responsibility at different socio-ecological levels; and required awareness, supports and interventions at these levels. Stakeholders, notably young people, are thus essential in the development and planning of user-led and culturally appropriate interventions in LMIC.

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Research protocol for a pragmatic randomized controlled effectiveness and cost effectiveness study of Well Parent Japan (WPJ) for Japanese mothers of children with ADHD: The TRaining And Nurturing Support FOR Mothers TRANSFORM (Preprint)

10.2196/preprints.32693 ◽

2021 ◽

Author(s):

Shizuka Shimabukuro ◽

David Daley ◽

Takahiro Endo ◽

Satoshi Harada ◽

Akemi Tomoda ◽

...

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Data Collection ◽

Controlled Trial ◽

Clinical Care ◽

Neurodevelopmental Disorder ◽

Pragmatic Trial ◽

Well Being ◽

Children With Adhd ◽

The Cost

BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder associated with numerous functional deficits and poor long-term outcomes. Internationally, behavioral interventions are recommended as part of a multimodal treatment approach for children with ADHD. Currently in Japan there are limited interventions available targeting ADHD. Well Parent Japan (WPJ), a new hybrid parent training program, provides a culturally acceptable, and effective way to help support Japanese children with ADHD and their parents. OBJECTIVE This pragmatic multi-center randomised controlled trial will provide preliminary evidence about the effectiveness and cost-effectiveness of WPJ evaluated against treatment as usual (TAU) within routine Japanese mental health services. METHODS Mothers of children (6-12 years) diagnosed with ADHD will be recruited from child and adolescent mental health care services at three hospital sites across Japan (Fukui, Fukuoka and Okinawa). Mothers will be randomized to immediate treatment or TAU. The effectiveness and cost effectiveness of WPJ over TAU at the end of intervention and at 3-month follow-up will be evaluated. The primary outcome is maternal Parent Domain stress in the parenting role. The following secondary outcomes will be explored: child behavior, including severity of ADHD symptoms; parenting practices; emotional well-being and the parent-child relationship. Data analysis will follow intention-to-treat principles with treatment effects quantified through ANCOVA by means of multi-level modeling. An incremental cost effectiveness ratio (ICER) will be used to analyse the cost-effectiveness of the WPJ intervention. RESULTS Study funding was secured from a Proof of Concept grant in July 2018. IRB approval for the data collection sites was obtained between 2017 and 2019. Data collection began in August 2019 with expected completion date of January 2022. Subject recruitment (N = 120) was completed in May 2021. Effectiveness and cost-effectivenss analyses are expected to be completed by July 2022 and December 2022 respectively. These timelines are subject to change due to Covid-19. CONCLUSIONS This is the first multisite pragmatic trial of WPJ based on the recruitment of children referred directly to routine clinical services in Japan. This multisite randomized trial tests the effectiveness of WPJ with children and families by comparing WPJ directly to the usual clinical care on offer for children diagnosed with ADHD in Japan. We also seek to assess and compare the cost effectiveness of WPJ with TAU in Japan. CLINICALTRIAL The study was retrospectively registered with ISRCTN after the first of three waves of participant recruitment. Trial registration number: ISRCTN66978270 (https://www.isrctn.com/ISRCTN66978270).

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Defining well-being in community development from the ground up: a case study of participant and practitioner perspectives

Community Development Journal ◽

10.1093/cdj/bsy048 ◽

2018 ◽

Vol 55 (2) ◽

pp. 237-257 ◽

Cited By ~ 1

Author(s):

Annette Coburn ◽

Sinéad Gormally

Keyword(s):

Mental Health ◽

Community Development ◽

Well Being ◽

Community Safety ◽

Health Improvement ◽

Advisory Group ◽

Human Flourishing ◽

Briefing Paper ◽

Safety Consideration ◽

Development Practice

Abstract The concept of well-being is part of an inter-disciplinary agenda for health improvement and human flourishing, critiqued as a superficial ‘solution’ to structural inequality (Friedli, L. (2003) Mental Health Improvement ‘concepts and definitions’: briefing Paper for the National Advisory Group, Scottish Executive, Edinburgh; White, S. C. (2010) Analysing wellbeing: a framework for development practice, Development in Practice, 20 (2), 158–172). This article discusses an evaluation of three health promoting community projects, over a two-year period. The study identifies important features for understanding well-being at grassroots, community and practice levels. Local people had viable and holistic perceptions of well-being that helped them reflect on their current contexts. Practitioners tended to have a more limited conceptualization by associating wellbeing with mental health or community safety. Consideration of findings identified five conditions of wellbeing for community development practice: creating a sense of community; strong volunteering ethos; networking and partnership working; positive language; enhanced relationships. Applying these findings in practice helped to create a new reflective grid, incorporating seven elements of well-being. Participants found this grid easy to use and affirming in facilitating reflection on their personal well-being. This was also beneficial for community practitioners, who were not clinically qualified, to facilitate reflective learning at grassroots level. Analysis of this research enables a conclusion to be drawn to suggest that well-being is a valuable construct in unifying community development.

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