Opening the doors: Critically examining the locked wards policy for public mental health inpatient units in Queensland Australia

2021 ◽  
pp. 000486742110256
Author(s):  
Neeraj S Gill ◽  
Stephen Parker ◽  
Andrew Amos ◽  
Richard Lakeman ◽  
Mary Emeleus ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Models Of Care ◽  
Persons With Disabilities ◽  
International Evidence ◽  
Queensland Health ◽  
Depth Analysis ◽  
Treat All ◽  
Inpatient Units

The Queensland Government issued a policy directive to lock all acute adult public mental health inpatient wards in 2013. Despite criticism from professional bodies and advocacy for an alternative, the policy has been retained to this day. A blanket directive to treat all psychiatric inpatients in a locked environment without individualised consideration of safety is inconsistent with least restrictive recovery-oriented care. It is against the principles of the United Nations Convention on the Rights of Persons with Disabilities, to which Australia is a signatory. It is also contrary to the main objects of the Mental Health Act 2016 (Qld). Queensland Health has reported a reduction in ‘absences without permission’ from psychiatric inpatient wards after the introduction of the locked wards policy; however, no in-depth analysis of the consequences of this policy has been conducted. It has been argued that patients returning late or not returning from approved leave is a more common event than patients ‘escaping’ from mental health wards, yet all may be counted as ‘absent without permission’ events. A review of the international literature found little evidence of reduced absconding from locked wards. Disadvantages for inpatients of locked wards include lowered self-esteem and autonomy, and a sense of exclusion, confinement and stigma. Locked wards are also associated with lower satisfaction with services and higher rates of medication refusal. On the contrary, there is significant international evidence that models of care like Safewards and having open door policies can improve the environment on inpatient units and may lead to less need for containment and restrictive practices. We recommend a review of the locked wards policy in light of human rights principles and international evidence.

scholarly journals Health professionals’ perceptions of how gender sensitive care is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carol O’Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Health Professionals ◽  
Psychiatric Inpatient ◽  
Models Of Care ◽  
Normalisation Process Theory ◽  
Biomedical Model ◽  
Case Study Methodology ◽  
Psychiatric Units ◽  
Inpatient Units

Abstract Background Sexual violence is a global public health issue. It is a form of gender-based violence commonly experienced by women accessing mental health services. The biomedical model has been the dominant model of care in acute psychiatric units, however, there has been a global movement towards more gender-sensitive and trauma-informed models. To date, only a small amount of research has focused on evaluating these models of care and health professionals’ experiences of providing this care. The aim of this study is to gain an in-depth understanding of healthcare professionals’ perceptions of how Gender Sensitive Care (GSC) is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence. Methods This study used case study methodology and the Normalisation Process Theory (NPT) conceptual framework. NPT is a practical framework that can be used to evaluate the implementation of complex models of care in health settings. It included semi-structured interviews with 40 health professionals, document and policy reviews, and observations from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic and content analysis. Results Themes were developed under the four NPT core constructs; 1) Understanding GSC in acute psychiatric units: “Without the corridors there’s not a lot we can do”, 2) Engagement and Commitment to GSC in acute psychiatric units: “There are a few of us who have that gender sensitive lens”, 3) Organising, relating and involvement in GSC: “It’s band aid stuff”, 4) Monitoring and Evaluation of GSC in acute psychiatric units: “We are not perfect, we have to receive that feedback”. Discussion Many health professionals held a simplistic understanding of GSC and avoided the responsibility of implementing it. Additionally, the competing demands of the biomedical model and a lack of appraisal has resulted in an inconsistent enactment of GSC. Conclusions Health professionals in this study enacted GSC to varying levels. Our findings suggest the need to address each NPT construct comprehensively to adequately implement GSC.

scholarly journals Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units.

2019 ◽  
Author(s):  
Carol O'Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Professional Training ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Structured Interviews ◽  
Trauma Informed ◽  
Inpatient Units

Abstract Background Survivors of sexual violence commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units.Methods This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis.Results Three main themes were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. Discussion Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences.Conclusions Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.

scholarly journals Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units.

2019 ◽  
Author(s):  
Carol O'Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Professional Training ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Structured Interviews ◽  
Trauma Informed ◽  
Inpatient Units

Abstract Background: Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units. Methods: This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis. Results: Three main typologies were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. Discussion: Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences. Conclusions: Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perceptions and promote trauma-informed and gender-sensitive care across all disciplines, genders and levels of experience.

scholarly journals Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carol O’Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Professional Training ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Structured Interviews ◽  
Trauma Informed ◽  
Inpatient Units

Abstract Background Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units. Methods This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis. Results Three main typologies were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. Discussion Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences. Conclusions Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.

Queensland smoking care in adult acute mental health inpatient units: Supporting practice change

2020 ◽  
Vol 54 (9) ◽  
pp. 919-927
Author(s):  
Sally Plever ◽  
Irene McCarthy ◽  
Melissa Anzolin ◽  
Brett Emmerson ◽  
John Allan ◽  
...  
Keyword(s):  
Mental Health ◽  
Smoking Cessation ◽  
Clinical Practice ◽  
Mental Health Services ◽  
Health Services ◽  
Smoking Status ◽  
Public Mental Health ◽  
Practice Change ◽  
Public Mental Health Services ◽  
Inpatient Units

Objective: To review a clinical practice improvement approach to statewide implementation of smoking care in adult acute mental health inpatient units across public mental health services in Queensland. Method: Queensland public mental health services, with adult acute inpatient units, joined a statewide collaborative to work together to increase the routine screening of smoking and delivery of a Smoking Cessation Clinical Pathway brief intervention to identified smokers. Results: Over a 2-year period, statewide improvements were demonstrated in the recording of smoking status (88–97%) and in the provision of a brief smoking cessation intervention to smokers (38–73%). In addition, all individual mental health services increased the delivery of a brief intervention to identified smokers and the recording of smoking status either improved or remained at high levels. Conclusion: Smoking remains an ongoing challenge for mental health services and one of the most important physical health issues for people living with a mental illness. The ability to implement statewide smoking care in public mental health services is an important step in shifting poor health outcomes. The clinical practice change approach adopted in Queensland has demonstrated encouraging outcomes in improving the delivery of smoking care that has been sustained over a 2-year period.

scholarly journals How health care systems let our patients down: a systematic review into suicide deaths

2020 ◽  
Vol 32 (5) ◽  
pp. 285-291
Author(s):  
Marianne Wyder ◽  
Manaan K Ray ◽  
Helena Roennfeldt ◽  
Michael Daly ◽  
David Crompton
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Family Involvement ◽  
English Language ◽  
Data Extraction ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Full Data ◽  
Data Set ◽  
System Errors

Abstract Purpose To synthesize the literature in relation to findings of system errors through reviews of suicide deaths in the public mental health system. Data sources A systematic narrative meta-synthesis using the PRISMA methodology was conducted. Study selection All English language articles published between 2000 and 2017 that reported on system errors identified through reviews of suicide deaths were included. Articles that reported on patient factors, contact with General Practitioners or individual cases were excluded. Data extraction Results were extracted and summarized. An overarching coding framework was developed inductively. This coding framework was reapplied to the full data set. Results of data synthesis Fourteen peer reviewed publications were identified. Nine focussed on suicide deaths that occurred in hospital or psychiatric inpatient units. Five studies focussed on suicide deaths while being treated in the community. Vulnerabilities were identified throughout the patient’s journey (i.e. point of entry, transitioning between teams, and point of exit with the service) and centred on information gathering (i.e. inadequate and incomplete risk assessments or lack of family involvement) and information flow (i.e. transitions between different teams). Beyond enhancing policy, guidelines, documentation and regular training for frontline staff there were very limited suggestions as to how systems can make it easier for staff to support their patients. Conclusions There are currently limited studies that have investigated learnings and recommendations. Identifying critical vulnerabilities in systems and to be proactive about these could be one way to develop a highly reliable mental health care system.

Absconding from Public Mental Health Inpatient Units – Who Does it, and why?

2020 ◽  
Author(s):  
Sonja CABARKAPA ◽  
Raja Sadhu ◽  
Joel King ◽  
Nathan Dowling ◽  
Raghavakurup Radhakrishnan ◽  
...  
Keyword(s):  
Mental Health ◽  
Public Mental Health ◽  
Inpatient Units

Factors affecting restraint practices in psychiatric inpatient units: A sample from a mental health hospital in Turkey

2016 ◽  
Vol 33 (S1) ◽  
pp. S194-S194
Author(s):  
U. Ozer Ceri ◽  
U. Uzun ◽  
B. Sancak ◽  
V. Ceri ◽  
S. Ozen
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
Related Disorder ◽  
Factors Affecting ◽  
Significant Difference ◽  
Competing Interest ◽  
New Guidelines ◽  
Inpatient Units

IntroductionNew guidelines aimed to minimize restraint in psychiatry clinics due to ethical reasons.ObjectivesFurther studies investigating factors affecting the decision of restraint and its potential benefits and harms are needed.AimsWe aimed to determine current rates of restraint in psychiatric clinics and sociodemographic/clinical variables which may be related with restraint practices.MethodsThe study was conducted in 64-bed male and 28-bed female psychiatric inpatient units, between March 1–May 31 2015. Sociodemographic and clinical data forms were completed using case files and restraint records.ResultsIn a total number of 481 inpatients (351 males, 130 females), number of restrained patients was 98 (20.3%) (90 (25.7%) males, 8 (6.2%) females). There was no significant difference in sociodemographic characteristics between restrained and unrestrained patients, but duration of the illness and electroconvulsive therapy rates were significantly different. Substance abuse (44.4%) was higher in restrained male patients. Also, restraint rates were higher in patients having a diagnosis of substance-related disorder compared to other diagnoses. Restraints occurred most commonly in the first day (48%) of hospitalization.ConclusionsThe studies carried out in psychiatric hospitals suggested major differences in the rates and types of restraints among different countries and institutions. In our study, a higher restraint rate is obtained compared to other studies. Consistently with the literature, substance abuse was higher in restrained patients, and restraints occurred most commonly in the first day of hospitalization. Many factors including substance abuse should be considered to reduce restraint rates, which are still quite high in mental health hospitals in Turkey.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Use of personal electronic devices by psychiatric inpatients: benefits, risks and attitudes of patients and staff

2018 ◽  
Vol 26 (3) ◽  
pp. 263-266
Author(s):  
Nick O’Connor ◽  
Katherine Zantos ◽  
Viviana Sepulveda-Flores
Keyword(s):  
Mental Health ◽  
New South ◽  
Electronic Devices ◽  
Psychiatric Inpatient ◽  
New South Wales ◽  
Psychiatric Inpatients ◽  
Local Policy ◽  
South Wales ◽  
Potential Benefits ◽  
Inpatient Units

Objectives: The study aimed to evaluate the attitudes of patients and staff in relation to the potential benefits and risks of allowing psychiatric inpatients controlled access to personal electronic devices (PEDs), and to document a snapshot audit of practice within the mental health inpatient units of New South Wales, Australia. Methods: Psychiatric inpatients and staff at Royal North Shore Hospital’s Mental Health inpatient units were surveyed, and an audit of the policies of the psychiatric inpatients of New South Wales was undertaken. Results: Access to PEDs is denied in 85% of New South Wales psychiatric inpatient units. While patients and staff appear to concur on the risks of access to PEDs and the need for risk assessment and rules, compared to patients, staff appear to underestimate the importance of PEDs to maintaining social connection and recovery. Conclusions: This study may assist in the formulation of local policy and procedure to allow a more recovery-oriented approach to the question of whether patients should have access to their PEDs while in hospital.

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