User violence in mental health services: Adaptation of an instrument. Healthcare-workers’ Aggressive Behavior Scale-Users-Mental Health Version (HABS-U-MH)

Abstract Background The Covid-19 pandemic has imposed extraordinary strains on healthcare workers. But, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic. Methods The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. Results Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. Conclusions Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings can help in identifying targets for support.

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Experiences of NHS Mental Healthcare Workers During the Covid-19 Pandemic: Qualitative Study

10.21203/rs.3.rs-301568/v1 ◽

2021 ◽

Author(s):

Elisa Liberati ◽

Natalie Richards ◽

Janet Willars ◽

David Scott ◽

Nicola Boydell ◽

...

Keyword(s):

Mental Health ◽

Decision Making ◽

Mental Health Services ◽

Health Services ◽

Healthcare Workers ◽

Clinical Decision Making ◽

Health Workers ◽

Comparative Method ◽

Mental Healthcare ◽

Community Mental Health Services

Abstract Background: The Covid-19 pandemic has imposed extraordinary strains on healthcare workers, but, in contrast with acute settings, relatively little attention has been given to those who work in mental health settings. We aimed to characterise the experiences of those working in English NHS secondary mental health services during the first wave of the pandemic.Methods: The design was a qualitative interview-based study. We conducted semi-structured, remote (telephone or online) interviews with 35 members of staff from NHS secondary (inpatient and community) mental health services in England. Analysis was based on the constant comparative method. Results: Participants reported wide-ranging changes in the organisation of secondary mental health care and the nature of work in response to the pandemic, including pausing of all services deemed to be “non-essential”, deployment of staff across services to new and unfamiliar roles, and moves to remote working. The quality of participants’ working life was impaired by increasing levels of daily challenge associated with trying to provide care in trying and constrained circumstances, the problems of forging new ways of working remotely, and constraints on ability to access informal support for decision-making. Participants were confronted with difficult dilemmas relating to clinical decision-making, prioritisation of care, and compromises in ability to perform the therapeutic function of their roles. Other dilemmas centred on trying to balance the risks of controlling infection with the need for human contact. Many reported features of moral injury linked to their perceived failures in providing the quality or level of care that they felt service users needed. They sometimes sought to compensate for deficits in care through increased advocacy, taking on additional tasks, or making exceptions, but this led to further personal strain. Many experienced feelings of grief, helplessness, isolation, distress, and burnout. These problems were compounded by sometimes poor communication about service changes and by staff feeling that they could not take time off because of the potential impact on others. Some reported feeling poorly supported by organisations. Conclusions: Mental health workers faced multiple adversities during the pandemic that were highly consequential for their wellbeing. These findings help in identifying targets for support.

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Physical intervention to manage aggression in older adults: how often is it employed?

International Psychogeriatrics ◽

10.1017/s1041610208007047 ◽

2008 ◽

Vol 20 (4) ◽

pp. 855-857 ◽

Cited By ~ 16

Author(s):

Brendon Stubbs ◽

Graeme Yorston ◽

Caroline Knight

Keyword(s):

Mental Health ◽

Older Adults ◽

Mental Health Services ◽

Health Services ◽

Aggressive Behavior ◽

Nursing Staff ◽

Clinical Excellence ◽

Safe Management ◽

Hands On ◽

Special Hospitals

There has been growing concern about the levels of violence on psychiatric wards in recent years, which has led to increased emphasis on the safe management of such behavior. Physical intervention (PI) is a form of “hands on restraint” to manage the aggressive patient. PI was originally introduced as control and restraint in high security special hospitals in the mid-1980s to enable nursing staff to manage aggressive behavior in a systematic manner. The use of PI is highly emotive and controversial, yet staff are trained in the techniques across all mental health services in the U.K. (Wright et al., 2005). To be legally and ethically justifiable, the form of PI employed must be an appropriate, proportionate and reasonable response to the risk posed and be terminated at the earliest possible opportunity (National Institute of Clinical Excellence, 2005).

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