The evaluation of a physical health promotion intervention for people with severe mental illness receiving community based accommodational support: a mixed-method pilot study

Background Unhealthy lifestyle constitutes a cause of increased morbidity and mortality in people with severe mental illness. The aim of this mixed-method pilot study was to investigate the feasibility and preliminary effectiveness of an intervention to promote a health-conscious lifestyle in comparison to care as usual among people with severe mental illness receiving accommodational support in community settings. Methods This was a prospective, quasi-experimental, controlled study over four six-month assessment points (t0, + 6 months, + 12 months, + 18 months) with 70 persons with severe mental illness receiving community based accommodational support. Mental health staff members of the housing facilities were trained in Motivational Interviewing and conducted a six-week health course with the intervention group participants in addition to care as usual. Next to the primary outcome - self-rated physical well-being (FEW 16) - anthropometric parameters and unhealthy behaviours (diet, physical activity, alcohol and tobacco consumption, and oral hygiene) were examined. Effectiveness analysis was conducted using mixed-effects regression models with propensity score adjustment to control for selection bias. One year after the end of the intervention, semi-standardized expert interviews were conducted with 12 of these employees and evaluated by content analysis. Results The qualitative interviews with mental health staff underline the intervention’s feasibility in people with severe mental illness in sheltered housing, and the acceptability of and satisfaction with the intervention among mental health workers. But in this pilot study no superiority of the HELPS intervention compared to routine care could be demonstrated in terms of the investigated outcomes. Conclusions The findings of this pilot study underscore the feasibility and acceptability of health promotion programmes based on Motivational Interviewing and highlight the need to further develop multi-modal programs according to the needs of the target group. Long-term and sustainable support for healthy lifestyles of people with severe mental illness receiving community mental health care requires multi-modal concepts and organisational change. Trial registration DRKS00011659, date of registration was 2017/02/15; retrospectively registered as date of first enrolment was 2017/01/24.

Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19

Universal screening for suicidal ideation in primary care and mental health settings has become a key prevention tool in many healthcare systems, including the Veterans Healthcare Administration (VHA). In response to the coronavirus pandemic, healthcare providers faced a number of challenges, including how to quickly adapt screening practices. The objective of this analyses was to learn staff perspectives on how the pandemic impacted suicide risk screening in primary care and mental health settings. Forty semi-structured interviews were conducted with primary care and mental health staff between April-September 2020 across 12 VHA facilities. A multi-disciplinary team employed a qualitative thematic analysis using a hybrid inductive/deductive approach. Staff reported multiple concerns for patients during the crisis, especially regarding vulnerable populations at risk for social isolation. Lack of clear protocols at some sites on how to serve patients screening positive for suicidal ideation created confusion for staff and led some sites to temporarily stop screening. Sites had varying degrees of adaptability to virtual based care, with the biggest challenge being completion of warm hand-offs to mental health specialists. Unanticipated opportunities that emerged during this time included increased ability of patients and staff to conduct virtual care, which is expected to continue benefit post-pandemic.

Establishing and Understanding of Group Dynamics and Process within Single-Session Music Therapy Groups Open to Both Adolescents with Mental Illness and Mental Health Staff

<p>The purpose of this research was to gain an understanding of group dynamics and process within single-session music therapy groups open to both adolescents and mental health staff. The study investigated factors that influenced group dynamics; how existing understandings of group process were evidenced within the sessions and how the groups could best be facilitated. A qualitative, exploratory method was used. Secondary analysis of clinical data from seven group music therapy sessions was carried out. A process of thematic analysis was applied to the narrative data and recordings of group improvisations were analysed using an adapted version of the Music Therapy Group Improvisation Analysis Model (MTGI-AM). It was found that developmental group process was evident within single sessions of music therapy. For example, a process of moving from disconnection, to establishing common ground, developing musical cohesion, then taking risks and negotiating closure, was audible within group improvisations. Group dynamics were affected by the physical environment and wider institutional contexts; by the leadership styles and structures implemented; the contributions of group members; the quality of existing and emerging connections between individuals; and aspects of the individuals themselves. The structure of music provided stability, mediated energy levels and presented opportunities for individuals to develop leadership and autonomy. Groups became more autonomous and took more risks as musical and interpersonal cohesion was established.</p>

Establishing and Understanding of Group Dynamics and Process within Single-Session Music Therapy Groups Open to Both Adolescents with Mental Illness and Mental Health Staff

<p>The purpose of this research was to gain an understanding of group dynamics and process within single-session music therapy groups open to both adolescents and mental health staff. The study investigated factors that influenced group dynamics; how existing understandings of group process were evidenced within the sessions and how the groups could best be facilitated. A qualitative, exploratory method was used. Secondary analysis of clinical data from seven group music therapy sessions was carried out. A process of thematic analysis was applied to the narrative data and recordings of group improvisations were analysed using an adapted version of the Music Therapy Group Improvisation Analysis Model (MTGI-AM). It was found that developmental group process was evident within single sessions of music therapy. For example, a process of moving from disconnection, to establishing common ground, developing musical cohesion, then taking risks and negotiating closure, was audible within group improvisations. Group dynamics were affected by the physical environment and wider institutional contexts; by the leadership styles and structures implemented; the contributions of group members; the quality of existing and emerging connections between individuals; and aspects of the individuals themselves. The structure of music provided stability, mediated energy levels and presented opportunities for individuals to develop leadership and autonomy. Groups became more autonomous and took more risks as musical and interpersonal cohesion was established.</p>

Evaluating patients and healthcare professionals' understanding of voting rights for patients in government elections

AimsTo understand whether mental health patients vote in government electionsTo ascertain the barriers that prevent them from doing soTo explore ways in which mental health services can support patients to voteTo determine whether mental health staff are aware of patients’ right to voteBackgroundMembers of Parliament (MPs) can influence decisions regarding the National Health Service (NHS) and mental health legislation. The general election on 12th December 2019 highlighted that many patients were not using their democratic right to vote. It also appeared that many staff members were not aware that patients under the Mental Health Act (MHA) were entitled to vote (except for those under ‘forensic’ sections of the MHA). We therefore conducted a survey to ascertain both patient and staff understanding of their democratic rights and to better understand how we could increase the rate of voting amongst psychiatric patients.MethodTwo questionnaires were produced, one for patients and the other for staff members. This was tested by the clinical governance team before approval was granted. Data were collected at the Coventry and Warwickshire Partnership NHS Trust in the form of paper forms or electronically through a survey website. Forty-two patients and twenty-five staff members responded.ResultNo staff members had received formal training with regards to patients’ right to vote. Over half of staff members incorrectly believed that patients under Section 2 or 3 of the MHA and those lacking capacity couldn't vote. More than half of the team members surveyed stated that they had not supported patients in registering or casting a vote. Roughly one third of healthcare professionals felt that it was their responsibility to promote patients’ right to vote, with one third disagreeing and the remaining third unsure.Over 75% of patients did not vote but less than one quarter of all patients surveyed felt support from mental health services would increase the likelihood of them voting. The main barriers to voting were being mentally unwell, hospital admission or a lack of knowledge on the candidates and election process.ConclusionBasic training is required to improve staff knowledge of patients’ voting rights, which should help improve their ability to support patients to vote. Trusts should have a clear protocol in place in the event of future elections, with information on who can vote, how to request a postal vote and the candidates in that area.

Improving attitudes towards the COVID-19 vaccine in forensic mental health workers: a quality improvement project

AimsThe primary aim of the project was to improve attitudes towards the COVID-19 vaccine in forensic mental health staff at a large regional tertiary forensic psychiatry unit. The main variable examined was attitudes towards safety of the vaccine. Secondary aims included decreasing misinformation about the vaccine and improving vaccine uptake.MethodPaper questionnaires were distributed to willing staff members across 6 forensic inpatient wards within the North London Forensic Service. Participants included a range of allied health professionals including nurses, health care assistants, ward managers, occupational therapists, assistant therapists and administrative staff. Questionnaires used a mixture of Likert scale for agreement/disagreement with statements and yes/no questions.Plan-Do-Study-Act (PDSA) methodology was utilised in implementing changes, and repeat questionnaires used to measure changes in attitude and behaviour. Change ideas implemented included the creation of ‘mythbusters’ posters which target vaccine misinformation, the creation and distribution of posters of staff members who had already taken their vaccine, the creation of vaccine champions to aid engagement in conversation about the vaccine, vaccine information packs being distributed to all wards and the opportunity for staff to ‘drop-in’ to clinics for information about the vaccine.ResultVaccine uptake improved from 7% before interventions to 69% after interventions.The proportion of people very unlikely or unlikely to get the vaccine reduced from 25% to just 9%. The proportion of those feeling neutral reduced from 32% to 6%. The proportion of those either likely or very likely to get the vaccine increased from 34% to 85%.Before interventions only 20% felt that the vaccine was either safe or very safe. This improved to 63% after interventionsBefore interventions, only 27% of respondents felt they had received enough information by the trust to make an informed decision. After interventions, 80% said they had received enough information.The project was successful in reducing misinformation in every domain. Particularly reassuring was the reduction to zero of some of the most harmful misinformation claims, such as the presence of a tracking chip in the vaccine and the belief that COVID does not exist.71% of respondents indicated the interventions we set out changed their view on the COVID-19 vaccine.ConclusionThe changes implemented lead to clear improvements in all domains measured, suggesting targeted information is an effective strategy in improving uptake and attitudes around the vaccination program.

COVID-19 and ECT – a Victorian perspective

Objectives: (i) to describe the operational strategies implemented to practise electroconvulsive therapy (ECT) safely, and (ii) to explore the effect of the lockdown and operational strategies on the characteristics of patients who received ECT during the initial 6 months of the COVID-19 lockdown. Methods: At first, the operational strategies that were implemented at the Broadmeadows ECT suite were summarised. Subsequently, the characteristics of patients who received ECT in the lockdown period (16 March–16 September 2020) and in the comparison period (16 March–16 September 2019) were compared. Results: Many safety measures were implemented, and there was no COVID-19 infection among mental health staff and patients. In the lockdown period, the number of patients (23.9%) and the total number of ECTs (29.4%) were less. This pattern was more prominent among the aged patients. Conclusion: Safe practices are essential to provide ECT during lockdowns even when the community transmission of COVID-19 is high.