Search

Accessible summary: What is known on the subject?: Engagement is regarded as important and beneficial for service users and mental health servicesA universal definition of engagement is not yet fully agreed upon. What this paper adds to existing knowledge?: Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users).Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users. What are the implications for practice?: Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement.Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings.Role descriptions and expectations of community mental health workers should account for the wide‐ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes. Introduction: Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals' experiences and understanding of effective engagement have been published. Aim: This review aimed to systematically identify, evaluate and synthesize results from these studies with a view to informing effective practice in this area. Methods: Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners' experiences of engagement in community mental health settings was conducted. Results: Mental health practitioners see engaging service users as depending upon complex, multi‐dimensional phenomena which should include individualized person‐centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users. Implications for practice: As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner's engagement experiences in early intervention settings. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Personal experiences of self-injury and staff reactions have been published., What this paper adds to existing knowledge? There is an absence of a detailed account of the interpersonal processes surrounding self-injury within a specific helping relationship., This paper is the first to explore the in-depth relationship between self-injury and shame., What are the implications for practice? This research identifies a cycle of shame in which people come to expect negative responses from others, which further reinforce their negative beliefs and supports a continuing cycle of harm., Mental Health Nurses may work with clients to understand the interpersonal processes and consequences of their self-injury in the helping relationship., Abstract Introduction Literature on self-injury has recognized the impact on the relationship between clients and staff. Rationale There is an absence of a detailed account of interpersonal processes surrounding self-injury. Aim A Bricolage qualitative research approach was carried out in the United Kingdom that explored the interpersonal processes surrounding self-injury. Method Three pairs of clients and staff were interviewed about an incident of self-injury. The interviews were thematically analysed and then synthesized producing a deeper exploration of the relationship between the client and staff. Findings An interpersonal trigger followed by anger and shame, resulted in self-injury to 'numb' these experiences. Discussion Self-injury is conceptualized as a safety behaviour to avoid shame and anger and then as a maintenance cycle that traps the client in a reinforcing and rejecting relationship. Staff interviewed were able to reflect with the clients and help them reframe these experiences. Implications for practice Mental Health Nurses can work with clients to understand their own interpersonal cycles of self-injury. They can then reflect on their own roles in this process and avoid reinforcing the clients' negative beliefs. What the study adds to international evidence This is the first international paper to explore the interconnection between the client and a professional helper in their lived experiences of self-injury. [ABSTRACT FROM AUTHOR]

Accessible summary The idea for this research and practice development project emerged from the production of a recently published book of recovery narratives, written by a community of people broadly working in the mental health recovery movement., The research component of this project, described in this paper, sits within: narrative inquiry as a moral endeavour in the human sciences; the pedagogy of suffering in the sociology of health and illness; and mental health narrative recovery., Two inter-related data sources will be used in the research. The first is chapters contributed by authors to the book. The second is interview data from those authors., Integrative textual and interview transcript analysis will extend to the end of 2012., The research component of this project represents a commitment to a mental health nursing practice allied to recovery as narrative healing as opposed to forms of psychiatric nursing which endorse and tacitly support abuses committed in the name of institutional psychiatry., Abstract This paper, part one of a two paper report, describes key aspects of the research context of an ongoing practice development project, conducted on two UK sites. The paper begins with a discussion of the project's origins within a community of people working in the recovery paradigm, including the contributory strand of the first author's recovery and survivor writing. The discussion then turns to three inter-related areas within which the research component sits and which provide it with philosophical, theoretical and conceptual coherence. Each area will be unpacked and its significance explained. This will provide a platform for discussing the focus, methodology and methods of the research, and related assumptions governing both data collection and analysis. The paper concludes with a research commitment to a mental health nursing practice allied to recovery as narrative healing. Links are made to the second paper which describes the context and specifics of a Writing for Recovery project for users, survivors and carers. This shares with, and builds on, the overall project's research context and its assumptions. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Family focused practice leads to positive outcomes for parents and children., There are barriers and enablers for practitioners being family focused., What this paper adds to existing knowledge? Worker skill, knowledge and confidence about family work are the most important factors associated with family focused practices., What are the implications for practice? Mental health nurses require specific skill training in family focused practices, time to engage with clients on parenting issues and that there are adequate services to refer family members to., Abstract Introduction Family focused practice is thought to lead to positive outcomes for all family members. However, there are multiple barriers and enablers in adult mental health services to practitioners undertaking these actions. Aim The aim of this study was to examine the relative importance of worker, workforce and family factors to predict family focused practices ( FFPs) in adult mental health services. Method Three hundred and seven adult mental health workers completed a 45 items family focused practice measure of 16 family focused practices. Thesis It was found that worker skill and knowledge about family work and an ability to assess the degree of parental insight into the child's connections to other family members and the community were important predictors of FFP, along with the closely related-worker confidence. While aspects of the worker, workplace and family each contribute to FFPs, this study highlighted the importance of worker skill, knowledge and confidence as central issues for adult mental health workers. Implications for practice Study implications include the need for training in specific FFPs, the provision of time to engage with clients on parenting issues and the need 5 to ensure that there are adequate services for workers to refer family members to. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? UK mental health policy dictates user involvement in mental health care planning., Service users report feeling marginalized in the care planning process., Ongoing dissatisfaction with care planning involvement suggests a failure to translate policy into practice over time., What this paper adds to existing knowledge? Service user involvement should no longer be regarded as a nebulous concept., Ten key criteria underpin service user satisfaction with care planning involvement., Five criteria characterizing the process of care planning involvement are prioritized by service users., What are the implications for practice? Service users can conceptualize and describe meaningful user involvement. Service user requests, summarized through a 10C framework of care planning involvement, provide a clear structure for practice improvement., Abstract Background Service users wish to be involved in care planning but typically feel marginalized in this process. Qualitative explorations of the barriers and enablers of user involvement in mental health care planning are limited. Question How is user involvement in care planning conceptualized by service users and how can meaningful involvement be instilled in the care planning process? Methods In 2013, we conducted five focus groups ( n = 27) and 23 individual interviews with current or recent adult users of secondary care mental health services ( n = 27) in England. Eight users participated in both. Data were analysed using Framework Analysis. Results Ten themes emerged from the data: these themes encompassed procedural elements (connection; contribution; currency; care consolidation; and consequence), service user characteristics (capacity and confidence) and professional enablers (consultation; choice; and clarity of expression). Procedural elements were discussed most frequently in service user discourse. Discussion The process of care planning, centred on the user-clinician relationship, is key to user involvement. Implications for Practice Users describe a common model of meaningful involvement in care planning. Their requests, summarized through a 10C framework of care planning involvement, provide clear direction for improving service users satisfaction with care planning and enhancing the culture of services. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? Many studies indicate that working with people with a personality disorder is a real challenge, which is especially known by professionals, and it also displays different attitudes that can affect their professional stance. There is no specific study examining those difficulties, emotional reactions and attitudes of mental health professionals towards people with a PD in Turkey., What this paper adds to existing knowledge? We examined emotional reactions, difficulties and attitudes of mental health professionals towards people with a PD and also the interaction between these variables. We found a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing boundaries against people with a PD. Besides, a higher level of education resulted in reduced experience of difficulties while working with patients with a diagnosis of 'PD' among nurses., What are the implications for practice? Mental health professionals and especially nurses who spend most of their time working with people with PD in the inpatient services need to be well educated and be experienced in coping with patients' relational problems and emotional fluctuations, and also be aware of their own emotional reactions., Abstract Introduction Working with people with a personality disorder ( PD) can arouse strong feelings, and cause difficulties as well as different attitudes among mental health workers ( MHWs). While attitudes towards people with PD and the difficulties experienced by MHWs have been previously investigated, the reciprocal relationship between the two has not been thoroughly investigated. Aim/Question This study aims to investigate (1) affective reactions of MHWs to people with personality disorders, (2) the difficulties that MHWs experience while working with these patients, (3) their attitudes towards these patients, and (4) the interaction between these variables. Method The data for this study were collected through a Personal Information Questionnaire, the Difficulty of Working with Personality Disorders Scale and the Attitudes towards Patients with Personality Disorders Scale from 332 MHWs from several mental health clinics in Turkey, all of whom were experienced in working with people with PD. Results The results indicate that the participants described 'difficulty in forming a relationship, understanding the client, and estab lishing cooperation' among the primary reasons of difficulties. This study also shows that there is a strong relationship between MHWs' feelings of boredom/discontent, guilt/pity and a tendency to display positive behaviours/an inability of establishing borders against people with PD. Discussion The findings of this study imply that the level of education, expertise, psychotherapy treatment and clinical supervision of MHWs all affect perceived difficulties and attitudes towards people with PD. It is also noted that among nurses, a higher level of education results in reduced experience of difficulties while working with patients with PD. Implication for practice The results foreground the need for specific skills to be developed in MHWs through theoretical training, case-focused supervision and receiving personal psychotherapy for MHWs. [ABSTRACT FROM AUTHOR]