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Child sexual abuse (CSA) is an issue of epidemic proportions in the United Kingdom (UK) and an international public health problem. Evidence suggests that in the UK one in 20 children have been sexually abused, with one in three not telling anyone about it at the time of the abuse. Conservative estimates suggest that around one in six men have experienced sexual abuse before the age of 18. CSA has been correlated with the development of numerous mental health problems, abused men often displaying externalizing behaviours, including substance misuse, 'risky' sexual behaviours, anti-social behaviour, and offending. This article reports on one aspect of a research study focusing specifically on male survivors of CSA and its effect on their mental health. Using narrative research, face-to-face interviews were used to collect the stories of four men who participated in the research. Interviews were audio-recorded and transcribed verbatim. Analysis used a two-phase approach; initially, each narrative was analysed as a whole, with an across transcripts analysis then being carried out identifying shared themes emerging from the individual stories. Whilst findings from the second phase of the analysis identify four themes, it is the theme of 'Blocking the Memories' that is the focus for this article. Making a valuable contribution to existent knowledge regarding the experiences of men who were sexually abused as children, this article will help to inform mental health practitioners who are likely to deliver care to male survivors of CSA.

Globally, an increasing number of people who Self-Harm (SH) are being treated in mental health hospitals. Incidences of SH are common in secure hospitals, with those using the behaviour being highly dependent on staff for care and support but impacting on often limited resources. While literature related to the lived experiences of people who SH exists, this is in its infancy in African countries. The aim of this study was to explore the lived experiences of people who SH in two secure mental health hospitals in Ghana. Interpretive Phenomenological Analysis (IPA) was used to explore the experiences of people who SH in two secure mental hospitals in Ghana. A convenience sample of nine participants were recruited and face-to-face in-depth semi structured interviews were used to collect data. With the permission of each participant, all interviews were audio recorded and notes were made by the researcher (first author). Each interview was transcribed and analysed using the IPA seven-step approach, with three superordinate and 11 subordinate themes being identified. The superordinate themes were: Being let down; Living with the negative self; Forces of the supernatural and religion. Findings demonstrate that there is a need to develop a collaborative health care package if appropriate care and support is to be offered to people in secure settings who use high-risk behaviours, such as SH. To ensure care is holistic, culturally, and temporally relevant research is needed, particularly in Sub-Saharan Africa.

Background: Stress, and particularly burnout, is a major problem among healthcare workers and can lead to high staff turnover and low patient/client satisfaction. Objective: To explore the impact of 3-day compassion-focused therapy training on those delivering education to healthcare students. The underpinning premise was that the training course could potentially be replicated through the participants’ work with students embarking on a career within the helping professions. Design: Mixed-methods study, with the qualitative findings being presented in this paper. Setting: Training course was delivered in one higher education institution in England. Methods: In total, 44 healthcare lecturers attended the course, with 6 taking part in a reflective focus group. Findings: The analysis highlighted four main themes: reassurance and increased knowledge, increased compassion towards others, self-compassion and empathy, and blocks to compassion. Conclusion: Findings add to previous quantitative research findings showing that participants who undertook training were able to engage with their compassionate self and consider the importance of showing compassion towards the self and others in healthcare education.

The purpose of this paper is two-fold: Firstly, it reports on one man's experience of bulimia. After being interviewed it became evident that he did not meet the inclusion criteria for the study, which was focussed on anorexia in men. Secondly, the paper explores the implications for a novice researcher of including someone in a study who does not meet the inclusion criteria. The researcher's story reflects upon the implications of self-doubt when embarking upon sensitive research, and the morality of holding onto a rogue participant's story. It offers others an opportunity to consider and learn from this experience.

Background A key component of caring for service users (SUs) in acute mental health inpatient environments is Therapeutic Engagement (TE). To that end, the Therapeutic Engagement Questionnaire (TEQ) was developed and validated. The TEQ measures TE between SUs and registered mental health nurses (RMHNs) from the perspective of both parties and can quantify and recognise how nurses engage with SUs and monitor this activity as well as its enhancement of SU care and recovery. The aim of this study was to explore the views of SUs and RMHNs in relation to the TEQ and how it could be adopted into clinical practice within an acute inpatient environment. Methods As part of the validation stage of the development of the TEQ, the views of 628 SUs and 543 RMHNs were collected using a qualitative approach by way of free text at the end of the questionnaire. Two questions required free text response: – ‘what do you think of the TEQ?’, and ‘how can it be utilised?’ Results Following thematic analysis, it was found that both sets of participants stated that such a tool could be utilised to improve the service, could help nurses with reflective practice, be utilised as part of clinical supervision and to aid nurses’ professional development. The nurse participants also stated that such a tool would help track SU participation and enablement in their care. Furthermore, the nurses noted that the tool would help to reinforce the core ‘caring’ value of nursing and the overall goal of recovery. The SUs added that the TEQ would recognise the work of mental health nurses and provide them with a clear opportunity to express their views in relation to nursing staff. Conclusions Therapeutic engagement (TE) has been identified as part of the repertoire of mental health nursing and both groups of participants identified how a tool to assess this construct may be utilised in day-to-day clinical practice to the benefit of each group.

Background\ud Compassion Focused Therapy (CFT) and Compassionate Mind Training (CMT) aim to help people cultivate compassion for self and others. To date, there is little evidence exploring the effects CMT has on those engaged in or embarking on a career in the helping professions. Interventions that encourage self‐reflection and self‐practice may help practitioners cultivate self‐compassion, leading to the promotion of self‐care.\ud \ud Aim\ud To explore the impact CMT has on students’ levels of self‐compassion and self‐criticism, and on their work as healthcare practitioners/counsellors/psychotherapists.\ud \ud Methodology\ud This was a mixed‐methods study (N = 15). Pre‐ and post‐quantitative data were collected via three questionnaires: The Self‐Compassion Scale‐SF, the Forms of Self‐Criticising/Self‐Attacking and Self‐Reassuring Scale and the Functions of Self‐Criticising/Self‐Attacking Scale. Qualitative data were collected via diaries and a focus group to portray the impact training had on students.\ud \ud Findings\ud Results revealed a statistically significant increase in self‐compassion post‐training and a statistically significant increase in scores on the reassured self subscale. Statistically significant reductions in self‐correction scores and inadequate self scores were observed post‐training. There was no statistical significant difference post‐training on the hated self or self‐persecution subscales. Themes identified from the weekly diaries included the following: the benefits of compassion; when compassion arises; and difficulties and opportunities. Themes identified by the focus group data included the following: self‐reflection and self‐practice; finding balance; and critical self and compassionate self.\ud \ud Implications\ud Incorporating interventions into education programmes that help student’s foster compassion may help them cultivate a compassionate mindset and learn to be kinder to self.

Globally, the exodus of individuals who have been forced to flee their home and seek refuge in countries of safety has led to a refugee crisis. The United Kingdom (UK) has engaged with the United Nations High Commissioner for Refugees (UNHCR) in playing a significant role in the long-term resettlement of refugees, half of whom are children and young people. One initiative of such humanitarian resettlement is the Gateway Protection Programme (GPP). To date, there is a dearth of studies investigating aspects of acculturation that affect the mental health of young refugees resettled under the UNHCR humanitarian programme. This study aimed to explore aspects of acculturation that could enhance the mental health of GPP young refugees several years after resettlement. Using narrative research, a purposive sample of 31 GPP young refugees, who had a minimum of three-year stay in the UK, were recruited from local refugee community organizations. Data were collected through a multi-method design combining focus group discussions (FGDs) with visual arts-based narrative research (VABNR) and analysed thematically. Three overarching themes emerged: People and places; Its nearly all new to me; and Finding self. This study contributes important knowledge regarding the mental well-being of young people who have engaged in a resettlement programme and offers valuable information for policymakers and mental health professionals working with GPP young refugees.

Service users’ involvement in mental health service research is increasingly acknowledged as important, yet, whilst involving users of mental health services as research participants is commonplace, seeking out their experience and indeed their “expertise” to facilitate the development of tools to be used within mental health services is in its infancy. This article describes the involvement and views of service users in the development of a nursing metric—the Therapeutic Engagement Questionnaire. It presents their role in the three stages of development: generation, statement reduction and authentication.

The number of men diagnosed with anorexia has increased, men now representing 25% of those with eating disorders (EDs). Research has mainly been quantitative and female focused, with only two qualitative studies exploring the experiences of men. This study focused on the lived experiences of men diagnosed with an ED, and its impact on 'everyday' aspects of their lives. Qualitative research adopting narrative interviews was conducted with seven men aged 23-34 years old. Narrative analysis was used to interpret each individual story, with thematic analysis used to explore commonalities across all seven narratives. Four themes were identified, 1) The Final John Doe; 2) Help! I need somebody - Bedlam revisited; 3) Masculinity; 4) Not Working 9 to 5. Narratives highlight the need for further research if men are to receive appropriate mental health care and better understanding and acceptance on the part of society, service providers, employers and men themselves.

Burnout is a common problem among mental health nurses. High levels of burnout result in job dissatisfaction, rapid turnover of staff, physical and psychological discomfort, and a reduction in the quality of patient care. While there is an abundance of research relating to burnout per se, research regarding the impact of burnout prevention programmes is lacking. This study aimed to measure the effects of a burnout prevention programme on mental health nurses working in Saudi Arabia (SA). A quasi-experimental design was used to test the effectiveness of a two-day burnout prevention workshop. The sample consisted of an intervention group (n = 154) and a control group (n = 142). Data collected using the Maslach Burnout Inventory (MBI) measured the effects of the workshop at 1-, 3-, and 6-month intervals after completion of the programme. Data were analysed using the latest version of SPSS. Means, standard deviations, frequencies, and percentages were used to describe the sample and levels of burnout. A t-test, ANOVA, multiple linear regression, and chi-squared were used to measure the effect of the workshop before and at the three time points after exposure. Findings indicate the programme was effective with a significant reduction being reported 1 month after the intervention. However, although not returning to baseline scores, burnout scores had increased at 6 months. In conclusion, while the overall efficacy of the burnout reduction programme is evident, mental health nurses would benefit from having opportunity to use some of the strategies on a regular basis.

Estimates suggest 1 in 4 adults are diagnosed with a depressive episode at some point during their life; however, only one in four people with a diagnosis of depression in the UK receive any form of treatment. To address this, the Improving Access to Psychological Therapies (IAPT) program was established, ensuring people accessing NHS treatment had choice. Initially the only therapy commonly available was Cognitive Behavioural Therapy (CBT), raising concern regarding client choice and prompting the British Association of Counselling and Psychotherapy (BACP) to call for the development of a new evidence-based therapy called “Counselling for Depression” [CfD]. With regard to counselling, it is suggested that without knowing the client's view of their therapy there can be no effective evaluation of that therapy. In light of the above, the focus of this research is on the client's perceptions of CfD, the purpose of the study being two-fold; (1) to explore and evaluate CfD from the perspective of the client (2) to inform the counselling profession of what is taking place within this therapeutic approach as perceived by the client. This qualitative study, using Interpretative Phenomenological Analysis [IPA], focused on twelve clients' perceptions of CfD. Clients receiving CfD completed a Helpful Aspect of Therapy questionnaire after each counselling session and attended a semi-structured interview on completion of counselling. Findings identified four superordinate themes; a helpful process; Client’s view of a counsellor; Gains; and Negative aspects. As no previous study has considered CfD in this way, this study gives voice to the client enabling them to convey their understanding of what they perceive is effective therapy. In addition, this study makes a significant original contribution both to the knowledge base regarding CfD and its effectiveness, and to the professional practice of counselling.

Introduction: In the UK almost 50% of illness diagnosed among working age adults is mental distress, with depression and chronic anxiety cited as the two most prevalent psychological illnesses. However, only 24% of those who experience anxiety and depression, consistent with diagnoses, receive National Health Service (NHS) interventions. Effective mental health care is predicated on understanding the lived experiences of those using services in order to provide sensitively-attuned therapy. An understanding of the process of counselling and what makes it effective will only be achieved through hearing the voices of service users. However, with regard to counselling, the literature foregrounding the perspectives of those using services remains sparse. Method: This paper reports on a qualitative research project, adopting a case study approach, the aim of which was to explore detailed narratives of the experiences of people who had used a voluntary sector mental health counselling service in order to elicit the strengths and/or opportunities for improvement of the service. Twelve participants, five males and seven females, were interviewed on a one to one basis and six themes were identified; Mindful of the Gap; Easing like Sunday Morning; Magic Moments; Love is in the Air; Lighting up a Future and Following up the Changes: Spreading the Word. Results: Findings suggest the service is beneficial, with therapeutic interventions being tailor-made to meet the person’s needs and one which ensures a safe environment and compassionate care for those in distress.

WHAT IS KNOWN ON THE SUBJECT?: While there is no single definition of the concept of recovery for people with mental illness, hope has been recognized as a guiding principle; the belief that it is possible for a person to regain a meaningful life, despite serious mental illness. Little is known about the recovery process of women diagnosed with schizophrenia per se, with only six studies offering the woman's voice identified and these all having taken place in developed countries. No studies on this topic have been carried out in Sub-Saharan Africa, including Swaziland. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study provides unique insight into what is important to Swazi women, diagnosed with schizophrenia, in their process of their recovery. Because of current trends in migration, the findings of this study may provide mental health professionals with a better understand of the needs of those from this particular Sub-Saharan country. The study discusses a range of issues affecting women including being labelled as mentally ill, stigma and discrimination, the importance of the sociocultural context of illness and positive attributes which promote women's recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study provides mental health practitioners with insights and understanding of the lives of women from a Sub-Saharan developing country. This will be helpful for better understanding of the context of mental illness both for practitioners supporting the development of services in such countries and for those working in Western countries with migrant populations.INTRODUCTION: Globally, twenty-four million people live with schizophrenia, 90% living in developing countries. While most Western cultures recognize service user expertise within the recovery process, this is not evident in developing countries. In particular, Swazi women diagnosed with schizophrenia experience stigma from family, community and care providers, thus compromising their recovery process.This study aimed to explore the experiences and meanings of recovery for Swazi women living with schizophrenia.Interpretive phenomenological analysis was used. Fifteen women were recruited from Swaziland National Psychiatric Hospital out-patients' department, and face-to-face interviews were conducted.Four super-ordinate themes were identified: (a) The emotionality of "illness of the brain"; (b) Pain! Living with the illness and with others; (c) She is mad just ignore her; and (d) Being better.Discussion focuses on the findings of this study and a number of positive and negative implications emanating from them: labelling, stigma and the roles of family, culture and religious beliefs on the process of recovery.This study provides practitioners with insight into the importance of the sociocultural context of the lives of women diagnosed with schizophrenia and how, in understanding this, mental health care could be improved.

In Western society, policy and legislation seeks to minimize restrictive interventions, including physical restraint; yet research suggests the use of such practices continues to raise concerns. Whilst international agreement has sought to define physical restraint, diversity in the way in which countries use restraint remains disparate. Research to date has reported on statistics regarding restraint, how and why it is used, and staff and service user perspectives about its use. However, there is limited evidence directly exploring the physical and psychological harm restraint may cause to people being cared for within mental health inpatient settings. This study reports on an integrative review of the literature exploring available evidence regarding the physical and psychological impact of restraint. The review included both experimental and nonexperimental research papers, using Cooper's (1998) five-stage approach to synthesize the findings. Eight themes emerged: Trauma/retraumatization; Distress; Fear; Feeling ignored; Control; Power; Calm; and Dehumanizing conditions. In conclusion, whilst further research is required regarding the physical and psychological implications of physical restraint in mental health settings, mental health nurses are in a prime position to use their skills and knowledge to address the issues identified to eradicate the use of restraint and better meet the needs of those experiencing mental illness.

In the Western world, there is increasing concern regarding the ability of health care professionals to meet the physical health care needs of those diagnosed with mental illness. This discussion paper seeks to explore some of the issues facing mental health nurses in delivering care to those who have both mental and physical illness. Criticism of the National Health Service for failing to meet the physical health needs of people with serious mental illness has generated a number of political strategies aimed at addressing inequalities between mental and physical health care, a consequence being a change in pre-registration nurse education. It is envisaged that such changes will enable all nurses to deliver safe, effective care to service users, with adult and mental health nurses being more adept at meeting both the mental and physical health needs of those in their care. The impact of three key areas identified within the literature will be considered: the impact of co-existing physical and mental illness; the role of mental health nurses and perceptions of service users re physical health care; and education, training and learning from others in the Western world. In conclusion, the complexities of delivering such care will be addressed.

This paper explores the use of painting with a group of pre-registration nursing students, as one-approach educators might use to encourage deeper thinking and reflection. During the second week of their course, the students were asked to paint a picture of what they believed nursing to be, using colour to capture their feelings associated with nursing. On completion of their paintings, the students shared their ideas and beliefs with the group. This process was repeated at the start of the second year when, on completion of a second painting, their first picture was returned; with time devoted for the students to analyse both paintings and write a reflective account. Analysis was required on three levels: (1) to examine the content of each picture; (2) to explain why they had painted particular images, and explore factors influencing changes or similarities between pictures; and (3) at a deeper level, begin exploring how their values and beliefs had shaped their paintings. Through a facilitated group, st...

Quality nursing plays a central role in the delivery of contemporary health and social care, with a positive correlation being demonstrated between patient satisfaction and the quality of nursing care received. One way to ensure such quality is to develop metrics that measure the effectiveness of various aspects of care across a variety of settings. Effective mental health nursing is predicated on understanding the lived experiences of service users in order to provide sensitively-attuned nursing care. To achieve this, mental health nurses need to establish the all-important therapeutic relationship, showing compassion and creating a dialogue whereby service users feel comfortable to share their experiences that help contextualize their distress. Indeed, service users value positive attitudes, being listened to, and being able to trust those who provide care, while mental health nurses value their ability to relate through talking, listening, and expressing empathy. However, the literature suggests that within mental health practice, a disproportionate amount of time is taken up by other activities, with little time being spent listening and talking to service users. The present study discusses the evidence relating to the therapeutic relationship in acute mental health wards and explores why, after five decades, it is not recognized as a fundamental metric of mental health nursing.

Safeguarding, balancing the concept of risk with the need for public protection and its implication for the lives of individuals, is an important facet of contemporary mental health care. Integral to safeguarding is the protection of human rights; the right to live free from torture, inhuman, or degrading treatment, and having the right to liberty, security, respect, and privacy. Professionals are required to recognise all of these rights when delivering care to vulnerable people. In the United Kingdom (UK) there has been growing public concern regarding abusive practices in institutions, with a number of unacceptable methods of restraint being identified as a feature of care, particularly in mental health care. In keeping with the service user movement, and following a review of the literature, this paper discusses the evidence regarding restraint from the perspectives of service users and professionals within mental health services and considers the implications for future practice and research. In reviewing the literature, findings revealed that restraint can be a form of abuse, it's inappropriate use often being a consequence of fear, neglect, and lack of using de-escalation techniques. Using restraint in this way can have negative implications for the well-being of service users and mental health professionals alike.

There is considerable interest in the various ethical problems associated with undertaking health and social science research. Participants in such research are often considered vulnerable because of their health status, social position, or dependence on others for health and welfare services. Researchers and ethics committees pay scrupulous attention to the identification and amelioration of risks to participants. Rarely are the benefits to participants of engaging in research highlighted or drawn to the attention of potential participants. Such potential benefits need to be considered by researchers and reviewers when considering the balance of benefits and harms associated with research projects. In this paper, we particularly consider the psychotherapeutic benefits of participation in research.

Suicidality among young people is a global concern, with international studies demonstrating an increased prevalence among young gay men. Being gay is not inevitably linked to mental illness, but growing up gay in a heterosexist society can compromise mental well being. This qualitative study, using free association narrative interviewing, offers an in-depth understanding of gay men’s experience. One shared experience that emerged was “knowing and not knowing,” the story of gay children growing up in a heterosexist society. This story provides valuable insights for mental health nurses becoming more attuned to the importance of providing professional nurturing of gay children.

International studies consistently demonstrate that individuals diagnosed with severe mental illness (SMI) have an increased risk of co-morbid physical health problems and premature death. During the past decade, government policy in the UK has focused on improving the physical health of those with SMI. Despite this, international research has continued to report barriers to accessing appropriate services. These have been identified as emanating from service users and professionals alike, and also from institutional bureaucracy. Most of this research has reported difficulties from the perspective of various professional groups, with little attention being paid to the service user voice. Studies from the service user perspective undertaken in the past 10 years equate to six qualitative and three quantitative studies, and it appears that poor physical health care remains a problem in the developed world. The quality of this care is compromised by practical problems and interpersonal difficulties between service users and health-care providers and between providers of mental health services and those providing physical health care. This paper presents a review of the nine international studies and discusses the implications for developing policy and practices that could lead to improved physical health-care services for people experiencing SMI.

Young carers are a global phenomenon. The UK estimates it has in excess of 175 000 young carers, the onset of their caring role often occurring between 8 and 10 years of age. Of these, 17 000 are caring for a parent who has severe mental illness, a significant factor for children entering the health and social care system, as up to 60% experience mental health difficulties themselves. This paper reports on the outcome of a participatory project aimed at better understanding the needs of young people. A World Cafe event was hosted, bringing together those involved in promoting the mental health of young people in a partnership consortium. The event was led by young service users and carers. Important issues raised by the young carers were being excluded from being included; stuck in the here and now, ignoring the future; a hole in the net; and ensuring the hidden is on the agenda. The World Cafe gave the university the privilege of insight into what local young carers need to improve their mental health, and more importantly, how we can utilize our skills to help them achieve their goals.

Narrative inquiry as a qualitative research method appears to be growing in popularity among mental health nurses. This paper argues that there are a number of parallels between narrative inquiry and psychotherapy, and mental health nurses familiar with the practice of therapeutic engagement need to be mindful of these when using this approach to research. The symbiotic relationship between those engaged in narrative inquiry and those engaged in psychotherapeutic practice is explored in order to provide greater understanding of some of the ethical issues involved and how new researchers, supervisors and practitioners might better respond to the complexities inherent in using narrative inquiry which may itself be therapeutic. Our focus for this paper is the tensions experienced by the mental health nurse while working as a researcher when the research encounter provides a trigger that would normally elicit a therapeutic response for both participant and nurse. Using a selection of psychoanalytic theories and principles this paper explores the relationship between the processes of psychotherapy and narrative inquiry. This discussion paper is based on the authors' own research experiences of using narrative inquiry to explore a number of sensitive issues and many years of supervisory relationships with students and practitioners alike.

Nurturance, love, compassion, respect, humanity, self awareness, mind emptying and mindfulness are all qualities considered necessary for the development of the therapeutic relationship which is central to holistic care. Likewise raised levels of academia within nurse education have lead to the notion of emotional intelligence where such qualities, often associated with tacit and experiential knowledge, are inextricably bound with theory, practice and research. In an environment where nursing theory and research dominate, we suggest that such qualities are more likely to be attained if those expected to portray them, students, are themselves in receipt of the same or similar qualities from the organisations, namely education and practice.\ud This paper explores the concept of preparedness in terms of developing the above qualities with those we educate and what might be required of educationalists in achieving this goal. \ud Using psychoanalytic concepts of mirroring, holding and containing we explore the role of the educationalist in ‘preparing’ nurses to become emotionally intelligent practitioners. If we are to move from the rhetoric to the reality of an emotionally intelligent practitioner, nurse educators need to ensure that the student experience, in terms of their own learning, becomes the centre of their educational universe. We believe that this is more likely to occur when we as educationalists are able to personalise the educational process through mirroring love, care and nurturance, thus validating the emotional context of the students’ personal experience as a foundation for their learning.

Contemporary standards and policies advocate carer involvement in planning, implementing, and evaluating mental health services. Critics have questioned why such standards and policies fail to move from rhetoric to reality, this particularly being applicable to carer involvement within acute psychiatric settings. As there is only limited UK research on this topic, this interpretive phenomenological study was undertaken to explore the perceived level of involvement from the perspective of carers of service users who were admitted to acute inpatient settings within the previous 2 years. Interviews were conducted with four individuals who cared for a loved one with a mental illness. The interview analysis was influenced by Van Manen, whose interpretive approach seeks to generate a deeper understanding of the phenomenon under study. Four main themes emerged: powerlessness, feeling isolated, needing to be recognized and valued, and a desire for partnership. The findings reflect the views expressed by carers in other studies, identifying that while carers seek to work in partnership with health-care professionals, at a clinical level they often feel excluded. The study concludes by discussing ways of improving and promoting carer involvement and advocating a partnership in care approach within acute psychiatry.

As mental health nurses acquire and utilize knowledge for practice, both emotion and learning become interrelated, interactive, and interdependent aspects of personal functioning and professional practice. Emotion and learning in combination are powerful sources of meaning and direction. This paper explores how, in addressing these important aspects of ‘becoming’ and ‘being’ a mental health nurse with students, the medium of painting was used to facilitate the exploration of their self in relation to others encountered in recent clinical practice. Broad principles of psychoanalytic theory are used in analysing the experiences depicted in the student paintings, and their explanatory accounts, in order to explore the emotionality of mental health nursing and the complexities of addressing this within current educational processes. What is revealed is that in the uncertainties of everyday clinical and educational practice, working and learning in the place between knowing and not knowing can give rise to unconscious defence mechanisms being used to achieve emotional homeostasis. This paper argues that while working and learning in this hinterland can sometimes be experienced as being threatening and anxiety provoking, it is also a place for personal and professional development and growth. The tutor’s role in facilitating such opportunities for growth is seen as being crucial. However, this will require tutors to actively engage in critical reflection in and on their educational practice in order to better understand and use their authentic self in more effectively supporting the student.

Individuals working for the emergency services often bear witness to distressing events. This outcome study examines therapeutic interventions for Fire Service personnel (FSP) experiencing symptoms of trauma, depression, anxiety and low levels of self-compassion. This study aims to investigate the effectiveness of using Compassion-Focused Therapy (CFT) as an adjunct to Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) in reducing symptoms of trauma, anxiety and depression and increasing self-compassion. A convenience sample (n= 17) of participants, referred for therapy following a traumatic incident, were allocated to receive 12 sessions of either TF-CBT or TF-CBT coupled with CFT. The study employed a repeated-measures design. Data were gathered pre- and post-therapy, using three questionnaires: (1) Hospital Anxiety and Depression Scale; (2) Impact of Events Scale-R; (3) Self-Compassion Scale – Short Form. TF-CBT combined with CFT was more effective than TF-CBT alone on measures of self-compassion. Significant reductions in symptoms of depression, anxiety, hyperarousal, intrusion and avoidance and a significant increase in self-compassion occurred in both groups post-therapy. The study provides some preliminary evidence to suggest that FSP may benefit from therapeutic interventions aimed at cultivating self-compassion. Further research is warranted using a larger sample size and adequately powered randomized controlled trial, to detect statistically significant differences and to negate the risk of confound due to low numbers resulting in significant differences between groups at baseline. Using CFT as an adjunct to TF-CBT may help FSP, who bear witness to the distress of others, cultivate compassion for their own suffering.

This discussion paper seeks to explore an approach that metal health nurses can adopt that ensures the patient is at the centre of training and professional development opportunities. Although nurse training and education is shaped by practice and theory, the lived experiences of the patients as an educational resource often become lost in the milieu of 'doing' nursing. We argue that in addition to theoretical knowledge and practice knowledge, there is the need to harness the equally important patient experience knowledge. Drawing upon Ptolemaic concepts, this paper explores the potential tensions for mental health nurses resulting from the imbalance in power when engaging in therapeutic relationships with patients. It is argued that in order for mental health nurses to become more effective, they need to learn how to relinquish some of their power, even where this gives rise to uncomfortable tensions for the nurse. Such tensions result from the centrality afforded to theoretical knowledge and ritualized practice that underpins nursing and the difficulties this may cause for many nurses in accepting the value of patient experience as a primary source of knowledge. The difficulties of adopting this approach point to a need for mental health nurses and nurse educationalists to take a more reflexive approach to their patient encounters and within their encounters with each other.

Background: There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. Methods: This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received. Results: The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care. Conclusions: A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing.

This paper seeks to address a range of unconscious organisational, professional and educational processes that impact upon the provision of mental health nursing care and the service users experiences of this care. These can often result in a state of anomie for the service user and inhibit real choice being a feature within therapeutic relationships. The paper argues that mental health nurses do not set out to practice in this way, but because of the unconscious nature of many of their responses, their practice is often restricting and only serves to reinforce traditional professional/patient relationships. Using a psychoanalytical approach to data analysis, these unconscious processes are examined. A possible way to address these concerns is posited that advocates greater direct involvement of service users in the educational processes of nurses.

Drawing on psychodynamic and managerialist concepts, this paper explores possible consequences for patients and mental health nurses of the policy driven "splitting" of mental health service provision in the UK. Services and resources are now split for those with a severe and enduring mental illness and those with a common mental problem. We argue the damaging divisiveness in creating these two "political" groups makes determining how to meet the needs of individuals with common yet complex problems more difficult. The way in which an increased awareness and understanding of psychodynamic concepts can help the mental health nurse deal with such complexity is explored.

The shackles of abuse: unprepared to work at the edges of reason Childhood sexual abuse is an international public health problem. Research suggests similar prevalence rates in both Western and non-Western societies. The long-term consequences of child sexual abuse include wide ranging mental health problems in adult life. Psychiatric services and, in particular, counselling has been highlighted as being the most helpful to those who have experienced child sex abuse. This evidence base should be informing mental health nursing education and practice. However, we argue there is a divergence between the discourse of evidence-based theory and practice reality. The aim of this paper is to explore the preparedness of mental health nurses to work with adults who have experienced sexual abuse during their childhood. It is the first part of a three-part research project and reviews the literature relating to how (and if) mental health nurses are prepared to work with those who have sexual abuse histories. An important issue considered in this review is the impact upon patient/nurse relationships as a consequence of the nurse themselves being survivors of sexual abuse. We argue that a number of conflicting discourses need to be addressed, if mental health nurses are to be appropriately prepared to offer cogent, sensitive care to those in their care who are shackled to their past sexual abuse through the confines of their current mental illness. Language: en

Deliberate self-harm predominantly occurs in women under the age of 30 years. This qualitative case study using feminist methods explored the experiences of three women who each had a long history of self-harming behaviour. Psychoanalytical concepts are used to explore the meaning of the conflicts that these women experience. Emergent themes include: great expectations, I speak but no one hears, sexual naivety meets sexual violence, and redrawing the sexual map. This thematic analysis helps facilitate an insight into what these women are trying to communicate, and provides guidance for mental health professionals to more effectively respond to the challenges of working with women who self-harm.

The United Kingdom is currently experiencing a recruitment and retention crisis in its nursing workforce. Mental health care is a particular problem area. Widening access to health and social care careers is a challenge for educational and health care organizations. This discussion paper examines the congruence between an educational programme aimed at developing Mental Health Assistant Practitioners’ and the organizational responses to the subsequent opportunities for practice innovation within mental health care services. Whilst the ‘learning while working’ philosophy of the educational programme has been enthusiastically embraced by many health care organizations, the change in management required for using these assistant practitioners in service innovation appears beset by organizational, cultural and professional concerns. Not least of which are the often ambiguous concepts of the role and purpose of being a mental health nurse. This paper argues that if current mental health nurses are unclear about their role it is oxymoronic to establish the mental health assistant practitioners.

IntroductionIn the UK, almost 50% of illness diagnosed among working age adults is mental distress, depression and chronic anxiety being the two most prevalent illnesses. However, only 24% of those diagnosed receive appropriate interventions within the National Health Service (NHS). In light of this, third sector organisations, such as MIND, are left to fill the gap in providing therapeutic care. This paper reports on an evaluative study of what Mind offers as opposed to statutory services from a service user perspective.AimAn exploration of the differences in mental health care between statutory and non-statutory organisations.ObjectivesTo identify how service users experienced MIND's counselling service. To establish the benefits and disadvantages of mental health care within statutory and non-statutory services. To identify the impact of mental health care from non-statutory services.MethodThis qualitative research project, adopted a case study approach. Using one to one narrative interviews, data from 12 participants, five males and seven females were collected. Following transcription, each narrative was analysed individually, with thematic analysis being used across all 12 interviews.ResultsSix themes were identified; mindful of the gap; easing like sunday morning; magic moments; love is in the air; lighting up a future and changing the status quo.ConclusionMind plays a significant role in enabling those with psychological problems to move towards building a better future. Findings suggest statutory services can learn important lessons from non-statutory organisations not least how best to provide cohesive, collaborative and compassionate mental health care for those in distress.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The incidence of adolescent self-harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self-harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self-harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young people's experiences of help and support for self-harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self-harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people.

Background: female genital mutilation/cutting (FGM/C) is the procedure of removing healthy external genitalia from girls/women for socio-cultural reasons. There is much scientific literature on the adverse physical health complications that can result from having FGM/C, but little is known about its psychological impact and treatment. Objective: to identify psychological problems that may follow from a woman having FGM/C and success of treatment herein, and relate findings to the role of the maternity care professional.Study design: a structured narrative review, which identified 10 studies, was carried out.Findings: eight of ten studies reported psychological consequences, such as post-traumatic stress disorder (PTSD) and affective disorders. Also identified were socio-cultural differences in the meaning of perceived consequences for different individuals. Two studies reported inconclusive results regarding the psychological impact of FGM/C on women’s lives.Key conclusion: while these findings provide an indication of adverse psychological effects of women/girls having FGM/C, more studies are needed. In particular, studies that focus on the role that cutting extent, circumstances surrounding the cutting, and girls’ level of knowledge of what was going to take place, and their relationships to psychological outcomes.Implications for practice:raising awareness of the risk of negative psychological consequences is important, with maternal health care professionals requiring training on how to treat and care for women/girls who are suffering problems that result from having FGM/C.

The terms ‘Female Circumcision’ (FC), ‘FG Cutting’ (FGC) and ‘FG Mutilation’ (FGM) refer to procedures involving the partial or total removal of the external female genitalia for non-medical reasons. In practicing countries, FGC/FC is more widely used, as it is believed to be inoffensive, providing more impartial ways of discussing the practice. Positive beliefs about FC/FGC include virginity, marriage prospects, family reputation, or passage to adulthood. Regardless of terminology, the practice exists in at least 28 African counties, and a few Asian and Middle Eastern countries. In Western society, FGM is considered a breach of human rights, being outlawed in a number of countries. With immigration trends, FGC is now prominent in Western society among practicing communities. While the past decade has seen an increase in studies and recommendations for health-care support related to the physical health consequences of FGM, little is known about the psychological impact and its management. For many girls and women, FGC is a traumatic practice, transforming it to FGM and affecting their mental health. This discussion paper focuses on evidence relating to the mental health consequences of FGM, therapeutic interventions, and the mental health nurse's role in addressing the needs of this group of women.

There is considerable interest in the various ethical problems associated with undertaking health and social science research. Participants in such research are often considered vulnerable because of their health status, social position, or dependence on others for health and welfare services. Researchers and ethics committees pay scrupulous attention to the identification and amelioration of risks to participants. Rarely are the benefits to participants of engaging in research highlighted or drawn to the attention of potential participants. Such potential benefits need to be considered by researchers and reviewers when considering the balance of benefits and harms associated with research projects. In this paper, we particularly consider the psychotherapeutic benefits of participation in research.