Reflexivity and detachment: a discursive approach to women's depression

Reflexivity and detachment: a discursive approach to women's depression This paper explores a discursive approach to understanding women's depression by presenting the results of research into women's narratives of their experiences. The discursive approach taken acknowledges women's immersion in cultural practices that determine the subject positions available to them and places a value on attributes of reflexivity and detachment that are not usually associated with their performance. The social and cultural context of the individual's experience is significant because if the focus is simply on the individual this supposes that the problem lies solely with the individual. An understanding of cultural expectations and their relation to mental distress is important to mental health nursing practice. The psychotherapeutic relationship that is fundamental to mental health nursing practice requires an understanding of the meaning of individual's responses in their cultural context in order to provide facilitative and meaningful care for the women that they nurse.     

Profiling police presentations of mental health consumers to an emergency department

Public mental health systems have been called on to better meet the needs of consumers presenting to health services with the police, yet few studies have examined police presentations among mental health consumers in large public mental health systems. This study was designed to determine the frequency profile and characteristics of consumers of mental health services brought in by police to an emergency department (ED) in Sydney, Australia. Using data from the emergency department information system and obtaining the psychiatric assessment from the medical record, we have examined trends and characteristics in mental health presentations brought in by the police to a general ED between 2003 and 2005. The sample consisted of 542 consumers with a mental health problem brought in by the police to the ED of a 350-bed community hospital. The characteristics of this group were compared with those of all mental health related ED presentations for the same period using logistic regression. Results indicated that police presentations are likely to be young males who are unemployed, have past and present alcohol and other drugs use, present after hours, and are admitted to hospital as a result of their presentation. These consumers are likely to have a presenting problem of a psychotic disorder, less likely to have a presenting problem of depression and/or anxiety, and given a triage code of three or higher. The study results highlight the importance of the availability of 24-hour access to mental health care to ensure a quick care delivery response. Police presentations to EDs with mental health issues are an indicator of significant impact on health services, especially with the current overcrowding of EDs and the associated long waiting times. Systems need to be developed that facilitate collaboration between EDs, hospital security, police services, mental health, and ambulance services.     

Police and mental health clinician partnership in response to mental health crisis: A qualitative study

Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one‐to‐one semistructured interviews. Themes emerged about the challenge created by a stand‐alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer ‘down‐time’, improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition.     

Review article: Interventions for people presenting to emergency departments with a mental health problem: A systematic scoping review

The number of people presenting to EDs with mental health problems is increasing. To enhance and promote the delivery of safe and efficient healthcare to this group, there is a need to identify evidence‐based, best‐practice models of care. This scoping review aims to identify and evaluate current research on interventions commenced or delivered in the ED for people presenting with a mental health problem. A systematic search of eight databases using search terms including emergency department, mental health, psyc* and interventions, with additional reference chaining, was undertaken. For included studies, level of evidence was assessed using the NHMRC research guidelines and existing knowledge was synthesised to map key concepts and identify current research gaps. A total of 277 papers met the inclusion criteria. These were grouped thematically into seven domains based on primary intervention type: pharmacological (n = 43), psychological/behavioural (n = 25), triage/assessment/screening (n = 28), educational/informational (n = 12), case management (n = 28), referral/follow up (n = 36) and mixed interventions (n = 105). There was large heterogeneity observed as to the level of evidence within each intervention group. The interventions varied widely from pharmacological to behavioural. Interventions were focused on either staff, patient or institutional process domains. Few interventions focused on multiple domains (n = 64) and/or included the patient's family (n = 1). The effectiveness of interventions varied. There is considerable, yet disconnected, evidence around ED interventions to support people with mental health problems. A lack of integrated, multifaceted, person‐centred interventions is an important barrier to providing effective care for this vulnerable population who present to the ED.     

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well‐being throughout their lives, compared to non‐Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme ‘supports along the road to recovery’. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients’ mental health needs. These insights may inform service review, workforce development, and further research.     

Real mental health promotion requires a reorientation of nursing education, practice and research

The evidence for the individual, social and economic benefits of mental health promotion is now well established. The indication is that a broader public health approach that addresses social and environmental factors related to mental health and well-being is required. Mainstream mental health services, however, continue to operate in relative isolation, allocating the greatest proportion of funding and resources to the treatment of mental illness and disorder. Relevant to health promotion, this paper explores the bidirectional link between physical and mental health and the social determinants of mental health. The growing interest in the positive aspects of health and well-being which focuses on wellness rather than illness is also discussed. One example of how mental health nurses can adopt principles of positive mental health to education, practice and research is presented. The author proposes that as the largest professional group in health care, nurses must become more actively involved in initiatives that reorientate practices and services away from an illness culture towards the adoption of wider mental health promotion principles.     

An ethnic interpretation of mental distress from the perspective of Tongan men and community leaders

Tongan people living in New Zealand have a high prevalence of mental illness and low uptake of mental health services. Rates of mental illnesses also differ between those born in Tonga and those born in New Zealand. However, little is known about the personalized and culturally shaped meaning and experience of mental distress in this population. Therefore, this research explored the meaning of mental distress for Tongan men and community leaders living in Auckland, New Zealand. The Tongan cultural framework, talanoa (talking, to tell), enabled a culturally congruent and collective approach to examining mental health‐related ideologies and ensuing distress. Two talanoa groups were held (one with men and one with community leaders), with a total of 18 participants. The primary research questions focused on tufunga faka‐Tonga (Tongan constructions of mental distress). Four themes emerged: fa’unga (reality), hu‘unga (directionality), ta‘anga (temporality), and tu‘unga (positionality). The analytic lens used to define reality was fa‘unga, because this concept encompasses the creation/preservation of sino (body), me‘a (thing, something), and mo‘oni (truth, real). The findings suggested that it is necessary to incorporate tufunga faka‐Tonga into all aspects of service delivery to improve mental health services for the Tongan population. The Tongan community will benefit from increased awareness of tufunga faka‐paiōsaikosōsiolo (biopsychosocial constructions of mental distress) and tufunga fepaki mo e fetaulaki he vaha‘a ‘o e tufunga faka‐paiōsaikosōsiolo mo e tufunga faka‐Tonga (intersections between biopsychosocial and Tongan constructions of mental distress) to support identification of health risks and health service seeking behaviours.     

Police and mental health responses to mental health crisis in the Waikato region of New Zealand

New Zealand police report a high level of involvement with people in mental health crisis, something that has been reported in the international literature in recent decades. Involvement of police represents a coercive pathway to care and is likely to be associated with use of force. The aim of this study was to investigate the clinical, legal, and social characteristics of individuals subject to police response in the Waikato region of New Zealand. Data were also collected on characteristics of police response, including use of force, time of day, and disposition. Use of force, most commonly use of handcuffs, occurred in 78% of cases involving police. The study showed that Māori were overrepresented in police responses, but no more likely than Europeans to experience use of force. Almost half those subject to police response were not subsequently admitted to hospital, raising questions about the need for and nature of police response in these cases. Because mental health nurses are often part of police response, nurses need to take cognisance of their relationship with police and contribute to any initiatives that can reduce coercion in the pathway to care, and improve service users' experience in mental health crises.     

The impact of COVID-19 on the mental health workforce: A rapid review

The COVID-19 pandemic led to significant adaptations to healthcare. Provision of mental healthcare in a changing environment presented healthcare workers with unique challenges and demands, including changes in workload and expectations. To inform current and future healthcare service responses, and adaptations, the current review aimed to collate and examine the impact of the pandemic on mental healthcare workers (MHWs). We conducted a rapid systematic review to examine the overall impact of the COVID-19 pandemic on MHWs. Searches were conducted in Ovid Medline and PsycInfo and restricted to articles published from 2020. Inclusion criteria specified articles written in English, published in peer-reviewed journals, and that examined any outcome of the impact of COVID-19 on MHWs; 55 articles fulfilled these criteria. Outcomes were categorized into ‘work-related outcomes’ and ‘personal outcomes’. Mental healthcare workers worldwide experienced a range of work-related and personal adversities during the pandemic. Key work-related outcomes included increased workload, changed roles, burnout, decreased job satisfaction, telehealth challenges, difficulties with work-life balance, altered job performance, vicarious trauma and increased workplace violence. Personal outcomes included decreased well-being, increased psychological distress and psychosocial difficulties. These outcomes differed between inpatient, outpatient and remote settings. The COVID-19 pandemic significantly altered the delivery of mental healthcare and MHWs experienced both work-related and personal adversities during the COVID-19 pandemic. With the continuation of changes introduced to healthcare in the initial stages of the pandemic, it will be important to maintain efforts to monitor negative outcomes and ensure supports for MHWs, going forward.     

Practices to support co-design processes: A case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol

Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating ‘trust among partners’, ‘shared visions, goals and/or missions’, ‘effective/frequent communication’, and ‘well-structured meetings’. Fewer practices were observed for ‘effective conflict resolution’, ‘positive community impact’ and for avoiding ‘excessive funding pressure/control struggles’ and ‘high burden of activities’. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants.     

Let's get physical

There is growing recognition and understanding of the inextricable interrelationship between physical and mental health. In mental health care, the physical health of consumers is now acknowledged as a serious problem requiring urgent action. This issue is undoubtedly related to negative symptoms and the lifestyle of people with mental illness. Much of the burden is also clearly linked with the detrimental side effects of psychotropic medications and deficits in the knowledge, skill, and confidence of mental health clinicians in relation to physical health matters. This paper highlights the problem of physical health in mental health care and presents recommendations to address this issue. The benefits of exercise on mental health in particular are explored. The authors argue that mental health nurses must play an active role in health promotion, primary prevention, and the early detection and management of physical health problems in all areas of clinical practice.     

Use of Psychiatric Nurse Practitioner Students to Provide Services in Rural School-Based Health Clinics

Seventy to eighty percent of youth receiving mental health services receive these services in schools. Nurses have been identified as the second major provider of mental health services in the schools, yet little has been written about the role of psychiatric mental health nurses in rural school-based clinics or how they were trained in this role. This paper describes an innovative clinical experience for graduate students to shape the role of advanced psychiatric mental health nurses in rural, minority schools using evidence-based approaches. The authors describe the context, theoretical frameworks, role development, outcomes, and lessons learned.     

‘There's more to a person than what's in front of you’: Nursing students’ experiences of consumer taught mental health education

Holistic and person‐centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery‐oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience‐led teaching as part of a co‐produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person‐centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person‐centred care and recovery‐oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students’ approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery‐oriented practice in mental health and holistic and person‐centred practice in all areas of health care.     

Rethinking mental health nursing education in Australia: a case for direct entry

Desperate times call for creative solutions. The mental health workforce shortage has created an opportunity to rethink current and future education and training needs in order to prepare competent and compassionate practitioners to meet the changing demands of consumers and their carers requiring mental heath treatment and support. This article urges consideration of an undergraduate direct entry mental health programme similar to that of midwifery or the nursing foundation/mental health branch programmes of the UK.     

Implementing Telemental Health to Improve Access to Mental Health Care in Rural Vermont

Mental health care shortages in the United States are most pronounced in rural areas. This practice-change project aimed to increase access to quality mental health care in rural areas for the treatment of depression and anxiety via telemental health delivery of care. The project yielded improvements across project aims, including an increased percent of enrolled patients from Healthcare Provider Shortage Areas; a decrease in quality measures for depression, anxiety, and disability; and increased patient satisfaction with care. The project can serve as a template for other practices wishing to increase access to mental health care in rural areas.