Engaging women at risk for poor perinatal mental health outcomes: A mixed‐methods study

Risk factors for poor perinatal mental health are well known. Psychosocial assessment and depression screening during the perinatal period aim to identify women at risk for poor perinatal outcomes. Early intervention programmes are known to improve the mental health outcomes of women and infants. Key to any intervention is initial and ongoing engagement in the therapeutic process. This mixed‐methods study reports the proportion of women who engage/do not engage with services and their characteristics, as well as the strategies clinicians use to engage women. Data were collected by reviewing medical records, interviewing perinatal and infant mental health (PIMH) clinicians, their managers, key stakeholders, and women service users. Analyses identified that most (71.3%) women referred engaged with the PIMH service. Themes related to non‐engagement are ‘time to rethink’ and ‘stigma’. Themes reflecting the engagement strategies used by PIMH clinicians are initial engagement: ‘back to basics’ and ‘building trust’, therapeutic engagement: ‘making myself useful’, engagement at discharge: ‘woman or clinician led’, and models that facilitate engagement.     

Tackling perinatal loss, a participatory action research approach: research protocol

pastor-montero s.m., romero-sánchez j.m., paramio-cuevas j.c., hueso-montoro c., paloma-castro o., lillo-crespo m., castro-yuste c., toledano-losa a.c., carnicer-fuentes c., ortegón-gallego j.a. & frandsen a.j. (2012) Tackling perinatal loss, a participatory action research approach: research protocol. Journal of Advanced Nursing68(11), 2578-2585. ABSTRACT: Aim. The aim of this study was to promote changes to improve the care provided to parents who have experienced a perinatal loss through participatory action research. Background. The birth of a child is a joyful event for most families, however, unfortunately some pregnancies end in loss. Perinatal loss creates a heavy emotional impact not only on parents but also on health professionals, where in most cases there is an evident lack of skills, strategies and resources to cope with these kinds of situations. Design. Participatory action research is the methodology proposed to achieve the purpose of this study. Methods. Participatory action research consists of five stages: outreach and awareness, induction, interaction, implementation and systematization. The working group will include professionals from the Mother and Child Unit for patients at a tertiary level public hospital in Spain. The duration of the study will be 3?years since the approval of the protocol in January 2011. The qualitative techniques used will include group dynamics such as the SWOT analysis the nominal group technique, focus groups and brainstorming, among others that will be recorded and transcribed, generating reports throughout the evolution of the group sessions and about the consensus reached. Content analysis will be conducted on the field diaries kept by the participants and researchers. This project has been funded by the Andalusian Regional Ministry of Health. Discussion. Participatory action research is a methodological strategy that allows changes in clinical practice to conduct a comprehensive transformative action in the care process for perinatal loss.     

Using action research to change health-promoting practice

Action research was used as a method to develop an educational skills training program focusing on the health education aspect of nurses' health-promoting role. The program was based on the theoretical concepts of the Transtheoretical Model and Motivational Interviewing. Interviews were used to collect the data on a purposive sample of nurses working in an acute hospital ward. Three main themes were identified: using the skills, barriers to implementing the skills, and facilitators of implementing the skills. Most nurses were more aware of health education and health promotion and were able to incorporate the skills learnt and instigated a change in practice. There was evidence, however, that further training was required. This might focus more on helping nurses to use the skills with patients who are very resistant to change and to better recognize health-promoting opportunities. Ways of offering the training program to other health professionals also should be explored.     

Participative mental health consumer research for improving physical health care: An integrative review

People with mental illness have a significantly lower life expectancy and higher rates of chronic physical illnesses than the general population. Health care system reform to improve access and quality is greatly needed to address this inequity. The inclusion of consumers of mental health services as co‐investigators in research is likely to enhance service reform. In light of this, the current paper reviews mental health consumer focussed research conducted to date, addressing the neglect of physical health in mental health care and initiatives with the aim of improving physical health care. The international literature on physical healthcare in the context of mental health services was searched for articles, including mental health consumers in research roles, via Medline, CINAHL and Google Scholar, in October 2015. Four studies where mental health consumers participated as researchers were identified. Three studies involved qualitative research on barriers and facilitators to physical health care access, and a fourth study on developing technologies for more effective communication between GPs and patients. This review found that participatory mental health consumer research in physical health care reform has only become visible in the academic literature in 2015. Heightened consideration of mental health consumer participation in research is required by health care providers and researchers. Mental health nurses can provide leadership in increasing mental health consumer research on integrated care directed towards reducing the health gap between people with and without mental illness.     

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.     

The mental health experiences of gay men: a research study exploring gay men's health needs

As part of a qualitative study exploring the health needs of gay men, undertaken in the Lothian area of Scotland (Robertson & Hutcheson 1995), the mental health needs of gay men were elicited through focus groups and individual interviews. A grounded theory approach (Glaser & Strauss 1967) was used to analyse the responses from a sample of 37 gay men. This research followed a social interactionist approach and examined from the respondents' stance the effects of being perceived as deviant and the subsequent impact on self-identity and self-esteem. The findings were that there is a reluctance amongst gay men to disclose their sexuality in health care settings which results in mental health needs remaining unrecognized by health professionals. The research also showed that the respondents faced profound social difficulties when coming to terms with their sexuality, a process that can occur throughout their life time. Those who were married faced the strain of living two lives and cited alcohol misuse and depression amongst the effects of this stressful lifestyle.     

小学教师心理健康社会支持及心理需求状况调查

目的：了解小学教师的心理健康、社会支持及心理需求状况。方法对120名教师采用症状自评量表、社会支持评定量表及心理服务需求问卷进行测评分析。结果小学教师症状自评量表评分除人际关系敏感因子外,总均分及各因子分均显著高于国内常模（P＜0．01）;总均分、人际关系敏感、抑郁、焦虑、敌对、偏执、精神病性因子分与社会支持评定量表对社会支持的利用度维度分呈显著负相关（ P＜0．05或0．01）,精神病性因子分与社会支持评定量表总分呈显著负相关（ P＜0．05）。本组62．5％的教师需要心理卫生服务,53．3％的教师希望获得孩子教育方面的服务。结论小学教师的心理健康水平较低,对社会支持的利用度与心理健康水平显著相关,相关部门应注重教师的心理健康问题,予以有针对性地心理干预。     

Evaluating services for women with serious and ongoing mental health problems: developing an appropriate research method

Despite an increase in the literature on women with less disabling or transitory mental health problems, there is little relating to women with serious and ongoing difficulties. In considering the means by which the needs of this population might be studied, tension arises over methodology. Research comparing the clinical, functional and service use characteristics of women and men might demonstrate their different mental health problems but would neither elucidate women's particular needs nor examine the social reasons for this difference. A feminist methodology would, however, offer a means of exploring the experiences of women, a framework for understanding sex differences, and generate findings that would be beneficial to women. The present study gives an insight into ways in which the exploration of sex differences can be combined with a study of women for women without compromising the relevance and impact of the findings.     

‘Outside the Original Remit’: Co‐production in UK mental health research,lessons from the field

The aim of this discursive paper was to explore the development of co‐production and service user involvement in UK university‐based mental health research and to offer practical recommendations for practitioners co‐producing research with service users and survivors, informed by an overview of the key literature on co‐production in mental health and from a critical reflection on applied research through the medium of a case study. The paper is co‐written by a mental health nurse academic and a service user/survivor researcher academic. The authors argue that the implications of co‐production for mental health research remain underexplored, but that both the practitioner and service user/survivor researcher experience and perspective of co‐production in research can provide practical reflections to inform developing research practice. The theories and values of emancipatory research can provide a framework from which both practitioners and service users can work together on a research project, in a way that requires reflection on process and power dynamics. The authors conclude that whilst co‐produced investigations can offer unique opportunities for advancing emancipatory and applied research in mental health, practitioner researchers need to be more radical in their consideration of power in the research process.     

住院肺结核患者心理健康与社会支持的相关性

目的探讨住院肺结核患者心理健康状况与社会支持的相关性。方法采用症状自评量表、领悟支持量表对北京市某结核病研究所接受治疗且已确诊的158例肺结核患者进行问卷调查,并对结果进行统计分析。结果本组患者的心理健康状况较差;肺结核患者社会支持程度低,症状自评量表总分与社会支持呈负相关(r=-0.20,P0.05),除精神症状外,症状自评量表各因子分与家庭外支持呈负相关(P0.01或P0.05)。结论社会支持与住院肺结核患者的心理症状密切相关,进行躯体治疗的同时,应充分评估和利用患者的社会支持,促进其心身康复。     

Extending the boundaries: autoethnography as an emergent method in mental health nursing research

An exploration of the 'self' is generally considered a fundamental and necessary place from which to commence practice as a mental health nurse. Self-awareness and attention to one's own feelings, thoughts, and experiences can contribute to the therapeutic use of self in effective provision of mental health nursing care. This purposeful use of self, inherent in the role of the mental health nurse, may also be seen as synchronous to the role of the qualitative researcher who seeks to uncover the meaning of others' experiences. Autoethnography is a qualitative research method that connects the researcher's personal self to the broader cultural context. Evocative writing, where the writer shares personal stories on their experiences, is used to extend understanding of a particular social issue. This paper will argue how this emerging method in social science research is of particular relevance to mental health nursing research and practice.