The Current and Ideal State of Mental Health Training: Pediatric Resident Perspectives

Phenomenon: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. Approach: The purpose of this study is to describe pediatric residents’ experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Findings: Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and dissemination to enhance trainees’ MH knowledge and skills to provide optimal MH care for children.     

Child and Adolescent Mental Health Services in the UK: Nurse Consultants

TOPIC: Children's mental health services in the UK are transforming. Innovations in health, social welfare, education, and youth justice agencies have all got emotional literacy at their core. The changing face of children's services has called for partnerships and new ways of planning and delivering services in statutory and voluntary sectors. Alongside this, nursing is evolving and developing new ways to meet the challenges that modernization brings. Nurse consultants are children's champions who have a leading role in helping lead children's services into the 21st century. PURPOSE: The following article explores the role of nurse consultants in child and adolescent mental health services (CAMHS).     

Juvenile Mental Health Courts for Adjudicated Youth: Role Implications for Child and Adolescent Psychiatric Mental Health Nurses

TOPIC: Juvenile mental health courts for adjudicated youth. PURPOSE: To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts. SOURCES: ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000–2010. CONCLUSIONS: Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.     

海上训练官兵SCL-90的测评分析

目的探讨海上训练官兵的整体心理健康状况,为做好海上训练官兵的心理卫生工作提供依据。方法应用症状自评量表（SCL-90）分别对1012名海上训练的官兵及980名未参加海上训练的官兵进行测试和分析。结果海上训练官兵SCL-90量表的测评总分、总分均值、阳性项目数、阳性项目均分及阴性项目数均明显高于未参加海上训练的官兵和常模,差异有统计学意义（P〈0．01）;未参加海上训练的官兵总分、总分均值、阳性项目数、阳性项目均分及阴性项目数与常模比较,差异无统计学意义（P〉0．05）。同时,海上训练官兵各因子得分均高于未参加海上训练的官兵及常模,差异有统计学意义（P〈0．01）;而未参加海上训练的官兵各因子得分与常模比较,无统计学意义（P〉0．05）。结论医院应开展海上训练官兵心理影响的研究,加强海上训练官兵的心理健康教育,增强官兵的心理防护能力和应急反应能力,不断提高部队的战斗力。     

自主式心理健康教育活动在高职护生中的实施研究

目的缓解心理健康教育工作中存在的两多一少(学生人数多、心理问题多、专业老师少)困境,开发学生助人、助己的潜能。方法以某校2005级高职护理专业17个班学生(共952人)为主要对象,开展自助、互助、求助等自主式心理健康教育活动,为期1年。以症状自评量表(Symptom Checklist-90,SCL-90)为工具,在教育前后进行测查。结果心理健康教育前2005级高职护生SCL-90总均分及各因子分明显高于全国常模(P<0.01)。开展自主式心理健康教育后,除躯体化、恐怖2项指标外,其余项目分均有明显下降(P<0.05或P<0.01)。结论充分发挥高职护生在心理健康教育活动中的自主作用,有利于学生心理健康水平提高。     

The Role of Training in Improving Community Care Staff Awareness of Mental Health Problems in People with Intellectual Disabilities

Background Care staff play a key role in identifying individuals with intellectual disabilities and additional mental health problems. Yet, few receive training in mental health, and evidence about the effectiveness of training is scant. Materials and Methods A pre–post study is reported, using a mental health screen and a self‐report questionnaire to examine staff awareness of mental health problems and to measure whether training improved knowledge of psychopathology, attitudes towards mental health services and referral decisions. Results Prior to training, deficits in awareness were evident. The Psychiatric Assessment Schedule for Adults with a Developmental Disability (PAS‐ADD) Checklist detected significant psychopathology in approximately one‐third of the individuals judged to have no mental health problems according to staff. Four months after the delivery of training, significant improvements in knowledge, attitudes and referral decisions were observed. Conclusion Brief training interventions may improve awareness of mental health problems, but further research is needed to understand the referral process and to demonstrate the role of training in influencing actual staff behaviour.     

Mental Health Nurses as therapists in a rehabilitation setting: A phenomenological study

Mental Health Nurses have a long tradition of delivering talk‐based interventions across a range of clinical settings. Despite this, Mental Health Nurses receive limited recognition of this contribution. This paper presents findings from a study that explored Mental Health Nurses' experience of delivering talk‐based therapies in an inpatient rehabilitation setting. This study uses semistructured interviews and a phenomenological approach to explore eight Mental Health Nurses' experience. Themes emerging included that: mental health nursing is a talk‐based therapy in its own right, talk‐based therapy was part of everyday nursing care on the floor and integrated talk‐based therapy enhanced recovery opportunities for consumers. However, a further theme was that there were tensions around providing talk‐based therapy conflicted with other roles including unit management and the role of nurses in controlling challenging behaviours. This study found that Mental Health Nurses, in this setting, are offering talk‐based therapy to the people they care for. The findings of this study have implications for research: there needs to be a larger study investigating nurses' use of talk‐based therapy in inpatient settings. If, as the authors expect that, it is found that mental health nurses are offering these therapies generally in inpatient settings, this has serious implications for postgraduate education in Mental Health Nursing policy in terms of recognition that this is happening and finding ways to support nurses to do this well. There also needs to be further research in the best ways to offer talk‐based therapy in these settings.     

A 21st Century Problem: Cannabis Toxicity in a 13-Month-Old Child

Background

Cannabis is one of the most abused drugs worldwide, with more than 20 million users in the United States (US). As access to cannabis products increases with expanding US legislation and decriminalization of marijuana, emergency physicians must be adept in recognizing unintentional cannabis toxicity in young children, which can range from altered mental status to encephalopathy and coma.

发挥护理专业优势强化"四个贴近"夯实新世纪城市卫生服务基础

介绍了大庆市卫生局发挥护理专业优势 ,把护理工作延伸到社区 ;发挥护士素质特长 ,把健康理念落实到社区 ;发挥护士特有的潜能 ,全心全意服务于社区。通过社区护理工作 ,使卫生服务更加贴近社区、贴近家庭、贴近百姓、贴近生活。保证全市人民“生能顺利、病能医治、老能康乐、死能安息。”的具体做法和成效。     

Proposed changes to the Mental Health Act of England and Wales: research indicating future educational and training needs for mental health nurses

Proposed changes to the Mental Health Act (MHA) legislation in England and Wales have been identified as having significant impact upon both mental health service delivery and professional roles. Key issues being identified for both service delivery and professionals are the creation of approved mental health professionals (AMHP), increased demand upon community services and a potential negative impact upon the therapeutic relationship. Mental health nurses in particular have expressed their concerns, through their professional bodies, regarding the impact of the proposed MHA changes upon the therapeutic relationship. The aim of this article is to present findings from recently conducted research that explores experiences and perceptions of approved social workers (ASWs) regarding the impact of invoking the MHA upon the therapeutic relationship. These findings inform wider mental health nursing practice of essential skills and knowledge to protect and potentially enhance the therapeutic relationship while invoking MHA legislation. A questionnaire was distributed to ASWs working within the Trent region. The questionnaire included both closed and open questions inviting respondents to expand upon their experiences with the brief initial findings being earlier published. Semi-structured interviews with eight invited respondents to develop their responses were undertaken enabling an approach that was both conversational and emergent.     

A psychometric analysis of the Mental Health Consumer Participation Questionnaire

If consumer participation is to be translated from rhetoric into reality, the attitudes of health professionals need to be addressed. Educational strategies can play an important role, but measures of attitudes are needed to determine the effectiveness of these strategies. This paper seeks to establish the Mental Health Consumer Participation Questionnaire (MHCPQ) on psychometric grounds, and explore attitude levels. Overall, the 150 nursing students who participated saw consumer participation in a favourable light, although this varied with the nature and extent of involvement. Psychometric properties, attitude structure, and attitude differences are reported. The MHCPQ displays good face validity and can be further developed and used in mental health-care settings.     

Developing a Mental Health Guide for Families and Carers of People with Intellectual Disabilities

Background Although there is already information available about caring for someone with a mental health problem, there is very little written for families and carers of people with intellectual disabilities. Materials and methods This paper describes the development of a Guide as such a resource. The consultation stage involved interviews and focus groups with families, service users and paid carers (n = 20) to highlight their needs and preferred format. Additional carers (n = 12) completed structured questionnaires to evaluate the Guide. Results The initial consultation showed that an easily accessible and user‐friendly information resource was needed. The evaluation showed that family carers were satisfied with the Guide, finding it easy to read and covering most of the information required. However, they did highlight areas that needed further detail. Conclusions The involvement of carers in the development of such resources is essential, emphasizing the benefit of carers’ knowledge and experience to professionals.