Providing clinical services for a diverse population: views on training of child and adolescent mental health practitioners

The aim of this study was to explore what professionals working in a child and adolescent mental health service (CAMHS) thought of provision of mental health services to diverse groups and what their training needs might be. Semi-structured interviews were undertaken and audiotaped with 17 CAMHS professionals. The tapes were transcribed and the data analysed using thematic analysis. The findings show no discernible pattern between different professional groups within the sample, although this is limited by the sample size and is perhaps not surprising given the common professional context. Just over half the participants perceived cultural diversity as equating with ethnic diversity. Staff thought diversity influenced service provision through access; communication; perceptions that different communities hold about mental health; perceptions that different communities hold about mental health services; and service factors. Staff were not clear about their own training needs and identified that training to date had not been entirely satisfactory. Staff openness may present an ideal opportunity to start dialogues with staff and community groups about how best services can be provided for an increasing diverse population of children and families.     

Identifying and addressing sexual health in serious mental illness: Views of mental health staff working in two National Health Service organizations in England

People with serious mental illness (service users) have needs related to sexual health and sexuality, yet these have been poorly addressed in mental health services. In the present study, we report the current practice of mental health professionals in relation to sexual health. Focus groups conducted in two mental health trusts explored routine practice in relation to discussing, assessing, and planning care in relation to sexual health. A thematic analysis identified seven themes: (i) sexual health provision is a complex issue; (ii) mental health staff are aware of sexual health needs; (iii) current provision regarding sexual health is ‘neglected’; (iv) barriers to sexual health provision; (v) enabling a discussion around sexual health; (vi) sexual health provision is a role for mental health professionals; and (vii) training needs. Mental health staff are aware of complex issues related to sexual health for service users, but this is mainly seen through the lens of risk management and safeguarding. We need to develop the mental health workforce to be able to incorporate sexual health into routine health care.     

Comorbidity of mental health and substance misuse problems: a review of workers' reported attitudes and perceptions

A comorbidity of mental health and substance misuse problems has been associated with deleterious outcomes. In the United Kingdom it has been acknowledged that people with comorbidity have often received poor care, with gaps in service provision suggesting ambivalence towards this issue. Previous reviewing authors have concluded that health professionals hold stereotypical views towards people that misuse substances, but these findings may not be directly comparable to those who work within mental health services. There is however a growing body of evidence concerning this context. The author has reviewed the literature from 1996 to 2006 to ascertain mental health professionals and allied workers attitudes and perceptions towards comorbidity, perceptions on the effectiveness of service systems, and perceptions of personal knowledge and skill in providing effective interventions. The evidence presented mainly pertains to mental health nurses, which reflects their status as the largest discipline within the mental health workforce. Overall attitudes towards comorbidity are mixed, possibly being related to contextual issues of practice and are not necessarily negative. However, there is an almost universal negative perception of deficiencies in service provision and the adequacy of training. Implications for research, development and practice are explored.     

Addressing diversity in mental health care: a review of guidance documents

Discriminated against and marginalised groups of people within our communities continue to be over represented within mental health services and frequently their particular needs are not met. Challenging discrimination and working towards more equitable services are a vital part of anyone's role working within mental health services. This paper provides a review of guidance documents on diversity issues with a particular focus on ethnicity, gender, sexuality, learning disability, spirituality, homelessness and age. The review concludes with a summary of the range of approaches that are currently being advocated for translating guidelines and recommendations into improved and equitable mental health services that meet the needs of service users from a wide range of diverse groups.     

An extra pair of hands? A case study of the introduction of support workers in community mental health teams for older adults

Background Despite the expanding deployment of support workers in mental health services, little evidence exists on what managers and professional practitioners should expect of such staff in community settings. Aims This case study evaluated the introduction of support workers in community mental health teams for older adults. Method A multiple method design engaged support workers and professional colleagues in individual interviews, a focus group and a work satisfaction survey. Results While the new resource boosted service provision, disparity between the intended role and the assumptions of professional practitioners caused confusion and dissatisfaction. Conclusions The study highlights the need for managers to ensure role clarity when non‐professional workers are introduced into multidisciplinary community teams. Implications for nursing management Promoting diversity of skills in the mental health workforce is a progressive move in tuning services to the heterogenous needs of clients in the community. However, introducing unqualified workers into multi‐disciplinary teams necessitates clear guidance to prevent their activity being confined within existing professional models. Support workers offer much potential in innovative service delivery.     

Community psychiatric nursing: focus on effectiveness

The focus for provision of mental health services is now the community in most developed countries. Different ways of organizing community mental health services are evident in the literature. Community psychiatric nurses (CPNs) have a key role to play in these services but the literature indicates that the CPN role varies from area to area within different models of service provision. This paper presents the findings of a study in which 13 service users and 15 CPNs in five focus groups discussed the effectiveness of mental health service. Selected staff and service users were chosen from a representative range of community mental health services across Northern Ireland. Service users expressed concern at the variety of CPN and other professional roles within multidisciplinary teams and some CPNs expressed dissatisfaction with their role and with role boundaries within teams. These findings suggest that further work is needed within community mental health services to ensure the role of the CPN remains effective and develops to meet the needs of service users.     

Development and organization of child and adolescent mental health services

Against the backdrop of involving children and families in their own care and the clear need to protect their interest, this article will consider care within child and adolescent mental health services (CAMHS). Following a brief overview of the incidence and prevalence of mental health problems, the development and organization of CAMHS will be explored, giving consideration to some of the literature that discusses the effectiveness of services. A review of the literature revealed that, while there is some evidence of how children feel about the services they receive, there is not currently a significant amount of literature available. Nevertheless, these views are of value in relation to the development of service provision.     

Specialist Versus Generic Models of Psychiatry Training and Service Provision for People with Intellectual Disabilities

Background Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists’ knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.     

Psychiatric care and home care service - an exploration of the professional world encountered by persons with long-term mental illness

Psychiatric care and home care service - an exploration of the professional world encountered by persons with long-term mental illness This study focuses on the views of professional health care providers within a geographical district in Sweden. A total of 52 interviews with persons representing different professional levels within psychiatry and the social services were conducted. The purpose was to compare their understanding of what their responsibility entailed as well as their perceptions of goals and required competence. A content analysis, supplemented with interpretations within a hermeneutic tradition, showed that there are both similarities and differences within and between the two organizations. A common finding is that professionals with the least education are to a great extent responsible for the practical care of persons with long-term mental illness. The implication of this finding is that it is important to be aware of this division of responsibility when developing psychiatric nursing and the home care services according to the needs of long-term mentally ill patients.     

Carer participation in mental health service delivery

There is increasing emphasis on enhancing consumer and carer participation in the planning and provision of mental health services. However, health professionals, consumers, and carers have different perceptions about what constitutes optimal care; identifying, negotiating, and meeting their respective needs can be challenging. The aim of the paper is to highlight the challenges of facilitating carer participation in daily practice and emphasize the broader issues that would benefit from more extensive discussion among health professionals. By examining the strategies used to enhance consumer participation, there is the potential to avoid many of the mistakes of the past and create a flexible and responsive framework to increase carer involvement. The authors anticipate that this discussion will resonate with many clinical staff as well as carers themselves. Identifying barriers to carer participation opens the way to promoting collaboration and enhancing care.     

The Thorn Course: rhetoric and reality

The Thorn Course that provides psychosocial interventions and family work training for UK mental health professionals was founded in 1992. Since this time policy, service provision and needs have changed. The aim of this study was to examine the Thorn Course through relevant literature, in order to establish whether research and policy have been integrated into practice within training and services. A search of professional journal databases was conducted. Keywords used were 'Thorn Course' and 'psychosocial intervention training'. The resulting body of literature was reviewed. Five main themes emerged which were examined: needs identified, delivering the Thorn Course, training outcomes, implementing interventions and user and carer involvement. There is a distinct lack of research studies evaluating any aspect of the Thorn Course. There is little evidence that user and carer involvement has moved beyond rhetoric and community mental health nurses continue to lack opportunities and support to implement psychosocial skills acquired in training.     

A review of the literature on the historical development of community mental health services in the United Kingdom

Community mental health encompasses a diverse range of statutory, voluntary and informal care services. However, little has been written about how changes in policy, legislation and philosophies throughout time impact on the service user experience of mental health care today. The purpose of this paper was to review the literature using systematic approaches and address the question: ‘How have historical factors influenced the development of community mental health care in the United Kingdom?’ Following a comprehensive literature search, we included 70 texts. Owing to the difficulties of classifying historical texts numerically, two themes were identified: (1) changing perspectives towards mental illness and the mentally ill; and (2) the complexities of mental health care provision. We structured the review around these themes. A narrative approach was used to illustrate the diversity within the identified texts. In response to the review question, an exploration of the historical literature demonstrates that some form of community care has always been evident. It also suggests that over time different philosophical ideas have influenced mental health policy and service structure. These have in turn shaped the care a service user receives when they come into contact with mental health professionals.     

Barriers to Family Care in Psychiatric Settings

PURPOSE: To identify barriers to family care in psychiatric settings and to describe family and provider perspectives about what constitutes effective family care. DESIGN AND METHODS: A qualitative exploratory approach with focus groups. Seventy-eight people participated in 11 focus groups conducted with families, patients, and health professionals. FINDINGS: Families identified poor quality care, conflict with health professionals about treatment, and lack of a role for families in the treatment. African American families also identified isolation of their communities from the mental health care system. Adolescents emphasized their role as caregivers and their needs for support. Health professionals conveyed concerns about system-based barriers, professional practice-based barriers, and family-based barriers to care. Patients stated the need for their families to be better educated about mental illness. CONCLUSIONS: The lack of family care in psychiatric settings is a multifaceted problem. Current health policies do not show endorsement of a family care approach. Responses from families and health professionals indicated conflicting opinions about content of family care. Health professionals reported they often lacked training and resources to deal with complex family issues. Families believed that lengthy and intensive interventions were neither necessary nor desired to address their concerns. Family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals.     

Mental Health Nursing Practice and Indigenous Australians: A Multi-Sited Ethnography

Criticism of public mental services provided to Indigenous Australians have persisted over the last two decades, despite several national reports and policies that have attempted to promote positive service change. Mental health nurses represent the largest professional group practising within these services. This paper reports on a multi-sited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about specialist mental health nursing practice and Indigenous Australians. The study found a disunited approach to practice during the fieldwork. Practice was expressed as a series of individual constructions built upon the nurses’ beliefs about Indigenous Australians and their experiences in practice with these peoples. The criticism of mental health services from Indigenous communities was understandable to the mental health nurses, but how they could address this through their individual practices was not always clear to them. The actions by public mental health services to improve cultural safety through generic training related to the broad area of Indigenous health and health service needs, does not appear to evolve into informed specialist mental health nursing practice for Indigenous Australian service users.     

A comparative review of palliative care development in six countries represented by the Middle East Cancer Consortium (MECC)

Palliative care development and services were reviewed in the region represented by the six members of the Middle East Cancer Consortium: Cyprus, Egypt, Israel, Jordan, the Palestinian Authority, and Turkey. The multimethod review synthesized evidence from ethnographic field visits to inpatient units, home care hospice teams and free-standing hospices, including interviews with hospice and palliative care clinicians, administrators, volunteers, policy makers and academic researchers. Public health data and relevant literature were collated together with internet-accessed information on services and health care systems. A total of 69 services were located; two country members have a history of relatively sustained development of hospice and palliative care, but provision across the Middle East Cancer Consortium region is highly variable at a local level. Considerable barriers to service development were identified in a region already struggling with many military and political conflicts. Key problems are a lack of secure funds and government support, inadequate professional training programs, opioid phobia in professionals and the public, and a lack of awareness and understanding of palliative care needs at public, government, and professional levels. Key areas for further attention were increasing national and international professional training and public education programs, improving opioid legislation and health care policies, negotiating for secure government or health insurance funding provision, raising awareness about the need for pediatric services and for patients with other illnesses, as well as for those with cancer, and working to integrate palliative care into mainstream health service provision and education.     

Aggressive and violent incidents: perceptions of training and support among staff caring for older people and people with head injury

Background. Reported rates of workplace violence are increasing and studies of violence and aggression to health service staff in the United Kingdom have largely focused upon mental health and accident and emergency units. The study of violence and aggression in other specialties has been neglected. This paper reports the findings from a survey of staff perceptions of training and support in an elderly care and head injury unit. Aims and objectives. Staff in a care of older people and head injury unit, half of whom were nurses, were surveyed to identify their experiences of violence and aggression in the workplace, their receipt of training, the relevance of training and knowledge of support services. Methods. An anonymous semi‐structured questionnaire was sent to all nursing, therapy and psychology staff in the unit. Quantitative data were analysed by SPSS and content analysis was adopted for the qualitative data. Results. Just over half the participants had experienced an incident of violence or aggression in the past 12 months. Training was judged to be relevant by almost 90% of respondents but was not always delivered in line with trust guidance. Staff who had been involved in incidents were more likely to identify training needs. A higher percentage of nurses than other professions were involved in incidents, but they were not as aware of the staff support department as other professional groups. Conclusions. The findings indicate that care of older people and head injury units should examine more closely the delivery of staff training on violence and aggression, and invite staff to identify their training needs. A national survey of approaches to staff support may be worthwhile. Relevance to clinical practice. Staff who had received training judged it to be relevant to their working situations, but outstanding training needs should be identified and addressed. Confidential staff support facilities should be well publicized.     

Modernising cancer and palliative care education in the UK: insights from one Cancer Network.

This article reports on a scoping study into cancer education provision in one UK Cancer Network. A range of professionals (nurses, allied health professionals (AHPs), health care support workers and educationalists) were invited to participate in focus group or individual interviews, or to return questionnaires regarding their perceptions of training needs and current opportunities. This yielded data from a total of 94 participants. In addition, curriculum documents from local universities were subjected to thematic analysis. Findings from the relevant section of The National Cancer Patient Survey were also considered to provide insight into the expressed needs of local service users. Most cancer and palliative care education was directed towards nurses employed in specialist oncology settings. Some groups appeared to be poorly served (including community nurses, senior nurses and AHPs). No evidence could be found of inter-professional cancer or palliative care education within the university sector. Curriculum content did not appear to reflect the ethnic diversity or socio-economic deprivation that characterised the local heath economy. Further research is needed to determine how best to ensure that continuing professional education reflects the needs of all practitioners involved in cancer and palliative care.