Consumer attitudes towards the use of routine outcome measures in a public mental health service: a consumer-driven study

In this study conducted by consumer consultants, 50 consumers who have a Barwon Health case manager (the majority of whom were nurses) were interviewed using a structured questionnaire to ascertain their attitudes towards the routine use of outcome measures. Forty participants (80% of those interviewed) reported they had been offered the Behaviour and Symptom Identification Scale (BASIS-32) to complete in routine care by their case managers and of those, 95% (n = 38) completed it. On those who completed the BASIS-32, 42% said their case manager had explained what the BASIS-32 would be used for, 45% said that the case manager had discussed their responses with them, 76% stated that completing the BASIS-32 had helped the case manager to understand them better and 66% believed that completing the BASIS-32 had led to them receiving better care. Only 30% of the group interviewed were aware that their case manager regularly completed a Health of the Nation Outcome Scales and Life Skills Profile. Feedback about the process of completing the BASIS-32 was obtained as well as suggestions on how the process may be improved. The results indicate that consumers see the benefit of routine outcome measurement and believe it leads to improved care. More information about outcome measures, including the clinician-rated outcome measures, needs to be provided to consumers if they are to be engaged constructively in this exercise.     

'Consumer consultant': expanding the role of consumers in modern mental health services

We aim to increase understanding about issues affecting 'consumer consultants' at an Area Mental Health Service level in the hope that consumers and mental health staff are informed of the challenges and changes associated with that role. Anecdotal feedback indicates that consumer consultants are working harder than ever and that their role is more diverse and challenging than before. Increased organizational demands and responsibilities are testing traditional roles and approaches. There is opportunity for greater sharing of expertise and skills among health professional staff and consumer consultants to enhance current work practices, increase workplace satisfaction, and achieve positive patient outcomes.     

Attitudes of postgraduate nursing students towards consumer participation in mental health services and the role of the consumer academic

Consumer participation in health care is increasingly becoming an expectation of health services. While important progress has been made in the mental health area, the attitudes of mental health professionals towards consumers poses a severe limitation. Greater consumer involvement in the education of mental health professionals has been presented as a strategy to encourage the development of a greater acceptance of consumer involvement by health professionals. A consumer academic position has been introduced into the Centre for Psychiatric Nursing Research and Practice. An important aspect of this role concerns the education of postgraduate psychiatric/mental health nursing students, in order to provide a consumer perspective and encourage greater consumer participation. In order to determine the impact of this project a questionnaire was developed by the authors to measure attitudes to consumer participation and the role of the consumer academic. This paper presents the first stage of this study. The questionnaire was administered to students (n = 25) on the first day of the course. The findings suggest that most students favour a high level of consumer participation but that this is limited to specific areas of treatment planning and delivery. Furthermore, the students' demonstrate some level of ambivalence regarding the value and necessity of the consumer academic role.     

Mental health nurses' attitudes towards severe perinatal mental illness

Title.  Mental health nurses' attitudes towards severe perinatal mental illness.
Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.
Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.
Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.
Findings.  Participants did not perceive any difference between symptoms during perinatal and non-perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision-making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.
Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.     

Nursing based evidence: moving beyond evidence-based practice in mental health nursing

Various authors suggest mental health nursing is dominated by knowledge borrowed from psychiatry, pharmacology and the behavioural sciences. These disciplines favour knowledge developed using quantitative methodologies so they and evidence-based practice (EBP) and evidence-based nursing (EBN), increasingly called for in mental health nursing, fit seamlessly together. Nevertheless, as these movements dismiss qualitative approaches to knowledge (evidence) development, I argue against the move toward EBP/EBN in mental health nursing. This is because the specialty's primary interests - human experiences of illness/health care and human relationships, often do not lend themselves to being quantitatively researched. Using nursing examples, I demonstrate how qualitative research, wholly unacceptable in relation to EBP/EBN quality of evidence scales, is indispensable to mental health nursing. The need for evidence arising from qualitative research in no way precludes the need for quantitatively derived evidence. Indeed, the specialty's twofold interest - the work of nurses with clients and the explication of phenomena which inform practice, require diverse knowledge and thus, diverse research approaches. This twofold interest defines the area of mental health nursing practice, and knowledge informing it is referred to as nursing based evidence (NBE). Because it values multiple approaches to knowledge development, NBE provides a way to articulate the specialty's distinct contribution to the health care of people experiencing mental illness and advances mental health nursing.     

Nurses' attitudes towards the use of PRN psychotropic medications in acute and forensic mental health settings

Many countries now have national mental health policies and guidelines to decrease or eliminate the use of seclusion and restraint yet the use of Pro Re Nata (PRN) medications has received less practice evaluation. This research aimed to identify mental health nurses' attitudes towards the use of PRN medications with mental health consumers. Participants were working in forensic mental health and non‐forensic acute mental health settings. The “Attitudes towards PRN medication use survey” was used and data were collected online. Data were analysed using the Statistical Package Social Sciences, Version 22.0. Practice differences between forensic and other acute mental health settings were identified related to the use of PRN medications to manage symptoms from nicotine, alcohol and other drug withdrawal. Differences related to the useage of comfort rooms and conducting comprehensive assessments of consumers' psychiatric symptoms were also detected. Qualitative findings highlighted the need for increased accountability for the prescribing and administration of PRN medications along with more nursing education/training to use alternative first line interventions. Nurses administering PRN medications should be vigilant regarding the indications for this practice to ensure they are facilitating the consumer's recovery by reducing the use of all forms of potentially restrictive practices in the hospital setting. The reasons for using PRN medications and PRN administration rates must be continually monitored to avoid practices such as high dose antipsychotics use and antipsychotic polypharmacy to ensure the efficacy of the consumers' management plans on their health care outcomes.     

Mental health professionals' attitudes towards consumer participation in inpatient units

Consumer participation has been a major focus in mental health services in recent years, but the attitudes of mental health professionals towards this initiative remain variable. The purpose of this study was to describe mental health professionals' attitudes towards mental health consumer participation in inpatient psychiatric units. The Consumer Participation and Consultant Questionnaire was used with a non-probability sample of 47 mental health professionals from two adult inpatient psychiatric units situated in a large Australian public general hospital. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using SPSS, Version 12. Overall, respondents had favourable attitudes towards consumer participation in management, care and treatment, and mental health planning. They were less supportive about matters that directly or indirectly related to their spheres of responsibility. The type of unit that the respondents worked in was not a factor in their beliefs about consumer participation. Recommendations are made about the development of guidelines for consumer participation in inpatient units, the educational preparation of mental health clinicians, and the need for mental health professionals to reflect on, and discuss their own beliefs and practices about, consumer participation.     

Mental health professionals' attitudes towards people who have experienced a mental health disorder

The aim of this study was to gain information about the attitudes of mental health professionals towards people who have experienced a mental illness. The study involved a survey of 266 mental health professionals employed in a range of mental health treatment settings. Respondents were administered a questionnaire based on one of two vignettes describing a person with schizophrenia or depression. Attitudes were represented as beliefs about prognosis and long-term outcomes in relation to the two vignettes. Professional groups were found to be less optimistic about prognosis, and less positive about likely long-term outcomes, when compared with the general public. Medical staff were less optimistic about outcomes than other professional groups, with mental health nurses generally most optimistic. Most professionals based their attitudes on their experiences of working with people with mental health problems.     

An exploratory investigation into the housing preferences of consumers of mental health services

In the present qualitative study, 10 mental health consumers living in the community were interviewed in relation to their housing situations. Three themes emerged from the interview data: ‘The place’, ‘Other consumers’ and ‘A normal life’. Consumers rejected congregated housing because it enables the larger community to more easily identify them as former psychiatric patients. The views of participants consistently indicate a desire to live a normal life. Results of this study highlight the need for greater consumer participation with mental health nurses and policy makers, in relation to the development of housing services.     

Consumer sexual relationships in a Forensic mental health hospital: Perceptions of nurses and consumers

The management of consumer‐related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long‐term and secure setting. Individual in‐depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes ‘supportive factors’ and ‘potential dangers’, reflecting their qualified support. Consumer responses included the subthemes ‘therapeutic’, ‘feeling normal’, ‘restrictions and barriers’, and ‘lack of support and secrecy’. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly‐avoided issue and the education of nurses and other health professionals is required.     

The attitudes of mental health professionals towards patients with mental illness in an inpatient setting in Palestine

Culture plays a vital role in shaping public and professional attitudes towards mental illness. In Arab cultures negative attitudes toward patients experiencing mental illnesses are common. There is a lack of studies that investigate the attitudes of professionals towards patients in inpatient mental health settings. This study aimed to assess the attitudes of professionals towards patients with mental illnesses in the only psychiatric hospital in Palestine. A survey was undertaken using the Attitudes Toward Acute Mental Health Scale (ATAMHS 33). The scale was distributed to a variety of professionals at the only psychiatric hospital in Bethlehem. Data was managed and analysed by using SPSS 15 (a statistical package for social sciences). The participants (mostly nurses) expressed both negative and positive attitudes toward patients, however, results revealed more negative than positive attitudes, particularly in relation to alcohol misuse, medication, patients' ability to control their emotions, and genetic predisposition to mental illness. This paper provides baseline data about the attitude of mental health professionals towards patients experiencing mental illnesses. Education and direct contact with patients with mental illness may not be enough to foster positive attitudes towards them. This may indicate the need to revise educational curriculum at the Palestinian universities and offer more training for mental health professionals in order to change their attitudes.     

Implications of evidence‐based practice for mental health nursing

The introduction of evidence‐based practice (EBP) and the hierarchical approach to evidence it engenders within research and evaluation has aroused controversy in the mental health professions. The aim of this paper is to present a critique of EBP with a specific relationship to mental health nursing. It will be argued that in its current form, EBP presents a potential impediment to the facilitation of consumer participation in mental health services and to the recovery model. The need for the consumer voice and the importance of the lived experience of mental illness are not readily reconciled with a strong scientific paradigm that promotes detachment and objectivity. The importance of evidence in contemporary mental health care will also be acknowledged and discussed in light of the current climate of increased consumer knowledge, fiscal constraint, and extensive social criticism of mental health‐care services. The current approach to EBP requires reconstruction to support the consumer‐focused nature of mental health nursing, and to facilitate the implementation of a recovery model for mental health care.     

Nursing attitudes towards acute mental health care: development of a measurement tool

AIM: This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units. BACKGROUND: The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported. METHODS: A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire. RESULTS: Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant 'Attitudes Towards Acute Mental Health Scale' (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0.72. CONCLUSION: The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care.