Adding SUGAR : service user and carer collaboration in mental health nursing research

‘SUGAR: Service users and carers group advising on research’ is an exciting initiative established to develop collaborative working in mental health nursing research between mental health service users, carers, researchers and practitioners at City University London, UK. This paper will describe the background to SUGAR and how and why it was established; how the group operates; some of the achievements to date including researcher reflections; and case studies of how this collaboration influences our research. Written reflective narratives of service user and carer experiences of SUGAR were analysed using constant comparative methods by the members. Common themes are presented with illustrative quotes. The article highlights the benefits and possible limitations identified so far by members of SUGAR; outlines future plans and considers the findings in relation to literature on involvement and empowerment. This paper has been written by staff and members of SUGAR and is the first venture into collaborative writing of the group and reflects the shared ethos of collaborative working.

Patterns of care: Primary research in mental health nursing

The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasises the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting engage in specific activities. The observations of this study determined that nurses' time is accounted for 31.65% in direct care, 51.63% in indirect care and 16.71% in service related activities.

Cultural safety and diversity: Refocusing our energies in mental health nursing practice, education and research

INTRODUCTION AND BACKGROUND: This presentation draws on a body of work assessing cultural safety's potential to generate change in mental health nursing research (Cox and Simpson 2015), in education and in clinical practice (Cox and Taua 2013, 2016; Happell, Cowin, Roper, Lakeman & Cox 2013). It presents evidence to suggest that cultural safety could resolve the conceptual confusion surrounding culture and diversity in nursing curricular, in clinical and in research practice. The history and nature of mental health work recommend cultural safety to focus attention on diversity, power imbalance, racism, cultural dominance, and structural inequality, identified as barriers and tensions in clinical practice and in service user participation. Cultural safety gives mental health nursing a well theorized and articulated model, which is evolving to improve practice into the future. DESCRIPTION: This work involved an immersion in the literature on cultural safety and the Service User Research movement. It draws on 5 months' work with a service users' research group in the UK and reflections on 9 years of cultural safety teaching. POLICY/PRACTICE CHANGE: This work provokes a crucial change of emphasis from locating the source of issues in the diversity of people to locating it in how society responds to diversity: a change from individualistic to systemic concerns. IMPLICATIONS FOR MENTAL HEALTH NURSING: Cultural safety in clinical practice, education, and research is specifically concerned with awareness of the impact of systemic workplace cultures and with staff cultural self-awareness to bring about cultural change and person-centred care of individuals' unique needs and aspirations within their life context.

Settings for mental health care

The quality of the environment is important to client recovery and rehabilitation. • The preferred environment for the care of the mentally ill over time has been the home. • Environmental strategies in the care of the mentally ill became more important in the eighteenth century, when it was noticed that patients were more manageable in a pleasant environment. • Confinement of the mentally ill in large public asylums was largely an innovation of the nineteenth century. • The therapeutic milieu is a consciously organised environment. • Maxwell Jones in the United States and Thomas Main in the United Kingdom pioneered the concept of the hospital and environment as treatment tools. • The goals of the therapeutic milieu are containment, structure, support, involvement, validation, symptom management, and maintaining links with family and the community. • The principles on which the therapeutic milieu is based include: open communication, democratisation, reality confrontation, permissiveness, group cohesion and the multidisciplinary team. • The principle guiding the care of clients in the community is that of the least-restrictive alternative. • The therapeutic community residence is an environment that encourages the development of the client as a person in interaction with others, rather than as someone suffering from a health problem or disability. • The preferred contemporary setting for the provision of mental health care is the community. • The predominant form of service delivery in the community is case management, which has been found to be most effective for people with severe mental illnesses. • The principles of caring in the community are self-determination, normalisation, a focus on client strengths, and the community as a resource

Getting that piece of paper : mental health nurses' experience of undertaking doctoral studies in Victoria, Australia

The aim of this study was to explore the experience of mental health nurses undertaking doctoral studies. The study was conducted in Victoria, Australia. A descriptive exploratory approach to inquiry was used for this study. Participants were mental health nurses who had successfully completed a doctoral qualification. Eligibility for inclusion required participants to be residing in Victoria (irrespective of where their doctoral studies were undertaken) and to have conducted their research within the domain of mental health and/or currently employed in the field of mental health nursing. Of the 20 potential participants invited, 16 accepted the invitation. Five emergent themes were explicated from narrative analyses. These themes were being a trail blazer, positioning for professional advancement, achieving a balance between competing priorities, maintaining a commitment to the development of the profession, and a point of affirmation. An understanding of the experience of undertaking doctoral studies can be used to influence the development of strategies to encourage more mental health nurses to consider undertaking a doctoral degree.

Research participation by people with intellectual disability and mental health issues : an examination of the processes of consent

Balancing the demands of research and ethics is always challenging and even more so when recruiting vulnerable groups. Within the context of current legislation and international human rights declarations, it is strongly advocated that research can and must be undertaken with all recipients of health care services. Research in the field of intellectual disability presents particular challenges in regard to consenting processes. This paper is a critical reflection and analysis of the complex processes undertaken and events that occurred in gaining informed consent from people with intellectual disability to participate in a study exploring their experiences of being an inpatient in mental health hospitals within Aotearoa/New Zealand. A framework based on capacity, information and voluntariness is presented with excerpts from the field provided to explore consenting processes. The practical implications of the processes utilised are then discussed in order to stimulate debate regarding clearer and enhanced methods of gaining informed consent from people with intellectual disability.

Factors that influence young people's mental health help‐seeking behaviour : a study based on the Health Belief Model

Aim To identify key predictors and moderators of mental health ‘help-seeking behavior’ in adolescents. Background Mental illness is highly prevalent in adolescents and young adults; however, individuals in this demographic group are among the least likely to seek help for such illnesses. Very little quantitative research has examined predictors of help-seeking behaviour in this demographic group. Design A cross-sectional design was used. Methods A group of 180 volunteers between the ages of 17–25 completed a survey designed to measure hypothesized predictors and moderators of help-seeking behaviour. Predictors included a range of health beliefs, personality traits and attitudes. Data were collected in August 2010 and were analysed using two standard and three hierarchical multiple regression analyses. Findings The standard multiple regression analyses revealed that extraversion, perceived benefits of seeking help, perceived barriers to seeking help and social support were direct predictors of help-seeking behaviour. Tests of moderated relationships (using hierarchical multiple regression analyses) indicated that perceived benefits were more important than barriers in predicting help-seeking behaviour. In addition, perceived susceptibility did not predict help-seeking behaviour unless individuals were health conscious to begin with or they believed that they would benefit from help. Conclusion A range of personality traits, attitudes and health beliefs can predict help-seeking behaviour for mental health problems in adolescents. The variable ‘Perceived Benefits’ is of particular importance as it is: (1) a strong and robust predictor of help-seeking behaviour, and; (2) a factor that can theoretically be modified based on health promotion programmes.

What keeps nurses busy in the mental health setting?

The foundation of mental health nursing has historically been grounded in an interpersonal, person-centred process of health care, yet recent evidence suggests that the interactional work of mental health nursing is being eroded. Literature emphasizes the importance of person-centred care on consumer outcomes, a model reliant upon the intimate engagement of nurses and consumers. Yet, the arrival of medical interventions in psychiatry has diverted nursing work from the therapeutic nursing role to task-based roles delegated by medicine, distancing nurses from consumers. This study used work sampling methodology to observe the proportion of time nurses working in an inpatient mental health setting spend in the activities of direct care, indirect care and service-related activities. Nurses spent 32 of their time in direct care, 52% in indirect care and 17% in service-related activities. Mental health nurses need to re-establish their therapeutic availability to maximize consumer experiences and outcomes.

"It broke our hearts": Understanding parents' lived experiences of their child's admission to an acute mental health care facility

This article reports the evaluative findings of an Early Psychosis Education Program (EPEP) designed to support parents caring for their child who was recently admitted to the psychiatric intensive care unit of an inpatient mental health care facility in Australia. The EPEP offered education on mental illness, treatment options, and medication, as well as information on the recovery model of care. The EPEP was facilitated by two RNs and was evaluated for educational effectiveness using a simple pre- and postevaluation questionnaire. The evaluation revealed two themes expressed by parents: "We didn't see it coming," and "Hopelessness and helplessness." The themes highlighted the parents' lack of mental health care knowledge prior to the EPEP, which had a significant impact on the parents' experiences and well-being. The evaluative findings highlighted a need for a nurse-led EPEP within the community. A community EPEP has the potential to strengthen the partnership between parents, families, and mental health service providers and to help with the provision of a recovery framework of care.

Bringing up Children Gran’s Way: Insights from a research project on Indigenous child and youth mental health

Background In 2000, the Mater Child and Youth Mental Health Service Indigenous consultant saw that Indigenous families were isolated from kinship networks following the assimilation policy and clinicians were largely unaware of these socio-cultural histories. Experiences of marginalisation by mainstream society and services were exacerbated by assumptions clinicians made about this population. To enhance Mater’s care the consultant undertook research with Indigenous Elders. The project, “Bringing up Children Gran’s Way”, on which the presenter is the research advisor, was funded by AIATSIS. Aims Increase service quality Improve staff confidence, skills and satisfaction working with this population Promote the wellbeing of Indigenous families Acknowledge the significance of Elders and extended family networks. Methods Over 2006/07 the team used narrative and Indigenous methodologies, (e.g. yarning circles and the use of Indigenous research staff) to arrange and audio-record structured interviews with 19 Aboriginal Elders, on growing up and parenting. The participants were recruited by the Indigenous consultant and gave written consent, following ethical approval and information giving. The team immersed themselves in the material by repeated reading of the transcripts to note recurring themes in Elders’ narratives. Findings The recurring themes included the importance of cultural protocols and extended family; impacts of being ‘under the Act and stories of surviving change; culture, spiritualty and religion; trans-generational impacts; childrearing and the need to reconcile with Elders. Discussion The narratives show Elders resilience in the face of enduring impact of policies of genocide and assimilation. Clinicians need to approach their work with a deeper understanding of the diversity of clients’ social experience and cultural identity. Clinicians need to examine their own cultural assumptions about this population. Conclusion The dissemination of the knowledge and experience of Elders is a matter of social justice and crucial for the well-being of future generations and for improved service access.

Consensus statement on the role of Accredited Exercise Physiologists within the treatment of mental disorders: A guide for mental health professionals

- Objective The aim is to identify the role and scope of Accredited Exercise Physiologist (AEP) services in the mental health sector and to provide insight as to how AEPs can contribute to the multidisciplinary mental health team. - Methods A modified Delphi approach was utilised. Thirteen AEPs with experience in mental health contributed to the iterative development of a national consensus statement. Six mental health professionals with expertise in psychiatry, mental health nursing, general practice and mental health research participated in the review process. Reviewers were provided with a template to systematically provide feedback on the language, content, structure and relevance to their professional group. - Results This consensus statement outlines how AEPs can contribute to the multidisciplinary mental health team, the aims and scope of AEP-led interventions in mental health services and examples of such interventions, the range of physical and mental health outcomes possible through AEP-led interventions and common referral pathways to community AEP services. - Outcome AEPs can play a key role in the treatment of individuals experiencing mental illness. The diversity of AEP interventions allows for a holistic approach to care, enhancing both physical and mental health outcomes.