Mental Health Nurses' Family Focused Practice with Parents who have Mental Illness, their Children and Families in Adult Mental Health Services in Ireland

Introduction: While it is recommended that mental health professionals engage in family focused practice (FFP), there is limited understanding regarding psychiatric nurses’ practice with parents who have mental illness, their children and families in adult mental health services.

Methods: This study utilized a mixed methods approach to measure the extent of psychiatric nurses’ family focused practice and factors that predicted it. It also sought to explore the nature and scope of high scoring psychiatric nurses’ FFP and factors that affected their capacity to engage in FFP. Three hundred and forty three psychiatric nurses in 12 mental health services throughout Ireland completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Fourteen nurses who achieved high scores on the FFMHPQ also participated in semi-structured interviews.

Results: Whilst the majority of nurses were not family focused a substantial minority were. High scoring nurses’ practice was complex and multifaceted, comprising various family focused activities, principles and processes. Nurses’ capacity to engage in FFP was determined by their knowledge and skills, working in community settings and own parenting experience.

Conclusions: Generally, low levels of family focused practice suggest the need for organizations to develop and implement guidelines, policies and training to support mental health professionals to adopt a whole family approach.

A global effort to advance systems change to address the needs of families where a parent has a mental illness.

As part of the Prato Collaborative I am undertaking a Delphi Study to explore the developmental journeys that nine different countries (including NI and Ireland) have undertaken to better meet the needs of families where a parent has a mental illness in adult mental health and children’s services. This research has potential to impact FFP in adult mental health and children's services.

Psychiatric Nurses’ Practice with Parents who have Mental Illness, their Children and Families, within Adult Mental Health Services in Ireland

Introduction: While it is recommended that mental health professionals engage in family focused practice (FFP), there is limited understanding regarding psychiatric nurses’ practice with parents who have mental illness, their children and families in adult mental health services.

Methods: This study utilized a mixed methods approach to measure the extent of psychiatric nurses’ family focused practice and factors that predicted it. It also sought to explore the nature and scope of high scoring psychiatric nurses’ FFP and factors that affected their capacity to engage in FFP. Three hundred and forty three psychiatric nurses in 12 mental health services throughout Ireland completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Fourteen nurses who achieved high scores on the FFMHPQ also participated in semi-structured interviews.

Results: Whilst the majority of nurses were not family focused a substantial minority were. High scoring nurses’ practice was complex and multifaceted, comprising various family focused activities, principles and processes. Nurses’ capacity to engage in FFP was determined by their knowledge and skills, working in community settings and own parenting experience.

Removing children from the care of adults with diagnosed mental illnesses - a clash of human rights?

Health and social services providers throughout Europe are increasingly aware of the possibility of litigation from service users arising from the application of a human rights perspective to public service provision. The substantial body of case law that has emerged from the European Court of Human Rights (ECHR) is used regularly as the basis for this litigation at national and European levels. This paper presents an analysis of ECHR cases related to breaches of human rights that occurred when children were taken into care from families in which one or both parents had a diagnosed mental illness. The issues raised by these cases include the following: how to ensure that the right to family life is protected for adults with mental illnesses; how to ensure access and opportunities for parents to continue bonding with children in care; and how to avoid damaging children while giving time for a proper assessment of the care situation.

Is low self-esteem an inevitable consequence of stigma? An example from women with chronic mental health problems

It is often assumed that membership in a stigmatized group has negative consequences for the self-concept. However, this relationship is neither straightforward nor inevitable, and there is evidence suggesting that negative consequences may not necessarily occur (Psychol. Rev. 96(4) (1989) 608). This paper argues that the relationship has not been sufficiently theorized, and that a more detailed analysis is called for in order to understand the relationship between stigma and the self. The paper presents a critical examination of modified labeling theory (Am. Sociol. Rev. 52 (1987) 96), with examples from a study examining perceptions of stigma and their relationship to self-evaluation in women with chronic mental health problems. Open-ended interviews and qualitative analyses were used in preference to global measures of self-esteem. It was found that although the women were aware of society's unfavorable representations of mental illness, and the effects this had on their lives, they did not accept these representations as valid and therefore rejected them as applicable to the self. The participants did not deny their mental health problems, but their acceptance of labels was critical and pragmatic. Labels were rejected when they were perceived as carrying an unrealistic and negative stereotype, or when the women felt that their symptoms did not fit with the diagnostic criteria. The research illustrates the importance of considering people's subjective understandings of stigmatized conditions and societal reactions in order to understand the relation between stigma and the self. (C) 2002 Elsevier Science Ltd. All rights reserved.

Attitudes of qualified versus student mental health nurses towards an individual diagnosed with schizophrenia

Aims: This paper is the report of a study which sought to compare the attitudes held by student and qualified mental health nurses towards individuals with schizophrenia in the Republic of Ireland. Background: Media portrayals of individuals with schizophrenia often include images of aggression and violence. With global initiatives aimed at reducing the stigma and exclusion associated with mental illness, the attitudes of those who care for people with schizophrenia are of particular interest. Methods: A survey was administered to 66 student mental health nurses, and 121 qualified mental health nurses. Participants completed the community attitudes to mental illness scale (CAMI) and the social interaction scale (SIS) in 2009. Multivariate analysis of variance was used to test for the effects of qualification, work setting, years of experience and education on the measures. Results: A statistically significant difference was found between community mental health nurses and those employed in an inpatient setting on the social restrictiveness and community mental health ideology subscales of the CAMI and on the SIS. Findings also showed a statistically significant difference between nurses in the 10-14 years of experience group and the 5-9 years of experience group on the SIS. Conclusions: Mental health nurses employed in an inpatient setting are often confronted with patients who have challenging behavioural presentations which may explain their socially restrictive attitudes. However, nurses must be alerted to the fact that such negative attitudes may adversely affect the therapeutic relationship and ultimately lead to stigmatisation and its negative consequences.

Supported Housing for People with Severe Mental Disorders

Background There has been a significant reduction in the number of people with severe mental illness who spend extended periods in long-stay hospitals. District health authorities, local authorities, housing associations and voluntary organisations are jointly expected to provide support for people with severe mental disorder/s. This 'support' may well involve some kind of special housing. Objectives To determine the effects of supported housing schemes compared with outreach support schemes or 'standard care' for people with severe mental disorder/s living in the community. Search methods For the 2006 update we searched the Cochrane Schizophrenia Group Trials Register (April 2006) and the Cochrane Central Register of Controlled Trials (CENTRAL, 2006 Issue 2). Selection criteria We included all relevant randomised, or quasi-randomised, trials dealing with people with 'severe mental disorder/s' allocated to supported housing, compared with outreach support schemes or standard care. We focused on outcomes of service utilisation, mental state, satisfaction with care, social functioning, quality of life and economic data. Data collection and analysis We reliably selected studies, quality rated them and undertook data extraction. For dichotomous data, we would have estimated relative risks (RR), with the 95% confidence intervals (CI). Where possible, we would have calculated the number needed to treat statistic (NNT). We would have carried out analysis by intention-to-treat and would have summated normal continuous data using the weighted mean difference (WMD). We would have presented scale data for only those tools that had attained pre-specified levels of quality and undertaken tests for heterogeneity and publication bias. Main results Although 139 citations were acquired from the searches, no study met the inclusion criteria. Authors' conclusions Dedicated schemes whereby people with severe mental illness are located within one site or building with assistance from professional workers have potential for great benefit as they provide a 'safe haven' for people in need of stability and support. This, however, may be at the risk of increasing dependence on professionals and prolonging exclusion from the community. Whether or not the benefits outweigh the risks can only be a matter of opinion in the absence of reliable evidence. There is an urgent need to investigate the effects of supported housing on people with severe mental illness within a randomised trial.