Mental Health Review Journal

Publisher:: Emerald Group Publishing Limited
Publication date:: 2021-02-01

ISBN:: 1361-9322

Issue Number

No. 29-4, October - October - August 2024

Latest documents

Embedding reflection sessions in (inter)cultural awareness trainings: value and learning outcomes based on workshops for health and social care professionals
Purpose: This article discusses the importance of the relationship between cultural awareness (CA) training and post-training reflection in the health-care sector, and considers the implications for future developments for CA training in relation to content, audience, process and format. Design/methodology/approach: A total of 77 health and social care professionals (HCSPs) took part in a 4-h CA training, 25 of whom also opted for an additional optional reflection hour. The results reported on in this paper are drawn from the experiences of the 25 participants in the optional reflection sessions (RSs), using a thematic analysis approach. Findings: Participants highly valued the “safe space” in both the CA workshop and the optional follow-on RS, enabling them to share experiences, revisit topics and feel supported to put things into practice. They also reported a growing confidence in dealing with intercultural challenges, in particular in asking questions and being curious about topics they did not understand. Originality/value: This research points towards a strong recommendation for open-ended CA training, allowing participants to articulate their experiences, fears and concerns. It also highlights the importance of a follow-on RS as an integral part of CA training; both of these were found to offer opportunities for strengthening HSCPs’ skills and facilitate the transition of learning from the workshop context into the workplace, with the ultimate aim of reducing inequalities in the quality of patient care.
Clinician perspectives on endings and discharges in community mental health work
Purpose: The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in this area. This paper aims to report on a service evaluation that sought to understand from clinicians working in a single adult community mental health team (CMHT) their experiences of discharge and issues arising in the process, factors considered in decision-making and what constitutes “good” endings and what support could be helpful to them in navigating this with clients. Design/methodology/approach: Semi-structured interviews were completed with six members of the multi-disciplinary team and analysed thematically. Findings: Clinicians described a range of criteria considered in discharge decision-making. Collaboration, planning and preparation were represented as key ingredients for “good” endings. Factors viewed as complicating discharge included complexity and changes in presentation, psychosocial contexts and re-referrals. Perceptions of clients’ feelings (resistance and dependence, fear and anger, relief and gratitude) and varying feelings evoked for clinicians (from little or no reported impact, to pride and confidence, sadness and worry) at the ending of the working relationship were reported. Suggested organisational supports for clinicians with endings and discharges involved opportunities to consult with colleagues, psychological formulation and advice and reflective supervision. Originality/value: There has been limited empirical attention to practitioner experiences of discharge in the work of CMHTs in a UK context; this practitioner-led evaluation explored clinician perspectives.
Designing sport and physical activity interventions for children and adolescents with ADHD: a conceptual framework
Purpose: This paper aims to present a theoretical framework and underpinning evidence to support researchers and practitioners to systematically design sport and exercise interventions. Design/methodology/approach: The framework highlights the theoretical underpinnings and practical feasibility considerations that are important when designing sport and exercise interventions for children and adolescents with attention deficit hyperactivity disorder (ADHD). Findings: Future research may wish to apply and evaluate the utility of this framework and research and practice and make recommendations for further refinement. Originality/value: The quality and strength of conclusions from this body of research has been undermined by a lack of methodological quality and clarity in these studies. One criticism has been the lack of an evidence based, transparent and consistent approach to the design of physical activity and sport interventions and selection of outcome measures. This paper will facilitate the transparent and evidence-based decision-making to guide the design of sport/physical activity interventions for children/adolescents with ADHD.
What is the experience of engaging in mentalization-based treatment? A meta-ethnography of client perspectives of the therapeutic process and outcome
Purpose: Mentalization-based treatment (MBT) is a psychotherapeutic approach that aims to increase mentalizing capacity. The purpose of this meta-ethnography was to synthesize the available qualitative literature on MBT to allow for a more thorough understanding of the lived experience of those who have undergone this therapy. Design/methodology/approach: A systematic search of seven databases was carried out. The Critical Appraisal Skills Programme was used to appraise the papers suitable for inclusion. The data were synthesized using a meta-ethnographic approach in which the second-order constructs from each paper were translated and reinterpreted creating a line of argument synthesis. Findings: A total of 11 studies were included in the meta-ethnography. Three overarching themes were identified within the included papers which outlined that participant experience of MBT consisted of three different developmental stages. Navigating the therapeutic process describes the participant’s experience of the therapeutic process of MBT. The processes of change in MBT outlined participant reports of mechanisms of change experienced in MBT. Mentalizing self and others described the experience of generalizing new knowledge and skills to the world outside of therapy and unveiled the impact that engaging in MBT had on participants. Originality/value: This meta-ethnography offers new insights into how clients experience MBT as a therapeutic process and offers suggestions for implementation in clinical practice as well as areas of focus for research of this therapeutic approach.
Damaging dichotomies and confounding contradictions in mental health inpatient nursing: lessons learned from Orwell’s 1984
Purpose: This discursive paper considers the use of restrictive practices in mental health inpatient settings and how these are often prioritised over relational approaches, especially where the diagnostic label of personality disorder intersects with risk. Design/methodology/approach: Key concepts from Orwell’s 1984 are studied for their pertinence to mental health inpatient settings, supporting our argument that restrictive practices arise from dichotomous thinking and externalised fears. Findings: Drawing upon Orwellian themes of power, social control and digital surveillance from 1984, the authors highlight the role of fear in perpetuating restrictive practices under a guise of benevolent care in mental health inpatient settings, especially for those who are diagnosed with a personality disorder. A lack of preparedness to work with complexity in such environments, coupled with a deficit in self-reflexivity and critical thinking, can exacerbate challenges. Research limitations/implications: To transcend damaging dichotomies and reduce restrictive practices in inpatient settings, the authors make the argument for the adequate preparation and education of the mental health nurse and authentic, collaborative, user-involved care. Originality/value: The authors use Orwell’s novel to support a critical discourse around those damaging dichotomies and inherent contradictions that contribute to restrictive practice in contemporary mental health settings and to question whose interests’ these restrictive practices serve.
How enduring and multi-faceted self-disgust threatens psychological recovery from anorexia nervosa: a qualitative enquiry
Purpose: Self-disgust appears to be a prominent feature in anorexia nervosa (AN), which might help explain why AN is often such a persistent disorder. Little is known about how this emotion can impact on recovering from this disorder. This study aims to develop our understanding of how people experience the emotion of self-disgust after physical recovery from AN. Design/methodology/approach: Twelve female participants who reported previously having had a clinical diagnosis of AN but had physically recovered according to their EDE-Q scores took part in a semi-structured interview to explore their experiences of recovery and the role self-disgust played within this. Interpretative phenomenological analysis was used to explore the data. Findings: Three themes were identified within the data to explain the experiences of self-disgust in those with AN: continued self-disgust following physical “Recovery”, multiple manifestations of self-disgust in recovery and increasing self-disgust in recovery as a driver for relapse. Practical implications: Self-disgust was something each participant appeared to experience often, despite being physically recovered from AN. Disgust-based reactions to the self are enduring and highly resistant to change even whilst other aspects of the disorder become less potent. Self-disgust is multi-faceted and may trigger relapse as the signs of improvement and behaviours inherent in recovering were generally viewed as disgusting to the individuals. Originality/value: Self-disgust is an emotion that continues to affect people with AN despite physical recovery. The recovery process itself is not linear and self-disgust is enduring and may cause those affected to relapse. Considering this emotion within therapeutic intervention may encourage those with AN to accept their recovered self.
Videoconferencing CBT: a mixed-methods analysis of outcomes amongst young people depending on current self-harm risk status
Purpose: A notable number of young people self-harm, with only a minority receiving professional support. Evidence suggests that therapy can help recovery from self-harm, but little is known about the experiences of those who self-harm and participate in therapy delivered via videoconferencing. Design/methodology/approach: Risk assessments were examined for evidence of self-harm and used to identify two groups for analysis: young people who had self-harmed in the past six months and those who had not. A mixed methods analysis was then conducted to examine process and outcome data for these two groups. Data included a number of sessions attended, late-cancelled and missed without notice; and patient-reported outcome measure scores (Young Person-Clinical Outcomes in Routine Evaluation and Revised Children’s Anxiety and Depression Scale). End-of-treatment reports were subsequently analysed using thematic analysis. Findings: Those with current self-harm risk appeared to start therapy with lower well-being. No notable differences in progress were found between groups on quantitative outcomes. There was greater reporting of poorer clinical outcomes in the reports of those with current self-harm risk, including two unique types of barriers to effective therapy: “general difficulties” (e.g. poor well-being limiting engagement, specific components of therapy being challenging) and “CBT was not preferred”. Originality/value: Lower baseline well-being could explain the greater ongoing care needs and lower well-being post-therapy among those with current self-harm risk, despite both groups appearing to make similar levels of therapeutic progress quantitatively. Recent self-harm does not appear to reduce the utility of videoconferencing cognitive behavioural therapy; however, clients’ individual needs should be carefully considered.
Understanding gender-responsive needs of girls in the Children and Young People Secure Estate (CYPSE): menstrual cycle considerations
Purpose: The current study aimed to examine the population of girls in two secure children’s homes (SCHs) in the North East of England to consider the impact of menstruation on girls’ physical, mental and emotional wellbeing within secure settings. Gender-responsive approaches and understanding gender differences are central to trauma-informed provision within the Children and Young People Secure Estate (CYPSE). Whilst trauma-informed approaches are central, it could be argued that basic gender differences, such as the menstrual cycle, are currently being overlooked within research and practice. Design/methodology/approach: A case file audit examined documentation of 24 girls who were admitted across both sites between January 2022 and January 2023. Findings: Of the sample (n = 24), 50% had information recorded regarding their menstrual cycle during admission assessments. Six girls (25%) disclosed experiencing irregular menstruation. Painful cramping was noted by two girls (8%). One girl (4%) disclosed heavy bleeding, and menorrhagia (abnormal heavy bleeding) was reported for one further girl (4%). One girl (4%) disclosed early onset menarche. Case formulations tended to focus less on girls’ menstrual cycles or the potential impact of this on wellbeing. However, 100% of case formulations considered the potential impact of trauma and/or disrupted attachment on girls’ presentations. Originality/value: The results indicate the impact of menstrual cycles on girls’ physical, mental and emotional wellbeing may benefit from much further consideration. Implications are presented alongside directions for future research.
Occupational therapists views on GAS-light as an outcome measure in community adult mental health
Purpose: The paper aims to gain understanding of perceived benefits and barriers to GAS-light as an occupational therapy outcome measure in community adult mental health. The study explored occupational therapists’ views on the client-centred nature of GAS-light and whether it is an applicable outcome measure for group intervention. It also aimed to understand how occupational therapists use of GAS-light informed their practice and the wider multidisciplinary team perspective. Design/methodology/approach: The study used a phenomenological design. This comprising of a focus group of occupational therapists experienced in using the tool, followed by framework analysis. Focus group questions were derived from literature. Findings: Three main themes were identified to reflect experiences relating to the GAS-light tool as an outcome measure; value in process, occupational narrative and language and expertise. Practical implications: The paper is indicative of practical implications regarding the use of the GAS-light tool with community mental health clients and therapists, including the perceived value in the process, the language used by the therapist and level of expertise. Originality/value: This paper fulfils an identified need to contribute towards an evidence base for occupational therapy and mental health.
The cycle of acceptance: mental health professionals’ experience of workplace violence in a UK community mental health team
Purpose: Violence and aggression against mental health professionals is a global concern with well-documented consequences. In the UK, mental health care is increasingly delivered in the community, yet little research has explored practitioner experiences of workplace violence (WPV) outside of inpatient settings. This study aimed to explore how mental health professionals in a UK community mental health team (CMHT) perceive, experience and cope with WPV. Design/methodology/approach: Face-to-face semi-structured interviews were conducted with ten multidisciplinary professionals based in a CMHT in a UK city. Data was analysed using interpretative phenomenological analysis. Findings: Three interconnected themes emerged. WPV was accepted as inevitable: participants carried on working despite its impact, and feeling unheard by management they gave up on change, perpetuating the perceived inevitability of WPV. Peer support and organisational resources like debriefing, counselling and occupational health improved coping. Stigma and ideas of professional responsibility were barriers to access. Originality/value: To mitigate against the negative consequences of WPV, CMHTs could offer peer support initiatives, improve communication and availability of organisational resources and involve staff in post-incident decision-making. Recommendations are made to shift the attitude of acceptance of WPV and encourage help-seeking.