The Journal of Mental Health Training, Education and Practice

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

ISBN:: 1755-6228

Issue Number

Latest documents

Lifelong learning and the structure of professionals' thinking, on the example of case conceptualisation
Purpose: The purpose of this study was to investigate the relationship between the elements of psychotherapists’ informal education and features of concept maps reflecting the properties of thinking structure. Design/methodology/approach: To study the structure of professional thinking, a complex diagnostic task (computer-aided conceptual mapping task) was used. The diagnostic task consisted of categorising the client’s statements, presenting relations between the categories and concept maps accounting for problems reported by the client and contributing factors and links between them. Findings: The obtained results showed that self-education, through participation in scientific conferences and attending training courses, was significantly associated with the number of perceived causal relationships between categories and the number of perceived reciprocal links between conceptual categories. Originality/value: This research show factors which may contribute to more reliable case conceptualisation in psychotherapy. The method used to measure integrative complexity was original.
Case note review of community mental health services for children and young people in a UK rural location
Purpose: The aim of the review is to investigate the reasons for referral to this child and adolescent mental health (CAMH) service and determine whether these had been met by the service. Design/methodology/approach: This is a retrospective case note analysis that was conducted of 66 referrals to CAMHS for children and young people serving a rural community of 132,000. Case notes were selected by the NHS CAMHS manager based on referrals during the pre-defined date set. Of the 66 referrals to CAMHS, 19 were not included in the analysis because they had not been accepted into the service. Data were analysed on the remaining 47 cases who were referred, accepted into the service and had been offered an assessment by the service. Findings: General practitioners represented the most frequent health care practitioner to refer to the service (n = 33, 70.2%). Self harm, suicidal intent, thoughts or overdose represented the highest percentage of referrals to the CAMHS service (38.3%); depression, low mood and sadness represented the next highest figure (19%) and anxiety and depression (10.6%) broadly speaking 68% of referrals related to low mood. Out of the 44 cases that were examined, 14/44 (32%) were referred back to the GP and no specific intervention was provided. Interventions provided to five cases were unspecified. Research limitations/implications: A number of opportunities for developing the service that allowed for a focus on the core business of helping children and young people with low mood were identified. One of the limitations of this retrospective review was the time frame selected because it had been identified as a particularly high period for referral into the service and may not have been representative of the usual trend. Practical implications: This informed a training strategy and resource allocation and a redefinition of discrete roles within the service. Originality/value: This study highlighted the evidence about where the demand was on this service and hence the requirement to focus on their core business. This evidence generated by the review prompted a redirection of resources within the service. Additional reflections and discussion informed the development of a new training strategy and a redefinition of discrete roles within the service.
Where’s that stethoscope? A survey of psychiatrists’ attitudes to their role in managing physical health
Purpose: This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients’ physical health problems. Design/methodology/approach: A 20-item electronic questionnaire was distributed to doctors working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was conducted, alongside qualitative analysis of free-text comments made by participants. Findings: Many participants perceived their physical examination skills to have deteriorated since working in psychiatry (78 per cent). Participants were questioned on which professional group should hold responsibility for managing the physical health of patients under psychiatric services. A minority felt it should be psychiatrist-led (5 per cent), followed by general practitioner (GP)-led (42 per cent) and then shared responsibility (47 per cent). The majority felt there should be more focused training on physical health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a framework analysis of qualitative data included potential barriers to shared care, psychiatrists’ concerns regarding their experience and confidence in managing physical health, reasons in favour of shared responsibility, ideas for training and suggestions for improving the current situation. Originality/value: Psychiatric patients may engage less well with health services, yet psychiatric medication often impacts significantly on physical health. In this context, there is often a blurring of role boundaries between a psychiatrist and a GP, and there is considerable variation between individual teams. There is a consistent call for more physical health training opportunities for psychiatrists and for mental health services to more proactively promote the physical health of their patients.
Yoga for anxiety and depression – a literature review
Purpose: The purpose of this paper is to investigate the effectiveness of classical yoga not only as a complementary therapy but also as a viable option in the management of anxiety and depression. Design/methodology/approach: Papers were retrieved using a combination of databases including PubMed/MEDLINE and PsycINFO. Findings: The findings revealed that the practice of yoga as complementary therapy and also as a stand-alone therapy is effective in managing and reducing anxiety and depression. Research limitations/implications: All the studies reviewed in this paper were methodologically limited in terms of sample size, sample heterogeneity, yoga intervention styles, duration of practice and teaching methods. Further research is needed to address key areas such as how much yoga is needed per week, duration of each class and specifically the types of asanas and pranayama to practise to bring about change in the anxiety and depressive states. Practical implications: This review has provided substantial insight to yoga as a complementary and/or stand-alone therapy for anxiety and depression which is much needed in this contemporary society. The Malaysian community especially teenagers and adults, should consider incorporating yoga as part of their daily routine to experience and reap its benefits. It is suggested that yoga be included as part of the physical education curriculum in learning institutions and as a recreational activity for staff in public and private organisations. Originality/value: The findings of this review provide an avenue for victims to cope with and manage anxiety and depression through the practice of yoga.
Training NHS staff to work with people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI)/borderline personality disorder
Purpose: Improvement is sorely needed to the National Health Service (NHS) care for people with trauma induced emotional regulation and interpersonal relational difficulties (TIERI), currently labelled as a variant of personality disorder [PD; borderline personalty disorder/emotionally unstable personality disorder (BPD/EUPD)]. This study aims to improve staff training. Design/methodology/approach: A mixed-methods evaluation demonstrated the benefits of offering 495 staff three-day trainings with a clinician-designed, unique training package. Findings: Statistically significant improvements were reported in both staff confidence and optimism when dealing with people with a diagnosis of PD (PWDPD) and scores on the Helping Alliance questionnaire. No statistically significant changes in social attitude resulted. Qualitative data shows negative descriptions generated by staff decreased post-training with an increase in positive and neutral descriptions. The responses generated six different themes: resources, client demand, medical model, emotional, human and positive rewards. Differing proportions were found pre and post-training. Research limitations/implications: This was a clinical-world evaluation, not a formal research project. Different pairs/combinations of experienced clinicians (predominantly clinical psychologists) acted as trainers. Some minor variation occurred within the training package used and presentation. Practical implications: Given the expense of staff time and resources, this evaluation shows the resultant positive changes achieved. TIERI staff about the difficulties experienced by PWDPD and how to negotiate the relational dynamic is essential. Training helps improve staff perception of the people involved, improves staff confidence and promotes better therapeutic alliances (key to providing the relational and trauma work needed). Ongoing supervision is likely needed post-training. Originality/value: Positive changes resulted from a mixed-methods evaluation of three-day trainings by using a specially designed training package.
Service user involvement in an undergraduate nursing programme
Purpose: The purpose of this study is to highlight the impacts that service user involvement can have on the education of UK undergraduate student mental health nurses both personally and professionally. It reports the findings from a short module evaluation of a collaboratively delivered theory unit using a qualitative approach. Design/methodology/approach: The study reports the findings from a short module evaluation of a collaboratively delivered theory unit using a qualitative approach embracing two focus groups. Findings: The findings from the two focus groups highlight that the service user input (expert by experience) offered a positive learning experience for the students, enabled them to appreciate the meaning of recovery and hope and facilitated the identification of the importance of their role in terms of connecting meaningfully with those they are supporting and reconsidering key priorities for practice. They also suggest that there is theory/practice gap reduction as students were able to connect the service user narratives to the evidence base for deeper understanding and application. Research limitations/implications: Although only a brief evaluation of a short theory module within a wider programme involving a small number of participants, the findings echo the wider literature and offers further rationale to support direct service user involvement within mental health education across all healthcare professions. This finding is also relevant, as, increasingly, learning/teaching programmes now seek to implement blended learning with significant online teaching and less face-to-face facilitation of learning. Practical implications: This study highlights not only the positive impact of service user input on health-care education but also the benevolent influence skilled narratives can have as a pedagogical approach to learning. Originality/value: Although there is much in the literature as to the benefits for student learning in involving service users within higher education institute education, there is limited information as to “how” and “why” this is the case, this article seeks to bridge that gap.
Navigating rocky terrain: a thematic analysis of mental health clinician experiences of family-focused practice
Purpose: Approximately 20 per cent of Australian children live with a parent who experiences mental illness. These children have poorer health and psychosocial outcomes than their peers. While family-focused practice (FFP) can improve these outcomes, family-focused service provision is inconsistent. The purpose of this paper is to understand clinicians’ experiences of FFP and associated workplace factors. Design/methodology/approach: In-depth interviews were conducted with ten community mental health clinicians. Interviews were audio recorded and transcribed. Data were analysed using thematic analysis. Findings: A global theme of “navigating rocky terrain” captured clinicians’ experiences of working with families. The rocky terrain encompassed both family complexity and workplace barriers to FFP. Clinicians navigated this terrain by using multiple strategies to support families, working in partnership with families and other clinicians and services, and drawing on personal resources. Interactive approaches to enhancing knowledge and skills were preferred over paper-based information. While an organisation-wide approach to support FFP was beneficial, clinicians continued to feel challenged in implementing FFP. Research limitations/implications: Working with families in which parents experience mental illness is affected by systemic issues at the family and organisational levels. Systemic approaches to both delivering and supporting this work are required. Partnership working and organisation-wide capacity building strategies emphasising interactive approaches to learning appear to have positive effects. Originality/value: This study explores the challenges of FFP in a real-world multidisciplinary context where there has been a systemic approach to enabling this work. It highlights the challenges clinicians face in family-focused practice in spite of substantial organisational supports and suggests some approaches that might be effective. This is a topic which has received minimal attention in the literature.
Lesbian, gay and bisexual individuals experience of mental health services - a systematic review
Purpose: Lesbian, gay and bisexual (LGB) individuals experience higher rates of mental health difficulties in comparison to their heterosexual counterparts (Meyer, 2003; Plöderl and Tremblay, 2015). This is in part due to the experience of homophobia and stigmatisation within society. This discrimination has also been perpetuated within the mental health field, where LGB individual’s sexuality has been pathologised. In response to this historical stigmatisation a number of policies have been created to develop ethical practice while working with this minority group (APA, 2012; BPS, 2019; HSE, 2009; PSI, 2015). The purpose of this paper is to capture the experience of LGB individuals within mental health services and examine if these guidelines are being adhered to. Design/methodology/approach: This study is a meta-narrative synthesis of 13 empirical papers, published between 1999 and 2019. Findings: This study has found both negative and positive experiences of service users. The paper discusses major themes, implications for practice and directions for future research. Originality/value: This is the first systematic review to look at the experiences of clients who have attended mental health services.
Peer supported open dialogue in a UK NHS trust – a qualitative exploration of clients’ and network members’ experiences
Purpose: As the evidence base in relation to open dialogue continues to grow and develop, this paper contributes to the growing evidence base within the UK. The purpose of this paper is to focus on the experiences of those who have received the service and reports a qualitative evaluation of an open dialogue service operating within the National Health Service of the UK. Design/methodology/approach: The opportunity to participate was offered to all those who had received open dialogue within this particular National Health Service (NHS) trust. In total, seven participants, from four different social networks, participated in the research and attended semi-structured focus groups. The audio recordings of all focus groups were transcribed and the data as subjected to inductive thematic analysis. Findings: The results provide an insight into the lived experience of the individuals who received open dialogue. The analysis of the data gathered in the focus groups revealed three major themes: relational mutuality, dichotomy with other mental health services and dialogical freedom. Practical implications: The results suggest that individuals and networks positively experienced receiving open dialogue, particularly in relation to the way in which they were able to relate to, and work with practitioners. However, the results did also raise some issues in relation to the complications of introducing the open dialogue model into existing NHS structures. Originality/value: This research contributes to the emerging evidence base in relation to open dialogue, especially considering the current lack of existing research undertaken within the UK.
Clinicians’ perceptions of telephone-delivered mental health services
Purpose: The adoption of telephone-delivered mental health services (TDMHS) for scaling collaborative care or addressing access to mental health services in routine primary care practice is gradual despite the needs of the population. Although there are multi-level factors associated with efficient implementation of collaborative care, there is limited understanding of clinicians’ perceptions, experiences and acceptability providing mental health treatment exclusively over the telephone. The purpose of this paper is to explore behavioral health clinicians’ delivery of mental health services over the telephone within primary care settings. Design/methodology/approach: This qualitative study explored behavioral health professionals’ perceptions and experiences providing remote, TDMHS. Convenience sampling was used to recruit 11 clinicians in New York, California and Arizona who provided collaborative care services to patients exclusively over the telephone. Semi-structured interviews were conducted, and analyzed using qualitative content analysis methods. Findings: Three main themes and associated subthemes emerged from the analyses. The first theme was participants’ perceptions of TDMHS prior to implementation relating to patient characteristics, patient engagement and comparison to in-person therapy. The second main theme identified was participants’ experiences implementing TDMHS with subthemes relating to benefits, quality of care, gaps in care and concerns implementing TDMHS. The final theme that emerged from the analysis was participants’ perceived acceptability of TDMHS by patients. Research limitations/implications: The small sample size limits the generalizability of these findings. Practical implications: Mental health services delivered over the telephone are perceived as feasible and acceptable by behavioral health clinicians. Originality/value: This study contributes to gaps in research about behavioral health clinicians’ beliefs, uptake and acceptability toward mental health services delivered exclusively over the telephone.