The Journal of Mental Health Training, Education and Practice

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

ISBN:: 1755-6228

Issue Number

No. 20-1, January - December - November 2025

Latest documents

Evaluation of co-produced routine trauma enquiry training within secondary mental health services in England
Purpose: There is a significant gap in training on trauma-informed care and routine enquiry into trauma for mental health practitioners in England (McNally et al., 2023). Best practice suggests that training should be provided by mental health trusts in England and co-produced with individuals who have lived experience of trauma (Trevillion et al., 2022). The purpose of this paper is to explore whether co-produced routine trauma enquiry training increases staff confidence within secondary mental health services. Design/methodology/approach: This paper used a mixed-method evaluation, which included brief questionnaires administered before and after the intervention, as well as at a two-month follow-up period, to assess staff confidence and knowledge and whether these were sustained over time. Participants were also interviewed using a semi-structured approach, and the data were analysed using framework analysis. Findings: The intervention improved knowledge in several areas: when to ask about trauma, how to ask, how to respond to a disclosure, how to bring the person back to baseline (within their window of tolerance) and how professionals can care for themselves following a disclosure. Participants reported that the co-produced training increased their confidence in these areas. The intervention benefited all participants, enhancing self-confidence in asking about trauma in a trauma-informed way (routine trauma enquiry), with this increased confidence sustained over the follow-up period. Participants unanimously felt that this training should be mandatory for all staff. One emerging theme highlighted the importance of the service user’s perspective and the powerful impact participants found it to have. Research limitations/implications: This paper demonstrates the importance of trauma-informed routine trauma enquiry training for mental health staff. It also has implications for future research, as further studies may be needed to explore why trauma-informed care and approaches are not being implemented, by analysing the views of both clinical mental health practitioners and key informants. Originality/value: This paper advances the research on trauma-informed care and its implementation in secondary mental health services in England.
What works for psychological interventions designed to increase wellbeing in psychological therapy trainees? A systematic review
Purpose: This systematic review aims to identify what works for psychological interventions or teaching strategies designed to improve wellbeing in psychological therapy trainees (PTTs). Design/methodology/approach: A systematic review was conducted in keeping with best-practice guidelines. The protocol for the review was registered prospectively on PROSPERO. Findings: Seventy studies were included in the review. The balance of evidence across quantitative, qualitative and mixed-methods studies cautiously suggests that interventions designed to improve PTT wellbeing may be of value. Novel findings regarding barriers and facilitators of successful intervention were identified. Particularly notable in this regard was the finding that providing trainees with a degree of choice or control over elements of the intervention appeared to be an important facilitator of success. Importantly, however, the review identified a number of methodological weaknesses in the literature, undermining the certainty of findings. More high-quality research is needed to answer the questions of the review decisively. Practical implications: Evidence tentatively suggests that interventions to support trainee wellbeing are often received well by trainees and are frequently perceived by trainees as beneficial. Providing trainees with some degree of choice or control regarding how to engage with wellbeing interventions during training may be important. Originality/value: To the best of the authors’ knowledge, this is the first review to systematically identify and synthesise findings on this important topic.
A re-design of intellectual disability undergraduate medical training and implementation of an e-learning tool; improving students’ knowledge, skills and attitudes
Purpose: People with intellectual disability face extensive health inequality and premature mortality. Medical students have reported that they lack the skills, knowledge and confidence to work with those with intellectual disability and autism. This emphasises the need for tomorrow’s doctors to be adequately trained. This study aims to investigate students’ knowledge, skills and attitudes towards people with intellectual disability and autism, examining whether these outcomes change following curricula re-design and with implementation of an e-learning module. Design/methodology/approach: The university curricula in intellectual disability and autism were re-designed and an e-learning module developed using co-production. This was delivered to fourth-year medical students with a subgroup receiving the additional e-learning. A controlled trial evaluated students’ knowledge, skills and attitudes using pre- and post-questionnaires. Statistical tests of difference were used to the scores obtained. Findings: This study showed an improvement in knowledge, skills and attitudes with intellectual disability and autism after curricula engagement, with an incremental benefit observed for students also completing the e-learning module. There was significant difference in pre-and-post placement scores assessing student attitudes towards intellectual disability and autism teaching. Originality/value: This study highlights the importance of a multi-faceted, co-produced curricula re-design in intellectual disability and autism. The benefit of the e-learning module holds hope that the newly introduced mandatory Oliver McGowan training will be beneficial in the development of tomorrow’s doctors. Effective training in intellectual disability and autism is vital to improve the care and support delivered and reduce unnecessary deaths.
Mental health literacy training for employees in cooperative extension: a qualitative program evaluation
Purpose: This study aims to evaluate the outcomes of participating in a brief three-part mental health literacy (MHL) training, the Mental Health Awareness and Advocacy (MHAA) training among employees in cooperative extension. Design/methodology/approach: The authors used a case study research approach for program evaluation to understand the outcomes of participating in a brief three-part mental health literacy training, the Mental Health Awareness and Advocacy training. Participants were eight individuals who completed all three parts of the training and consented to participate in semi-structured interviews. The authors used knowledge, self-efficacy and behavior as the theory-informed analytic framework, the authors also engaged in inductive coding to examine other salient areas as discussed by participants. Findings: All participants reported meaningful increases in knowledge, self-efficacy and covert (non-observable) behavior changes, while some reported overt (observable) behavior changes. Originality/value: The current study used a case study research approach for program evaluation to understand the outcomes of participating in a brief three-part mental health literacy (MHL) training, the Mental Health Awareness and Advocacy (MHAA) training. While previous quantitative research on MHAA programming have documented significant increases in knowledge and self-efficacy, quantitative analyses have largely failed to identify significant behavioral changes. The qualitative methods used in the current study were valuable in identifying behavioral indicators of MHL that may help refine evaluation of behavioral changes following MHL programming.
Co-developing a care pathway for patients discharged from inpatient treatment for anorexia nervosa: a case study
Purpose: The transition period from eating disorder inpatient (IP) care to outpatient care can be difficult for patients and is often characterised by high relapse rates. This study aims to co-develop a novel treatment pathway to support patients during this critical period. Design/methodology/approach: This was a mixed-methods case study using co-production methodology and a nested qualitative component. The authors co-developed an initial proposed pathway structure with clinicians and people with lived experience of an eating disorder, based on a review of the literature. They then conducted interviews with clinicians and patients (n = 8) to refine the pathway; these were analysed using framework analysis. Findings: A four-component pathway structure was developed. Six main themes emerged from this qualitative analysis: autonomy, the need for holistic patient care, difficult experiences, service provision, relationships and feedback on the discharge pathway. Practical implications: This study highlighted the importance of centring patient autonomy during treatment, as well as ensuring treatments are holistic in nature. This may reduce the high levels of relapse associated with discharge from IP treatment and improve the quality and effectiveness of eating disorder treatment delivered. Originality/value: Co-production approaches were used to develop the IP discharge pathway with members of a Lived Experience Advisory Panel alongside clinicians. To the best of the authors’ knowledge, this study was also the first intervention development study aimed at providing targeted support for patients dealing with the adverse effects of hospitalisation and difficulties transitioning to outpatient care.
Staff’s understanding of the role of least restrictive practice in the development of obesity in secure psychiatric inpatients
Purpose: This study aims to explore the ethical challenges of managing the weight of psychiatric patients in the least restrictive manner in secure mental health settings and whether these could be considered as a source of moral distress for health practitioners, which may be linked to staff burnout and ultimately lead to suboptimal patient care. Design/methodology/approach: A qualitative semi-structured interview study design was used to explore the understanding, views and experiences of six staff members working on two medium-secure wards in a UK mental health hospital using an opportunity sampling technique and Interpretative Phenomenological Analysis. Findings: Analysis of semi-structured interviews revealed a multitude of moral events that evoked feelings of frustration, powerlessness and anxiety related to the management of obesity in the least restrictive way, which is indicative of moral distress. Research limitations/implications: Due to the small sample size and the qualitative nature of the research, the findings of this study are of explorative in nature. Further quantitative research would be required to establish a causative link between the ethical challenges associated with obesity management and staff’s moral distress. Practical implications: Addressing the health-care professionals’ knowledge deficit on how to achieve the right balance in their duty of care through inclusion of bioethics into professional discussions and training could improve staff’s well-being and the organisation’s ethical climate. Originality/value: To the best of the authors’ knowledge, this is the first qualitative work exploring the role of least restrictive practice in the challenges associated with health promotion within secure psychiatric settings, and the effect these challenges have on mental health staff.
Mindfulness-based stress reduction via mobile phone on female family caregivers' anxiety and sleep quality during COVID-19
Purpose: This study aims to determine the effect of Mindfulness-Based Stress Reduction (MBSR) via mobile phone on female family caregivers during COVID-19. Design/methodology/approach: In the experimental study, 81 female family caregivers were randomly divided into the experimental group (n = 40) and control group (n = 41). The experimental group received MBSR via mobile phone. Pittsburgh Sleep Quality Inventory and Generalized Anxiety Disorder Questionnaire - Seventh Edition were evaluated at the beginning of the study, week 3 and week 8, respectively. Findings: In both groups, anxiety decreased over time, although the decrease in the experimental group was significantly higher than in the control group (F = 22.912 p < 0.001). Sleep quality improved slightly in both groups over time; this improvement in the experimental group was significantly more than in the control group (F = 3.751 p = 0.035). Originality/value: The MBSR via mobile phone helps to reduce anxiety and improve sleep quality in women caring for isolated patients at home.
A scoping review on combating workplace violence against psychiatry residents
Purpose: This paper aims to illuminate the issue of workplace violence (WPV) against psychiatry residents. Workplace violence is known to negatively impact physical and emotional well-being, professional development and the quality of the care that mental health professionals provide to patients. The authors discuss the prevalence of, risk factors for and consequences of WPV against psychiatry residents, as well as the need for support and resources to help residents cope with the emotional challenges of their job. Design/methodology/approach: This paper is a review of the literature on WPV against psychiatry residents, and includes studies on its prevalence, associated risk factors and consequences. Findings: Psychiatry residents face a heightened risk of WPV, including physical and verbal attacks, which can harm their mental and physical health and disrupt their continuity of care. Factors that contribute to WPV against psychiatry residents include exposure to aggressive or violent behaviors, inadequate training in WPV, understaffing, the stigmatization of mental illnesses, and discriminatory treatment. Furthermore, psychiatry residents who encounter WPV may develop negative emotions and attitudes toward their patients, which can compromise the care they provide. Research limitations/implications: The inherent heterogeneity of study designs highlighted in this review could hinder the establishment of definitive conclusions about the impact of workplace violence on psychiatry residents. A focus on studies published in English may inadvertently exclude relevant literature in other languages, potentially limiting the comprehensiveness of study findings. Originality/value: This paper highlights resident physicians’ personal experiences with and perceptions of WPV encountered during residency training. In response, potential solutions are proposed to address WPV, including increased support for resident physicians, mandatory reporting of WPV incidents, and a cultural shift toward zero tolerance for WPV. In addition, the paper raises awareness of the limited research on this topic and the importance of further investigation.
Online training in trauma-informed intervention and care for mental health workers in India during COVID-19 pandemic: a mixed method evaluation study
Purpose: This paper aims to describe a response to the needs of mental health workers (MHWs) in India during COVID-19 pandemic, through an online training program on trauma-informed intervention and care. Design/methodology/approach: A four-module online training program was developed. Two modules were aimed to bridge the knowledge gap on trauma for MHWs, so that they could effectively address the associated symptoms of fear and grief. The other two modules aimed to support MHWs’ self-care and create supportive connections among colleagues. In this mixed method evaluation study, needs expressed before the training and lessons derived from the training were collected through questionnaires, focus group discussion and interviews. Findings: Of the 3,168 MHWs who registered for the training, 534 completed the pre-questionnaire. Of the 125 post-questionnaire records, 38 had watched all four modules. A great need for learning to work with grief and manage the increased workload without burnout was observed. Post-training gains included skills for working with fear and grief, which increased the confidence of MHWs. The importance of self-care was an eye-opener for many. Social implications: This study indicates a way to equip MHWs to address the trauma that will continue to live in people in the aftermath of crises. Originality/value: This study examined the challenges MHWs in India faced during the COVID-19 pandemic, revealing a knowledge gap on dealing with this level of trauma. It can contribute to the knowledge on how to support MHWs in such crises.
Increasing pediatric primary care providers’ confidence and use of in-office interventions for anxiety: an application of the project ECHO model
Purpose: The prevalence of pediatric anxiety disorders is on the rise but youth have challenges in accessing specialty evidence-based mental health care. As a result, families turn to their pediatric primary care provider (PCP) for assessment and management of anxiety. To increase PCPs’ abilities to manage anxiety, the Extension for Community Healthcare Outcomes (“Project ECHO”) was used. The purpose of this study is to explore the impact of Project ECHO on participating PCPs’ knowledge, self-efficacy and interventions surrounding the assessment and management of anxiety. Design/methodology/approach: Data were collected pre- and post-course across five cohorts. Participants completed a clinical knowledge test, ratings of self-efficacy and self-reported frequencies of in-office interventions. Satisfaction was also measured. Findings: Attendance remained strong, and participants rated high satisfaction. From pre- to post-course, participants demonstrated increased knowledge on almost all objective questions. Participants reported increased self-efficacy across all domains. Finally, participants endorsed increased use of several in-office interventions. Practical implications: This study highlights the importance of Project ECHO as a continuing education model to enhance PCPs’ abilities and confidence in the assessment and management of anxiety. Future continuing education endeavors should consider Project ECHO as a means of increasing PCPs’ capacity to manage mental health conditions. Originality/value: To the best of the authors’ knowledge, this is the first study that applied the Project ECHO model to pediatric anxiety as a mechanism of increasing knowledge, self-efficacy and in-office interventions with PCPs.