Mental Health Review Journal

De Silva, Raneesha; Ireland, Jane L.; Birch, Philip; Ireland, Carol A.; Lewis, Michael; Dissanayake, Ravindra; Atapattu, Methma

2023 Mental Health Review Journal

doi: 10.1108/mhrj-11-2021-0081

The purpose of this study is to explore mental health difficulties, including risk and protective factors, which may impact on symptom severity after exposure to crisis situations (war, terrorism and/or natural disasters), among first responders from uniformed services.Design/methodology/approachPeer-reviewed journal articles published in English between January 2012 and March 2022 were searched in ProQuest, Wiley, Google Scholar and PubMed databases. In total, 12 articles were obtained from an original screening of 94,058 articles. Full article texts were screened for content and quality by two reviewers, with high agreeability.FindingsPost-traumatic stress disorder and depression were the most common diagnoses. Risk factors identified were pre-deployment factors of overweight, low cognitive ability and social support, existing emotional difficulties, negative childhood experiences and stressful life events; during crisis situations factors of higher frequency and subjective severity of combat, increased rates of combat stress reaction, high levels of concerns for life and family, more stressful mission position, threat of death/severe injury and high rate of killing the enemy; and post-deployment factors, such as low social support and physical health, lack of coping mechanisms and use of avoidance strategies and social stigma. Protective factors increasing resilience and lessening symptom severity were reported as pre-deployment cognitive ability, high social support, stable physical health, effective coping, post-traumatic growth and high levels of perceived adequacy in pre-deployment preparation and training. In addition to main findings, data about author(s), publication type, population, age, type of crisis and evaluation measures were extracted. Key findings and related theories, gaps in literature and recommendations are discussed.Originality/valueAs yet, however, research into the factors that could serve as risk and/or protective factors are not clearly indicated in terms of post-crisis recovery. As per the authors’ knowledge, this study is an initial approach to considering this area.

Clayton, David; Clifton, Andrew; de Vries, Kay; Kuuya, Henson; Ochieng, Bertha

2023 Mental Health Review Journal

doi: 10.1108/mhrj-11-2021-0089

“My Story” is based on a life story approach. This study aims to facilitate therapeutic alliances by providing a format for older and younger people to interact.Design/methodology/approachThree pairings were studied to explore the experiences of the older and younger person using “My Story”. The focus of the case studies was on how and if any therapeutic alliance emerged.FindingsThis study found that in the two of the pairings, “My Story” helped to create a bond and mutual benefit for the participants’ central to a therapeutic alliance. This led one of the pairings to develop into an intergenerational friendship and potentially help with loneliness.Research limitations/implicationsAs this was an exploratory and small pilot, more cases and research are required to fully assess if “My Story” is a useful approach to develop intergenerational befriending.Practical implicationsIntergenerational befriending may be one solution that could help with loneliness and social isolation through forming a therapeutic alliance to make the befriending successful.Social implicationsLoneliness and social isolation for older people remain a problem.Originality/valueAn original pilot was undertaken to test the approach by bringing together older people identified as lonely by a voluntary sector provider and pairing these with a student volunteer. The students visited the older person over six weeks to discuss their life story and create an artefact based on the story for the older person.

Stíobhairt, Antaine; Staunton, David; Guerin, Suzanne

2023 Mental Health Review Journal

doi: 10.1108/mhrj-02-2022-0009

This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services.Design/methodology/approachA systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having “major” relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes.FindingsThere was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery.Research limitations/implicationsThis review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English.Originality/valueThis review makes a unique contribution, highlighting that, to the best of the authors’ knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary.

Robinson, Amie; De Boos, Danielle; Moghaddam, Nima

2023 Mental Health Review Journal

doi: 10.1108/mhrj-07-2022-0047

This study aims to improve the efficiency of the assessment process within a Step4 Psychological Therapies Service by identifying factors related to assessment non-attendance and service suitability for referred clients.Design/methodology/approachReferral and assessment information was accessed between October 2019 and March 2020 from Step4 routine service data, electronic client records where necessary and Step4 staff self-report questionnaires.FindingsAll clients offered an assessment during this time attended. Findings indicated several factors could influence service suitability in meeting client need. These included individual differences such as readiness to change, which was not necessarily identified at referral or prior to assessment, and potential systemic factors, such as the opt-in procedure, which possibly impeded access. Though the necessity for assessment in clarifying client needs and treatment was indicated, an assessment (from referral to assessment appointment) that led to discharge could take an excess of one working day of service time, associated with considerable opportunity cost to other clients awaiting assessment. Recommendations are made for improving assessment efficiency.Originality/valueWith a high prevalence of poor mental health in the UK, efforts must be made to identify and reduce additional demand upon service time and resources within mental health services to effectively meet people’s needs. Recommendations to improve assessment process efficiency include the use of a standardised referral form, offer of follow-up support procedures, increased client involvement, a streamlined opt-in battery and ongoing monitoring to ensure shared practice between clinicians. These are transferable to other mental health services, with implications for subsequent quality and timeliness of care.

Alshawwa, Yusra; Sethi, Faisil

2023 Mental Health Review Journal

doi: 10.1108/mhrj-07-2022-0042

This paper aims to explore the impact of the COVID-19 pandemic on mental health organisations in England.Design/methodology/approachA qualitative mixed-methods approach was applied, including a review of the academic literature, a review of the non-academic literature and a brief semi-structured survey. Respondents of the semi-structured survey included seven healthcare leaders from four different NHS Mental Health Trusts in England. This review applied thematic analysis to the data findings.FindingsMental health organisations in England have been significantly impacted by the COVID-19 pandemic. The analysis of the identified resources found four overarching areas for learning: organisational structures, approaches to practice (working and delivering care), leadership and staff support. Organisational structures refer to structural, systemic and procedural changes that have taken place. Approaches to practice relate to shifts in organisational work and delivery of care. Leadership identifies styles used to manage change and disruption. Staff support refers to measures and interventions applied to meet changing staff needs and well-being.Practical implicationsMental health organisations can reduce the ongoing impact of the COVID-19 pandemic through continuous improvements in future crisis planning, innovations in clinical practice and a sustained focus on staff well-being.Originality/valueA multi-dimensional exploration into the impact of the COVID-19 pandemic on mental health organisations was conducted. The review also provides insights into the experience of healthcare leadership in managing change during the COVID-19 pandemic.

Chatterjee, Paula; Turri, Maria Grazia

2023 Mental Health Review Journal

doi: 10.1108/mhrj-03-2022-0014

Service users’ voice is at the forefront of movements within psychiatry that look to create more humanising care. Although genuine co-production of knowledge is limited by the power differential intrinsically functional to the health care setting, the arts have the potential to create collaborative environments and equalise relationships. The purpose of this case study is to describe and discuss the design and pilot evaluation of creative writing workshops in a forensic mental health ward as an innovative method for humanising care.Design/methodology/approachA creative writing intervention focussing on everyday experiences was implemented in a forensic mental health ward and involved four residents and four mental health professionals working together. Interviews were conducted with the four mental health professionals as part of a service evaluation. Transcripts were analysed using thematic analysis.FindingsTwo themes emerged from the analysis of interviews with mental health professionals: “a new way of learning about each other” and “imagining beyond the staff-resident relationship”. The authors discuss the intervention’s benefits in terms of its potential to foster mutuality and empathy beyond the illness narrative.Practical implicationsCreative writing can be used to engage patients and mental health professionals to jointly share everyday experiences and identities beyond illness.Originality/valueThe creative writing workshops present an innovative approach concerning the use of creative arts for humanising care through mutuality.

Paulino Ferreira, Luís; Ribeiro, Nuno Filipe; Duarte, Marco António

2023 Mental Health Review Journal

doi: 10.1108/mhrj-05-2022-0030

Post-traumatic stress disorder (PTSD) is associated with risk of suicide and chronic psychological impairment. The continued exposure to stress suffered by health-care workers (HCWs) during the COVID-19 pandemic can be considered a mass traumatic event and contribute to higher rates of PTSD in this population. The purpose of this research is to find out the prevalence and factors associated with PTSD among HCW in a general hospital.Design/methodology/approachThe authors devised a survey to assess the prevalence of PTSD among HCWs in a general hospital and its relationship with sex, social support, profession, work experience in health care, time spent caring for COVID-19 patients and place in which the COVID-19-related activities were carried out. PTSD symptoms were assessed using the PCL-5, Portuguese version.FindingsA total of 226 HCWs were included in the study. Provisional diagnosis of PTSD was made based on the PCL-5 responses, considering DSM-5 criteria and the cutoff score of 33. In total, 79 (35.0%) HCWs had a provisional diagnosis of PTSD, and a significant association was found between PTSD and time spent working with COVID-19 patients and between PTSD and place of work, namely, the COVID-19 emergency room and intensive care unit.Originality/valueThe results highlight the need for a reflection on the importance of mental health promotion among HCWs, specially in adverse conditions such as the current pandemic.

Holland, Hannah Sophia; Tickle, Anna

2023 Mental Health Review Journal

doi: 10.1108/mhrj-07-2022-0043

This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances.Design/methodology/approachSystematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies.FindingsSeven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours.Research limitations/implicationsThis review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention.Practical implicationsDespite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies.Originality/valueAlthough the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.