The Journal of Mental Health Training, Education and Practice

Ebrahim, Selma

2018 The Journal of Mental Health Training, Education and Practice

doi: 10.1108/JMHTEP-03-2017-0019

PurposeThe purpose of this paper is to explore how multi-professional approved clinicians (MPACs), responsible for the care of patients detained under the Mental Health Act (2007), can enable clinical leadership in mental health settings.Design/methodology/approachA questionnaire was completed by clinical psychology and mental health nursing practitioners in a mental health trust in the UK working towards or having gained approved clinician (AC) status, identifying barriers to implementation of the roles and enablers. Qualitative interview data were also gathered with psychiatrists, clinical psychologist and Mental Health Nurse ACs (three in each group).FindingsThere are a number of barriers and enablers of distributed leadership promoted by the MPAC role. Themes identified focused on enabling person-centred care, clinical leadership and culture change more broadly within mental health care. The AC role is supporting clinical leadership by a range of professionals, promoting patient choice by enabling access to clinicians with the appropriate skills to meet needs. Clinical leadership roles are promoting links between organisational priorities, teams and patient care, fostering distributed leadership in practice.Research limitations/implicationsThis project reflects the views of a limited number of practitioners within one organisation which limits generalisabilty.Practical implicationsOrganisations need clear strategies linked to workforce development and implementation of the roles to capitalise on their potential to support clinical leadership and person-centred care.Originality/valueThis study provides initial qualitative data on potential benefits and challenges of implementing the role.

Vicary, Sarah Anne Oakley; Bailey, John

2018 The Journal of Mental Health Training, Education and Practice

doi: 10.1108/JMHTEP-08-2016-0039

PurposeThe purpose of this paper is twofold. First, to examine the impact on mental health social work of integrated care; and second, to explore the effectiveness of the use of deliberative research, a methodology which is new to mental health social work research.Design/methodology/approachDeveloped to enable examination of policy, deliberative research is underpinned by a desire to permit choice and change brought about through an iterative dialogue. This communication is based on informed and respectful equality between policy makers or implementers and those subject to that implementation. In order to achieve this equality, participation in debate by participants is viewed as essential, including as part of the process, participants becoming better informed about the phenomenon in question.FindingsThe findings show that effective mental health social work underpins successful integrated care which, in turn, is viewed as relevant. In addition, people who access services identified that mental health social workers are well positioned as facilitators and explainers in integrated care. The issue to be further explored by research, therefore, is not whether services should be delivered separately or in an integrated way, but how to keep improving and developing integrated care and especially the impact of ongoing power differentials.Research limitations/implicationsThe use of deliberative research worked reasonably well as an underpinning methodology for this study in that it sought to achieve the opinions of the public, in this instance consumers who provided or accessed mental health social work. The ethical need to ensure no harm came to this particular group meant that their opinions were not debated with the whole. This limitation to iterative dialogue is undoubtedly a consideration when undertaking deliberative research on such populations. This study offered just this, a one-off event, as in reality the commitment from participants to attend more than this one session would have been prohibitive.Practical implicationsThe test, practically, comes with the events for data collection. This is not just the debate as to whether these, as one-off events, bring about agreement and not deliberation, but also whether researchers can, with a group that has particular needs, effectively integrate them into the deliberation. Given that it is an ethical priority to ensure that the participants are not harmed, this is not always going to be possible where the “public” includes those who may be vulnerable.Originality/valueDeliberative research methodology is a new approach in mental health social work research. The influential finding is activism: people who access services recognise and suggest a challenge to the normative power differential in integrated care, as embodied in mental health social workers, and it is this aspect that warrants further investigation.

Collins, Rachael; Shakespeare, Tom; Firth, Lucy

2018 The Journal of Mental Health Training, Education and Practice

doi: 10.1108/JMHTEP-05-2017-0037

PurposeThe purpose of this paper is to provide insights into the views and attitudes that psychiatrists have about recovery colleges (RCs).Design/methodology/approachSemi-structured interviews were conducted with ten psychiatrists from the Norfolk and Suffolk Foundation Trust.FindingsPsychiatrists had a strong concept of the RC model, and were broadly positive about it, recognising many benefits. Various challenges were also acknowledged including how the RC model interacts with the medical model.Originality/valueThis is the first known study to explore solely the psychiatrists’ views of RCs, a group who are likely to be particularly influential within services. The sample was relatively unexposed to RCs, enabling insight into how the RC is perceived by those outside of its functioning as well as the state of wider organisational support, which is important for the success of RCs.

Drown, Chris; Harding, Thomas; Marshall, Robert

2018 The Journal of Mental Health Training, Education and Practice

doi: 10.1108/JMHTEP-12-2016-0055

PurposeThe purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and alternatives to seclusion.Design/methodology/approachA questionnaire was circulated to mental health inpatient staff. Data from the Ministry of Health for seclusion numbers and rates for Ma¯ori and non-Ma¯ori were also collected.FindingsThe major barriers to reducing the use of seclusion related to staffing issues, a lack of management and medical support, and physical characteristics of the facility. Data from the Office of the Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion events, the number of patients secluded, and the percentage of total patients secluded. However, the percentage of Ma¯ori secluded compared to the total number of patients secluded showed little change from 2007 to 2013.Originality/valueFurther analysis of the nurse’s responses showed that four of the six least-used strategies incorporated Ma¯ori cultural approaches. The authors surmise that an inability to provide culturally sensitive care, either through staffing or education factors, may be implicated in the lack of change in the seclusion rates for Ma¯ori. This may also be pertinent to seclusion rates for indigenous peoples in other countries.

Bentley, Kia J.; Cummings, Cory R.; Casey, Rachel C.; Kogut, Christopher P.

2018 The Journal of Mental Health Training, Education and Practice

doi: 10.1108/JMHTEP-02-2017-0009

PurposeThe purpose of this paper is to increase awareness of shared decision making, the initial aim of the study was to understand how psychiatrists-in-training defined themselves as unique among physicians with an eye on how professional identity might shape approach to care. The second aim was to use those definitions and descriptions related to professional identity and tailor a brief training module to promote awareness of the shared decision making model.Design/methodology/approachThe authors do this by first conducting focus groups to ascertain how psychiatric residents characterize their professional identity and unique disciplinary characteristics. The authors then designed a brief training session that exploits the relationship between how they define themselves as physicians and how they approach clinical decision making with patients.FindingsThree major themes that emerged from the focus group data: the central role of societal and treatment contexts in shaping their professional identity and approaches to care, a professional identity characterized by a great sense of pride, and a strong commitment to systematic decision-making processes in practice. While the assessment of the training module is preliminary and lacks rigor for any generalizability or statements of causality, responses likely affirm the training tailored around professional identity as a possible vehicle for effective exposure to the concept of shared decision making and served as a useful avenue for self-reflection about needed changes to more fully embrace the practice.Research limitations/implicationsMore inquiry may be needed into the association between trust, relationship longevity and power and paternalism, as a way to bring greater insight into the adoption of shared decision making. Future research will have to investigate whether or not including identity-related content is empirically connected to successful training on shared decision making. Likewise, future research should also look at the reciprocal impact of effectively using shared decision making on the affirmation of professional identity among psychiatrists, and indeed all who embrace patient-centered care.Originality/valueThis is the one of the first papers to investigate issues of professional identity among psychiatry residents, and also among the first papers to consider the relationship between professional identity and use of shared decision making.

Lamph, Gary; Sampson, Mark; Smith, Debra; Williamson, Gary; Guyers, Mark

2018 The Journal of Mental Health Training, Education and Practice

doi: 10.1108/JMHTEP-03-2017-0023

PurposePersonality disorder is reported to elicit strong emotional responses and negative attitudes in mental health staff (Bodner et al., 2015). The purpose of this paper is to provide an overview of the design and development of a co-produced e-learning training package for personality disorder awareness and an evaluation of its effectiveness. This study was carried out to explore if e-learning is an effective mode of training delivery for raising personality disorder awareness.Design/methodology/approachThe e-learning was uniquely developed by subject matter experts working in co-production with people with lived experience. Self-reported measures were completed at three separate intervals to evaluate the effectiveness of the training: at pre-, post- and three-month follow up. Quantitative data were collected via these questionnaires.FindingsThe results from this evaluation show that e-learning is an effective mode of delivery for raising the awareness of personality disorder among mental health professionals, achieving similar outcomes to those reported following face-to-ace training.Research limitations/implicationsAttrition at follow-up phase was high which was consistent with other similar studies. The evaluation was led by the lead contributors and in the geographical area of its development. The study was relatively small and the participants were self-selected, therefore findings should be treated with caution.Practical implicationsE-learning can provide flexible training to compliment and act as an alternative to face-to-face personality disorder training. E-learning may provide an alternative refresher course to knowledge and understanding framework or other face-to-face methods. Co-produced training can be mirrored within an e-learning programme, careful planning to ensure the service user voice is heard and that their lived experience is embraced is required.Originality/valueThis is the first evaluation of a co-produced e-learning only personality disorder awareness training. It is also the first paper to carry out a review of the published evaluations of personality awareness training in the UK with comparisons explored across the studies.