Impact of strengths model training and supervision on the therapeutic practice of Australian mental health clinicians

This study explored the impact of Strengths Model training, supervision and mentorship on the practice of a group of multi-disciplinary mental health clinicians that included mental health nurses, social workers, psychologists, and occupational therapists. A qualitative approach that combined critical realism and grounded theory was used. The findings demonstrated how a substantive category, Getting to Know Clients Better, facilitated participants' progression through a basic social psychological process, Becoming a Strengths-Informed Practitioner. This process consisted of a discernible and sustained change towards more person-centred, hopeful, and recovery-oriented practice. The findings also described an underlying generative mechanism for this, the Client Becomes Visible, which accorded with theoretical models of empathy, based on enhanced cognitive processing. The strength-based approach to practice facilitated the establishment of a collaborative relationship and a stronger therapeutic alliance between the client and clinician. The research demonstrated that Strengths Model is an effective vehicle for improving recovery-orientated mental health services.     

Towards healthy professional-client relationships: The value of an interprofessional training course

Boundary violations that threaten professional-client relationships are rarely discussed at the coalface. There is an assumption that healthcare practitioners have the skills necessary to manage professional boundary dilemmas with clients. The issue, if addressed, is usually confined to discipline specific education and training. A one-day Professional Boundaries for Health Professionals (PBHP) training program was developed in response to real life practice dilemmas experienced by health practitioners across the continuum of care. The program was delivered to 109 participants throughout the state of Queensland, Australia, from government and non-government organizations. Participants were doctors, nurses, allied health (physiotherapists, occupational therapists, social workers, psychologists, dietitians, speech therapists), therapy assistants and personal care staff from a diverse range of hospital and community settings. Evaluations of PBHP suggest that the interprofessional learning context was valued with specific advantages identified in the use of adult learning approaches, the teaching of ethical decision making principles, the value of supervision and peer support and the opportunities provided for critical reflection. The effectiveness of training for healthcare practitioners in this area is discussed as a meaningful way of developing skills and engendering collaborative relationships between professional (e.g., occupational therapist, social worker) and paraprofessional (e.g., therapy assistant, personal care worker) groups. A combination of intensive training in professional boundaries and opportunities for ongoing professional development are important for all health practitioners.     

Portrait of occupational therapy

The profession of occupational therapy promotes individuals to achieve health and wellness through engagement in meaningful occupations of daily living. This occupation-focused profession plays a critical role in health care in a multitude of settings with a wide range of clients. The paper highlights a global overview of the philosophies of occupational therapy, the current international practices in occupational therapy, the education of therapists, and the roles of law and professional societies that govern the practice of occupational therapy.     

‘It's just a peripheral issue’: A qualitative analysis of mental health clinicians’ accounts of (not) addressing sexuality in their work

Sexuality, relationships, and intimacy are integral parts of many peoples’ lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In‐depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants’ accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were ‘Sexuality is hard to talk about’ and ‘Sexuality is a “peripheral issue”’. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub‐themes): that sexuality rarely ‘comes up’, that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants’ roles or skill sets. A third theme captured the contrasting perception that ‘Sexuality could be better addressed’ in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery‐oriented principles in mental health settings.     

Nurses' perceptions of a mental health education programme for Australian nurses

In the present study, we present qualitative findings of study of nurses' perceptions of a mental health education programme for Australian nurses. Many nurses avoid disclosing their mental health problem/illness because of the stigmatization by health workers. Mental health education is a successful means to address workplace stigma; thus, it can be anticipated that such education can address workplace difficulties experienced by nurses with mental health problems. During 2008, a qualitative study was conducted to obtain nurses' perceptions of a short mental health education programme for nurses. The workshop purpose was to improve mental health literacy in order to improve support to colleagues with mental health problems. Semistructured, audio-taped interviews were conducted with 13 nurses and then transcribed. A framework analysis approach guided interpretation of the data. The education programme had limited effect on the participants' attitudes towards colleagues with mental health problems. This was likely due to their high level of mental health literacy and experiences prior to the workshop. Participants felt that a more focused nurse-specific programme might have been more efficacious. Implementing a nurse-specific education session is potentially an effective means to improve support to nurses who experience mental health problems.     

A concept mapping exploration of social workers' and mental health nurses' understanding of the role of the Approved Mental Health Professional

This study uses concept mapping and participant interviews to explore how differing professional viewpoints and levels of knowledge held by social workers and mental health nurses affect perceptions of the Approved Mental Health Professional (AMHP) role during an interprofessional training programme. The results suggest that social workers entering the programme had a greater understanding of the role in comparison to mental health nurses; however, on completion of the programme, both professional groups demonstrated similar levels of learning. The study challenges assumptions that nurses may be inherently disadvantaged by their professional background in terms of learning about a role that is traditionally associated with social work practice. Study participants valued the concept mapping process and felt that the approach may be a valuable tool for clinical supervision.     

Urban–rural differences in mental health among Chinese patients with multiple chronic conditions

Mental health is impacted by social, economic, and environmental influences related to where people live. Mental health problems commonly co‐occur with long‐term physical conditions and impact individuals’ health synergistically. Multiple chronic conditions (MCCs) including mental health problems are becoming a public health challenge globally. However, there is limited information about urban–rural differences in mental health among patients with MCCs in China. The present study aimed to identify differences in mental health between urban and rural patients with MCCs. Using a cross‐sectional design, 347 patients with MCCs were recruited from a tertiary hospital in North Anhui, China. A self‐reported questionnaire, including socio‐demographic and clinical variables, the 12‐item Short‐Form survey version 2 on quality of life, and the Hospital Anxiety and Depression Scale, was administered to outpatients. Findings showed that rural participants reported more symptoms of anxiety and depression and had worse mental health compared to urban participants. Unemployment status, lower educational level, more long‐term health conditions, and a higher degree of anxiety were associated with worse mental health. This study highlights disparities in mental health among patients with MCCs living in urban and rural areas of China. Appropriate mental health support programmes should be developed for patients with MCCs, especially for those living in rural areas.     

Listening for recovery: the vocational success of people living with mental illness

BACKGROUND: Mental health occupational therapists work with some individuals who want employment but who are not successful at finding or keeping a job. PURPOSE: The purpose of this qualitative study was to suggest factors contributing to vocational success. METHOD: The investigators interviewed 8 participants who were recovering from psychosis. The interview texts were coded and analyzed for emerging themes. RESULTS: Three themes emerged that describe how the participants achieved vocational success: self-assessing their mental health regularly, actively working to maintain and improve their mental health, and striving to feel connected to others at work. The results are consistent with previous studies that found that a positive fit between a worker and the workplace is linked to the worker feeling connected to and valued by the workplace. PRACTICE IMPLICATIONS: This study suggests that supporting the ways individuals assess and promote their own mental health and recovery will contribute to their success at work. Occupational therapists are urged to help people find workplaces where they feel encouraged and comfortable as this appears to be an important factor in vocational success.     

Training case managers to deliver focused psychological strategies

ABSTRACT:  Anxiety and mood disorders are prevalent in the Australian community and can be functionally disabling. Access to treatment for these disorders can be difficult, particularly in rural areas where there is limited availability of specialist mental health practitioners such as psychiatrists and clinical psychologists. One way to address this problem is to improve the skills of local mental health practitioners in recognizing and providing treatment for these disorders. This paper describes a program that aimed to enhance access to psychological treatment for depression and anxiety by improving the skills of rural mental health case managers through training and education and support by psychiatrists and clinical psychologists. Thirty-two case managers participated in the program which delivered 10 training modules using a cognitive behavioural therapy framework. Case managers consisted primarily of psychiatric nurses, with others having social work or psychology backgrounds. Participants were assessed pre- and post-training using quantitative and qualitative measures. The effect of the training was noted in several areas including attitudinal changes, improved knowledge of psychological therapies, and changes to stated practice. However, there was concern expressed by participants about their competence and confidence to translate skills learned into practice. While the results of such a program are promising, they highlight some of the complexities of delivering such programs in rural settings.     

Effectiveness of 1‐day trauma‐informed care training programme on attitudes in psychiatric hospitals: A pre–post study

Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma‐informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow‐up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre–post design with 3‐month follow‐up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1‐day programme consisting of a 3.5‐hour lecture and 1‐hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma‐Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2 years. The mean score of the Attitude Related Trauma‐Informed Care scale scores increased significantly from 5.1 during pre‐training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3–0.5) and 5.4 after 3 months (mean difference: 0.3; 95% confidence interval: 0.2–0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3‐month follow‐up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.     

Health promotion in the office

Occupational therapists have the training and skill to modify office environments in order to promote employee health. Minor changes in the ways tasks are performed can improve work performance, decrease the incidence of minor health complaints, and help prevent repetition injury. Two employee health promotion education programs are described. They were conducted by an occupational therapist and can be replicated in other settings. One program was a seven-session series for bank employees; the other was a luncheon presentation to office workers employed by a health science university.     

Resourcefulness Training for Women Dementia Caregivers: Acceptability and Feasibility of Two Methods

Mental health nurses are ideally placed to assess mental health service users’ physical health and provide relevant interventions. However, they may lack the confidence and knowledge to do so, as a result of limited education on physical health issues. This mixed methods pilot study sought to evaluate the effect of education on confidence in assessing and addressing physical health needs following attendance at a module entitled “Physical Health Issues in Adult Mental Health Practice.” An explanatory sequential design was used in which quantitative data regarding participants’ perceptions of their confidence on assessing and addressing physical health issues with service users were collected via a questionnaire pre- and post-module. Additionally, a focus group interview was conducted to expand on survey responses. Findings indicated that confidence scores increased for all participants following the module, with participants identifying new knowledge and plans for practice change. Further research is needed to educate and support mental health staff in improving their confidence and knowledge in this area.     

Role changes experienced by clinical staff in relation to clients' recovery from psychosis

This study investigates the subjective experiences of staff from many interdisciplinary teams working with clients in the recovery process from psychosis. The clinical staff interviewed in this study included: staff nurses, clinical nurse specialists, occupational therapists, psychologists, social workers, rehabilitation workers, recreation therapists, music therapists, psychiatrists, and lodging home operators. The purpose of this study was to examine the clinical staff's changing roles and relationships with clients recovering from psychosis. The investigation used a naturalistic qualitative design with an ethnographic method of data analysis. The participants were clinical staff working with clients about to commence treatment with clozapine or risperidone. The settings used were a tertiary-care psychiatric hospital and a general hospital. The clinical staff members who participated in the study were interviewed every 3 months. In the initial interview, members of the clinical staff were asked about their knowledge regarding the new medication and their role in the decision to try the new medication. In all the interviews, clinical staff members were asked about how the recovery process was progressing with the client. Data regarding clinical staff fears related to the client's situation, changes in their relationships with the client and the client's family, and what they perceived to be current rehabilitation implications, were collected. Some of the clinical staff roles that evolved during the recovery process were: health teacher; advocate; counsellor; and support person.     

Building resilience in regional youth: Impacts of a universal mental health promotion programme

Mental health is a leading health issue facing young people today, particularly those living in rural and regional areas. Although public policy supports schools‐based health promotion, there is limited evidence of the efficacy of such programmes and the elements that enhance successful implementation in rural and regional areas. A study was designed to evaluate a mental health promotion programme, delivered collaboratively by nurses, guidance officers, and teachers, to 850 young people from 23 rural and regional high schools in Queensland, Australia. The study aims were to determine what effect the intervention had on young peoples’ resilience, coping, and self‐efficacy, and to understand the implications of delivering the programme in the regional Queensland school setting. Students completed self‐report measures of self‐efficacy, resilience, and coping strategies pre‐ and postprogramme, as well as at 8‐week follow‐up. We found that after programme completion there was a significant increase in self‐efficacy and in the number of positive coping strategies used by the participating young people. Qualitative data indicated that participants benefited from the collaboration between health and education sectors; that is, nurses, guidance officers, and teachers delivered the programme together in ways that were perceived to be respectful of young people and effectively discussion‐based, and engaging.     

'I wanted to learn how to heal my heart': family carer experiences of receiving an emotional support service in the Well Ways programme

Family carers of people with mental illness provide an immense contribution to society in caring for mental health consumers. However, carers can experience substantial burdens and poor health outcomes themselves. Recognition of their needs for education and support has led to the development of a range of family education programmes. Throughout Australia, the Mental Illness Fellowship Australia offers the Well Ways programme, a group-based, family-to-family, education programme that provides information and aims to increase carers' capacity to care effectively for themselves, their families, and the mental health consumers. This paper describes a qualitative evaluation of an emotional support service piloted in a Well Ways programme in rural Queensland, Australia. The pilot service comprised individual emotional support offered to family carers attending the weekly Well Ways group education programme. Six of eight family carers who received the emotional support engaged in semistructured interviews exploring their experience of receiving the support. Three themes emerged from their experience: dealing with difficult times, connecting through shared experience, and exploring different options. Family carers found the emotional support beneficial, and reported that it enhanced their capacity to manage their own well-being, as well as their caregiving roles.     

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well‐being throughout their lives, compared to non‐Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme ‘supports along the road to recovery’. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients’ mental health needs. These insights may inform service review, workforce development, and further research.