Staff experience of team case formulation to address challenging behaviour on acute psychiatric wards: a mixed-methods study.

BACKGROUND: Team case formulation on acute psychiatric wards aims to support staff to manage significant levels of challenging behaviour. However, there is limited research on staff experience of case formulation in this setting. AIM: This study aimed to investigate staff experience of team case formulation sessions on acute psychiatric wards and their impact on staff wellbeing. METHODS: Eighteen multidisciplinary staff (nurses, doctors, occupational therapists, support workers, activities coordinators) from five acute wards at a South London psychiatric hospital completed a semi-structured interview and visual analogue scales on their experience of attending case formulation. Thematic analysis was employed to analyse qualitative data. RESULTS: Participants reported that case formulation supported staff to develop a holistic understanding of service users, provided a safe space for staff to discuss the impact of challenging behaviour and improved teamwork and communication. Participants reported that these benefits increased their ability to identify and support the needs of service users and improved therapeutic relationships. Challenges with establishing continuity of care were highlighted. CONCLUSION: Team case formulation is an important intervention to support ward staff and has significant benefits to staff wellbeing and quality of care. Greater integration with existing ward practices may benefit both staff and service users.

Virtual reality-based training for mental health staff: a novel approach to increase empathy, compassion, and subjective understanding of service user experience.

BACKGROUND: Mental health service users report that staff empathy is key to developing positive therapeutic relationships but promoting empathy in staff training is challenging. Staff may struggle to maintain their compassion, particularly in challenging settings, and have limited clinical confidence when treating conditions of which they lack subjective understanding. Novel interventions are required to address these needs. MAIN BODY OF THE TEXT: Virtual reality-based simulation training has been shown to be an effective training modality for healthcare professionals; it has the potential to deliver crucial empathy-building learning for frontline mental health staff due to its capacity to increase staff understanding of service users' experiences. Virtual reality and simulation technology take interactivity and experiential learning to a level beyond which we have seen in teaching and training before. Subjective understanding is elicited because this is a technology for enhanced experiential learning, which in turn fosters greater empathy and compassion. Increased empathy in the workforce is likely to yield significant benefits for service users. Greater empathy in nursing is linked with reduced restrictive practices and reduced conflict between staff and service users. Restrictive practices, including restraint and seclusion, are widely used in mental health settings within the UK, and are an aspect of mental health nursing that is at odds with the therapeutic role of nursing. Despite these innovative developments, there are challenges ahead. Many nurses feel that complete eradication of restrictive practices is impossible and that barriers include a limitation of resources, communication, management, and lack of education. There is a need to make simulation training economically viable so that it can be upscaled and widely available. Therefore, greater investment and resources are needed to bring this innovative training to the wider workforce to support staff and to realise the benefits for service users. SHORT CONCLUSION: Virtual reality-based training has great potential for mental health staff, which could have important consequences in terms of improved staff empathy and reductions in harmful restrictive practices. Further research and funding for such training is necessary so that it can be more widely available.

WELLFOCUS PPT: Modifying positive psychotherapy for psychosis.

Positive psychotherapy (PPT) is an established psychological intervention initially validated with people experiencing symptoms of depression. PPT is a positive psychology intervention, an academic discipline that has developed somewhat separately from psychotherapy and focuses on amplifying well-being rather than ameliorating deficit. The processes targeted in PPT (e.g., strengths, forgiveness, gratitude, savoring) are not emphasized in traditional psychotherapy approaches to psychosis. The goal in modifying PPT is to develop a new clinical approach to helping people experiencing psychosis. An evidence-based theoretical framework was therefore used to modify 14-session standard PPT into a manualized intervention, called WELLFOCUS PPT, which aims to improve well-being for people with psychosis. Informed by a systematic review and qualitative research, modification was undertaken in 4 stages: qualitative study, expert consultation, manualization, and stake-holder review. The resulting WELLFOCUS PPT is a theory-based 11-session manualized group therapy.