Birth trauma in a population requiring inpatient mental health care in the postpartum period.

OBJECTIVE: This study explores rates of birth-related symptoms of trauma in a population of parents experiencing severe perinatal mental illness. METHOD: Birthing-parents admitted to a perinatal inpatient unit completed birth trauma measures on admission which were descriptively analyzed. RESULTS: The population had higher rates of birth-related potentially traumatic events and trauma-related symptoms than the general population. CONCLUSIONS: The findings highlight that assessing for and responding to experiences of birth trauma is highly relevant to an inpatient perinatal population.

Editorial Perspective: Prato Research Collaborative for change in parent and child mental health - principles and recommendations for working with children and parents living with parental mental illness.

Children whose parents have mental illnesses are among the most vulnerable in our communities. There is however, much that can be done to prevent or mitigate the impact of a parent's illness on children. Notwithstanding the availability of several evidence-based interventions, efforts to support these children have been limited by a lack of adequate support structures. Major service reorientation is required to better meet the needs of these children and their families. This editorial provides recommendations for practice, organisational, and systems change.

Intergenerational Trauma and Its Relationship to Mental Health Care: A Qualitative Inquiry.

Intergenerational trauma is a discrete form of trauma which occurs when traumatic effects are passed across generations without exposure to the original event. This qualitative study aimed to explore how psychiatrists understand intergenerational trauma in respect to their practice, for the purposes of identifying interventions for addressing intergenerational trauma in public mental health services. Findings revealed that psychiatrists observe intergenerational trauma frequently in their roles and try to opportunistically promote awareness of trauma with adults, and refer families to external services for supportive interventions. They feel powerless when faced with directly intervening with intergenerational trauma and required restructuring of their roles to adequately address it in public settings. Findings have implications for training, advocacy and research on the relationship between trauma and mental illness. Alongside this, there is an indicated need for examination of how systems can ensure access to appropriate services once organisations become trauma-informed.

Involving Mental Health Consumers in Nursing Handover: A Qualitative Study of Consumer Perspectives.

A number of benefits have been identified for including consumers in nursing handover, such as improved safety and information exchange. In mental health settings these benefits may translate to improved nurse-consumer engagement and working towards the provision of recovery orientated practice. The process of including the consumer, whilst considered best practice, is not well established in mental health settings. Therefore further understanding, in regards to the consumer perspectives about this practice, is needed to inform its adoption and implementation.This qualitative descriptive study explores consumers' perspectives of their possible involvement in the nursing handover process within a mental health inpatient setting. The study took place in two mental health inpatient units in regional New South Wales, Australia. Thirteen semi-structured individual interviews were conducted with consumers, and a conventional content analysis method was used to analyse the data. Findings are presented under two categories: understanding the purpose and process of nursing handover and considering consumer involvement in handover.Findings provide insight into the views of consumers about being involved in nursing handover and further strengthen the rationale for establishing the process as part of routine practice within acute inpatient mental health units. The study also highlights the need to ensure that all processes within these settings accommodate consumer perspectives and involvement.

Is trauma informed care possible in the current public mental health system?

OBJECTIVES: As mental health services move towards implementing 'Trauma-informed care', there is a need to consider the challenges posed within services and systems. This paper raises some of the challenges associated with integrating TIC into the current public mental health system. . CONCLUSION: The lack of clarity about expectations of trauma-informed approaches causes difficulties for its integration into services, but the wider political context of mental health services is also of relevance. Transparent and ongoing debate is required about approaches to mental health care, to ensure the system meets the needs of those who require it, while questioning what other purposes it may be serving at social and political levels.

The 'trauma' of trauma-informed care.

OBJECTIVES: As mental health services increasingly position themselves as providing 'trauma-informed care', there is a need for ongoing critical reflection on the challenges that this movement highlights for mental health services, including those related to the concept of trauma itself. CONCLUSIONS: To become trauma-informed requires opportunities to reflect on what trauma means and consideration of the challenges the concept poses to diagnostically driven systems. Alongside uptake, further debate is required.

Does a community based recovery service reduce inpatient bed days?

OBJECTIVE: Increasing options for the delivery of community-based care may be one way to reduce inpatient bed pressures. This study set out to examine the effect of community-based step up/step down (SUSD) care on hospital usage for service users with multi-service usage. METHODS: A retrospective audit was undertaken of the medical records of all individuals admitted to a SUSD unit over a 2-year period, calculating inpatient bed days for the 12 months prior to, and the 12 months after, the SUSD admission. RESULTS: There was a statistically nonsignificant decrease in bed days in the 12 months following admission. CONCLUSION: It is possible that inpatient bed day reduction may not be an appropriate outcome measure for a service built on principles of personal recovery. How to translate recovery-outcomes to justifiable financial benefits for services requires further consideration and alignment of values with reporting measures.

A qualitative inquiry into psychiatrists' perspectives on the relationship of psychological trauma to mental illness and treatment: implications for trauma-informed care.

BACKGROUND: Trauma is a factor impacting the lives of many people experiencing psychiatric disorders. Trauma affects people's responses to illness as well as their interactions with services. AIM: This study aimed to explore the understandings and experiences of psychiatrists of working with trauma and emerging models of Trauma-Informed Care. METHODS: An interpretive qualitative inquiry was undertaken using semi-structured in-depth interviews with psychiatrists. RESULTS: Four themes were identified: Making sense of trauma; A contentious relationship between trauma and mental illness; Treatment made more challenging by trauma; Trauma-Informed Care highlights tensions. Psychiatrists are familiar with the concept of trauma but there are differences in beliefs about its relationship to mental illness that are consequential for practice. Trauma-Informed Care is seen as an effort to humanise mental health services, but with perceived limited impact on psychiatrists' roles. CONCLUSION: Findings indicate need for further consultation and collaboration with psychiatrists around trauma-informed care implementation; as well as consideration of what is required to develop professional consensus on trauma and its relationship to illness.

Motivational Interviewing: Reconciling Recovery-Focused Care and Mental Health Nursing Practice.

Motivational interviewing (MI) is a long-established evidenced-based intervention aimed at guiding people to implement change. Originally developed by William Miller from the United States and Stephen Rollnick from the United Kingdom, a strong emphasis for MI is the underlying 'spirit', rather than merely the specific techniques within the model. The 'spirit' of MI consists of four key components: acceptance, partnership, evocation and compassion. These have direct overlap with concepts within the personal recovery model recognised as a critical framework in delivery of contemporary mental health services for consumers. Despite this recognition, recovery concepts have struggled to gain consistent traction, particularly within inpatient mental health units. This paper proposes that MI presents one strategy for integrating recovery-focused principles within routine mental health nursing (MHN) practice. An overview of MI and its relationship with recovery principles is discussed in the context of contemporary MHN practice. Evaluation results of a locally developed MI workshop for MHNs within a regional area of New South Wales (NSW) in Australia are presented to highlight the emerging evidence for this potential. Following the workshop, MHN participants showed key improvements in knowledge and confidence scores, as well as in understanding of key MI processes and strategies. The consolidation of these skills through training and a supervision framework is outlined.

A frog in boiling water? A qualitative analysis of psychiatrists' use of metaphor in relation to psychological trauma.

OBJECTIVE: Tensions about the definition, diagnostics, and role of psychological trauma in psychiatry are long-standing. This study sought to explore what metaphor patterns in qualitative interviews may reveal about the beliefs of psychiatrists in relation to trauma. METHOD: A qualitative inquiry using systematic metaphor analysis of 13 in-depth interviews with Australian psychiatrists. RESULTS: Three themes were identified: a power struggle between people, trauma, and psychiatry; trauma is not a medical condition; and serving the profession to protect society. CONCLUSIONS: Metaphors present trauma as a powerful force that people can manage in different ways. Psychiatrists may view trauma as a social rather than medical issue. Psychiatrists experience role pressure associated with trauma including incongruence with risk management expectations of their roles.

Preventing intergenerational trauma transmission: A critical interpretive synthesis.

AIM AND OBJECTIVE: To synthesise and critically interpret literature of relevance to intervening in intergenerational transmission of relational trauma within parent-infant relationships. BACKGROUND: Intergenerational trauma is a discrete process and form of psychological trauma transmitted within families and communities. Intergenerational trauma can be transmitted through attachment relationships where the parent has experienced relational trauma and have significant impacts upon individuals across the lifespan, including predisposition to further trauma. DESIGN: Critical interpretive synthesis (CIS) was used. CIS is an inductive qualitative process that generates new theory grounded within reviewed literature. METHODS: The review commenced by systematically searching for literature on interventions for intergenerational trauma. As the core theoretical construct emerged, elements that may contribute to preventing intergenerational trauma were identified iteratively and influenced further searching. In the final synthesis, 77 articles were included from the fields of intergenerational trauma, trauma interventions and attachment interventions. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. RESULTS: The key construct is that prevention of intergenerational trauma transmission is the key intervention. The two contributing constructs were identified as "resolving parental trauma" and "actively supporting parent-infant attachment." CONCLUSIONS: Prevention is the most effective intervention approach for intergenerational transmission of trauma. Prevention requires trauma-specific interventions with adults and attachment-focused interventions within families. Preventative strategies need to target individual, relationship, familial, community and societal levels, as addressing and preventing trauma requires a multipronged, multisystemic approach. RELEVANCE TO CLINICAL PRACTICE: Systematic trauma-informed attachment-focused interventions in health and social service settings are recommended. There are opportunities to provide multifocal individual and relational interventions within existing services that work with parents to help prevent the likelihood and impact of transmission of intergenerational relational trauma within families. Nurses are well placed to provide preventative interventions in mental health, early childhood and primary health settings.

'A different kind of space': Mixed methods evaluation of facilitated reflective practice groups for nurses in an acute inpatient mental health unit.

Despite recognising the value of reflective practice, there are challenges in implementation of clinical supervision for nurses. This study reports on the implementation of Reflective Practice Groups for nurses in an acute inpatient mental health setting as a means of introducing nurses to reflective practice. A mixed-methods approach explored participant and facilitator experiences through session evaluation questionnaires, facilitator field notes, and interviews with participants. Findings demonstrate challenges in implementing Reflective Practice Groups however the perceived benefits suggest promise in using Reflective Practice Groups to engage busy nurses in facilitated reflection with an aim to transition to reflective clinical supervision.

Using relational mindfulness to facilitate safety in the clinical encounter.

OBJECTIVE: The therapeutic relationship in psychiatry is reliant upon first establishing a sense of interpersonal safety. This paper explores relational mindfulness as a way to facilitate safety in the clinical encounter, as well as proposes factors that enhance a clinician's capacity to remain mindfully present. CONCLUSIONS: Through the ongoing practice of mindful awareness, self-care and self-awareness all clinicians can benefit from increased capacity for relational mindfulness to enhance interpersonal safety. This is then likely to benefit not only the patient and the therapeutic relationship but also the clinician.

Evaluating the use of responsive art therapy in an inpatient child and adolescent mental health services unit.

OBJECTIVES: We describe the use of responsive art therapy in an inpatient child and adolescent mental health services unit, including its acceptability rated through a satisfaction questionnaire. METHODS: A patient satisfaction questionnaire was developed to collect feedback from 46 adolescents. Images from therapy were photographed and collated looking for patterns across diagnoses and stages of treatment. RESULTS: Adolescents reported that art therapy helped them learn how to express themselves safely (80%) and understand how their thoughts related to their feelings (78%). CONCLUSIONS: Responsive art therapy was a useful strategy to support the safe expression of distress and was seen as a positive experience by adolescents in inpatient mental health care.

Safe and Collaborative Communication Skills: A Step towards Mental Health Nurses Implementing Trauma Informed Care.

Trauma Informed Care (TIC) acknowledges the presence and effects of trauma in the lives of many mental health service users and the responsibility of services to provide physical and emotional safety. One challenge of TIC is a lack of clarity about translating the philosophy into practice. This paper describes the delivery and evaluation of a trauma informed communication workshop for mental health nurses that aimed to increase their knowledge of the potential impacts of trauma on consumers, and translate TIC concepts into their communication approaches within the therapeutic relationship.

Navigating the social synapse: the neurobiology of bedside manner.

OBJECTIVES: This paper seeks to explore the application of neurobiology to further understanding the importance of developing, refining and modelling good bedside manner in psychiatry. The concept of a social synapse is used as a framework to understand the impact of verbal and non-verbal information that crosses between two attuned individuals. Research shows that widely distributed cortical and subcortical networks are involved in processing of social information and the perception of safety. CONCLUSIONS: Good bedside manner is proposed as the ability of a clinician to navigate the social synapse and make a patient feel at ease. Findings from neurobiology suggest that good bedside manner needs to be a more considered component of effective psychiatric health care.

Neuro-reciprocity and vicarious trauma in psychiatrists.

OBJECTIVES: This paper aims to briefly overview the processes of neuro-reciprocity relevant to vicarious traumatization of psychiatrists through their clinical roles. CONCLUSIONS: High rates of trauma in mental health service users, understanding of the effects of trauma on the brain and mechanisms of neuro-reciprocity in empathic attunement suggest that psychiatrists are at high risk of vicarious trauma. Preventing vicarious trauma at an organizational level through trauma-informed approaches is of paramount importance.

An Emotional Awareness Based Parenting Group for Parents with Mental Illness: A Mixed Methods Feasibility Study of Community Mental Health Nurse Facilitation.

There has been limited examination of the use of relationship based structured parenting programs that focus on emotional interactions in the parent-child dyad in families where a parent has a mental illness. There is also a lack of awareness of the practicalities of providing such interventions within adult mental health services. This study explores the process and outcomes of a nurse led emotional awareness based parenting program for adult clients of a mental health service. Participants demonstrated a significant reduction in difficult parenting moments and associated stress and distress as well as promising improvements in overall distress and emotional awareness.

Trauma informed care: a radical shift or basic good practice?

OBJECTIVE: There is significant multidisciplinary work contributing to the implementation of trauma informed care (TIC) into mental health policy and practice in Australia. Within psychiatry, there may be potential confusion about how to navigate the integration of TIC into a speciality built upon treating psychological distress; creating dismissive reactions of a patronising approach and paradoxical radicalism. This paper aims to discuss the need for psychiatry to view TIC as a significant and urgent paradigm shift required to integrate existing knowledge about the prevalence and effects of trauma into a progressive articulation of the relational and interpersonal underpinnings of modern psychiatric practice; and to lead and support its widespread implementation. CONCLUSION: Active consideration of the intent of TIC may aid in reducing misunderstanding and misaligned resistance while allowing services and individuals an important opportunity to reflect on how to deliver mental health treatment that is universally sensitive to the dynamics of trauma in the care environment.

Community Treatment Orders (CTOs): a demographic cross-sectional analysis.

OBJECTIVES: Existing research on Community Treatment Orders (CTOs) questions what purposes they serve, for whom and for how long. This study aimed to identify demographics of the CTO population, differences between individuals who require short CTOs from those who require repeat CTO and clinician-determined factors which influence these decisions. METHODS: Using a cross-sectional snapshot method, 301detailed audits were analysed for frequencies and relationships between variables. RESULTS: People on CTOs (n = 301) comprised 9% of the community mental health population (n = 3268); 21% (n = 62) having it be their first CTO, 50% (n = 149) on repeat CTOs (continuous) and 29% (n = 85) on second episode or more of CTOs (non-continuous). There were 82% (n = 231) of people on a CTO who had a primary diagnosis of schizophrenia. There was a higher occurrence of males with co-existing factors of aggression and current substance misuse. Age had a relationship with length of actual and predicted CTOs. CONCLUSIONS: Men of middle age, with a diagnosis of schizophrenia, a history of aggression, current substance misuse and reported previous CTO efficacy are the primary individuals predicted to require ongoing CTOs. Improving CTO efficacy should focus on providing targeted intervention for this group and a closer analysis of the use of CTOs in other groups.