Workforce strategies to address children's mental health and behavioural needs in rural, regional and remote areas: A scoping review.

INTRODUCTION: Children living in rural, regional and remote locations experience challenges to receiving services for mental illness and challenging behaviours. Additionally, there is a lack of clarity about the workforce characteristics to address the needs of this population. OBJECTIVE: To scope the literature on the rural, regional and remote child mental health and behavioural workforce and identify barriers and enabling mechanisms to mental health service provision. DESIGN: A scoping review utilising the Joanna Briggs Institute methodology. A database search was undertaken using Medline, CINAHL, PsycINFO, ProQuest and Scopus to identify papers published 2010-2023. Research articles reporting data on mental health workforce characteristics for children aged under 12 years, in rural, regional or remote locations were reviewed for inclusion. FINDINGS: Seven hundred and fifty-four papers were imported into Covidence with 22 studies being retained. Retained studies confirmed that providing services to meet the needs of children's mental health is an international challenge. DISCUSSION: The thematic analysis of the review findings highlighted four workforce strategies to potentially mitigate some of these challenges. These were: (1) The use of telehealth for clinical services and workforce upskilling; (2) Role shifting where non mental health professionals assumed mental health workforce roles; (3) Service structure strategies, and (4) Indigenous and rural cultural factors. CONCLUSION: A range of potential strategies exists to better meet the needs of children with mental health and behavioural issues. Adapting these to specific community contexts through co-design and production may enhance their efficacy.

It takes it out of the textbook: Benefits of and barriers to expert by experience involvement in pre-registration mental health nursing education.

WHAT IS KNOWN ON THE SUBJECT?: Service user involvement in mental health nursing education is beneficial in terms of attitudinal change to reduce stigma, clinical skill development and enhancing understandings of recovery-oriented practice. Service users as experts by experience have not been embedded within pre-registration nursing programs. Consequently, they remain limited in number, ad hoc and frequently tokenistic. Nurse academics responsible for the design and delivery of pre-registration mental health nursing curricula have a potentially important role in facilitating expert by experience involvement in mental health nursing education. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: Nurse academics teaching mental health nursing have generally favourable views about the importance of expert by experience involvement. Nurse academics experience significant barriers in supporting the implementation of academic positions for experts by experience, particularly in obtaining funding. The experts by experience could contribute to mental health nursing education does not appear to be clearly understood by nurse academics. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health services aspire to adopt a recovery-oriented approach to practice. Involving experts by experience in mental health nursing education can facilitate increased understanding and appreciation of recovery-oriented practice. Nurse academics could play an important role in supporting the implementation of experts by experience positions in nursing academia. To do so, they require an understanding of the benefits of EBE involvement in academia and the barriers that can be encountered when attempting to facilitate the implementation of such positions. Experts by experience contribute unique expertise, essential to the development of quality mental health services. Conveying this expertise through the educating the future nursing workforce in mental health is essential. ABSTRACT: INTRODUCTION: Involving service users in mental health nursing education is ad hoc and minimal, despite growing evidence of its benefits. Insights and experiences of nurse academics teaching mental health to pre-registration students have been underrepresented in the research to date. AIM: To seek insights and experiences of nurse academics involved in designing and delivering pre-registration mental health nursing education in Australian universities regarding involving service users in mental health nursing education. METHODS: A descriptive qualitative study involving 19 nurse academics from 13 Australian universities, involved in pre-registration mental health nursing education. Data were analysed thematically. RESULTS: Participants reported minimal service user involvement. Most sought an increase and identified barriers. Data analysis resulted in five identified themes: (1) value-rich, (2) resource-poor, (3) imperfect processes, (4) 'part, but not all' and (5) unrecognised worth. CONCLUSIONS: Increasing meaningful involvement of service-users in mental health nursing education requires support and investment from multiple stakeholders. Nurse academics are crucial stakeholders in understanding the unique expertise service users bring. IMPLICATIONS FOR PRACTICE: Service users being central to all aspects of mental health services requires their active participation in the education of health professionals. Nurse academics have an important role in realising this goal.

"The third wing of the plane": Fathers' perceptions of their role in the treatment process for daughters with eating disorders.

Eating disorders are complex mental health conditions exacerbated by high mortality rates. International and national guidelines recommend family involvement in the treatment process, recognising the family as an important source of support to young people. Research suggests fathers engage less in the process compared to mothers. In studies exploring parental perspectives, most samples consisted of mothers, with fathers minimally represented. Few studies explore family involvement from the perspective of fathers. This study aimed to explore the experiences of fathers regarding their involvement in the treatment process. Qualitative descriptive methods were used, involving focus group interviews of seven fathers. Interviews were assisted by a semi-structured interview guide. A qualitative content analysis approach was used to analyse the data regarding paternal experiences of engagement in the treatment process. Fathers understood the importance of the whole family working together but viewed mothers as taking a more central role in the treatment process, with fathers more at the periphery. Gender emerged as an influencing factor in paternal involvement, with mothers primarily taking on responsibility for the child with the eating disorder and fathers providing secondary support. Healthcare providers need to be aware of the contribution of gendered roles within the family system and consider this when working with families within the treatment process. Consequently, mental health nurses have an important role in encouraging fathers to become actively involved in the treatment process.

"It was a reflection of myself, that i was weak": The impact of depression on the sense of self - An interpretive phenomenological analysis.

The World Health Organisation states that more than 350 million people experience depression globally. The phenomenological changes in individuals experiencing depression are profound Phenomenological research can further researchers' and clinicians' understanding of this experience. This study aimed to gain a phenomenological understanding of how individuals with depression understood and made sense of their experiences. A methodology of interpretative phenomenological analysis was adopted. In-depth semi-structured interviews explored the lived experience of depression for eight individuals. Data were analysed into the superordinate theme Broken Self - Transforming the Self. The superordinate theme developed from the subordinate themes of 'unknown self, loss of self and one's identity', 'desperate for a way out', and thirdly, 'conflict with self and what's known', which related directly to how individuals made sense of their experience of depression. These research findings highlight the human implications of the experience of depression and the limitations of viewing depression from a biological or medical model lens. Understanding the human impact is essential for the effective, holistic practice of mental health nursing.

An evaluation of a trauma-informed educational intervention to enhance therapeutic engagement and reduce coercive practices in a child and adolescent inpatient mental health unit.

High-risk behaviours are sometimes encountered in Child and Adolescent inpatient mental health units and can prompt the use of coercive practices to maintain safety. Coercive practices may lead to re-traumatisation of young people and deteriorating therapeutic relationships. Trauma-informed practice (TIP) has successfully reduced coercive practices. While education is identified as foundational to implementation, evaluations of programmes remain minimal. The aim of this study was to explore mental health professionals' views and experiences of a trauma-informed education programme and its likely impact on their approach to practice. Five mental health professionals agreed to participate, four contributed in a focus group and one in an individual interview. Data were analysed thematically using the Braun and Clarke Framework. Three main themes were identified. Firstly, shifting attitudes and perceptions of trauma-informed practice. Participants believed they had developed more compassion towards clients and these attitudes were reflected in their clinical practice. Secondly, challenges associated with trauma-informed practice educational intervention. Staffing issues and shift work made it difficult for participants to attend education sessions regularly. Participants identified barriers to practicing in a trauma-informed manner in the current clinical environment. Finally, the need for interdisciplinary communication and support was identified. Participants saw the need for all professionals, not only nurses, to take responsibility for changing practice, and for stronger support at the organisational level. Trauma-informed practice is crucial to recovery-focused mental health nursing practice. These findings highlight the importance of TIP education and suggest areas for further improvement to enhance positive mental health outcomes for young people.

The Wisdom of Hindsight: Allies Reflections on Their Role in Supporting the Implementation of Expert by Experience Positions in Academia.

Experts by experience involvement in mental health education has consistently demonstrated positive attitudinal outcomes including a greater appreciation for recovery-focused practice. Mental health academic allies have played a crucial role in supporting implementation of expert by experience academic positions. To date the inclusion of their views in research is limited. The aim of this study was to explore and present allies' reflections on their involvement in supporting expert by experience academic roles in relation to "hindsight" and "foresight." A qualitative descriptive design was used, involving in-depth semi-structured interviews with allies who had supported the implementation of academic roles for experts by experience. Participants described the wisdom of hindsight. Based on their own experiences they emphasised the importance of, laying the groundwork, facilitating a supportive environment, contributing to meaningful, credible, and sustainable roles, and vision for the future as key to successful implementation. They also described a vision for the expansion of expert by experience roles in mental health education in the future. Allies' reflections suggest the importance of preparation to facilitate a smooth as possible implementation process and enhance the likelihood of successful outcomes. The transition to recovery-focused mental health services requires the attitudes of health professionals to change. The potential of experts by experience to influence attitudinal change can be enhanced by understanding the experiences and reflections of academic allies.

Informing the development of a fit-for-purpose mental health nursing curriculum: A survey of mental health nurse academics in Australia.

Inadequate mental health nursing content in pre-registration nursing curricula has been the topic of debate and concern since the introduction of comprehensive nursing education in Australia. Government-initiated inquiries and the efforts of mental health professional organizations and leaders have not successfully addressed this problem. The aim of the current study was to garner the perspectives and experiences of mental health nurse academics regarding the adequacy of mental health content in producing graduates able to work effectively in mental health settings and identify barriers and enablers to implementing and sustaining sufficient mental health content in pre-registration programs. A survey was distributed to mental health academics in Australian universities offering pre-registration nursing degrees. In total, 44 complete responses were included in the analysis. The results demonstrated the following: Most participants considered the current mental health content, theory and clinical hours insufficient to prepare graduates for practice in mental health settings. They reported a scarcity of tenured mental health nurse academics to deliver content effectively. Most participants were dissatisfied with the comprehensive approach to nurse education and preferred a double degree (nursing and mental health nursing), or a direct entry mental health nursing program. These findings provide further evidence for the current crisis in mental health nursing education and highlight the need for urgent action. People accessing health services have the right to receive high-quality care from appropriately qualified nurses. The inadequacy of mental health content in these programs effectively denies vulnerable people the standard of care and treatment they should be entitled to.

The nurse bombarded, consumed and vulnerable: An interpretative phenomenological analysis of mental health nurses' self-care at work.

INTRODUCTION: Self-care is essential for nurses' wellbeing, with stress posing a major barrier. Research into self-care is often absorbed into studies of burnout or resilience. Understanding lived experiences of influences on nurses' self-care practices is essential. There is currently a paucity of literature on this topic. AIM: To explore mental health nurses' views about what influences their ability to self-care in relation to workplace stress and the impact on their practice and work environment. METHODS: An Interpretative Phenomenological Analysis approach was utilized. In-depth interviews explored how nurses perceived the influence of environment and relationships on self-care practices in the workplace. RESULTS: Participants' perceptions and experiences are embodied by the theme: the nurse bombarded, comprising two subordinate themes-the nurse consumed by the intensity of work and therapeutic relationships; and feeling vulnerable from colleague relationships and feeling undervalued. Participants described conflict between workload demands and expectations and the desire to provide optimal care. CONCLUSIONS: Stressful working environments pose major barriers to effective self-care. Feeling bombarded and vulnerable, impacts nurses' lives personally and professionally. IMPLICATIONS FOR PRACTICE: Mental health nurses' self-care is crucial for quality practice. Strategies to address relational, personal and environmental barriers to self-care are therefore necessary.

'We only come from one perspective': Exploring experiences of allies supporting expert by experience leadership in mental health education.

INTRODUCTION: Academics from health professional backgrounds have a crucial role in supporting the implementation and sustainability of academic positions for experts by experience in mental health education. Perspectives and experiences of these academics have yet to be extensively explored. A deeper understanding will add to our understanding of this important role and provide guidance for academics with similar aspirations. AIM: The aim of the study was to explore the experiences of supporting academic positions for experts by experience in mental health education. METHODS: A qualitative exploratory design was utilised. In-depth interviews were conducted with academics who have actively supported academic positions for experts by experience. RESULTS: Allyship was a key theme identified. Participants described allyship as complex, time-consuming and rewarding, through three sub-themes: the tension of allyship, the impact of being an ally and interpersonal and relational issues with health professional academics. CONCLUSIONS: Allyship was influenced by the negative attitudes of many health professional academics, who do not appreciate the value of this work. IMPLICATIONS FOR PRACTICE: Allyship has a crucial role in enhancing experts by experience leadership in the education of health professionals. Understanding the experience of allyship will assist in further understanding and developing these important roles.

Predictors of Satisfaction and Value of Advanced Training for Mental Health Professionals in Wartime Ukraine.

The full-scale escalation of Russia's war against Ukraine in 2022 created a surge of mental health issues, requiring urgent, evidence-based interventions to reduce trauma and mitigate stress. Reflecting recommendations from leading specialists in the field, Ukrainian mental health professionals sought to develop appropriate skills and knowledge for working in wartime through advanced training programs. This study aimed to investigate the experiences of Ukrainian mental health professionals having completed advanced training in mental health topics in wartime. A survey design was adopted, using the purposefully developed, and validated 'Wartime Learning Satisfaction Scale'. Regression analysis assessed the hypothesized contribution of four scales (Education, Educator, Learner, and War) to the perceived value of advanced training and learners' satisfaction. Respondents (n = 271) were trained in up to 30 courses (M = 4.27, SD = 3.03) lasting from two to over 120 h. Regression analysis revealed different predictors for satisfaction and value of the courses. Advanced training resulted in higher satisfaction with learning if it matched professional goals of mental health professionals and perceived higher value when relevant to societal demand, consistently constructed, practically useful, and not solely focusing on war-related issues. Respondents who completed all advanced training courses they were interested demonstrated significantly higher confidence in working in wartime. These findings are essential for effective mental health practice during wartime.

The Impact of an Online Post-Graduate Interdisciplinary Mental Health Programme on Graduates' Confidence and Practice.

This study aimed to examine the experiences of graduates of online interdisciplinary postgraduate mental health programmes in Australia. The program was delivered in 6-week terms. Seven graduates from diverse backgrounds were interviewed about their experiences with the course and its impact on their practice, confidence, professional identity, views on mental health service users, and their motivation for additional learning. The interviews were recorded and transcribed and underwent thematic content analysis. The graduates reported an increase in confidence and knowledge after completing the course, which led to a change in their views and attitudes towards service users. They appreciated the examination of psychotherapies and motivational interviewing, and applied their newly acquired skills and knowledge in their practice. The course was found to have improved their clinical practice. This study highlights a departure from traditional pedagogical approaches in mental health skill acquisition, as the entire program was delivered online. There is a need for further research to determine who might benefit most from this mode of delivery and to verify the competencies acquired by graduates in real-world situations. Online mental health courses are a feasible option and have been positively received by graduates. To enable graduates to participate in transforming mental health services, systemic change and recognition of their capabilities, particularly those from non-traditional backgrounds, is required. The results of this study suggest the potential for online postgraduate programs to play a significant role in transforming mental health services.

Nurse-Led Physical Health Interventions for People with Mental Illness: A Scoping Review of International Literature.

People with mental illness have a higher prevalence of co-occurring physical health conditions and poor health behaviors, leading a mortality gap of up to 16 years, compared with the general population. Nurses working in mental health settings play an important role in addressing factors influencing sub-optimal physical health. Therefore, this scoping review aimed to identify nurse-led physical health interventions and align interventions to eight recognized physical healthcare priority areas (i.e. Equally Well in Victoria Framework). A systematic search strategy was used to identify relevant literature. Data extraction included alignment to the Equally Well priority areas, research design, and indication of co-design (meaningful and collaborative involvement of consumers and significant others) and recovery-oriented practice (focusing on needs and goals of a consumer's recovery journey). All included papers (n = 74) were aligned to at least one of eight Equally Well priority areas. Papers were predominately quantitative (n = 64, 86%), with the remainder mixed methods (n = 9, 9%) or qualitative (n = 4, 5%). Most papers were aligned to improving metabolic health and support to quit smoking. One study focused on nurse-led intervention designed to reduce falls. Recovery-oriented practice was evident in six papers. No paper described evidence of co-design. A research gap was identified for nurse-led intervention to reduce falls and improve dental/oral care. Relative to mental healthcare policy, there is a need for future nurse-led physical health research to be co-designed and include recovery-oriented practice. Evaluation and description of future nurse-led physical interventions should seek to report perspectives of key stakeholders as these remain relatively unknown.

Mental Health Nurses' Self-Care at Work, Searching for Equilibrium: An Interpretative Phenomenological Analysis.

The nursing workforce plays a central role in quality health care delivery. Nursing work is associated with high levels of stress due to often unmanageable workloads. The associated attrition poses a serious challenge for recruitment and retention strategies. Self-care is recognised as a tactic for addressing workplace stressors, shaping a sense of cohesion where the world is viewed as comprehensible, meaningful, and manageable, thereby mitigating the risk of burnout. Yet research suggests it is not widely utilised by nurses. The aim of this study was to understand mental health nurses' lived experience of self-care at work. The research was undertaken using an Interpretative Phenomenological Analysis methodology. In-depth individual interviews explored nurses' attitudes to self-care and how they did or did not adopt self-care practices in the workplace. Data were analysed thematically. The Search for Equilibrium, was identified as the superordinate theme, developed from three subordinate themes, The past self: "tormented and spent", the intricacy of self-care, and the trusted inner circle: "safe and supported". These findings highlight the complexity of self-care and the importance of considering it as much broader than purely an intra-personal phenomenon, emphasising the importance of relationships and interpersonal connections. Time past, present, and future influenced how participants made sense of their workplace experiences. These findings provide a deeper understanding of self-care in response to workplace stress and could assist in developing strategies to promote self-care for nurses, and ultimately positively enhance recruitment.

'They don't really know why they're here' mental health professionals' perspectives of consumer representatives.

There are several barriers to meaningful, non-tokenistic consumer representation in mental health, including stigma and negative attitudes towards consumers. The aim of this study was to examine mental health professionals' perspectives about collaborating with consumer representatives. Semi-structured interviews were conducted with 11 mental health professionals across Australia. Informed by the social identity framework, the findings are discussed in relation to the themes of (1) the need for greater clarity about the roles of consumer representatives, (2) perceptions about whether consumer representatives are held to equal professional standards, (3) understandings of consumers' place in organizational hierarchies, (4) facilitating more meaningful collaboration between consumer representatives and non-consumer health professionals and (5) the blurring of these identities when mental health professionals have lived experience. Findings suggest that the social identities of mental health consumer representatives (along with their organizational roles) are often unclear and need development within healthcare organizations. Leaders can provide guidance on group boundaries to enable effective collaboration. The implications for healthcare organizations and policy include the provision of clear frameworks for collaborative mental healthcare and clear roles, terminology and responsibilities for mental health consumer representatives.

There is something about oppression: Allies' perspectives on challenges in relationships with experts by experience.

The genuine and meaningful involvement of Experts by Experience in the education of health professionals has consistently demonstrated positive attitudinal change in students. These changes are essential if policy goals for recovery-oriented services and service user participation in mental health services are to be realized. To date academic roles for Experts by Experience have often relied on the support of allies. Despite the important role allies play, research investigating their experiences is limited. The aim of this research was to explore allies' views on supporting implementation of the academic positions for Experts by Experience. A qualitative exploratory study was undertaken involving in-depth interviews with 16 allies. Data were analysed thematically. Challenges that can exist between allies and Experts by Experience was one theme identified from the data. Allies described occasional difficulties in their relationships with Experts by Experience where they felt they were perceived as representative of members of their broader profession with whom Experts by Experience had negative experiences. The perspectives of allies are presented in four subthemes: relationships imbedded in history; consequences of interpersonal stigma; supportive, protective or paternalistic?; and the passion remains, which describes allies' ongoing commitment to supporting Expert by Experience involvement. Understanding the challenges can assist allies to respond appropriately in a non-judgemental and supportive manner. Trauma informed practice may provide a useful framework to address conflicts and facilitate more positive relationships between allies and Experts by Experience. These positive relationships are essential to maximize the positive benefits of Experts by Experience on future clinicians.

The physical health nurse consultant and mental health consumer: An important therapeutic partnership.

People diagnosed with mental illness (hereon referred to as consumers) experience a disproportionately lower life expectancy of up 30 years compared to the general population. Systemic issues such as diagnostic overshadowing and stigma from healthcare professionals have inhibited the development of positive therapeutic partnerships that enable consumers to seek and engage support for their physical health concerns. Consumers have called for healthcare professionals to skillfully develop and prioritize therapeutic partnerships whilst coordinating and providing physical healthcare. The aim of this qualitative descriptive research was to explore consumer views and experiences of their interactions with a specialist mental health nursing role, the Physical Health Nurse Consultant. Semi-structured interviews were conducted with 14 consumers from a large public Community Mental Health Service in the Australian Capital Territory. Interviews were transcribed and thematically analysed. Therapeutic partnerships were an overarching theme identified from the data and included three sub-themes: personal attributes of the Physical Health Nurse Consultant; behaviour change engagement strategies; and impact of the therapeutic partnership. Consumers described the personal and professional attributes of the Physical Health Nurse Consultant that enabled the establishment and maintenance of their highly valued therapeutic partnership. This therapeutic partnership was perceived to positively impact their personal and clinical outcomes. With increasing support from consumers, clinical practice settings should move towards embedding a Physical Health Nurse Consultant role in routine practice. Further research exploring the co-development of health behaviour change goals and, barriers and facilitators experienced by the consumers regarding the Physical Health Nurse Consultant is required to further role development.

Changing 'the world for the better': motivations of mental health academics for supporting expert by experience roles in mental health education.

BACKGROUND: Despite demonstrating positive outcomes in education, academic positions for Experts by Experience in mental health have not been widely implemented. To date positions have been driven by individual champions (allies). Their motivation for this support has not yet been researched. AIMS: To deepen understanding of motivations of mental health academics who have championed and supported implementation of EBE positions. METHODS: A Qualitative exploratory, study was undertaken involving in-depth individual interviews with 16 academics with experience of actively supporting the implementation of Expert by Experience positions in academia. Data were analysed independently by two researchers using a structured thematic framework. RESULTS: Motivations commonly arose from allies' own experiences of working with or exposure to Experts by Experience. Other motivating factors included: belief in the value of specific knowledge and expertise Experts by Experience contributed to mental health education; and, identifying the essential role Experts by Experience play in meeting policy expectations, and the broader philosophy of the university. CONCLUSIONS: The motivations identified by allies in this study have implications for Expert by Experience roles. Deeper understanding of motivations to support these roles is essential to arguing for their value, and ultimately producing positive outcomes in the education of health professionals.