Service User Experience of Receiving Remote Inpatient Mental Health Treatment via the Homecare Service.

The Homecare Service was developed as a response to the COVID-19 pandemic, providing all the elements of a mental health inpatient programme remotely, in the comfort and safety of the service user's home thus reducing the need for a physical admission. The aim of this study was to explore service user experiences of a remote virtual inpatient care at an Irish independent mental health service. All participants who had a virtual admission in a 3-month period were invited to complete a series of questions via an online survey. Three open-ended questions generated qualitative data from this mixed methods study, which were thematically analysed. Three themes reflected service user experience: 'The Homecare Service: a viable alternative to inpatient care'; 'Importance of relationships' and 'Technology and Homecare.' Overall, there was general satisfaction with the service. This study provided a good opportunity to identify issues that have emerged considering the prompt implementation of the initiative. Feedback relating to improvements can be implemented in future service delivery.

An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service.

WHAT IS KNOWN ON THE SUBJECT?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed. There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED. This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme. The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery. This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment. Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. ABSTRACT: INTRODUCTION: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. AIM: To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. METHOD: A qualitative descriptive methodology informed the study. In-depth semi-structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. RESULTS: Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. DISCUSSION: An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real-time anxiety as they endeavour to negotiate an effective support network. IMPLICATIONS FOR PRACTICE: The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme.

'Finding my Hard Hat': Reflections of recovery from a service user and caring professional.

ACCESSIBLE SUMMARY: What is known on the subject? Lived experience narratives of recovery can provide an insight and subtlety where academic papers can often fall short. There is a need for people who work in mental health services to address and take care of their own psychosocial needs. What the paper adds to existing knowledge? This paper provides a unique insight into a care professional's recovery from mental ill health. Looked at through this dual lens of service user and care professional provide the reader with a rich narrative from the perspective of both sides of the caring role. What are the implications for practice? People who work in caring roles need to be vigilant of their own needs and the impact that the work can have on them. Safety protocol for managing one's own mental health should be a requirement for people within the caring profession. ABSTRACT: Introduction This is an account of my experiences becoming unwell and accessing general and mental health services in Ireland. Aim It is hoped that this lived narrative of my recovery will shed light on accessing mental health services from a dual lens; that of service user and social worker. Method It traces this experience from initial contact with my general practitioner, to admission to a secure psychiatric ward where recovery slowly began. Results It is also hoped that reading my experiences of recovery and some of the insights shared will help those in the nursing or social care profession consider how they may be affected by their work. Discussion It is important to note that this account views my experiences within a neurobiology framework and this might not align to other people's experiences. However, my narrative of help-seeking is complex and includes multiple points where I uncover insights and encounter different healthcare professionals.

Development of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement Instrument.

BACKGROUND: Instruments that measure clinical learning environments have lacked rigorous methodological approaches in their development and validity. METHOD: Development research using a survey design approach was conducted for an instrument to evaluate the quality of nursing students' clinical practice placement. RESULTS: The development and validity of the Student Nurse Subjective Evaluation of Completed Clinical Practice Placement (SNEP) resulted in a 40-item instrument to evaluate nursing students' experience of their completed clinical practice placement. Adequate level of model fit was indicated (χ2[719] = 1909.47, p < .001) for the confirmatory factor analysis (χ2/df = 2.66, comparative fit index = 0.92, Tucker-Lewis Index = 0.92, and root-mean-square error of approximation = 0.07). Standardized factor loadings were high, ranging from 0.68 to 0.95. CONCLUSION: The SNEP was designed and validated incorporating the perspective of various nurse stakeholders and can be used in both research and clinical learning environments. [J Nurs Educ. 2022;61(10):559-569.].

Nurses' experiences of managing vulnerability when working with seriously ill children.

BACKGROUND: Nurses who work with very unwell or dying children may experience intense sorrow and distress in response to loss, which can take an emotional toll on them, potentially affecting care provision. AIM: This study aimed to explore the experiences of children's nurses who work with seriously ill children and to gain an insight into the dynamics involved in working with children and their families, as well as the nurses' experiences of managing their own vulnerability. METHODS: In-depth interviews were conducted with five children's nurse participants, and data were analysed using interpretive phenomenological analysis. FINDINGS: Three thematic categories were identified - 'being emotionally full', 'navigating the rules of grief' and 'prism of time'. Caring for seriously ill and dying children is a unique type of nursing and is often regarded as contrary to the 'natural' process of life. Findings were dominated by unresolved grief and the mechanisms used to cope with this emotional pain. CONCLUSION: Nurse educators must be aware of the strategies that people use to avoid engaging with painful emotional experiences. Without this understanding and self-awareness, children's nurses can be caught in a cycle of unresolved grief that affects their own health and could affect their ability to engage with children and families in an empathetic and supportive way.

Patient Experience of Physical Restraint in the Acute Setting: A Systematic Review of the Qualitative Research Evidence.

The use of physical restraint is a contentious practice in the acute mental health setting. There are a plethora of guidelines surrounding the safe use of restraint. However, there is a scarcity of literature dedicated specifically from the perspective of the patient. The existing literature suggests that there are serious physical and psychological implications associated with the use of physical restraint for both mental health patients and nurses alike. The debate surrounding this practice has been intensified by the compelling evidence suggesting that the application of restraint is not compatible with the values of recovery in mental health care. To influence clinical practice that governs the use of restraint, it is essential to explore patient experiences of its use. Therefore, this review aims to explore patient experiences of physical restraint in the acute setting. PubMed, CINAHL and PsycINFO were systematically searched using keywords; "physical restraint" and "patient experience" and "acute setting". The search yielded n = 482 papers in total. Following the application of rigorous inclusion and exclusion criteria and data extraction, a total of n = 9 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, three themes were identified: 'the bio-psychosocial impact of restraint on patients', 'the impact of restraint on the therapeutic relationship' and 'patient needs concerning the use of restraint'. Future research opportunities have been identified that will add to the body of evidence in developing appropriate health interventions and supports for this population.

Psychological Impact of the COVID-19 Pandemic on Mental Health Nurses.

The aim of this research was to assess the psychological effects of the novel coronavirus disease (COVID-19) on mental health nurses. An internet-based questionnaire that included the Impact of Event Scale-Revised (IES-R) and the Zung Self Rating Anxiety Score (SAS) was used to assess the impact of the pandemic on the wellbeing of mental health nurses in an Irish mental health service. Among the nurses surveyed (n = 161), 12% of the participants had an overall IES-R score from 24 to 32 indicating that posttraumatic stress disorder (PTSD) was a clinical concern, while 38% had an overall IES-R score >32 indicating that PTSD was a probable diagnosis. The mean SAS score that had been converted to anxiety index scores was 40.78 (SD = 9.25). The results showed that 30% of mental health nurses experienced anxiety levels from moderate to extreme. Overall findings confirm that mental health nurses are experiencing psychological distress as a result of working during the COVID-19 pandemic. Nurses who were <30 years of age or who were in their current roles for less than a year or were ward-based and worked full-time, were most likely to be affected. Working during COVID-19 has not been routine work practice and for a cohort of workers who are already under pressure, the sacrifice in terms of general well-being has been immense. The offer of individualized psychological support for mental health nurses working during the pandemic should be both practical in nature and flexible enough to meet individual needs.

LGBTQ+ Psychosocial Concerns in Nursing and Midwifery Education Programmes: Qualitative Findings from a Mixed-Methods Study.

LGBTQ+ people experience significant physical and psychosocial health issues and concerns, and encounter barriers when accessing healthcare services. We conducted a mixed-methods research study across all Schools of Nursing and Midwifery in the United Kingdom and Ireland using a survey and qualitative interviews. This was to identify the current content within nursing and midwifery pre-registration programmes in relation to LGBTQ+ health and to identity best practice and education innovation within these programmes. The survey was completed by 29 academics, with 12 selected to participate in a follow-up in-depth qualitative interview. Analysis of the data from the survey and interviews identified five themes: there is variable programme content; academics are developing their own programmes with no clear consistency; LGBTQ+ health is being linked to equality and diversity; there are barriers to education provision; and these is some evidence of best practice examples. The findings of the study support the need to develop and implement a curriculum for LGBTQ+ health in nursing and midwifery pre-registration programmes with learning aims and outcomes. Academics need support and tools to prepare and deliver LGBTQ+ health content to nurses and midwives as they ultimately have the potential to improve the experiences of LGBTQ+ people when accessing healthcare.

Decider Life Skills training as a method of promoting resilience with mental health student nurses on clinical placement.

AIM: The aim of this study is to explore mental health student nurses' perceptions and application of a CBT-orientated training programme - the Decider Life Skills programme. BACKGROUND: The undergraduate nursing degree programme is a challenging one and places high demands both professionally and personally on students. Mental health nursing students are faced with particular stressors including working with people in significant psychological distress, which can result in students feeling overwhelmed and emotionally burdened. There is a requirement for student nurses to be supported to cope with professional and personal difficulties while on practice placement. The Decider Life Skills is a one-day training programme that aims to build resilience and increase effective coping skills. This programme was offered to internship mental health nursing students with the aim of providing them with a toolbox of skills to maintain their wellbeing while on clinical placement. METHODS: A qualitative descriptive design was used, and data were collected through two 45-min focus group interviews with mental health students (n = 10) on their internship placement. These students had received a one-day training in Decider Life Skills prior to their clinical placements. Full ethical approval was achieved for this study. RESULTS: Participants reported that they found the skills imparted in the training easy to understand and apply in both their professional and their personal lives. CONCLUSIONS: The findings from this study that the Decider Life Skills helped students cope in stressful situations and become more mindful of protecting their own mental health is important, as there is a need to safeguard the emotional well-being of mental health nursing students and support them to become resilient practitioners.

Views and Experiences of LGBTQ+ People in Prison Regarding Their Psychosocial Needs: A Systematic Review of the Qualitative Research Evidence.

People who identify as LGBTQ+ and are in prison often experience many additional challenges. Once in prison, there is systemic discrimination against imprisoned LGBTQ+ people and a lack of understanding and concern regarding their care, treatment and support needs. While there is growing interest in their protection and that of other vulnerable populations in prison settings, little is known about their views and experiences regarding their distinct psychosocial needs. The aim of this systematic review is to critically evaluate and synthesize the existing research evidence relating to the unique psychological and social experiences of LGBTQ+ people in prison and identify aspects that may help or hinder access to appropriate psychosocial interventions and supports. The PRISMA procedure was utilized. A search of relevant databases from January 2010 to March 2021 was undertaken. Studies were identified that involved LGBTQ+ people, and addressed their views and experiences regarding their psychosocial needs whilst in prison. The search yielded 858 papers in total. Following the application of rigorous inclusion and exclusion criteria a total of 12 papers were considered suitable for the systematic review. Quality was assessed using the CASP instrument. Following analysis, three themes were identified: (i) interpersonal factors (ii) intrapersonal factors and (iii) institutional factors. The policy, education and practice development implications are highlighted and discussed. Future research opportunities have been identified that will add significantly to the body of evidence that may further the development of appropriate health interventions and supports specific to the LGBTQ+ population in prison.

Experiences and Perceptions of Trans and Gender Non-Binary People Regarding Their Psychosocial Support Needs: A Systematic Review of the Qualitative Research Evidence.

People who identify as trans and gender non-binary experience many challenges in their lives and more interest is being paid to their overall health and wellbeing. However, little is known about their experiences and perceptions regarding their distinct psychosocial needs. The aim of this systematic review is to critically evaluate and synthesize the existing research evidence relating to the unique psychological and social experiences of trans people and identify aspects that may help or hinder access to appropriate psychosocial interventions and supports. The PRISMA procedure was utilized. A search of relevant databases from January 2010 to January 2021 was undertaken. Studies were identified that involved trans people, and addressed issues related to their psychosocial needs. The search yielded 954 papers in total. Following the application of rigorous inclusion and exclusion criteria a total of 18 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, four themes were identified: (i) stigma, discrimination and marginalization (ii) trans affirmative experiences (iii) formal and informal supports, and (iv) healthcare access. The policy, education and practice development implications are highlighted and discussed. Future research opportunities have been identified that will add significantly to the body of evidence that may further the development of appropriate health interventions and supports to this population.

Mental health nurses' perceived preparedness to work with adults who have child sexual abuse histories.

WHAT IS KNOWN ON THE SUBJECT?: The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to help to identify and support the person with the associated challenges of child sexual abuse (CSA). Feelings of discomfort have been identified by mental health nurses (MHNs) when working with survivors of CSA due to a lack of knowledge, poor confidence and feeling unprepared to inquire and respond to such a sensitive topic. WHAT DOES THE STUDY ADD TO EXISTING KNOWLEDGE?: MHNs are willing to engage in CSA dialogue; however, the level of engagement is often conditional with clear parameters set by participants. Whilst all participants reported they were willing to engage in conversation initiated by the service user, some were unwilling to listen to details of the CSA and used strategies to censor service users from providing details of the CSA. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Whilst self-protecting boundaries helped MHNs to engage in CSA dialogue, strategies to censor aspects of the service user's dialogue may reinforce the belief that their experience of CSA is too shameful to talk about, hence denying the reality of their experience and contributing to feelings of re-shaming. MHNs need a combination of theoretical knowledge and psychosocial skills to achieve clinical competence when working with CSA; therefore, training should not only include information pertaining to facts and statistics but also case presentations, clinical training and supervision. Clinical supervision was highlighted by all participants as a necessary means of formal support, more specifically group clinical supervision whereby peer support can also be availed of in a formalized setting. ABSTRACT: Introduction The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to support the person with the associated challenges of CSA, yet little is known about the preparedness of MHNs to work with this client population. Aim To explore MHNs' perceived preparedness to work with adults who have CSA histories, and to elicit their views, skills and confidence in relation to working with this sensitive issue. Method In-depth semi-structured interviews were conducted with five consenting MHNs. A qualitative descriptive methodology informed the study. A thematic analysis framework guided the data analysis. Results The findings assert that MHNs are willing to work with survivors of CSA despite feeling unprepared to so, MHNs described feeling ill-prepared in how to respond to CSA, calling for not just education and training specific to CSA but also citing the need for clinical supervision and additional guidelines to enhance their preparedness. Discussion Results of this study further highlighted the omission of CSA within nursing curricula and the absence of role models within clinical practice as a major barrier to preparedness to work with survivors of CSA. Recommendations are made for training, education and the inclusion of clinical supervision.

Mental Health Nurse experiences of delivering care to severely depressed adults receiving electroconvulsive therapy.

WHAT IS KNOWN ON THE SUBJECT?: ECT is a fast-working and potentially life-saving treatment, but it is still considered a controversial treatment choice. Due to lack of knowledge and public stigma, ECT can be an anxiety-inducing treatment for people experiencing severe depression. The nurse's role is to alleviate this anxiety, aid recovery and minimize the risk of relapse. They manage this onerous task ideally through the therapeutic relationship, and use the skills of assessment and risk identification in order to maximize patient outcomes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The views of mental health nurses who provide care for adults receiving treatment of ECT for severe depressive illness are in the main positive. The knowledge of and attitude towards ECT among nurses may reflect on patients and influence treatment choice. If stigma is not addressed, then patients will not be appropriately informed regarding their treatment options. Mental health nurses need to engage in reflective practice to ensure that the dignity of the patient is maintained throughout this treatment. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental Health nurses should engage with additional training, formalized clinical supervision and avail of peer support in order to improve confidence, skills and quality of care in the delivery of ECT. Education modules should include a presentation of evidence of effectiveness of ECT as a treatment option. Dialogue among mental healthcare colleagues is important about caring for people presenting for ECT treatment. This will ensure that the mental health nurse can remain cognizant of the potential for patient distress throughout this treatment. ABSTRACT: Background There is a considerable dearth of literature on attitudes towards Electroconvulsive Therapy (ECT) as a treatment for severe depression. Despite being a highly effective treatment, it is still stigmatized even among professionals. Understanding perceptions and knowledge related to ECT treatment among healthcare providers is important for ensuring that treatment can be safely explored as a treatment option with patients. Aim The overall aim of this study is to explore the views of mental health nurses who provide nursing care to people receiving ECT for severe depressive illness in a mental health setting. Methods This is a qualitative study using focus groups (n = 2) with 14 mental health nurses who had a minimum of 3 months experience caring for older adults receiving ECT. Transcripts were subjected to a thematic analysis. Full ethical approval was granted for this study. Results In total, four themes were identified exploring attitudinal changes, managing patient dignity, reflecting changes in practice and managing the unknown. In general, participants experienced ECT as a positive treatment option for adults with severe depressive illness contributing to an enhanced quality of life. Conclusion Findings indicate a desire to improve person-centred care for patients undergoing ECT. Educational support for nurses who work in this area would improve confidence on work practices and lead to improved patient experience. Mental health personnel without direct experience of the treatment should be exposed to educational modules to decrease stigma and to best facilitate informed decision-making among the patient cohort.

'Not Left in Limbo': Service User Experiences of Mental Health Nurse Prescribing in Home Care Settings.

Prescribing in mental health nursing in the Republic of Ireland is still an unusual occurrence and despite an uptake in prescriber training, this does not often translate to practice. Recent Irish research, however, has identified that nurse prescribing when offered, is perceived to enhance care and offer better delivery of services. Since the legislation was introduced in the Republic of Ireland to enable nurses and midwives to prescribe in May 2007, there are now 1,123 nurses registered to prescribe medication. Mental health nurses, however, do not tend to be a priority when it comes to training in prescribing; in the UK it took two years after nurse prescribing was rolled out to extend the scheme to mental health nursing. Although nurse and other professional perspectives explored this topic, there is limited research specifically detailing the experience of service users in long term care who are prescribed by mental health nurse practitioners in a home care setting. This research follows a qualitative exploratory research design using thematic analysis to explore service user (n = 12) experiences of mental health nurse prescribing. The following four themes emerged from the analysis: 'empowerment and trust'; 'person-centered care'; 'time and flexibility' and 'collaborative approach'. Results indicate a positive and rich experience of nurse prescribing, which facilitate a more trusting, holistic and autonomous therapeutic relationship. Future research looking at other issues relating to medication including reduction and support for coming off where appropriate is recommended.

Risky Business? A Year-Long Study of Adult Voluntary Admissions Who Leave Psychiatric in-Patient Care without Informing Staff.

Patients leaving inpatient psychiatric care without informing staff can have serious consequences for patient welfare, their families and staff. Even in cases where there are no serious outcomes and patients return, treatment can be interrupted and staff morale compromised. Given these potential deleterious effects, it is important to have an in-depth understanding of why people leave when they do. The aim of this study is to examine the profile of service-users who leave in-patient psychiatric care without notifying staff and to determine their reasons for doing so, what they did when they left the hospital setting and reasons for returning. This is a prospective descriptive study of service users leaving without notifying staff from a national mental health service in Ireland. It investigated the frequency, timing, and motivations of these absconding events among a sample of in-patients over a 12-month period. This year-long review identified 75 episodes of leaving without notifying staff, 55 of which met this studies criteria. 22% of episodes were from a locked unit, 58.2% were repeated episodes. 89% of service users returned to hospital following the episode and 11% were discharged against medical advice. Although no fatalities, three service users were seen in an emergency department as a result of activity during leave. Upon return from leave, all service users were reviewed and their care plans were updated where necessary.

"I found it daunting": An exploration of educational needs and experiences of mental health student nurses working with children and adolescents with eating disorders.

WHAT IS KNOWN ABOUT THE SUBJECT?: A therapeutic relationship with a professional who displays an informed approach has a positive effect on outcomes for young people presenting with an eating disorder. There is a dearth of research available on the student mental health nurse experience of working with young people with an eating disorder both internationally and from the Republic of Ireland. Within this limited literature, nursing students were found to hold more negative perceptions towards this group than more experienced clinicians. The causes of eating disorders are complex, which make education and support to understand the individual with an eating disorder essential. Within the Republic of Ireland, child and adolescent mental health historically has received very little attention in the undergraduate mental health nursing curriculum. WHAT DOES THE STUDY ADD TO EXISTING KNOWLEDGE?: Findings from this study recommend that a set of guidelines are made available for students to feel more confident in their role. It is suggested that this resource would include the therapeutic skills to engage the young person with an eating disorder. A specialist clinical placement has been identified as the most appropriate time to consider the development of a study day or days to facilitate learning of the skills and therapeutic techniques to work with adolescents. Application of these skills would occur within the clinical learning environment under supervision and guidance of the clinical preceptor. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Specialized training for student mental health nurses working with this group will enhance confidence and competence levels in forming therapeutic relationships, thereby improving outcomes for those attending the services. Better student experience may also enhance future nursing recruitment into this area. Students need additional support in managing these often complex and ambivalent presentations and their own fears or stigma around people with an eating disorder. This is recommended as taking the form of reflective practice during the placement. There is a need for nursing management to support nurses in their role as preceptor. This would involve protected time for preceptors to engage the student nurse in clinical education and reflective practice. ABSTRACT: Introduction There is limited attention given to child and adolescent mental health in the undergraduate mental health nursing curriculum within the Republic of Ireland. There is a dearth of research available on specifically the student mental health nurse experience both internationally and from the Republic of Ireland. Aim To explore factors that impact on the experience of mental health student nurses working with adolescents who present with eating disorders. Method This qualitative descriptive study was conducted through individual semi-structured interviews with n = 4 mental health student nurses. Data were then subjected to a schematic content analysis. Results The participants experienced developing therapeutic relationships with this group as a challenging process. They believed that the theoretical component of the undergraduate programme facilitated them in their understanding but did not prepare them to engage therapeutically with these adolescents. Discussion Preceptors are identified as the main source of support but improvements to the clinical learning environment would enhance the learning experience. Implications for practice Support for the role of the preceptor in the specialist clinical setting in the form of training and protected time to engage students in clinical education and reflection was suggested as a method to enhance the clinical learning environment.

An Exploration of the Relationship Between Spirituality, Religion and Mental Health Among Youth Who Identify as LGBT+: A Systematic Literature Review.

There is a growing interest in addressing spirituality in health care with evidence emerging that personal spiritual and religious practices, and support of these, can influence mental health in a positive way. However, there can be distinct challenges to spiritual expression and mental health issues for youth who identify as LGBT+. The goal of this paper was to undertake a systematic review of the available evidence to investigate the relationship between mental health, spirituality and religion as experienced by LGBT+ youth. A comprehensive literature search was conducted using medical and psychological databases that focused on spirituality, mental health and LGBT+ youth. The search yielded a total of ten articles published in English between May 2008 and June 2018. The key findings highlighted issues around discriminatory attitudes, shame related to disclosure, spirituality as a supportive resource, internalised conflict and external factors around sexual orientation concerns. The psychological, social and health implications are presented and discussed.

Exploring Mental Health Issues through the Use of Blogs: A Scoping Review of the Research Evidence.

The aim of this scoping review of the available research evidence was to explore the experiences and perceptions of people with mental health difficulties through the use of blogs. A search of relevant electronic databases was undertaken from January 2009 to February 2019. Selected studies included people who blog about their mental health difficulties online. The PRISMA system was used to present the results of the searches. Following the application of specific inclusion and exclusion criteria, the final number of included studies was eleven. Following data analysis, the subordinate categories in the public category were moderation, confidentiality and boundaries. The subordinate categories in the private sphere included catharsis, enhanced coping strategies and social connectedness. The implications for mental health practice developments and research, are presented and discussed.