"Write here, sanctuary" creative writing for refugees and people seeking asylum.

Background: There are few research studies reporting findings from creative writing groups amongst refugees and people seeking asylum. This study evaluates the educational, wellbeing, social and satisfaction outcomes of writing groups across three cities in the UK. Methods: This study employs a mixed-method design comprising: a thematic analysis of writers' (facilitators) diaries, demographic and satisfaction survey and 14 qualitative interviews. Results: The project delivered a creative writing programme for refugees and people seeking asylum in three UK cities. This evaluation has determined that it provided both educational and wellbeing outcomes for 144 attendees. Participants asserted that they had improved their English language and wellbeing. Satisfaction was extremely high across the cities. Participants reported increased confidence and an increased sense of hope. Conclusions: Professionally led creative writing groups may be effective in enabling people to help come to terms with past experiences and find ways of coping for the future.

Project eARTh: participatory arts and mental health recovery, a qualitative study.

AIMS: To identify the potential mental health benefits of a rural-based participatory arts programme in the United Kingdom. METHODS: Fourteen narrative interviews were conducted among participants of the Project eARTh programme. The data were subjected to a thematic analysis process. RESULTS: Three overarching themes were identified: identity and self-expression; connectedness through occupation; wellbeing and personal growth. The importance of meaningful relationships was highlighted as preventing social isolation, particularly in rural locations. Engagement in artistic group activities enable participants to connect with their communities. CONCLUSIONS: Artistic activities help people to develop friendships and to engage with local communities in rural locations. Connectedness to people and places were valued by participants as part of their personal growth. The groups empower people to experience increased confidence and identities beyond illness narratives. Artistic group activities can benefit the mental health of participants in rural locations.

Master's level mental health nursing competencies, a prerequisite for equal health among service users in mental health care.

PURPOSE: This discussion paper aims to explore the need of a clarified definition of master's level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging. METHODS: Master's level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services. RESULTS: The discussion show contents, values and utility of master's level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master's level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care. CONCLUSION: This discussion paper shapes implications for developments in master's level mental health nursing education curricula.

Advancing the knowledge, skills and attitudes of mental health nurses working with families and caregivers: A critical review of the literature.

Involving and supporting the family members and caregivers of people with mental illness is essential to high-quality mental health services. However, literature suggests that there is a lack of engagement between family members and mental health nurses (MHNs). Lack of knowledge among MHNs is often cited as one of the main reasons for this lack of engagement. The aim of this review was to explore the knowledge, skills and attitudes that are required by MHNs to enable to them to work more effectively with families affected by mental illness. A literature based critical review was used to access and review 35 papers in order to extract concepts that could inform the design of eLearning materials to assist MHNs advance their knowledge in this area. Two overarching themes were identified; 'Mental health problems and the family' and 'Working with the family'. From these themes, the knowledge, skills and attitudes required to work more effectively with families are described. The findings from this review provide a descriptive account of the knowledge skills and attitudes that are required for effective family work. In addition, the review provides an empirical foundation for education programmes in the area.

The art of recovery: outcomes from participatory arts activities for people using mental health services.

BACKGROUND: There is a growing evidence base for the use of participatory arts for the purposes of health promotion. In recent years, recovery approaches in mental healthcare have become commonplace in English speaking countries amongst others. There are few studies that bring together these two fields of practice. AIMS: The two aims of this study were (a) to investigate the validity of the CHIME framework for characterising the experience of Participatory Arts and (b) to use the CHIME framework to investigate the relationship between participatory arts and mental health recovery. METHOD: The study employed a two-phase methodology: a rapid review of relevant literature followed by secondary analysis of qualitative data collected from 38 people who use mental health service who took part in participatory arts activities designed to improve mental health. RESULTS: Each of the recovery processes identified by CHIME are present in the qualitative research literature as well as in the data of the secondary analysis. CONCLUSIONS: Participatory arts activities produce outcomes which support recovery, specifically including enhancing connectedness and improving hope. They can be recommended to people living with mental health problems.

Transforming identity through participation in music and theatre: exploring narratives of people with mental health problems.

BACKGROUND: There is a growing understanding that mental health problems and prolonged contact with mental healthcare systems can affect people's identities. Working with identity is an important element in mental health recovery. PURPOSE: In this article, we explore the significance of participation in a music and theatre workshop in terms of people`s experiences of identity. DESIGN AND METHODS: This is a qualitative study based on a hermeneutical phenomenological epistemology. Data were collected from in-depth interviews with 11 participants at a music and theater workshop, analysed through a narrative analysis and presented in an ideographical "long" narrative form. The music and theater workshop is not overtly therapeutic although the activity takes place in a Norwegian mental health hospital for adults living with long-term mental health problems. RESULTS: We identified three crosscutting themes: (1) becoming a whole person, (2) being allowed to hold multiple identities and (3) exploring diverse perspectives. CONCLUSION: Findings show that participation in the music and theatre workshop transformed the participants' experiences of identity on two levels: individually and collectively. The participants developed a broader picture of themselves through their creative work with others. When they developed new identities, the narratives of themselves expanded.

Working with Families Affected by Mental Distress: Stakeholders' Perceptions of Mental Health Nurses Educational Needs.

Family and informal caregivers provide a substantial amount of care and support to people who experience mental health problems. The aim of this study was to explore mental health nurses', students' and service users' perceptions of the knowledge, skills and attitudes that are required by mental health nurses to work with families and carers using a qualitative methodology. Three themes emerged from the data: Knowledge of the family and how mental distress affects the family; working with the family - support and education; and valuing the role of the family. The three themes demonstrate the complexity of preparing mental health nurses to work with families and carers, and the article offers recommendations about how this might be achieved.

Arts on prescription in Scandinavia: a review of current practice and future possibilities.

AIMS: This article reviews current practice relating to arts and culture on prescription in Sweden, Norway, Denmark and in the United Kingdom. It considers future possibilities and also each of the Scandinavian countries from a culture and health policy and research perspective. The United Kingdom perhaps leads the field of Arts on Prescription practice, and subsequent research is described in order to help identify what the Scandinavian countries might learn from the UK research. METHOD: The method adopted for the literature search was a rapid review which included peer-reviewed and grey literature in English and the respective languages of Scandinavia. RESULTS: The discussion considers the evidence to support social prescription and the potential obstacles of the implementation of Arts on Prescription in Scandinavian countries. CONCLUSION: The article concludes that of the Scandinavian countries, Sweden is ahead in terms of Arts on Prescription and has embraced the use of culture for health benefits on a different scale compared to Norway and Denmark. Denmark, in particular, is behind in recognising ways in which art and culture can benefit patients and for wider public health promotion. All three countries may benefit from the evidence provided by UK researchers.

From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project.

OBJECTIVES: This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice. DESIGN: This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES: In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS: We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS: A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS: This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

Recovery as a threshold concept in mental health nurse education.

This theoretical review discusses the complexities of understanding and applying the concept of recovery for pre-registration mental health nursing. It is suggested that reframing recovering as a threshold concept in mental health nurse education will illuminate the issues and challenges that students and educators appear to encounter. This is attributed to the transformative nature of learning in this area which requires the student to reassess beliefs and prejudices and enter into an uncertain territory where knowledge and values are questioned. Educational approaches are proposed which aim to facilitate the depth of learning required to engage with the concept of recovery at this level whilst responding sensitively to the students' potential reluctance, discomfort and in some cases resistance. Teaching recovery in mental health nursing therefore challenges educators to use any and every approach that stimulates emotional and transformational learning. As such, recovery in mental health is a threshold concept, that once learned, may transform not only the learner in the classroom but their practice in the future.

Student life - Straight from the source.

Calls for the involvement of service users in nurse education are not new. In 1996 the English National Board for Nursing, then responsible for education standards, said service users and carers should have a role, particularly in student assessment.

From SOLER to SURETY for effective non-verbal communication.

BACKGROUND: This paper critiques the model for non-verbal communication referred to as SOLER (which stands for: "Sit squarely"; "Open posture"; "Lean towards the other"; "Eye contact; "Relax"). It has been approximately thirty years since Egan (1975) introduced his acronym SOLER as an aid for teaching and learning about non-verbal communication. AIM: There is evidence that the SOLER framework has been widely used in nurse education with little published critical appraisal. A new acronym that might be appropriate for non-verbal communication skills training and education is proposed and this is SURETY (which stands for "Sit at an angle"; "Uncross legs and arms"; "Relax"; "Eye contact"; "Touch"; "Your intuition"). THE NEW MODEL: The proposed model advances the SOLER model by including the use of touch and the importance of individual intuition is emphasised. The model encourages student nurse educators to also think about therapeutic space when they teach skills of non-verbal communication.

Developing a service user designed tool for the assessment of student mental health nurses in practice: a collaborative process.

In this article we describe and critically analyse the process of developing an assessment tool designed by users of mental health services to assess student nurses in practice. The developmental process raised a number of complex and unexpected issues. The findings suggest that rather than "assess" student nurses in practice, service users should have a role in reviewing student's practice. Whilst there was a consensus amongst stake-holders that engaging in this feedback process is beneficial to both the student and service user, it is the manner in which it is sought which requires further investigation.

Does prescribing participation in arts help to promote recovery for mental health clients?

BACKGROUND: Although recovery has become the focus of mental health policy in the UK, few models of practice show how mentalhealth nurses may promote recovery through participatory arts. AIM: To explore the experiences of people who engaged with an arts on prescription programme. METHOD: This study used narrative inquiry and participants were interviewed three times over one year. RESULTS AND DISCUSSION: Participants clearly benefited, especiallyin terms of having a "safe place" to come to, and from making new friends and experiencing peer support. It also enabled some to access education an d voluntarywork. CONCLUSION: Engaging with community based arts activities may provide opportunities for clients to make friends, become more socially engaged and have a greater sense of belonging.

The meaning of art to people who use mental health services.

AIMS: This article reports upon a research study which explored the significance of art to people who use mental health services. METHOD: A narrative approach to data collection was chosen as the most appropriate method of gaining in-depth stories regarding the significance of art to the person. This involved the implementation of arts based workshops and in-depth individual follow-up interviews. RESULTS: The study offers a contribution to the debate surrounding the most appropriate research methods for identifying the relationship between the arts and health. The findings give an indication of the unique and complex meaning attached to art. It is evident that creativity represents an integral aspect of the person's perception of themselves and that for many it is an essential component of the way they wish to live their life. The multiple benefits described by participants suggest the need for the development of creative resources within statutory mental health care, thus complementing medically based interventions. CONCLUSION: A research approach that is creative and consistent with empowering and inclusive practice has been employed in this study. Furthermore, greater attention in research methods to the often neglected area of people's stories is advocated. Historically, in mental health care, people have felt oppressed by statutory service providers. Narrative approaches in research enable the person to become centre-stage, and, as a parallel to creative expression, the person is given a voice.

Empathy and nurse education.

It is widely accepted that the ability of nurses to empathise with their patients is a desirable quality. There is however little discussion of the implications of this for nurse educators. This article reviews the nursing and counselling literature related to empathy. We begin with an exploration of different perspectives of empathy; from its behavioural and measurable characteristics to its less tangible, intuitive qualities. By drawing upon both policy and research, it is clear that patients want empathic and emotionally competent nurses. Nurse educators therefore have a responsibility to provide an education that engenders empathic understanding. We explore the implications of these findings for nurse education, identifying key areas for consideration in the preparation of emotionally skilled, empathic student nurses.

The practice assessment of student nurses by people who use mental health services.

This paper reports on a participatory action research project focusing upon service-user involvement in the assessment of student mental health nurses in practice. The principle of student nurses being assessed by service-users was found to be desirable in theory. However, its implementation proved to be fraught with difficulty especially with regard to the concerns about increased workload and feelings of vulnerability amongst students. It is recommended that the model of assessment should be adjusted to that of review and that a program of service-users reviewing student nurses on placement be implemented and evaluated.