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1.
PLoS One ; 16(9): e0257270, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34529705

RESUMO

BACKGROUND: The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS: We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS: The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION: Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , COVID-19/epidemiologia , COVID-19/virologia , Atenção à Saúde/métodos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde Mental/normas , Pessoa de Meia-Idade , Pandemias , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , SARS-CoV-2/fisiologia , Inquéritos e Questionários/estatística & dados numéricos , Telemedicina/métodos , Adulto Jovem
2.
Int J Geriatr Psychiatry ; 36(11): 1748-1758, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34216045

RESUMO

OBJECTIVES: The COVID-19 pandemic has had a significant impact on older adults mental health care. Our study aimed to explore staff perspectives on key challenges and innovations in order to help inform the delivery of older adults mental health care in subsequent waves of the pandemic. METHODS: A mixed methods online questionnaire developed by National Institute for Health Research Mental Health Policy Research Unit was used to gather staff perspectives on their challenges at work, problems faced by service users and their carers, and sources of help and support. Descriptive statistics were used for quantitative analysis and descriptive content analysis for qualitative analysis. RESULTS: 158 participants, working in either community or inpatient settings, and from a range of professional disciplines, were included. For inpatient staff, a significant challenge was infection control. In the community, staff identified a lack of access to physical and social care as well as reduced contact with friends and families as being challenges for patients. Remote working was seen as a positive innovation along with COVID-19 related guidance from various sources and peer support. CONCLUSION: Our study, with a focus on staff and patient well-being, helps to inform service development for future waves of the pandemic. We discuss measures to improve infection control in inpatient settings, the role of voluntary organisations in supporting socially isolated community patients, the need for better integration of physical and mental health services at an organisational level, and the importance of training staff to support patients and their families with end of life planning.


Assuntos
COVID-19 , Serviços de Saúde Mental , Idoso , Cuidadores , Humanos , Pandemias , SARS-CoV-2
4.
Soc Psychiatry Psychiatr Epidemiol ; 56(8): 1447-1457, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33665680

RESUMO

PURPOSE: Research is beginning to quantify the impact of COVID-19 on people with pre-existing mental health conditions. Our paper addresses a lack of in-depth qualitative research exploring their experiences and perceptions of how life has changed at this time. METHODS: We used qualitative interviews (N = 49) to explore experiences of the pandemic for people with pre-existing mental health conditions. In a participatory, coproduced approach, researchers with lived experiences of mental health conditions conducted interviews and analysed data as part of a multi-disciplinary research team. RESULTS: Existing mental health difficulties were exacerbated for many people. People experienced specific psychological impacts of the pandemic, struggles with social connectedness, and inadequate access to mental health services, while some found new ways to cope and connect to the community. New remote ways to access mental health care, including digital solutions, provided continuity of care for some but presented substantial barriers for others. People from black and ethnic minority (BAME) communities experienced heightened anxiety, stigma and racism associated with the pandemic, further impacting their mental health. CONCLUSION: There is a need for evidence-based solutions to achieve accessible and effective mental health care in response to the pandemic, especially remote approaches to care. Further research should explore the long-term impacts of COVID-19 on people with pre-existing mental health conditions. Particular attention should be paid to understanding inequalities of impact on mental health, especially for people from BAME communities.


Assuntos
COVID-19 , Pandemias , Grupos Étnicos , Humanos , Saúde Mental , Grupos Minoritários , Pesquisa Qualitativa , SARS-CoV-2 , Reino Unido/epidemiologia
5.
J Psychiatr Ment Health Nurs ; 28(2): 126-137, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33608956

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: During the COVID-19 pandemic, there has been research considering the impact on medical healthcare professionals and the mental health needs of the general population. However, limited focus has been placed on mental health services or mental health staff providing care in the community and in hospitals. While nurses make up the largest section of the mental health workforce in the UK, the impact that this pandemic has had on their work has been largely ignored. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides a unique insight into the experiences and impact that the COVID-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: By understanding the impact the pandemic has had on mental health nursing care, we can understand the gaps in guidance that exist, the challenges being faced and the impact the crisis has had on care for mental health service users. By doing so, we can plan for the ongoing nature of this pandemic and the aftermath that the crisis may leave for our service users and workforce alike. ABSTRACT: Introduction While evidence has emerged concerning the impact of COVID-19 on the general population and the challenges facing health services, much less is known regarding how the pandemic has directly affected the delivery of mental health nursing care. Aim This paper aimed to explore how COVID-19 has affected the ability of mental health nurses to deliver care in community and inpatient mental health services in the UK. Method We investigated staff reports regarding the impact of the COVID-19 pandemic on mental healthcare and mental health service users in the UK, using a mixed-methods online survey. A total of 897 nurses across a range of inpatient and community settings participated. Discussion Key themes within the data explore the following: new ways of working; remote working; risks of infection/infection control challenges; and the impact on service users. Targeted guidelines are required to support mental health nurses providing care and support during a pandemic to people in severe mental distress, often in unsuitable environments. Implications for Practice Service developments need to occur alongside tailored guidance and support for staff welfare supported by clear leadership. These findings identify areas requiring attention and investment to prepare for future crises and the consequences of the pandemic.


Assuntos
COVID-19/psicologia , Atenção à Saúde/métodos , Serviços de Saúde Mental , Enfermeiras e Enfermeiros/psicologia , Enfermagem Psiquiátrica/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Inquéritos e Questionários , Reino Unido , Adulto Jovem
6.
Soc Psychiatry Psychiatr Epidemiol ; 56(1): 25-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32857218

RESUMO

PURPOSE: The COVID-19 pandemic has potential to disrupt and burden the mental health care system, and to magnify inequalities experienced by mental health service users. METHODS: We investigated staff reports regarding the impact of the COVID-19 pandemic in its early weeks on mental health care and mental health service users in the UK using a mixed methods online survey. Recruitment channels included professional associations and networks, charities, and social media. Quantitative findings were reported with descriptive statistics, and content analysis conducted for qualitative data. RESULTS: 2,180 staff from a range of sectors, professions, and specialties participated. Immediate infection control concerns were highly salient for inpatient staff, new ways of working for community staff. Multiple rapid adaptations and innovations in response to the crisis were described, especially remote working. This was cautiously welcomed but found successful in only some clinical situations. Staff had specific concerns about many groups of service users, including people whose conditions are exacerbated by pandemic anxieties and social disruptions; people experiencing loneliness, domestic abuse and family conflict; those unable to understand and follow social distancing requirements; and those who cannot engage with remote care. CONCLUSION: This overview of staff concerns and experiences in the early COVID-19 pandemic suggests directions for further research and service development: we suggest that how to combine infection control and a therapeutic environment in hospital, and how to achieve effective and targeted tele-health implementation in the community, should be priorities. The limitations of our convenience sample must be noted.


Assuntos
COVID-19 , Serviços de Saúde Mental , Humanos , Saúde Mental , Pandemias , SARS-CoV-2 , Reino Unido/epidemiologia
7.
Int J Eat Disord ; 53(8): 1219-1223, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31904140

RESUMO

OBJECTIVE: Online forums related to eating disorders (EDs) represent sources of support for recovery, and comments on these platforms might therefore highlight aspects of recovery that have been previously neglected in research. Reddit, an online discussion platform, hosts several ED-related forums. Due to the unique benefits of examining ED-related social media comments, we aimed to use a qualitative approach to conduct an exploratory study to examine users' conceptualizations of recovery from an ED. METHOD: We extracted public comments mentioning recovery that were posted on three ED-related online forums on Reddit between March 2017 and August 2017. We thematically analyzed the data corpus using an inductive approach to examine how recovery is defined in the context of ED-related online communities. RESULTS: Two superordinate themes ("Recovery as a Process," "Psychosocial Factors") and three subordinate themes emerged (within the "Psychosocial Factors" theme: cognitive/affective, behavioral/physical, social). DISCUSSION: The data support a definition of recovery that includes positive aspects of well-being and quality of life. Furthermore, the data highlight that recovery is experienced as an ongoing process that is unique to each individual.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Qualidade de Vida/psicologia , Mídias Sociais/normas , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Masculino
8.
J Psychiatr Ment Health Nurs ; 27(4): 482-493, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31957154

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: Boredom is a big issue on inpatient mental health wards that is linked to poor patient satisfaction, feelings of frustration and increased incidents of self-harm and aggression. This is even more so for people detained under the Mental Health Act. Where wards have a good range of activities, for example art, music, computer games, gardening and exercise, service users felt less bored and had improved well-being. Over many years, studies have reported a lack of activities, especially during evenings and weekends. It has also been found that little is known about what activities service users want, or how activities might be meaningful for them. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This review found that very few studies have asked service users about what activities would be useful and why. By seeing what makes activities desirable and accessible, we can understand how to improve the experiences of service users on wards. Overall, these data help to understand what impact activities (or lack of activities) have on service users and staff experiences on these wards. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Through identifying the activities most appreciated and engaged with by service users and by asking service users what activities they would like available, we can inform best practice guidance for the commissioning and provision of inpatient mental health care. This will enable service provider organizations to target their effort and resources on supporting good practice and to redirect resources from less useful activities. ABSTRACT: Background Concern about the lack of activities on mental health inpatient wards is long-standing with reports consistently finding that service users receive insufficient access to a range of activities and report high levels of boredom. There is recognition that little is known about what service users want when admitted to inpatient wards. Aim This review seeks to understand service users' experiences and views in relation to the provision and availability of activities, and to explore the perceived benefits and barriers to service users. Methods We searched multiple databases (Scopus, MEDLINE, CINAHL, PsycINFO and Embase) for studies that evaluated activities on acute adult inpatient mental health wards. We identified 12 papers across a range of methodological designs from which the narrative synthesis has been analysed. Results Findings show that the provision of activities is unsatisfactory for many service users, which in turn is related to increased boredom that has a negative impact on service users' well-being. We explore the benefits and barriers to engagement, providing an insight into the aspects that make an activity important. Conclusion There are few studies exploring the needs of service users regarding activity provision; therefore, there is limited knowledge about what is meaningful for individuals.


Assuntos
Tédio , Pacientes Internados , Transtornos Mentais/terapia , Preferência do Paciente , Unidade Hospitalar de Psiquiatria , Humanos , Unidade Hospitalar de Psiquiatria/normas
9.
J Psychiatr Ment Health Nurs ; 27(4): 406-416, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31957244

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: People with mental health problems have higher rates of physical health concerns and hospital admissions than those without mental health problems. These patients have poorer outcomes from surgery and have worse experiences of care when admitted for medical or surgical procedures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper looks to understand why care may be poorer for patients with mental health problems by speaking to staff providing care in these settings. We spoke to 30 general hospital staff about mental health on the wards and found that a lack of leadership and ownership for prioritising mental health led to people not seeing it as their job, and that it was somebody else's business to manage that side of care. We also found that the emotional effect of caring for people who had attempted suicide or had self-harm injuries was difficult for staff, impacting on staff well-being and leading them to distance themselves from providing care in those cases. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need for staff to be supported from the top-down, with management providing clear leadership around issues and pathways for mental health needs so they know the best way to provide care and encourage collaborative working. In addition, bottom-up support is needed to help staff personally manage their own well-being and mental health, including supervision and debriefing from mental health specialists to improve understanding from the patient's perspective and to provide emotional support to manage difficulties. RELEVANCE STATEMENT: This paper places focus on the care of patients with mental health problems in medical and surgical care settings highlighting the interplay between mental and physical health from a perspective that is less often explored. This paper provides insights into the multidisciplinary nature of nursing and the need for integrated care. This provides findings that build a picture of how mental health nursing specialism is needed beyond psychiatric wards and within medical and surgical settings. ABSTRACT: Introduction Evidence shows that patients with mental health problems have poorer physical health outcomes, increased mortality and experience poorer care during surgery and medical admissions. Issues related to lack of training, stigmatizing attitudes, fear or hopelessness may help understand these poor outcomes. Aim To explore the experiences of staff in providing care for people with mental health problems. Method A qualitative service evaluation approach was used. Participants working in an acute care hospital in inner-city London were recruited across professions and job levels using a self-selection sampling method. A total of 30 participants took part in semi-structured interviews (n = 17) and two focus groups (n = 13), and data were thematically analysed. Relevant organizational documents and service use data were utilized to inform the evaluation. Results Key themes were organized across the macro, meso and micro levels to understand the levels of disconnection and silence around mental health in acute care. Themes include systemic factors surrounding the institutional culture, ward cultures and collaborative working, and individuals' sense-making of mental health and personal well-being. Implications for practice These findings signpost the growing need for greater mental health nursing input on medical and surgical wards and within these teams to provide informed knowledge, support and supervision.


Assuntos
Departamentos Hospitalares , Hospitais Gerais , Pacientes Internados , Transtornos Mentais/terapia , Recursos Humanos em Hospital/normas , Enfermagem Psiquiátrica , Doença Aguda , Adulto , Departamentos Hospitalares/organização & administração , Departamentos Hospitalares/normas , Hospitais Gerais/organização & administração , Hospitais Gerais/normas , Humanos , Enfermagem Psiquiátrica/organização & administração , Enfermagem Psiquiátrica/normas , Pesquisa Qualitativa
10.
Eat Weight Disord ; 24(2): 299-306, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30569396

RESUMO

PURPOSE: This study aims to explore the role of Emotional Intelligence (EI) and specific facets that may underpin the aetiology of disordered eating attitudes and behaviours, as a means to understand what aspects of these deficits to target within treatments. METHODS: Participants were recruited from the UK and Ireland. Among the sample of 355 participants, 84% were women and 16% were men. Regarding age, 59% were between 18 and 29, 30% were between 30 and 49, and 11% were 50 or older. Using a cross-sectional design, participants completed the Schutte Self-Report Emotional Intelligence Test to measure levels of trait EI and The Eating Attitudes Test (EAT-26) as a measure of eating disorder risk and the presence of disordered eating attitudes. RESULTS: EAT-26 scores were negatively correlated with total EI scores and with the following EI subscales: appraisal of own emotions, regulation of emotions, utilisation of emotions, and optimism. Also, compared to those without an eating disorder history, participants who reported having had an eating disorder had significantly lower total EI scores and lower scores on four EI subscales: appraisal of others emotions, appraisal of own emotions, regulation of emotions, and optimism. CONCLUSIONS: Considering these findings, EI (especially appraisal of own emotions, regulation of emotions, and optimism) may need to be addressed by interventions and treatments for eating disorders. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.


Assuntos
Ingestão de Alimentos/psicologia , Inteligência Emocional/fisiologia , Emoções/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Reino Unido , Adulto Jovem
11.
Eat Disord ; 27(3): 321-342, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30235074

RESUMO

Emotional difficulties have been observed in individuals with eating disorders across awide range of studies, including poor interoceptive awareness, confusion of emotional states and difficulties with emotional language. Literature has linked these difficulties with emotional functioning as being an important factor related to the core aetiology ofeating disorders, however limited knowledge exists to how this impacts on professionalability to engage patients within treatment as a result of such dysfunction. Using aqualitative design this paper explores how facets of Emotional intelligence (EI) are related to the experience of an eating disorder. The study sampled a total of 32 participants with either a professional background working with eating disorders (n=27)or participants with personal lived experience (n=5), with a number of the participants (n=13) identified as having dual roles. The findings of the study show that aspects of EIsuch as emotional regulation and lack of an emotional language are considered to beat the core of the onset and maintenance of these disorders. Additional aspects of emotional awareness and expression were found to be related to treatment disengagement and difficulties. Building on previous literature, this paper found suchemotional deficits as a transdiagnostic issue rather than specifically anorexia nervosa. Furthermore, such dysfunction was seen by professionals to have a considerable impact on therapeutic relationships and successful treatment. These findings provide insight into the potential applications that EI may have in addressing aspects of theeating disorder to create better outcomes for treatment and intervention models.


Assuntos
Conscientização , Inteligência Emocional , Emoções/fisiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Adulto , Feminino , Grupos Focais , Pessoal de Saúde/psicologia , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Inquéritos e Questionários
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