Peer support for discharge from inpatient mental health care versus care as usual in England (ENRICH): a parallel, two-group, individually randomised controlled trial.

BACKGROUND: High numbers of patients discharged from psychiatric hospital care are readmitted within a year. Peer support for discharge has been suggested as an approach to reducing readmission post-discharge. Implementation has been called for in policy, however, evidence of effectiveness from large rigorous trials is missing. We aimed to establish whether peer support for discharge reduces readmissions in the year post-discharge. METHODS: We report a parallel, two-group, individually randomised, controlled superiority trial, with trial personnel masked to allocation. Patients were adult psychiatric inpatients (age ≥18 years) with at least one previous admission in the preceding 2 years, excluding those who had a diagnosis of any organic mental disorder, or a primary diagnosis of learning disability, an eating disorder, or drug or alcohol dependency, recruited from seven state-funded mental health services in England. Patients were randomly assigned (1:1) to the intervention (peer support plus care as usual) or control (care as usual) groups by an in-house, online randomisation service, stratified by site and diagnostic group (psychotic disorders, personality disorders, and other eligible non-psychotic disorders) with randomly permuted blocks of randomly varying length to conceal the allocation sequence and achieve the allocation ratio. The peer support group received manual-based, one-to-one peer support, focused on building individual strengths and engaging with activities in the community, beginning during the index admission and continuing for 4 months after discharge, plus care as usual. Care as usual consisted of follow-up by community mental health services within 7 days of discharge. The primary outcome was psychiatric readmission 12 months after discharge (number of patients readmitted at least once), analysed on an intention-to-treat basis. All patients were included in a safety analysis, excluding those who withdrew consent for use of their data. The trial is registered with the ISRCTN registry, ISRCTN10043328. The trial was complete at the time of reporting. FINDINGS: Between Dec 1, 2016, and Feb 8, 2019, 590 patients were recruited and randomly assigned, with 294 allocated to peer support (287 included in the analysis after withdrawals and loss to follow-up), and 296 to care as usual (291 in the analysis). Mean age was 39·7 years (SD 13·7; range 18-75). 306 patients were women, 267 were men, three were transgender, and two preferred not to say. 353 patients were White, 94 were Black, African, Caribbean, or Black British, 68 were Asian or Asian British, 48 were of mixed or multiple ethnic groups, and 13 were of other ethnic groups. In the peer support group, 136 (47%) of 287 patients were readmitted at least once within 12 months of discharge. 146 (50%) of 291 were readmitted in the care as usual group. The adjusted risk ratio of readmission was 0·97 (95% CI 0·82-1·14; p=0·68), and the adjusted odds ratio for readmission was 0·93 (95% CI 0·66-1·30; p=0·68). The unadjusted risk difference was 0·03 (95% CI -0·11 to 0·05; p=0·51) in favour of the peer support group. Serious adverse events were infrequent (67 events) and similar between groups (34 in the peer support group, 33 in the care as usual group). Threat to life (self-harm) was the most common serious adverse event (35 [52%] of 67 serious adverse events). 391 other adverse events were reported, with self-harm (not life threatening) the most common (189 [48%] of 391). INTERPRETATION: One-to-one peer support for discharge from inpatient psychiatric care, plus care as usual, was not superior to care as usual alone in the 12 months after discharge. This definitive, high-quality trial addresses uncertainty in the evidence base and suggests that peer support should not be implemented to reduce readmission post-discharge for patients at risk of readmission. Further research needs to be done to improve engagement with peer support in high-need groups, and to explore differential effects of peer support for people from different ethnic communities. FUNDING: UK National Institute for Health Research.

Effects of structural features of psychiatric hospital settings on coercive measures

Background and Objectives Involuntary hospital admissions and coercive measures are a long-lasting burden in psychiatry. Many efforts have been undertaken to diminish these wearing circumstances. With the Bochum “track system,” which is structured in mental health teams across inpatient and outpatient clinics without any closed admission wards, we would like to present a new way of facing coercion. To examine the effects of establishing the so-called Bochum “‘track system”’ regarding the presumed reduction of coercive measures within a naturalistic, quantitative pre- and post- comparison.

Residência terapêutica: permanências e rupturas nas práticas de trabalho / Residencia terapéutica: estancias y descansos en las prácticas laborales / Therapeutic residency: permanencies and breaks in work practices

RESUMO. No Brasil, o funcionamento das residências terapêuticas tende a apresentar desafios, tais como a falta de apoio social, que podem dificultar a produção do cuidado em saúde e afetar os trabalhadores do serviço. Por isso, a presente pesquisa tem como objetivo relatar a experiência de realização de oficinas com profissionais de uma residência terapêutica, além de descrever os desafios e potencialidades enfrentados pelos profissionais ao produzirem o cuidado em saúde. Para tanto, realizou-se um estudo qualitativo-descritivo, do tipo relato de experiência, embasado na abordagem metodológica do construcionismo social. Os dados foram coletados a partir de entrevistas semiestruturadas, gravadas, com cinco profissionais de uma residência terapêutica, seguidas por quatro oficinas, adaptadas a partir da Metodologia 'Ritmos da Vida', e diários de campo da pesquisadora. A partir dos relatos apresentados percebe-se que as participantes do estudo relataram muito mais desafios do que potencialidades para a produção do cuidado em saúde mental. Contudo, os espaços de fala e de escuta ofertados às profissionais parecem ter disponibilizado reflexões que possibilitaram a construção de sentidos positivos relacionados ao trabalho em saúde mental.

RESUMEN. En el Brasil, el funcionamiento de las residencias terapéuticas tiende a presentar desafíos, como la falta de apoyo social, que pueden dificultar la producción del cuidado en salud y afectar a los trabajadores del servicio. Por eso, la presente investigación tiene como objetivo relatar la experiencia de realización de talleres con profesionales de una residencia terapéutica, además describir los desafíos y potencialidades enfrentados por los profesionales al producir el cuidado en salud. Para ello, se realizó un estudio cualitativo-descriptivo, del tipo relato de experiencia, basado en el enfoque metodológico del construccionismo social. Los datos fueron recolectados a partir de entrevistas semiestructuradas, grabadas, con cinco profesionales de una residencia terapéutica, seguidas por cuatro talleres, adaptados a partir de la Metodología 'Ritmos da Vida', y diarios de campo de la investigadora. A partir de los relatos presentados se percibe que las participantes del estudio relataron mucho más desafíos que potencialidades para la producción del cuidado en salud mental. Sin embargo, los espacios de habla y de escucha ofrecidos a las profesionales parecen haber ofrecido reflexiones que posibilitaron la construcción de sentidos positivos relacionados con el trabajo en salud mental.

ABSTRACT. n Brazil, the functioning of therapeutic residences tends to present challenges, such as the lack of social support, which can hinder the production of health care and affect the workers of the service. Therefore, this study aimed to report the experience of conducting workshops with professionals of a therapeutic residence, besides describing the challenges and potentialities faced by professionals when producing health care. To this end, a qualitative-descriptive study, experience report was carried out, based on the social constructionism approach. Data were collected from semi-structured interviews, recorded, with five professionals of a therapeutic residence, followed by four workshops, adapted from the methodology 'Rhythms of Life', and field diaries of the first author. From the reports presented, the study participants clearly reported many more challenges than potentialities to produce mental health care. However, the spaces for talking and listening offered to professionals seem to have provided reflections that enabled the construction of positive meanings related to mental health work.

“Lo que es, fue y será el Manicomio de Leganés”: un proyecto de reforma de José Salas y Vaca (1911-1929) / “The Leganés Asylum: present, past, and future”. A reform project by José Salas y Vaca (1911-1929)1

El Manicomio Nacional de Leganés ha sido objeto de estudios diversos sobre la historia institucional y la actividad clínica desarrollada en el establecimiento desde su fundación, en 1851. En las primeras décadas del siglo XX, José Salas y Vaca, como jefe facultativo, impulsó una serie de cambios en la institución en consonancia con el espíritu modernizador y reformista de la Generación de Archivos de Neurobiología, base de las reformas republicanas. El objetivo de este trabajo es estudiar, a través de fuentes primarias de la época e historias clínicas del período de Salas y Vaca, cómo estas ideas reformistas se tradujeron en mejoras realizadas en esta institución. Se abordan aspectos como el aumento de la plantilla, la apertura a la enseñanza de la psiquiatría y la introducción de las novedades terapéuticas del primer tercio del siglo XX. (AU)

Since its foundation in 1851, the Leganés asylum´s institutional history and clinical activity have been studied. In the first decades of the 20th century, José Salas y Vaca, as chief medical officer, as member of the so-called “Archivos de Neurobiología Generation”, a group of reformist psychiatrists who inspired the republican reforms, promoted a series of changes in the institution. The aim of this paper is to study, through primary sources and clinical records of Salas y Vaca, how these reformist ideas improved the institution. The article deals with the increase in the workforce, the beginning of the teaching of psychiatry in the institution and the introduction of therapeutic innovations during the first third of the 20th century. (AU)

Mental Health and Addiction Response: Supporting Nursing Resilience in a Pandemic.

In their paper, Stelnicki and Carleton (2021) highlight both the findings of their 2019 survey of nurses' mental health (Stelnicki et al. 2020) and more recent literature published during the COVID-19 pandemic. This response outlines the role of nursing leaders in enabling the mental health of nurses in a mental health and addiction setting, particularly during the COVID-19 pandemic.

Effects of COVID-19 on Healthcare Providers: Opportunities for Education and Support (ECHOES).

Healthcare providers (HCPs) working at point of care with patients have experienced health-, home- and work-related stressors from the COVID-19 pandemic. The magnitude and duration of the pandemic pose particular challenges for nursing leadership, and there is little research to guide them during this unprecedented time. This study was designed to explore how the pandemic influences HCP well-being, professional practice, inter-professional collaboration and the education and supports that would assist them during the pandemic recovery period. The article reports on the qualitative portion of a mixed-methods study, which included 56 HCPs who work in a large mental healthcare facility in Ontario. Witnessing the impact of the pandemic restrictions on patients was a significant source of stress for HCPs. HCPs recommended strategies, such as learning new therapeutic modalities and participating in the redesign of health services as key strategies to support them during the pandemic as these would promote patient well-being. Lastly, the pandemic provided opportunities for HCPs to deepen their understanding of other professions. This awareness was viewed as a strength that could support interprofessional collaboration and enhance health services redesign. The findings and recommendations can assist leaders to address the mental health challenges arising from the pandemic.

Clinical Outcomes Following Acute Residential Psychiatric Treatment in Transgender and Gender Diverse Adolescents.

Importance: Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers. Objective: To examine mental health outcomes among TGD vs cisgender adolescents in residential treatment. Design, Setting, and Participants: This cohort study's longitudinal design was used to compare groups at treatment entry and discharge, and 1-month postdischarge follow-up. The setting was an adolescent acute residential treatment program for psychiatric disorders. Participants were TGD or cisgender adolescents enrolled in the treatment program. Statistical analysis was performed October 2019 to March 2021. Exposure: Adolescents participated in a 2-week acute residential treatment program for psychiatric disorders. Main Outcomes and Measures: Primary outcomes were depressive (the Center for Epidemiologic Studies Depression Scale [CES-D]) and anxiety (the Multidimensional Anxiety Scale for Children [MASC]) symptoms, and emotional dysregulation (the Difficulties in Emotion Regulation Scale [DERS]), measured at treatment entry and discharge, and postdischarge follow-up. Age of depression onset, suicidality, self-injury, and childhood trauma also were assessed at treatment entry. Results: Of 200 adolescent participants who completed treatment entry and discharge assessments, the mean (SD) age was 16.2 (1.5) years; 109 reported being assigned female at birth (54.5%), 35 were TGD (17.5%), and 66 (49.3%) completed 1-month follow-up. TGD participants had an earlier mean (SD) age of depression onset (TGD: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher mean (SD) suicidality scores (TGD: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (mean [SD] RBQ-A score for TGD: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, mean [SD] CTQ-SF score for emotional abuse in TGD: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). The TGD group also had higher symptom scores (CES-D mean difference: 7.69; 95% CI, 3.30 to 12.08; P < .001; MASC mean difference: 7.56; 95% CI, 0.46 to 14.66; P = .04; and DERS mean difference: 18.43; 95% CI, 8.39 to 28.47; P < .001). Symptom scores were significantly higher at entry vs discharge (CES-D mean difference, -12.16; 95% CI, -14.50 to -9.80; P < .001; MASC mean difference: -3.79; 95% CI, -6.16 to -1.42; P = .02; and DERS mean difference: -6.37; 95% CI, -10.80 to -1.94; P = .05) and follow-up (CES-D mean difference: -9.69; 95% CI, -13.0 to -6.42; P < .001; MASC mean difference: -6.92; 95% CI, -10.25 to -3.59; P < .001; and DERS mean difference: -12.47; 95% CI, -18.68 to -6.26; P < .001). Conclusions and Relevance: This cohort study found mental health disparities in TGD youth relative to cisgender youth, with worse scores observed across assessment time points. For all participants, primary clinical outcome measures were significantly lower at treatment discharge than at entry, with no significant differences between discharge and 1-month follow-up. Given the substantial degree of mental health disparities reported in TGD individuals, these findings warrant focused clinical attention to optimize treatment outcomes in gender minority populations.

"This Is ME": Promoting Person-Centred Care within the Digital Health Environment.

In this paper, we describe the implementation of an initiative called "This Is ME," which involves a change in the summary page of a patient's electronic health record in order to include their story and provide a more humanistic perspective. The change includes information related to their family, hobbies and interests - a change that has important implications for facilitating conversation and relationship-building between providers and patients. Since implementation, 1,246 (and counting) patient stories were shared with over 300 healthcare providers, including nurses, social workers, physicians and others. We also share the results of our evaluation of the initiative and provide recommendations for organizations embarking on similar initiatives.

Virtual family town hall: An innovative multi-family telehealth intervention during COVID-19.

The COVID-19 pandemic has posed unprecedented challenges to the U.S. mental healthcare system. Immediate action has been required to transform existing social work practice models to ensure uninterrupted delivery of essential mental health services. This paper describes how clinicians in a residential program, who offered an in-person multi-family education workshop, rapidly pivoted in the context of the pandemic to develop and implement an alternative and unique multi-family intervention model - a virtual family town hall. This innovative telehealth practice model serves as an exemplar of best practices amidst the COVID-19 pandemic as it prioritized health and safety, increased accessibility, and allowed clinicians to effectively respond to family members' heightened informational needs.

Investigation of varicella outbreak among residents and healthcare workers in psychiatric hospital- Saudi Arabia.

BACKGROUND: Outbreak is an infection control challenge in health care setting especially when it occurs in a special setting as psychiatric hospitals. Objectives: Investigate and control an outbreak of varicella among patients and healthcare workers (HCWs) in a psychiatric hospital of Saudi Arabia. Methods: A multidisciplinary team of different specialties assigned to assess the situation, confirm the diagnosis, identify the causes and put an action plan to deal with such a situation. Results: The team investigated the varicella outbreak as per the Ministry of Health's (MOH) outbreak guidelines. Multiple risk factors contributed to this outbreak as the location of the outbreak in a psychiatric hospital, breaches in the hospital infection control program. Conclusion: Investigation of this outbreak was conducted as per MOH and CDC definitions and guidelines. Outbreak control plan was instituted and successfully implemented including enforcement of infection control program, the establishment of an employee health program, basic infection control orientation programs.

The history of mental health policy in Turkey: tradition, transition and transformation.

This article offers a brief history and the evolution of mental health policy in Turkey. It aims to analyse how mental health policies were transformed and why certain policies were introduced at specific times. The modern history of mental health policy is divided into three periods: the institutionalization of psychiatry and hospital-based mental health services; the introduction of community-based mental healthcare services; and lastly, the policy of deinstitutionalization after the 1980s. These periods have been categorized in a way that basically coincides with Turkey's modern political history.

Modelos de gestão em enfermagem na saúde mental: scopping review / Modelos de gestión de enfermería en salud mental: scoping review / Mental health nursing management models: a scoping review

RESUMO Objetivo: este estudo tem como objetivo mapear as evidências científicas disponíveis sobre modelos de gestão de Enfermagem na saúde mental. Método: Scoping Review realizada nas bases de dados MEDLINE via PubMed e CINAHL via EBSCO, no Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), na Biblioteca Digital Brasileira de Teses e Dissertações (BDTD) e na Biblioteca Virtual em Saúde (BVS). Resultados: a amostra final foi de oito estudos e a partir da análise destes construiu-se uma síntese qualitativa dando origem a duas categorias: modelos de gestão aproximados de teorias administrativas tradicionais, normativas e prescritivas; e modelos de gestão aproximados de estilos gerenciais inovadores, participativos e centrados nas pessoas. Conclusão: os modelos identificados se aproximaram de uma gestão voltada para teorias administrativas tradicionais e autocráticas, que privilegiam atividades administrativas e burocráticas, assim como uma liderança autoritária. Constatou-se, no entanto, que as transformações impulsionadas pela Reforma Psiquiátrica no Brasil e no mundo e o redirecionamento do cuidado em saúde mental, com políticas de humanização e valorização do usuário, aceleraram a transição desses modelos para uma gestão mais participativa, com foco no cuidado.

RESUMEN Objetivo: este estudio tiene como objetivo mapear la evidencia científica disponible sobre modelos de gestión de enfermería en salud mental. Método: Scoping Review realizada en bases de datos MEDLINE vía PubMed y CINAHL vía EBSCO, en el Catálogo de Tesis y Disertaciones de la Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES), en la Biblioteca Digital Brasileña de Tesis y Disertaciones (BDTD) y en el Biblioteca Virtual de Salud (BVS). Resultados: la muestra final constó de ocho estudios y, a partir de su análisis, se construyó una síntesis cualitativa, dando lugar a dos categorías: modelos de gestión aproximados a las teorías administrativas tradicionales, normativos y prescriptivos; y modelos de gestión aproximados a estilos de gestión innovadores, participativos y centrados en las personas. Conclusión: los modelos identificados se aproximaron de una gestión centrada en las teorías administrativas tradicionales y autocráticas, que privilegian las actividades administrativas y burocráticas, así como un liderazgo autoritario. Sin embargo, se encontró que las transformaciones impulsadas por la Reforma Psiquiátrica en Brasil y en el mundo y la reorientación de la atención en salud mental, con políticas de humanización y mejora del usuario, aceleraron la transición de estos modelos hacia una gestión más participativa, con enfoque en cuidado.

ABSTRACT Objective: the objective of this study was to map the scientific evidence available about Mental Health Nursing management models. Method: a Scoping Review conducted in the MEDLINE and CINHAL databases via PubMed and EBSCO, respectively, in the Theses and Dissertations Catalog of the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES), in the Brazilian Digital Library of Theses and Dissertations (Biblioteca Digital Brasileira de Teses e Dissertações, BDTD) and in the Virtual Library in Health (Biblioteca Virtual em Saúde, BVS). Results: the final sample consisted of eight studies and, based on the analysis, a qualitative synthesis was prepared, giving rise to two categories: management models approaching traditional, normative and prescriptive administrative theories; and management models approaching innovative, participatory and people-centered management styles. Conclusion: the models identified were approached from a management aimed at traditional and autocratic administrative theories, which privilege administrative and bureaucratic activities, as well as an authoritarian leadership. However, it was found that the transformations driven by the Psychiatric Reform in Brazil and in the world and the retargeting of mental health care, with humanization and user appreciation policies, accelerated the transition of these models to a more participatory management, with a focus on care.

Lessons Learned From a Mental Health Hospital: Managing COVID-19.

Congregate settings such as psychiatric units have an increased risk of disease transmission because of the milieu setting and the inability to isolate patients. Interventions to prevent infection and cross-contamination are discussed including monitoring of patient temperatures, personal protective equipment, remote care, monitoring of human resources, and reinforcement of infection prevention strategies. We discuss the effectiveness of those interventions and the lessons learned, including implications for psychiatric clinical care, during future pandemics or a next wave of COVID-19.

[COVID-19 and psychiatry†: urgent opening of a cohort ward at Geneva's psychiatric hospital]. / Covid-19 et psychiatrie†: ouverture en urgence d'une unité de cohortage à la Clinique psychiatrique de Genève.

Due to the rapid spread of the novel coronavirus pandemic, a reorganization of the health care sector was needed. Many questions arose concerning the specificity of psychiatric care in this unprecedented situation. In Geneva, Switzerland, the department of psychiatry decided to open a new ward for its infected patients. Beyond the challenge of setting it up quickly, we faced the challenges of taking care of a heterogeneous group of patients and of incorporating protection measures we were not accustomed to, which add a significant amount of time to the daily care of patients. The staff recruitment on a voluntary basis, close supervision, availability of the personal protective material as well as support from the infection prevention and control unit have enabled proper functioning of the ward.

Devant la vitesse de propagation de la pandémie due au nouveau coronavirus, une réorganisation des systèmes de santé a été nécessaire. De nombreuses questions se sont posées quant à la spécificité de la psychiatrie dans cette situation exceptionnelle. À Genève, le département de psychiatrie a pris la décision d'ouvrir une nouvelle unité de cohortage pour ses patients contaminés. Outre le défi du délai court pour la mettre en place, nous avons été confrontés à celui de prendre en charge une patientèle hétérogène et de devoir appliquer des mesures de protections avec lesquelles nous étions peu familiers, chronophages. Le recrutement de l'équipe sur une base volontaire, un encadrement très présent, la disponibilité du matériel de protection et le soutien du service prévention et contrôle de l'infection ont permis un bon fonctionnement de l'unité.