The Experience of Hearing Voices: Challenges and Coping Mechanisms.

Auditory hallucinations or hearing voices are often associated with schizophrenia and other psychotic disorders. However, several voice-hearers do not have any mental health issues or diagnoses. The study presented in this paper aimed to explore how voice-hearers understand and react to their concerns by reflecting on and exploring their experiences and interpretations of these experiences. The participants were nine individuals - three females, four males and two others, all experiencing auditory hallucinations for at least five years, residing either at their home or at one of the Hostels run by Richmond Foundation (Malta). A qualitative approach following the principles of Interpretative Phenomenological Analysis was used. In-depth interviews were conducted to explore how the participants perceive their voices, what coping strategies are used, and how their experiences affect their lives. Four super-ordinate themes related to the participants' perceptions and their interpretation of the experience of hearing voices were identified: 'A tough experience', 'Methods used to cope with voices', 'Factors linked to recovery' and 'Relationships'. Furthermore, the study elicited the voice-hearers' recommendations (both for other voice-hearers and mental health professionals).

The role of health promotion theories in Stroke Awareness and Education.

The aim of this paper is to provide an overview of health promotion theories and their application to Stroke Awareness and Education. Stroke stands as one of the leading causes of mortality and morbidity even though treatment is readily available. One of the major challenges in this area is that the effectiveness of treatment depends heavily on timely presentation to healthcare services. Unfortunately, many individuals do not seek help whilst experiencing symptoms or only do so after a significant delay. This paper explores the main health promotion theories related to this problematic health behaviour in relation to stroke.

Covid-19 Restrictive Measures: A Theoretical Exploration of Defiant Attitudes.

The aim of this paper is to explore defiant attitudes to Covid-19 restrictions against a backdrop of Health Behaviour Theories, so as to gain further understanding of such behaviour and target it accordingly. In an attempt to limit the mortality and morbidity of the pandemic, health authorities are encouraging and enforcing the adherence to restrictive measures. Still, defiant attitudes persist. Possible reasons for these attitudes include an unappreciation of possible consequences and feelings of helplessness. The psychiatric nurse has a specific toolkit that is crucial in addressing these thought processes and behaviours-this shall be explored.

A Comparison of Narrative Exposure Therapy and Non-Trauma-Focused Treatment in Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis.

Background: Narrative Exposure Therapy (NET) is a relatively new treatment that may be beneficial as a standalone approach or as an adjunct for use in individuals who suffer from simple or complex Posttraumatic Stress Disorder (PTSD).Aims: The main objective of this review was to explore the effectiveness of NET in remediating PTSD symptoms as compared to Non Trauma-Focused-Therapy (NTFT).Methods: A systematic search in Medline, PsycINFO, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL) was carried out. Reference lists of papers and grey literature were hand searched. Experimental studies that compare NET to NTFT with no preference to age, gender or nationality of participants that include a baseline and 3-6 month measurement of PTSD outcomes using tools with good psychometric properties were included. The search resulted in 10 randomised controlled trials. Data extraction, collection and analysis was then carried out by the authors.Results: In all of the studies, the difference in the PTSD symptoms' mean score after 3-6 months between the NET group and the NTFT group was in favour of NET. However, the level of significance was attained in six of the studies only. The overall effect size (standardised mean difference) of the trials is 0.684 in favour of NET (p < .001).Conclusions: NET was shown to be superior to NTFT in post-traumatic stress disorder. The most important recommendations are in relation to research and target the methodological limitations of existing studies in particular the small sample sizes, lack of blindness and inadequate rigour during the trials. More research is needed to further explore the benefits of NET for different populations and trauma-types.

Service Users' Perception of the Therapeutic Milieu in a Mental Health Rehabilitation Unit.

Although the concept of the therapeutic milieu has been given prominence, the perceptions of care receivers in this regard are sparse. This study aimed to explore service users' perceptions of the therapeutic milieu in a mental health rehabilitation unit. The method used was document analysis of annual reports generated by the unit through data collection from the care receivers. Four themes were identified, namely, the 'physical environment', the 'structure of the therapeutic programme', 'relationships with the professionals' and the 'experience of living as a community'. The study contributed to previous research through meaningful ramifications for research, practice and education.

An account of loneliness while living with an eating disorder.

WHAT IS KNOWN ON THE SUBJECT?: Severe and prolonged loneliness is known to be detrimental to mental well-being. Eating disorders and loneliness are linked to each other with loneliness often acting as a barrier during the recovery journey. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper explores the experience of loneliness while recovering from an eating disorder, as framed within the context of childrearing and challenging family dynamics. While loneliness has negative connotations, it may act as a 'companion' to the person experiencing it. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The first visible need is that for public figures to raise awareness of loneliness and mental well-being. Another emerging issue is the need to re-think automatic negative assumptions associated with loneliness. Importantly, professionals and caregivers have to consider the co-morbidity of loneliness and mental illness. Links between loneliness and unhealthy family dynamics also need to be assessed when providing support.

Hit by the wave: The experiences of adult males living with lymphoedema.

Lymphoedema arises when the lymphatic system has been damaged and may occur secondary to cancer treatment. While much of the extant literature focuses on quality of life in females with breast cancer- related lymphoedema, this study explores the impact of living with lymphoedema secondary to cancer treatment in males. Semi-structured interviews were conducted with 13 male participants, aged between 50 to 85 years. Data collected were analysed using interpretative phenomenological analysis. The super-ordinate theme 'Hit by a wave' encompasses the profound impact of lymphoedema on the participants' quality of life. The males expressed body image concerns and struggled with feelings of frustration, anger, anxiety and depression. Physical changes such as weight increase, disrupted sleep, pain, swollen genitals and urinary difficulties were experienced. Changes in lifestyle were also expressed, such as an increased dependence on carers; work-related and role changes. Nevertheless, many participants endorsed the need to focus on the present moment and expressed a heightened appreciation of authenticity in life. By understanding the unique narratives of males with lymphoedema, health care practitioners together with patients can formulate care plans that truly resonate with the needs, concerns, and experiences of males living with lymphoedema.

To Hell and Back: A Performer's mental health journey during the COVID-19 pandemic.

WHAT IS KNOWN ON THE SUBJECT?: The COVID-19 pandemic has induced a considerable amount of mental health difficulties, ranging from anxiety and depression to psychosis. As services struggle to cope with the demand for support, the effect of such psychological challenges on quality of life remains a major concern. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Since the beginning of the COVID-19 pandemic, a vast amount of research has focused on the physical consequences of the virus. Gradually, studies on the mental health effects related to the pandemic started to emerge, as it became clear that mental health difficulties were as present and as concerning as the physical ones. Whilst such studies commonly explore the prevalence and nature of the presenting mental health challenges, the publication of personal mental health experiences linked to the ongoing situation is lacking. Introducing the human element in literature is an important means of raising awareness on the mental health difficulties that can be triggered by the pandemic. Using public figures such as the individual in this paper is additionally powerful due to the role model effect. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The paper highlights the need for enhanced awareness and monitoring of mental health especially by health professionals who therefore need to receive adequate mental health training. Furthermore, mental health awareness efforts need to be considered as being a part of the role of the psychiatric and mental health nurse who is at a prime position to educate, monitor and support those receiving care.

Development of a European Centre of Excellence (Coe) for Research in Continuing Professional Development (UPGRADE).

The European Centre of Excellence (CoE) for Research in Continuing Professional Development (UPGRADE) is a pan-European network of researchers, clinicians, regulators, educators, and professional bodies, established in 2020 through a consensus group of experts, who defined its mission, vision, values, aims and objectives. The Centre's aim is to advance the science of Continuing Professional Development (CPD) for healthcare professionals through research and dissemination of best practices for CPD. Debate among UPGRADE partners and interchange of research data will yield best practices across countries to optimise quality CPD programmes. Collaboration, information exchange and communication among CPD experts will be facilitated through UPGRADE via an online Community of Inquiry (CoI). UPGRADE aims to evolve as a driving force network of academics and health professional leaders in research, education, professional regulation, and clinical practice whose collaborative work ensures quality and safe person-centred care. UPGRADE members are from 22 European countries, represented by strategic leaders in diverse sectors of health, policy, academia, and professional organisations. Three research-working groups constitute the pillars of UPGRADE, which addresses gaps in research, collect and create critical databases, and solidify the effectiveness of CPD.

Walking on eggshells: A life defined by obsessive-compulsive personality disorder.

WHAT IS KNOWN ON THE SUBJECT?: Obsessive-compulsive personality disorder (OCPD), which is experienced by 2.1-7.9% of the population, is characterized by an excessive need for orderliness, neatness and perfectionism. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Existing studies on OCPD commonly focus on the physiological aspects, treatment and/or comparison of features with other disorders. Studies that explore the personal experiences related to OCPD are lacking and so the human element of this condition is missing. This paper contributes to this gap by presenting a glimpse into life with OCPD. The narrative is provided by the daughter of a person who lived with OCPD and presents the ordeals, victories and aspects of everyday life as framed by the condition. Whilst personality disorders such as OCPD are subjected to a high level of stigma, this relative's story shows that love and compassion can be found even in the darkest corridors that OCPD can take one to. As the story shows, behind every disorder there is a human being and the disorder is not the totality of that being. In this view, the paper sheds light on the human element related to the condition. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The paper highlights the need for continuous, hands-on community support to those experiencing OCPD and their significant others. In order to enhance continuity of care, support is ideally centralized and provided by one keyworker who builds a strong therapeutic relationship with the person and their loved ones.

Psychiatric hospital nurses' attitudes towards trauma-informed care.

WHAT IS KNOWN ON THE SUBJECT?: Research indicates many clients using mental health services have trauma histories. Consequently, mental health professionals must be aware of the impact of trauma and of how they can avoid retraumatizing service-users. Care delivered with this awareness is known as trauma-informed care (TIC). There is little research on attitudes towards TIC. To date, only one study explored these attitudes among MHNs exclusively. Additionally, a richer understanding of TIC attitudes using methods like in-depth interviews is needed. It is unclear whether knowledge of TIC results in more favourable attitudes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: MHNs in this study had little knowledge of TIC but expressed overall favourable TIC attitudes. Traumatic histories were not appreciated as causes of challenging behaviour. On rehabilitation wards, clients come to be perceived as family members and this makes it harder for MHNs to not take challenging behaviour of clients personally. MHNs face work-related traumas which interfere with their ability to provide TIC. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings of this study can be used to guide plans to implement TIC in psychiatric hospitals. Policymakers are called to appreciate that ensuring MHN well-being on the workplace will facilitate their delivery of TIC. TIC training initiatives for MHNs must stress the importance of acknowledging traumatic histories as causes of challenging behaviour and of maintaining professional boundaries with long-term clients. This would benefit service-users by ensuring MHNs are more trauma-informed. More research on attitudes towards TIC among MHNs is needed. ABSTRACT: Introduction Quantitative studies exploring trauma-informed care (TIC) attitudes have not used samples made up exclusively of mental health nurses (MHNs). Qualitative methods were sparingly used. Aim To examine nurses' TIC attitudes at a psychiatric hospital. Method A mixed-method design was used. One hundred and thirty-six MHNs completed the Attitudes Related to Trauma-Informed Care scale. Data were analysed using inferential statistics. A focus group interview among ten MHNs ensued. Thematic analysis was used. Results MHNs demonstrated favourable TIC attitudes. Ambivalent attitudes for the subscale "Causes" were identified. MHNs employed for less than 5 years at the hospital and those in acute settings displayed more favourable attitudes on some subscales. Three themes "Awareness," "Unhealthy boundaries" and "Inhibition" emerged from qualitative analysis. Discussion Challenges uncovered in the provision of TIC include the unacknowledged impact of trauma on challenging behaviour among MHNS, the influence of blurred professional boundaries with long-term clients on the cycle of perpetuated trauma identified by previous research and MHNs work-related traumas. Implications for practice Identified challenges to TIC integration among MHNs can facilitate the implementation of TIC in hospitals. TIC educational packages for MHNs should acknowledge traumatic histories in the aetiology of challenging behaviour and stress the importance of maintaining professional boundaries with clients.

Adopting the Concept of 'Ba' and the 'SECI' Model in Developing Person-Centered Practices in Child and Adolescent Mental Health Services.

The concept of knowledge is divided into explicit and tacit knowledge; explicit knowledge refers to the knowledge that can be articulated, written and stored, while tacit knowledge refers to personal experiences, values, beliefs and emotions of an individual. By Nonaka's theory, explicit and tacit knowledge do not lie separately but interact together by interactions and relationships between human beings. Thus, the SECI model is based on the assumption that knowledge is created through the social interaction of tacit and explicit knowledge; known as knowledge conversion. The SECI model is based upon four modes of knowledge conversion; socialization, externalization, combination and internalization. 'Ba' is considered to be a shared platform for knowledge creation. 'Ba' is a shared space, be it physical, mental or a combination of both that serves as a foundation of knowledge creation. Ba involves sharing of tacit knowledge i.e. emotions, feelings, experiences and mental images. It also involves the formation of a collective relationship which is open to the sharing of practices, values, processes and culture. This concept focuses mainly on the individual as a person who holds the knowledge rather than just on the knowledge itself. It aims to create a common space to bring people together where they can dialogue to share and create knowledge. As in the relationships formed in person-centered practices, relationships formed in Ba are based on not just the sharing of objective knowledge but also on sharing values, beliefs, and emotions. It also reflects the formation of a person-centered environment as a basis for person-centered research where healthful relationships with the participants are formed. Furthermore, Ba will aid in creating a sense of connectiveness and dialogue, thus focusing on the idea that the development of new practices is done with others rather than to others. In this article we will discuss how these Eastern concepts can be adapted and used to develop person-centered practices within child and adolescent mental health services, specifically related to rehabilitation and recovery. The concepts of personhood will be discussed, followed by a reflection on current practices adopted when working with children and adolescents.

Reaching out for Help: Calls to a Mental Health Helpline Prior to and during the COVID-19 Pandemic.

The COVID-19 pandemic is a major health crisis associated with adverse mental health consequences. This study examined 2908 calls made to a national mental health helpline over a 10 month period, 2 months prior to (Pre-COVID) and 8 months during the pandemic phase, that incorporated the imposition of a partial lockdown, followed by the removal and reintroduction of restrictive measures locally. Data collected included reason/s for call assistance, gender, age and number of daily diagnosed cases and deaths due to COVID-19. In the Pre-COVID phase, calls for assistance were related to information needs and depression. With the imposition of a partial lockdown, coupled with the first local deaths and spikes in number of diagnosed cases, a significant increase in number of calls targeting mental health, medication management and physical and financial issues were identified. Following the removal of local restrictions, the number of calls decreased significantly; however, with the subsequent reintroduction of restrictions, coupled with the rise in cases and deaths, assistance requested significantly targeted informational needs. Hence, whilst calls in the initial phase of the pandemic mainly targeted mental health issues, over time this shifted towards information seeking requests, even within a context where the number of deaths and cases had significantly risen.

COVID-19 in Malta: The mental health impact.

The COVID-19 pandemic has had a devastating impact on health, economies, and other societal pillars. The Maltese archipelago has also been affected by this viral threat. Due to Malta's characteristics as one of the smallest islands in Europe, the picture, which shall be portrayed in this article, may have some unique features, especially in terms of mental health and societal well-being. (PsycInfo Database Record (c) 2020 APA, all rights reserved).