Sleep problems and referral intentions in mental health services: service user self-report and staff proxy report surveys

BACKGROUND

Sleep problems are common in mental health service users, but few non-pharmacological therapies are offered. Therapies are being developed and tested, but there may be barriers to these therapies reaching those who need them.

METHODS

Light-Dark and Activity Rhythm Therapy (L-DART), is a new sleep therapy delivered by an occupational therapist, which has been feasibility tested in people with schizophrenia spectrum diagnoses. This paper presents two surveys, conducted with mental health staff and service users, on sleep problems, treatment wishes; and barriers and facilitators to uptake of L-DART or similar therapies. Descriptive statistics, single-level and multi-level ordinal logistic regression were used to examine factors associated with sleep problems and referral intentions.

FINDINGS

Sleep problems were commonly identified by staff and service users, there was demand for non-pharmacological intervention across diagnostic and demographic categories, but staff readiness to refer differed according to NHS Trust and service user diagnosis. Staff and service user reports differed in awareness of sleep disordered breathing and parasomnias, and wish for referral. Staff were more confident identifying sleep problems than addressing them, but more training was associated with greater confidence concerning both assessment and treatment.

CONCLUSIONS

A range of sleep problems are prevalent and recognised in mental health service users, and there is an unmet need for non-pharmacological sleep interventions. Improving suitable resources to support self-management in this group may help; Staff and service users also reported a high readiness to refer or be referred for sleep interventions. Staff training to improve identification of sleep problems, and differentiation between types of sleep problems, would support access to the most appropriate treatments.

Profile, Practice and Perspectives of Occupational Therapists in Community Mental Health Teams in Ireland

The Mental Health Commission (2006a) and the Department of Health and Children (2006) have identified a gap in the knowledge relating to the interventions carried out by mental health workers in community mental health teams (CMHTs) in Ireland. The purpose of this research was to address this gap by exploring the profile, the work practices and the perspectives of occupational therapists working in CMHTs in Ireland.

A mixed methodological approach was chosen: survey questionnaires (quantitative) were sent to 40 occupational therapists working in CMHTs, with 21 responding (52.5% response rate), and semi-structured interviews (qualitative) were carried out with six occupational therapists.

The results suggest that occupational therapists working in CMHTs are experienced and are generally satisfied in their positions. Occupational therapists in this setting offer a wide variety of interventions, guided by models of practice, frames of reference and outcome measures. The issues facing occupational therapists include a lack of resources, role blurring and the need for access to supervision and postgraduate education specifically tailored to mental health. Finally, the findings suggest the need for occupational therapists to establish a channel in which to inform wider mental health practice of their contribution to clients' recovery journeys.

The Future of Occupational Therapy in Mental Health in Ireland

The settings and roles of occupational therapists working in Ireland in mental health have changed greatly over the last decade. Occupational therapy's central tenet, however, that of focusing on occupation and the belief that it is vital in maintaining and promoting people's health and wellbeing, has not. If occupational therapists wish to remain a strong presence in mental health, they will have to adopt many generic roles and work activities while developing and maintaining unique discipline-specific roles. It is time for occupational therapists to focus on occupation, government policy and evidence-based practice in order to identify specialist roles for occupational therapy in mental health. Through this process, health promotion, social inclusion and supported employment stand out as three key areas with which occupational therapy has a good fit.

Occupational Therapy Students' Views of Health Promotion

With the increased interest in the contribution of occupational therapists to health promotion, the College of Occupational Therapists (2004a) recommended that pre-registration programmes should prepare graduates for practice that includes health promotion. This study ascertained the views of second-year occupational therapy students about health promotion. Thirty-five (30%) students responded to a self-report questionnaire and demonstrated positive views about the future relationship between health promotion and occupational therapy. The students thought that health promotion should be included in the education of occupational therapists and did not consider that there had been too much emphasis on health promotion in their own education programme.

Patient ethnicity and three psychiatric intensive care units compared: the Tompkins Acute Ward Study

Psychiatric care units provide care to disturbed patients in a context of higher security and staffing levels. Although such units are numerous, few systematic comparisons have been made, and there are indications that ethnic minority groups may be over-represented. The aim of this study was to compare the rates of adverse incidents and patterns of usage of three psychiatric intensive care units. The study used a triangulation or multi-method design, bringing together data from official statistics, local audit and interviews conducted with staff. Intensive care patients were more likely to be young, male and suffering a psychotic disorder, as compared with general acute ward patients. Caribbean patients were twice as likely, and Asian patients half as likely, to receive intensive care (age, gender and diagnosis controlled). There were large differences in service levels, staffing, team functioning and adverse incidents between the three units. Various aspects of physical security were important in preventing absconds. More evaluative research is required in order to define effective service levels, and to explore the nature of the interaction between ethnicity and inpatient care provision during acute illness.

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards

AIM

This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards.

BACKGROUND

Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent.

METHOD

A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002-2004.

FINDINGS

The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds.

CONCLUSION

Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods.

Re-examining the evaluation of interprofessional education for community mental health teams with a different lens: understanding presage, process and product factors

This paper revisits the formative evaluation of a pilot project that offered in-service interprofessional education (IPE), which is designed to enhance the collaborative practice, to two UK community mental health teams (CMHTs). While the IPE was well received and resulted in some improvements in team functioning, wider successes were elusive. Specifically, collaborative action plans were not implemented, and the pilot programme was ultimately not rolled out to other CMHTs. The purpose of this paper is to test the usefulness of the presage-process-product (3P) framework for analysis as a means to untangle the complex web of factors that promoted and inhibited success in this initiative. The framework, which captures key features of the initiative as a dynamic system, proved effective, yielding new insights, making connections clearer and highlighting the critical importance of presage. We argue that use of the 3P model during the development of in-service IPE could ensure that planning oversights are minimized, thereby improving outcomes.

Serious untoward incidents and their aftermath in acute inpatient psychiatry: the Tompkins Acute Ward study

Serious untoward incidents, or sentinel events (suicide, homicide, suicide attempt, serious assault, and absconding of high-risk patients) occur from time to time in association with acute psychiatric inpatient wards. The aim of this study was to discover the impact of serious untoward incidents on inpatient wards. Doctors, nurses, and occupational therapists at three hospitals were interviewed about these events and their impact on their wards. Staff reported feelings of shock, depression, demoralization, upset, loss, and grief, followed by ruminations, guilt, and anxiety. Levels of containment increased, as did the focus on risk assessment. Processing of the emotional impact was hindered by the pace of ward life, a lack of external support, and management investigations. Patient responses were largely ignored. A few staff responded negatively, hindering service improvements. Much more attention needs to be given to the needs of the patient group following incidents. Substantial planning, organization, and investment are required to properly prepare for such events and manage their outcome. Without this planning and action, acute inpatient work has the capacity to be damaging to staff.