Edward McCann

Investigating mental health service user views regarding sexual and relationship issues.

To date, very few empirical studies exist that investigate sexual and relationship issues and people who experience enduring mental health problems and less attention has been paid to the personal accounts of clients in this respect. The present study, carried out in the UK, involved 30 people who were asked about past and present relationship experiences and elicited hopes and aspirations for future sexual and relationship needs. A semi-structured interview schedule was constructed that specifically addressed potential sexual and relationship concerns and was conducted face-to-face. The aim was to capture in-depth perspectives of people with a medical diagnosis of schizophrenia regarding intimate relationships. The results of the study showed that people are willing and able to articulate thoughts, feeling and beliefs in the area. The findings are presented, and the implications in terms of mental health practice, education and research are discussed.

The sexual and relationship needs of people who experience psychosis: quantitative findings of a UK study

Few studies have investigated the experiences of people regarding sexual and relationship issues in the area of mental health. This study presents the quantitative findings of a larger study that was conducted in London, UK. The aims of the study were to establish clients sexual and relationship experiences and perceived needs. A total of 30 people with a medical diagnosis of schizophrenia, living in the community, were interviewed using three questionnaires. The first related to demographics, the second used relevant parts of the Camberwell Assessment of Need (CAN) and the third looked at possible determinants of sexual behaviour. The CAN also captured keyworker responses to issues related to their clients sexual and relationship requirements. The results showed that 83% of the clients were currently experiencing sexual feelings. Some 90% of clients felt some need in relation to sexual expression and 83% for needs related to intimate relationships. Only 10% of staff recognized sexual expression as a need in clients in their care and 43% perceived a need for intimate relationships. Furthermore, most clients interviewed thought that their psychotropic medication caused sexual problems. Contrasts are made with other studies to help highlight the important issues that emerged for service users.

Service user involvement in mental health practitioner education in Ireland

In recent years, there is an ever increasing call to involve people who use mental health services in the development, delivery and evaluation of education programmes. Within Ireland, there is very little evidence of the degree of service user involvement in the educational preparation of mental health practitioners. This paper presents the findings on service user involvement in the education and training of professionals working in mental health services in Ireland. Findings from this study indicate that in the vast majority of courses curricula are planned and delivered without consultation or input from service users. Currently the scope of service user involvement is on teaching, with little involvement in curriculum development, student assessment and student selection. However, there is evidence that this is changing, with many respondents indicating an eagerness to move this agenda forward.

Lesbian, gay, bisexual and transgender older people in Ireland: Mental health issues

International policy initiatives have highlighted the need to include older lesbian, gay, bisexual and transgender (LGBT) issues in the provision of appropriate health and social care. However, empirical studies in the area remain sparse. The aim of this study was to investigate the experiences and needs of LGBT people over the age of 55 years living in Ireland and this article reports on specific mental health issues. Mixed methods were used involving 144 surveys and 36 semi-structured in-depth interviews. The findings revealed that a significant number of the survey respondents had experienced a mental health problem at some point in their lives with interview participants providing further details of their concerns. It is recommended that policy makers address the mental health needs of older LGBT people in future strategic directives and develop standards of care that support the principles of equality, inclusion and respect for diversity.

Psychiatric nurses’ views on criteria for psychiatric intensive care: acute and intensive care staff compared

AIM To explore and investigate differences between the views of qualified nurses working in psychiatric intensive care units (PICUs) and acute care wards on which patients are appropriate for PICU care. BACKGROUND Previous research on the area of psychiatric intensive care highlights the great differences that exist in all aspects of service provision, from unit size and staffing levels to treatment approaches and physical environment. One of the most common areas of controversy is the type of client behaviour that warrants admission to the PICU. METHOD Structured interviews of 100 qualified nursing staff (in the London area, England) working on either acute or PICU wards were used to gather data on appropriate and inappropriate referral to PICUs. Comments made during the course of the interviews were also collected and subjected to content analysis. FINDINGS There was evidence to support the hypothesis that acute ward staff considered patients suitable for PICU care at a lower level of risk than PICU staff thought appropriate. In comparison to acute ward nurses, those working in PICUs attended to a broader range of factors when considering suitability for admission to PICU. Appropriate reasons for transfer fell into five groups: risk to others; risk of intentional harm to self; risk of unintentional harm to self; therapeutic benefit from the PICU environment; and legitimate acute ward care problem. Inappropriate reasons for transfer fell into four groups: low risk to others and/or self; illegitimate acute admission care problems; patient belongs elsewhere; policy issues. CONCLUSION The study opens up a range of issues not previously studied in relation to the use of PICUs and the intricate relationship of this use with the available acute care wards and other services. These findings and their implications for the care of acute and disturbed psychiatric patients are discussed.

The experiences and support needs of people with intellectual disabilities who identify as LGBT: A review of the literature

BACKGROUND People who identify as lesbian, gay, bisexual and transgender (LGBT) can face many challenges in society including accessing education, care and support appropriate to individual needs. However, there is a growing and evolving evidence base about the specific needs of people with intellectual disabilities (ID) in this regard. AIMS The aim of this review was to explore the experiences of people with ID who identified as LGBT through an examination of studies that addressed their views and highlighted specific issues, concerns and service responses. METHODS AND PROCEDURES A comprehensive search of relevant databases from February 1995 to February 2015 was conducted. Studies were identified that met specific criteria that included: empirical peer reviewed studies, the use of recognised research methods and focused on people with ID whom identified as LGBT. The search yielded 161 papers in total. The search was narrowed and 37 papers were screened using rigorous inclusion and exclusion criteria. Finally, 14 papers were considered suitable for the review. OUTCOMES AND RESULTS The data were analysed and key themes identified that included accessing health services, gender and sexual identity, attitudes of people with ID regarding their LGBT status, and education, supports and therapeutic interventions. CONCLUSIONS AND IMPLICATIONS There is a need for service providers and carers to be more responsive to the concerns of people with ID who identify as LGBT to improve their health and well-being by reducing stigma and discrimination and by increasing awareness of their care and support needs. The implications are discussed in terms of policy, education, research and practice developments.

RECENT DEVELOPMENTS IN PSYCHOSOCIAL INTERVENTIONS FOR PEOPLE WITH PSYCHOSIS

The advent of drug treatments for psychotic illness in the 1950s, along with changes in social policy, heralded the move from institutionalized care to community care. Over the last decade, there have been research developments in the use of psychological techniques to manage psychotic symptomatology, particularly in the realms of cognitive behavioral therapies. There is growing evidence to suggest that psychological treatments can offer an adjunct or even an alternative to traditional medical treatments for patients with schizophrenia and other serious mental illnesses. Opportunities have arisen for mental health nurses to learn these new approaches to caring for people with enduring mental illnesses. The impact of psychological interventions in the treatment of psychosis and the implications for mental health nursing practice are discussed.

Mental Health Needs of People Who Identify as Transgender: A Review of the Literature

Transgender people face many challenges in society including accessing and using healthcare systems. However, little is known about the specific mental health service needs and concerns of transgender people in this regard. The aim of the study was to establish the mental health service needs of transgender people through a review of relevant studies that address the experiences and views of this group. A comprehensive search of CINHAL, Cochrane, Google Scholar, PubMed, PsychInfo, PsychLit, Sociological Abstracts, Scopus, and Web of Science databases from inception to January 2014 was conducted. Studies were identified that met specific criteria that included: using qualitative methods, involving transgender people, and addressing issues related to mental health services. The search yielded 217 papers in total. Following the application of rigorous inclusion and exclusion criteria 33 papers were included for retrieval. Finally, 10 papers were considered suitable for the review. The data were analyzed and key themes identified. The review highlighted distinct challenges that exist in terms of mental health service provision. These included accessing appropriate services and treatments, responsiveness of practitioners, the provision of family supports and potential mental health service developments. The review findings are discussed and key recommendations are made in terms of mental health nursing practice developments, education and research.

Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: A narrative account

The views and opinions of people who use mental health services are being increasingly acknowledged in relation to rights-based, socially-inclusive, and recovery-oriented care. However, little is known of the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in this respect. The aim of the present study was to explore the experiences and needs of LGBT people in relation to mental health services. The study was an exploratory design utilizing mixed methods. Both quantitative and qualitative data were collected using a survey instrument (n = 125) and in-depth semistructured interviews (n = 20) with a sample of people who had completed the survey. This paper will report on the findings from the interview data. The data were thematically analysed, and the main themes that emerged included accessing services, treatment choices, mental health service experiences, and other supports. The findings inform the discussion, and recommendations are made in terms of future mental health practice, education, and research.

Promoting HIV and sexual safety behaviour in people with severe mental illness: A systematic review of behavioural interventions

People diagnosed with severe mental illness (SMI) are at greater risk of HIV than the general population. However, little attention has been given to how best to reduce sexual risk taking in this group. The aim of the review was to evaluate the effectiveness of behavioural interventions to promote sexual safety behaviour in people diagnosed with SMI. A comprehensive search of relevant databases was undertaken, and studies were included if they were randomized, controlled trials; behavioural intervention related to sexual behaviour; included adults diagnosed with SMI; and if a behavioural outcome was reported. The Cochrane Assessment of Bias Tool was used. Of the initial 515 papers identified, 11 trials were included for quality assessment and data extraction. The studies were heterogeneous in content and dose of intervention, as well as outcome measure and follow-up periods, and all had some risk of bias. Four of the studies demonstrated significant improvement in safer sexual behaviour at follow up, but this effect diminished over time. The effect sizes were extremely variable. There is emerging evidence to suggest that a behavioural intervention has the potential to reduce sexual risks in people diagnosed with SMI. However, further high-quality research is needed in this area.