Elizabeth Collier

Creative Solutions: Innovative Use of the Arts in Mental Health Settings

A recent study of occupational stress on the unit (Clare, 2004) highlighted that staff valued the importance of the socialization process in reducing their stress levels. This process incorporates the need for peer support and acceptance, and an understanding of what is expected of them (e.g., roles and responsibilities), supported by a culture of learning, problem solving, and working together. This process is similar to the approach taken by the arts project in nurturing ideas and initiatives in a safe, respectful way. It is apparent that the arts project has been more than just a creative activity; it has had wider implications for both staff and service users in reducing stress. It has: * Enabled staff retention. In fact, there is a waiting list of nurses wishing to work on the unit. * Reduced incidents of damage to property. * Reduced use of p.r.n. medication. * Enhanced the good reputation of the service, which is often commented on by visitors to the unit. The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity.

A literature review exploring the preparation of mental health nurses for working with people with learning disability and mental illness

The aim of this literature review is to explore whether mental health nurses are being appropriately prepared to care for learning disabled patients who also suffer from mental ill health. A systematic approach was adopted in order to identify relevant literature for review on the topic. Five electronic databases were searched; CINAHL, Medline, ERIC, PubMed and Scopus. Searches were limited to the years 2001-2013. A total of 13 articles were identified as relevant to the topic area for review. Three main themes were identified relating to (a) attitudes (b) practice and (c) education. There appears to be a lack of research that directly addresses this issue and the existing literature suggests that there are considerable deficits in the ability of mental health nurses to be able to provide appropriate care for those with both a learning disability and mental ill health. The findings of this review would suggest that this topic area is in urgent need of further investigation and research. Further research into this area of practice could possibly help to inform education regarding this subject at pre-registration and post qualifying levels, which could therefore in turn, improve the delivery of mental health nursing care to this particular client group.

Schizophrenia in older adults.

Although the number of people older than 55 with schizophrenia is expected to double during the next 20 years, the research data on older adults with schizophrenia are limited. This appears to be because until the middle of the 20th century, it was assumed that mental illness in older adults was a part of the aging process and because older adults are often excluded from research investigations. Nursing research is needed to explore how people with schizophrenia learn to manage their problems as they age, as well as how those who are first diagnosed with schizophrenia in later life adapt to their illness. Mental health nurses need to be cautious in assigning premature labels to older adults with mental illness that may lead to unsubstantiated assumptions about levels of disability. Instead, nurses should realize individual potential regarding undiscovered strengths and should attempt to create interventions that recognize and foster personal development for older adults with schizophrenia.

Dementia education in Higher Education Institutions

This article is a contemporary issues piece which discusses the challenges in providing dementia education in Higher Education Institutions.

Literature review of post‐traumatic stress disorder in the critical care population

Aim To determine which factors relate to the development of post-traumatic stress disorder, in adult patients who are admitted to critical care units. Background Patient survival rates from critical care areas are improving each year and this has led to interest in the long-term outcomes for patients who have been discharged from such environments. Patients typically require invasive and extensive treatment, which places a stress on physical and mental health. Prevalence estimates of post-traumatic stress disorder in the critical care discharge population vary from 5–63%, yet it remains unclear what the predisposing factors are. Design A systematised review. Method Subject heading and keyword searches were conducted in MEDLINE, CINAHL, PsycINFO and ScienceDirect, with 23 articles identified that examined the relationship between critical care and the development of post-traumatic stress disorder. Results Three main themes were identified; Critical Care Factors, Patient Factors and Experience Factors. Eight key and three potential causative factors were found: younger age, female, previous psychiatric history, length of ICU stay, benzodiazepine sedation, use of stress hormones, delusional memory and traumatic memory, delirium, GCS score of ≤9 on admission & use of mechanical restraint. Conclusions Post-traumatic stress reactions can be strongly related to the development and presence of traumatic and delusional memories. Younger patients may exclude themselves from research to avoid their traumatic thoughts. The role of prior psychiatric illness is unknown. Distinction between ‘factual’ and ‘false’ or delusional memory as occurs in the literature maybe unhelpful in understanding trauma reactions. Relevance to clinical practice There are around 38,000 occupied critical care beds each year in England. The scale of the issue is therefore substantial. Risk factors can be isolated from available evidence and provide a rudimentary risk assessment tool to inform practice development in this area.

Enabling mental health through social and cultural inclusion

blueSCI is a not‐for‐profit organisation based in Trafford that aims to enable good mental health through facilitating progress towards personal goals and development for people in the local community. Alicia Clare, Elizabeth Collier and Steven Higgin describe this inclusive, person‐centred, recovery‐oriented service that has emerged from a boundary‐breaking partnership between a mental health professional and a professional artist.

The impact on relationships following disclosure of transgenderism: a wife's tale

Accessible summary: What is known on the subject?The experiences of transgender people are becoming increasingly more visible in popular culture, biographical literature and the media.The topic has received little attention within the psychiatric and mental health nursing literature.There is a paucity of literature exploring the impact on relationships following a disclosure of transgenderism. What does this paper add to existing knowledge?A narrative account of the consequences for the wife of one transwoman and their relationships with friends and family following the disclosure of transgenderism.The article identifies a range of issues that require further attention in relation to healthcare provision. These include the mental health needs of partners and spouses; attitudes of healthcare professionals towards transgender issues; and the adequacy of the formal support offered to partners and spouses of transgender people. &NA; What are the implications for practice?There is a need for healthcare practitioners to explore their understanding of transgender issues and how these may impact on the mental health of partners and spouses.It is important that healthcare professionals provide a hopeful and supportive environment to enable couples to explore their relationships following disclosure of transgenderism.

Teaching age and discrimination: A life course perspective

Age discrimination in health and social care is a universal issue with significant potential ramifications for practice, and one which should be explicitly addressed in health and social care pre-registration education. However, developing teaching and learning strategies to effectively address this subject is complex given that implicit/indirect discrimination based upon tacit beliefs and assumptions, is problematic and difficult to tackle. This paper discusses the importance of teaching age and discrimination to student nurses in the context of the development of a novel approach to this aspect of education from a life course perspective. This discussion is based personal and professional reflections of the authors on the delivery of the teaching session over a number of years with approximately 500 student mental health nurses to date. The emerging themes of this are reported here and their implications for education and practice discussed. Exploring age and discrimination in relation to children and young people and older people in particular has enabled student nurses to explore the concept as one which requires critical reflection. This promotes awareness of usually unexamined personal attitudes in relation to age in order to enhance the potential for good experiences of health services for all people in need of them.

Hidden in plain sight; the reality for older military veterans.

Services for ex-service personnel have improved in the UK in recent years with collaborative partnerships between the National Health Service and the Ministry of Defence. However, older veterans are left hidden in plain sight: misunderstood, excluded and overlooked. Military veterans are defined as anyone who has served in the armed forces for at least 1 day as a regular or reservist (Ministry of Defence, 2011), and therefore could have very different experiences regarding lengths of service and involvement in conflicts. The Mental Health Foundation (2015) report that not only do 4% of UK military personnel experience post-traumatic stress disorder (during and after service) but also that 19.7% report common mental health problems (anxiety/depression) and 13% alcohol issues which could be linked to a post-traumatic stress syndrome. International details on military mental health are hard to find. The psychiatric category of post-traumatic stress disorder was 35 years old in 2015, though an attempt to understand the concept has a long history. Diagnostic criteria offer a medical perspective of mental health problems, but personal experience is far more nuanced where individuals seek to find personally meaningful explanations for their distressing experiences. Many people may struggle with violent thoughts or behaviours over a long period of time. Barriers to talking about mental health problems are well documented, but for those who are older veterans stigma maybe internalized from the sociocultural context of early life. They will have grown up understanding mental illness as ‘lunacy’ and something to be ashamed of as Bernard, whose story of growing older with post-traumatic stress disorder in this issue demonstrates. Combat stress (2015) report that the average time taken to seek help is 13.1 years. When help is sought, General Practitioners are often the first point of contact, and are therefore need to be able to provide intervention. Recognition of post-traumatic stress disorder may be a challenge particularly with older veterans who may have lived a lifetime not talking about their experiences and difficulties. For military veterans over the age of 60 whose experience of conflict is decades previously, they may still not recognize the origins of their mental distress and feel unable to share experiences and feelings about traumatic memories that impact everyday life and which no one else will understand. For many, sharing stories of conflict may be something to be avoided unless with a select group with special insights. It may feel as though it was a different, separate life, resulting in living with trauma long term without seeking support. Eric Lomax (1996) in his book The Railway Man, shows us how, having kept silent for decades, he was driven in his 70s to seek healing through revisiting the place of his torture and his torturer. These maybe hidden, private stories and they are not consigned to history, but alive in the minds of people in the present. Relying on diagnostic criteria may risk missing those who no longer meet diagnostic thresholds, but who continue to experience significant distress. Mental health problems in older people are more likely to be undiagnosed (WHO, 2015); their mental health may have improved over time, but they may still experience significant distress in later life. For a generation for which mental ill health was stigmatized and post-traumatic stress disorder did not exist, how can we be sure that older veterans’ mental health is recognized and support received? Similarly, how as mental health nurses do we identify and support such people who have likely struggled for many years or for whom the effects of trauma has emerged in later life? Veterans are entitled to priority treatment where the condition relates to their service (Ministry of Defence 2011) but this can only happen if the veteran identifies themselves as such to their General Practitioner. This is a key barrier; older veterans may no longer see its relevance and if it has been buried for so long, how can self-identification be a reasonable expectation? General Practitioners and other health and social care professionals have to be proactive in asking, even if that person may be 50 years or more post service. Considering the potential challenges for recognizing and ensuring older veterans receive the support they need, how can mental health nurses and services respond? Specialist mental health services such as Military Veterans IAPT service, Combat Stress and other charitable organizations encourage segregation. Segregated services could be part of the problem; the dilemma is, do we enhance and increase specialist services or do we improve the skills and knowledge more widely in the health and social care workforce? What is needed is a