Heikki Ellilä

From the rhetoric to the real : A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula – the eMenthe project

OBJECTIVES This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Masters level in order to bring about significant and positive change to practice. DESIGN This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Masters level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland

Background: Few studies have focused on the recent trends in clinical features child and adolescent inpatient. Aims: This study focuses on the change in the characteristics of child and adolescent psychiatric inpatients in Finland. Methods: The data collection was carried out on selected study days in 2000 and 2011. Questionnaires were sent to the psychiatrists of all child and adolescent wards in Finland. Results: By comparing the data obtained in 2000 (n = 504) and 2011 (n = 412), several changes were found: the percentage of girls in adolescent wards grew and the diagnoses of depression, anxiety disorders, attention deficit hyperactivity disorder and eating disorders increased. In contrast, the diagnoses of psychosis and conduct or oppositional disorders decreased. General functioning was evaluated with the Childreńs Global Assessment Scale (CGAS). There were no changes in the distribution of CGAS scores among child inpatients, whereas among adolescents the share of inpatients with lowest CGAS scores (1–30) increased significantly. The mean length of stay dropped. Conclusions: The growing percentage of girls in adolescent wards is associated with an increase in diagnoses that are more prevalent among girls than boys, namely depression, anxiety, and eating disorders. The changes in the distribution of diagnoses may be due to changes in diagnostic or referral practices, or reflect true changes in the prevalence of disorders among children and adolescents in need of inpatient treatment. The share of adolescent inpatients with the poorest general functioning has increased. The observed shortening in inpatient treatment time seems to be a result of changes in treatment practices.

The required knowledge for lifespan mental health promotion and prevention for Master’s level mental health nurse education – the eMenthe project

Abstract In this study, we address the kind of knowledge that is required for Master’s level nurse education for lifespan mental health promotion and prevention. Data were collected through structured interviews (N = 109). The interviews were conducted across five European countries. The data were analysed using a thematic content analysis approach. The findings show that Master’s level nurse education needs knowledge related to lifespan issues. Needs were raised in several issues like importance of increasing skills and knowledge of mental health workers. We conclude that there is a need to emphasise the knowledge required for mental health promotion and prevention for Master’s level nursing education across Europe.

National time trend changes in psychotropic medication of child and adolescent psychiatric inpatients across Finland

BACKGROUND There have been no comprehensive studies on trends in psychotropic medication use in child and adolescent inpatient settings. The aim of this nationwide study was to report changes in the psychotropic medication given to child and adolescent psychiatric inpatients across Finland and the factors associated with those changes. METHODS We asked the psychiatrist responsible for each inpatient to complete a questionnaire that included questions about the pharmacological treatment and background information. The data were collected on all inpatients on one selected study day in 2000 and 2011. Changes in the use of regular psychotropic medication were studied by comparing the data on 504 patients in 2000 and 412 patients in 2011. RESULTS The study showed that there had been a significant increase in the use of psychotropic medication from 2000 to 2011. According to the multivariate analysis, the increase in psychotropic medication was associated with the study year (in 2000 39%, in 2011 58%), but could not be explained by changes in diagnostic profiles, age distribution, suicidality, violence or the Childrens Global Assessment Scale scores. The use of combined psychotropic medication increased from 9% in 2000 to 25% in 2011. The increase in the use of antipsychotics among child inpatients was particularly noteworthy, with an increase from 10% to 32%. CONCLUSIONS There is a need for evidence-based studies to clarify recommendations for indications and treatment practices when using psychotropic medication in children and adolescents. Cross-cultural studies of the use of psychotropic medication are warranted.

Nursing students’ attitudes towards people with diagnosed with mental illness and mental health nursing: an international project from Europe and Australia

Abstract The stigma associated with a diagnosis of mental illness is well known yet has not reduced significantly in recent years. Health professionals, including nurses, have been found to share similar negative attitudes towards people with labelled with mental illness as the general public. The low uptake of mental health nursing as a career option reflects these stigmatised views and is generally regarded as one of the least popular areas of in which to establish a nursing career. The aim of the current project was to examine nursing students’ attitudes towards the concept of mental illness and mental health nursing across four European countries (Ireland, Finland, Norway and the Netherlands), and Australia, using the Opening Minds Scale and the Mental Health Nurse Education survey. The surveys were distributed to students prior to the commencement of the mental health theory component. Attitudes towards mental health nursing were generally favourable. Differences in opinion were evident in attitudes towards mental illness as a construct; with students from Australia and Ireland tending to have more positive attitudes than students from Finland, Norway and the Netherlands. The future quality of mental health services is dependent on attracting sufficient nurses with the desire, knowledge and attitudes to work in mental health settings. Understanding attitudes towards mental illness and mental health nursing is essential to achieving this aim.

Master’s level mental health nursing competencies, a prerequisite for equal health among service users in mental health care

ABSTRACT Purpose: This discussion paper aims to explore the need of a clarified definition of master’s level mental health nursing competencies in terms of knowledge, skills and attitudes in a European context. Mental health service users have, in spite of their right to equal overall health, higher rates of physical illness and are more likely to experience premature death than the general population. Implementation of a holistic concept of health comprising mental, physical and social aspects of health in mental health services has previously proved to be challenging. Methods: Master’s level mental health nursing competencies in recent literature are discussed and illuminated in terms of knowledge, skills and attitudes in order to enable the promotion of equal overall health among service users in mental health services. Results: The discussion show contents, values and utility of master’s level mental health nursing competencies in mental health services and contribute to reduced role ambiguity by distinguishing master’s level responsibilities from undergraduate nursing tasks and obligations of other professionals in mental health care. Conclusion: This discussion paper shapes implications for developments in master’s level mental health nursing education curricula.