Justin Newton Scanlan

Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far. A review of the literature.

Introduction: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review. Results: Seven key strategy types emerged from the analysis: (i) policy change/ leadership; (ii) external review/debriefi ng; (iii) data use; (iv) training; (v) consumer/ family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment. Conclusion: The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.

Pilot study of a sensory room in an acute inpatient psychiatric unit

Objective: The use of sensory rooms (also known as comfort rooms) to reduce seclusion rates has generated a great deal of interest. This study examined the outcomes associated with the introduction of a sensory room in an acute inpatient psychiatric unit. Method: Consumers rated distress and staff rated a variety of disturbed behaviours before and after each use of the room. Items used during each episode were recorded. Results: Use of the room was associated with significant reductions in distress and improvements in a range of disturbed behaviours. Those individuals who used the weighted blanket reported significantly greater reductions in distress and clinician-rated anxiety than those who did not. No changes were noted in rates of seclusion or aggression. Conclusions: The sensory room was an effective intervention to ameliorate distress and disturbed behaviour, although this did not translate into reductions in overall rates of seclusion or aggression. Weighted blankets appear to be particularly useful.

Job satisfaction, burnout and turnover intention in occupational therapists working in mental health

BACKGROUND/AIM Employee wellbeing is an important issue for mental health services. Poor employee wellbeing (i.e., high levels of burnout or low job satisfaction) is associated with poorer consumer outcomes and higher staff turnover. This study set out to examine factors related to job satisfaction, turnover intention and burnout in a group of occupational therapists in mental health. METHOD Thirty-four occupational therapists (response rate approximately 60%) in a metropolitan public mental health service participated in a whole-of-service workforce survey. The survey included measures of job satisfaction, turnover intention, burnout, job hindrances, job challenges and job resources and questions about positive and negative aspects of positions and factors that attracted employees to their current position. RESULTS Burnout was associated with lower job satisfaction and higher turnover intention. Higher job satisfaction was associated with rewards (remuneration and recognition) as well as cognitively challenging work. The variables most significantly associated with poorer wellbeing (higher turnover intention and burnout) were recipient contact demands (perception that contact with service users or families was demanding), and feelings of stress or fatigue. CONCLUSION This study provides a detailed analysis of factors associated with job satisfaction, turnover intention and burnout in a group of occupational therapists working in mental health. To promote workforce wellbeing and enhanced retention, interventions to minimise burnout should be implemented and evaluated. These strategies should focus on enhancing job resources such as supervisor support, feedback and participation in decision making as well as building the personal resilience of occupational therapists working in mental health.

Enhancing retention of occupational therapists working in mental health: relationships between wellbeing at work and turnover intention.

BACKGROUND/AIM Occupational therapists working in mental health who experience burnout, low work engagement or poor job satisfaction are at risk of poor wellbeing at work and may be more likely to leave their jobs. The aim of this project was to explore factors associated with wellbeing at work and turnover intention in a sample of occupational therapists working in mental health. METHODS One hundred and three occupational therapists working in mental health in Queensland completed a survey exploring work/life balance, effort invested in work, rewards received from work, wellbeing at work (job satisfaction, burnout and work engagement) and turnover intention. Analyses were conducted to explore relationships between work/life balance, effort, reward, wellbeing at work and turnover intention. RESULTS All measures of wellbeing at work were significantly associated with turnover intention. A large proportion (33%) of the variance in turnover intention was predicted by job satisfaction. Perceptions of both work/life balance and effort invested in work, as well as perceived rewards in terms of recognition, prestige and personal satisfaction were significantly associated with work-related wellbeing scores. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY Results from this study deepen the understanding of factors associated with wellbeing at work and turnover intention for occupational therapists in mental health. This knowledge will support the development of interventions aimed at reducing turnover intention and enhancing retention of occupational therapists in the mental health workforce.

Is the health of young unemployed Australians worse in times of low unemployment

Objective : To compare the health of young unemployed Australians during a period of low unemployment (April 2007: rate 4.4%) against published Australian norms for 18–24 year olds and unemployed people during a time of higher unemployment (February 1995 to January 1996: rate 8.1% to 8.9%).

Recovery Assessment Scale – Domains and Stages (RAS-DS): Its feasibility and outcome measurement capacity

Objective: A self-report instrument of mental health recovery is needed both to facilitate collaborative, recovery-oriented practice and measure recovery-focused outcomes. The Recovery Assessment Scale – Domains and Stages (RAS-DS) has been developed to simultaneously fulfill these goals. The aim of this study was to test the feasibility and measurement properties of the RAS-DS. Method: Feasibility was examined by 58 consumer-staff pairs volunteering from 3 non-government organisations. Consumers completed the RAS-DS, discussed it with staff, and then both completed Usefulness Questionnaires. The psychometric properties were examined using Rasch analysis with the data from these consumer participants and from additional participants recruited from two Partners in Recovery programs (N=324). Results: Over 70% of consumers reported taking 15 minutes or less to complete the RAS-DS and rated the instrument as easy or very easy to use. Qualitative data from both consumers and staff indicated that, for most, the RAS-DS was an easy to use, meaningful resource that facilitated shared understandings and collaborative goal setting. However, for a very small number of consumers, the instrument was too confronting and hard to use. Rasch analysis demonstrated evidence for excellent internal reliability and validity. Raw scores were highly correlated with Rasch-generated overall scores and thus no transformation is required, easing use for clinicians. Preliminary evidence for sensitivity to change was demonstrated. Conclusions: The results provide evidence of the feasibility and psychometric strengths of the RAS-DS. Although further research is required, the RAS-DS shows promise as a potential addition to the national suite of routine outcome measures.

Can Rasch analysis enhance the abstract ranking process in scientific conferences? Issues of interrater variability and abstract rating burden

Introduction: Abstract ranking processes for scientific conferences are essential but controversial. This study examined the validity of a structured abstract rating instrument, evaluated interrater variability, and modeled the impact of interrater variability on abstract ranking decisions. Additionally, we examined whether a more efficient rating process (abstracts rated by two rather than three raters) supported valid abstract rankings. Methods: Data were 4016 sets of abstract ratings from the 2011 and 2013 national scientific conferences for a health discipline. Many‐faceted Rasch analysis procedures were used to examine validity of the abstract rating instrument and to identify and adjust for the presence of interrater variability. The two‐rater simulation was created by the deletion of one set of ratings for each abstract in the 2013 data set. Results: The abstract rating instrument demonstrated sound measurement properties. Although each rater applied the rating criteria consistently (intrarater reliability), there was significant variability between raters. Adjusting for interrater variability changed the final presentation format for approximately 10–20% of abstracts. The two‐rater simulation demonstrated that abstract rankings derived through this process were valid, although the impact of interrater variability was more substantial. Discussion: Interrater variability exerts a small but important influence on overall abstract acceptance outcome. The use of many‐faceted Rasch analysis allows for this variability to be adjusted for. Additionally, Rasch processes allow for more efficient abstract ranking by reducing the need for multiple raters.

Evaluation of a peer-delivered, transitional and post-discharge support program following psychiatric hospitalisation

BackgroundThe time following discharge from psychiatric hospitalisation is a high risk period. Rates of hospital readmission are high and there is increased risk for homelessness and suicide. Transitional and post-discharge support programs have demonstrated positive results in terms of enhanced wellbeing, improved connection with community-based services and, in some cases, reductions in hospital re-admission. This paper reports on the outcomes of a peer-delivered post-discharge support program.MethodsThe program involved peer workers (individuals with their own lived experience of mental illness and recovery) providing individualised practical and emotional support to individuals for six to eight weeks following discharge from an inpatient psychiatric unit. Outcomes measures included self-reported mental health recovery, personal wellness and self-reported re-admission rates. Process and satisfaction measures were also collected and semi-structured follow-up interviews were completed with consenting participants.ResultsThe program provided support for a total of 64 individuals, 38 of whom consented to participate in the evaluation. Participants reported improvements in terms of functional and clinical recovery and in the areas of intellectual, social and psychological wellness. Participants self-report of hospital readmissions suggested that there was a reduction in hospital bed days following engagement with the program. Themes from the follow up interviews included: Easing the transition to the “real world”; Practical and individualised support; Someone to talk to; Positive qualities of the worker, Workers’ lived experience was a positive thing, and It wasn’t long enough.ConclusionOverall, evaluation data suggest that the program supported positive outcomes for participants in terms of recovery, wellbeing and hospital avoidance. Participant feedback suggested that the use of support workers with their own lived experience of mental illness was a particularly powerful aspect of the program.

Cognitive remediation has global cognitive and functional benefits for people with schizophrenia when combined with psychiatric rehabilitation

[Summary and Commentary of Wykes, T., Huddy, V., Cellard, C., McGurk, S. R., & Czobor, P. (2011). A meta-analysis of cognitive remediation for schizophrenia: Methodology and effect sizes. American Journal of Psychiatry, 168, 472–485.] [Extract] Objectives of the review: To determine the effects of cognitive remediation therapy to treat cognitive problems that affect functioning of people with schizophrenia and whether study method or potential moderators influence the estimates.

Characteristics of falls in inpatient psychiatric units

Objective: Falls in inpatient psychiatric units are more frequent than in other age-matched unit types. We set out to explore factors associated with falls in inpatient units in a large metropolitan mental health service. Method: Contributory factors, location, activity and outcomes were identified for 559 falls. Overall falls rates were also calculated. Results: Falls rate was 1.25 per 1000 occupied bed days, with highest rates in psychogeriatric units. Almost 50% of falls were related to physiological factors, with balance or mobility difficulties accounting for 19% of all falls. Falls most frequently occurred in bedrooms, outdoor areas, corridors and bathrooms. The most common activity at the time of the fall was walking (41%) and transfers were associated with 17% of falls. Outcomes were evenly spread between no outcome and minor to moderate injury. No severe injuries were reported. Conclusions: Although falls may have been under-reported, this study establishes an analysis framework and baseline data for the monitoring of falls in inpatient psychiatric units in Australia.