Sharon Lawn

The Mental Health Expert Patient: Findings from a Pilot Study of a Generic Chronic Condition Self-Management Programme for People with Mental Illness

Background: Less than optimal outcomes and escalating costs for chronic conditions including mental illness have prompted calls for innovative approaches to chronic illness management. Aims: This study aimed to test the feasibility and utility of combining a generic, clinician administered and peer-led self-management group approach for people with serious mental illness. Method: General practitioners and mental health case managers used a patient centred care model (the Flinders model) to assist 38 patients with serious mental illness to identify their self-management needs, and match these with interventions including Stanford peer-led, self-management groups and one-to-one peer support. Self-management and quality of life outcomes were measured and qualitative evaluation elicited feedback from all participants. Results: Collaborative care planning, combined with a problems and goals focused approach, resulted in improved self-management and mental functioning at 3 to 6 months follow-up. The Stanford self-management course was applicable and acceptable to patients with serious mental illnesses. Qualitative feedback was highly supportive of this approach. Conclusions: Generic, structured assessment and care planning approaches, resulting in self-management education targeted to the individual, improved self-management and quality of life. Patients and service providers reported considerable gains despite the challenges associated with introducing a generic model within the mental health and general practice sector.

Empowerment, patient centred care and self‐management

Background  Patient or person centred care is widely accepted as the philosophy and practice that underpins quality care. An examination of the Australian National Chronic Disease Strategy and literature in the field highlights assumptions about the self‐manager as patient and a focus on clinical settings.

Mental health peer support for hospital avoidance and early discharge: An Australian example of consumer driven and operated service

Background: An international trend towards greater involvement of mental health consumers to support fellow consumers is part of the shift towards more recovery-based services. Aims: Evaluation of the first 3 months of operation of an Australian mental health peer support service providing hospital avoidance and early discharge support to consumers of adult mental health services. Method: Key performance indicators such as bed days saved, crisis service contact, ED presentations, and readmission rates were gathered, along with feedback from various stakeholders including consumers, carers, mental health staff, GPs, and peer support workers via phone questionnaires and focus groups. Results: In the first 3 months of operation 49 support packages were provided with 300 bed days saved, equating to

Systemic Barriers to Quitting Smoking among Institutionalised Public Mental Health Service Populations: A Comparison of Two Australian Sites

93,150 AUS saved after project set up, delivery and administration costs of approximately

Factors Associated With Success of Smoke-Free Initiatives in Australian Psychiatric Inpatient Units

19,850. Feedback from all stakeholders was overwhelmingly positive. Conclusions: Using peers to provide support to consumers at this stage of their recovery seems highly effective as an adjunct to mainstream mental health services. It has personal benefit to consumers and peers, substantial savings to systems, as well as much potential for encouraging mental health service culture and practice towards a greater recovery focus and improved collaboration with GPs. Declaration of interest: We would like to acknowledge the financial support of Southern Mental Health and Metro Home Link and the South Australian Department of Health/Mental Health Unit for providing operational and setup funds for this service.

Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research

Background: This article reports the findings from a comparative study investigating smoking behaviours among institutionalised psychiatric populations from a sociological perspective. Method: The study involved participant observation of two separate Australian sites between 1999 and 2002, the second site serving to generalise the findings from the first site. Discussion and conclusions: Systemic barriers to quitting were identified, emanating from the mental health system in general. Cigarettes were identified as the currency by which economic, social and political exchange took place between participants who described an enculturation process that involved complex processes of reinforcement to smoke. Once entered into, escape from the smoking culture of the settings appeared to be extremely difficult for clients and staff.

Faculty perceptions of interprofessional education

OBJECTIVE Smoking is the largest cause of preventable illness in the United States, the United Kingdom, Canada, Australia, and many other countries. Smokers with mental illness smoke significantly more than those without mental illness and therefore experience even greater smoke-related harm. Internationally, there is increasing pressure on psychiatric inpatient settings to adopt smoke-free policies. This study examined smoke-free policies across psychiatric inpatient settings in Australia and thereby identified factors that may contribute to the success or failure of smoke-free initiatives in order to better inform best practice in this important area. METHODS Semistructured in-depth telephone interviews were conducted with 60 senior administrators and clinical staff with direct day-to-day experience with smoking activities in 99 adult psychiatric inpatient settings across Australia. Quantitative data were analyzed using descriptive statistical analysis and Pearsons chi square correlations measure of association. RESULTS Factors associated with greater success of smoke-free initiatives were clear, consistent, and visible leadership; cohesive teamwork; extensive training opportunities for clinical staff; fewer staff smokers; adequate planning time; effective use of nicotine replacement therapies; and consistent enforcement of a smoke-free policy. CONCLUSIONS A smoke-free policy is possible within psychiatric inpatient settings, but a number of core interlinking features are important for success and ongoing sustainability.

Implementing smoke-free policies in mental health inpatient units: learning from unsuccessful experience

The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders’ continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.

What skills do primary health care professionals need to provide effective self-management support?: seeking consumer perspectives

Nurses and other health professionals are required to demonstrate broad levels of expertise and service to ensure quality patient-centred health care. Interprofessional practice aligned with interprofessional education (IPE) has been promoted as a vehicle to promote broad levels of expertise. However, challenges remain for universities and other higher education institutions to successfully provide IPE opportunities for students. This paper presents perceptions of academic staff towards IPE from one Australian multi-campus health faculty. Perceptions were collected using interviews and two workshops. Findings are themed under the categories of faculty barriers, industry challenges and future opportunities. The perceptions of one health faculty regarding the fundamental factors required for IPE success were executive leadership of IPE, a supportive funding framework and an IPE based curricula. Nursing education can play a key role in embracing and leading future IPE approaches given that nurses are the numerically dominant health professional group and work collaboratively with other professionals to deliver patient-centred care.

Nicotine withdrawal: pathway to aggression and assault in the locked psychiatric ward?

Objective: The aim of this paper is to describe the introduction, trial and termination of a smoke-free policy in an acute mental health unit of a regional hospital, and to consider factors that may contribute to the success of such policies in other settings. Methods: This analysis is based on key informant interviews and review of correspondence related to the trial, and examination of the relevant incident-reporting database. Results: Planning for implementation is described. The trial itself was terminated after 6 weeks due to perceived increases in aggression by patients towards staff working in the high dependency unit. Staff perceived that these episodes were directly related to these patients not being allowed to smoke. While there was an increase in events during the trial relating to two seriously ill individuals, examination of formal incident reports over a period of 2 years suggests little change in the overall number of incidents. Conclusions: Despite clear public health benefits, implementation of a smoke-free policy may have untoward behavioural effects in institutional mental health settings. In addition, staff expectations and perceptions are critical. Salient factors appear to be preparation of staff and patients, appropriate training, avoidance of exceptions and inconsistency, considering alternatives to smoking to fill the gap created by the policy, and a culture of critical evaluation in practice. Such processes will facilitate understanding and cooperation so that mental health services are able to participate in important policy processes with implications for the health of patients and staff.