Consumers/service users: is nursing listening?

A World of Indifference/Un Monde D'Indifférence: Canadian Women's Experiences of Psychiatric Hospitalization/Expériences Canadiennes d'hospitalization psychiatrique au Canada

This article presents findings and analysis stemming from a two-year qualitative study that explored, in their own voices, women's lived experience of psychiatric hospitalization. Feminist Standpoint Theory and Foucauldian analysis frame and provide the moorings for validity, methodology, and analysis of this woman-centred inquiry. The verbatim representation of lived experience, coupled with the coauthoring of this article with two of the study's participants provides an authentic articulation of participant standpoint. Furthermore, this approach creates a space in nursing scholarship in which the co-development of knowledge is also made possible. Overarching themes of docility-making, harm, betrayal, indifference, and resistance are presented and situated in a broader analysis of the hegemony of bio-psychiatric discourse and its colonization of nursing practice. In order to disrupt systems that fail to meet patient needs and fail to represent nursing's values and ethos, we shed light on the possible systemic factors behind the experience of "indifference".

Mental health nurses' views of recovery within an acute setting

How the principles of a recovery-oriented mental health service are incorporated in the day-to-day nursing practice of mental health nurses in inpatient settings is unclear. In this study, we interviewed 21 mental health nurses working in acute inpatient mental health units about a range of recovery-focused topics. Three overlapping themes were identified: (i) the perception of recovery; (ii) congruent humanistic approaches; and (iii) practical realities. Only four interviewees had some formal training about recovery. Most respondents recognize that positive attitudes, person-centred care, hope, education about mental illness, medication and side-effects, and the acknowledgement of individual recovery pathways are necessary to prevent readmission, and are central to a better life for people who live with a mental illness. This research supports the view that ideas and practices associated with the recovery movement have been adopted to some degree by nurses working at the acute end of the services continuum. However, most saw the recovery orientation as rhetoric rather than as an appropriately resourced, coordinated, and integrated program. These nurses, however, speak of much more detailed aspects of working with patients and being required to prepare them for the exigencies of living in the community post-discharge.

Acute inpatient units in a comprehensive (integrated) mental health system: a review of the literature

Acute inpatient mental health units can be seen as one important link in the chain of complementary mental health specific and generic community support services that need to address the real needs of people in the area from which clients are drawn. This article reviews the reasons for admission to these units and research initiatives to evaluate alternative models of care within the community. Assertive community treatment and other alternative programs are discussed within a continuum of community-psychiatric support intervention models. An argument is then developed for mental health systems to be conceived within a continuous care framework for all service users, and with recovery in the forefront of service design and delivery. Further research is required to define nursing clinical priorities and philosophies to ensure a recovery focus in which care is aligned with that of consumer expectations and is consistent with other service providers.

Transition to psychiatric/mental health nursing programs: Expectations and practical considerations

Mental health services have developed transition programs to attract staff, including new graduates, staff with mental health nursing experience without formal qualifications, experienced nurses wishing to move into mental health, and nurses returning to the workforce. Transition to psychiatric/mental health programs are considered to be particularly significant in the mental health field because of the relative under-representation of mental health content in undergraduate curricula. Unfortunately, transition programs have received only minor attention in the literature and there is a paucity of published evaluations to determine their effectiveness. The aim of this paper is to examine transition programs and consider how they meet the expectations of stakeholders, such as consumers of mental health services, and program participants' expectations. It is concluded that published systematic evaluations are lacking, particularly those considered from the perspective of stakeholders. Consideration of these expectations should be reflected in the design and delivery of mental health nursing transition programs.

Doing my best: poverty and self-care among individuals with schizophrenia and diabetes mellitus

Diabetes mellitus (DM) is more common among individuals with schizophrenia/schizoaffective disorders than among the general population. Eleven mental health consumers diagnosed with comorbid schizophrenia/schizoaffective disorder and DM participated in a grounded theory study that examined their approaches to diabetic self-care. The resulting model, Evolving Self-Care, describes the process by which respondents developed health beliefs about the self-care of dual illnesses. One subcategory of the model, Doing My Best, was further analyzed to examine the social context of respondents' diabetic self-care. Limited financial resources and material deprivation interfered with access to the resources necessary for adequate diabetic self-care. Mental health providers are encouraged to provide treatment and patient education that are consistent with the real world living situations of individuals with schizophrenia. Policymakers at the federal and state levels need to address the impact of financing of mental health services on the overall health of vulnerable individuals with serious mental illnesses.

Splitting the difference: the heroes and villains of mental health policy and nursing practice

Drawing on psychodynamic and managerialist concepts, this paper explores possible consequences for patients and mental health nurses of the policy driven "splitting" of mental health service provision in the UK. Services and resources are now split for those with a severe and enduring mental illness and those with a common mental problem. We argue the damaging divisiveness in creating these two "political" groups makes determining how to meet the needs of individuals with common yet complex problems more difficult. The way in which an increased awareness and understanding of psychodynamic concepts can help the mental health nurse deal with such complexity is explored.

Helping Parents with Mental Illnesses and their Children: A Call for Family-Focused Mental Health Care

1. Large numbers of individuals with mental illnesses are parents to minor children. 2. Recommendations to improve services suggest that services provided by the adult mental health system and child service agencies be coordinated. 3. Nursing care intersects both the adult and child systems, and nurses have the expertise to offer a variety of services. 4. There is an urgent need to improve family-focused mental health nursing care to benefit parents with mental illnesses, their children and families, and the overall community and society.