Characterizing the inpatient care of young adults experiencing early psychosis: A medical record review

Evaluating outcomes following adolescent and youth mental health inpatient admissions: A systematic review

AIM

Increasing rates of mental illness among young people, exacerbated by the negative impacts of COVID-19, has resulted in growing pressure on available psychiatric resources to meet increasing demand. Inpatient units provide specialist care for young people with the most severe and complex mental disorders but are one of the most expensive models of psychiatric care. The aim of this review is to provide an update on the effectiveness of adolescent and youth mental health inpatient units in improving outcomes to inform the most efficacious use of psychiatric resources.

METHODS

Systematic searches of PubMed, The Cochrane Library, PsycINFO, EMBASE, and Web of Science were conducted for studies published in English between January 2011 to May 2022. Criteria for selection included participants aged 12-25 years who had been admitted to amental health inpatient unit. Studies were excluded if set in substance abuse or disability specific units, outpatient or forensic settings, or assessed novel interventions.

RESULTS

23 studies were identified as meeting inclusion criteria, with most (n = 19) utilizing a pre-post observational design and reporting improvement across various domains following inpatient treatment. A total of 24 different outcome measures or methods were used meaning a meta-analysis of results was not possible. There was also a lack of consistency across models of care, lengths of stay, admission policies, and interventions provided.

CONCLUSION

Inpatient units provide positive outcomes for consumers however a clear understanding of clinical significance and comparison to other treatment settings is lacking.

Nurses' experiences when conducting the mental state examination (MSE): A scoping review

The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in-patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in-patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in-patient mental health nurses. This review identified the need for evidence-based research related to the MSE and its application in nursing practice. Evidence-based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer-nurse therapeutic alliance in acute in-patient mental health settings.

Prevalence and predictors of restrictive interventions in a youth-specific mental health inpatient unit

INTRODUCTION

The use of restrictive interventions is one of the most controversial practices in medicine. They are utilized in an inpatient setting to manage agitated or aggressive behaviour or to ensure that an individual receives the necessary treatments. However, restrictive interventions remove autonomy and adverse events can be associated with their practice. Youth-specific inpatient units (IPUs) are now being established and it is imperative that the use of restrictive interventions is reduced. In order to inform and facilitate prevention and reduction strategies, this study aimed to determine the prevalence and determinants of restrictive interventions (restraint, seclusion and medication without consent) in a youth specialist mental health IPU.

METHODS

This study was set at a 16-bed youth specialist acute IPU of Orygen Youth Health, a specialist youth mental health service that provides inpatient care for those aged 18 to 25 years within a catchment area of west and north-western regions of Melbourne, Australia. A retrospective file audit was conducted of all the admissions to the unit from 01 January 2015 to 30 June 2015.

RESULTS

Over the 6-month study period, 159 young people were admitted and this accounted for 188 admissions. Over half (54.3%) of admissions were involuntary and restrictive intervention were used in 17.6% of admissions. Specifically, 15.7% (N = 25) of young people experienced restraint, 10.1% (N = 16) were secluded, and 8.1% (N = 12) experienced medication without consent. Absent insight and involuntary status on admission were associated with restrictive interventions.

CONCLUSION

As youth mental health services develop, interventions aimed at reducing restrictive interventions are needed.

The experiences of inpatient nursing staff caring for young people with early psychosis

BACKGROUND

Early intervention services aim to improve outcomes for people with first episode psychosis and, where possible, to prevent psychiatric hospital admission. When hospitalisation does occur, inpatient staff are required to support patients and families who may be less familiar with services, uncertain about possible outcomes, and may be experiencing a psychiatric hospital for the first time.

AIMS

Our study aimed to understand the process of hospitalisation in early psychosis, from the perspective of inpatient nursing staff. We were particularly interested in their experiences of working with younger people in the context of adult psychiatric wards.

METHODS

Nine inpatient nursing staff took part in semi-structured interviews, which were transcribed and then analysed using interpretative phenomenological analysis.

RESULTS

Five themes are outlined: 'it's all new and it's all learning'; the threatening, unpredictable environment; care and conflict within the intergenerational relationship; motivation and hope; and coping and self-preservation.

CONCLUSIONS

The phenomenological focus of our approach throws the relational component of psychiatric nursing into sharp relief. We reflect on the implications for organisations, staff, families and young people. We suggest that the conventional mode of delivering acute psychiatric inpatient care is not likely to support the best relational and therapeutic outcomes.