Safety, risk, and aggression: Health professionals' experiences of caring for people affected by methamphetamine when presenting for emergency care

Experiences of violence among people with stimulant use disorder in psychiatric inpatient settings: A qualitative study

OBJECTIVE

To describe the perspectives of those with lived experience of stimulant use disorder on methamphetamine-related violence in psychiatric inpatient settings.

METHOD

Eight adult psychiatric inpatients with stimulant use disorder were recruited. Semi-structured interviews were recorded, transcribed and analysed using thematic analysis.

RESULTS

Participants reported that traumatic experiences predisposed those using methamphetamine to violent behaviour. Participants were fearful of psychiatric hospitalisation because of loss of autonomy and stigma. Methamphetamine use was associated with mercurial intense emotions. Participants believed these factors led to violence during psychiatric admissions.

CONCLUSIONS

People with stimulant use disorder have a sophisticated understanding of the complex causal pathways from methamphetamine use to violent behaviour. Their lived experience can make an important contribution to service development.

Methamphetamine dependence in Australia-why is 'ice' (crystal meth) so addictive?

Australia has one of the highest rates in the world of the use of the crystalline form of methamphetamine, a highly addictive stimulant that is often associated with a chronic, relapsing dependency. Methamphetamine use is associated with both acquisitive and violent offending, which cause substantial personal and societal costs. Whilst the short-term euphoria and stimulation provide a positive reinforcement to methamphetamine use, the aversive states of withdrawing from methamphetamine and the associated craving, which may last up to five weeks into abstinence, underlie the negative reinforcement to continued methamphetamine use. Although many methamphetamine-dependent users experience high levels of psychological distress, it is likely that less than half engage with treatment or support services, and current intervention and treatment programmes have high discontinuation rates. Stigma and discrimination, even from paramedics and health clinicians, are prominent barriers to methamphetamine-dependent users accessing treatment in Australia.

'An accident waiting to happen' - experiences of police officers, paramedics, and mental health clinicians involved in 911-mental health crises: a cross-sectional survey

WHAT IS KNOWN ON THE SUBJECT

Police and ambulance staff are increasingly asked to help people experiencing mental health crises, but they often feel under-prepared. The single frontline service approach is time-intensive and risks a coercive pathway to care. The emergency department is the default location for transfers by police or ambulance involving a person involved in a mental health crisis, despite being viewed as suboptimal.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Police and ambulance staff struggled keeping up with the mental health demand, reporting inadequate mental health training, little enjoyment and negative experiences when trying to access help from other services. Most mental health staff had adequate mental health training and enjoyed their work, but many experienced difficulties getting help from other services. Police and ambulance staff found it hard to work with mental health services.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

The combination of limited training, poor interagency referral processes, and difficulties accessing support from mental health services means that when police and ambulance services attend mental health crises alone, distress may be heightened and prolonged. Enhanced mental health training for first responders and more streamlined referral processes may improve process and outcomes. Mental health nurses have key skills that could be utilized in assisting police and ambulance staff who attend 911 emergency mental health calls. New models such as co-response teams, whereby police, mental health clinicians and ambulance staff respond conjointly should be trialled and evaluated.

ABSTRACT

INTRODUCTION: First responders are increasingly called to assist people experiencing mental health crises but little research exists canvassing multi-agency perspectives of such work.

AIM/QUESTION

To understand the views of police officers, ambulance and mental health staff attending mental health or suicide-related crises in Aotearoa New Zealand and to discover how they experience current models of cross-agency collaboration.

METHODS

A descriptive cross-sectional survey involving mixed methods. Quantitative data were analysed using descriptive statistics and free text by content analysis.

RESULTS

Participants included 57 police officers, 29 paramedics and 33 mental health professionals. Mental health staff felt adequately trained, but only 36% described good processes for accessing inter-agency support. Police and ambulance staff felt undertrained and unprepared. Accessing mental health expertise was considered difficult by 89% of police and 62% of ambulance staff.

DISCUSSION

Frontline services struggle managing mental health-related 911 emergencies. Current models are not working well. Miscommunication, dissatisfaction and distrust exist between police, ambulance and mental health services.

CONCLUSION

The single-agency frontline response may be detrimental to service users in crisis and under-utilizes the skills of mental health staff. New ways of inter-agency cooperation are required, such as co-located police, ambulance and mental health nurses responding in partnership.

Identifying barriers and facilitators for implementing harm reduction strategies for methamphetamine use into hospital settings

INTRODUCTION

Harm reduction strategies for substance use disorder are not currently offered in Canadian hospitals. Previous research has suggested that substance use may continue to occur which can lead to further complications such as new infections. Harm reduction strategies may be a solution to this issue. This secondary analysis aims to explore the current barriers and potential facilitators for implementing harm reduction into the hospital from the perspective of health care and service providers.

METHOD

Primary data was collected from 31 health care and service providers who participated in a series of virtual focus groups and one-to-one interviews regarding their perspectives on harm reduction. All staff were recruited from hospitals in Southwestern Ontario, Canada from February 2021 to December 2021. Health care and service professionals completed a one-time individual interview or a virtual focus group using an open-ended qualitative interview survey. Qualitative data was transcribed verbatim and analyzed using an ethnographic thematic approach. Themes and subthemes were identified and coded based on responses.

FINDINGS

Attitude and Knowledge, Pragmatics, and Safety/Reduction of Harm were identified as the core themes. Attitudinal barriers such as stigma and lack of acceptance were reported but education, openness and community support were regarded as potential facilitators. Cost, space, time and availability of substances on site were regarded as Pragmatic barriers but potential facilitators such as organizational support, flexible harm reduction services and a specialized team were identified. Policy and liability were perceived as both a barrier and a potential facilitator. Safety and impact of substances on treatment were considered as both a barrier and a potential facilitator but sharps boxes and continuity of care were regarded as potential facilitators.

DISCUSSION

Although barriers in implementing harm reduction in hospital settings exist, there are opportunities to facilitate change. As identified in this study, feasible and achievable solutions are available. Education on harm reduction for staff was considered to be a key clinical implication in facilitating harm reduction implementation.

Social issues, crisis, and care coordination: First responders experience responding to people affected by methamphetamines

Methamphetamines remain a public health problem due to the extensive burden of illicit drug use on society. Callout events in the pre-hospital environment related to methamphetamine use is increasing. In addition, there has been an increase in reported mental health side effects and breakdown in relationships and social networks. Descriptive phenomenology research design was undertaken and data analysed using thematic analysis. Semi-structured interviews were utilized to collect data exploring the experience of first responders attending callouts to people affected by methamphetamines in the pre-hospital environment. Interviews included paramedics (8) and police officers (10) from across Australia. Overall, participants reported responding to people affected by methamphetamines was complex in nature. Complexity was affected by extensive social circumstances, people presenting in states of crisis, lack of coordinated approach, and unsuitable care environments. The social impact of methamphetamine addiction is extensive. Staff working as first responders have an opportunity to help reduce the social impact and crises, referring people to follow-up care and drug and alcohol support services. Further research is needed to determine if a standardized approach, between first responders and EDs, should be developed to help streamlines services and improve how the individual services respond as a group to people affected by substances.

Addressing Methamphetamine Use in Primary Care: Provider Perspectives

INTRODUCTION

The opioid epidemic has evolved into a combined stimulant epidemic, with escalating stimulant and fentanyl-related overdose deaths. Primary care providers are on the frontlines grappling with patients' methamphetamine use. Although effective models exist for treating opioid use disorder in primary care, little is known about current clinical practices for methamphetamine use.

METHODS

Six semistructured group interviews were conducted with 38 primary care providers. Interviews focused on provider perceptions of patients with methamphetamine use problems and their care. Data were analyzed using inductive and thematic analysis and summarized along the following dimensions: (1) problem identification, (2) clinical management, (3) barriers and facilitators to care, and (4) perceived needs to improve services.

RESULTS

Primary care providers varied in their approach to identifying and treating patient methamphetamine use. Unlike opioid use disorders, providers reported lacking standardized screening measures and evidence-based treatments, particularly medications, to address methamphetamine use. They seek more standardized screening tools, Food and Drug Administration-approved medications, reliable connections to addiction medicine specialists, and more training. Interest in novel behavioral health interventions suitable for primary care settings was also noteworthy.

CONCLUSIONS

The findings from this qualitative analysis revealed that primary care providers are using a wide range of tools to screen and treat methamphetamine use, but with little perceived effectiveness. Primary care faces multiple challenges in effectively addressing methamphetamine use among patients singularly or comorbid with opioid use disorders, including the lack of Food and Drug Administration-approved medications, limited patient retention, referral opportunities, funding, and training for methamphetamine use. Focusing on patients' medical issues using a harm reduction, motivational interviewing approach, and linkage with addiction medicine specialists may be the most reasonable options to support primary care in compassionately and effectively managing patients who use methamphetamines.

Complexity, safety and challenges: Emergency responders’ experience of people affected by methamphetamines

Providing care to methamphetamine‐related callout events in the prehospital environment is often complex and resource‐intensive, requiring staff to manage agitation and violence‐related side effects of methamphetamines. In Australia, emergency responders are increasingly required to attend events related to methamphetamines, even though reports suggest methamphetamine use across Australia has declined. The aim of the study was to explore Australian police and paramedic experiences attending methamphetamine‐related events. A qualitative descriptive phenomenology design was employed using semi‐structured interviews with employed police (10) and paramedics (8) from Australia. Data were analyzed using thematic analysis. Participants described the complexities associated with providing prehospital care to people affected by methamphetamines. Participants described associated domestic/family violence, increased levels of violence, challenges with communication, and responder emotional and psychological distress and physical injury. Violence associated with methamphetamine use is a critical factor in prehospital care. Workplace violence and family/domestic violence are important issues that require further research to ensure families and staff are well supported and have the services they need to continue responding to people affected by methamphetamine use.

Multi-site study exploring the experiences of security staff responding to mental health, drug health and behavioural challenges in the emergency department

OBJECTIVE

This multi-site study aimed to give voice to the views and experiences of security staff in assisting with the response to the growing number of people with mental health, drug health and behavioural problems attending EDs.

METHODS

Explorative qualitative research design, using semi-structured interviews were conducted with security staff (n = 26) working in three different emergency settings across New South Wales, Australia. The data were analysed thematically.

RESULTS

Participants recognised that long waiting times in the ED 'guarding' patients frequently accounted for escalating behaviour and increased the likelihood of restrictive interventions. Security staff expressed concerns about safety and were uncomfortable with a sense of uncertainty regarding their legal position. They voiced frustration over limited communication and lack of information provided by clinical staff on patient background, and the coordination of incidents and ongoing patient care. There was a perception that security staff are not treated with respect and their input was not valued.

CONCLUSION

Expecting non-clinicians to undertake a clinical role (often under stressful circumstances involving close patient contact) places security staff and patients in a precarious position. Greater clarity regarding the role of security staff and information that allows them to adequately and safely undertake their work is required. If security staff are expected to participate in patient care then access to relevant information and the ability to document their activities and patient interactions should be provided. The vital support role that security staff perform needs to be valued and respected.

Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study

Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants' experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed.

Gaps in the ice: Methamphetamine in Australia; its history, treatment, and ramifications for users and their families

It is now well-established that Australia has a significant issue with methamphetamine. Recent dramatic changes in manufacturing have led to significant shifts in both the patterns of use and the relative purity of this illicit drug, with the crystalline form of methamphetamine commonly referred to as 'ice'. Excessive use not only impacts on those taking the drug, but also takes a heavy toll on their families. With few effective treatment options currently available, there is a strong focus on developing replacement pharmacotherapies and examining the efficacy of outpatient counselling and residential treatment options. Recent research in addiction care supports the positive impact that families of users can have on both treatment and recovery for their loved ones. Despite this recognition, there is little current research looking at the experiences of families of users of the uniquely problematic drug methamphetamine. This paper outlines the historical narrative that has led to the current worldwide phenomenon of ice use and explores contemporary directions of research into its impact and potential treatments. In doing so, it outlines the relatively unexplored impact of ice on families and highlights a current need for nursing research into their experiences living with loved ones using the drug.

Sensory strategies in adult mental health: A qualitative exploration of staff perspectives following the introduction of a sensory room on a male adult acute ward

In recent years, there has been growing interest in the use of sensory techniques to help with emotional regulation in adult mental health populations. This is against a backdrop of international policies aimed at reducing restrictive interventions and improving the effectiveness of de-escalation techniques. A sensory room was designed and implemented on a male adult acute psychiatric ward. Staff perspectives were sought to evaluate the effectiveness of the room in managing emotional distress by exploring staff awareness of a broader range of de-escalation strategies and by exploring what effect the room had on staff behaviours with respect to sensory interventions. A series of semi-structured interviews were carried out, analysed, and grouped into themes. Three themes emerged as follows: enhancing de-escalation, sensory interventions, and impact on staff. Findings showed that increased awareness of sensory processing and use of sensory strategies such as the sensory room were perceived by staff to have a positive impact on reducing distress with male service users. Staff use of the room was also discovered to have benefits that included staff attending to their own emotional needs and the use of the room supporting reflective learning during critical incident debriefing.