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Rammou A, Berry C, Fowler D, Hayward M. "Attitudes to voices": a survey exploring the factors influencing clinicians' intention to assess distressing voices and attitudes towards working with young people who hear voices. Front Psychol 2023; 14:1167869. [PMID: 37287782 PMCID: PMC10242135 DOI: 10.3389/fpsyg.2023.1167869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/28/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Due to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians' job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth. Method Nine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention. Results Compared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician's intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention. Discussion Clinicians' intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.
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Affiliation(s)
- Aikaterini Rammou
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| | - Clio Berry
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Hove, United Kingdom
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MacLeod MLP, Penz KL, Banner D, Jahner S, Koren I, Thomlinson A, Moffitt P, Labrecque ME. Mental health nursing practice in rural and remote Canada: Insights from a national survey. Int J Ment Health Nurs 2022; 31:128-141. [PMID: 34668279 PMCID: PMC9298219 DOI: 10.1111/inm.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
Access to and delivery of quality mental health services remains challenging in rural and remote Canada. To improve access, services, and support providers, improved understanding is needed about nurses who identify mental health as an area of practice. The aim of this study is to explore the characteristics and context of practice of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs) in rural and remote Canada, who provide care to those experiencing mental health concerns. Data were from a pan-Canadian cross-sectional survey of 3822 regulated nurses in rural and remote areas. Individual and work community characteristics, practice responsibilities, and workplace factors were analysed, along with responses to open-ended questions. Few nurses identified mental health as their sole area of practice, with the majority of those being RPNs employed in mental health or crisis centres, and general or psychiatric hospitals. Nurses who indicated that mental health was only one area of their practice were predominantly employed as generalists, often working in both hospital and primary care settings. Both groups experienced moderate levels of job resources and demands. Over half of the nurses, particularly LPNs, had recently experienced and/or witnessed violence. Persons with mental health concerns in rural and remote Canada often receive care from those for whom mental health nursing is only part of their everyday practice. Practice and education supports tailored for generalist nurses are, therefore, essential, especially to support nurses in smaller communities, those at risk of violence, and those distant from advanced referral centres.
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Affiliation(s)
- Martha L P MacLeod
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Kelly L Penz
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Sharleen Jahner
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Irene Koren
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
| | - Alexandra Thomlinson
- Health Research Institute, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Pertice Moffitt
- Aurora Research Institute, Yellowknife, Northwest Territories, Canada
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Molloy R, Brand G, Munro I, Pope N. Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing. J Clin Nurs 2021; 32:1662-1673. [PMID: 34873769 DOI: 10.1111/jocn.16151] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 12/16/2022]
Abstract
AIM To systematically identify, explore and synthesise qualitative data related to mental health consumer and health professional experiences of diagnostic overshadowing. BACKGROUND Mental health consumers experience significantly high rates of physical illness, poorer health outcomes and are more likely to die prematurely of physical illnesses than the general population. Diagnostic overshadowing is a complex and life-threatening phenomenon that occurs when physical symptoms reported by mental health consumers are misattributed to mental disorders by health professionals. This typically occurs in general healthcare settings. METHODS Drawing on JBI methodology for systematic reviews, four scholarly databases and grey literature was searched, followed by eligibility screening and quality assessment using JBI QARI frameworks, resulting in six studies for inclusion. Findings were synthesised using meta-aggregation. The PRISMA checklist was adhered to throughout this process. FINDINGS Five synthesised findings emerged. Three from the health professional experience: working in ill-suited healthcare systems, missing the complete diagnostic picture, and misunderstanding the lived experience of mental illness. Two from the mental health consumer experience: not knowing if the cause is physical or mental, and surviving and ill-suited health care system. CONCLUSIONS Diagnostic overshadowing is a multidimensional experience of interconnecting factors including systematic healthcare system issues, health professionals limited mental health knowledge and skills, stigmatic attitudes and mental health consumers miscommunicating their physical healthcare needs. Further research is needed to make diagnostic overshadowing visible and mitigate against this phenomenon that deprives mental health consumers of equitable access to quality healthcare. RELEVANCE TO CLINICAL PRACTICE Those who govern healthcare systems have an obligation to recognise and address the unique needs of mental health consumers who seek help for physical illnesses to ensure they receive quality and safe care. Forming collaborative partnerships with mental health consumers in the development of knowledge translation initiatives targeting healthcare policy, practice and education are urgently required.
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Affiliation(s)
- Renee Molloy
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Gabrielle Brand
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Ian Munro
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Nicole Pope
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.,The Western Australian Group for Evidence Informed Healthcare Practice: A JBI Centre of Excellence, Perth, Western Australia, Australia
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O'Brien AJ, Abraham RM. Evaluation of metabolic monitoring practices for mental health consumers in the Southern District Health Board Region of New Zealand. J Psychiatr Ment Health Nurs 2021; 28:1005-1017. [PMID: 33382181 DOI: 10.1111/jpm.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/22/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THIS SUBJECT?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally. Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes. No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care. Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring. Guidelines may have a role to play in improved monitoring but need service-level support in order to be effective. ABSTRACT: Introduction People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness.
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Fitzpatrick SJ, Handley T, Powell N, Read D, Inder KJ, Perkins D, Brew BK. Suicide in rural Australia: A retrospective study of mental health problems, health-seeking and service utilisation. PLoS One 2021; 16:e0245271. [PMID: 34288909 PMCID: PMC8294514 DOI: 10.1371/journal.pone.0245271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Suicide rates are higher in rural Australia than in major cities, although the factors contributing to this are not well understood. This study highlights trends in suicide and examines the prevalence of mental health problems and service utilisation of non-Indigenous Australians by geographic remoteness in rural Australia. Methods A retrospective study of National Coronial Information System data of intentional self-harm deaths in rural New South Wales, Queensland, South Australia and Tasmania for 2010–2015 from the National Coronial Information System. Results There were 3163 closed cases of intentional self-harm deaths by non-Indigenous Australians for the period 2010–2015. The suicide rate of 12.7 deaths per 100,000 persons was 11% higher than the national Australian rate and increased with remoteness. Among people who died by suicide, up to 56% had a diagnosed mental illness, and a further 24% had undiagnosed symptoms. Reported diagnoses of mental illness decreased with remoteness, as did treatment for mental illness, particularly in men. The most reported diagnoses were mood disorders (70%), psychotic disorders (9%) and anxiety disorders (8%). In the six weeks before suicide, 22% of cases had visited any type of health service at least once, and 6% had visited two or more services. Medication alone accounted for 76% of all cases treated. Conclusions Higher suicide rates in rural areas, which increase with remoteness, may be attributable to decreasing diagnosis and treatment of mental disorders, particularly in men. Less availability of mental health specialists coupled with socio-demographic factors within more remote areas may contribute to lower mental health diagnoses and treatment. Despite an emphasis on improving health-seeking and service accessibility in rural Australia, research is needed to determine factors related to the under-utilisation of services and treatment by specific groups vulnerable to death by suicide.
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Affiliation(s)
- Scott J. Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
- * E-mail:
| | - Tonelle Handley
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Nic Powell
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women and Children’s Health, University of New South Wales, Sydney, Australia
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Fitzpatrick SJ, Read D, Brew BK, Perkins D. A sociological autopsy lens on older adult suicide in rural Australia: Addressing health, psychosocial factors and care practices at the intersection of policies and institutions. Soc Sci Med 2021; 284:114196. [PMID: 34271402 DOI: 10.1016/j.socscimed.2021.114196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally-normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options.
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Affiliation(s)
- Scott J Fitzpatrick
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia.
| | - Donna Read
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
| | - Bronwyn K Brew
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women and Children's Health, University of New South Wales, Sydney, Australia
| | - David Perkins
- Centre for Rural and Remote Mental Health, University of Newcastle, Orange, Australia
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Voorhees HL, Mackert M. Helping Future Providers Talk About Mental Health. CLINICAL TEACHER 2020; 18:247-251. [PMID: 33073912 DOI: 10.1111/tct.13294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Michael Mackert
- The Center for Health Communication, The University of Texas at Austin, Austin, USA
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Romain AJ, Trottier A, Karelis AD, Abdel-Baki A. Do Mental Health Professionals Promote a Healthy Lifestyle among Individuals Experiencing Serious Mental Illness? Issues Ment Health Nurs 2020; 41:531-539. [PMID: 32286095 DOI: 10.1080/01612840.2019.1688436] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: While a healthy lifestyle would be an asset to people experiencing psychotic disorders, not all mental health professionals provide counselling regarding healthy behaviours, such as physical activity, healthy nutrition, and tobacco cessation. Therefore, the objective of the present study was to investigate the factors associated with health promotion practice (HPP) among mental health professionals.Methods: Cross-sectional survey including mental health professionals across the Province of Quebec (Canada). The promotion of health behaviour and the "Exercise in Mental Illness Questionnaire - Health Practitioner Version" and its adaptation for nutrition improvement and tobacco cessation were used to evaluate knowledge, beliefs, promotion behaviours, and barriers to HPP.Results: One hundred mental health professionals, most being nurses (29%) and medical doctors/psychiatrists (20%) were recruited throughout the province of Quebec (Canada). The rate of formal training among professionals was 11% for physical activity, 26% for nutrition, and 21% for tobacco cessation. Approximately 60% were promoting physical activity, 49% good nutrition, and 41% tobacco cessation. Professionals promoting healthy behaviours had a higher level of self-efficacy in HPP, were more likely to value physical health, and less likely to endorse barriers to HPP.Conclusion: Rates of formal training in lifestyle habits and health promotion (aiming at improving a healthy lifestyle in patients experiencing psychotic disorders) among mental health professionals are currently low in the Province of Quebec and need to be improved. In addition, the level of confidence and barriers that endorse healthy behaviours appear to be key factors in HPP among mental health professionals.
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Affiliation(s)
- Ahmed Jerome Romain
- Department of Psychiatry, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Alexia Trottier
- Department of Psychiatry, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Antony D Karelis
- Department of Physical Activity Sciences, University of Quebec at Montreal, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.,Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada.,Department of Psychiatry, University Hospital of Montreal (CHUM) - Notre-Dame Hospital, Montreal, Quebec, Canada
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Avery J, Schreier A, Swanson M. A complex population: Nurse's professional preparedness to care for medical-surgical patients with mental illness. Appl Nurs Res 2020; 52:151232. [PMID: 31937475 DOI: 10.1016/j.apnr.2020.151232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
Globally, patients with the co-morbidity of physical and mental illness experience greater health complexities than the general population. Yet nurses caring for medical-surgical patients with a secondary diagnosis of mental illness are often unprepared for these complexities. This paper focuses on professional experiences from a more extensive parent study that evaluated components of nursing preparedness (nursing care self-efficacy and mental health care competency) to provide care for medical-surgical patients who also have mental illness. The parent study explored characteristics of variables (personal, educational and professional) more frequently associated with and more predictive of nursing preparedness. Discussed will be the findings from characteristics of professional experiences that best indicated nurse preparedness to care for medical-surgical patients with mental illness. A descriptive correlational design was used with a convenience sample of RNs (N = 260) from a tertiary health system in the south-eastern United States. Findings significantly indicated three characteristics of professional experiences - mentoring, frequency of care and continuing education - best prepare a registered nurse to care for this complex population. Further research is necessary to locate, grow and develop mentors and to construct accessible, affordable continuing education regarding care of this population for a prepared nursing workforce and work environment.
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Affiliation(s)
- Jeanette Avery
- East Carolina University College of Nursing, Greenville, NC 27858, USA.
| | - Ann Schreier
- East Carolina University College of Nursing, Greenville, NC 27858, USA
| | - Melvin Swanson
- East Carolina University College of Nursing, Greenville, NC 27858, USA
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Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Hals E, Granerud A, Doody R, Chan SWC, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Browne G, Griffin M, Russell S, MacGabhann L, Bjornsson E, Biering P. “But I’m not going to be a mental health nurse”: nursing students’ perceptions of the influence of experts by experience on their attitudes to mental health nursing. J Ment Health 2019; 30:556-563. [DOI: 10.1080/09638237.2019.1677872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Brenda Happell
- Professor of Nursing and Equally Well Ambassador, School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, Australia
| | - Shifra Waks
- Consumer Academic, the University of Melbourne, Parkville, Ireland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, the Australian National University, Woden, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, Expert by Experience Lecturer, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, the Australian National University, Woden, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- Area Lead for Mental Health Engagement, Southern Area Health Service Executive, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | | | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland
- Department of Nursing Science, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Graeme Browne
- Masters Mental Health Nursing, School of Nursing & Midwifery, Coordinator Port Macquarie Campus
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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