Stories of change: the text analysis of handovers in an Italian psychiatric residential care home

Healthcare Professionals' Experiences of Recovery-Oriented Collaboration Between Mental Health Centres and Municipalities: A Qualitative Study

Collaboration within mental health centres and with municipalities in Western European healthcare has presented challenges due to structural and cultural disparities. The Danish healthcare system faces obstacles that impact mental healthcare services, particularly in cross-sectorial cooperation. Our aim was to investigate healthcare professionals' experiences of recovery-oriented collaboration within a mental healthcare setting across hospitals and municipalities to gather a deeper understanding of this issue. Twenty-four employees were purposively sampled from mental health centres in Copenhagen and focus group interviews were conducted to explore their perceptions of working together. Inductive content analysis was used to analyse the data and identify themes and categories. The participants emphasised challenges in communication and coordination to improve collaboration within across the two sectors. This study can contribute to a greater understanding of collaboration between mental health centres and municipalities. It aims to inspire improvements in communication, coordination, and the optimisation of mental health service delivery across sectors.

Recovery-Oriented Intersectoral Care in Mental Health: As Perceived by Healthcare Professionals and Users

This study aimed to explore how mental health professionals and users perceive recovery-oriented intersectoral care when comparing mental health hospitals and community mental healthcare. Methodological design: Five audio-recorded focus group interviews of nurses, other health professionals and users were explored using manifest and latent content analysis. Ethical issues and approval: The study was designed in accordance with the ethical principles of the Helsinki Declaration and Danish law. Each study participant in the two intersectoral sectors gave their informed consent after verbal and written information was provided. Findings: From the health professionals’ perspective, the main theme informed by subthemes and categories was formulated: ‘Recovery-oriented intersectoral care requires more coordination and desire for collaboration’. Two subthemes were subsequently formulated: ‘The users´ perspective of the centre’ and ‘Need for a common agenda and understanding of recovery-oriented intersectoral care’. From the users´ perspective, the main theme was formulated as: ‘Recovery-oriented intersectoral care in tension between medical- and holistically oriented care’. This theme was informed by two subthemes: ‘The users´ perspective is not in focus’ and ‘A trusting relationship and a holistic approach brings coherence’. Conclusions: This study reveals that health professionals want to work in a recovery-oriented manner in intersectoral care, but several challenges appear which make achieving this aim difficult. A common understanding of recovery and how it should be carried out in intersectoral care does not exist. Care decisions are primarily made paternalistically, where the users’ and relatives’ voices are ignored. In an attempt to create coherence across sectors, intersectoral network meetings have been established with health professionals from both sectors. However, the meetings are characterised by a lack of a clear purpose regarding the meeting structure and content, and users are only minimally involved. Our results can contribute to dealing with the challenges of incorporating recovery-oriented intersectoral care as an ideology in all psychiatric and municipal contexts and is, therefore, important for health professionals and users.

Healthcare Professionals' and Users' Experiences of Intersectoral Care between Hospital and Community Mental Healthcare

This paper explores healthcare professionals’ and users’ experience of coherent intersectoral care between hospital mental healthcare and community mental healthcare. A total of 20 healthcare professionals, primarily nurses, and 14 users with a range of mental illnesses participated in nine focus group interviews (FGIs). Participants were encouraged in the FGIs to reflect upon their experience of coherency in intersectoral care. The analysis of FGIs was informed by a phenomenological-hermeneutic approach in a research group from 2016–2019. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to ensure complete and accurate reporting of the study. The analysis led to the generation of several themes from a professional perspective and from a user perspective, addressed barriers to coherent intersectoral care. The healthcare professionals experienced barriers such as a lack of common language and knowledge of partners. The users did not feel involved and lacked coherence in their recovery processes and, as such, intersectoral care was often experienced as being lost in a maze.

Constructing positive narrative identities in a forensic setting: a single case evaluation of phototherapy

PURPOSE

The purpose of this paper is to evaluate the use of a phototherapeutic technique called "Talking Pictures" within the forensic setting. This approach involves the use of a set of photographs to facilitate clients' disclosure, self-growth and promote the development of positive self-narratives. The use of art therapies and the construction of adaptive identity narratives have been proven to support desistance and increase resocialization in the prison population.

DESIGN/METHODOLOGY/APPROACH

A 42-year-old Italian male offender was met for six therapy sessions and invited to talk about his past, present and future through the use of photographs. Session transcripts were analysed using the software for linguistic analysis T-LAB.

FINDINGS

Results show a progression in the language used during the sessions: in the beginning the client uses a denotative language with many concrete nouns and no emotional words, in subsequent sessions his speech begins to assume more symbolic connotations and emotional words are used to describe past traumas as well as to find new meanings to present events. Moreover, the fixity of the client's self-image is contrasted with the emergence of new sides to his personality encompassing agency and self-worth.

RESEARCH LIMITATIONS/IMPLICATIONS

The study is based on a single case, therefore results cannot be generalised to the prison population; moreover, the absence of any follow-up and standardized measurements of the client's progression should be addressed by future research by both involving larger samples and including follow-up and quantitative measures of the study results.

PRACTICAL IMPLICATIONS

The paper provides details on an innovative technique that might be used to explore the offenders' goods and values and to develop truly redemptive rehabilitation programmes.

ORIGINALITY/VALUE

This paper adds to the scant literature on phototherapy in prisons and connects it with a reflection on desistance indicating that phototherapeutic interventions might be used to promote positive self-narratives, thus increasing desistance.

Factors Associated with Long-Stays in an Italian Psychiatric Intensive Treatment Facility: 1-Year Retrospective Observational Analysis

Psychiatric Intensive Treatment Facilities (PITF) are health inpatient settings for patients affected by sub-acute psychiatric disorders with impaired personal and social functioning. The aim of this study is to analyse the demographic and clinical variables related to long-stays in an Italian PITF in order to highlight the risk factors for stay lengthening. We retrospectively collected the selected variables from all patients and their stays in a PITF from 1 to 11-2016 to 31-10-2017. We divided the stays according to the median of duration, ≤29 and > 29 days, to compare selected variables in the two groups of stay length. Patients hospitalized for >29 days more frequently presented "Self-neglect", nursing diagnosis NANDA-I, and needed economic social service support. Multiple linear regression revealed that the presence of some variables as "many medical consultations", "economic social service support", "clinical interviews extended to institutional figures" were statistically significantly associated with an increased stay duration, suggesting that both clinical severity and difficult economic conditions were associated with the lengthening of stay. The knowledge of these factors can contribute to improve psychiatric treatments, reducing potential risk conditions for patient institutional dependence.