Post-discharge needs of Iranian women diagnosed with severe mental illness: A qualitative study

Preventing post-discharge suicides in psychiatric patients: insights from patients, lay healthcare supporters, and mental health professionals-a qualitative analysis

BACKGROUND

Discharged psychiatric patients are at higher risk of suicide due to various risk factors in their lives compared to the general population. However, specific problems and needs of these patients after discharge remain unclear. This research constitutes a segment of a broader implementation study designed to formulate an interventional strategy targeting post-discharge suicide among Chinese psychiatric patients. The present study seeks to qualitatively investigate the problems and needs from the perspectives of patients, their lay healthcare supporters (LHSs), and mental health professionals (MPs), aiming to enhance the efficacy of the interventional strategy.

METHODS

This study is part of a larger implementation study based on Shenzhen Kangning Hospital (SKH) in Shenzhen, Guangdong, China. Under the community-based participatory research framework, we recruited discharged psychiatric patients, their LHSs, and MPs as a collaborative community team, and we conducted individual in-depth interviews for patients and LSHs and focus group interviews with MPs. We utilized a thematic analysis approach to identify sub-themes and themes from interviews through systematically coding and analyzing the data.

RESULTS

A total of 45 participants were recruited for interviews, comprising 17 patients, 8 LHSs, and 20 MPs. We conducted 25 individual in-depth interviews and 3 focus group interviews. Through the interviews, we identified three themes of post-discharge problems: problems related to self, family-related problems, societal and community-related problems. We also identified four themes related to reducing post-discharge suicide: proactive self-management, multifunctional relatives, multifunctional MP group, and a warm society. The tangible support from LHSs and emotional support from MPs are strongly emphasized. Follow-up interventions were identified as the most significant way to addressing these unmet needs. Instrumental support from the community and a caring and non-discriminatory environment for individuals with mental disorders are essential for reducing suicide risk.

CONCLUSIONS

Establishing an integrated mental health care service network that connects psychiatric patients, LHSs, and MPs cross community and societal sectors, with patient-centered follow-up care at its core, is a practical approach to better address patients' needs and reduce post-discharge suicide.

TRIAL REGISTRATION

Registration number: NCT04907669. Date of registration: May 26th,2021.

A systematic review on the use of action research methods in mental health nursing care

AIMS

To identify and synthesize evidence on the use of action research methods in mental health nursing care.

DESIGN

Systematic review.

DATA SOURCES

CINAHL, Web of Science, PubMed and Scopus databases were searched in January 2021.

REVIEW METHODS

Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Two reviewers independently conducted the study selection, and quality appraisal using Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research, data extraction and data analysis procedures.

RESULTS

Sixteen studies, half of which used participatory action research, were included in this review. Nurses, along with other stakeholders, were an active part of the action research process. The main topics of interest addressed were categorized as improving the adoption of a person-centred approach to care and improving decision-making procedures. The use of action research helped the participants to identify the meaning they attached to the topic of interest to be improved. Moreover, this method helped to identify needs and strategies for improving care. The studies concurred that the use of action research enabled participants to gain awareness, improve attitudes and acquire knowledge. In addition, it enabled participants to gain confidence and security in the group context, as key aspects of their empowerment.

CONCLUSION

This review shows the usefulness of action research in any mental health nursing context, contributing to the improvement of care at both the individual and collective levels.

IMPACT

This paper demonstrates the use of the action research method in the field of mental health nursing. Its use has improved the clinical practice of nurses as well as that of teams in both community and hospital settings, addressing issues of the person-centred approach to care and decision-making procedures.

Exploration of the Barriers to Clozapine Prescribing in Patients with Treatment-Resistant Schizophrenia: A Qualitative Study

Treatment-resistance schizophrenia (TRS) is one of the psychiatric challenges. While clozapine is an effective treatment for patients with TRS, there are some barriers to clozapine prescribing in these patients. The study aims to explore the barriers from Iranian psychiatrists' points of view. The study was conducted by a qualitative approach using content analysis. The Participants included 12 psychiatrists who were selected purposefully. Data were collected using a semi-structured interview from May to December 2020. All interviews were recorded and transcribed and analyzed qualitatively using constant comparisons. Three main categories emerged concerning barriers to the use of clozapine: drug-related barriers, psychiatrist and health system-related barriers, and patient and family-related barriers. Additionally, specific subcategories within each main category were documented. The present study showed that there are three main groups of barriers to the use of clozapine in patients with TRS. Psychiatrist and health system-related barriers may influence the other two groups of barriers. Further research to investigate the effective strategies to overcome the barriers is recommended.

Triangulation study of needs assessment of people with severe mental illness in “follow‐up” day hospital settings

AIM

The aim of research was to assess the needs of patients with severe mental illness (SMI) attending follow-up day hospital (DH) programmes from the patients', relatives' and experts' perspective.

DESIGN

This triangulation research relies on three sources of information and two techniques of data collection.

METHODS

Qualitative research was conducted comprising semi-structured interviews (n = 15) and focus groups (n = 4) in three sequential rounds, triangulating patients', relatives' and experts' views. A content analysis was carried out.

RESULTS

Study reveals a diverse spectrum of needs of SMI patients in follow-up DH programmes. The analysis yielded six themes: optimal daily functioning, work and educational activities, social network inclusion, continuous treatment, support and guidance, long-term care. DH programmes should assess the needs of patients with SMI and be adapted according to the findings. In addition to clinical treatment, requirements for continuous treatment, psychological and social needs, therapeutic relationship in less-restrictive settings should be considered.