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Carney R, El-Metaal H, Law H, Savage S, Small I, Hann M, Shields G, Shiers D, Carmichael-Murphy P, Jones R, Kimber E, McDonald A, Parker S. Motiv8: a study protocol for a cluster-randomised feasibility trial of a weight management intervention for adults with severe mental illness in secure forensic services. Pilot Feasibility Stud 2024; 10:48. [PMID: 38429815 PMCID: PMC10908020 DOI: 10.1186/s40814-024-01458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION People with severe mental illness have physical comorbidities which result in significant reductions in quality of life and premature mortality. Effective interventions are required that are suitable for people in secure forensic mental health services. We conducted pilot work of a multidisciplinary weight management intervention (Motiv8) which showed improvements in physical and mental health and high levels of satisfaction. We aim to test the feasibility of Motiv8 under cluster randomised conditions, with an aim to investigate the acceptability, feasibility and potential effectiveness of this intervention to supplement standard secure care. METHODS AND ANALYSIS A randomised waitlist-controlled feasibility trial of a lifestyle intervention (Motiv8) + TAU compared with TAU (+ Motiv8 waitlist) for adults on secure mental health units will be conducted. Thirty-two people (4 cohorts) will be recruited from secure services in Greater Manchester Mental Health NHS Foundation Trust. Participants will be randomly allocated to Motiv8 or TAU + Motiv8 waitlist. All participants will receive Motiv8 during the trial. Assessor-blinded physical/mental health and lifestyle assessments will be conducted at baseline, 10 weeks (post-intervention/waitlist), and after 12 weeks (post-waitlist intervention/follow-up). Motiv8 is a multidisciplinary intervention including exercise sessions, cooking/nutrition classes, physical health education, psychology sessions, sleep hygiene, peer support and medication review by pharmacy. A nested qualitative study will be conducted with a subsample of participants (n = 10) to explore their experiences of taking part. The analysis will focus on feasibility outcomes and tabulated success indicators of the study (e.g. Recruitment rates, retention rates, follow-up retention and response rates, attendance at sessions, the experience of involvement in the trial and delivery of the intervention, assessment of safety, development of a manualised intervention). Thematic analysis will be conducted through qualitative interviews. The analysis will aim to inform the development of a definitive trial. ETHICS AND DISSEMINATION The trial has been granted ethical approval from the NHS Health Research Authority and adopted onto the UK Clinical Research Network Portfolio. Findings will be disseminated via peer-reviewed publications, professional and public networks, conferences and clinical services. TRIAL REGISTRATION ISRCTN13539285.
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Affiliation(s)
- Rebekah Carney
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
| | - Hany El-Metaal
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Law
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Siobhan Savage
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ingrid Small
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mark Hann
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, Health Services Research, and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
- School of Medicine, University of Keele, Staffordshire, UK
| | - Parise Carmichael-Murphy
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard Jones
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Elizabeth Kimber
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andrew McDonald
- Lancashire and South Cumbria, NHS Foundation Trust, Preston, UK
- School of Nursing and Midwifery, University of Bolton, Bolton, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, UK
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Mateo-Urdiales A, Michael M, Simpson C, Beenstock J. Evaluation of a participatory approach to improve healthy eating and physical activity in a secure mental health setting. JOURNAL OF PUBLIC MENTAL HEALTH 2020. [DOI: 10.1108/jpmh-11-2019-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose
The prevalence of obesity in secure mental health units is higher than in the general population, having a negative impact on the physical health and mental well-being of people with severe mental health illness (SMI). The purpose of this study was to describe the feasibility of a programme aimed to help people with SMI to eat healthily and be physically active.
Design/methodology/approach
A mixed-methods approach was used. A questionnaire administered to patients in both wards measured acceptability, demand, implementation and practicality of the project. Individual semi-structured interviews and focus groups were used to explore staff and patients’ perceptions of the project; as well as the barriers and enablers towards an effective implementation and participation in the project’s activities.
Findings
Patients were, overall, satisfied with the activities implemented. Successful activities were easy to implement, had staff actively engaged and did not require logistic or administrative planning beforehand. Barriers included unawareness around funding mechanisms of activities, staff capacity issues or lack of patients’ permission to leave the ward.
Originality/value
Few studies have assessed the feasibility of real-life interventions aimed to improve healthy eating and physical activity in secure mental health units. The results of this study can inform commissioners and providers of mental health services to design and implement new interventions and programmes.
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Holmes D, Perron A, Jacob JD, Paradis-Gagné É, Gratton SM. Pratique en milieu de psychiatrie légale : proposition d’un modèle interdisciplinaire. Rech Soins Infirm 2018:33-43. [DOI: 10.3917/rsi.134.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Johnson M, Day M, Moholkar R, Gilluley P, Goyder E. Tackling obesity in mental health secure units: a mixed method synthesis of available evidence. BJPsych Open 2018; 4:294-301. [PMID: 30083382 PMCID: PMC6066985 DOI: 10.1192/bjo.2018.26] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence and incidence of obesity are high in people with severe mental illness (SMI). In England, around 6000 people with SMI access care from secure mental health units. There is currently no specific guidance on how to reduce the risk of obesity-related morbidity and mortality in this population. AIMS To identify international evidence that addresses the issue of obesity in mental health secure units. METHOD A mixed method review of evidence (published 2000-2015) was carried out to assess obesity prevalence, intervention and policy change, as well as barriers to change. RESULTS Evidence from 22 mainly small, non-comparator studies (reported in 21 papers) using a range of methods was reviewed. Dietary, physical activity and cultural interventions being implemented within secure units to address the problem of obesity showed some promising outcomes for physical health and health education. These were facilitated by adequate organisational resources, staff training and motivated staff. Holistic interventions that included a social and/or competitive element were more likely to be taken up. Involving patients in decision-making mediated the tension between facilitating behaviour change and imposing control. Barriers to successful outcomes included patient movement in and out of units, severity of mental health condition and resistance to change by patients and staff. CONCLUSIONS Despite the promising outcomes reported, further assessment is needed of the feasibility, acceptability and effectiveness of interventions and policies targeting the obesogenic environment, using robust research methods. DECLARATION OF INTEREST None.
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Affiliation(s)
- Maxine Johnson
- Research Fellow, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew Day
- Consultant in Public Health for Specialised Commissioning, Public Health England, UK
| | - Rajesh Moholkar
- Consultant Forensic Psychiatrist, Reaside Clinic, and Lecturer, School of Psychology, Birmingham University, Birmingham, UK
| | - Paul Gilluley
- Consultant Forensic Psychiatrist and Head of Forensic Services, East London NHS Foundation Trust, London, UK
| | - Elizabeth Goyder
- Professor of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Tomlin J, Bartlett P, Völlm B. Experiences of restrictiveness in forensic psychiatric care: Systematic review and concept analysis. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 57:31-41. [PMID: 29548502 DOI: 10.1016/j.ijlp.2017.12.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/13/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023]
Abstract
Mentally disordered offenders may be sent to secure psychiatric hospitals. These settings can resemble carceral spaces, employing high levels of security restricting resident autonomy, expression and social interaction. However, research exploring the restrictiveness of forensic settings is sparse. A systematic review was therefore undertaken to conceptualize this restrictiveness. Eight databases were searched for papers that address restrictive elements of secure forensic care in a non-cursory way. Fifty sources (empirical articles and policy documents) were included and subject to thematic analysis to identify 1) antecedent conditions to, 2) characteristic attributes, 3) consequences and 4) 'deviant' cases of the developing concept. The restrictiveness of forensic care was experienced across three levels: individual, institutional and systemic. Restrictiveness was subjective and included such disparate elements as limited leave and grounds access, ownership of personal belongings and staff attitudes. The manner and extent to which these are experienced as restrictive was influenced by two antecedent conditions; whether the purpose of forensic care was to be more caring or custodial and the extent to which residents were perceived to be risky. We argue that there must be a reflexivity from stakeholders between the level of restrictiveness needed to safely provide care in a therapeutic milieu and enable the maximum amount of resident autonomy.
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Affiliation(s)
- Jack Tomlin
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.
| | - Peter Bartlett
- School of Law, Law and Social Sciences Building, University Park, Nottingham, NG7 2RD, UK
| | - Birgit Völlm
- Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK
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Happell B, Platania-Phung C, Scott D, Stanton R. Predictors of Nurse Support for the Introduction of the Cardiometabolic Health Nurse in the Australian Mental Health Sector. Perspect Psychiatr Care 2015; 51:162-70. [PMID: 24957751 DOI: 10.1111/ppc.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE A cardiometabolic specialist nursing role could potentially improve physical health of people with serious mental illness. DESIGN AND METHODS A national survey of Australian nurses working in mental health settings investigated predictors of support for the role. FINDINGS Predictors included belief in physical healthcare neglect, interest in training; higher perceived value of improving physical health care. PRACTICE IMPLICATIONS The findings suggest that nurses see the cardiometabolic health nurse role as a promising initiative for closing gaps in cardiometabolic health care and skilling other nurses in mental health. However, as the majority of variance in cardiometabolic health nurse support was unexplained, more research is urgently needed on factors that explain differences in cardiometabolic health nurse endorsement.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Chris Platania-Phung
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - David Scott
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Robert Stanton
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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Happell B, Stanton R, Hoey W, Scott D. Reduced ambivalence to the role of the cardiometabolic health nurse following a 6-month trial. Perspect Psychiatr Care 2015; 51:80-5. [PMID: 24602142 DOI: 10.1111/ppc.12066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/24/2014] [Accepted: 02/06/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To determine the changes in attitudes toward the inclusion of a cardiometabolic health nurse for the physical healthcare management of people with serious mental illness following a 6-month trial. DESIGN AND METHODS Repeated survey of nurses working in a regional mental health facility. FINDINGS Nurses working in mental health were initially supportive of the role. A 6-month trial of a cardiometabolic health nurse in the workplace reduced ambivalence and increased positivity toward the role. PRACTICE IMPLICATIONS Reduced ambivalence and improved positivity toward the role may facilitate less organization resistance to the implementation of a cardiometabolic health nurse in the mental healthcare setting. Specialized training and role recognition may be needed to further support this role.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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Happell B, Platania-Phung C, Scott D. A systematic review of nurse physical healthcare for consumers utilizing mental health services. J Psychiatr Ment Health Nurs 2014; 21:11-22. [PMID: 23419025 DOI: 10.1111/jpm.12041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2013] [Indexed: 11/29/2022]
Abstract
People with serious mental illness have higher rates of physical illness and are more likely to experience premature death than the general population. Nurse-led strategies to improve physical healthcare in mental healthcare services could potentially reduce these inequalities. However the extent of nurse involvement in physical healthcare (such as physical risk screening, health education and care co-ordination) in mental health settings is not known. A systematic review was conducted on nurse-led physical healthcare reported for consumers with serious mental illness (SMI) in mental health services, and their benefits. Electronic literature bases (CINAHL, Proquest, PsychINFO and Web of Science) were systematically searched, in conjunction with a manual search of literature reviews on physical healthcare in mental health services. Articles were included if they: (a) were published in the last 10 years; (b) were English language; (c) involved physical healthcare of adult consumers receiving mental healthcare services; and (d) reported nurse involvement in physical healthcare. Forty articles were included in the review. The distribution of types of care were: health education (47%), screening and/or monitoring (33.3%), care co-ordination and management (33.3%), lifestyle programme delivery (30.5%), follow-up actions to screening results (25%) and registers and data administration (5.5%). Overall, the evaluation of nurse-based physical healthcare is in early stages. Thus far, they appear to have positive implications for consumers with SMI.
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Affiliation(s)
- B Happell
- Centre for Mental Health Nursing Innovation, Institute for Health and Social Science Research, Rockhampton, Qld, Australia; School of Nursing and Midwifery, Central Queensland University, Rockhampton, Qld, Australia
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Happell B, Scott D, Platania-Phung C. Nurse views on the cardiometabolic health nurse as an approach to improving the physical health of people with serious mental illness in Australia. Int J Ment Health Nurs 2013; 22:418-29. [PMID: 23211091 DOI: 10.1111/j.1447-0349.2012.00892.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
People with serious mental illness (SMI) die prematurely from common physical illnesses such as cardiovascular disease and diabetes. These cardiometabolic risks are preventable and manageable yet these aspects of health care have been neglected in mental health services. A potential nurse-based strategy to decisively improve cardiometabolic health of people with SMI is to introduce a cardiometabolic health nurse (CHN) into mental health services. The current study aimed to establish the views of nurses working in mental health care on the potential benefits and limits of CHN to improve physical health-care standards in Australia. All members of the Australian College of Mental Health Nurses were invited to participate in an online survey and 643 participated. Nurses generally agreed that a CHN role would provide a range of improvements to physical health care, such as increased detection, assessment on, and follow up of cardiometabolic risks, and decreased workload for other nurses. While participants were generally supportive of such a role, they felt it would not be suitable in all health-care settings in Australia.
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Affiliation(s)
- Brenda Happell
- Central Queensland University, Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, QLD 4702, Australia.
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Martin T, Maguire T, Quinn C, Ryan J, Bawden L, Summers M. Standards of practice for forensic mental health nurses--identifying contemporary practice. JOURNAL OF FORENSIC NURSING 2013; 9:171-178. [PMID: 24158155 DOI: 10.1097/jfn.0b013e31827a593a] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Forensic mental health nursing is a recognized field of nursing in most countries. Despite a growing body of literature describing aspects of practice, no publication has been found that captures the core knowledge, skills, and attitudes of forensic mental health nurses. One group of nurses in Australia have pooled their knowledge of relevant literature and their own clinical experience and have written standards of practice for forensic mental health nursing. This paper identifies the need for standards, provides a summary of the standards of practice for forensic mental health nurses, and concludes with how these standards can be used and can articulate to others the desired and achievable level of performance in the specialty area.
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Affiliation(s)
- Trish Martin
- Author Affiliations: 1Forensicare, Victoria, Australia, 2Monash University, and 3Central Queensland University
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