Mental illness remains a significant public health challenge in Australia, affecting nearly half of the adult population and placing a considerable strain on the healthcare system. The Australian government has implemented the Stepped Care Model (SCM) within primary mental health care to address this issue to improve service access, efficiency, and outcomes. This study explores the experiences of nine consumers (also referred to as patients) who received care under the SCM, focusing on their perspectives on accessing and navigating mental health services. Ethical approval was obtained from the Federation University Human Research Ethics Committee, and measures were implemented to ensure the privacy and confidentiality of all participants. Through a qualitative thematic analysis, five key themes emerged: (1) the mental health impact of life events; (2) hurdles in accessing care; (3) barriers to optimal care; (4) positive experiences with individual practitioners; and (5) mixed sentiments on the effectiveness of the SCM. While participants acknowledged the holistic and interdisciplinary benefits of the SCM, some expressed frustrations with waiting times, limited service capacity, and rigid session limits. Positive therapeutic outcomes were often attributed to empathetic, personalised care from individual practitioners, emphasising the need for continuity in therapeutic relationships. However, participants with complex mental health conditions felt underserved by the model's lack of flexibility. These findings highlight the need to address systemic barriers and enhance the SCM's adaptability to serve individuals with varying mental health needs better. Future research should explore longer-term interventions and more flexible care pathways to optimise the effectiveness of the SCM in Australia.

Traditionally, postnatal depression (PND) has been considered as depression in the first year after giving birth, although it has been argued that the 12-month cut-off may be somewhat arbitrary. Specialist perinatal mental health services in England have recently been extended to include women in their second year postpartum; however, there is no good estimate for the prevalence of PND beyond the first year. This review aimed to obtain the best estimate of the prevalence of PND in the second postpartum year. Eligible studies were those that assessed PND and provided a point prevalence using a validated screening tool or clinical diagnosis at least once beyond the first 12 months in women over the age of 18 years in any country. Studies were excluded if they only included women who were already depressed or had elevated depression scores at baseline. PubMed, Embase, Web of Science, CINAHL and PsychINFO were searched in January 2021 (and updated in February 2024) for studies that included the prevalence of PND beyond the first 12 postnatal months. Study quality was assessed using Cochrane's ROBINS-I and Risk of Bias 2 tools. Prevalence data were combined in meta-analysis using prediction intervals (PIs). A total of 6340 papers were found, and of these, 32 studies including 57210 participants across 18 countries met the inclusion criteria and were meta-analysed. The prevalence of PND in the second year (13-24 months) was 15% (95% confidence interval [CI] 12%, 17%; 95% PI 4%, 30%) and similar to that in the first year, 16% (95% CI 14%, 19%; 95% PI 6%, 31%). Despite considerable heterogeneity, common in meta-analysis of prevalence studies, findings show that a similar proportion of women experience PND in the second year after birth.

Alternative to discipline programs, defined as programs for nurses 'impaired' by issues such as alcohol and/or drug use, provide treatment and support to return to the profession. This paper aims to explore alternative to discipline programs for nurses to determine whether these programs are relevant to other geographical contexts. A scoping review was conducted in accordance with the JBI methodology. The PRIMSA-ScR checklist was used in this scoping review. The databases searched included MEDLINE (PubMed), Embase (Elsevier), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), and ProQuest Dissertations and Theses Global (ProQuest) from 1984 to 2024. Title and abstract screening was conducted on 1622 papers, resulting in 90 papers for full-text screening. After full-text screening, 19 papers met the inclusion criteria for this scoping review. Issues related to the cost of programs, strict requirements for abstinence, and a lack of 'bespoke' options that address participant needs were identified in this review and need to be addressed prior to global implementation of these programs. Impairment of nurses due to alcohol and/or drug use threatens workforce sustainability, and without 'alternatives to discipline', can mean experience nurses are lost to the profession, often without treatment. Exploration of alterative to discipline programs is essential to ensure that nurses with alcohol and other drug challenges are retained in the profession and receive the treatment required to remain safe practitioners. Likewise, the perception that programs were punitive in nature should be addressed to ensure acceptability of these programs as an alternative to the loss of employment.

Evidence suggests that health care workers are often uncomfortable talking with people about hearing voices, despite recommendations that voice-hearers be provided with opportunities to freely discuss their experiences. Moreover, in rural and remote Australia, workforce shortages mean that a broader range of workers, often non-specialists, are providing services for people with complex mental health presentations. Improving the skills of this non-specialist workforce is therefore an important endeavour. The Hearing Voices that are Distressing (HVD) simulation workshop was originally developed by voice-hearers and provides participants with first-hand experience of what it might be like to hear voices that are distressing. HVD simulation workshops were delivered by a mental health academic, a mental health clinician, and a person with lived experience to 62 health and social care workers in rural South Australia. Mixed methods were used to examine the impact of the workshop on participants' level of empathy for people who hear distressing voices. The revised Kiersma-Chen Empathy Scale assessed changes in empathy, and post-simulation reflective group discussions were qualitatively analysed. Statistically significant increases in empathy were reported following participation in the simulation (p's < 0.001). Participants reflected that having practical experience helped them develop deeper understanding of the impact hearing distressing voices has on a person's day-to-day life; how they may be preoccupied with their internal world; impacting their concentration and engagement with others. Results indicated that this training would be highly valuable for health and social care workers, and particularly generalist workers in rural settings where resources are stretched.

Team-based collaborative models utilise a broad range of healthcare clinicians that practise at the top of their licence, while proactively redistributing shared work through task-shifting, offering meaningful ways to contribute to patient care while ensuring high-quality outcomes. A mental health hospital in Canada embarked on a Collaborative Patient Care (CPC) initiative to optimise skill and skill mix of interdisciplinary inpatient teams. Implementation science, specifically the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework, was utilised to guide the project. Following qualitative and quantitative syntheses, analyses and stakeholder engagement, CPC re-imagined team-based care by restructuring one clinical team of recreational therapy and introduced 26 new positions to infuse across the organisation, including new disciplines of rehabilitation assistant, geriatric physiotherapist, occupational therapists and bachelor of social work roles, while recruiting for more child and youth workers, recreational therapists, secretaries, psychologists, behavioural therapists and personal support workers. Scopes of work were defined to support differences (i.e., between Registered Nurses (RN) and Registered Practical Nurses (RPN)) while team responsibilities were designed to support shared practices. An educational upskilling plan was implemented to support unregulated and regulated clinicians to perform at the level of the new model. At the time of this paper, CPC is immersed in its Sustainment stage. CPC represents a comprehensive plan aimed at enhancing patient care through service efficiencies and optimising resource allocation. It is anticipated that the implementation of CPC will contribute to a shared vision for a better future where patients (and families) receive the right care at the right time by the right clinician.

As rates of mental illness continue to rise, mental health nurses are in increasing demand to meet the needs for specialised health care. While mental health nurse credentialing provides a standardised process within Australia to identify suitably qualified nurses to work in the specialty of mental health, the number of credentialled nurses has been declining. This study aimed to identify attitudes and motivations about mental health nurse credentialing. A cross-sectional online survey open to all registered nursing staff working in mental health settings within the Metro South Health district in Queensland and all credentialled mental health nurses in QLD was conducted over a three-month period. The survey indicated that credentialing was valued by many credentialled and non-credentialled nursing staff and was viewed as important to people's professional identity and pride. However, nursing staff did not believe that the process provided any benefits and little value for money as there were no actual benefits associated with being credentialled and the credentialing process had no impact on their private practice or recognition by APHRA. Considering the current workforce shortages of mental health nurses that are predicted to continue to increase, the results indicate the importance of having mental health nurse credentialing at the core of any workforce planning for mental health service delivery.

This paper examines critical thinking as a fundamental proficiency essential for inclusion in international mental health nurse education. Pragmatic solutions ensure the ongoing development of critical thinking in mental health nurses. The suitability of current mental health nurse education is under scrutiny globally. Critics claim that regulatory and educational standards have shifted from a focus on mental health-specific skills to generic physical health-based competencies, which do not adequately equip mental health nurses for clinical practice. The vital skill of critical thinking within mental health nurse theory and practice has been diluted (stating that it is a position paper or critical review, for example). This paper is a critical review of mental health nursing education. By summarising the global contextual background of generic-based nursing education, it highlights the impact of the loss of mental health-specific skill sets. Critical thinking is identified as a vital skill for the 21st-century mental health nurse. This paper provides pragmatic suggestions to include critical thinking in nurse education in the absence of global reform and systemic educational change. Personal lived experience is used to illustrate the importance of critical thinking and service users' experience of care. Critical thinking can be a partial solution to the current dilution of mental health nurse education occurring across the global North. Nurse educators should strive to embed critical thinking into mental health nurse education in order to develop lifelong critical thinkers who are not afraid to question the hegemonic perspective and continually ask, "why?" Recommendations are for nurse educators to be consciously aware of methods to encourage critical thinking, such as Socratic questioning, the consideration of epistemic injustice, coproduction, critical reflexivity and including case-based ethical learning.

Throughout history, the conceptualisation of "humour" has posed a challenge, without achieving a definitive consensus. This study explores the application of humour in mental health, highlighting its potential to strengthen the therapeutic relationship. This research seeks to fill the knowledge gap in this constantly evolving field. To investigate mental health professionals' perceptions of using humour in the therapeutic relationship. A phenomenological interpretative approach was employed, following qualitative guidelines in healthcare. The study was conducted between November and December 2023. The target population consisted of mental health professionals working in acute units. A purposive sample of 10 participants was selected for the study. COREQ was used to organise individual interviews. Data collection included recorded interviews. The study had Ethics Committee approval and informed consent from participants. Data were analysed with ATLAS.Ti version 24. Ten professionals (5 women and 5 men), aged between 42 and 61 years with 20 to 35 years of experience in mental health, participated in the interviews. Data analysis yielded five main categories: barriers and benefits of using humour, professionals' humour styles, training in humour, and communication skills in the therapeutic relationship. An integrated understanding of humour in mental health and its impact on the therapeutic relationship is revealed. Barriers and benefits are highlighted, emphasising the need for specific training. The affiliative style is valued for its emotional connection, cautioning against other styles. The lack of training underlines the need to integrate humour into mental health training. The importance of adaptation and empathy in communicative interventions is emphasised, highlighting the need for greater awareness and training for a more humane and effective therapeutic environment.

The COVID-19 pandemic has caused disruption to healthcare services worldwide, and although the pandemic was declared over, nurses continue to experience burnout and mental health implications because of events experienced since 2020. The aim of this study was to explore the experiences of trauma among nurses during the COVID-19 pandemic, using a qualitative descriptive study design. This paper used secondary analysis of qualitative, semi-structured interviews conducted with 55 Australian nurses exploring their alcohol consumption, due to the frequent narratives of trauma and traumatic events arising during this process. Data were analysed using structural coding and reported in accordance with the Consolidated Checklist for Reporting Qualitative Data (CORE-Q guidelines). Four themes emerged during data analysis: managing the traumatic stress of the clinical environment in COVID ('it doesn't feel like it's gone away'), post-pandemic trauma ('it was like war, wasn't it?'), bonding over shared trauma ('I was not expecting the camaraderie that developed') and managing trauma after the event ('If something bad happens whilst you're on shift, you just have to pretend like it hasn't happened'). Participants in this study described lasting mental health effects from working clinically during the COVID-19 pandemic that they described as trauma. These effects have lasted since governments worldwide have announced an end to the pandemic, and although participants described bonding over these shared experiences, they continue to have a detrimental impact on workforce well-being and sustainability.

Specific differences between interviewer-rated and self-report suicide risk assessments are unknown. This descriptive cross-sectional study examined the acceptance of the Columbia-Suicide Severity Rating Scale (C-SSRS) screener, conducted by nurse-interviewers versus self-reporting, and identified the factors contributing to refusal in each mode. We reviewed the charts of inpatients at a general hospital that included the C-SSRS screener at the time of admission. C-SSRS screening by a nurse-interviewer and self-reported mode were included. Two modes and the acceptors and refusers were compared using descriptive statistics. Multi-variate logistic regression was performed to determine associations between the studied factors and suicide risk. The study included 398 patients. The acceptance of the nurse-interview and self-report modes was 93.8% and 74.7%, respectively. Refusers for the former were more likely to be male (p = 0.029) and from the surgical departments (p < 0.001). Refusers for the latter tended to be older (p < 0.001). Compared to the nurse-interview group, the self-report group was more likely to report a high risk of suicide (odds ratio = 6.508, p = 0.041). Each mode of the C-SSRS screener, when used in general hospital inpatients, has its own advantages and disadvantages. Healthcare providers should select the mode optimal for their institutional environment after comprehensively considering the patients' characteristics and available hospital resources.

The work mental health nurses undertake is widely acknowledged as being challenging. Stressors encountered in the workplace can negatively impact nurses' psychological wellbeing and contribute to issues with retaining nurses in the profession. There is limited interventional research that focuses on external factors that foster nurse wellbeing. This study aimed to evaluate a peer group intervention to promote nurse wellbeing. A longitudinal mixed-methods study with an equal status concurrent design was undertaken. Qualitative and quantitative data were collected via semi-structured interviews and surveys across three timepoints, baseline, mid-intervention, and post-intervention. Qualitative data were collected to explore interviewees' experiences of participating in the intervention, and quantitative data were obtained to assess for any measurable effect on wellbeing outcomes. Fifteen peer group participants completed semi-structured interviews. There were n = 28 responses to the baseline survey, n = 27 returned the mid-intervention survey, and n = 25 responded to the post-intervention survey. Qualitative data analysis identified four main themes: Attending Peer Group, Participating in Peer Group, Impact on the Individual, and Unrelated Workplace Change. Wellbeing scores were found to be significantly modified by the number of peer group sessions attended for depression (p = 0.006), stress (p = 0.004), and emotional exhaustion (p = 0.02) By the post-intervention survey, more favourable scores were significantly associated with higher attendance levels for all three measures. Integration of the qualitative findings and quantitative results demonstrated potential benefits of peer groups for nurse wellbeing. Given that greater exposure to the intervention was associated with better outcomes, facilitating attendance is essential to realise the benefits of peer groups.

Over 100 million people are affected by suicide loss every year. Descriptive and qualitative research describes the consequences of this loss, such as elevated health risks, as well as describing experiences that can potentially lead to resilience for suicide loss survivors (SLS). The facts that suicide loss is highly transformative, and that it affects many people, underscore the need to understand the relationship dynamics leading up to suicide loss. This study aims to explore relational dynamics between suicide victims and the involved SLS in suicidal trajectories that end in death, through examining the SLS lived experiences. The study is designed and conducted through a phenomenological, reflective lifeworld approach. Twenty-two in-depth interviews concerning SLS's lived experiences of suicidality that ended in a loved one's death by suicide were conducted. This study formulates how the relationship between the suicide victims and the SLS in a suicidal trajectory are shaped around the dynamics of 'May I', 'Will I' and 'Why', and explores how living through these concurrent phases creates a suicidal death course. A central finding indicates that suicidality is often shared between the suicide victims and the SLS, and another is that there exists a determinate dynamic of negotiation aiming for a mutual understanding of the intention to die. The essence of an interpersonal relationship in a suicidal trajectory can be understood as 'an implicit negotiation in which a shared understanding of the intention to die is reached'. This study gives scientific support to the conclusion that SLS may have important information through their own experiences that can be of value for suicide care and assessment.

This integrative literature review examines the evolving role of artificial intelligence (AI) and machine learning (ML) based clinical decision support systems (CDSS) in mental health (MH) care, expanding on findings from a prior review (Higgins et al. 2023). Using and integrative review framework, a systematic search of six databases was conducted with a focus on primary research published between 2022 and 2024. Five studies met the inclusion criteria and were analysed for key themes, methodologies, and findings. The results reaffirm AI's potential to enhance MH care delivery by improving diagnostic accuracy, alleviating clinician workloads, and addressing missed care. New evidence highlights the importance of clinician trust, system transparency, and ethical concerns, including algorithmic bias and equity, particularly for vulnerable populations. Advancements in AI model complexity, such as multimodal learning systems, demonstrate improved predictive capacity but underscore the ongoing challenge of balancing interpretability with innovation. Workforce challenges, including clinician burnout and staffing shortages, persist as fundamental barriers that AI alone cannot resolve. The review not only confirms the findings from the first review but also adds new layers of complexity and understanding to the discourse on AI-based CDSS in MH care. While AI-driven CDSS holds significant promise for optimising MH care, sustainable improvements require the integration of AI solutions with systemic workforce enhancements. Future research should prioritise large-scale, longitudinal studies to ensure equitable, transparent, and effective implementation of AI in diverse clinical contexts. A balanced approach addressing both technological and workforce challenges remain critical for advancing mental health care delivery.

Lifestyle interventions encompass educational and treatment components addressing health risk behaviours such as sedentary lifestyles, nutrition, tobacco use, alcohol and drug use, sleep hygiene, and sexual health behaviours, and are known to improve symptoms of mental illness. However, these interventions are not widely available to young adults. The aims of this study were to (1) determine the proportion of young adults with mental illness who would benefit from lifestyle interventions and (2) describe the benefits and operational factors that should be considered when planning lifestyle interventions for young adults. A two-stage approach was utilised, including structured consultation with experts in youth mental health (n = 12) and an online Delphi study with respondents with expertise and interest in lifestyle interventions (n = 14). The recommended proportion of young adults benefiting from lifestyle interventions varied between the structured consultation and Delphi study. Generally, the proportion increased with illness severity. Overall, study participants recommended that more young adults should have access to individually delivered interventions compared to group interventions. This study provides provisional estimates and operational details that could be used to increase the availability of lifestyle interventions for young adults, improving mental health, functioning, and physical health, and supporting improved life outcomes.

Loneliness is a widespread issue that significantly affects the well-being of older adults globally, with cultural shifts and urbanisation increasing their vulnerability to social isolation. Despite growing concern about this issue, there is a lack of research on coping strategies for loneliness among older adults in Indonesia. This study aimed to explore how older adults in Belitung, Indonesia cope with loneliness. A descriptive phenomenology design was used, and in-depth semi-structured focus group discussions (FGDs) were conducted with older adults (aged 60 and above) at two public health centres. The first FGD, with five participants, took place in October 2023, followed by a second FGD with ten participants in March 2024. Both sessions were audio-recorded. The interview data were transcribed verbatim and analysed using Colaizzi's method. The results showed that all participants reported experiencing loneliness and shared various coping strategies. Five themes emerged from the analysis: (1) Cultural and Religious Practices as Coping Mechanisms, highlighting the significance of spirituality; (2) Traditional Social Interactions, such as 'Ngelakar' and 'Begalor,' which strengthen community bonds; (3) Staying Active through 'Posyandu Lansia,' which supports physical and emotional well-being; (4) The Role of Family and Grandchildren, providing emotional warmth and a sense of purpose; and (5) Leisure and Recreational Activities, offering enjoyment and distraction. The findings reveal that older adults use culturally rooted strategies to manage loneliness, emphasising the importance of community, tradition, and spirituality. Gender differences were also noted. These results may inform the development of culturally tailored community nursing interventions aimed at reducing loneliness and enhancing the well-being of older adults.

The clinical reasoning cycle was designed to guide nursing care and assist with clinical-reasoning and decision-making. While originally developed with an acute health lens, more recently an adapted version has been created for forensic mental health nurses. It is possible that such a framework may also be helpful for mental health nurses working in generalist settings. This study aimed to explore the utility of the original cycle and adapted forensic version with mental health nurses across the state of Victoria, Australia, to determine if the cycle might be suitable to their practice and if any adaptations were necessary. Eighteen nurses participated in focus groups or interviews to explore both versions of the cycle. Following thematic data analysis from phase one, a Nominal Group Technique was used to facilitate exploration of adaptations. Verbal and written responses were collected and participants (n = 6) voted on changes. Three main themes were interpreted from phase one: (1) the mysterious disappearance of nursing frameworks, (2) the CRC fits with what we do, says what we do, and demonstrates what we do, and (3) The CRC becomes more relevant without the word "forensic" in the title. In the nominal group, consensus was reached on 4 of 10 suggested changes from phase one, and the mental health nursing-clinical reasoning cycle was developed. There was concern that many nurses did not have a framework to guide decision-making, and the newly adapted cycle was seen as offering a way of demonstrating the contribution of mental health nursing care to safe practice.

Nursing programs provide holistic education in caring for people with various health conditions, including mental health conditions. This study aimed to explore the experience of faculty regarding planning and implementing mental health simulation as a method for enhancing the mental health nursing competency training of undergraduate students. The researchers have adopted an action research design under the qualitative paradigm to find answers to the research questions. A purposive sample of nine participants, including mental health nursing faculty and simulation unit staff working in a public university in Oman were included in the study. Ethical clearance was obtained from the institutional ethics committee. Data were collected through in-depth individual interviews with the faculty. Thematic analysis was done synchronously with the steps of action research through the process of coding, categorising and organising the data into meaningful themes. Member checking was done to ensure the transparency and correctness of the themes and subthemes. Seven themes were derived from thematic analysis of the transcripts, such as 'Need for creating innovative mental health nursing learning experiences for students', 'Perceived readiness for simulation', 'Experience in developing mental health simulation', 'Arrangement of resources', 'The zeal for implementing simulation', 'Challenges in the simulation experience', and 'Gaining momentum and confidence'. A conceptual framework for simulation in mental health nursing was developed by the authors based on the findings and by referring to existing models. Faculty can effectively plan and implement simulation experiences for their students. Simulation-based training can become an effective means to make the students more confident and competent in mental health nursing. Implementation of simulation-based teaching will enhance the quality of nursing education and, thereby, the standard of mental health care in clinical settings.

Safewards is a model and set of interventions with demonstrated effectiveness in reducing conflict and containment which are associated with negative consumer experiences within inpatient mental health settings. Safewards has been widely adopted internationally as a way of enhancing safety and reducing restrictive practices. Despite this, consumers' experiences of Safewards and its effect on their personal safety are less understood and therefore require further exploration. This qualitative exploratory study sought to explore consumers' experiences of Safewards in acute inpatient mental health units. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used for reporting purposes. Fifteen consumers across two sites participated in semi-structured focus groups. Thematic analysis generated four themes: (1) engaging consumers in Safewards, (2) consumers supporting each other, (3) interacting and communicating and (4) access, availability and expectations. Participants expressed positive views about Safewards and wanted to be more involved in its day-to-day application. Enhanced consumer involvement in Safewards was associated with improved safety and wellbeing for consumers within acute inpatient mental health units. These findings have the potential to influence practice towards improving the consumers experience of Safewards. This requires an exploration of ways to harness informal consumer supports, recognising that consumers need to spend meaningful time with nurses to feel safe and acknowledging that all forms of restrictive practice have an impact on consumers within acute inpatient environments.

Over the past decade, as a broader push to address community needs and improve health outcomes, socially marginalised people have become increasingly involved in co-design research and education. More recently, people with lived experience of substance dependence have co-designed and co-delivered Alcohol and Other Drugs (AOD) education with nurse educators. Evaluations of co-designed AOD education have largely focused on educational and clinical outcomes but not on the process of co-design. Because of this gap, there is a need for research that explores the process of undertaking co-design with people who use substances and clinicians, including facilitators and barriers to the process that are specific to these groups. This research reports on a qualitative study exploring the barriers, facilitators, and perceived value of a co-design process for an AOD clinical education program involving people with lived experience of substance use, nurse clinicians, and academics (nursing and public health). The participants reported that building trusting relationships and skilled facilitation enhanced the co-design process, enabling positive conditions for working in partnership to achieve the project outcomes. However, challenging interpersonal dynamics, lack of adequate resources, and overly directive facilitation could impact team dynamics and undermine the co-design process. Authentic co-design has the potential to transform AOD education, ensuring that it centres the needs of people with lived experience. However, co-design initiatives require adequate resourcing and time to develop equal and respectful relationships for this vision to be realised.

Primary healthcare remains an essential aspect of mental health service delivery in most developed nations worldwide. Mental health nurses (MHNs) play an important role in the delivery of mental health care within primary health care settings. This study, a subset of a broader study, explores MHNs' experiences of the stepped care model (SCM) in Australian primary mental healthcare. Through semistructured interviews, the exploratory descriptive inquiry study explores the perspectives of eight MHNs on the implementation and effectiveness of the SCM across diverse settings, delving into their roles, motivations, approaches to care, experiences and the challenges encountered. Five themes were identified: the diverse roles of MHNs in the SCM, motivation to work in SCM, a consumer-centred approach, challenges of the SCM and 'it is great if you can get it'. Findings reveal diverse roles, from delivering psychotherapy to consumers presenting with mild to moderate needs to coordinating care for individuals presenting with severe and complex challenges. MHNs working in the SCM are driven by a desire to provide flexible, recovery-focused care. They prioritise consumer-centred approaches and tailored care to meet individual needs. They experience challenges, including professional isolation in some cases, resource constraints, limited session availability for the consumers they work with and administrative burdens. The study underscores the need for structural enhancements to optimise the SCM's effectiveness and meet diverse consumer needs. These insights from MHNs are relevant to policymakers, Primary Health Networks (PHNs), service providers and clinicians. Future research could expand the scope to include perspectives from various disciplines involved in the model, as well as consumers and carers accessing SCM services. Overall, this paper contributes valuable insights to the discourse on the effectiveness of the SCM through the lens of MHNs delivering care within the model.

The PreVCo study ('Prevention of Violence and Coercion') investigated the effects of a structured programme for the implementation of guideline recommendations for the management of aggression and the prevention of violence and coercion in psychiatric hospitals in a multicentre randomised controlled trial with 55 participating wards. The intervention was a 1-year individually tailored implementation programme supported by external consultants. An independent evaluation of the individual wards' process aimed at identifying barriers and facilitators in implementation. We conducted guideline-based group interviews with 53 of 55 participating teams during the implementation process. The Consolidated Framework for Implementation Research (CFIR) was used for the qualitative analysis. Two coders independently coded the transcripts and conducted a summary content analysis. The focus was on facilitators and barriers in the implementation process. The design of the intervention, in particular the framework of a controlled study, external guidance and the opportunity to choose and adapt the implementation programme according to the wards' possibilities and needs, was generally perceived as useful and supportive. The context of pandemic management at the time of the study interfered with the implementation process, mostly because of organisational transformations, challenges for information exchange and increased workload of the staff. With regard to the wards participating in the study, the main facilitators were a receptive, collaborative ward culture, team spirit and previous experiences in successful transformation processes. Barriers included the demanding working situation, frequent fluctuation of staff and low team cohesion, obstacles in communication, a deficit-oriented perception of patients and low priority of the implementation process. Provision of necessary resources by the organisation was not self-evident. Stakeholders devoted to the ideas of transformation of psychiatry and reduction of coercion were important facilitators of the implementation; however, some employees kept a resigned attitude and could not be engaged. The analysis of barriers and facilitators shows that an implementation process of innovative routines on psychiatric wards can benefit from external, individually tailored guidance. However, the working conditions on psychiatric wards remain to be challenging. Trial Registration: Clinical Trial Registration at www.isrctn.com with the identifier ISRCTN 71467851.

Individuals living with mental illness can experience dire oral health and face numerous barriers to oral health care. While mental health providers are important in oral health promotion, there is a major gap in knowledge on their oral health knowledge, attitudes and practices and guidelines/recommendations for best practice. This integrative review addresses this gap by synthesising evidence on mental health providers oral health knowledge, attitudes and practices and available clinical guidelines/recommendations. Searches were undertaken across six databases, supplemented with grey literature searches. The inclusion criteria were mental health providers, including nurses, doctors and allied health providers. Articles or guidelines/recommendations were excluded if they primarily related to drug and alcohol or substance use and eating disorders. A total of 16 studies and five guidelines/recommendations were included (20 were of high-moderate quality). Mental health providers were receptive to playing a role in oral health promotion and screening and this was supported by guidelines/recommendations. However, current practices of mental health providers in promoting oral health are fragmented and inconsistent due to various barriers: limited knowledge, education, and training, lack of collaboration with dental services, heavy workloads, time constraints and challenging client behaviours. This review highlights an urgent need to strengthen supports for mental health providers to promote oral health with professional development in oral health, more detailed clinical practice guidelines, brief and user-friendly oral health screening tools and streamlined dental referral pathways.

Committing a family member with schizophrenia to a psychiatric ward is a coping mechanism often employed under challenging circumstances. This decision entails significant emotional repercussions and ethical dilemmas, potentially undermining the psychological well-being of the family and eroding public trust in mental health services and professionals. This study investigates the experiences of regret among family members after deciding to commit a relative to a locked ward, adhering to the COREQ guidelines. Employing a descriptive qualitative methodology, we conducted in-depth interviews with 14 family members in Heilongjiang Province, China, who faced this difficult choice. Data were analysed using reflexive thematic analysis, which identified seven themes within three stages: Decision antecedent (limited comprehension of schizophrenia and treatment, deficiencies in supportive environment), decision process (suboptimal communication, hospitalisation and weighing of alternative options) and decision outcome (emotional burden of a loved one's hospital life, the indelible mark of schizophrenia, impact on family dynamics). The study highlights the need for targeted interventions, including addressing biased social media portrayals, enhancing the accuracy of medical information, ensuring transparency in psychiatric practices and improving support for families during hospitalisation.

Australian government approval has been granted for 3,4-methylenedioxy-methamphetamine (MDMA) treatment of post-traumatic stress disorder and psilocybin for treatment-resistant depression, but the process of translating psychedelic-assisted therapies (PAT) into more widespread use is complex. Along with establishing the efficacy and feasibility of PATs, their acceptability amongst consumers is a crucial factor of successful implementation. This study utilised the Theory of Planned Behaviour to evaluate the acceptability of PATs amongst mental health consumers, identifying potential influences of these attitudes and predictors of PAT uptake. Participants completed an online survey between February and July 2023. Survey items evaluated consumer characteristics, acceptability of PAT (effectiveness, efficacy and social norms) and behavioural intentions to undertake PAT. The 254 participants had a mean age of 42.5 years (SD = 12.8) and 79.1% were female. Three quarters expressed a desire to access PAT. Acceptability scores indicated strong agreement regarding the effectiveness of PAT, social norms that moderately endorsed PAT and mixed feelings about its expected efficacy. Whilst univariate analyses indicated that previous psychedelic experience was associated with increased acceptability of PAT (ds = 0.63-0.80), multivariate analyses revealed that intentions to access PAT were associated with higher acceptability scores (ds = 0.37-1.32) and poorer experiences of conventional therapy (d = -0.31). Although a relatively large portion of participants had used psychedelics recreationally, the desire to access PATs was more strongly related to its acceptability, along with more negative experiences of conventional therapy. This implies that mental health consumers who are looking for alternatives to conventional therapy may view PATs as a desirable option, despite some safety reservations.

Although combating stigma is a fundamental intervention area that should be addressed in comprehensive care, information on the effect of the family's experience of stigma on the lives of individuals diagnosed with schizophrenia is limited. This study was aimed at exploring the family's experience of stigma from the perspective of individuals diagnosed with schizophrenia and the effects of this experience on the patient's life. In this study, a descriptive qualitative approach was employed, and the participants were recruited from a university hospital in Türkiye. Semi-structured interviews were conducted with 16 individuals diagnosed with schizophrenia. Data were analysed via content analysis. The data were categorised into five themes: (1) dimensions of the stigma experience, (2) causes of family stigma, (3) confronting the effects of stigma, (4) efforts to control stigma and (5) recommendations. Family stigma is a difficulty that is accompanied by distressing emotions and social losses and restricts the lives of both patients and their families. Society's stereotypes towards the patient and the family, aggression and psychotic symptoms have been associated with the family stigma. In order to control stigma, family members limit the patient's behaviours, which puts the patient under pressure. Nurses should question the family's experience of stigmatisation, the psychosocial consequences of this experience on the patient and family and strategies coping with stigma. They should help family members be aware of coping methods that negatively affect the patient and develop adaptive coping skills through psychoeducational interventions and should create stigma-free social environments for both the patient and the family.

Providing safe care within psychiatric wards is essential to promote the well-being and recovery of patients on the wards. This can however be complicated because patients' behaviours can present risks to themselves and others. Understanding what patients think about safety on psychiatric wards holds crucial insight about addressing and managing safety issues on the wards. The aim of this study is to understand safety on psychiatric wards from the perspective of the patients. The study is a systematic review that follows PRISMA guidance and registered with PROSPERO. A comprehensive search of five electronic databases was completed. Searches were limited to peer-reviewed academic journal articles published in English language from 2014 which examine safety on psychiatric settings from the patients' perspective. An initial result of 28 567 studies was filtered to six studies that met all the eligibility criteria. Quality assessment was completed using Critical Appraisal Skills Programme whereas data synthesis was conducted using thematic analysis. Four major themes that describe safety on psychiatric wards emerged: perception of safety; prevalence of lack of safety: perpetuating lack of safety; and promoting safety. Safety on psychiatric wards is like two sides of a coin: what promotes safety can also perpetuate lack of safety. The place (hospital), people (staff) and practice can both promote safety and perpetuate lack of safety. Finding and maintaining the right balance is crucial for achieving safety on psychiatric wards. These findings have implications for the effective management of safety issues on psychiatric wards.

Physical activity has been shown to improve outcomes across a range of physical and mental health conditions as an adjunct or standalone intervention for many mental disorders. The outcome and effectiveness of physical activity in acute mental health units are less well understood. Systematic searches were completed in three databases (CINAHL, MEDLINE, and PsycINFO). Eligible studies were published between March 2013 and February 2024, included a physical activity intervention for inpatients on acute mental health units, and reported primary quantitative, qualitative, or mixed methods data for patients between 18 and 65 years of age. Participants must have had a primary diagnosis of a mental health condition with or without physical comorbidities. Data extracted included reported components of the interventions and individual health outcomes. Methodological quality and risk of bias was assessed using the mixed methods appraisal tool and cochrane risk of bias tools for randomised and non-randomised controlled trials. Twelve studies were identified for review (combined sample size of 560). Seven studies reported improvements in mental health outcomes, and two reported improvements in physical health outcomes in favour of the intervention group. There was a large variation between intervention characteristics and clarity in reporting. Assessment and measurement of outcomes contributed to a high risk of bias among included studies due largely to self-assessment. Physical activity interventions on AMHUs have the potential to contribute to improvements in mental and physical wellbeing beyond that experienced from usual treatment practices (e.g., medication). However, further work is needed in the specific context of acute mental health units regarding the development and evaluation of physical activity interventions.

To meet the aim of synthesising research on nurses' experiences of promoting personal recovery within psychiatric inpatient care, meta ethnography according to Noblit and Hare has been chosen as the method, which is a qualitative review of scientific literature that results in a synthesis. The focus is on interpretation and is expressed to be able to reduce a story, but at the same time keep what is unique using metaphors. Nine articles formed the basis of the synthesis. The analysis resulted in two levels of synthesis. The first level involved the translation of metaphors into one another, which proceeded in two directions, described as two principal headings. The second level produced five overarching metaphors. The first principal heading is that 'erected walls in psychiatric inpatient care impedes personal recovery.' It encompasses the overarching metaphors 'cultivating in exhausted soil' and 'nurses are gatekeeping watchdogs'. The second principal heading is 'torn-down walls in psychiatric inpatient care enable personal recovery'. It encompasses the overarching metaphors 'disarming and de-escalating', 'facing suffering together reveals treasures' and 'elevating the competent partner promotes recovery'. Conclusively, if the nurse is to be able to promote personal recovery in psychiatric inpatient care, bridges of cooperation and consensus need to be built to other professions in care. Otherwise, the obstacles to promoting personal recovery will be far too hard to overcome.

PNDA are complex health conditions affecting up to one in five women. The causes of PNDA are not well understood and no proven prevention exists. This study aimed: (1) to understand health professionals' perspectives of the common drivers contributing to PNDA amongst women from regional and rural areas in Australia; (2) to identify clinical practice related to PNDA-associated challenges; (3) to identify and inform areas for intervention. We conducted four online Group Model Building (GMB) workshops with health professionals from the southwest of Victoria, Australia. Informed by local data, participants built a model that progressed from connection circles to causal loop diagrams (CLD) to capture a shared understanding of the key drivers of PNDA rates within the region. The CLD was thematically analysed and common drivers were grouped. The GMB transcripts were thematically analysed inductively identifying emergent themes about PNDA drivers and intervention ideas. The CLD revealed 28 drivers and four key themes that stakeholders perceived to be driving the increasing rates of PNDA. An additional three major themes were identified from the GMB transcripts: (1) Social determinants of women's health; (2) Health system issues; (3) Negative birth experiences. Three key intervention themes were proposed, to improve collaboration between health services and departments, increase training availability, and increase continuity of care. Our findings suggest that dedicated training and pathways for collaboration between large regional and smaller rural services are necessary to address the rising rates of PNDA in the region.

Workplace violence (WPV) is a harmful phenomenon happening in psychiatric wards. Despite preventive efforts, mental health services cannot eliminate WPV. If mental health services can increase the coping and resilience of frontline mental healthcare professionals (FMHPs) towards WPV, it could contribute to their mental health and well-being. To perform a systematic review of comparative studies on interventions to improve coping and resilience towards WPV aimed at FMHPs working in psychiatric wards. Systematic review on comparative intervention studies, with electronic searches in MEDLINE, Embase, Cochrane CENTRAL, PsycINFO and CINAHL. We registered our protocol in PROSPERO (CRD42022373757). Performing a meta-analysis seemed not to be feasible, so we provided a narrative summary of the included studies, methodological quality and results. We included nine studies, with interventions focused on positive behavioural support, resilience enhancement and aggression management training. Most studies reported positive effects, though with a moderate to high risk of bias. Positive behavioural support, biofeedback and aggression management training are promising interventions in our review. Biofeedback interventions and positive behavioural support could be valuable additions to existing training programmes to improve coping and resilience. Future studies should focus on demonstrating the robustness of effects, the mechanism of increasing coping and resilience regarding WPV and the development and implementation of effective interventions.