April/May Update

Since our last update, we’ve published three blogs, won 2 prizes and published another paper. In April, Emily Pattinson wrote about the new study led by Liz Hughes that will explore NHS staff views about collecting sexual identity data from patients. Then, Susan Guthrie blogged about embarking on her PhD as one of the new CArDiNAL Fellows. Finally, Krysia Canvin marked Menstrual Hygiene Day 2019 by revisiting the issue of period poverty and its impact on service users’ dignity in mental health settings. She concluded by reflecting on how, ultimately service users’ dignity is at the centre of all our research endeavours.

Out and About

Leila Sharda, final year PhD student, attended the Faculty of Liaison Psychiatry Annual Conference, 15th May – 17th May. The conference was held at the Royal College of Psychiatrists in London and focused on long term conditions. Leila’s research examines how general hospitals respond to patients diagnosed with a personality disorder who are distressed. She presented a poster and gave a talk about the adverse responses these patients receive. Leila’s work was very well received: she was awarded joint first prize for her oral presentation by the panel of expert judges.

Leila’s poster of her PhD findings

Dakota Scollen (@DakotaScollen), third year mental health nursing student, attended the Future of Mental Health Nursing Conference in Edinburgh after winning a competition. Entrants were invited to submit a quote that captures the essence of Mental Health Nursing. Dakota won with her entry, a favourite quote from Alice in Wonderland:

“When you can’t look on the bright side, we’ll sit with you in the dark”

The Mad Hatter, Alice in Wonderland by Lewis Carroll

Look out for Dakota’s blog about the conference, coming soon.

Latest Publications

The contribution of mental health services to a new strategic direction for sexual assault and abuse services

Liz Hughes contributed to a paper published recently in the Journal of Forensic and Legal Medicine led by Professor Charlie Brooker. The paper reports a freedom of information request to NHS mental health care providers to ask whether they had a clear pathway to sexual assault referral centres following disclosure of sexual assaults by people using their services. Very few trusts reported that they had such a pathway. Given that sexual violence is not uncommon in people who use mental health services, and that sexual assault has a significant impact on mental health, there is a need for better joined up services.

Look out for a blog about Liz’ related study about the effectiveness of sexual assault referral centres with regard to mental health and substance use, coming soon.

March Update

This month we published two blogs written by PhD students affiliated to the Mental Health Research Group. Both Susan and Angela are engaged in important work that focuses on areas of which the public – including many of us working in mental health – are unaware. On Delusion Awareness Day, Angela gave us an insight into the occurrence of delusions in intensive care. Susan then brought our attention to the difficulties eating, drinking and swallowing that may be experienced by people with mental health conditions on Swallowing Awareness Day.

Out and About

Liz was invited to speak at a joint mental health and HIV cross party group at the Scottish Government on 20th March. Liz described her systematic review (available free from The Lancet) of blood borne viruses in people with serious mental illness and how there is limited data in BBV prevalence in this group in the UK. She then introduced her new feasibility study of sexual health promotion for people with severe mental illness: the Respect study (details coming soon).

Nicola held a very successful World Café event on 14th March in collaboration with staff from Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH). Thirty-five carers and carer champions attended the event and their contributions (pictured) – and some very large slices of cake – made the day a great success. We learned a lot about what carers want from health research and how they would like to be involved. The project is funded by the School of Healthcare Pump Priming Fund and supported by the RDaSH Patient and Public Engagement Team.

John attended the two-day Educational Meeting on the Multidisciplinary Management of Acute Disturbance hosted by the British Association for Psychopharmacology (BAP) and the National Association of Psychiatric Intensive Care & Low Secure Units (NAPICU). The event made it clear just how little research has been conducted into the use of rapid tranquilisation (particularly how to reduce its use), and services users’ views of this practice. Evidence-based guidance on the clinical management of acute disturbance (de-escalation and rapid tranquilisation) produced jointly by BAP and NAPICU in 2018 is available online from BAP.

Latest Publications

Sexual Violence and Mental Health Services: A Call to Action

Liz published an editorial in which she issues a call for action on sexual violence in mental health services. In the absence of routine enquiry about experiences of sexual violence, the editorial explores the evidence and makes some recommendations about how staff can discuss sexual issues.

Provision of Care for Women in the Postpartum Period (STUDY Protocol)

Rebekah Shallcross, who recently joined us here in Leeds, has published the protocol for the ESMI study, a collaboration with University of Manchester and Kings College London. The study will compare the effectiveness and cost-effectiveness of mother and baby units with general psychiatric inpatient wards and crisis resolution team services.

Staff Experiences and Understandings of the REsTRAIN Yourself Initiative

Finally, John has published the first in a series of papers coming out this year that present findings from REsTRAIN Yourself. REsTRAIN Yourself is the UK adaptation of “6 Core Strategies”, an intervention designed to reduce the use of restrictive practices. The study was led by Professor Joy Duxbury, now at Manchester Metropolitan University, and the toolkit is free to download.

Delusions in intensive care: How can healthcare professionals help?

BBC Radio 4 recently aired the series The History of Delusions. One episode focused on delusions specific to people who had been patients on intensive care units.

An intensive care unit (ICU) is a highly specialised area of secondary care. They provide technology-driven treatment for patients in multi-organ failure. Until recently, little attention was paid to the psychological impact of admission to ICU. Delirium, previously referred to as ICU Syndrome or ICU Psychosis, affects around 60% of ICU patients (Brummel and Girard, 2013). Delirium is thought to be caused by critical illness, sleep deprivation, and sedative drugs such as Benzodiazepines. Delirious patients may appear agitated or withdrawn; or display both states alternately. The syndrome is associated with poor post-discharge outcomes, including anxiety and depression (Salluh et al., 2015) and reduced socio-economic function (Griffiths et al., 2013).

“Delusions are false beliefs stemming from an incorrect perception of reality.”

Delusions are one element of delirium and are false beliefs stemming from an incorrect perception of reality. Delusions can also be experienced by non-delirious patients. Post-discharge, former ICU patients report vivid memories of their delusions, often over-powering actual ‘factual’ memories of intensive care. These ‘false’ memories have been linked to the development of post-traumatic stress disorder (Jones, 2010).

Patients report experiencing feelings of motion and of being moved (Svenningsen et al., 2016), which can perhaps be linked to the use of pressure-relieving air mattresses together with the way patients are frequently moved around the unit to accommodate new admissions. As a former ICU sister, I heard numerous beliefs and stories from my patients. One lady accused staff of stealing her organs, one by one, night after night. Another was convinced her sons had left her in intensive care so we could murder her and they could receive their inheritance. Another patient wrote to staff to tell them about his delusions, the memory of which persisted a year after his discharge. He recalled how ‘Satan and his helpers’ visited each patient. I interpreted this as a reference to the consultants’ ward round.

“One lady accused staff of stealing her organs, one by one, night after night.”

The journalist David Aaronovitch reportedly fought off nurses who he believed were using oxygen to tenderise his flesh prior to eating him. Many patients report believing that they are involved in games or challenges, where they feel compelled to do certain tasks ‘or else’.  Such delusions may explain some of the agitation and hypervigilance seen amongst ICU patients. Not all delusions are persecutory, however: one patient told me that he was on a cruise with the greats of Formula 1 motor racing and asked his bemused relatives to bring in his passport and dinner jacket.

“Not all delusions are persecutory, however: one patient told me that he was on a cruise with the greats of Formula 1 motor racing…”

So how can healthcare professionals help?

We have written about how discharged patients value diaries written by their family and ICU staff. The diaries help patients reclaim ownership of lost time and reconstruct their illness narrative. Such diaries should be used alongside multi-disciplinary follow-up support (Teece and Baker, 2017). The recent POPPI Trial explored the use of nurse-led interventions to provide a calm environment and detect signs of psychological distress in patients, and future phases will trial the effectiveness of other interventions. The bedside nurse has an important role to play in screening for delirium, re-orientating, reassuring, and comforting frightened and vulnerable patients.

Do you have any experience of caring for delirious patients, or supporting discharged patients who have experienced delirium whilst in hospital? Comments and questions are very welcome. You can
contact Angela Teece directly or use the comments form below.

References

BRUMMEL, N. E. & GIRARD, T. D. 2013. Preventing delirium in the intensive care unit. Critical Care Clinics, 29, 51-65.

GRIFFITHS, J., HATCH, R. A., BISHOP, J., MORGAN, K., JENKINSON, C., CUTHBERTSON, B. H. & BRETT, S. J. 2013. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Critical Care, 17, 1-12.

JONES, C. 2010. Post-traumatic stress disorder in ICU survivors. Journal of the Intensive Care Society, 11, 12-14.

SALLUH, J. I. F., WANG, H., SCHNEIDER, E. B., NAGARAJA, N., YENOKYAN, G., DAMLUJI, A., SERAFIM, R. B. & STEVENS, R. D. 2015. Outcome of delirium in critically ill patients: systematic review and meta-analysis. British Medical Journal, 350.

SVENNINGSEN, H., EGEROD, I. & DREYER, P. 2016. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. Journal of Clinical Nursing, 25, 2807-2815. h

TEECE, A. & BAKER, J. 2017. Thematic Analysis: How do patient diaries affect survivors’ psychological recovery? Intensive and Critical Care Nursing, 41, 50-56.

Artwork credit: original artist unknown, but sourced from the Delirium Care Network @deliriumcare

January 2019 – Welcome!

In the month that we launch our new website we’ve been busy. The start of the month saw Liz Hughes publish a joint position paper with other members of Mental Health Nurse Academics UK and people with lived experience: “Seeing Red” raises the issue of period dignity in inpatient mental health settings. Liz engaged in a streamed video chat about this issue with UNITE Mental Health.

In addition, Liz is a co-investigator on a new study Identifying and evaluating mental health early intervention services and self-care support for lesbian, gay, bisexual and transgender young people: a mixed methods study led by Lancaster University and funded by the Health Services and Delivery Research stream of the NIHR. The study will examine and evaluate access to mental health support for young people who identify as lesbian, gay bisexual, or transsexual (LGBT). LGBT young people report significantly higher rates of depression, self-harm, suicidality and poor mental health than heterosexual youth. We are pleased to welcome Dr Emily Pattinson, who will be working with Liz on this three year study, to the Mental Health Research Group. 

John Baker and Kathryn Berzins have been busy blogging for the National Elf Service (@mentalelf on Twitter). Kathryn’s blog examined a review which focused on the role of carers under the Mental Health Act, and John’s discussed a recently published systematic review on Community Treatment Orders.

A journal accepted our first paper to explore some of the work led by Joy Duxbury’s team to reduce the use of restrictive interventions in acute mental health settings informed by the 6 Core Strategies approach (more on this in a future blog).

Nicola Clibbens‘ upcoming World Café will focus on carers’ views about their participation in mental health research featured on the radio (Hallam FM). The World Café event will be held in Doncaster at The Dome in Doncaster on 14th March 1-3.30pm as a partnership between Rotherham, Doncaster and South Humber NHS Trust and The University of Leeds.