A review of the limited empirical and theoretical literature indicates that current mass media representations of mental health service users appear to emphasize violence, dangerousness and criminality. This is despite the empirical evidence that indicates a decline over the last 40 years in the number of homicides carried out by people identified as suffering from mental health problems. Such inappropriate representations do much to increase stigma, ostracism, harassment and victimization of these individuals by the public. Furthermore, it can be argued that there is another repercussion of these representations and that is the subsequent government position/policy and the resulting legislation concerning care of people with mental health problems. Consequently, this paper argues that there is a clear need for psychiatric/mental health (P/MH) nurses to become more mindful of the wider, socio-political environment in which their practice occurs, particularly if psycho-social approaches to practice are adopted in their fullest sense, and as a result increase their political lobby. Such increased lobbying should occur on behalf of, and in collaboration with, service users, and accordingly the authors describe a range of activities under the broad headings of pro-active and reactive lobbying. Furthermore, it is incumbent upon P/MH nurse educationalists to prepare aspirant P/MH nurses for this lobbying role and equip them with the skills necessary to do so.
Objectives: To analyse service use and variation for people with severe mental illness in the last year of life in Wales. Methods: This is an observational retrospective cohort study between 2018 to 2023 using anonymised linked routinely collected health datasets within a data dashboard. Results: We identified n=4722 (2.3%) deaths with ICD-10 codes for severe mental illness for the period 2018-2023. As a group people with severe mental illness die younger, are in receipt of specialist palliative care at lower rates, die more often in institutional settings rather than their own homes and comorbidity indicates more unscheduled care use in the last year of life. Conclusions: Unscheduled care use in the last year of life is associated with comorbidity indicating opportunities for upstream intervention to improve treatment, experience and quality of life for people with severe mental illness. Further investigation such as mixed methodological approaches to examine experiences of those with severe mental illness in the last year of life, and the human and systems factors influencing the nature and effectiveness of unscheduled delivery for this patient cohort alongside developments in data linkage that include general practice, social care, nursing and specialist palliative care inputs are needed.
Abstract Aim A discussion which aims to explore the diversity of decision‐making during teenage and young adult cancer treatment. The discussion will be related to the concepts of autonomy, dependence and decision‐making in this age group. Background The experience of cancer involves a significant series of treatment decisions. However, other non‐treatment decisions also have to be made which can relate to any aspect of everyday life. These decisions occur against the backdrop of young people's disease experience. Design Discussion paper. Data sources A literature search for the period 1990–2013 was undertaken. This included searching the following databases: Cumulative Index for Nursing and Allied Health Literature ( CINAHL ), SCOPUS , Medline, DARE , Applied Social Sciences Index and Abstracts ( ASSIA ), (Psych Info) and The Cochrane Library. Implications for nursing There is a lack of evidence into the experience of everyday decisions made by young people during cancer treatment. This may affect them in the form of unmet needs that nurses, or other professionals, fail to appreciate. Conclusion Further exploration of how teenagers and young adults experience the range and process of decision‐making during cancer treatment could be useful in helping to provide effective supportive care for this age group.
The collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively. COCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday ‘frontline’ practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide potential explanations and understanding. COCAPP will help identify the key components that support and hinder the provision of personalised, recovery-focused care planning and provide an informed rationale for a future planned intervention and evaluation.
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