Brenda Happell

Introduction: Safewards effectively reduces restrictive practices within acute inpatient mental health units. Consumers' experiences of Safewards impact on broader experiences within these settings. Given the influence mental health nurses have on consumers' experiences, nurses' responses to these experiences require further exploration. Aim: To explore the responses of mental health nurses to consumers' experiences of Safewards within acute inpatient mental health units. Methods: A qualitative exploratory method was used for this study, involving semi‐structured focus groups with mental health nurses from two acute inpatient mental health units. Participants were asked to respond to a summary of themes about consumers' experiences of Safewards. Results: Thematic analysis uncovered three themes: (1) Prioritising respectful communication and investing time with consumers; (2) Relating Safewards to everyday work with consumers; (3) Safewards and its impact on restrictive practices. Discussion: Participants acknowledged consumers' experiences of Safewards and their frustrations when mental health nurses were unavailable. Some participants expressed uncertainty about the suitability of Safewards, despite consumers' endorsement, highlighting a possible discrepancy between mental health nurses' and consumers' views. Most participants perceived Safewards to be effective but inconsistently applied, in part due to varying acceptance and understanding of Safewards. Limitations: Differences between the units may not be captured in combined data analyses and other views about the consumers' experiences of Safewards may not be represented. Researcher bias may have influenced the way in which data were collected, analysed and reported. Implications for Practice: Safewards requires partnership between mental health nurses and consumers, and a more nuanced understanding of its application within an acute inpatient mental health setting to realise its full potential. Task‐based approaches that hinder mental health nurse engagement with consumers may impact Safewards' effectiveness. Recommendations: Discrepancies between the views of mental health nurses and consumers' experiences require further exploration. Increasing consumers' involvement in the everyday application of Safewards should be considered.

The Safewards model and its ten interventions have been effective in reducing restrictive practices and preventing conflict within acute inpatient mental health units. However, few studies in the current literature explore the consumers' experiences of Safewards. This exploration also needs to consider the views of Mental Health Nurses and the Lived Experience Workforce, who are both important stakeholders in the application of Safewards and how it impacts on consumers' experiences. Despite this, the views of Mental Health Nurses and the Lived Experience Workforce about consumers' experiences of Safewards are limited. This qualitative study explored the views of Lived Experience Workforce leaders about consumers' experiences of Safewards, and Mental Health Nurses' responses to these experiences in acute inpatient mental health units in Australia. Six Lived Experience Workforce leaders participated in individual interviews. Data were analysed using thematic analysis, revealing four themes: (1) consolidating Safewards through understanding consumers' experiences, (2) consumers as leaders in Safewards, (3) acknowledging the realities of acute inpatient mental health units and (4) practice foundations underpinning Safewards. Results highlighted the positive impact of improved consumer involvement in Safewards. Additionally, mechanisms to develop strategic partnerships between Lived Experience Workforce leaders and mental health nurses warrant further investigation. This study highlighted the restrictive nature of acute inpatient mental health units and the need to acknowledge the impact this has on consumers. Further embedding of foundational approaches, such as trauma‐informed and recovery‐oriented practice within Safewards, is also required to align with consumers' expectations. Greater recognition of consumers' experiences and their agency within the model, and consideration of other Safewards interventions, is also needed. This is required to increase safety, reduce harms associated with restrictive practice, and enhance Safewards effectiveness.

Mental health nurses are increasingly part of consultation–liaison psychiatry teams, yet their roles are not well documented. This is the second of a two‐part paper examining a consultation–liaison psychiatry team consisting of medical, nursing and psychology staff within a major metropolitan health service in Victoria, Australia. An exploratory‐descriptive qualitative design was used to examine the tri‐disciplinary team (Part 1) and the mental health nursing role within it (Part 2) as documented by the organisation and articulated by team members. An audit of consultation–liaison psychiatry‐related documents was conducted, and the content was analysed for references to the nursing role. Perspectives of team members were obtained through a focus group, and individual interviews, and examined using thematic analysis. The findings indicate the nurses practice at an advanced level with general and specialist mental health nursing expertise and are an integral part of the team. Two related themes were identified: mental health nurse consultants as an expert resource and a consistent presence . These themes converged into a central theme of conduit reflecting their connecting role both within the team and between the team and the nurses. Within the team, they made themselves available to orientate, educate and support team members. With the nurses, they shared a common identity and communication style, were trusted, and worked collaboratively with them in providing care. The study affirms the value of including mental health nurses as core members of CLP teams and their consistent presence positions them to lead improvements in mental health nursing practice.

Descriptions of multidisciplinary consultation‐liaison psychiatry teams are notably scarce in contemporary literature which is a significant gap given the articulation of the dimensions of service delivery is necessary for service evaluation. This exploratory‐descriptive qualitative study examined a consultation‐liaison psychiatry team consisting of medical, nursing and psychology staff within a major metropolitan health service in Victoria, Australia. The aim of this two‐part study was to gain an in‐depth understanding of the service (Part 1) and the mental health nursing role within it (Part 2) as documented by the organisation and articulated by team members. Data were collected through a document audit, a focus group and semi‐structured individual interviews with team members. Data were examined using content analysis for the structure, process and outcome dimensions of service delivery. A preliminary service description was produced, verified and finalised. The final description includes staffing profile, general and specialist team configuration, model of service delivery, referral processes, mandated data collection and desired outcomes. A team approach was emphasised with each discipline offering different perspectives, knowledge and skills, collaborating to provide coordinated care. There were also shared functions such as patient engagement, assessment and reviews. Resource deficits impacted the service's ability to meet demand and to review performance against outcome measures. This paper adds to the limited literature base describing how multidisciplinary consultation‐liaison psychiatry teams operate and can potentially contribute to the development of standards for service delivery.

Despite the implementation of physical health policies, research and interventions, people diagnosed with mental health conditions (referred to as consumers) continue to experience increased morbidity and mortality compared with the general population. Underpinning this disparity, systemic and personal barriers continue to impede consumers' abilities, commitment and resourcing towards health behaviour changes. Evidence suggests appropriately skilled, interpersonally capable and empowered healthcare professionals like Physical Health Nurse Consultants can deliver person‐centred physical health care aligning with goal‐setting theory. However, little to no research focuses on the application of goal‐setting theory regarding physical health interventions for consumers. This qualitative exploratory study seeks to explore consumers' views and experiences using goal‐setting to co‐develop and implement their personalised health goals. Between November 2020 and April 2021, fourteen consenting consumers participated in 30‐to‐60‐min semi‐structured individual interviews that were transcribed and thematically analysed. Three themes identified from the data reflect consumers' positive experience of health goal‐setting with the PHNC. The themes communicate: (i) the process of goal‐setting, (ii) techniques, barriers and facilitators to implementing and sustaining, and (iii) impact of health goals. Consumers perceived collaborative care‐planning processes aligning with goal‐setting theory facilitated co‐development and implementation of varying health goals and goal types. Barriers to consumers' health goal attainment were effectively mitigated by the PHNC who applied elements of goal‐setting theory to increase congruency with their physical and mental capacity and commitment. Subsequently, consumers indicated positive impacts on several health domains indicating the value of the PHNC in supporting behaviour change and directing future research regarding consumer physical health interventions to underpin behaviour change theories and measure both clinical and personal outcomes.

Coproduction has emerged as an important means of effective mental health service delivery. Unfortunately, this term is commonly misunderstood, with tokenistic participation too often presented as coproduction. Funding and resourcing have been identified as significant, and often insurmountable, barriers to achieving coproduction. This paper presents findings from a cooperative inquiry project, addressing ideas and strategies for working towards coproduction within an academic unit. Three consumer/lived Experience academics and three nonconsumer academics (from Nursing, Occupational Therapy and Social Work) participated in a series of in‐depth conversations to consider and identify potential strategies to advance the faculty's progress towards coproduction. Conversations were transcribed and analysed using a thematic approach. Five main themes were identified: importance of coproduction; preparing for coproduction; barriers to coproduction; the need for university transformation; and power. A belief in the inherent value of coproduction was shared among the group, and strategies were identified to clarify the level of participation. Radical transformation of universities, aligned with contemporary industry practice, is essential to achieving coproduction. Strategies such as allocating vacant academic positions for health professionals to consumer academics are indicative of measures required for genuine aspirations for coproduction to be realised and to address the seemingly insurmountable funding issues. Universities must recognise power differences and remain honest about their position according to participation ladders. These findings provide guidance for academics who acknowledge the value of coproduction to address the commonly identified barriers to its implementation.

People living with psychosis live up to 20 years less compared to the general population. Cardiometabolic ill-health and barriers to health-related behaviour are significant contributors. This is a cross-sectional descriptive study of cardiometabolic health and health behaviours of consumers attending a public community mental health service in an Australian city. One hundred and fourteen consumers currently living with psychosis participated. Standard measures of cardiometabolic health, quality of life and, health-related behaviours were utilised. Data were analysed using descriptive statistics. The cohort reported higher fruit intake and physical activity, and lower excess alcohol use compared to previous studies. Health-related behaviours including smoking and vegetable intake were poorer than previously reported. Participants had low levels of cardiometabolic health (e.g. abnormal lipids). Physical and mental quality of life was also lower than for general populations. Improved efforts to address physical health for people with mental health conditions are urgently needed.

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.