The rising prevalence of mental health conditions (MHCs), coupled with increased public awareness, has led to greater help-seeking behaviours and heightened demands on nurses across healthcare settings. However, many general trained nurses report feeling inadequately prepared to care for individuals with MHCs due to limited training and clinical exposure. This lack of preparedness may result in compromised quality of care, reduced professional satisfaction and poorer recovery outcomes for clients. Existing systematic reviews have predominantly focused on psychosocial interventions for psychiatric nurses, limiting insights into interventions relevant to the broader nursing workforce. This review aimed to map the available evidence on interventions that prepare general trained nurses to care for individuals with MHCs. A comprehensive search was conducted across eight electronic databases between August and September 2024, alongside grey literature sources, including ProQuest Dissertations and Theses and ClinicalTrials.gov, searched between September and October 2024. A total of 7646 records were identified. Following title and abstract screening, 38 full-text articles were reviewed, of which 24 met the inclusion criteria. A narrative synthesis was undertaken, with findings organised into delivery methods, intervention domains and implementation challenges. The review found that interventions targeting mental health literacy, stigma reduction, interpersonal and communication skills, and nurse safety and resilience were associated with improved confidence, empathy, therapeutic relationships and willingness to provide care. Overall, the findings underscore the importance of multifaceted, contextually relevant approaches, including digital literacy training, ongoing evaluation and stronger organisational support, to enhance nurses' preparedness and well-being in mental health care.
To explore the factors shaping mental health experiences among rural and remote first responders and to examine how organisational and contextual conditions influence psychological wellbeing. First responders are routinely exposed to traumatic events and are at elevated risk of mental health difficulties. In rural and remote settings, geographic isolation, limited workforce capacity, and reduced access to specialised services may compound these risks. However, less is known about how workplace culture and service structures interact with trauma exposure in these contexts. A participatory action research (PAR) approach was used to co-design this study, using phenomenological qualitative methods through semi-structured interviews with rural and remote first responders. Data were analysed using reflexive thematic analysis informed by phenomenological principles to explore lived experience. An advisory group contributed to the interpretation and refinement of findings. Participants described cumulative mental health strain arising not only from trauma exposure but also from structural and cultural conditions embedded within rural service environments. Geographic isolation, small team structures, high workload, and limited anonymity intensified emotional labour. Workplace cultures characterised by expectations of stoicism, 'hero' narratives, misogyny and gender discrimination, and limited recognition contributed to moral distress and psychological burden. Participants identified significant gaps in mental health service provision, including limited access to trauma-informed and first responder-specific supports in rural areas. Mental health challenges among rural first responders are shaped by intersecting individual, organisational, and structural factors. Trauma exposure alone does not account for the complexity of distress experienced in these settings. Interventions must extend beyond individual resilience-building to include organisational reform, psychologically safe workplace cultures, and improved access to tailored, trauma-informed mental health services in rural and remote contexts.
Adult acute mental health wards operate under sustained pressure, characterised by high patient acuity, workforce shortages and a focus on risk management that can limit opportunities for therapeutic engagement. Although physical activity is increasingly recognised as beneficial for mental and physical health, there remains limited evidence to guide its implementation within acute inpatient settings. The purpose of this study was to generate practice-relevant insights to inform the design and implementation of feasible physical activity interventions in adult acute mental health wards. A qualitative study was conducted using focus groups across two National Health Service mental health trusts in England. Thirty participants took part, including mental health nurses, multidisciplinary staff and people with lived experience of acute ward care. Data were analysed using reflexive thematic analysis within a multidisciplinary and lived-experience-informed research team. Three interrelated themes were identified. Barriers to implementation reflected the interaction between patient acuity, medication effects, restrictive practices, workforce pressures and ward organisation. Enablers and opportunities included nursing leadership, flexible and relational delivery approaches, staff participation and active involvement of patients in the design of activities and care planning. Participants also highlighted the importance of evaluation approaches that balance feasibility with meaningful patient-centred and ward-level outcomes, including staff wellbeing and ward atmosphere. Physical activity was perceived as both desirable and achievable when adapted to the realities of acute ward environments. These findings address an important evidence gap and can inform the development of context-sensitive, recovery-oriented physical activity interventions aligned with acute inpatient mental health nursing practice.
Persistent challenges remain in attracting and retaining early-in-career mental health nurses in Australia. Key contributing factors include gaps in undergraduate nursing preparation, with many students reporting insufficient mental health placement experience to inform career choice. Health services have responded to recognised gaps between undergraduate preparation and the realities of clinical practice by developing structured early-in-career programs, such as graduate nurse and transition-to-practice initiatives. These programs combine supported clinical exposure, targeted education and mentorship to consolidate core skills. However, early-in-career mental health nursing practice often occurs within unpredictable and complex environments that can be hostile and emotionally demanding, compounding stress for recently graduated nurses. This study aimed to explore early-in-career mental health nurses' experiences of (1) workplace readiness, (2) wellbeing and (3) preparedness for practice. Using a qualitative descriptive design, we recruited 12 early-in-career mental health nurses from a tertiary hospital in metropolitan Melbourne, Australia. Semi-structured interviews were thematically analysed according to Braun and Clarkes methodology. From analysis, four themes were identified: (1) Feeling ready, becoming ready; (2) Finding the right fit; (3) Practising under pressure; and (4) Organisational influences on readiness. This study provides important insights into early-in-career nursing experiences, highlighting the role of placement quality, exposure to workplace violence and organisational support in shaping preparedness and workforce retention. Variability in placement experiences contributed to misaligned expectations and heightened transition challenges. Findings also underscore occupational violence perpetrated by consumers and their family members highlighting the need for targeted preparation during undergraduate education and early career transition, as well as organisational responses to support safe workplaces.
This paper presents a reflective account of the implementation of the Safe Steps for De-escalation practice model over a 12-month period across three acute mental health units. It describes the implementation process of the model, designed to reduce restrictive practices in acute mental health settings. The Safe Steps model is a mental health nurse-designed and led approach for person-centred, structured and relational de-escalation. It positions therapeutic engagement, emotional attunement, and psychological safety as central components of effective responding, particularly during high-stress situations. The model offers a practical and adaptable resource for diverse acute care environments. This paper examines the implementation process and lessons learned from a multi-site evaluation of the Safe Steps model in a number of acute mental health units. The evaluation was guided by the complexity model of Skivington et al. (2021), which emphasises multifaceted real-world approaches to evaluation. Drawing on reflective accounts from the research and implementation leads, using practice-informed insights, the paper explores the opportunities, challenges and lessons learned in embedding a relational de-escalation model into everyday clinical practice. Particular attention is given to capability building, scenario-based learning, and team-based support strategies that facilitated implementation. The findings highlight the importance of leadership, emotional safety, and inclusion of the consumer voice in sustaining reductions in coercive practices. The paper offers practical insights for clinicians and researchers seeking to implement relational and trauma-informed approaches in acute mental health services.
Māori, the indigenous people of Aotearoa New Zealand have poorer outcomes and experiences when accessing adult mental health services (MHS), including higher rates of seclusion and compulsory treatment. These inequities for Māori represent a breach of Te Tiriti o Waitangi, the constitutional foundation of Aotearoa New Zealand, and stem from over a 100 years of European colonisation involving massive confiscation of Māori land, population decline, and suppression of Māori identity and culture. The recent New Zealand mental health Inquiry, He Ara Oranga, emphasised the need to transform the cultural responsiveness of mental health services for Māori. Similar issues were highlighted by Dr. Irihapeti Ramsden who pioneered the concept of cultural safety for Māori in nursing practice, which when applied to Māori consumers is referred to as 'Kawa Whakaruruhau'. This qualitative study explored 10 Māori and non-Māori senior nursing leaders' perspectives on the status of Kawa Whakaruruhau and Cultural Safety for Māori consumers (tāngata whaiora) and their family (whānau) accessing adult MHS in Aotearoa-New Zealand. The participants came from four health regions and a national mental health nursing organisation. Key themes focussed on Kawa Whakaruruhau and Cultural Safety as either cultural competence or power relationships between nurses and Māori, and there were many opportunities for improving Kawa Whakaruruhau in services. The results suggested that from a nursing perspective, the status of Kawa Whakaruruhau and Cultural Safety in adult mental health services for tāngata whaiora Māori and their whānau is highly problematic. This report is adherent with the COREQ checklist.
This study explored how participation in a person-centred group intervention influenced the personal recovery process of individuals with mental illness at the end of the intervention and 3 months after. Using a qualitative longitudinal design, the study was conducted in an outpatient clinic at the Psychiatric Department of the North Denmark Region. Seventeen participants completed the 12-week intervention, which included two Discovery group sessions and 10 Guided Self-Determination method sessions. Participants were interviewed post-intervention and at three-month follow-up. Data were analysed using reflexive thematic analysis by Braun and Clarke and the CHIME framework with a deductive approach. The intervention positively influenced participants' personal recovery process across all CHIME categories. Being among peers fostered a sense of belonging, trust and mutual understanding leading to greater openness and confidence in relationships within and beyond mental health services. Participation in the intervention enhanced self-understanding, hope and optimism about the future, though some participants emphasized the need for ongoing support to sustain these gains. Engagement in the group promoted self-acceptance and openness about mental illness, increased awareness of factors affecting well-being and encouraged focus on opportunities and quality of life. Participants also reported greater self-reflection, self-esteem and responsibility, leading to a stronger sense of control over their lives. Overall, the person-centred group intervention supported participants' personal recovery process by strengthening connectedness, hope, identity, meaning and empowerment. Continued professional support was viewed as essential to sustain and integrate these positive changes.
With one in eight people living with a mental health condition as of 2019, it is reasonable to assume that this population would also include mental health professionals. Despite the global prevalence of lived experience of this nature, its integration into practice and professional roles has yet to be achieved on a wider scale, with its value underestimated and affixed with a significant level of stigma. This study aimed to explore the perceived and actualised value of lived experience among mental health professionals and its influence on practice. A qualitative approach utilising systematic review methodology identified and synthesised the findings of 10 relevant papers. Such an approach acknowledged the range and complexity, and thus the subjectivity, of identified experiences, creating the interpretive space necessary to promote a deeper understanding, from a phenomenological perspective, of how mental health professionals with lived experience utilise their unique knowledge and skills in practice and the value added. Thematic analysis generated two main themes, each with two sub-themes. These were the Intrapersonal and Interpersonal value of lived experience in terms of their influence on practice, the former with Attitudes, Values and Beliefs and Deeper Understanding as sub-themes; the latter with Connection and Approach to Practice as sub-themes. The results of this study have significant implications not only for policy and practice but also for research, calling for social change around mental health stigma. Ultimately, the results highlight the value of integrating lived experience within the healthcare workforce and clinical practice, and the unique perspective and insight it brings.
Motherhood is a meaningful part of the life plans of many women diagnosed with severe mental illness, but they often experience motherhood or the desire for it in a context of vulnerability, stigma, and poorly coordinated care. The literature on the meaning of motherhood in this group is limited, especially research offering the perspective of humanistic models centred on the person. Identify how women diagnosed with severe mental illness give meaning to their desire to be mothers (or not) and their experience of motherhood (or not becoming a mother), using the Tidal Model as an interpretive framework. Descriptive qualitative study with intentional sampling. Eight women diagnosed with severe mental illness in Catalonia, Spain participated in semi-structured interviews. Data were analysed using thematic analysis guided by the Tidal Model. We report the findings using the COREQ criteria for qualitative rigour. We identified six themes structured in the three dimensions of the Tidal Model: (1) sharing the desire (or not) to become a mother; (2) stigma related to the decision to become a mother (or not to become one); (3) taking care of myself to become a mother; (4) self-stigma; (5) lack of specialised support and misinformation; and (6) barriers created by stigma. The narratives reveal the importance of validation, the impact of internal and external stigma, and the difficulties arising from the lack of service coordination. Participants faced multiple personal, relational, and structural barriers to their plans to become mothers. The findings indicate the need for interdisciplinary, empathetic, and person-centred care, as well as coordinated care circuits that integrate reproductive desire into clinical practice in mental health. Mental health nurses can play a pivotal role in validating women's reproductive desires, mitigating internal and external stigma, and providing nuanced, person-centred guidance regarding risks, care needs, and reproductive options. They are also essential in fostering coordinated care pathways that support informed decision-making and accompany women throughout their reproductive journeys.
Collaboration is a foundational characteristic of ethical mental healthcare. However, inpatient mental healthcare often fails to espouse the practices and principles that would establish meaningful collaborative care, with coercion and restrictive practices an ongoing aspect of consumers' lived experience. This qualitative descriptive study aimed to understand consumers' perspectives of collaboration with clinicians in the inpatient mental health setting. One-on-one semi-structured interviews were conducted with 12 people who have experienced involuntary inpatient mental healthcare; data were analysed by thematic analysis. The participants of this study valued collaborative inpatient mental healthcare. However, they reported that their own perspectives were not sufficiently sought or considered. Clinicians' default scepticism compounded participants' experiences of inconsideration. In contrast, genuinely caring interpersonal relationships with clinicians were valued, establishing a sense of safety and collaboration. The failure to establish collaboration requires systemic reform and the resolution of micro-cultures that disenfranchise the perspectives of people receiving inpatient mental healthcare. Notably, the participants of this study reported that interpersonal relationships with clinicians facilitated meaningful collaboration. Collaboration relies on the presence of strong interpersonal care; the culture, policy and structures of inpatient mental healthcare must be oriented to be interpersonal.
Stigmatising beliefs towards people with mental health disorders impede treatment-seeking and recovery. This study examined how the predictive contributions of knowledge, attitudes, and behaviours to stigmatising beliefs towards people with mental health disorders differed by clinical practicum experience among nursing students exposed to auditory hallucination simulation. A non-randomised comparative cross-sectional design was employed (Strengthening the Reporting of Observational Studies in Epidemiology guidelines). Nursing students (n = 363) from four Korean universities were allocated to groups with (n = 175) and without (n = 188) clinical practicum experience based on academic progression. All participants completed an auditory hallucination simulation programme followed by questionnaires measuring knowledge, attitudes, behaviours, and stigma. Stepwise multiple regression analyses revealed that among students without clinical experience, knowledge (β = -0.435, p < 0.001), attitudes (β = -0.259, p < 0.001), and behaviours (β = -0.144, p = 0.020) predicted stigma (Adjusted R2 = 0.419). Among students with clinical experience, only knowledge (β = -0.455, p < 0.001) and attitudes (β = -0.287, p < 0.001) predicted stigma (Adjusted R2 = 0.478); behaviours did not reach significance despite a stronger bivariate correlation in the experienced (r = -0.390) than inexperienced group (r = -0.332). This paradoxical pattern-a stronger zero-order association losing independent variance in the multivariate model-suggests clinical experience integrates the three stigma components such that behaviour's effect becomes fully mediated through knowledge and attitudes. These findings support a stage-sensitive model: direct behavioural strategies are most effective pre-practicum, while post-practicum intervention should prioritise cognitive-affective integration via structured debriefing.
Mental health reform represents a sustained effort to improve the accessibility, quality and human rights orientation of mental health systems through changes to policy, legislation and service delivery. The scale and pace of growth in the lived and living experience workforce (LLEW) is unprecedented within mental health services, with a marked increase in roles representing a significant shift in the contemporary mental health landscape. In Australia, the state of Victoria is currently undergoing the most significant mental health reform in its history. This study aimed to explore mental health nurses' perceptions of the impacts of mental health reform on (1) their delivery of care in relation to consumer and carer safety and wellbeing and (2) their experiences of working alongside lived experience workers within reformed service contexts. This study employed a qualitative descriptive design, with secondary analysis of existing qualitative data (Szabo and Strang 1997), which were thematically analysed using Braun and Clarke and reported in accordance with CORE-Q guidelines. Semi-structured interviews were conducted with mental health nurses working in Victoria (N = 14), Australia, with three themes generated through reflexive thematic analysis: (1) Mind the gap: Reform impacts to safety and risk; (2) When care comes too late: reform impacts to care and treatment; and (3) Between sympathy and resistance: ambivalent attitudes towards LLEW roles. Persistent integration challenges related to LLEW influenced nurses' perceptions of usefulness. Nurses also described that an increased legislative emphasis on consumer choice, relative to clinical decision-making, contributed to uncertainty and hesitancy in intervention, which nurses perceived as negatively affecting care outcomes in some situations.
ABSTRACT This study aimed to evaluate the effectiveness of interventions involving a dual contact pedagogical intervention on nursing students' attitudes toward mental illness, and to further explore their learning experiences and perspectives. A mixed methods approach using an explanatory sequential design was applied with a single group quasi‐experimental design, and a qualitative deductive approach guided by Kolb's experiential learning theory. The dual‐contact intervention involving both inpatients and individuals in recovery was integrated into the psychiatric nursing curriculum. Forty‐four nursing students enrolled in a five‐year junior college in southern Taiwan participated in the intervention group, including 13 who took part in three focus groups. Quantitative data from three self‐report scales assessing attitudes, perceived stigma and social distance were analysed using repeated one‐way analysis of variance, while qualitative data from focus group interviews conducted after students completed their psychiatric nursing practicum were analysed using content analysis. There were significant differences in attitudes and social distance, particularly after contact with the individuals in recovery. Qualitative data analysis identified that the Dual Learning Strategies with Meaningful Contacts category was associated with these changes, which encompassed three subcategories: (1) Reflective learning experiences, (2) Transforming experiential insights into clinical practice and (3) Debriefing of contacts across phases of psychiatric care. Both contact‐based interventions improved attitudes. Notably, engaging with individuals in recovery significantly reduced perceived stigma and social distance. Interaction with inpatients reinforced theoretical knowledge integrating clinical contexts, while engaging with individuals in recovery cultivated empathy and caregiving competencies. Both contact‐based interventions provided complementary learning benefits.
Iatrogenic harm in psychotherapy remains under-recognised, despite longstanding evidence that psychological treatments can produce adverse effects. This omission is consequential in eating disorder care, where treatment is often intensive, prolonged and characterised by significant power asymmetries alongside poor long-term outcomes. This article examines iatrogenic harm in the context of eating disorders through an epistemic justice and intersectional framework. Drawing on qualitative and lived-experience-led scholarship, it argues that iatrogenesis is produced through structural features of mental health systems, including rigid diagnostic practices and manualised treatment models, limited professional accountability and the marginalisation of experiential knowledge. Treatment dropout and the attribution of treatment failure to patients are examined as mechanisms that obscure harm and inflate perceptions of treatment safety and effectiveness. Rather than rejecting evidence-based psychotherapy, the article calls for epistemic pluralism, routine monitoring and reporting of iatrogenesis and meaningful co-production as prerequisites for ethical, accountable and humane eating disorder care.
