Purpose This paper explores the limits of current research methods in mental health. Quantitative methods are useful for diagnosis, measurement and treatment outcomes, but they do not fully capture patient experience, meaning and cultural context. The aim of this study is to highlight the importance of combining quantitative and qualitative approaches. A more balanced and practical approach may improve understanding of mental illness and support better clinical care and research. Design/methodology/approach This is a viewpoint paper based on existing literature from psychiatry and related fields. No new data were collected. The paper reviews and discusses key concepts such as measurement, diagnosis, patient experience and cultural factors. It compares quantitative and qualitative methods and explains how each contributes to clinical understanding. The discussion is based on published studies and theoretical work. Findings Quantitative methods are helpful for standardised assessment and treatment planning but may miss individual experience and context. Diagnostic categories and rating scales can shape how symptoms are understood. Qualitative approaches help to understand patient experience, meaning and cultural background. Both methods have strengths and limitations. A combined approach may give a more complete understanding of mental illness and improve clinical decision-making. Originality/value This paper adds value by highlighting the practical limits of relying only on quantitative methods in mental health research. It emphasises the need to include patient experience, meaning and cultural context in both research and clinical practice. The paper presents a clear argument for using both quantitative and qualitative approaches together, rather than treating them separately. This perspective is useful for clinicians and researchers, as it supports more holistic assessment, better understanding of patients and more informed clinical decision-making.
Purpose Research on routine cognitive behavioural therapy (CBT) supervision highlights the prevalence of supervisory drift (SD), whereby core supervisory tasks are avoided or deprioritised, often related to unaddressed interpersonal processes within the supervisory relationship. This study aims to evaluate the acceptability of a newly developed interpersonal process model of CBT supervision designed to support supervisors and supervisees in identifying and formulating such processes. Design/methodology/approach The model was introduced to two groups of CBT supervisors (n = 31) via two workshops. In all, 12 supervisors provided follow-up qualitative feedback one month later using an anonymous online survey. Responses were analysed using reflexive thematic analysis. Findings Three overarching themes were identified: seeing the bigger picture; application of the model; and accessibility. These responses highlighted both the perceived value of the model and concerns regarding implementation. Research limitations/implications The participant response rate limits the generalisability of the findings, and use of a qualitative survey restricted opportunities for deeper exploration of supervisors’ experiences and reactions. Further research should focus on examining the actual use of the model and evaluating its effectiveness in reducing SD. Practical implications The model offers a CBT-congruent formulation that may help supervision dyads develop a shared language for recognising and addressing interpersonal processes associated with SD. Further guidance, simplification and applied examples are required to support confident implementation in routine supervisory practice. Originality/value This study addresses a gap in CBT supervision theory and practice by presenting an empirically informed interpersonal process formulation model specifically for CBT supervision.
Purpose - This study aims to compare internet dependence (ID) and mental health outcomes among Brazilian medical students before the COVID-19 pandemic (2019) and during peak distancing (2021), and to assess whether baseline ID predicted mental health outcomes at follow-up. Design/methodology/approach - This prospective longitudinal cohort study was conducted at a private medical school in Brazil with two waves (2019, in-person; 2021, online). Instruments included the Internet Addiction Test (IAT), PHQ-9, GAD-7 and the Life Orientation Test-Revised (LOT-R). Paired t-tests and McNemar tests compared within-person changes. Correlations and multivariable linear regression models adjusted for age, sex, family income and mental health service use assessed associations, including change scores (? = T1-T0). Statistical significance was set at p < 0.05. Findings - Ninety-four students completed both waves. Mean PHQ-9 scores increased from 10.56 to 14.80 (? = +4.24; p < 0.001), and mean GAD-7 scores increased from 9.74 to 13.08 (? = +3.34; p < 0.001). Optimism declined from 8.54 to 5.42 (p < 0.001), pessimism increased from 6.97 to 7.73 (p = 0.028) and ID increased from 40.59 to 47.43 on the IAT (p < 0.001). At baseline, ID correlated with higher depressive symptoms (r = 0.282; p = 0.038) and anxiety (r = 0.260; p = 0.042). In adjusted regression models, baseline ID predicted higher anxiety at follow-up (beta = 0.699; p = 0.042), but not depressive symptoms at follow-up (beta = 0.087; p = 0.148). Higher baseline ID also predicted greater increases in PHQ-9 (beta = 0.201; p = 0.022) and GAD-7 (beta = 0.398; p = 0.042) scores from 2019-2021. Originality/value - This study provides longitudinal evidence from a middle-income country tracking ID and mental health among medical students from a pre-pandemic baseline to the period of peak distancing. By examining both negative psychological symptoms and positive psychological markers such as optimism, the findings underscore digital hyperconnectivity as a salient, modifiable correlate of distress in medical training. The results support routine screening and the integration of digital literacy and self-regulation strategies into medical curricula to mitigate risk and promote well-being.
Purpose This study aims to examine the mediating role of self-compassion in the relationship between insomnia, depression and anxiety among university students and staff in Nigeria.Design/methodology/approach A cross-sectional survey design was adopted. Participants comprised university students and staff recruited from a university community in Nigeria. Data were collected using standardised measures of insomnia, self-compassion, depression and anxiety. Mediation analyses were conducted to examine the indirect role of self-compassion in the relationship between insomnia and psychological distress outcomes.Findings The findings revealed that insomnia was significantly associated with depression and anxiety. Self-compassion fully mediated the relationship between insomnia and depression and partially mediated the relationship between insomnia and anxiety. The results suggest that self-compassion may serve as a protective psychological resource in reducing distress associated with insomnia.Research limitations/implications The study used a cross-sectional design, so it cannot confirm cause-and-effect links between insomnia, depression, anxiety and self-compassion. The sample was drawn from a single Nigerian university community, which may limit how widely the results can be applied. Self-reported questionnaires also carry some risk of bias. Future research should use longitudinal or experimental designs and include broader populations to provide stronger evidence on how self-compassion interventions can help reduce mental health problems related to sleep difficulties.Practical implications The findings suggest that interventions that build self-compassion can reduce depression and anxiety in people with sleep difficulties. For universities and healthcare institutions, training programs that include mindfulness, self-kindness and emotional resilience could help students and staff manage stress better. Clinicians and counsellors can also include self-compassion strategies as part of therapy for clients struggling with insomnia and poor mental health. These approaches could improve wellbeing, strengthen coping and reduce burnout among young people and healthcare workers.Social implications By showing how self-compassion protects against mental health difficulties, the study highlights its social value in communities facing high stress and limited access to mental health care. Promoting self-compassion could reduce stigma around mental illness by encouraging more understanding and self-acceptance. On a broader scale, universities and health organisations that adopt self-compassion programs can improve community wellbeing, reduce stress-related absenteeism and encourage healthier coping strategies. This could foster more resilient academic and healthcare environments.Originality/value This study contributes to the growing literature on sleep and mental health by highlighting the mediating role of self-compassion among university students and staff within a Nigerian context. The findings provide insight into the potential usefulness of self-compassion-focused interventions in university mental health support services.
Purpose - This paper aims to evaluate the effectiveness of a virtual simulation-based adjunctive learning tool in enhancing nursing students' skills, knowledge and attitudes toward recognizing and managing psychomotor agitation in mental health settings, and its efficacy in delaying knowledge decay. Design/methodology/approach - This single-blind, two-arm randomized controlled trial used a repeated measures design. Sixty-one third-year undergraduate nursing students were randomly allocated to either the intervention group (virtual simulation-based adjunctive learning tool, n = 30) or the control group (case analysis, n = 31). An objective structured clinical examination (OSCE) was administered immediately following classroom instruction. Knowledge levels and attitudes were assessed at baseline (T0), immediately postintervention (T1), one-week postintervention (T2) and one-month postintervention (T3). Findings - The intervention group achieved significantly higher mean scores at each OSCE station and overall compared to the control group (p = 0.001). Generalized estimating equations indicated statistically significant interaction effects for knowledge level and management attitude in both groups (p < 0.001, p = 0.036, respectively). The intervention group also demonstrated significantly higher classroom practice performance (p < 0.001). Research limitations/implications - This study has several limitations. First, participants were recruited from a single institution, limiting generalizability to nursing students or other healthcare practitioners in diverse settings. Second, the one-month follow-up was brief; longer-term tracking is needed to assess knowledge retention. Third, the study used only quantitative data, lacking qualitative insights into students' perceptions, emotional responses and decision-making processes-a gap that future mixed-methods research could address. Fourth, there was a slight age difference between groups due to a few students repeating the year, but all were within the cognitively stable 19-21 age range, and we consider this impact minimal. Fifth, the simulation modules did not include sensory modulation interventions, an evidence-based approach for managing agitation. Moreover, practices such as the definition and use of "restraint" are culturally nuanced, and the current simulation may not fully capture these variations. Finally, although virtual simulation effectively built cognitive and decision-making readiness as assessed by OSCEs, how this translates into real-world clinical performance warrants further investigation. Practical implications - This study supports integrating virtual simulation-based adjunctive learning tool into nursing education. As a standardized preparatory module, it can build students' cognitive and decision-making foundations and serve as a scalable resource for ongoing clinical training. Effective implementation requires organizational support from educational administrators and clinical mentors to bridge learning and practice. Future research should explore its complementarity with high-fidelity simulation, conduct longitudinal clinical studies, and use mixed methods to examine cognitive and attitudinal changes, supporting a sustainable training system focused on competency transfer. In addition, future iterations of the training should incorporate sensory modulation interventions to align with current best practices in acute mental health care. Originality/value - Nursing students using the virtual simulation-based adjunctive learning tool outperformed those using case analysis in classroom performance, practical skills, knowledge retention and managerial attitudes. The tool also improved long-term knowledge retention (one-month).
Purpose The expansion of online learning in India has enhanced accessibility and flexibility in education but has also led to growing concerns about students' mental health. This study aims to examine the adverse effects of excessive online learning on secondary school students in Tier 1 Indian cities, focusing on anxiety, stress and burnout. It identifies key stressors, including prolonged screen time, social isolation and academic pressure, and highlights the need for a balanced approach that integrates mental health considerations into India's evolving education system.Design/methodology/approach A quantitative research approach was used to analyze the relationship between online learning and mental health outcomes. Data were collected from 475 students in Grades 9-12 through an online survey using stratified random sampling. The survey assessed generalized anxiety disorder (GAD), stress and burnout levels alongside online learning habits. Structural model analysis was conducted to evaluate relationships between these variables, with path coefficients measuring the influence of GAD on stress and burnout.Findings The study found strong correlations between excessive online learning and mental health challenges. GAD significantly influenced both stress (path coefficient = 0.571) and burnout (path coefficient = 0.512). Major contributing factors included prolonged screen exposure, lack of peer interaction and academic workload. The findings underscore the need for intervention strategies such as regulated screen time, mental health support and hybrid learning models to create a healthier digital learning environment. The study highlights the importance of contextual factors such as socio-cultural pressures and digital inequality in shaping students' mental health outcomes in India.Research limitations/implications This study focuses on secondary school students in Tier 1 Indian cities, limiting its applicability to rural students and those from different socio-economic backgrounds. The reliance on self-reported data may introduce bias, and external factors like parental support and school policies were not explored in depth. Future research should use longitudinal studies to assess long-term effects and develop targeted interventions for diverse student populations.Practical implications The study calls for structured online learning policies that prioritize student well-being. Recommendations include mental health awareness programs, screen time regulation, peer engagement and hybrid learning models. Training for teachers and parents to identify early signs of anxiety and burnout is crucial for fostering a supportive learning environment.Social implications The rising dependence on online education has intensified mental health issues among Indian students, exacerbated by social isolation and academic pressure. Policies must address mental health counseling in schools, equitable digital access and community-driven initiatives to mitigate these challenges. Promoting a culture of well-being in education ensures both academic success and emotional resilienceOriginality/value This study offers a novel, empirical examination of the impact of online learning on Indian secondary school students' mental health. By integrating structural model analysis, it provides critical insights for policymakers, educators and mental health professionals to design balanced online education strategies that support student well-being.
Purpose Admission to a specialist Children and Young People's Mental Health Services (CAMHS) inpatient unit is a pivotal moment in a young person's care journey, often accompanied by intense emotional distress for both the individual and their family. While some existing practices - such as ward visits, the involvement of experts by experience and affirming communication - support trust and orientation, substantial inconsistencies and challenges remain. Families often experience the early stages of admission as being chaotic, especially during out-of-hours or crisis scenarios, leaving them unable to process lengthy or complex materials. Key concerns include safety protocols, ward routines, specific staff roles and access to advocacy and emotional support. Current pre-admission materials were often viewed as inaccessible due to dense text, formal language and a lack of inclusive formats. Design/methodology/approach The purpose of this study is to investigate the pre-admission information that is provided to young people and parents across eight CAMHS inpatient units. Using a mixed-methods approach, including qualitative focus groups and quantitative survey data, the research identifies critical strengths and gaps in how information is provided prior to admission.Findings To address these issues, the study proposes a series of actionable recommendations: the inclusion of a "Quick Key Information" page in welcome packs, a modular structure tailored to each phase of the admission journey, audience-specific booklets for young people, carers and siblings, and materials available in varied, accessible formats such as easy-read, infographics, videos and audio. Additional recommendations include clearer definitions of medical terms, regular updates to FAQs and proactive signposting to advocacy and emotional support services. Originality/value This research emphasises the need for emotionally supportive and practical communication tools. By prioritising family inclusion, accessibility and clarity, providers can create compassionate environments, build trust and improve engagement and recovery outcomes. This work calls for a cultural shift, recognising families as active partners in care rather than passive recipients.
PurposeAs the demand for mental health services increases, new models of care are necessary to address shortages of mental health professionals. Research in low- and middle-income countries has shown that lay individuals with limited formal education and no experience with mental health service delivery can be trained as providers; however, research in this model is limited in the United States. This study sought to assess the feasibility of training lay individuals to deliver Behavioral Activation (BA) to Spanish-speaking Latinos using the BA for Latinos Treatment Manual (i.e. the BA Manual).Design/methodology/approachUsing a pilot feasibility trial, the authors trained four women who worked as receptionists at a community-based organization in Camden, New Jersey as community health workers (CHWs). CHWs attended three days of training and delivered BA sessions under supervision to Spanish-speaking Latinas with mild to moderate depression or anxiety.FindingsUsing the Pragmatic BA Fidelity tool, CHWs and their supervisors assessed high levels of fidelity in the delivery of the intervention. However, due to challenges with scheduling, CHWs completed only four of the planned six sessions. All participants expressed satisfaction with the intervention.Research limitations/implicationsThis study suggests the feasibility of training lay individuals to deliver the BA intervention in community-based settings; however, modifications are necessary before moving to efficacy testing. The study was supported through pilot funding, which required us to focus on a limited number of outcomes. Based on the methods proposed by Teresi et al. (2022), the authors designed this study to focus specifically on fidelity to the intervention and acceptability of the intervention to diverse stakeholders. The authors were not able to address factors such as recruitment and retention of interventionists or more detailed assessment of recipients' adherence to/engagement with the intervention. Further research will be necessary to address these components of intervention fidelity.Practical implicationsGiven the small scale and exploratory nature of this study, the findings should not be interpreted as evidence of effectiveness but rather as an indication of whether the approach can be implemented and refined. The fact that both CHWs and their supervisors were confused about the number and timing of sessions, suggests that more time should be spent on training these participants on the BA model to enhance intervention fidelity. The next phase of this research will involve revising the training schedule, reviewing the translation of the intervention manual, and creating reporting templates to ensure consistency with the intervention's aims. The authors expect these changes to significantly improve fidelity to the BA model, which the authors plan to test with a larger sample size.Social implicationsThe fact that service recipients benefited from the program (i.e. decreased depression/anxiety symptoms and high satisfaction with the program) suggests that this approach may represent a promising direction for expanding access to culturally appropriate services, particularly in settings where traditional resources are limited. After further feasibility testing, the study team plans to conduct a pilot test with sufficient sample size to randomize recipients to service delivery either from a CHW or a mental health professional. Although the stakeholders in the present study identified few problems with either the training or service delivery, a larger pilot study that would train and compare these aspects of the intervention for lay individuals versus professional therapists is likely to identify more specific areas for improvement.Originality/valueThis study provides preliminary evidence of the feasibility of training lay individuals to deliver a BA intervention. The next phase of the research will incorporate findings from this study to test the model in a larger sample.
Purpose Presentations to healthcare settings increase prior to suicide, making healthcare professionals optimally positioned to intervene. However, health and social care students receive insufficient training on engaging with individuals at risk of suicide or self-harm. This study aims to identify barriers and facilitators to implementing a suicide prevention module within undergraduate health and social care education. Design/methodology/approach A World Café methodology facilitated contributions from health and social care academics, researchers, students and representatives from governmental and non-governmental organisations. Participants took part in four rounds of structured discussion to identify key barriers and enablers to the implementation of an undergraduate healthcare suicide prevention training module. Data were gathered through a combination of group facilitator written notes and audio recordings. An online qualitative survey of participants who could not attend in-person supplemented the findings. A thematic analysis, following Braun and Clarke’s approach, was conducted. Findings A total of 24 individuals took part, including 17 World Café participants and seven survey respondents. Analysis revealed four overarching themes: (i) a blended, integrated, sustainable model; (ii) accredited and incentivised course; (iii) an evidence and policy-based offering and (iv) a student-centred approach. Research limitations/implications Findings have identified barriers and facilitators to implementation of an undergraduate suicide prevention module embedded within professional and institutional frameworks. Practical implications Key recommendations include adopting a blended delivery model, offering formal recognition for learning and utilising a train-the-trainer approach to ensure future sustainable scalability. Social implications This work highlights the value of evidence-informed curriculum innovation to address a critical gap in undergraduate suicide prevention education and prepare health and social care students for compassionate, real-world practice. Originality/value These findings have served to since inform the pilot module rollout and design of a train-the-trainer programme for this education nationally, with international collaborations also established for wider adaptation and delivery.
Purpose The Independent Review of Greater Manchester Mental Health NHS Foundation Trust published in 2024 re-emphasised that the abuse of patients within psychiatric institutions continues to occur. The findings and recommendations of inquiries are often so specific to the individual context that general principles for application to other institutions cannot be drawn. To reduce the likelihood of patient abuse, it is imperative that such principles are identified. This study aims to identify the common themes contributing to patient abuse across institutions and construct a generalisable framework that enables analysis and mitigation of underlying causes by different health-care professionals. Design/methodology/approach Using thematic analysis, the authors qualitatively analysed inquiries into six psychiatric institutions. Inquiries were selected to represent a variety of types of institutions (learning disability, general psychiatric and forensic services) across a wide timescale. Findings The identified thematic structure comprised three levels at which processes relevant to the behaviour of concern operate ("Proximal", "Organisational" and "System" Dynamic), with a fourth, cross-cutting theme of how concerns are responded to. Originality/value This study has enabled the development of a novel and generalisable framework to help understand the levels at which processes contributing to abuse occur. The framework can be used to assess and mitigate the incidence of abuse within psychiatric institutions, as well as educate and empower others to recognise when abuse may be occurring. It will benefit from further empirical testing to support its use.
PurposeThis study aims to explore the use of the open dialogue approach (ODA) in a community mental health service. The ODA is a collaborative framework designed for individuals facing complex mental health challenges, such as psychosis, which has shown positive outcomes for people with psychosis in Finland.Design/methodology/approachInterpretative phenomenological analysis informed the exploration of five mental health nurses' experiences of using ODA, illuminating their views on the efficacy and mechanisms of action of ODA. Data were generated through semi-structured interviews. Ethical approval had been awarded.FindingsThe overarching theme that was revealed through thematic analysis was that of the importance of power in the therapeutic relationship. Sub-themes that were identified include the dichotomy of experiential learning versus formalised training; the efficacy of ODA; and barriers to the implementation of ODA in the UK.Research limitations/implicationsThe limitation of this study is its small size (n = 5) and the fact it was limited to the nursing profession alone and to one specific service within one health provider. However, the themes generated within this study are transferrable to other similar areas and something others should consider.Practical implicationsThe findings underscore the need for flexibility in implementing ODA within the UK context and, most importantly, how the principle of tolerance of uncertainty can be ameliorated whilst maintaining the apparent effectiveness of ODA (as reported subjectively by all participants). Also, training, support and supervision are crucial for clinicians to effectively adopt ODA. Finally, ODA was reported by all participants as being effective for service users and was viewed as a positive experience for staff which may help with staff burnout and help with staff retention.Originality/value ODA by its very nature operates on a transparent relationship between those experiencing psychosis and health professionals. This directly challenges the legislative processes in the UK, where conversations about risk assessment and management are often covert and recorded in medical notes. Integrating ODA into the UK mental health culture promotes the maintenance of a therapeutic and transparent relationship between people accessing mental health services and mental health professionals. All participants reported that ODA appeared to have a positive effect upon service users, and this may act as a protective factor against staff burnout and help with staff retention. Finally, further research is necessary to validate its impact within the UK and to inform broader clinical practice and policy development.
Purpose - This study aims to explore the long-term personal and professional outcomes of an inner-child-centered expressive arts workshop designed for psychology graduate students. While such experiential learning is increasingly integrated into counselor education to enhance self-reflection and emotional literacy, empirical evidence regarding its enduring effects remains limited. Design/methodology/approach - A convergent parallel mixed-methods design was used. Twenty-five master's students in psychology participated in a 14-h closed-group expressive arts workshop. Immediate reflections were analyzed thematically. Four years later, 22 participants (88% retention) completed three open-ended reflective questions and two validated scales: the self-compassion scale-short form (alpha = 0.88) and the Chinese Connor-Davidson resilience scale (alpha = 0.93). Findings -Thematic analysis identified three enduring developmental themes: (1) heightened self-awareness, (2) reconnection with formative experiences and (3) deepened inner dialogue. Participants also described greater confidence in using expressive techniques and an enhanced capacity for therapeutic holding. Quantitatively, both self-compassion (M = 48.32, SD = 6.14) and resilience (M = 96.32, SD = 9.34) remained high at the four-year follow-up, with a modest but significant correlation between the two constructs (r = 0.28, p < 0.05). Research limitations/implications - Small, gender-skewed, single-site sample; lack of a control group; and reliance on self-report measures at follow-up limit generalizability and causal inference. Practical implications - Embedding structured inner child modules in professional training can foster emotional growth, improve empathy and accelerate the development of therapists' self-regulation and client-holding capacity. Social implications - Promoting inner-child-focused expressive work among mental health professionals can enhance service quality and contribute to a more emotionally resilient and compassionate helping workforce. Originality/value - To the best of the authors' knowledge, this study provides one of the first longitudinal mixed-methods evaluations of inner-child-focused expressive arts training within counselor education. The findings suggest that even brief, well-structured experiential modules can yield durable gains in self-compassion, resilience and therapeutic presence. Embedding such interventions - supported by reflective supervision - may enhance emotion regulation and professional identity formation among developing practitioners.
PurposeTrainee clinical psychologists with parenting responsibilities are vulnerable to experiencing a stress response from the demands they are faced with from the training programme and parenting. There is very little literature to understand their experience. The exploratory study aims to understand the experiences of parents who have completed the DClinPsy training programme.Design/methodology/approachQualitative semi-structured interviews were conducted with 12 Clinical Psychologists who were parents during their training in January 2024. Thematic analysis was used to analyse the data.FindingsFour themes were developed. They were theme one connection vs disconnection, theme two rigidity vs flexibility, theme three the effects on the trainee, theme four facilitators of managing demands.Originality/valueThis study expands the literature from understanding stress at the individual level, to considering systemic and cultural factors which are apparent. This population benefits from increased flexibility and connection within their training journey.
PurposeCounselors impact well-being and resilience in their communities when they themselves are well and resilient. Counselors begin learning how to prioritize wellness when they are in their academic and pre-licensed training seasons. Therefore, clinical supervisors can directly influence counselor wellness and community wellness. Faculty members can maximize this influence by bolstering and supporting the supervisors working with their students. The purpose of this paper is equip faculty with a framework for supporting clinical supervisors working with counselor education programs. Design/methodology/approachAuthors synthesized extant literature on supervision and clinical training with their own experiences as clinical faculty. FindingsThis study presents a framework to orient and support site supervisors working with counselor education programs, nominally called FOundation building, Supervision Training and Education and Reflective Space (FOSTER). Originality/valueIn the absence of any comprehensive framework to inform the design of supportive infrastructure for supervisors of master’s-level counselors, this study’s aim is to promote further discussion through presenting the FOSTER framework.
PurposeThe growing recognition of the role of traumatic events in the development and maintenance of psychopathology has led to a proliferation of trauma-informed care treatment frameworks and training programmes. Yet, specialist trauma education and practice guidance typically omit consideration of trauma needs arising from one's own actions, specifically from offending behaviour, suicide attempts and non-suicidal self-injury (NSSI). Whilst the prevalence and impacts of autogenic sources of trauma are documented, there is limited understanding of clinician awareness, attitudes and practice in this area. The present study sought to address these omissions in the literature.Design/methodology/approachRegistered health professionals in the UK completed an e-survey exploring awareness of, attitudes towards and current clinical practice in relation to post-traumatic stress disorder (PTSD) arising from one's own actions.FindingsOf 102 participants, 94 reported having some level of awareness of autogenic sources of PTSD. Most participants affirmed their validity for Criterion A requirements for PTSD, although 33% were unsure if engaging in NSSI was a potentially traumatic experience. Half reported integrating autogenic sources of PTSD into clinical activities. Lower levels of integration were associated with limited awareness of, and ambivalent attitudes towards, autogenic sources of PTSD.Research limitations/implicationsExperienced traumatologists both endorse and demonstrate a degree of ambivalence towards autogenic sources of PTSD. Factors underlying the discordance between acceptance and limited integration in clinical practice indicate the importance of educating clinicians about trauma responses arising from one's own behaviour.Originality/valueThis study identifies current core training and education needs to improve the recognition and management of PTSD arising from one's own actions.
PurposeThis study aims to explore the content and communication styles of one-on-one peer support sessions by analysing role-play exercises used in the training of mental health peer support workers (PSWs).Design/methodology/approachA qualitative study was conducted using content and thematic analysis of 11 role-play exercises. Transcriptions of sessions involving 12 participants with lived experience of mental health challenges were coded for attributes including participant gender, conversational role, perspective, valence, sentence type and type of interaction; and analysed thematically.FindingsConversations primarily addressed service users' challenges (30.3%) and the negotiation of peer relationships (24.0%). PSWs predominantly embodied a mutual, non-directive communication style, using self-disclosure (21%) as the most frequent interaction type to foster collaboration. This approach provided a "supportive validation" that complements traditional clinical models by focusing on idiographic recovery processes.Research limitations/implicationsFindings were based on a convenience sample and role-play simulations, which may not fully reflect real-world interactions. Further research in actual peer support settings is needed to validate these results.Practical implicationsThe study underscores the value of PSW training in fostering recovery-oriented communication, which can enhance mental health service delivery by integrating lived experience into professional practice.Social implicationsPeer support promotes empowerment and citizenship, addressing service users' rights and hope, which may challenge biomedical models and support community integration for individuals with mental health challenges.Originality/valueThis study provides a novel examination of the specific conversational themes and communication styles in PSW role-play training, offering insights into their unique, recovery-focused approach.
Purpose This study aims to develop and evaluate a culturally tailored, video-based workshop designed to enhance verbal de-escalation skills among nursing staff in inpatient psychiatric settings. Design/methodology/approach The study used a quasi-experimental design and was conducted in 2024-2025 at Iran Mental Health Hospital with 52 nursing staff. The training was developed based on Kern's Six-Step Approach and included locally produced video scenarios drawn from common aggression management situations in the hospital. Participants attended a four-hour session and completed a scenario-based assessment at baseline, immediately after the session, and three months later. Statistical analyses included the Wilcoxon signed-rank test and independent-sample t-tests. Findings Verbal de-escalation scores increased significantly after the training (p < 0.001), with mean scores rising from 4.32 (SD = 2.54) at baseline to 6.55 (SD = 2.75) post-intervention. At three-month follow-up (mean = 6.38, SD = 2.45), improvements were largely maintained, with no significant decline (p = 0.753). Participant feedback indicated that the video scenarios were relevant to daily clinical practice and supported practical skill development. Research limitations/implications This study relied on self-reported data and a relatively short follow-up period of three months, which may not fully capture long-term retention or behavioral changes in clinical practice. Additionally, the absence of direct observational measures or patient perspectives limits the generalizability of findings. Future research should include longer-term evaluations, comparisons with alternative educational modalities (e.g. simulation, team-based learning), and assessments across diverse psychiatric care settings. Broader studies may further clarify the scalability and sustainability of video-based training as a complementary tool in psychiatric nursing education and staff development. Practical implications The findings suggest that video-based de-escalation workshops offer a scalable and low-cost method for enhancing psychiatric nurses' confidence and skills in managing patient aggression. By integrating realistic, culturally tailored scenarios, the program provides a psychologically safe environment for practicing complex communication techniques. This approach can be incorporated into psychiatric nursing curricula and staff development initiatives, especially in resource-limited settings, to reduce reliance on coercive practices and improve patient-staff interactions. It also highlights the value of multimedia educational tools for addressing hard-to-teach competencies, supporting sustainable improvements in psychiatric care delivery. Social implications By promoting non-coercive strategies in psychiatric care, video-based de-escalation training can reduce the use of restraint and seclusion, thereby enhancing patient dignity, safety, and trust. Improved staff competence in managing aggression fosters healthier therapeutic relationships and contributes to a more humane ward culture. On a broader level, this approach supports mental health systems in addressing stigma, workplace violence, and ethical concerns, while advancing global efforts to shift from coercive practices toward patient-centered, rights-based care models. Ultimately, such training may help create safer, more compassionate, and socially responsive psychiatric environments. Originality/value This study describes a culturally contextualized video-based de-escalation training program developed using Kern's Six-Step Approach. By combining structured educational planning with realistic clinical scenarios, the program provides a practical approach to supporting non-coercive aggression management training in psychiatric care settings.
PurposeThe purpose of this study is to examine the effect of designing anti-stigma posters on the beliefs of students taking the psychiatric nursing course toward mental illness. Design/methodology/approachThis study used a single group pretest−posttest pattern. The study was conducted with 91 students who took the psychiatric nursing course. The data were evaluated using the Beliefs Toward Mental Illness Scale. Students divided into groups exhibited the posters they had prepared in the classroom environment. FindingsIt was determined that the difference between the overall score averages of the Beliefs Toward Mental Illness Scale before and after the group studies was statistically significant (p < 0.05). When the overall mean scores of the subscales of Beliefs Toward Mental Illness Scale were examined, it was determined that the “Dangerousness” and “Helplessness and Deterioration in Interpersonal Relationships” subscales had a significant difference between the pretest and posttest overall mean scores (p < 0.05), while there was no significant difference between the pretest and posttest overall mean scores of the “Shame” subscale (p > 0.05). Practical implicationsIn the process of fighting against stigma on mental illness, it may be recommended to include the practice of designing anti-stigma posters in the psychiatric nursing curriculum. Originality/valueIn the study, poster design and protest method was used in nursing education to reduce the stigma toward mental illnesses.
PurposeThe flexible assertive community treatment (FACT) model has rapidly gained ground in Norwegian mental health services. The interprofessional team aims to support all service users’ needs and work in a recovery-oriented way. The involvement of service users in shaping the services they need has been debated. This study aims to examine how the professionals in FACT teams facilitate user involvement. Design/methodology/approachQualitative interviews were conducted with 24 professionals from three teams in urban areas of Norway. All participants had more than one year of experience working in FACT teams. Reflexive thematic analysis was applied. FindingsThis study identified three strategies for service user involvement used by professionals in FACT teams. First, professionals exercised discretion and improvised, forgoing strict adherence to professional norms grounded in experience. Second, they worked on balancing the power asymmetry between service users and professionals. Third, they navigated the system to achieve service users’ goals. Research limitations/implicationsOnly professionals in FACT teams were interviewed in this study. Further research is needed on how service users experience the facilitation and negotiation of user involvement. Originality/valueThis study demonstrates important strategies that FACT professionals use to facilitate and negotiate user involvement in recovery-oriented practices.
PurposeThe objective of this study is to examine the impact of mental health on managers’ performance of small and medium-sized enterprises (SMEs) in an emerging market called Iran both during and after the COVID-19 pandemic. Furthermore, this paper studies mediating role of corporate strategy on mental health and management performance. Third, the current study aims to investigate whether the emotional intelligence (EI) moderates this relationship. Design/methodology/approachThe questionnaire tool is used to measure our variables including mental health, EI, corporate strategy and managerial performance. The authors collected the data from 384 managers in SMEs. To analyze the data, the study employs structural equation modeling with a partial least squares method while incorporating Random Forest, the Sobel Z-test and multi-gross analysis to evaluate the differences between pandemic and post-pandemic periods. FindingsConsistent with the upper echelons theory, the results show that there is a positive and significant relationship between mental health and SME managerial performance, which is mediated by corporate strategy. In other words, improved mental well-being enables SME managers to thoroughly analyze various aspects and contingencies, including the organizational structure, the economic climate of the country and internal capabilities and challenges, so they can adopt a fitting strategy leading to the economic prosperity of the company. Notably, the postcrisis performance was most strongly predicted by corporate strategy which also dealt with the prolonged impact of the pandemic further intensified by ongoing sanctions. Moreover, the findings confirm the moderating impact of EI on the relationship between mental health and managers’ performance. This means that managers with high in EI generally have a positive perspective towards tackling challenges, interpreting them as chances rather than stressors, so that they are empowered to provide competent decision-making in challenging situations. As a brief note, this article demonstrates the significant psychological stress experienced by Iranian SME managers as a result of the persistent financial instability through sanctions, inflation and political unrest. Mental health and high EI for managerial performance will still be important after the end of the pandemic. Practical implicationsThe study provides a powerful message for SME board members to do a greater job of addressing the mental health and EI of their managers when the market becomes tough so they can safeguard financial resources in order to keep a company’s value. The paper states that SMEs can learn some specific ways to nurture the mental health of their managers that would facilitate sound decision-making and leadership ability, enhance organizational productivity and increase organizational growth. Originality/valueWhereas most previous studies focused on the employee’s mental health, to the best of the authors’ knowledge, this paper is one of the first to focus on the CEO mental health as a determinant of performance in an emerging market experiencing the greatest stressors, addressing the research gap at the level of managers. Finally, the study contributes a thorough comprehension of how the relationship is in general affected by the moderating effects of EI and the mediating effect of corporate strategy.
