The growing number of people worldwide with mental health problems is increasing and making intensive demands on existing services. Recent reorganizations of healthcare provision in the UK have focused predominantly on administrative efficiency, standardization and cost-effectiveness. Although little evidence exists that reorganizations, per se, directly result in improved health nationally, nevertheless, organizational change coupled with improved care provision can have a considerable impact on the mental health of people. It is known that service users want person-centred help with improving their confidence, autonomy and cognitive and social skills so as to be able to manage their lives within the social context in which they live. In this study, semi-structured interviews were used to explore service users' expectations and experiences of acute inpatient care and the early post-discharge period. While the social environment of the wards was seen by many as conducive to promoting safety and interpersonal relationships, others found the experience lacking in assisting them to resume their lives post discharge. If acute care is to become more than a mechanism for addressing and containing risk, better targeted interventions are required to help individuals find strategies that are transferable to the context of their 'real' lives. A number of factors that were identified by respondents in this study are identified and discussed.

Healthcare professionals are key providers of information about antipsychotic medication and may have a significant influence on the decisions that service users make about how their medication is delivered. This systematic review aimed to explore health professionals' attitudes and beliefs towards antipsychotic depot medication. A systematic search of AMED, BNI, CINAHL, EMBASE, HEALTH BUSINESS ELITE, HMIC, MEDLINE and PsycINFO was carried out, as well as hand searches of journals and citation searches. Studies were selected if the terms 'attitudes/beliefs' and 'depot/injection' were included in the title or abstract, if health professionals were participants in the study and if original data were included. The search strategy produced 131 papers. Eight relevant studies were then selected for the review. They included six cross-sectional surveys and two qualitative studies. It was shown that the research carried out is still very sparse. Depots are seen as old fashioned, stigmatizing, causingside effects and being costly, and they are often not prescribed because of a presumed adherence to oral medication. More research needs to be carried out to further explore these issues, to look at the role of non-medical prescribers and explore the relationship between health professionals' attitudes and those of service users.

For mental health nurses and service users to realize the benefits of non-medical prescribing, psychiatrists need to understand the remit of this role and be actively involved in influencing it. Although healthcare policy in the UK supports the expansion of non-medical prescribing, it requires much more for the successful implementation of such initiatives in practice. The aim of this survey was to explore the attitudes of all grades of psychiatrist working in two mental health trusts in the West Midlands to nurse prescribing. A specifically designed questionnaire was sent out to two groups of psychiatrists to assess their attitudes towards non-medical prescribing. Psychiatrists (n = 147) completed and returned a specifically designed questionnaire of their views. The more senior doctors appeared less concerned about nurse prescribing. Junior doctors expressed equivocation towards the role, suggesting that nurse prescribers be consistently supervised and have limited access to mental health drugs. The findings from this study have considerable implications for teams if junior doctors hold different views to their senior colleagues. Without the assistance of trusts in facilitating role change, the introduction of new roles could potentially heighten conflict between professions.

Even though the introduction of the role of the nurse prescriber promises improved access to medicines and increased flexibility in the workforce, the take-up of this role to date has been variable across the UK. This questionnaire-based study sought to compare the expectations of two distinct groups of nurses, one from a mental health and the other from a non-mental health background prior to becoming prescribers. Non-mental health nurses were of the opinion that being able to prescribe would increase efficiency and maximize resources, while mental health nurses saw prescribing primarily in terms of the benefits to clients-increased choice, improved access to care, better information about treatments and better quality of care.

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This paper argues that in their trainings health professionals are encouraged to use language naively as if it were a transparent medium of scientific communication We contend that language use, particularly in the field of mental health care, should be studied in terms of its social functions and attention should be paid to the inevitably constructive nature of language in patients’records, in order that a‘fictional distance’opens up between patients and their records Recent developments in literary theory and narrative analysis can be deployed as theoretical frameworks to understand this process, and we suggest that more attention to the use of language should be included in the educational programmes for health care professionals to counteract the risk of‘linguistic entrapment’or‘incarceration’

Depression will be the second most common threat to health by the end of the next decade. The incidence of depression in primary care is already high. This has serious implications for the types of services available, the range of personnel who deliver them and the extent to which patients are helped by the treatments provided. Research reveals that approximately two-thirds of patients with depression are treated with medication, although it is not known how effective medication is in the long term. It would appear that the relationship between the patient and prescriber is a highly significant factor in determining whether or not patients adhere to treatment regimens and to what extent they improve. This study used a qualitative approach to identify how patients treated with medication for their depression perceived the relationship with their prescribing clinician, what kinds of information and advice they received and what they wanted. Several aspects of the helpful relationship are identified, such as the characteristics and behaviour of the clinician, as well as the way in which information is imparted. The frequency of monitoring consultations and patients' perceptions of their importance were also examined. The issue of stigma, particularly self-stigma and what can be done to prevent it, is discussed. The paper concludes with suggestions for improving the quality of primary care for patients' prescribed medication for depression, and especially for making maximum use of the initial consultation. The main implication for mental health nurses is that central to all interventions for depression is the primacy of the relationship, without which, clients' belief in treatment is diminished.

AIMS This paper reports a study to elicit background data from recently qualified nurse prescribers and explore aspects of their work. BACKGROUND Nurse prescribing has been introduced quite recently in the United Kingdom. Although a certain amount of information is available about the characteristics of nurse prescribers, relatively little is known about their professional backgrounds, their reasons for choosing to become nurse prescribers and their perceptions of their emerging role. More information is needed to inform the selection, education and support of nurse prescribers. METHOD All nurses who undertook a nurse prescribing course in one university in the West Midlands during 2003-2004 were invited to participate in the study. A 40-item questionnaire was used to gather data on demographics, expectations of nurse prescribing, personal and professional development and perceived education needs. FINDINGS Respondents considered that, despite initial problems, the nurse prescribing initiative would ultimately prove to be a cornerstone of improved service delivery for service users. The majority of nurses were already heavily involved in prescribing 'by proxy' and the course merely formalized what they were currently doing. Potentially, prescribing could advance the professional development of nurses, improve communication between professionals and patients, and make the experience of patients more beneficial. However, some concerns were expressed about how supportive the current climate in health care could be, given the multiple demands on time and energy required by so many other innovations. CONCLUSIONS Respondents appeared balanced in their perceptions of this innovation and what it could realistically achieve. They were not indifferent to the many short and long-term problems that need to be resolved before it can be claimed to have become embedded in practice. The success of non-medical prescribing may depend on organizational support, coupled with a robust continuing professional development strategy for all nurse prescribers.

With the reconfiguration of health services in both the primary and secondary sectors, the role of community mental health nurses (CMHNs) has become a highly contested one within mental health care. There would be great variability in the skills that CMHNs possess, the contexts in which they work and the nature of the work they do. This study sought to explore aspects of the work of those nurses who provide services at the interface between policy and practice. Two groups of CMHNs were compared, one working in an urban setting (Trust A) and the other in a rural (Trust B), focusing particularly on caseloads and client mix, the values held by CMHNs, the models of care they utilize and what they consider would improve care in the future. A specially designed 39-item questionnaire was employed, with a mix of open and closed questions, and statements to which participants were asked to respond on a three-point Likert scale. The findings raised interesting issues around collaborative working, whether CMHNs are happy to take on clients previously on their caseload, bureaucratization, autonomy, role definition within a culture of working with primary care, lack of specific models utilized by CMHNs, and the demand for greater training and educational support. The implications of the study are discussed with the aim of assisting mental health nurses determine their future roles.

Health care professionals should aspire to making medicine the most humane of the sciences It would not be difficult to support the claim that medical achievements during the 20th century rank as high, if not higher, than those in any other field of human endeavour.1 Doctors have played a significant part in delivering the findings of science to patients in a variety of health care settings. Yet, the climate today in medicine and health care is not an optimistic one; indeed, it may never have been so gloomy. We are living in an era of frequent public inquiries into health professionals’ conduct, sensational headlines about failed, inadequate or unethical care, constant surveillance of performance and outcomes, concerns about NHS funding, and growing criticism from user groups and patients. Criticism of the effectiveness and cost of the biomedical model has been growing for at least three decades. Some would say that medicine’s efficacy has been overstated and that improvements in health have been largely due to improved nutrition and living conditions, hygiene, and changing patterns of reproduction.2 Illich argued that medicine has deskilled people in caring for themselves and their families, by ignoring the contribution they can make to their own care and recovery and encouraging dependency on medical “experts”.3 Another criticism is that medicine now tends to focus solely on pathology and fails to locate the person within his or her socioenvironmental context. Patterns of morbidity and mortality are related to factors other than biology including, gender, class, race, education, income, and age.4 By looking only at the biological changes within the body, doctors fail to appreciate the links between people’s lifestyles, their domestic, cultural and social circumstances, and their illness. While never before has so much been on offer to so many patients by way …

There is little scholarship to compare the work of mental health nurses in different countries, although this is perhaps understandable given that mental health nursing as a discrete discipline exists only in a few countries worldwide. The small-scale study reported here sought to compare the perceptions of UK and American Clinical Nurse Specialists of various aspects of their work, including latest professional developments, current therapies and interventions, and the major problems confronting nurses today. Prior to the main study being undertaken, a short questionnaire was piloted in both countries. The main questionnaire was distributed to 34 American nurses and completed by 25 (75.5% response rate), and to 28 UK nurses and completed by 24 (86% response rate). Descriptive statistics and content analyses were used to analyse the data which suggested that where UK nurses were concerned with the range and availability of services for clients and their families, American nurses were primarily preoccupied with the quality of those services. The American sample placed greater emphasis on the provision of care that enabled clients to take responsibility for themselves than did their UK counterparts. While acknowledging the limitations of the study, the results would appear to suggest that American nurses tend to favour humanistic care, have a belief in the efficacy of chemotherapy and aim to get people functioning independently. They fear the threat to their relationship with clients that managed care might entail. Concurrently, UK nurses appear to be preoccupied with finding appropriate services for their clients and they appear to believe that the changing nature of their work is designed to accommodate structural changes in the health service, rather than to meet the needs of clients. The implications of these findings are discussed.

This study explores mental health nurses' and psychiatrists' perceptions of their work. It was carried out in five mental health Trusts in the West Midlands, UK. Three groups were surveyed: psychiatrists, hospital-based nurses and community mental health nurses (CMHNs). Results showed that CMHNs' sources of job satisfaction and dissatisfaction were more similar to those of psychiatrists than to those of their hospital-based counterparts. All three groups cited the intrinsic worthwhileness of their work, autonomy, the scope for creativity, the variety their job offered and their contact with clients as contributing to their overall job satisfaction. Hospital-based nurses listed the support they received from colleagues as their second source of job satisfaction, whereas CMHNs and psychiatrists cited the provision of care to patients. Excessive administrative duties and the absence of or poor quality of management were perceived by all three groups as sources for dissatisfaction with their work. Hospital nurses cited job insecurity as a principal concern more frequently than CMHNs and psychiatrists. The paper concludes by discussing recommendations for changes to improve the nature of the work in mental health services and in the work environment. Changes must reflect the concerns of the different groups of mental health professionals.

While there is agreement among stakeholders that change is required in mental healthcare, yet the precise nature of this change and how it should be brought about are relatively under-explored. Research has looked at developments taking place in primary mental health services, but relatively little has examined the work of community mental health nurses (CMHNs), especially those working at the interface between primary and secondary care. This study used a 39-item questionnaire to explore how CMHNs perceive their role and the degree to which they are able to carry it out. The findings suggests that while CMHNs are enthusiastic about their work and are keen to see mental health services develop in primary care, many are concerned about how they are perceived by other health personnel, deficiencies in their therapeutic skills and the level of support they currently receive. The study concludes by suggesting areas that managers, commissioners and educators should target to enable CMHNs to continue to play their part in a service that relies heavily upon them.

This paper explores the impact of placing Community Mental Health Nurses (CMHNs) at two primary care practices in South Staffordshire. Data were collected by means of a questionnaire which was sent to primary care personnel at these practices, to ascertain their opinions with respect to the contribution of practice-based CMHNs. Overall, primary care personnel were satisfied with the quality of the service received from the CMHNs, especially in terms of improved communication. They felt that the new arrangements enabled a quicker and more efficient access to the services of the CMHN. The results are discussed in terms of the value of having CMHNs within the primary care setting, and in terms of service planning and future recommendations for mental health services within primary care.

Previous historical studies of the care of the insane in nineteenth century England have been based in the history of medicine. In this thesis, such care is placed in the context of the English poor law. The theory of the 1834 poor law was essentially silent on the treatment of the insane. That did not mean that developments in poor law had no effect only that the effects must be established by examination of administrative practices. To that end, this thesis focuses on the networks of administration of the poor law of lunacy, from 1834 to 1870. County asylums, a creation of the old (pre-1834) poor law, grew in numbers and scale only under the new poor law. While remaining under the authority of local Justices of the Peace, mid-century legislation provided an increasing role for local poor law staff in the admissions process. At the same time, workhouse care of the insane increased. Medical specialists in lunacy were generally excluded from local admissions decisions. The role of central commissioners was limited to inspecting and reporting; actual decision-making remained at the local level. The webs of influence between these administrators are traced, and the criteria they used to make decisions identified. The Leicestershire and Rutland Lunatic asylum provides a local study of these relations. Particular attention is given to admission documents and casebooks for those admitted to the asylum between 1861 and 1865. The examination of the asylum documents, the analysis of the broader relationships of the administrators, and a reading of the legislation itself, all point up tensions between ideologies of the old and new poor law in the administration of pauper lunacy.

Aims. This study aimed to ascertain mental health nurses' perceptions of theadvantages and disadvantages of nurse prescribing and to identify the educational needs of mental health nurse prescribers.Design. A questionnaire was designed and administered to a convenience sample in the UK of 73 mental health nurses in clinical practice, 14 working in in-patient settings and 59 in the community. Questions included both closed and open-ended items. Descriptive statistics were used for numerical data, and category analysis of the open-ended questions was undertaken by two of the researchers independently and then conjointly.Findings. The majority of respondents felt that mental health nurse prescribing would significantly improve clients' access to medication, improve compliance, prevent relapse and prove cost effective. However, many were anxious that they did not have sufficient knowledge and skills to assume responsibility for prescribing.Conclusions. Although there would be benefits to clients and patients, further training, rigorous supervision and the co-operation of doctors will be required if mental health nurse prescribing is to yield the anticipated benefits.

Based on a paper given at the Cinderella Services conference at South Bank University, London, in April 2001, this paper explores the origins and development of the asylum system in Ireland, and traces the relationship between the politics and practice of mental health care. The role of the attendants is illuminated in so far as the limited primary source material allows. Although some aspects of the history of Irish mental health services have been subject to scholarship, psychiatric nursing is an area that has not. In particular, very little attention has been paid to the role that attendants and asylum nurses played in the Irish asylum system, especially during the late nineteenth and early twentieth centuries. The government constructed an extensive network of asylums and workhouses to deal with the growing numbers of mentally disordered and impoverished people. Irish asylum nurses tended to come from rural stock, and have agricultural skills; they were able to communicate with patients in either English or Gaelic. They were encouraged to impart to patients skills that would permit them to find employment or contribute to the upkeep of the asylum.

Recent studies suggest that violence in health care environments, especially mental health care, appears to be increasing. Although there is a lack of cross-cultural studies to prove it, this increase in violence would seem to be an international phenomenon. The present study sought to compare the extent and nature of violence encountered by mental health nurses in Sweden and England. Systematic studies of violence have previously been carried out independently in both countries but this was the first attempt to compare levels of violence. Clearly defined study protocols were put in place, an operational definition of `violence’ adhered to, and random samples recruited. A specially designed questionnaire was sent to every subject (Swedish nurses n=720; English nurses n=296) enquiring about the extent of nurses’ exposure to violence, the nature and severity of the violence experienced, and the effect of violence on self-esteem and job satisfaction. Significant differences were found with English nurses experiencing more violence than their Swedish counterparts. Yet support for English nurses appeared to be less good than for Swedish nurses. Reasons for the differences are discussed along with possible measures to minimise the frequency of violence against nurses and the negative effects on their work.

Nursing, in common with all healthcare disciplines, has had to respond to major developments in the wider context of health care. Shifts in government policy, changing preferences for the location of health care, over-stretched resources and new developments in medical technologies have all had a considerable impact on the modes of healthcare delivery, including nursing care. In times of rapid change, new healthcare roles emerge, others are reconstructed and some decline, as happened when fever nursing became obsolete owing to improvements in health care and living conditions during the first half of the twentieth century (Currie 1997). Over the past two decades, some nursing disciplines have expanded considerably--especially those based in the community--and specialist nursing roles in areas such as infection control, continence care, palliative care, psychotherapy, tissue viability and pain management have become commonplace. This article examines some of the implications of the 'new NHS' for practice nurses and community mental health nurses (CMHNs).