Background: Existing research on poor perinatal mental health largely focuses on recognition and treatment of postnatal depression. Consequently, there is a need to explore antenatal mental health. Aim: To assess poor mental health prevalence in pregnancy, its relationship to sociodemographic characteristics, self-efficacy and perceived support networks. To understand experiences and barriers preventing women with mental health problems from receiving help and explore midwives’ understanding of their role. Method: Questionnaires were completed by women in early pregnancy. A subset identified to have mental health problems, were interviewed in late pregnancy to explore their experiences and barriers to receiving care. Midwives completed questionnaires exploring their experiences of supporting women with mental health problems and focus groups further discussed the issues raised. Results: Amongst participants (n=302), the Edinburgh Postnatal Depression Scale (EPDS) identified 8.6%, and the Generalised Anxiety Disorder Assessment (GAD-7) 8.3%, with symptoms of depression or anxiety respectively. Low self-efficacy (p=0.01) and history of previous mental health problems (p<0.01) were most strongly associated with anxiety or depression. Thematic analysis of interviews with women (n=20) identified three themes: ‘past present and future’; ‘expectations and control’; and ‘knowledge and conversations’. Questionnaires were completed by 145 midwives. The three themes identified from the focus groups with midwives were: ‘conversations’; ‘it’s immensely complex’; and ‘there’s another gap in their care’. Conclusion: Prevalence rates of anxiety and depression amongst women in early pregnancy were found to be similar to those reported in the literature. Low self-efficacy and previous poor mental health were significant predictors of anxiety and depression. Continuity and more time at appointments were suggested by midwives and women to improve discussions regarding mental health. Midwives were keen to support women but lacked knowledge and confidence. Consistent reference was made to the need for training regarding the practical aspects of supporting women’s mental health.
Nicola has a series of journal papers lined up from her doctorate, with the one I’ve linked to above (‘Prevalence and predictors of poor mental health among pregnant women in Wales using a cross-sectional survey’) being just the first.
In the event I was able to make less of the conference than I had intended, but I did have the opportunity to co-present a paper with Michael Coffey titled Involving stakeholders and widening the net: reflections on going beyond database searching arising from an evidence synthesis in the area of end of life care for people with severe mental illness. Our presentation arose from the MENLOC study, and specifically addressed the incorporation of non-research materials in evidence syntheses and the value of directly working with people with experience of the field. Here’s a link to the recording we made, on behalf of the whole project team:
At June’s MHNAUK meeting the group heard from Dr Crystal Oldman, of the Queen’s Nursing Institute, who spoke about specialist practice qualifications. Updates from colleagues across the four countries of the UK were followed by meetings of each of MHNAUK’s standing groups, where in the Research group we talked (amongst other things) about the importance of growing capacity in mental health nursing research. Elsewhere in the whole-group meeting we heard of plans to seek charitible status for MHNAUK: an exciting move, in my view.
This paper, appearing in the journal Nurse Education Today, is a fine piece of work and a good example of theory-informed evaluation. Here’s the abstract:
Background: Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice.
Objective: This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice.
Design: Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within “context,” and to ask what “mechanisms” are acting to produce which “outcomes.” This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4).
Methods: Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements.
Results: This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts.
Conclusion: The findings from this study should inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for such programmes is to maintain and improve patient care.
This new paper has been a long time in the making. Work on it began with preparations for an address given at the Australian College of Mental Health Nurses conference in 2018. Refinements and updates happened towards the end of 2019, in the context of preparing for a talk delivered at a Royal College of Nursing-sponsored event in Cardiff in 2019, with a further version presented at an online conference organised by Julia Terry, from Swansea University, during the 2020 coronavirus lockdown. Along the way the written article has benefited from a critical reading from both Michael Coffey and Nicola Evans, and from no fewer than four anonymous peer reviewers. My thanks to all of them.
Wales is a small country, with an aging population, high levels of population health need and an economy with a significant reliance on public services. Its health system attracts little attention, with analyses tending to underplay the differences between the four countries of the United Kingdom (UK). This paper helps redress this via a case study of Welsh mental health policy, services and nursing practice. Distinctively, successive devolved governments in Wales have emphasised public planning and provision. Wales also has primary legislation addressing sustainability and future generations, safe nurse staffing, and rights of access to mental health services. However, in a context in which gaps always exist between national policy, local services and face-to-face care, evidence points to the existence of tension between Welsh policy aspirations and realities. Mental health nurses in Wales have produced a framework for action, which describes practice exemplars and looks forward to a secure future for the profession. With policy, however enlightened, lacking the singular potency to bring about intended change, nurses as the largest of the professional groups involved in mental health care have opportunities to make a difference in Wales through leadership, influence and collective action.
The argument I’ve developed here is that policy for health care in Wales, and for mental health care specifically, has distinctive features. As a peer reviewer I continue to have to correct manuscripts which conflate ‘England’ with the ‘UK’, and I’ve tried in this article to point out some of the things which make Wales different. I have also highlighted what seem, to me, to be gaps between well-intentioned policy aspirations and actual experiences as revealed through research. Overall, though, I intend the paper to convey a message of optimism, noting (amongst other things) the high value placed on the relational work of mental health nurses and the positive differences nurses make. Enjoy the read!
As this most difficult of years reaches its end here’s a big shout-out for registered and student mental health nurses everywhere, whose work and study has been tipped on its head during the pandemic. It’s not been easy, as this preprint from the Mental Health Policy Research Unit shows. The article reports pre-peer review findings from a survey examining how the coronavirus crisis has exerted an impact on the care provided by mental health nurses in the UK. Here’s the ‘what this paper adds’ section:
This paper provides a unique insight into the experiences and impact that the Covid-19 pandemic has had on mental health nurses across a range of community and inpatient settings to understand what has changed in their work and the care they can and do provide during this crisis. This includes exploring how services have changed, the move to remote working, the impact of the protective equipment crisis on nurses, and the difficult working conditions facing those in inpatient settings where there is minimal guidance provided.
The COVID-19 pandemic has drawn attention to the existence of devolved government in the UK. Here in Wales we’re used to hearing from Mark Drakeford, but my guess is that it’s only in recent months that most people in other parts of the UK will have become actively aware of his role as First Minister, and indeed the authority held by the Welsh Government to create policy and to legislate. For a helpful discussion on all things Wales and COVID-related, here’s a link to an episode of The Bunker podcast on the same.
In a Wales-themed episode of #mhTV held in October 2020 I joined a discussion panel alongside Hazel Powell (Nursing Officer for Mental Health and Learning Disability in the Chief Nursing Officer’s team) and Michelle Forkings (Associate Director of Nursing/Divisional Nurse for Mental Health and Learning Disability in Aneurin Bevan University Health Board) to talk about policy, power and mental health health nursing. Here’s a link:
This year’s International Mental Health Nursing Research Conference (#MHNR2020) happened over two weeks in September, as planned through #mhTV and with a whole lot of help from Dave Munday, Nicky Lambert and Vanessa Gilmartin. Along with everyone else who values this annual event I’m indebted to all three for the work they’ve put in over the months to make #mhTV happen, and to do so as an entirely free offering open to anyone with use of an internet connection.
I enjoyed my chance to join Mick McKeown as a co-host of #MHNR2020’s evening panel discussions, and the format of inviting guests to pre-record and upload their presentations ahead of bringing them together in themed groups worked well. Every pre-recorded presentation and panel conflab can be viewed on the conference webpage, and will remain there as a resource for the future. As it happens, I pitched up as a panel member on the evening of September 25th, speaking about findings from the MENLOC evidence synthesis in the area of end of life care for people severe mental illness. As a shortcut, here’s a link to my pre-recorded presentation summarising our main findings:
Back in summer 2019 (which seems, for pandemic-related reasons, to be much longer than a year ago) I wrote a short post introducing the 3MDR study. Here, now, is the main findings paper in early view in the journal Acta Psychiatrica Scandinavica. Working on a clinical trial has been an interesting, learning, experience for me and this feels like an important project to have made a contribution to.
I realise, too, that I’ve neglected to draw attention on this site to two papers co-written with Ray Samuriwo, both drawing on systems perspectives, wounds and mental health: see here and here. Ray is an original thinker, and makes interesting connections across different fields: check out, too, Values in health and social carefor which Ray was lead author.
Back in pre-pandemic January 2020, the idea that a couple of hundred curious mental health nurses and their friends might gather together to share their research, practice development, educational and related projects seemed quite unremarkable. At that time, with the aim of enouraging a gathering of this sort, I published a short post on this site promoting the call for abstracts for the 2020 edition of the International Mental Health Nursing Research Conference.
How much has changed since then. As an organising committee we made a relatively early decision to call off the face-to-face conference originally scheduled for June 11th at Middlesex University. Now, in May 2020, #MHNR2020 is being brought into a new initiative called #mhTV.
The #MHNR2020 scientific committee will be reviewing all abstracts submitted for the intended June 11th conference, and once this work is done we’ll be in touch with invitations for authors to consider turning their presentations into a format suitable for #mhTV. We’ll identify episodes selected in this way as part of #MHNR2020 and publish details on the MHNAUK website. In the meantime, more on #mhTV and on how to submit new ideas can be found here.