Magical thinking and moral injury: exclusion culture in psychiatry

Beale, Chloe

doi:10.1192/bjb.2021.86

Cited by 31 publications

(37 citation statements)

References 11 publications

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“…11 Liaison psychiatry, owing to its placement in acute hospitals and role in the provision of psychosocial assessments for patients who have self-harmed, provides an important pathway to aftercare. 6,12,13 Although significant service issues for patients seeking help for selfharm are indicated, [14][15][16][17][18] no studies have investigated barriers and facilitators to accessing aftercare from the perspective of staff referring on to services. Working closely with staff and patients to understand the service context may provide opportunities to improve patient safety and access to aftercare.…”

mentioning

confidence: 99%

Liaison psychiatry practitioners’ views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study

et al. 2023

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Background Timely provision of aftercare following self-harm may reduce risks of repetition and premature death, but existing services are frequently reported as being inadequate. Aims To explore barriers and facilitators to accessing aftercare and psychological therapies for patients presenting to hospital following self-harm, from the perspective of liaison psychiatry practitioners. Method Between March 2019 and December 2020, we interviewed 51 staff members across 32 liaison psychiatry services in England. We used thematic analyses to interpret the interview data. Results Barriers to accessing services may heighten risk of further self-harm for patients and burnout for staff. Barriers included: perceived risk, exclusionary thresholds, long waiting times, siloed working and bureaucracy. Strategies to increase access to aftercare included: (a) improving assessments and care plans via input from skilled staff working in multidisciplinary teams (e.g. including social workers and clinical psychologists); (b) supporting staff to focus on assessments as therapeutic intervention; (c) probing boundaries and involving senior staff to negotiate risk and advocate for patients; and (d) building relationships and integration across services. Conclusions Our findings highlight practitioners’ views on barriers to accessing aftercare and strategies to circumvent some of these impediments. Provision of aftercare and psychological therapies as part of the liaison psychiatry service were deemed as an essential mechanism for optimising patient safety and experience and staff well-being. To close treatment gaps and reduce inequalities, it is important to work closely with staff and patients, learn from experiences of good practice and implement change more widely across services.

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confidence: 99%

Liaison psychiatry practitioners’ views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study

et al. 2023

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“…Our study gives warning that that distilling the complexity of suicide risk in this way can reinforce false notions about the ability of clinicians to be able to control and prevent such incidents. It also risks shutting down genuine communication between mental health professionals and the patient [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Psychiatrists’ Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study

Tamworth

Killaspy

Billings

et al. 2022

IJERPH

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There is a lack of support for mental health professionals who experience a patient suicide or homicide. This is despite a high likelihood of such an occurrence and the heavy professional and personal toll the experience can take. We conducted 15 interviews with members of a facilitated peer support group run for consultant psychiatrists who have experienced a patient homicide or suicide. Our interviews explored the trauma of the experience as well as the effectiveness of the group in helping the clinician heal. Our results echoed previous research that the experience can be profoundly traumatic. A professionally facilitated, consultant-only peer group specifically dedicated to suicide and homicide were the key components helping participants to process their grief. Mental health trusts should consider setting up facilitated peer support groups for clinicians who experience patient suicide or homicide.

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“…2020, pg.1)’, is important, so is ED's role in raising concerns and advocating for better service access, other than waiting in a busy ED (Allison et al . 2019; Beale, 2022; Van Der Linden et al . 2019; White & Brooker 2020).…”

Section: Challenging the Status Quo And Advocating For Better Patient...mentioning

confidence: 99%

“…Overall, endeavours to advocate for better access to care for those experiencing mental health issues, often influenced by drug and social factors (Yap et al 2020), remain a key focus for the local ED. Whilst ownership, in accepting and providing mental health care within this acute setting when there is 'nowhere else to go (Duggan et al 2020, pg.1)', is important, so is ED's role in raising concerns and advocating for better service access, other than waiting in a busy ED (Allison et al 2019;Beale, 2022;Van Der Linden et al 2019;White & Brooker 2020).…”

Section: Challenging the Status Quo And Advocating For Better Patient...mentioning

confidence: 99%

“…Internationally, a recent publication identified that the United Kingdom's (UK) National Health Service (NHS) highlighted concerns around a lack of accessibility and availability of mental health services (Beale, 2022). Positive findings reported from the RPAH project, in particular the MHLN (NP) role, found improved patient experiences and outcomes, increased ED staff confidence, and reduced workload activity on overstretched mental health services (Wand et al 2021a;White & Brooker 2020).…”

Section: Challenging the Status Quo And Advocating For Better Patient...mentioning

confidence: 99%

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Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective

O’Sullivan

2022

Int J Mental Health Nurs

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Providing appropriate, timely intervention and care to people who present with mental health issues to an Emergency Department presents unique ongoing challenges, often affecting patient experiences and outcomes. To address such concerns, a Mental Health Liaison Nurse role, led by a Mental Health Nurse Practitioner, was introduced to a regional Emergency Department. This role provided integrated emergency‐based mental health clinical practice, with positive findings reported in a recently published multi‐site translational research project. With sound quantitative and qualitative evidence detailing the benefits of this role, the experiential perspective from a clinician working in this frontline space further confirms the importance of having access to such a position in leading cultural and systemic change. This discussion article identifies key processes that align current research with the clinical perspective. Such processes recognize the challenges of implementing a new role and moving forward from these to embed consistent clinical practices. The need to build sound internal and external stakeholder partnerships, effect change implementation, and assign recommendations to ensure sustainability of improved practice and processes are highlighted in this paper. This article is, therefore, designed to assist other advanced practice nurses, who may be embarking on a similar journey and want to influence organizational policy and practice.

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Magical thinking and moral injury: exclusion culture in psychiatry

Cited by 31 publications

References 11 publications

Liaison psychiatry practitioners’ views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study

Liaison psychiatry practitioners’ views on accessing aftercare and psychological therapies for patients who present to hospital following self-harm: multi-site interview study

Psychiatrists’ Experience of a Peer Support Group for Reflecting on Patient Suicide and Homicide: A Qualitative Study

Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective

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