• A conceptual framework outlining the use of compassionate mind training following incidents of moral injury within forensic mental health services

  Williams, Catrin; Cook, Aimee (Emerald Group Publishing, 2025)

  Purpose: Forensic mental health professionals often face challenging situations that can lead to moral injury. This occurs when individuals' experiences or actions conflict with their values and moral beliefs, leading to psychological distress or discomfort. Moral injury has been shown to be linked with a plethora of adverse psychological health outcomes, and can impair both occupational and personal functioning, including the quality of care delivered to service users. Design/methodology/approach: This paper details how forensic mental health professionals can respond to threat-based thinking, emotions and self-criticism using compassion following incidents of moral injury with compassionate mind training (CMT). Finding(s): CMT has been found to alleviate psychological distress and support development of soothing capabilities (Gilbert and Procter, 2006). Practical implications: This paper describes the central tenets of CMT and how it supports the balancing of three motivational systems: threat, drive and soothing systems. Originality/value: It further highlights the three flows of compassion: compassion from others, compassion towards others and compassion for self and how this can influence staff well-being in relation to moral injury. Copyright © 2025, Emerald Publishing Limited.
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  Mechanical restraint in inpatient psychiatric settings : a systematic review of international prevalence, associations, outcomes, and reduction strategies

  Whiting, Daniel; Tully, John (Cambridge University Press, 2025)

  BACKGROUND: There is increasing emphasis on reducing the use and improving the safety of mechanical restraint (MR) in psychiatric settings, and on improving the quality of evidence for outcomes. To date, however, a systematic appraisal of evidence has been lacking. METHODS: We included studies of adults (aged 18-65) admitted to inpatient psychiatric settings. We included primary randomised or observational studies from 1990 onwards that reported patterns of MR and/or outcomes associated with MR, and qualitative studies referring to an index admission or MR episode. We presented prevalence data only for studies from 2010 onwards. The risk of bias was assessed using an adapted checklist for randomised/observational studies and the Newcastle-Ottawa scale for interventional studies. RESULTS: We included 83 articles on 73 studies from 1990-2022, from 22 countries. Twenty-six studies, from 11 countries, 2010 onwards, presented data from on proportions of patients/admissions affected by MR. There was wide variation in prevalence (<1-51%). This appeared to be mostly due to variations in standard protocols between countries and regions, which dictated use compared to other restrictive practices such as seclusion. Indications for MR were typically broad (violence/aggression, danger to self or property). The most consistently associated factors were the early phase of admission, male sex, and younger age. Ward and staff factors were inconsistently examined. There was limited reporting of patient experience or positive effects. CONCLUSIONS: MR remains widely practiced in psychiatric settings internationally, with considerable variation in rates, but few high-quality studies of outcomes. There was a notable lack of studies investigating different types of restraint, indications, clinical factors associated with use, the impact of ethnicity and language, and evidence for outcomes. Studies examining these factors are crucial areas for future research. In limiting the use of MR, some ward-level interventions show promise, however, wider contextual factors are often overlooked.
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  Barriers and facilitators to using standardised diagnostic assessments in child and adolescent mental health services : a qualitative process evaluation of the STADIA trial

  Thomson, Louise; Newman, Kristina L.; Ewart, Colleen; Sayal, Kapil (Springer Nature, 2025)

  The STADIA trial aimed to assess the effectiveness of a standardised diagnostic assessment tool (Development and Wellbeing Assessment, DAWBA) in aiding clinician-made diagnosis decisions in Child and Adolescent Mental Health Services (CAMHS). This study reports the qualitative process evaluation of the STADIA trial, which aimed to identify barriers and facilitators to using the online-completed DAWBA in CAMHS. Qualitative data were collected through 109 semi-structured interviews with young people, parents/carers, healthcare professionals and service commissioners/funders in 8 CAMHS sites across England. Deductive thematic analysis was guided by the domains of the Consolidated Framework for Implementation Research. Young people and parents/carers showed high levels of engagement with the DAWBA. They perceived a validation of symptoms from the generated DAWBA report, which they actively used as 'evidence' when seeking help from other services. Clinicians involved in determining referral acceptance/rejection decisions were positive about its use and saw benefits in aiding decision-making. In contrast, however, barriers to clinicians engaging with the DAWBA report during the assessment stage arose from limited awareness and accessibility to the report, a context of high workload and pressure, and general concerns about the value of a diagnosis. The DAWBA was not widely used by clinicians in the expected way to aid diagnostic decision-making. However, it may offer children and young people much-needed engagement during long waiting times for initial assessment in CAMHS. The DAWBA may be more acceptable to clinical teams in triaging referrals to help with timely decisions about the most suitable services.Trial registration ISRCTN15748675 (29/05/2019).
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  Black psychiatrists' experience of discrimination and related behaviours in the workplace : UK survey

  Orrell, Martin (Cambridge University Press, 2025)

  AIMS AND METHOD: In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being. RESULTS: Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance. CLINICAL IMPLICATIONS: These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.
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  What works well for people with dementia and their supporters from South Asian, African and Caribbean communities in the UK: A narrative synthesis systematic review and expert consultations

  Orrell, Martin (Wiley, 2025)

  OBJECTIVES: This review aims to synthesise the evidence regarding the use and provision of dementia services and support for people with dementia and/or supporters from South Asian, African or Caribbean backgrounds living in the UK. METHODS: A narrative synthesis systematic review of the original research articles published up to April 2024 was conducted. A lay summary of the initial review findings was evaluated by experts-by-experience (n = 15) for scrutiny and to enable further discussions, to produce key recommendations for further developing dementia services. RESULTS: A total of 18 studies (16 qualitative and 2 mixed methods studies) met the full inclusion criteria and were included in the review. The review findings and experts-by-experience consultations highlighted that: (1) dementia is not openly discussed or disclosed within many diverse ethnic communities. This can lead to family carers and people with dementia feeling isolated and unsupported. (2) Mainstream dementia support services and hospitals often do not meet diverse communities' cultural and religious needs, and (3) home-based care supported by external care agencies can be helpful but ensuring consistency of care staff in their culturally appropriate care can be extremely difficult to ensure. CONCLUSIONS: Encouraging South Asian, African and Caribbean communities to increase their dementia knowledge is important. However, mainstream dementia support services also need to incorporate their cultural and religious essentials into care packages to encourage their help seeking behaviours and tackle dementia stigma. Collaborative service developments between the diverse communities, Health and Social Care providers and policy makers are essential to ensure equitable and culturally appropriate dementia care for diverse community members in the future.

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