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The purpose of this paper is to investigate optimal resources to promote resilience in staff working in inpatient mental health services. The study also provides an example of card sorting methodology used as an efficient way to identify the most helpful resources for resilience.

In total, 25 clinical staff participated in the study. A preliminary focus group and brief literature search identified resources used in two tasks. Two card sorting tasks identified resources participants found helpful vs unhelpful and abundant vs scarce, and resources they would find valuable to use more often.

The results indicate that most resources helpful to resilience and available to staff were personal resources (relating to positive outlooks or ways of working), whereas resources valuable to resilience but scarce in the working environment were organisational resources (relating to management or social workplace culture). Resources found to not be valuable to resilience were largely personal tangible resources (e.g. smoking, massages).

The findings and method may be generalisable to other mental health services, giving insight into promoting resilience within individuals and organisations. This information could serve as guidelines to streamline the allocation of organisational resources to best promote resilience across various mental health settings.

Staff resilience to working in mental health services contributes to high-quality, sustainable patient care. This study provides further insight into how personal and organisational resources are both vital to resilience in staff working in highly challenging environments.

Improving hospital care for people with dementia is a well-established priority. There is limited research evidence to guide nursing staff in delivering person-centred care, particularly under conditions where patients are emotionally distressed. Misunderstood distress has negative implications for patient well-being and hospital resources. The purpose of this study is to use the expertise of nurses to recommend ways to care for the emotional well-being of patients with dementia that are achievable within the current hospital setting.

A qualitative study was conducted in two long-stay wards providing dementia care in a UK hospital. Nursing staff (n = 12) were asked about facilitators and barriers to providing emotion-focused care. Data were analysed using thematic analysis.

Nursing staff said that resources existed within the ward team, including ways to gather and present personal information about patients, share multidisciplinary and personal approaches, work around routine hospital tasks and agree an ethos of being connected with patients in their experience. Staff said these did not incur financial cost and did not depend upon staffing numbers but did take an emotional toll. Examples are given within each of these broader themes.

The outcome is a short-list of recommended staff actions that hospital staff say could improve the emotional well-being of people with dementia when in hospital. These support and develop previous research.

In this paper, frontline nurses describe ways to improve person-centred hospital care for people with dementia.

The purpose of this paper is to explore how staff attend to their well-being when working in an inpatient mental health setting with older adults with dementia and complex mental health needs; how staff understand the link between their well-being and the well-being of patients.

A semi-structured group interview was held with 11 members of two multidisciplinary teams. The discussion was audio-recorded and analysed using thematic analysis.

Staff reported managing their well-being by both connecting with and avoiding the difficult emotions of the work. The team avoided the gravity of the work through humour, a task-focus, an absence of thinking and the displacement of workplace frustrations onto an outgroup. Connecting with emotions was done in tolerable ways: in contained reflective spaces, in the presence of supportive others, through genuine connections with patients as people and when the organisation demonstrated care for the staff.

Avoidant strategies appeared to represent short-term ways of maintaining staff well-being, while connecting with the gravity of the work appeared to represent what we hope is a more sustainable approach to managing well-being. A crucial premise for staff well-being is teams embedded within organisations that care for their employees.

Poor staff well-being can have serious consequences for an organisation, particularly in the existentially challenging environment of dementia care. This study offers a unique opportunity to explore staff well-being in a UK inpatient mental health setting with older adults with dementia and complex mental health needs.

The perspectives of frontline clinical staff working with individuals in later life within an inpatient mental health setting, of their role in recovery, have not yet been explored. The purpose of this paper is to understand what recovery means within an inpatient mental health setting for older adults. The authors address clear implications for clinical practice.

Semi-structured interviews were conducted with 11 multidisciplinary participants across two specialist older adult recovery units at an independent hospital in the UK. Thematic analysis was applied to the transcripts.

Three main themes were identified: participants identified their normative task as the promotion of “moving on” (clinical recovery) and their existential task as personal recovery. The context in which recovery happens was highlighted as the third theme. These represented competing workplace goals of clinical and personal recovery. This highlights the need to give permission to personal recovery as the process that enables mental health recovery in older adults.

Staff working in a inpatient mental health service for older adults discussed the meaning of recovery and their role in enabling recovery. This has implications for sustainable clinical practice in this setting. Recovery-orientated practice in this setting is required but the detail is not yet understood.

Adopting a sense of critical enquiry when examining historical sources, it is possible to gain a richer and broader sense of present practice. The aim of this study is to emphasise the importance of historical research to present practice in teasing out the different elements at work and how they developed. A core assumption is that our consciousness depends on our interactions with others.

This study is part of ongoing research into the historical background of the practice of discerning compassion. The methods used include archival research and the reading of primary and secondary literature.

In particular, it becomes clear that this way of working is always going to be problematic for political authorities as it promotes the questioning of accepted beliefs. This study emphasises that the core concepts underlying enabling community practice reach deep into the past and involve events not usually associated with the traditional histories of the approach. In particular, exploring outside of the traditional mental hospital background reveals a greater involvement of women than previously demonstrated. There are processes that have deep historical roots, the culture of enquiry, the benefits of mutual support and the understanding that people flourish better interacting with each other in a supportive and trusting environment rather than through coercion and instruction.

As with all historical research, this paper is limited by the resources available to examine particular events.

Recognition of the importance of historical enquiry as relevant to present-day practice.

Historical enquiry helps to acknowledge the importance of social events in shaping our present understanding. As W.H. Rivers argues, we have to understand what happened in the past before comprehending why present sociological events occur.

This paper is a unique enquiry into the early historical antecedents of enabling community practice. It is intended to stimulate more research into the field and to stimulate debate about the relevance of particular aspects of practice. It refers to sources that are not usually part of such discussions and, by implication, suggests that there is more to be explored. It is not an exhaustive account and is to be supplemented by another paper on leadership.

Although the idea of a therapeutic community (TC) has lost none of its dynamism, there are many modern‐day environments in which the original TC model has been unable to make headway. In recent years, new ideas have been emerging for the development of institutions and services that can be adapted to a wide range of psychological needs and settings, such as homelessness hostels and refuges. The psychologically‐informed environment (PIE) arises from the scope for reflective practice, leading to changes in day‐to‐day working ‐ including a more planned variant for high secure services. The PIE approach seems to offer greater flexibility in scope than the TC model. Nevertheless, such new approaches may yet need a clear values base; and the next article in this series will explore new ideas for the creation of ‘enabling environments’ in a still wider range of settings.

This paper aims to examine reform of mental health legislation in England and Wales. It covers the period from the introduction of the 1983 MHA to the proposed reforms outlined in the Wessley Review that was published in December 2018.

This is a literature-based project.

Reform of the mental health legislation reflects two potentially conflicting strands. One is the state’s power to incarcerate the “mad”, and the other is the move to protect the civil rights of those who are subject to such legislation. The failures to development adequately funded community-based mental health services and a series of inquiries in the 1990s led to the introduction of Community Treatment Orders in the 2007 reform of the MHA.

The development of mental health policy has seen a shift towards more coercive approaches in mental health.

The successful reform of the MHA can only be accomplished alongside investment in community mental health services.

The paper highlights the tensions between the factors that contribute to mental health legislation reform.

This paper seeks to grasp the nettle of developing a “checklist” of standards that can be used to accredit a therapeutic community, which are concrete enough to be objectively assessed as present to a greater or lesser degree, but at the same time reflect the daily living learning experience of a therapeutic community in a way that practitioners will recognise as a true picture of what they do or try to do.

The paper describes the development of a set of auditable standards for democratic therapeutic communities, and the results of an initial pilot study. The original 60‐item checklist is attached.

The Kennard‐Lees Audit Checklist (KLAC) was developed out of an accreditation structure proposed to the ATC by Morris in 1998. This was developed by the present authors into 42 specific items which were posted for comment and suggestions on the ATC website in October 1999. A modified version was then discussed with the Prison Service, as a result of which a number of further items were added, resulting in the 60 items versions that was published on the ATC website in October 2000.

The checklist provides a set of auditable standards acceptable to managers, practitioners and residents of TCs. This early work acts as a measure for how things have changed since 2001.

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified.

The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs.

While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation.

The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill.

A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.