To investigate levels of knowledge and attitudes towards advance healthcare directives among inpatient psychiatry service users in Ireland.

A survey was completed among adult inpatient psychiatry service users (n = 47) in Tallaght University Hospital, Dublin.

Just over one in ten (11%) inpatient psychiatry service users had heard of advance healthcare directives. None had created an advance healthcare directive, but over a quarter (25.5%) had written down or verbally told someone what they would like to happen when they became unwell. When asked ‘if you were supported by your healthcare provider to make an advance healthcare directive, would you like to make one?’, over two thirds responded either ‘definitely yes’ (34%) or ‘probably yes’ (34%). On multi-variable testing, future willingness to make an advance healthcare directive was significantly associated with younger age but not with ethnicity, gender, education, employment status, or prior knowledge of advance healthcare directives. All respondents would involve someone else in making an advance healthcare directive. There was high confidence that healthcare practitioners would respect an advance healthcare directive (87%).

There are high levels of interest in advance healthcare directives, but low levels of knowledge and use among inpatient psychiatry service users in Ireland. Our findings indicate a need for educational initiatives and resources to increase awareness. Such efforts could usefully focus especially on appropriate use of advance healthcare directives in psychiatric care and seek to bridge the gaps between evidence of benefit, legislative reform, and their use in mental healthcare.

Mentalization-based treatment (MBT) has promising transdiagnostic applications. The evidence base for its application in non-specialist settings, including general adult community mental health services requires further evaluation. This study explores the implementation of an MBT introductory (MBTi) group in an Irish secondary mental health service.

Two online MBTi groups were delivered between 2020 and 2021. A concurrent mixed-methods design was engaged. Qualitative pre- and post-intervention measures include the Clinical Outcomes in Routine Evaluation (CORE) scale, the World Health Organization Quality-of-Life (WHOQoL-BREF) scale and the Reflective Functioning Questionnaire (RFQ). Paired sample t-test was employed to analyse change. Interviews were conducted with seven participants post-intervention and inductive thematic analysis was utilised to identify themes.

Participants exhibited hypomentalizing tendencies, which improved following the delivery of the intervention (RFQu: MD = 0.54, p = 0.032, Cohen’s d = 0.71). There were improvements across the wellbeing, problems and functioning subscales of the CORE. There was no change in the risk domain, which was low at baseline. Improvements were observed in the WHOQoL-BREF subscale of psychological health and social relationships. Five main themes emerged from post-intervention interviews: barriers and facilitators; attitudes to design and delivery; perceived intervention effectiveness; intervention coherence; COVID-19 specific issues.

MBTi delivered in a non-specialist setting is associated with improvements in mentalizing capacity. The intervention is perceived as relevant and useful by participants, although the psychoeducation and online format conferred specific limitations. The findings support the role of MBTi as a feasible transdiagnostic intervention in general adult services, as part of a range of interventions.

The intersection between the Assisted Decision-making (Capacity) Act 2022 (ADMCA) and the Mental Health Act, 2001 (MHA) has prompted considerable debate. Although not alone in its differential treatment of mental health and physical health advance healthcare directives (AHDs), Ireland is unique in affording legally binding status to mental health AHDs for some but not all inpatient service users detained under mental health legislation. As such, in this study we aim to compare groups of service users for which AHDs would be binding or not at point of detention and to track changes in binding status over the course of admission.

This is a retrospective observational study examining involuntary admissions to a 36 bedded acute psychiatric unit in Dublin from 2021 to 2023. Admissions were grouped into those initially detained on grounds of risk or on the treatment criterion alone, as this would determine binding status of a mental health AHD. We also examined changes to binding status over the course of admission to calculate median bed days when a service user would be entitled to a binding AHD. Descriptive statistics and inferential testing (Chi-squared and Mann–Whitney U) were used to analyse the data.

Of 287 admissions of 212 service users, 73.9% admissions were under the treatment criterion alone and would therefore qualify for a binding AHD. We found that diagnosis, mode of detention, and service division were significantly associated with AHD binding status. Service users would qualify for binding AHDs on 83.6% of involuntary bed days and, of those admissions affirmed by the first tribunal, 89.9% would qualify for binding AHDs in the days afterward.

Most involuntary service users would qualify for a legally binding AHD under the ADMCA for at least part of their admission. Should AHDs become common practice, binding AHDs will play a significant role in inpatient psychiatric care.

The Collaborative Assessment and Management of Suicidality (CAMS) framework is an evidence-based approach to treating individuals with suicidality. It involves collaboration between patients and clinicians to assess, plan and treat suicidal risk, using the Suicide Status Form. This study applies the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to explore the experiences of Irish higher education counselling staff in implementing CAMS, providing insight into the factors that influence its successful integration into student mental health services.

A mixed-methods approach was adopted, via an online survey and follow-up interviews with student counselling staff to explore the implementation of the CAMS framework. Sixty-four staff members from student counselling services in Irish higher education institutions completed the online survey. Ten participants engaged in follow-up interviews to further explore survey findings. Data on reach, effectiveness, adoption, implementation and maintenance were gathered through the RE-AIM framework.

Survey respondents report treating approximately 44% of individuals presenting with suicidal risk using the CAMS framework. The majority (88.1%) of respondents reported positive outcomes for suicidal patients. Most respondents (91%) found the training beneficial and had ‘definitely’ or ‘somewhat’ incorporated CAMS into their management of suicidal patients. There were three main themes identified from interview data: diverse approaches to implementation, the value of CAMS in practice and challenges in implementing CAMS.

CAMS has provided a strong toolkit for improving suicide-specific skills, communication and collaboration, but fidelity varies due to resource and support limitations. Additional resourcing, increased staff buy-in and further research could lead to smoother implementation in student counselling services.

Advance care planning (ACP) involves nuanced conversations to elicit an individual’s beliefs, values, and preferences regarding future care. However, despite recognition of the positive impact, representative population surveys indicate low uptake of ACP, figures replicated internationally. Complex medical issues, including cognitive impairment, can interact with and exacerbate mental health challenges in later life, which can make decision-making more complex. ACP and Advance Healthcare Directives support people during periods of incapacitating mental illness. This paper reporting on the first stage of an action research study exploring ACP from the perspective of interdisciplinary mental healthcare professionals in the context of Older Person’s Mental Health, took place in the dawn of the Assisted Decision-Making Capacity Act (2015), which has considerable implications for practice.

The first action research stage consisted of three sub-stages combining quantitative and qualitative methods, with the findings of each sub-stage iteratively informing the development of the next.

The results of the study indicate that whilst overall ACP is largely viewed as positive by healthcare professionals, confidence, and experience levels vary in practice, with a strong desire for additional specific training and tools to support ACP engagement indicated. The study also revealed facilitators and barriers to ACP; and addressing existential anxiety, giving voice, person-centred approach, and push and pull factor themes.

This study highlights some important implications for person-centred practice centring on the need to balance an active stance to ACP whilst also respecting the right not to engage for varying psychological and emotional reasons.

Psychiatric advance directives (PADs) and joint crisis plans (JCPs) are documents that allow users of mental health services to state their preferences for treatment for a future situation in which they are unable to give consent. In Germany, both PADs and JCPs are legally binding in the context of mental healthcare.

The objective of this study was to examine mental health professionals’ views on PADs and JCPs, identify challenges in their application in clinical practice, and derive recommendations for their implementation.

We conducted semi-structured interviews with 14 mental health professionals with experience in JCPs in Germany. We analyzed the interviews following qualitative content analysis.

Participants identified several opportunities associated with JCPs, including strengthening the therapeutic relationship and building trust, promoting self-determination and participation, fostering therapeutic progress, reducing coercion, and enhancing the attitudes of mental health professionals. They also recognized a number of challenges, such as limited resources, insufficient knowledge and interest among service users, uncertainty and skepticism among mental health professionals, and the infrequent updating of JCPs. In addition, participants offered suggestions for improving the implementation of JCPs at both organizational and practical levels.

Mental health professionals describe a variety of opportunities and challenges of JCPs in clinical practice. To address these challenges and enhance the implementation of JCPs, further research and targeted training for mental health professionals are needed, alongside the development of institution-specific policies.

To examine awareness of metabolic syndrome, lifestyle habits and attitudes towards physical health monitoring in a cohort of service users prescribed clozapine.

A cross-sectional study, utilising chart reviews and surveys, of service users attending a clozapine clinic in Ireland, to examine awareness of metabolic syndrome, current dietary and exercise habits and attitudes towards physical health checks for metabolic syndrome was conducted.

Sixty-nine service users attending the clozapine clinic (53.1% of attendees) participated in the study of which 23 (33.3%) participants met criteria for metabolic syndrome within the previous 12 months. Nine (13.0%) participants were aware of the term “metabolic syndrome”, with six aware of what metabolic syndrome entailed. Forty-seven (68.1%) participants described their diet as “healthy”, with 17 (24.6%) participants reporting the consumption of five portions of fruit and vegetables per day on a regular basis. Thirty-eight (55.1%) participants reported engaging in ≥ 2.5 hours of exercise per week. Most participants (> 70% for all physical indices) agreed that physical health monitoring was important with 46 participants (66.7%) stating physical health monitoring should occur monthly.

Although there was a limited awareness and understanding of “metabolic syndrome” in this cohort of service users prescribed clozapine, monitoring of physical health indices was acknowledged as important. Early dietary and exercise interventions in an attempt to combat high morbidity and premature mortality rates are advised for this service user cohort.

Psychiatric advance directives (PADs) are documents enabling individuals with mental health conditions to specify their treatment preferences for future mental health crises. Despite the benefits of PADs, their implementation has progressed slowly. Concerns about PADs among professionals seem to be part of the explanation. A commonly reported concern is that service users will use PADs to document extensive treatment refusals. Research has not yet explored professionals’ views on ethical conflicts arising from such refusals.

The objective of this study was to explore professionals’ perspectives on ethical conflicts arising from treatment refusals in legally binding PADs.

We carried out semi-structured interviews with 14 mental health professionals working in Germany with professional experience with PADs. We prompted discussions using a case report of an ethical conflict arising from a treatment refusal documented in a PAD. We analyzed the data thematically.

Professionals described the case as extreme yet not unfamiliar. While many felt obligated to respect the PAD, they also felt inclined to override it to promote service user well-being, restore service user autonomy, and protect others. Those inclined to override the PAD focused on scrutinizing its validity and applicability, raising doubts about information disclosure, voluntariness, decision-making capacity, and PAD irrevocability. Professionals believed ethics consultation would help address the ethical conflict.

Legally binding PADs can create ethical conflicts when they include treatment refusals. While the best policy response remains unclear, professionals can help prevent such conflicts by supporting service users in drafting PADs.