• Attitudes of general hospital staff towards patients who self-harm in South India: A cross-sectional study

      Kumar, Narendra; Rajendra, Rajagopal; Majgi, Sumanth M.; Krishna, Murali; Keenan, Paul; Jones, Steven; University of Chester (Medknow, 2016-11-30)
      Background: There is growing global interest into the attitudes and clinical management of persons who deliberately self-harm. People who self-harm experience many problems and typically have many needs related to management of their psychological wellbeing. A positive attitude amongst general hospital staff should prevail with people who self-harm. The principal purpose was to determine student staff attitudes towards patients who self-harmed from a professional and cultural perspective, which might influence patient treatment following hospital admission. The focus concentrated upon staff knowledge, attitudes and beliefs regarding self-harm. Methods: A cross sectional survey of the hospital staff using a validated questionnaire was carried out. This paper reports on interdisciplinary staff from two large general hospitals in Mysuru, South India (n=773). Results: Findings suggest that within a general hospital setting there is wide variation in staff attitudes and knowledge levels related to self-harm. Whilst there is attitudinal evidence for staff attitudes, this study investigates interprofessional differences in an attempt to progress treatment approaches to a vulnerable societal group. Very few staff had any training in assessment of self harm survivors. Conclusion: There is an urgent need for training general hospital staff in self harm assessment and prevention in south India. The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and opens potential for cross cultural comparison studies. In addition, interventions must focus on current resources and contexts to move the evidence base and approaches to patient care forward.
    • Cognitive function and disability in late Life: An ecological validation of the 10/66 battery of cognitive tests among community dwelling older adults in south India

      Krishna, Murali; Beulah, Eunice; Jones, Steven; Sundaracharj, Rajesh; Saroja, A.; Kumaran, Kalyanaraman; Karat, Samuel C.; Prince, Martin; Fall, Caroline H. D.; University of Chester (Wiley, 2015-12-17)
      Key Points • 10/66 cognitive tests are well suited for identification of older adults with cognitive and functional impairment at a population level in LMIC setting. • Lower scores on individual domains of the 10/66 battery of cognitive tests are associated with higher levels of disability and functional impairment. • It is feasible to administer 10/66 cognitive assessments in participant's own homes in India. • 10/66 cognitive tests are education and culture fair, suitable for use in population based research in India.
    • Comparisons of attempted suicide between India and UK

      Jones, Steven; Keenan, Paul; Krishna, Murali; University of Chester (Mental Health Nursing Association, 2014)
      This paper aims to raise the issues and dilemmas within India by suicide and attempted suicide. In the UK evidence-based interventions have progressed over the past 20 years and changes are having positive benefits on standards of interventions and reducing deaths in some areas by suicide. However, when comparing one culture’s custom and practice with another, deficits of some areas of practice present and this facilitates some interesting insights for investigation. Fundamentally, the aim is not to place one above another but to aid identification for cross-cultural comparisons leading to practice advancements.
    • Decision making for refusals of treatment—a framework to consider

      Jones, Steven; Monteith, Paul; Williams, Barry (Journal of Paramedic Practice, 2014-05-02)
      Challenges to practice are encountered on a daily basis by paramedics that often share many common recurring themes around consent or refusal to treatment. The benefits of training and open debate acknowledge the often complex decisions relating to consent and mental capacity and reduce opportunities for future legal challenge. How the law should be integrated into everyday decision making will be examined and a framework proposed to assist practice for defendable decision making. This article was inspired following joint training undertaken with paramedics and local critical incident managers from the police, which highlighted a need for a practical decision-making framework to be available for application during incidents and for use as an analytical tool to aid post-decision reflection and learning at debrief.
    • Electro Convulsive Therapy: Milestones in its history

      Jones, Colin; Jones, Steven; University of Chester (Mental Health Nurses Association, 2018)
      ECT is a treatment where an electrical current is passed briefly through electrodes applied to the scalp to induce generalised seizure activity. This article explores the origins and developmental milestones of ECT, examines the literature on the history of ECT and concludes with the author’s work experiences.
    • Embedding recovery based approaches into mental health nurse training- a reflective account

      Jones, Steven; Bifarin, Oladayo O.; University of Chester (Mark Allen Healthcare, 2018-11-02)
      Background: Mental health nursing has undoubtedly progressed as a profession but is at a hiatus that is not assisted by government policy and decreased resources. Aims: This reflective account explores some of the considerable expectations placed upon qualified nurses and the real tensions that influence care delivery standards. Methods: Reflecting on experiences gained in clinical settings, underpinned by literature on recovery, some of the expectations placed on qualified nurses in contemporary mental health service delivery are examined. Conclusion: In order to adequately inform the practices and skill set of contemporary mental health nurses, recovery models and clinical staff input should play a central role in nurse education. Education and clinical practice areas should continue to move towards each other and seize every initiative to ensure both are on the same page.
    • High drug related mortality rates following prison release: Assessing the acceptance likelihood of a naltrexone injection and related concerns

      Murphy, Philip N.; Mohammed, Faizal; Wareing, Michelle; Cotton, Angela; McNeil, John; Irving, Paula; Jones, Steven; Sharples, Louisa; Monk, Rebecca; Elton, Peter; et al. (Elsevier, 2018-07-04)
      Background and aims. High drug related mortality amongst former prisoners in the 4 weeks following release is an internationally recognised problem. Naltrexone injections at release could diminish this by blockading opioid receptors, but naltrexone is not licenced for injection for treating opiate misuse in the United Kingdom and some other countries. This study examined the likelihood of accepting a naltrexone injection at release, and the relationship of this likelihood to other relevant variables. Method. Sixty-one male prisoners with a history of heroin use, who were approaching release from two prisons in the north-west of England, provided likelihood ratings for accepting a naltrexone injection if it were to have been available. Additional data was gathered regarding demographic and drug use histories, and also from psychometric instruments relevant to drug misuse and treatment preparedness. Results. Maximum likelihood ratings for accepting a naltrexone injection were recorded by 55.7% of the sample with only 9.8% indicating no likelihood of accepting an injection. Likelihood ratings were positively related to serving a current sentence for an acquisitive offence compared to drug related or violence offences, and negatively related to peak methadone dosages during the current sentence. Conclusions. Although naltrexone injections were not available to participants in this study, the findings suggest that the potential uptake for this intervention is sufficient to warrant a clinical trial with this population of British prisoners, with a view to potential changes to its current licencing status
    • An Interpretive Phenomenological Analysis (IPA) of coercion towards community dwelling older adults with dementia: Findings from MYsore studies of Natal effects on Ageing and Health (MYNAH)

      Danivas, Vijay; Bharmal, Mufaddal; Keenan, Paul; Jones, Steven; Karat, Samuel C.; Kalyanaraman, Kumaran; Prince, Martin; Fall, Caroline H. D.; Krishna, Murali; University of Chester (Springer, 2016-09-29)
      Purpose Limited availability of specialist services places a considerable burden on caregivers of Persons with Dementia (PwD) in Low- and Middle-Income Countries (LMICs). There are limited qualitative data on coercive behavior towards PwD in an LMIC setting. Aim The aim of this study was to find relevant themes of the lived experience of relatives as caregivers for PwD in view of their use of coercive measures in community setting in South India. Method Primary caregivers (n = 13) of PwDs from the Mysore study of Natal effects on Ageing and Health (MYNAH) in South India were interviewed to explore the nature and impact of coercion towards community dwelling older adults with dementia. The narrative data were coded using an Interpretative Phenomenological Analysis (IPA) approach for thematic analysis and theory formation. Results Caregivers reported feeling physical and emotional burn-out, a lack of respite care, an absence of shared caregiving arrangements, limited knowledge of dementia, and a complete lack of community support services. They reported restrictions on their lives through not being able take employment, a poor social life, reduced income and job opportunities, and restricted movement that impacted on their physical and emotional well-being. Inappropriate use of sedatives, seclusion and environmental restraint, and restricted dietary intake, access to finances and participation in social events, was commonly reported methods of coercion used by caregivers towards PwD. Reasons given by caregivers for employing these coercive measures included safeguarding of the PwD and for the management of behavioral problems and physical health. Conclusion There is an urgent need for training health and social care professionals to better understand the use of coercive measures and their impact on persons with dementia in India. It is feasible to conduct qualitative research using IPA in South India.
    • Mental Health Decisions; what every officer should consider

      Williams, Barry; Jones, Steven; University of Chester (Police Professional, 2012-05-24)
      It can often appear to Police officers that they are damned if they do make decisions, and damned if they don’t in mental health cases. A culture has evolved that triggers decision apathy and defensive decisions that arguably do not benefit the Police, public, or the mental health arrestee. Decisions of this presenting complexity in whatever profession must be made and firmly rooted within the current evidence base, lawful, and also be reasonable in the given situation. It is therefore not unreasonable to expect officers to explain and account for how and why they acted as they did, and the frameworks (statutes/ codes) which should underpin such practice decisions. It is of paramount importance that Police officers are kept appraised of developments in mental health cases and how this crucially will inform, and sometimes correct custom and practice. This article in three parts aims firstly to refresh officer’s knowledge. Second, inform current practice and address practice from recent cases involving the police and mental health patients. Thirdly, and perhaps the most crucial through case examples offer a decision making framework to support operational staff in the right direction for mental health practice and defend practice challenges that may arise at all levels.
    • Methadone‐Assisted Opiate Withdrawal and Subsequent Heroin Abstinence: The Importance of Psychological Preparedness

      Jones, Steven; Jack, Barbara; Kirby, Julie; Wilson, Thomas; Murphy, Philip; University of Chester
      Background and Objectives: Treatment guidelines emphasize patients’ readiness for transitioning from opiate substitution treatment (OST) to opiate withdrawal and abstinence. Psychological preparedness indicators for this transition were examined. Methods: Patients (all male) were recruited from three treatment settings: prison, an inpatient detoxification unit, and an outpatient clinic. Time 1 (T1) was admission to methadone‐assisted withdrawal in all settings. Time 2 (T2) was a 6‐month follow‐up. With n = 24 at T1 for each group (N = 72), a battery of instruments relevant to psychological preparedness was administered. Results: At T1, inpatients had higher self‐efficacy beliefs for successful treatment completion than prison patients. For patients contactable at T2, T1 self‐efficacy positively predicted T2 opiate abstinence. No other variable improved prediction. T1 SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale) ambivalence scores, age, and lifetime heroin use duration predicted maintenance of contact or not with treatment services and contactability by the researcher. Measures of mood did not differ between groups at T1 or predict T2 outcomes. Discussion and Conclusions: Self‐efficacy beliefs are a potentially useful indicator of readiness for transitioning from OST to a medically assisted opiate withdrawal and subsequent abstinence. Ambivalence regarding change, age, and lifetime heroin use duration are potentially useful predictors of patients maintaining contact with services, and of being retained in research. Scientific Significance: These findings advance existing literature and knowledge by highlighting the importance of self‐efficacy in psychological preparedness for opiate abstinence, and the predictive utility to clinicians of this and other variables measurable at admission, in the clinical management of opiate users
    • Nurses attitudes and beliefs to attempted suicide in Southern India

      Jones, Steven; Krishna, Murali; Rajendra, Raj G.; Keenan, Paul; University of Chester (Taylor and Francis, 2015-05-20)
      Background: There is growing global interest into the attitudes and clinical management of persons who have attempted suicide. Aims: The principal purpose was to determine senior nursing staff attitudes towards patients who had attempted suicide from a professional and cultural perspective, which might influence care following hospital admission. The focus concerned nursing staff interactions at a psychological level that compete with physical tasks on general hospital wards. Methods: A qualitative methodology was employed with audio-taped interviews utilising four level data coding. This article reports on a group of 15 nursing staff from a large general hospital in Mysore, Southern India. Results: Findings suggested that patient care and treatment is directly influenced by the nurse’s religious beliefs within a general hospital setting with physical duties prioritised over psychological support, which was underdeveloped throughout the participant group. Conclusion: The results allow a series of recommendations for educational and skills initiatives before progressing to patient assessment and treatment projects and cross-cultural comparison studies. In addition, interventions must focus on current resources and context to move the evidence-based suicide prevention forward.
    • Physical health impairment, disability and suicidal intent among self-harm survivors in South India

      Jones, Steven; Somashekar, R; Bharath, D.U; Maiji, Sumanth M; Taylor, Lou; Nagaraj, Santhosh; Krishna, Murali; Mysore Medical College and Research Institute; University of Chester; CSI Holdsworth Memorial Hospital; FRAMe; Viveka Hospital
      Background: Suicide is major public health concern in India. There are limited data examining the relationship between health impairment, disability and severity of suicidal intent. The aim of the study was to examine the associations of health impairment and disability with severity of suicidal intent among survivors following an act of self-harm. Methods: A pilot exploratory study of 453 self-harm survivors from a specialist hospital in South India. Sociodemographics, physical health impairment, disability (WHO Disability Schedule-II), suicidal intent, (Pierce suicide intent scale) and mental disorders were studied. Results: Arthritis was the most common physical impairment among self-harm survivors followed by gastrointestinal, sensory impairment and difficulty with mobilization. Nearly 10% of participants had some degree of functional impairment, with 38% experiencing severe physical pain in the week prior to self-harm. Past history of depression treatment, age, education and occupation influenced positively PSIS scores. There were significant associations between suicidal intent and disability. Conclusions: Indian self-harm survivors indicated complex relationships between physical health, disability and suicidal intent. Understanding these associations may help to develop suicide prevention strategies. Our findings suggest a need for integrating a comprehensive of physical health assessment in self harm survivors.
    • Social and Clinical Correlates of Stimulant Use Disorder (Mephedrone) in a Tertiary Mental Health Setting in Mumbai: A Pilot Exploratory Study

      Rao, S. Poornima; Kale, Vinayak Pandurang; Panigrahi, Sunilkumar; Krishna, Murali; Jones, Steven; Majgi, Sumanth Mallikarjuna; Bharath, D. U.; University of Chester
      Introduction: Increasing mephedrone use is a major public health concern in India. There are limited data on sociodemographic determinants and psychiatric comorbidity associated with stimulant use disorder (mephedrone) (SUD‑M) from India. Aim: The primary objective of this study was to report the clinical and social correlates of SUD‑M among those presenting to specialist mental health services in Mumbai, India. Methods: Patients with SUD-M were recruited from a clinical setting. Standardized culturally validated assessments were carried out to obtain information about sociodemographics and mental health: comorbid psychopathology Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Minnesota Multiphasic Personality Inventory‑2 for personality traits and a clinical assessment for diagnoses of mental disorders. Results: Seventy patients (aged between 21 and 30 years, of whom 58 men) with SUD-M consented. SUD‑M was more common among young men from the low socioeconomic position. The most common reasons for choosing mephedrone over other substances were better high from the drug and peer pressure. There were no associations between sociodemographic factors with the severity of SUD-M. Around 40% of the patients with SUD-M had psychiatric comorbidity. Psychotic disorders and anxiety symptoms were most common. Family history of substance use, comorbid substance use, and comorbid psychiatric disorders were directly related to the severity of SUD-M. Conclusions: This was a cross‑sectional study with a relatively smaller sample size of self‑nominating participantslimiting the generalizability of findings to a wider population. Therapeutic implication of this finding is that prompt attention and treatment of the comorbid psychiatric disorder is essential while treating patients with SUD-M. Further population-based studies are recommended for a better understanding of the burden of SUD-M.
    • Systematic review and meta-analysis of group cognitive behavioural psychotherapy for sub-clinical depression

      Krishna, Murali; Lepping, Peter; Jones, Steven; Lane, Stephen; University of Chester (Elsevier, 2015-06-04)
      Key Points • Group CBT for patients with sub-threshold depression has a significant effect on depressive symptomatology at post treatment in both working age and older adult population. • Group CBT does not appear to reduce the incidence of major depressive disorders. • Group CBT has minimal or no effect on depressive symptomatology during follow-up. The article considers group psychotherapy in sub-threshold depression to investigate if group psychological interventions reduce depressive symptoms post treatment, and whether these interventions result in a reduced incidence of new cases of major depressive disorder.
    • Training nurses in Mental Health Assessment using GMHAT/PC in India

      Jones, Steven; Keenan, Paul; Danivas, Vijay; Krishna, Murali; Rajendra, Rajgopal; University of Chester (Indian Psychiatric Society, 2017-07-23)
      Book chapter; Training of Indian general nurses in a hospital setting required the structure offered by the Global Mental Health Assessment Tool (GMHAT) that would provide a framework to underpin mental health assessment training. Attitudes of those undertaking the training and current levels of knowledge and awareness to mental health issues was explored prior to any training occurring in the use of GMHAT, that we considered fundamental to good mental health practice
    • Use of GMHAT/PC in old age population in India

      Krishna, Murali; Ramya, M.; Sharma, Vimal; Jones, Steven; University of Chester (Indian Psychiatric society, 2017)
      Book chapter