From the community to the emergency department: A study of hospital emergency department nursing practices from the perspective of carers of a loved one with Borderline Personality Disorder

Acres, Kristy; Loughhead, Mark; Procter, Nicholas

doi:10.1111/hsc.13558

Cited by 5 publications

(3 citation statements)

References 24 publications

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“…The mechanism for such changes remains unclear. Given that carers often report insensitive, judgemental or even bigoted responses about BPD from health professionals ( Acres et al, 2021 ; Chanen, 2021 ; Lamont and Dickens, 2021 ; Lawn and McMahon, 2015 ), it is possible that the experience of enrolling in a carer intervention (and study) might provide sufficient validation of the carers’ difficulties, instil hope and create an expectation of change, all of which might contribute to a reduction in burden ( Bateman and Fonagy, 2019 ). Longitudinal data on the natural course of burden, from a cohort of carers who have not received an intervention, would help to elucidate this issue.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features

Betts

Seigerman

Hulbert

et al. 2023

Aust N Z J Psychiatry

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Objective: Preliminary evidence indicates that interventions designed to support family and friends (‘carers’) of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial. Method: This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15–25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person’s sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, n = 38), or (2) the two self-directed online psychoeducational modules alone (Online, n = 41). The primary outcome was ‘negative experiences of care’, measured with the Experience of Caregiving Inventory, at the 7-week endpoint. Results: A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], Mage = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online n = 35 [47.9%], Online n = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary ( d = −0.32; 95% confidence interval = [−17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge. Conclusion: Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers’ preferences for support and barriers to care.

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Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features

Betts

Seigerman

Hulbert

et al. 2023

Aust N Z J Psychiatry

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“…Caregiving in the context of suicidal behaviour is particularly demanding, and is associated with poorer carer psychological, psychosomatic and physical health as well as increased caregiver burden (Marshall et al, 2023), defined as "the emotional, social, and financial stress that illnesses impose on caregivers" (Chessick et al, 2007, p. 483). Carers describe feelings of grief, helplessness, distress, overwhelm, guilt, fear, and anger (Acres et al, 2022;Izon et al, 2020;Lee et al, 2018;Spillane et al, 2020). They also report family conflict, disruption to work and social activities, and financial difficulties (Shah et al, 2010), as well as experiencing stigma, blame and social isolation (Spillane et al, 2020).…”

Section: Role Of Carersmentioning

confidence: 99%

Stronger Together: A case study exploring the development and piloting of an intervention facilitating family and informal carers to support adults at risk of suicide and serious self-harm

Frances

2024

Preprint

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Globally, more than 700,000 people die by suicide every year. Yet suicide is seen as a preventable phenomenon, and there are calls for prevention to be prioritised by mental health services. In the UK there is growing consensus in policies and guidelines towards carer involvement in a person’s mental healthcare, including their role in suicide prevention, and in the co-design and co-production of services. Notwithstanding, inadequate and inconsistent levels of collaborative working remain commonplace, with confidentiality and information-sharing protocols acting as a major barrier to involvement. There is also little recognition of the distress and difficulties carers may face in supporting those exhibiting suicidal behaviours, and what information, knowledge and support may be needed for them to safely hold high levels of risk.This project report provides a qualitative analysis of the literature exploring the needs and challenges of carers supporting suicidal adults, and how these can be addressed. It then critically reflects on the co-production of Stronger Together, a two-day quality improvement initiative being piloted in Devon to reduce suicide risk and improve patient safety through carer involvement. It also examines how this programme addresses (1) the needs and challenges of carers supporting those at high risk of suicide and serious harm, and (2) the barriers to carer collaboration within mental healthcare. A case study methodology employing autoethnographic and questionnaire methods is used for this purpose. Co-production was fundamental to shaping the content, structure and delivery of Stronger Together, to ensure its relevance and accessibility to carers. Learning from the development and implementation of this programme will be of value to mental health Trusts looking to find ways to embed a culture of carer collaboration to improve patient safety, reduce deaths by suicide and more effectively support patients’ family and friends.

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“…Carers who attend the ED with the person that is presenting come with an expectation that effective and compassionate mental health care will be provided (Acres et al . 2021 ) including after care (follow‐up). The National Standards for Mental Health Services clearly upholds the human rights of people who are entering the mental health system, affirming that they are partners of their own healthcare which should occur in a safe environment and in a timely manner (Australian Government 2010 ).…”

Section: Introductionmentioning

confidence: 99%

Communication pathways from the emergency department to community mental health services: A systematic review

McIntyre

Reeves

Loughhead

et al. 2022

Int J Mental Health Nurs

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This systematic review synthesizes existing peer reviewed evidence reporting on evaluated strategies used for enhancing communication pathways for continuity of care between the emergency department and mental health community supports. Following the PRISMA guidelines and the PICO framework, this review was conducted between January and July 2021. Included articles needed to evaluate communication pathway interventions for continuity of care between the emergency department and mental health community services which support service users with mental health and/or suicidal crisis. The seven included studies identified three support coordination interventions, two motivational interviewing interventions, an electronic record enhanced strategy and results from a phone follow-up study. This review demonstrates that support coordination, motivational interviewing, education, or an enhanced electronic record strategy can improve continuity of care, and in some cases, reduce the need for people to represent to ED when they are experiencing mental health concerns or suicidal crisis. Results of this review reveal that a multipronged approach of communication pathways for continuity of care would enable more effective connections with mental health community supports and enable better outcomes for people requiring services.

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From the community to the emergency department: A study of hospital emergency department nursing practices from the perspective of carers of a loved one with Borderline Personality Disorder

Cited by 5 publications

References 24 publications

A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features

A randomised controlled trial of a psychoeducational group intervention for family and friends of young people with borderline personality disorder features

Stronger Together: A case study exploring the development and piloting of an intervention facilitating family and informal carers to support adults at risk of suicide and serious self-harm

Communication pathways from the emergency department to community mental health services: A systematic review

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