International Journal of Healthcare Simulation

Background:

The mortality gap experienced by individuals with severe mental illness (SMI) remains high, with SMI patients having a life expectancy of 10–20 years lower than the general population, suggesting that these patients are benefiting less from advances in healthcare [1]. The past decade has seen an increased focus on policy and guidance to reduce restrictive interventions in mental health settings [2]. A large teaching hospital in South London identified a need to improve the care of patients with mental health needs in the acute Trust. This study presents the findings of a simulation-based training focused on reducing restrictive practices in acute settings with the aim of improving skills and knowledge in caring for mental health patients.

Methods:

The simulation courses were interprofessional and delivered online over 2 days. Day one involved didactic teaching around common mental health presentations, de-escalation skills, the public health approach to reducing restrictive practices when working with mental health patients in the Acute Trust, legal frameworks, referral pathways, and personal wellbeing. Day two comprised of 4–5 scenarios covering a range of common mental health presentations in the acute Trust, including Delirium/agitation/psychosis; Emotionally Unstable Personality Disorder, Angry Relative scenario, Hypoxia and craving meds/cigarettes, Bipolar. The simulations involved specially trained actors as simulated patients to ensure consistency and to allow for improvisation in their responses to participants. Actors represented the diverse communities of South London, and Equality, Diversity, and Inclusion was considered from the development stages discussed in debriefings. Participants (n=65) completed a pre- and post-course questionnaire measuring their confidence in course specific skills and human factors skills, as well as collecting qualitative feedback on their experience of the course and intention to apply the learning.

Results:

Participants (n=65) showed a statistically significant difference between their pre- (M=90.40, SD=19.96) and post- (M=100.03, SD=21.01) course human factors scores, t(64)=5.06, p<.001, CI[0.359, 0.891], with a moderate effect size of d=0.63. There was also a statistically significant difference between their pre- (M=33.11, SD=6.18) and post- (M=38.83, SD=4.59) course specific skills scores, t(64)=8.78, p<.001, CI[0.778, 1.393], with a large effect size of d=1.09.

Conclusion:

The course was effective at improving participants’ self-efficacy in working with mental health patients. Improving knowledge, skills, and confidence across disciplines and professions in Acute Trusts will enhance the quality of care that mental health patients from diverse backgrounds receive when requiring hospital care.

References

1. De Mooij LD, Kikkert M, Theunissen J, Beekman AT, De Haan L, Duurkoop PW, Van HL, Dekker JJ. Dying too soon: Excess mortality in severe mental illness. Frontiers in Psychiatry. 2019;10:855.

2. The Stationary Office. Mental Health Act 1983: Code of Practice. (2015). Norwich. 3: 98–338.