International Journal of Mental Health Nursing (2009) 18, 83–90 doi: 10.1111/j.1447-0349.2008.00578.

Feature Article
Mental health nurses establishing psychosocial
interventions within acute inpatient settings
Antony Mullen*
Lake Macquarie Mental Health Service, Hunter New England Area Health Service, University of Newcastle,
Newcastle, New South Wales, Australia

ABSTRACT: Acute inpatient units provide care for the most acutely unwell people experiencing a
mental illness. As a result, the focus for care is on the containment of difficult behaviour and the
management of those considered to be ‘at high risk’ of harm. Subsequently, recovery-based philoso-
phies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role
that mental health nurses play in the treatment process in the acute inpatient setting, a review of the
literature indicates that mental health nursing practice is too custodial, and essentially operates within
an observational framework without actively providing psychosocial interventions. This paper will
discuss the problems with mental health nursing practice in acute inpatient units highlighted in the
current literature. It will then put forward the argument for routine use of psychosocial interventions
as a means of addressing some of these problems.
KEY WORDS: acute inpatient unit, mental health nursing, psychosocial intervention.

INTRODUCTION relapse prevention, and psychoeducation. They also

There is no doubt that acute inpatient units are challeng-
ing environments to work in. They are extremely busy,
high-pressured environments that deal with complex
mental health issues. They also are expected to deal with
high bed occupancy rates, high patient turnover, and
short length of stays (Bowles 2000; Cleary 2003; Cleary
2004; Higgins et al. 1999; Hurst et al. 1998; Mistral et al.
2002). These reasons are used to explain why mental
health nurses find it difficult to provide evidence-based
psychosocial interventions in acute inpatient units
(Happell et al. 2002). Psychosocial interventions include
such strategies as stress management, self-coping skills,
Correspondence: Antony Mullen, Lake Macquarie Mental Health
Service, Hunter New England Area Health Service, PO Box 833,
Newcastle NSW 2300, Australia. Email: antony.mullen@hnehealth.
nsw.gov.au
Antony Mullen, RN, BN, MN, FACMHN
*A version of this paper was presented to the Hunter Mental Health
Conference ‘Getting it Right Acute Care’ in Newcastle (NSW, Australia)
in May 2006.
Accepted September 2008.
include psychological therapies, such as cognitive behav-
ioural strategies or motivational interviewing techniques.
A lack of skills and knowledge in these interventions
has also been used to explain this situation (Baker 2000;
Bowles 2000; Cleary et al. 2005; Gournay 1995; Gournay
et al. 1998). However, mental health nurses report that
there is no time to engage in these activities (Happell
et al. 2002). On the contrary, the more chaotic and busy
the environment, the greater the need to ensure that
structured and proactive interventions are provided.
Recently, a study in the UK attempted to outline the
purpose of acute inpatient units. Essentially, the function
of these units was to provide assessment of mental health
problems, management and care coordination, keep the
patient safe, meet basic health needs, and provide effec-
tive treatment (Bowers et al. 2005a). In another inquiry,
Bowers (2005) specified the roles of mental health nurses
within acute inpatient units: to collect and communicate
information, give and monitor treatment, tolerate and
manage disturbed behaviour, provide personal care, and
manage the environment.

© 2009 The Author

Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
84
On this basis, the provision of treatment is an agreed
function of acute inpatient mental health units and
alegitimate role for mental health nurses. Yet a vital part
of treatment, in the form of psychosocial interventions,
is not being provided. Another reason for this is that
patients in acute inpatient mental health units are
regarded as being ‘too unwell’, and therefore, lack the
necessary insight to benefit from psychosocial inter-
ventions. Despite this argument, authors have suggested
that acute inpatient units are indeed highly suitable places
for psychosocial interventions to be provided (Baker
2000; McGann & Bowers 2005).
Risk assessment and observation are the main
strategies used to maintain patient safety within inpatient
units (Barker & Cutliffe 1999; Bowles 2000; Bowles et al.
2002). There is an increasing trend towards managing
the risk by hospitalization itself, without also utilizing
structured therapeutic interventions (Bowles 2000). In
other words, there is no expectation to proactively engage
clients in psychosocial interventions as a means of
managing the risk.
The literature identifies a number of problems with
mental health nursing practice in inpatient settings.
In the present study, this literature is reviewed, and
an argument for the establishment of psychosocial
interventions as a partial solution to this situation is
articulated.
METHOD OF LITERATURE REVIEW
The CINAHL and MEDLINE databases were searched,
initially using general terms ‘acute inpatient mental health
units’ and ‘mental health nursing’, in order to identify
review or discussion articles. A number of key review
articles were produced from this initial search and articu-
lated certain problems with mental health nursing prac-
tice within acute inpatient units. Influential authors were
also identified through perusing the reference lists from
these review articles. Those authors were in turn searched
separately. Areas of practice and key terms began to
emerge, such as ‘custodial care’, ‘reactive practice’, and
‘observation culture’, and these were further searched as
keywords in the same databases. The final list of problems
generated were the most cited practice issues in the lit-
erature. The majority of articles reviewed were discussion
papers or qualitative studies of mental health nursing
practice. There is very little in the current literature that
reports empirical findings or measures the outcomes
of implementing psychosocial interventions in acute
inpatient settings.
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
A. MULLEN
PROBLEMS WITH MENTAL HEALTH
NURSING PRACTICE IN ACUTE
INPATIENT SETTINGS
Reduced patient interaction
The amount of time nurses spend in meaningful face-to-
face interactions has declined. Talking to patients seems
to have been replaced by observing patients. Further-
more, time spent in the nurse’s office or time involved
in paperwork and administrative duties is discussed as
contributing to this situation (Bowers et al. 2005a; Bowles
2000; Higgins et al. 1999; Hurst et al. 1998).
Observation culture
The trend towards observing and monitoring patients,
rather than interacting and engaging with them, is also
discussed in the literature and is referred to as the ‘obser-
vation culture’ (Barker & Cutliffe 1999; Bowles 2000;
Bowles et al. 2002). Policies appear to have reinforced an
over reliance on risk status and how often a patient is
observed and ‘checked’, rather than an understanding
of what is happening for the patient. The ongoing need to
engage, assess, and interact is therefore negated because
nurses inadvertently believe they already have the neces-
sary information to provide care.
Defensive and reactive practice
Related to an ‘observation culture’, mental health nurses
have fallen into a defensive mode of practice, where time
is spent reacting to situations, rather than being proactive
in planning individualized nursing interventions. It is
thought that mental health nurses have become psycho-
logically withdrawn from patient interactions (Bowles
2000; Fourie et al. 2005; Higgins et al. 1999). This may be
the by-product of working within acute inpatient environ-
ments and an attempt to protect oneself from burnout,
or be the result of burnout itself.
Focus on risk management and
observation protocols
Close observation protocols are a widely accepted method
of managing those patients deemed to be at risk (Cleary
et al. 1999) Some have questioned the rationale and/or
effectiveness of such protocols (Bertram & Stickley 2005;
Bowers et al. 2005a; Bowles 2000; Bowles et al. 2002).
For example, do they merely give the appearance of
keeping patients safe or are they a valid intervention?
Furthermore, patients have reported the experience of
continuous observation as being degrading and humiliat-
ing (Bowles et al. 2002). A focus on risk as the primary
problem potentially leads care away from the treatment
© 2009 The Author
ESTABLISHING PSYCHOSOCIAL INTERVENTIONS
of symptoms and the underlying condition. Surely the
emphasis is best placed on equipping the person with
the skills to manage distress in order to overcome future
situations where they may be at risk, rather than merely
focusing on the risk itself. In other words, a skills
approach for managing risk that aims to develop an
autonomous approach aimed at prevention and self
management.
Overemphasis on medication
While medication is an important part of treatment, it
would seem that it has become the default approach in
situations where other interventions could be used either
alone or in conjunction (Bowles 2000; O’Brien & Cole
2004). Where mental health nurses are most open to this
criticism is in the use of PRN, or as needed, medication;
for example, giving benzodiazepine medication for insom-
nia or agitation, without exploring sleep hygiene strate-
gies, relaxation or breathing exercises, or other forms of
distraction. Authors have suggested that the indication for
PRN is when other less invasive interventions have failed,
rather than being a first-line intervention (Usher & Luck
2004). Furthermore, the progress of a patient can be
measured by the amount of PRN medication that is being
used during a given period. It is a concern for nursing
practice if patient outcomes are being measured in such a
way. This is particularly concerning when you consider
that the documentation surrounding the rationale for
PRN medication and the effect is often unclear (Curtis &
Capp 2003).
The emerging evidence to support the delivery of cog-
nitive behaviour therapy (CBT) within acute inpatient
settings for psychotic disorders provides an interesting
opportunity for mental health nurses to balance the use
of PRN medication for psychotic symptoms. Specifi-
cally, this evidence centres on faster remission rates
and reductions in positive symptoms (Drury et al.
1996a,b; Haddock et al. 1999; Lewis et al. 2002; Startup
et al. 2004). It is crucial that the appropriate training and
supervision be provided if mental health nurses are to
utilize such strategies. Nonetheless, mental health nurses
can support the CBT framework in managing psychotic
symptoms in collaboration with other expert clinicians.
Custodial care
Current practice has been criticized for being overly cus-
todial, where patients are largely supervised by nurses in
a similar way that prisoners are watched by prison officers.
Furthermore, being overly controlling or paternal, or
where strict limit setting measures are used regularly, are
also features of custodial approaches to care cited in the
© 2009 The Author
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
85
literature (Alexander & Bowers 2004; Bertram & Stickley
2005). Authors have highlighted problems with puni-
tive responses and the risk of reinforcing dysfunctional
behaviour. This is widely viewed as a counterproductive
approach, where the denial of patient requests has been
linked with violence, and the imposing of restrictions
with absconding (Bertram & Stickley 2005; Bowers
et al. 2005b; Bowles 2000; Cleary et al. 1999; Crichton
1998; Nijman et al. 1997). This demonstrates a disparity
between the use of choice and respect to facilitate
functional interactions and behaviour. Setting limits is an
attempt to control difficult behaviour; however, being
inflexible only exacerbates problematic behaviour, thus
reducing control. The goal is to provide opportunities
for negotiating care. Psychosocial interventions provide
a structure for this to occur more easily.
Lack of use of psychosocial interventions
For some time, the literature has expressed concern over
the lack of routine use of psychosocial interventions
within mental health services, including acute inpatient
units (Gournay 1995; Sin & Scully 2008). One of the
reasons for this situation has been the lack of skills
and knowledge in the specific psychosocial interventions
themselves (Baker 2000; Bowles 2000; Cleary et al. 2005;
Gournay 1995; Gournay et al. 1998). It is unclear why
such efficacious psychosocial interventions that directly
address some of the reasons people are hospitalized are
not more routinely provided. Mental health nurses are
well placed to provide a number of these interventions
because of the close involvement they have with patient
care. This is further highlighted by the critical relation-
ship between consumer outcomes and mental health
nursing practice previously established in the literature
(Rydon 2005). A lack of involvement in case presentations
and review, ward rounds, and other multidisciplinary
communication forums have also been noted in the lite-
rature. This is either due to lack of confidence or skills,
perceived time pressures, or lack of perceived relevance.
These are all vital for the implementation and continua-
tion of psychosocial interventions (Bowles 2000; Cleary
et al. 2005; Gournay et al. 1998).
For the purposes of this discussion, psychosocial
interventions refer to the following:
• Engagement & management of therapeutic alliance
• Biopsychosocial assessment
• Cognitive behaviour therapy
• Dialectical behaviour therapy
• Psychoeducation and relapse prevention
• Stress management and problem solving
86
• Medication adherence strategies
• Motivational interviewing
(Baker 2000; Baker et al. 2005; Drury 1996a; Gamble
& Brennan 2000; Gournay 1995; Happell et al. 2002;
Kemp et al. 1998; Munro et al. 2005; Rydon 2005). It is a
systematic return to the routine use of psychosocial inter-
ventions that I believe addresses many of the problems
with mental health nursing practice identified in the
literature.
ESTABLISHING ROUTINE
PSYCHOSOCIAL INTERVENTIONS
In view of the criticisms of mental health nursing practice,
mental health nurses require an approach to practice that
can deal with the acute and chaotic nature of inpatient
environments and provide treatments that work. The
routine use of psychosocial interventions offers a practical
solution to this problem. A range of very practical thera-
peutic interventions outlined earlier form the basis of
this approach. For example, activity scheduling is a
recognized cognitive behavioural strategy used for the
management of depression.
The use of this strategy in acute inpatient units has
demonstrated improvements in the levels of pleasure
and satisfaction, with overall benefits for recovery from
depression (Iqbal & Bassett 2008).
There are even treatments with emerging efficacies
to deal with co-existing substance use problems, such
as motivational interviewing (Baker et al. 2005).
While there is emerging evidence for psychosocial
interventions, the degree of evidence available needs to
be considered carefully. Many attempts have been made
to empirically test the effectiveness of many of the psy-
chosocial interventions. The level of evidence we call
upon is significant in examining this concept (Mace &
Moorey 2001; Parry et al. 2005).
There are five levels of evidence, ranging from expert
opinion to randomized controlled trials. Randomized con-
trolled trials are notoriously difficult to apply to psycho-
social interventions. Because there are so many variables
that can affect the outcome, it is difficult to determine
whether the intervention tested was responsible. It is
often unclear how treatments evaluated in experimental
conditions will translate into the muddy world of clinical
practice, including acute inpatient environments (Mace &
Moorey 2001). However, lower levels of evidence, includ-
ing professional consensus, would argue that CBT strate-
gies should be part of treatment in an acute inpatient
setting. In other words, with the available evidence, it
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
A. MULLEN
makes sense and is worth providing. Arguably, treatments
that are evaluated within clinical practice provide the
most useful evidence. With all levels of evidence consid-
ered, we can appropriately refer to these psychosocial
interventions as evidence based (Mace & Moorey, 2001;
Parry et al. 2005).
This therefore presents another argument for mental
health nurses to be involved in the routine provision of
psychosocial interventions. We have sufficient insight
into what is reasonably expected to work and can there-
fore embark on this process of routine provision. We
need to keep adding to this evidence base by demon-
strating that these interventions provided by mental
health nurses in acute inpatient units can be clinically
beneficial.
A number of benefits attributable to the use of psy-
chosocial interventions are identified throughout the
literature. These benefits can be summed up as follows:
• Improved understanding of disorder
• Reframing troubling thoughts and cognitions
• Identifying potential causes/triggers
• Building motivation
• Enhancing coping strategies and responsibility
• Enhanced self-management skills
• Symptom relief and control
• Enhanced problem-solving skills
• Enhanced treatment adherence
• Reduced recovery time
• Changing patterns of maladaptive behaviour
(Baker 2000; Baker et al. 2005; Chadwick et al. 1999;
Drury et al. 1996a,b; Fowler et al. 2000; Kemp et al. 1998;
Lewis et al. 2002; Munro et al. 2005; Startup et al. 2004).
One of the main benefits of employing routine psycho-
social interventions is the engagement and management
of the therapeutic relationship required to provide them
effectively. In other words, high levels of patient interac-
tion and time spent with clients. Arguably, proactive time
reduces the time responding to crises or incidences
(Baker 2000). A consumer evaluation carried out in the
UK highlights the importance placed on time spent with
nursing staff (Brimblecombe et al. 2007). One of the
other advantages is that psychosocial interventions are
collaborative and skills based, therefore, encouraging a
greater sense of responsibility to be taken by the patient.
A patient who approaches a nurse with a problem in the
corridor is an opportunity to engage the patient in teach-
ing and reinforcement of problem-solving skills, rather
than a solution being nominated to solve the problem
on the patient’s behalf. When increased ownership of the
problem occurs, real intrinsic motivation to change can
© 2009 The Author
ESTABLISHING PSYCHOSOCIAL INTERVENTIONS
take place. There are also other benefits for mental
health nurses in terms of professional credibility and job
satisfaction.
Despite theses benefits, there are a number of reports
in the literature that discuss the difficulties of mental
health nurses implementing structured or planned thera-
peutic interventions. The reasons for this include time
pressures, conflicting demands, role confusion, and lack
of skills (Baker 2000; Cleary 2004; Cleary et al. 1999;
Happell et al. 2002).
Therefore, we have to question our practice and
decide whether these factors should prevent us from
being involved in providing psychosocial interventions
within acute inpatient units. There is a real opportunity to
provide patients who have a mental disorder with those
treatments and interventions that give them the best
chance of bringing about symptom relief or even endur-
ing recovery. So how do we balance the two?
Cleary (2003) highlighted the tension between pater-
nalistic approaches and human rights within mental
health nursing practice. There is a need to strike a balance
between managing both the safety of clients and promot-
ing independence and autonomy through a skills-based
therapeutic approach (Bertram & Stickley 2005; Cleary
2003).
Apart from a lack of time or a lack of skills, the reluc-
tance or inability to utilize such interventions may be
linked to a perception that providing these interventions
requires engagement in a deep form of ‘psychotherapy’.
The use of psychosocial interventions on a routine basis
includes both the structured approach, either from group
or individual session, but also the incidental interactions
where these interventions can inform and provide the
basis of the interaction. This is where mental health nurse
practice within acute inpatient units can be consolidated,
if not excelled.
Implementation and sustainability
Having made the case for the routine use of psychosocial
interventions by mental health nurses, the reality of the
acute inpatient unit environment being chaotic and vola-
tile, as well as one being dominated by a custodial culture,
cannot be ignored. Therefore, a system that seeks to
stabilize and counter the chaotic, volatile, and custodial
nature of acute inpatient units is required in order to
successfully sustain the implementation of psychosocial
interventions.
Mistral et al. (2002) adapted therapeutic community
principles to address problems with ward culture and
chaotic environment. This arguably has the potential to
successfully address some of the key barriers to providing
© 2009 The Author
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
87
psychosocial interventions within acute inpatient
units. Nurses were seen as custodians struggling in their
attempt to manage patients within this unit. The nurses
felt that on one hand they were excluded from providing
structured therapeutic interventions, and on the other,
lacked the skills and/or were too busy when the opportu-
nity to be involved was offered. This runs parallel to many
of the problems with mental health nurse practice dis-
cussed earlier. As a result, Mistral et al. (2002) described
a series of changes that were designed to address these
problems.
It was noted that some staff addressed patients in
an abrupt manner when attempting to seek information.
Staff–patient communication was addressed through
regular community meetings to de-emphasize the author-
ity of nurses. Information about the unit routine and
activities were provided as a way of patients taking more
responsibility. Opportunities for both patients and staff
to discuss any concerns were also part of these meetings.
The process involved regularly clarifying therapeutic
aims and rules within the unit, as well as outlining unac-
ceptable behaviour. Patients were seen as having an
important role in ensuring unacceptable behaviour was
addressed through a kind of peer pressure dynamic.
While there was no specific reference to educating
staff in the provision of any specific therapeutic interven-
tion, apart from the requirement to interact in a more
meaningful way, these changes brought about significant
benefits. These included improved communication and
team cohesiveness, better relationships with manage-
ment, more clarity and structure within the unit’s opera-
tion, increased morale and job satisfaction, and reduced
rates of seclusion and sick leave (Mistral et al. 2002).
Examples of psychosocial interventions within
acute inpatient units
McGann and Bowers (2005) rolled out training in psycho-
social interventions across seven acute inpatient mental
health units in the UK. Training was offered to all mental
health nurses in psychological interventions for psychosis,
the stress vulnerability model, engagement and assess-
ment processes, coping strategies, medication compli-
ance, and working with families and carers. Additional
training in motivational interviewing and working with
voices and thoughts was provided to more skilled staff.
Clinical supervision was provided as part of the training
and ongoing implementation. As a result, two of the units
were able to implement and continue to provide the inter-
ventions. The reasons for this success included strong
support and participation from managers and stability
of staffing.
88
Bowers et al. (2005b) developed a package for psycho-
social interventions developed as a means of reducing
absconding rates from 15 acute inpatient units across the
UK. Some of the units were locked for some of the time.
The package included clarifying rules, signing in and
out, identifying higher-risk patients, careful breaking of
bad news in terms of the language and communication
style, post-incident debriefing, and multidisciplinary team
reviews.
This study was able to demonstrate an absconding rate
reduction of 25.5%. The value of the nurse–patient inter-
action was identified. The way nurses spoke to patients
also had a significant bearing on patient behaviour and the
risk of absconding.
Dedicated inpatient Dialectical behaviour therapy
programmes have demonstrated reductions in self-
harming behaviours among people with borderline per-
sonality disorder (Barley et al. 1993). Acceptance and
validation were core principles of this programme and are
arguably transferable to any acute inpatient unit. Provid-
ing an accepting and validating environment is a crucial
component of mental health nursing practice, but is not
always provided on a consistent basis (Bendit 2006).
CONCLUSION
It would seem that there is a mutual responsibility
between staff and employers to ensure that psychosocial
interventions are offered. In order to rise to this chal-
lenge, we require mental health nurses who are well
motivated, well informed, and sufficiently trained and
skilled.
It makes a lot of sense that acute inpatient units
provide treatments that work and that mental health
nurses be at the forefront of this provision. Staff training
and professional development need to be systematized
and well coordinated by identified experts. There is also a
need for inpatient nurses to value interdisciplinary team
approaches to care, such as ward rounds and case review
meetings. It is vital that the unique perspectives and
insights that mental health nurses can offer these forums
are accessed in order to effectively plan and review treat-
ment. Mental health nursing needs to make a cultural
shift in order for practice to accommodate the routine use
of these interventions. It will take more than individual
nurses acquiring training to prepare themselves in the
skills and knowledge that these interventions require.
Training programmes, such as that described by McGann
and Bowers (2005) need to be systematically rolled out
across services to expose mental health nurses as a group
to practice in this way.
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
A. MULLEN
However, it is a catch-22 situation, stable staffing,
supportive management, and motivated staff with good
morale are all necessary factors in providing successful
psychosocial interventions on a routine basis (McGann &
Bowers 2005). Ironically, job satisfaction is potentially
enhanced through involvement in the provision of psy-
chosocial interventions, leading to more stable staffing
and improved morale.
Mental health nurses can feel powerless to break this
cycle of reactive practice. It is acknowledged that acute
inpatient units are busy, chaotic, and at times stressful
places. This in itself is further argument for structured
and planned approaches to practice.
It also takes a lot of energy to remain focused and
committed to therapeutic programmes. However, Mistral
et al. (2002) have demonstrated quite convincingly that no
matter how busy chaotic or stressful a unit is significant
improvements can be made.
As a result, psychosocial intervention programmes
can succeed (McGann & Bowers, 2005). There is also a
need to view these programmes as part of core business
and not just another project that has a limited life span,
only to see the return to former practices.
There is also no doubt that clinical supervision, along
with broader professional development activities, play a
key role in not only the overall practice of mental health
nurses, but also the implementation of such structured
programmes. Clinical supervision would need to be a key
element in any comprehensive psychosocial intervention
training. We are well aware of the benefits that clinical
supervision can provide in improving job satisfaction and
reducing burnout (Hancox et al. 2004; White & Roche
2006).
Another purpose for clinical supervision is to support
the use of structure interventions, such as psychosocial
interventions.
The importance of receiving clinical supervision when
undertaking training in psychosocial interventions was
well demonstrated by Bradshaw and Butterworth (2007).
There is a mutual obligation between staff, managers, and
clinical leaders to support sustainable clinical supervision
arrangements. There is also a need for mental health
nurses to embrace such supportive structures in a formal-
ized way and make them a priority (Cleary & Freeman
2005).
ACKNLOWLEDGEMENT
The author would like to acknowledge the assistance
of Professor Mike Hazelton (University of Newcastle,
© 2009 The Author
ESTABLISHING PSYCHOSOCIAL INTERVENTIONS
Newcastle, NSW, Australia) who provided invaluable
input into the development of this paper.
REFERENCES
Alexander, J. & Bowers, L. (2004). Acute psychiatric ward rules:
A review of the literature. Journal of Psychiatric and Mental
Health Nursing, 11, 623–631.
Baker, A., Lee, N., Claire, M. et al. (2005). Brief cognitive
behavioural interventions for regular amphetamine users:
A step in the right direction. Addiction, 100, 367–378.
Baker, J. (2000). Developing psychosocial care for acute psychi-
atric wards. Journal of Psychiatric and Mental Health
Nursing, 7, 95–100.
Barker, P. & Cutliffe, J. (1999). Clinical risk: A need for engage-
ment not observation. Mental Health Practice, 2, 8–12.
Barley, W., Buie, S., Peterson, E. et al. (1993). Development
of an inpatient cognitive behavioural treatment program
for borderline personality disorder. Journal of Personality
Disorders, 7 (3), 232–240.
Bendit, N. (2006) How routine care stuffs up patients with
borderline personality disorder. Proceedings of the Hunter
Mental Health Conference: Getting it Right Acute Care;
18–19 May 2006, Newcastle: Australian & New Zealand
College of Mental Health Nurses Inc – Hunter Sub-Branch.
Bertram, G. & Stickley, T. (2005). Mental health nurses,
promoters of inclusion or perpetuators of exclusion? Journal
of Psychiatric and Mental Health Nursing, 12, 387–395.
Bowers, L. (2005). Reason for admission and their implications
for the nature of acute inpatient psychiatric nursing. Journal
of Psychiatric and Mental Health Nursing, 12, 231–236.
Bowers, L., Simpson, A. & Alexander, J. (2005a). The nature and
purpose of acute psychiatric wards: The Tompkins Acute
Ward Study. Journal of Mental Health, 14 (6), 625–635.
Bowers, L., Simpson, A. & Alexander, J. (2005b). Real world
application of an intervention to reduce absconding. Journal
of Psychiatric and Mental Health Nursing, 12, 598–602.
Bowles, A. (2000). Therapeutic nursing care in acute psychiatric
wards: Engagement over control. Journal of Psychiatric and
Mental Health Nursing (Commentary), 7, 179–184.
Bowles, N., Dodds, P., Hackney, D., Sunderland, C. & Thomas,
P. (2002). Formal observations and engagement: A discus-
sion paper. Journal of Psychiatric and Mental Health
Nursing, 9, 255–260.
Bradshaw, T. & Butterworth, A. (2007). Does structured clinical
supervision during psychosocial intervention education
enhance outcome for mental health nurses and the service
users they work with? Journal of Psychiatric and Mental
Health Nursing, 14, 4–12.
Brimblecombe, N., Tingle, A. & Murrells, T. (2007). How
mental health nursing can best improve service users’ expe-
riences and outcomes in inpatient settings: Responses to a
national consultation. Journal of Psychiatric and Mental
Health Nursing, 14, 503–509.
© 2009 The Author
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
89
Chadwick, P., Birchwood, M. & Trower, P. (1999). Cognitive
Therapy for Delusions, Voices and Paranoia. Chichester:
Wiley.
Cleary, M. (2003). The challenges of mental health care reform
for contemporary mental health nursing practice: Relation-
ships, power and control. International Journal of Mental
Health Nursing, 12, 139–147.
Cleary, M. (2004). The realities of mental health nursing
in acute inpatient environments. International Journal of
Mental Health Nursing, 13, 53–60.
Cleary, M. & Freeman, A. (2005). The cultural realities of clini-
cal supervision in an acute inpatient mental health setting.
Issues in Mental Heath Nursing, 26 (5), 489–505.
Cleary, M., Jordan, R., Horsfall, J., Mazoudier, P. & Delaney,
J. (1999). Suicidal patients and special observation.
Journal of Psychiatric and Mental Health Nursing, 6, 461–
467.
Cleary, M., Walter, G. & Hunt, G. (2005). The experience and
views of mental health nurses regarding care delivery in an
integrated, inpatient setting. International Journal of Mental
Health Nursing, 14, 72–77.
Crichton, J. (1998). Staff responses to psychiatric inpatient
violence: An international comparison. Psychiatric Care, 5,
50–56.
Curtis, J. & Capp, K. (2003). Administration of ‘as needed’
psychotropic medication: A retrospective study.
International Journal of Mental Health Nursing, 12, 229–
234.
Drury, V., Birchwood, M. & Cochrane, R. (1996a). Cognitive
therapy and recovery from acute psychosis: A controlled trial.
I. Impact on psychotic symptoms. British Journal of Psychia-
try, 169, 593–601.
Drury, V., Birchwood, M. & Cochrane, R. (1996b). Cognitive
therapy and recovery from acute psychosis: A controlled trial.
II. Impact on recovery time. British Journal of Psychiatry,
169, 601–607.
Fourie, W., McDonald, S., Connor, J. & Bartlett, S. (2005). The
role of the registered nurse in an acute mental health
inpatient setting in New Zealand: Perceptions versus reality.
International Journal of Mental Health Nursing, 14, 134–
141.
Fowler, D., Garety, P. & Kuipers, E. (2000). Cognitive Therapy
for Psychosis: Theory and Practice. Chichester: Wiley.
Gamble, C. & Brennan, G. (2000). Working with Serious Mental
Illness – A Manual for Clinical Practice. Edinburgh: Bailliere
Tindall.
Gournay, K. (1995). Mental health nurses working purposefully
with people with serious and enduring mental illness – an
international perspective. International Journal of Nursing
Studies, 32, 341–352.
Gournay, K., Ward, M., Thornicroft, G. & Wright, S. (1998).
Crisis in the capital: Inpatient care in inner London. Mental
Health Practice, 1, 10–18.
Haddock, G., Tarrier, N., Morrison, A., Hopkins, R., Drake, R.
& Lewis, S. (1999). A pilot study evaluating the effectiveness
90
of individual inpatient cognitive behavioural therapy in early
psychosis. Social Psychiatry and Psychiatric Epidemiology,
34 (5), 254–258.
Hancox, K., Lynch, L., Happell, B. & Biondo, S. (2004). An
evaluation of an educational program for clinical supervision.
International Journal of Mental Health Nursing, 13, 198–
203.
Happell, B., Manias, E. & Pinikahana, J. (2002). The role of the
inpatient mental health nurse in facilitating patient adher-
ence to medication regime. International Journal of Mental
Health Nursing, 11, 251–259.
Higgins, R., Hurst, K. & Wistow, G. (1999). Nursing acute
psychiatric patients: A quantitative and qualitative study.
Journal of Advanced Nursing, 29 (1), 52–63.
Hurst, K., Wistow, G. & Higgins, R. (1998). Mental
health nursing in acute settings. Mental Health Practice, 2,
8–11.
Iqbal, S. & Bassett, M. (2008). Evaluation of perceived useful-
ness of activity scheduling in an inpatient depression group.
Journal of Psychiatric and Mental Health Nursing, 15, 393–
398.
Kemp, R., Kirov, G., Everitt, B., Hayward, P. & David, A.
(1998). Randomised controlled trial of compliance therapy.
British Journal of Psychiatry, 172, 413–419.
Lewis, S., Tarrier, N., Haddock, G. et al. (2002). Randomised
control trial of cognitive-behavioural therapy in early schizo-
phrenia: Acute phase symptoms. British Journal of Psychia-
try, 181 (Suppl. 43), s91–s97.
Mace, C. & Moorey, S. (2001). Evidence in psychotherapy: A
delicate balance. In: C. Mace, C. Moorey & S. Roberts (Eds).
Evidence in the Psychological Therapies: A Critical Guide
for Practitioners (pp. 1–11). Hove: Brunner-Routledge.
McGann, E. & Bowers, L. (2005). Training in cognitive behav-
ioural interventions on acute psychiatric inpatient wards.
Journal of Psychiatric and Mental Health Nursing, 12, 215–
222.
Mistral, W., Hall, A. & McKee, P. (2002). Using therapeutic
community principles to improve the functioning of a high
Journal compilation © 2009 Australian College of Mental Health Nurses Inc.
A. MULLEN
care psychiatric ward in the UK. International Journal of
Mental Health Nursing, 11, 10–17.
Munro, S., Baker, J. & Playle, J. (2005). Cognitive behavioural
therapy within an acute mental health care: A critical
appraisal. International Journal of Mental Health Nursing,
14, 96–102.
Nijman, H., Allertz, W., Merckelbach, H., à Campo, J. &
Ravelli, D. (1997). Aggressive behaviour on an acute psychi-
atric admission ward. European Journal of Psychiatry, 11,
106–114.
O’Brien, L. & Cole, R. (2004). Mental health nursing practice
in acute psychiatric close-observation areas. International
Journal of Mental Health Nursing, 13, 89–99.
Parry, G., Roth, A. & Fonagy, P. (2005). Chapter 3 psycho-
therapy research, health policy & service provision. In: A.
Roth & P. Fonagy (Eds). What Works for Whom? A Critical
Review of Psychotherapy Research, 2nd edn (pp. 43–65).
London: The Guildford Press.
Rydon, S. (2005). The attitudes, knowledge and skills needed in
mental health nurses: The perspective of users of mental
health services. International Journal of Mental Health
Nursing, 14, 78–87.
Sin, J. & Scully, E. (2008). An evaluation of education and
implementation of psychosocial interventions within one UK
mental healthcare trust. Journal of Psychiatric and Mental
Health Nursing, 15, 161–169.
Startup, M., Jackson, M. & Bendix, S. (2004). North Wales
randomised controlled trial of cognitive behaviour therapy
for acute schizophrenia spectrum disorders: Outcomes at
6 and 12 months. Psychological Medicine, 34, 413–422.
Usher, K. & Luck, L. (2004). Psychotropic PRN: A model for
best practice management of acute psychotic behavioural
disturbance in inpatient settings. International Journal of
Mental Health Nursing, 13, 89–99.
White, E. & Roche, M. (2006). A selective review of mental
health nursing in New South Wales, Australia, in relation to
clinical supervision. International Journal of Mental Health
Nursing, 15 (3), 209–219.
© 2009 The Author