Peer Reviewed Journal Articles
Richard Lakeman

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Some of the articles are available on-line for free. Click on the picture of the journal to visit the publisher or the to view the article directly.

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Journal Articles

Lakeman, R. (2014). The Finnish open dialogue approach to crisis intervention in psychosis: A review. Psychotherapy in Australia, 20(3), 26-33

The open dialogue approach to crisis intervention is an adaptation of the Finnish need-adapted approach to psychosis that stresses flexibility, rapid response to crisis, family-centred therapy meetings, and individual therapy. Open dialogue reflects a way of working with networks by encouraging dialogue between the treatment team, the individual and the wider social network.
RICHARD LAKEMAN reviews the outcome studies and descriptive literature published in the English language associated with open dialogue in psychosis and considers the critical ingredients. Findings indicate that in small cohorts of people in Western Lapland the duration of untreated psychosis has been reduced. Most people achieve functional recovery with minimal use of neuroleptic medication, have few residual symptoms and are not in receipt of disability benefits at follow-up. Open dialogue practices have evolved to become part of the integrated service culture. While it is unclear whether the open dialogue components of the service package account for the outcomes achieved, the approach appears well-accepted and has a good philosophical fit with reform agendas to improve service user participation in care. Further large scale trials and naturalistic studies are warranted.

Lakeman, R. (2014). Unknowing: A potential common factor in successful engagement and psychotherapy with people who have complex psychosocial needs. International Journal of Mental Health Nursing, Early View, 5 Mar 2014, DOI: 10.1111/inm.12067

Mental health nurses have a demonstrated capacity to work with people who have complex mental health and social problems in a respectful and non-coercive way for lengthy periods of time. Despite contributing to positive outcomes, nurses are rarely described as possessing psychotherapeutic skills or having advanced knowledge. More often, they are described as being instrumental to medicine, and nurses are socialized into not overstepping their subordinate position relative to medicine by claiming to know too much. Paradoxically, this position of unknowing, when employed mindfully, could be a critical ingredient in fostering therapeutic relationships with otherwise difficult to engage people. The concept of unknowing is explored with reference to different schools of psychotherapy. Adopting an unknowing stance, that is, not prematurely assuming to know what the person’s problem is, nor the best way to help, might enable a deeper and more authentic understanding of the person’s experience to emerge over time.

Lakeman, R. & Bradbury, J. (2014). Mental health nurses in primary care: quantitative outcomes of the Mental Health Nurse Incentive Program, Journal of Psychiatric and Mental Health Nursing, 21(4), 327-335.

The Mental Health Nurse Incentive Program (MHNIP) provides a funding mechanism for credentialed mental health nurses to work in primary care settings in Australia with people with complex and serious psychosocial and mental health problems. This project explored the extent to which the programme contributed to positive outcomes. Sixty-four service user profiles were provided by nurses working within the programme, including the Health of the Nation Outcome Scales (HoNOS), on admission and at the last review point. Mean total HoNOS scores on admission were higher than those typically seen on admission to inpatient care in Australia. Significant reductions in all problem areas except physical health problems were found at the last review point for this sample. These findings support the viewpoint that MHNIP is addressing the needs of people with the most complex needs in primary care and is achieving clinically significant outcomes.

Happell, B., Byrne, L., McAllister, M., Lampshire, D., Roper, C., Gaskin, C. J., Martin, G., Wynaden, D., McKenna, B., Lakeman, R., Platania-Phung, C. and Hamer, H. (2014). Consumer involvement in the tertiary-level education of mental health professionals: A systematic review. International Journal of Mental Health Nursing, 23(1), p.3-16

A systematic review of the published work on consumer involvement in the education of health professionals was undertaken using the PRISMA guidelines. Searches of the CINAHL, MEDLINE, and PsychINFO electronic databases returned 487 records, and 20 met the inclusion criteria. Further papers were obtained through scanning the reference lists of those articles included from the initial published work search and contacting researchers in the field. Thirty papers (representing 28 studies) were included in this review. Findings from three studies indicate that consumer involvement in the education of mental health professionals is limited and variable across professions. Evaluations of consumer involvement in 16 courses suggest that students gain insight into consumers' perspectives of: (i) what life is like for people with mental illness; (ii) mental illness itself; (iii) the experiences of admission to, and treatment within, mental health services; and (iv) how these services could be improved. Some students and educators, however, raised numerous concerns about consumer involvement in education (e.g. whether consumers were pursuing their own agendas, whether consumers' views were representative). Evaluations of consumer involvement in education are limited in that their main focus is on the perceptions of students. The findings of this review suggest that public policy expectations regarding consumer involvement in mental health services appear to be slowly affecting the education of mental health professionals. Future research needs to focus on determining the effect of consumer involvement in education on the behaviours and attitudes of students in healthcare environments.

Hurley, J., Browne, G., Lakeman, R., Angking, D. and Cashin, A. (2014). Released potential: A qualitative study of the Mental Health Nurse Incentive Program in Australia. International Journal of Mental Health Nursing, 23(1), p. 17-23

The Mental Health Nurse Incentive Program (MHNIP) is a Commonwealth Government funded scheme that supports people living with a mental illness. Despite its significance, the program has received little attention from researchers nor critical discussion within the published work. This paper first critically examines the MHNIP from the contexts of identities, autonomy, and capabilities of mental health nurses (MHN) and then reports on findings from a qualitative study that explored the experiences of staff working in the MHNIP. Key findings from this qualitative study include four main themes indicating that both the program and the nurses working within it are addressing the unmet needs of people living with a mental illness. They achieve these ends by adopting holistic and consumer-centred approaches and by providing a wide range of therapeutic interventions. As well, the MHN in this study valued the freedom and autonomy of their practice outside public health services and the respect received from colleagues working in other disciplines. Findings suggest that MHN within the study were experienced as having autonomous identities and roles that may be in contrast to the restrictive understandings of MHN capability within the program's funding rules.

Lakeman, R., Cashin, A., & Hurley, J. (2013). Values and valuing mental health nursing in primary care: what is wrong with the ‘before and on behalf of’ model? Journal of Psychiatric and Mental Health Nursing, n/a-n/a. doi: 10.1111/jpm.12117

The Mental Health Nurse Incentive Programme (MHNIP) provides funding to organizations to enable mental health nurses (MHNs) to provide care to people with complex needs in primary care settings in Australia. The programme is based on a ‘for and on-behalf of’ practice nursing model whereby the MHN is presumed to have no specialist knowledge, skills or professional autonomy, and rather extends the reach of medicine. This paper provides a profile of MHNs working in the MHNIP derived from an online survey. A content analysis of responses establishes that nurses who work within MHNIP are highly experienced, and have extensive postgraduate qualifications particularly in psychotherapy. Nurses have negotiated a range of complex employment and contractual arrangements with organizations and pushed the boundaries of the programme to realize good outcomes. The ‘practice nurse model’ of employment and the underpinning assumptions about MHNs and their skill set relative to other professions is critically examined. Changes to the programme funding mechanism and programme specifications are recommended.

Lakeman, R. (2013). Mental health nurses in primary care: Qualitative outcomes of the Mental Health Nurse Incentive Program. International Journal of Mental Health Nursing, 22(5), 391-398

The Mental Health Nurse Incentive Program (MHNIP) is a government-funded programme, which, since 2007, has enabled mental health nurses to work in primary care settings in Australia in collaboration with general practitioners (GPs) or private psychiatrists. To date, small-scale qualitative studies have explored outcomes of the programme from the point of view of nurses, consumers, and the perceptions of GPs. This study reports on an on-line survey of credentialed mental health nurses perceptions of outcomes of the MHNIP. Two hundred and twenty five nurses who worked in MHNIP provided detailed narrative responses that were examined using thematic content analysis. The most commonly-cited outcomes were reductions in symptoms or improved coping, improved relationships, and enhanced community participation. Other reported outcomes included reduced hospitalization or use of state-funded mental health services, better use of health services, the continuation or establishment of meaningful occupation, improved physical health and medication management, less use of coercive interventions, and greater independence.

Sibitz, I., Provaznikovaa, K., Lippa, M., Lakeman, R., & Amering, M. (2013). The impact of recovery-oriented day clinic treatment on internalized stigma: Preliminary report, Psychiatry Research, 209(3),326-32

Internalized stigma is a complicating feature in the treatment of schizophrenia spectrum disorders and considerably hinders the recovery process. The empowerment and recovery-oriented program of our day clinic might contribute to a reduction in internalized stigma. The aim of the study was to explore the influence of this day clinic program on internalized stigma and other subjectively important outcome measures such as quality of life and psychopathology. Data from two groups of patients had been collected twice, at baseline and after five weeks. The experimental group attended the day clinic treatment (N=40) and the control group waited for the day clinic treatment (N=40). The following significant differences between the two groups were found: Patients in day clinic treatment showed a reduction in internalized stigma while the control group showed a minimal increase (Cohen’s d = 0.446). The experimental group as compared with the control group also showed a greater improvement in the quality of life domain psychological health (Cohen’s d = 0.6) and in overall psychopathology (Cohen’s d = 0.452). Interestingly, changes in internalized stigma and psychological quality of life were not associated with changes in psychopathology. Results are encouraging but have to be confirmed in a randomized design.

O'Brien, L., Lakeman, R., & O'Brien, A. (2013). Managing potential conflict of interest in journal article publication, International Journal of Mental Health Nursing, 22(4), 368-373

The issue of potential conflict of interest and its risk to professional integrity in journal article publication has been strongly debated in medical circles. Most medical journals adhere to international requirements for disclosure of potential conflict of interest. The debate on this issue in nursing, and specifically mental health nursing, has been neither prolific nor strong, despite nursing's potential to influence particular viewpoints about treatment and indeed to prescribe particular treatments; and nursing being a target for pharmaceutical industry marketing. The purpose of this paper is to raise debate about potential conflict of interest in journal article publication and to make recommendations for the management of such potential for this journal.

Cutcliffe, J., Stevenson, C., & Lakeman, R. (2013). Oxymoronic or synergistic: Deconstructing the psychiatric and/or mental health nurse, International Journal of Mental Health Nursing, 22(2), 125-134

Examination of the names used to signify a nurse who specializes in working with people with mental health problems indicates the absence of a shared nomenclature and the frequent conflation of the terms ‘psychiatric’ and ‘mental health’. Informed by the work of Derrida (1978) and Saussure (1916–1983), the authors encourage the deconstruction of and problematization of these terms, and this shows that what nurses who work with people with so-called mental illness are called has depended on where they have worked, the vagaries of passing fashion, and public policy. Further, there are irreconcilable philosophical, theoretical, and clinical positions that prevent nurses from practicing simultaneously as ‘psychiatric’ and ‘mental health’ nurses. Related service user literature indicates that it is disingenuous to camouflage ‘psychiatric’ services as ‘mental health’ services, and as signifiers, signified, and signs, psychiatric and mental health nursing are sustained by political agendas, which do not necessarily prioritize the needs of the person with the illness. Clearly demarked and less disingenuous signs for both mental health and psychiatric care would not only be a more honest approach, but would also be in keeping with the service user literature that highlights the expectation that there are two signs (and thus two services): psychiatric and mental health services.

Lakeman, R. (2013) Talking science and wishing for miracles: Understanding cultures of mental health practice, International Journal of Mental Health Nursing, 22(2), 106-115

Science can only offer a limited account of and prescription for mental health care. Yet the language of science and faith in the universal applicability of particular scientific methods to the craft of mental health care has come to permeate mental health practice communities. This paper argues that many beliefs held by mental health professionals might be considered to be based on faith rather than science. This paper proposes that culture provides a useful lens for understanding mental health services and these paradoxes. Clearly there is a grand mental health narrative or colonising influence of biological psychiatry that in various ways affects all mains stream mental health services. Local health services and professional communities might be considered sub-cultures. Understanding how mental health professions and practice are embedded in culture may be useful in considering how practice changes and why. Culture and caring practices are mutually embedded in localised sub-cultures. Therefore a rich description of context and history is necessary in publication, presentation or other communications to enable genuine understanding by a global audience. Viewing mental health practice in a cultural context highlights the importance of values and difference and encourages humility in the face of ambiguity.

Lakeman, R., McAndrew, S., MacGabhann, L., & Warne, T. (2013). ‘That was helpful … no one has talked to me about that before’: Research participation as a therapeutic activity. International Journal of Mental Health Nursing, 22(1), 76-84.

There is considerable interest in the various ethical problems associated with undertaking health and social science research. Participants in such research are often considered vulnerable because of their health status, social position or dependence on others for health and welfare services. Researchers and ethics committees pay scrupulous attention to the identification and amelioration of risks to participants. Rarely are the benefits to participants of engaging in research highlighted or drawn to the attention of potential participants. Such potential benefits need to be considered by researchers and reviewers when considering the balance of benefits and harms associated with research projects. This paper particularly considers the psychotherapeutic benefits of participation in research.

Lakeman, R., McGowan, P., MacGabhann, L., Parkinson, M., Redmond, M., Sibitz, I., Stevenson, C., & Walsh, J. (2012). A qualitative study exploring experiences of discrimination associated with mental-health problems in Ireland. Epidemiology and Psychiatric Sciences, 21(3), 271-279

Aims - Stigma and discrimination related to mental health problems impacts negatively on people’s quality of life, help seeking behaviour and recovery trajectories. To date, the experience of discrimination by people with mental health problems has not been systematically explored in the republic of Ireland. This study aimed to explore the experience impact of discrimination as a consequence of being identified with a mental health problem.
Methods - Transcripts of semi-structured interviews with 30 people about their experience of discrimination were subject to thematic analysis and presented in summary form.
Results - People volunteered accounts of discrimination which clustered around employment, personal relationships, business and finance, and health care. Common experiences included being discounted or discredited, being mocked or shunned, and being inhibited or constrained by oneself and others.
Conclusions - Qualitative research of this type may serve to illustrate the complexity of discrimination and the processes whereby stigma is internalised and may shape behaviour. Such an understanding may assist health practitioners reduce stigma, and identify and remediate the impact of discrimination.

Lakeman, R. (2012). What is Good Mental Health Nursing? A Survey of Irish Nurses. Archives of Psychiatric Nursing, 26(3), 225-231.

The practice, theory, and preparation associated with nursing people with mental health issues has changed in profound ways in recent decades. This has in part been reflected by a shift in nurses identifying as being mental health rather than psychiatric nurses. Context, theory, and values shape what it means to be a mental health nurse. Thirty experienced mental health nurses in Ireland completed a survey on what good mental health nursing is and a definition induced from their responses. Mental health nursing is a professional, client-centered, goal-directed activity based on sound evidence, focused on the growth, development, and recovery of people with complex mental health needs. It involves caring, empathic, insightful, and respectful nurses using interpersonal skills to draw upon and develop the personal resources of individuals and to facilitate change in partnership with the individual and in collaboration with friends, family, and the health care team. This appears to encapsulate the best of what it meant to be a psychiatric nurse, but challenges remain regarding how to reconcile or whether to discard coercive practices incompatible with mental health nursing

Hurley, J., & Lakeman, R. (2011) Becoming a Psychiatric/Mental Health Nurse in the UK: A Qualitative Study Exploring Processes of Identity Formation. Issues in Mental Health Nursing, 32(12), 745-751.

Identity studies are well established across the social science literature with mental health nursing beginning to offer evidenced insights into what may, or may not, constitute key identity performances. For mental health nursing these performances remain contested, both from within the profession and from international contexts that favour generic constructions of mental health. This paper offers findings from a qualitative study that focused upon the process of how mental health nursing identity development is influenced, rather than what that identity may or may not be. These findings highlight that mental health nurses (MHNs) not only form their identity around service user centred education and training, but that many also use the education as a means to leave the profession. Through highlighting the impact of informal education (i.e., through work), formal education, and training upon the formation of mental health nursing identity, nurses are potentially alerted to the importance of clinically focussed mental health being prominent within curricula, rewarding mental health nursing skills specialisation, and the importance of the role of the service user in mental health nurse education and, hence, identity formation. Read More: http://informahealthcare.com/doi/abs/10.3109/01612840.2011.609634

Lakeman, R. (2011). How homeless sector workers deal with the death of service users: A grounded theory study. Death Studies, 35(10), 1-24.

Homeless sector workers often encounter the deaths of service users. A modified grounded theory methodology project was used to explore how workers make sense of, respond to, and cope with sudden death. In-depth interviews were undertaken with 16 paid homeless sector workers who had experienced the death of someone with whom they worked. Transcripts of interviews and field notes were analyzed using the constant comparative method and a theory that described the positive framing of death emerged. Dealing with death and trauma is not something that most workers expect when they begin work but exposure to the death of a service user heightens expectations that other service users may be harmed. How workers cope or positively frame death depends on several interlinked processes. These include how the death is encountered; how the worker and others mark the death; and the extent that the vulnerability of self, peers, and service users is recognised and responded to. Successfully framing death enables the worker to continue working in the sector whilst maintaining enthusiasm for the work and compassion for service users.

Lakeman, R. (2011). It's time to rethink our thinking about mental health problems. British Journal of Wellbeing, 2(5), 8-9.

This paper extends some ideas proposed in the previous editorial and encourages people to reject simplistic bio-genetic explanations for mental health problems and instead foster a scientist-practitioner approach to health care and a reinvigoration of the art of bio-psycho-social problem formulation.

Lakeman, R. (2011). Leave Your Dignity, Identity, and Day Clothes at the Door: The Persistence of Pyjama Therapy in an Age of Recovery and Evidence-Based Practice. Issues in Mental Health Nursing, 32(7), 479-482.

This paper considers the ethics, legality and compatibility with mental health recovery and evidence based practice of the enforced wearing of night attire by adults admitted to mental health inpatient facilities. This practice of “pyjama therapy” continues to persist in some places and is clearly unethical, probably in breach of international human rights law, is antithetical to personal recovery and has no basis as effective in research. Health professionals are urged to consider how in less visible and obvious ways institutional practices, subjugating social dynamics, and demeaning rituals may be played out in encounters with service users.

Sibitz, I., Scheutz, A., Lakeman, R., Schrank, B., Schaffer, M., & Amering, M. (2011) Impact of coercive measures on life stories: qualitative study. The British Journal of Psychiatry, 199(3), 239-244.

Background How people integrate the experience of involuntary hospital admission and treatment into their life narrative has not been explored systematically.
Aims To establish a typology of coercion perspectives and styles of integration into life stories.
Method Transcripts of recorded interviews with 15 persons who had previously been involuntarily admitted to hospital were coded and analysed thematically using a modified grounded theory approach.
Results With hindsight, people viewed the experience of involuntary hospital admission as a ‘necessary emergency brake’, an ‘unnecessary overreaction’ or a ‘practice in need of improvement’. With respect to how they integrated the experience into their life narratives, participants viewed it as ‘over and not to be recalled’, a ‘life-changing experience’ or a ‘motivation for political engagement’.
Conclusions The participants’ diverse and differentiated perspectives on coercive measures and their different styles of integration suggest that people may come to accept coercive measures as necessary when confronted with danger to self or others. However, the implementation of coercion needs to be improved substantially to counteract possible long-term adverse effects.

Lakeman, R., & Matthews, A. (2010). The views and experiences of members of new communities in Ireland: perspectives on mental health and well-being. Translocations: Migration and Social Change, 6(1), http://www.translocations.ie/volume_6_issue_1/index.shtml.

Ireland has a long history of outward migration but in recent years Ireland has become a destination of choice for migrants from the rest of the world. This has posed a challenge to Irish institutions and Irish society. This paper reports on the findings from a community development project undertaken in partnership between Cairde (a non government resource and advocacy organisation for ethnic minority groups) and Dublin City University. Members of new community groups in Dublin who were affiliated with Cairde took part in focus groups exploring their perceptions regarding mental health, mental ill-health and their experiences of mental health care provision. Participants focused more on their everyday experiences affecting their health and well-being rather than presenting their difficulties from within an illness paradigm. Whilst most participants had experience of accessing health services they had little contact with specialist mental health services. So while the study was designed to focus on conceptions of mental health/ill-health and services, the findings highlight structural inequalities that some migrants face in relation to legal status, accessing educational, occupational opportunities, and social service eligibility; all aspects of their everyday lives that cause them distress and fear.

Lakeman, R. (2010). Mental health nursing is not for sale: rethinking nursing's relationship with the pharmaceutical industry. Journal of Psychiatric and Mental Health Nursing, 17(2), 172-177.

The relationship between nursing and the pharmaceutical industry is conflicted. The pharmaceutical industry holds commercial interests which are incompatible with the interests of nursing and service users. Nursing and nurses are courted by the industry, most obviously to influence prescribing practices but also to promote a world view that psychiatric drugs are essential, and to sanitise the image of the industry (which has recently been rocked by fresh accusations of unethical practice). Nursing’s image, the public trust it enjoys and ultimately good relationships with service users stand to be tarnished unless nursing rethinks its relationship with the industry. Nursing ought to reposition (or restore its position) next to service users rather than next to the pharmaceutical industry.

This paper was peer reviewed and originally accepted for publication in Mental Health Practice. It was even advertised for publication. However, it was withdrawn by a new editor. A satisfactory explanation was not provided and despite a request for the grounds for this editorial decision to be shared with readership this was not provided either.

Cutcliffe, J., & Lakeman, R. (2010). Challenging Normative Orthodoxies in Depression: Huxley's Utopia or Dante's Inferno? Archives of Psychiatric Nursing, 24(2), 114-124.

Although there appears to be a widespread consensus that depression is a ubiquitous human experience, definitions of depression, its prevalence, and how mental health services respond to it have changed significantly over time, particularly during recent decades. Epistemological limitations notwithstanding, it is now estimated that approximately 121 million people experience depression. At the same time, it should be acknowledged that the last two decades have seen the widespread acceptance of depression as a chemical imbalance and a massive corresponding increase in the prescription of antidepressants, most notably of selective serotonin reuptake inhibitors (SSRIs). However, questions have been raised about the effectiveness and iatrogenic side effects of antidepressants; related questions have also been asked about whose interests are served by the marketing and sales of these drugs. Accordingly, this article attempts to problematize the normative orthodoxy concerning depression and creates a "space" in which an alternative can be articulated and enacted. In so doing, the article finds that the search for a world where the automatic response to depression is a pharmacological intervention not only ignores the use of alternative efficacious treatment options but may also inhibit the persons' chance to explore the meaning of their experience and thus prevent people from individual growth and personal development. Interestingly, in worlds analogous to this pharmacologically induced depression-free state, such as utopias like that in Huxley's Brave New World, no "properly conditioned citizen" is depressed or suicidal. Yet, in the same Brave New World, no one is free to suffer, to be different, or crucially, to be independent.

Lakeman, R. (2010). Mental health recovery competencies for mental health workers: A Delphi study. Journal of Mental Health, 19(1), 62-74.

Background: Mental health recovery is a concept that is now widely promoted. Lengthy sets of competency statements have been published to assist mental health workers become more recovery orientated in their work. However, there continues to be a lack of clarity around what constitutes recovery focused practice or which competencies are most helpful to assist people towards recovery.
Aims: To identify the most important or valued mental health worker competencies/practices that are supportive of mental health recovery.
Method: Experts by experience participated in an online Delphi survey to rate the importance of recovery competency statements, to reach consensus on the most important competencies and provide examples of specific practices that demonstrate competent practice.
Results: The top rated competencies emphasized mental health workers listening to and respecting the person's view points, conveying a belief that recovery is possible and recognizing, respecting and promoting the person's resources and capacity for recovery.
Conclusions: These results serve to clarify some boundaries around recovery-focused practices and demark these from other examples of good mental health practice.

Lakeman, R. (2010). Maintaining wellbeing when a service user dies. The British Journal of Wellbeing, 1(2), 28-33.

People who work with the homeless are likely to be exposed to the trauma and death of services users. A theory of how workers deal with sudden death was developed through grounded theory analysis of in-depth interviews with people who had worked in the sector. Maintaining well-being involves positively framing the life and death of the service user and homeless sector work. This involves a number of related processes and factors, such as the nature of the encounter with death, responding to death emotionally and procedurally, and being involved in the marking of death and memorials of the person’s life. Being able to recognise and respond to the vulnerability of self, peers and service users is also important. Successfully framing death enables workers to stay in the sector while maintaining their own wellbeing, enthusiasm for their work and compassion for users.

Lakeman, R. (2010). What can qualitative research tell us about helping a person who is suicidal? Nursing Times, 106(33), 23-26

This paper summarises the findings of a review and synthesis of qualitative research addressing how people live with or recover from being suicidal, focusing particularly on the implications for nurses in a range of practice settings. Most research relating to suicide has mostly assisted in identifying at-risk groups. Qualitative research can help in understanding the experience of the suicidal and the recovering individual. Despite different methodologies, sample groups and research questions some consistent findings emerge from this body of work which serve to highlight the pain, suffering and alienation attendant to the suicidal crisis. Qualitative research also reveals the importance of connection and engagement with people and the potential for nurses to make an important, even life saving difference to suicidal people through the way they relate to them.

Irving, K., & Lakeman, R. (2010). Reconciling mental health recovery with screening and early intervention in dementia care. International Journal of Mental Health Nursing, 19(6), 402-408.

If early intervention in dementia care is to be enhanced, it is important to have a critical debate over how this should be realized. In this paper, we offer a synthesis of two approaches to care: mental health recovery and person-centred care, and apply them to early-stage dementia care. ‘Person-centred care’ has become a catchphrase for good dementia care. However, many people have not experienced improvements in care, and other lynch pin concepts, such as ‘mental health recovery’, might have utility in driving reform. The similarities and differences between the two approaches are drawn out, and the difficulties of using the word ‘recovery’ when discussing a degenerative disease are highlighted. The implications of this discussion for early intervention are discussed. It could be seen that the two bodies of knowledge have much to offer each other, despite initial dissonance with the label of recovery in dementia care.

Lakeman, R., Watts, M., & Howell, M. (2010). Growing leaders in mental health recovery. British Journal of Wellbeing, 1(9), 7-9.

Mutual self-help groups have a long pedigree in assisting people in mental health recovery. One such group, GROW has quietly been providing a safe, supportive space for recovery for over fifty years and has gone beyond this role in terms of developing community leaders. Research has demonstrated that members assuming leadership roles has been pivotal in sustaining the organisation and that participating in mutual-help has many therapeutic benefits. This paper discusses how GROW develops leadership and outlines a new initiative to assist and recognise leaders in mental health recovery.

Lakeman, R., & Cutcliffe, J. (2009). Misplaced epistemological certainty and pharmaco-centrism in mental health nursing. Journal of Psychiatric and Mental Health Nursing, 16(2), 199-205.

This paper examines a trend and bias in nursing to overstate the evidence in support of pharmacological treatments. Examples of uncritical and emphatic statements of fact are drawn from recently published literature. Treating theories of biological causation of mental illness as fact and overstating the efficacy of pharmacological treatment leads to a pharmaco-centric view of mental distress and practice. This view is unscientific, and can be potentially dangerous in that it may constrain nurses from seeking the most appropriate responses to address the complex needs of those in need of nursing care

Lakeman, R., & Fitzgerald, M. (2009). The ethics of suicide research: The views of ethics committee members. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 30(1), 13-19.

Background. Good quality, ethically sound research is needed in order to better understand, appropriately respond to, and reduce the incidence of suicide. There is, however, a lack of clarity around the nature of ethical problems associated with suicide research and how to resolve them. This is a formidable challenge for ethics committee members in approving and monitoring research.
Aims. To describe the views that members of health research ethics committee hold regarding ethical problems and ethical practice in research involving people who are, or who have, been suicidal.
Methods. Ethics committee members were invited to complete an online survey addressing the risks, benefits, and ethical problems associated with suicide research. Findings were aggregated into themes using an inductive form of content analysis.
Results. Concerns of ethics committees centered on accessing the population, potential harm to participants or the researcher, researcher competency, maintaining confidentiality, providing support to participants, and responding sensitively to the needs of family.
Conclusions. Ethical research involving suicidal people requires both procedures to protect participants, and consideration of ethics as an ongoing negotiated process. The findings of this research provide a snapshot of views held by a number of ethics committee members.

Lakeman, R., & Fitzgerald, M. (2009). Ethical suicide research: A survey of researchers. International Journal of Mental Health Nursing, 18(1), 10-17.

Research is needed to better understand and respond effectively to people who are suicidal. Involving people who are suicidal in research poses some ethical and pragmatic problems. The ethical problems and difficulties in obtaining approval to involve people who are suicidal in research has contributed to the current paucity of research that explores the suicidal experience. To explore some of these problems, a web-based survey of suicide researchers was undertaken. Researchers identified from published reports were contacted by email and invited to participate in a web-based survey. Researchers were asked to describe any problems they encountered, how ethical problems were negotiated or resolved, and any advice received from human research ethics committees. The main problems identified were accessing the population, maintaining confidentiality, the extent of care owed by the researcher to participants, and the facilitation of support to participants. As with clinical practice, ethical research involving people who are suicidal involves a process of sensitive engagement, and careful consideration and remediation of risk.

Lakeman, R., & Glasgow, C. (2009). Introducing peer-group clinical supervision: An action research project. International Journal of Mental Health Nursing, 18(3), 204-210.

Clinical supervision (CS) has been found to be beneficial in the role development of nurses and can contribute to increased job satisfaction and reduced burnout. However, implementing CS can be resource intensive, and there are few accounts of it being implemented in developing countries. Ten psychiatric nurses in Trinidad engaged in an action research project over a 5-month period to develop, implement, and undertake an initial evaluation of a model of peer-group CS for use in routine practice. The participants were involved in undertaking peer-group CS and contributing to monthly focus groups to reflect on the practices and further refine the model. This inexpensive form of CS was perceived by participants to have positive effects on the way they viewed and practiced nursing. An outline of the model and initial evaluation is presented, but further research is necessary to establish the sustainability of the model in practice.

Lakeman, R. (2008). Practice standards to improve the quality of family and carer participation in adult mental health care: An overview and evaluation International Journal of Mental Health Nursing, 17(1), 44-56.

Mental health services are required to involve family, carers, and service users in the delivery and development of mental health services but how this can be done in routine practice is challenging. One potential solution is to prescribe practice standards or clear expectation relating to family involvement. This paper describes practice standards introduced to an adult mental health service and a study that aimed to evaluate the impact of the standards on practice. Hospital and community files were audited before and after the introduction of standards for evidence of participation and surveys of carers and consumers relating to the quality of participation were undertaken. Increases in documented carer participation were found, particularly in relation to treatment or care planning. The expressed needs relating to participation varied in hospital and community settings. The majority of carers and service users were satisfied with their level of participation. The introduction of practice standards is an acceptable, inexpensive, and feasible way of improving the quality of family and carer participation, but gains may be modest.

Lakeman, R. (2008). Family and carer participation in mental health care: perspectives of consumers and carers in hospital and home care settings. Journal of Psychiatric and Mental Health Nursing, 15(3), 203-211.

It is widely accepted that family and carer participation in adult mental health care is desirable. However, rarely is service development informed by representative opinions of both carers and service users. This study took place in the context of a larger project to introduce and evaluate practice standards relating to family participation. The aim of this paper is to explore the perceptions of service users and carers to carer participation in adult mental health services. One hundred and twenty-nine service users and 86 family members recruited via hospital and community settings completed a survey which addressed obstacles to family participation, perceived benefits of participation and areas for improvement. Many service users and family were entirely satisfied with existing levels of family participation. Different needs for information, support and the nature of participation in mental health care are highlighted in acute hospital and community settings. Across settings, the provision of support and accessing services were identified as the most useful aspects of family participation. Meaningful carer and family participation in mental health care should proceed from respectful connection with carers and be informed by need which will vary depending on setting and circumstances.

Lakeman, R. (2008). The medium, the message, and evidence based practice. Issues in Mental Health Nursing, 29(3), 319–327.

Marshal McLuhan, the media guru of the 1960s, famously observed “we shape our tools, and thereafter our tools shape us” (McLuhan, 1994, p. ix).Tools influence the way we think and behave, “we become what we behold” (McLuhan, 1994, p. 19).We extend ourselves through the tools we use but inevitably we also lose something in the process. For example, the invention of the automobile has greatly extended our mobility but it has also changed village life and led to pollution. In medicine, an over-reliance on diagnostic tests has been blamed for a loss of basic clinical skills (Bordage, 1995) and in nursing, an overextension of the scientific may lead to a diminishment of the humanistic. This paper considers McLuhan’s proposition that our tools shape us in relation to mental health care and the tools derived from evidence based practice (EBP).

Lakeman, R., & Fitzgerald, M. (2008). How people live with or get over being suicidal: a review of qualitative studies. Journal of Advanced Nursing, 64(2), 114-126

Aim: This paper is a report of a review of qualitative research to address how people live with suicidality or recover a desire to live. Background. Suicide is a pressing social and public health problem. Much emphasis in suicide research has been on the epidemiology of suicide and the identification of risk and protective factors. Relatively little emphasis has been given to the subjective experiences of suicidal people but this is necessary to inform the care and help provided to individuals.
Data sources: Electronic searches of CINAHL Plus with full text, Medline and PsychArticles (included PsycINFO, Social Services Abstracts and Sociological abstracts) were undertaken for the period from 1997 to April 2007. In addition, the following journals were hand searched (1997–2007): ‘Mortality’, ‘Death Studies’, ‘Archives of Suicide Research’ and ‘Crisis: The Journal of Crisis Intervention and Suicide Prevention’.
Method: A systematic review of the literature and thematic content analysis of findings. The findings were extracted from selected papers and synthesized by way of content analysis in narrative and tabular form.
Findings: Twelve studies were identified. Analysis revealed a number of interconnected themes: the experience of suffering, struggle, connection, turning points and coping.
Conclusions: Living with or overcoming suicidality involves various struggles, often existential in nature. Suicide may be seen as both a failure and a means of coping. People may turn away from suicide quite abruptly through experiencing, gaining or regaining the right kind of connection with others. Nurses working with suicidal individuals should aspire to be identified as people who can turn people’s lives around.

Lakeman, R., Walsh, J., & McGowan, P. (2007). Service users, authority, power and protest: A call for renewed activism. Mental Health Practice, 11(4), 12-16.

Recent years have seen an explosion of roles for service users within public mental health services and an elevation of some people to celebrity status, based in part on claims of having used mental health services. This paper proposes that there has come to be a hierarchy of service users in relation to perceived insight, power, authority and wealth that parallels and in part perpetuates the power hierarchy within psychiatry and the helping fields. This has not helped many people who use public mental health services. Service users and indeed all people with an interest in promoting mental health should be activists and continue to challenge authority, biomedical hegemony, coercion in mental health services and seek improvements and alternatives for those that use mental health services.

Lakeman, R. (2006). Adapting Psychotherapy to Psychosis. Australian e-Journal for the Advancement of Mental Health, 5(1). URL: http://www.auseinet.com/journal/vol5iss1/lakeman.pdf

The tradition in many schools of psychotherapy has been the exclusion of people experiencing psychosis or the suspension of psychotherapy when psychosis emerges. In this paper it is argued that those who experience psychosis have a need for psychotherapeutic assistance. Health professionals involved in the care of people with psychosis ought to interact in a psychotherapeutic manner and develop psychotherapeutic skills. The purposes and some selected techniques of psychotherapy along the supportive-exploratory continuum are reviewed and pragmatic considerations when selecting psychotherapeutic interventions are discussed

Lakeman, R. (2006). An anxious profession in an age of fear. Journal of Psychiatric & mental Health Nursing, 13, 395–400

This paper proposes that some practices and trends in mental health care may be considered as defensive responses to collective anxiety and fear. On a larger scale similar dynamics occur around fear of terrorism. Collectively and individually we are pulled by the defensive forces and dynamics associated with anxiety. This can in part explain the polarization that occurs around issues of definition and response to mental illness. Fear and anxiety push services towards simplistic viewpoints and futile practices. Pluralism, humility and the capacity to view things from the perspective of others may help in channelling anxiety productively.

Lakeman, R. (2004). Standardized routine outcome measurement: Pot holes in the road to recovery. International Journal of Mental Health Nursing, 13, 210-215.

Routine ‘outcome measurement’ is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people’s recovery journeys or provide information that can usefully inform care. Indeed, in its implementation nurses may be required to collude in practices or account for practice in ways which run counter to the personal recovery paradigm. Nurses should view a focus on outcomes as an opportunity for critical reflection as well as to seek ways to account for recovery stories in meaningful ways.

Lakeman, R. (2001). Making sense of the voices. International Journal of Nursing Studies, 38(5), 523-531.

Hearing voices is a common occurrence, and an experience of many people in psychiatric/mental health care. Nurses are challenged to provide care, which is empowering and helps people who hear voices. Nursing practice undertaken in partnership with the voice hearer and informed by a working explanatory model of hallucinations offers greater helping potential. This paper uses Slade's (1976. The British Journal of Social and Clinical Psychology 15, 415-423.) explanatory model as a framework for exploring interventions which may assist people in exerting some control over the experience and which might be used alongside pharmacological interventions. Principles and practical ideas for how nurses might assist people to cope with and make sense of the experience are explored.

Lakeman, R. (2000). Negotiating the ethical minefield of psychiatric nursing practice. Nursing Praxis in New Zealand, 16(3), 38-48.

Psychiatric nursing practice can be likened to an ethical minefield. Nurses are often in the middle of the minefield and are pushed and pulled by forces, which are sometimes beyond their control. This paper signposts some of the more problematic areas of practice so that nurses may be equipped with at least a broad over-view of the ethical terrain.

Lakeman, R. (2000). Charting the future today: psychiatric and mental health nurses in cyberspace. Australian and New Zealand Journal of Mental Health Nursing, 9(1), 42-50.

The development of the Internet is happening at a staggering pace and promises to have a dramatic impact on human relations. If nursing is to adapt to and benefit from these changes, consideration ought to be given to the experiences and opinions of nurses who have adapted to and use the technology. This paper provides an outline of the findings of an Email survey of psychiatric and mental health nurses who are experienced in using the Internet. Questions focused on what psychiatric and mental health nurses use the Internet for, how their use has changed, work-related benefits, and what impact they see the Internet having in the future.

Lakeman, R. (1999). Advanced nursing practice: Experience, education and something else. Nursing Praxis in New Zealand, 14(2), 4-12.

This paper provides some critical reflection on the development of the concept of 'advanced practice'. Whilst defining, credentialing and regulating advanced practice promises rich fruits for nursing, advancing nursing practice will be a consequence only if the right conditions are fostered for the development and provision of nursing expertise in practice. A conscious and collective effort must be made to ensure that nursing expertise of all nurses is recognised and developed. One process which has shown promise in psychiatric and mental health nursing is 'clinical supervision. Evolving nursing leadership roles and more education can only provide a partial solution to the problem of advancing practice.

Lakeman, R. (2000). Advanced nursing practice: experience, education and something else. Journal of Psychiatric and Mental Health Nursing, 7(1), 89-94.

This paper provides some critical reflection on the development of the concept of 'advanced practice'. Whilst defining, credentialing and regulating advanced practice promises rich fruits for nursing, advancing nursing practice will be a consequence only if the right conditions are fostered for the development and provision of nursing expertise in practice. A conscious and collective effort must be made to ensure that nursing expertise of all nurses is recognised and developed. One process which has shown promise in psychiatric and mental health nursing is 'clinical supervision. Evolving nursing leadership roles and more education can only provide a partial solution to the problem of advancing practice.

Lakeman, R. (1999). Remembering Hildegard Peplau. Vision, 5(8), 29-31.

On the 17th of March 1999, Hildegard Peplau died at the age of 89, ending a nursing career, which spanned over fifty years. Peplau is often recognised as the 'mother of psychiatric nursing' but her ideas have influenced all fields of nursing.

Lakeman, R. (1999). 'Growing old' versus declining miserably: Some facts about depression and the older adult. Vision, 5(9), 6-12.

The twentieth century has been described as the "age of melancholy" (Barker, 1992, p.24). Whilst first world countries such as New Zealand have enjoyed great improvements in life expectancy we have also become increasingly miserable. Epidemiological studies suggest a ten-fold increase in the prevalence of depression since the Second World War (Barker, 1992). The notion of 'growing' older, has for many people been replaced with a reality of hopelessness and despair. What is particularly frightening is that depression is perceived by many people (including health professionals), as a normal and expected part of ageing. This article aims to explore some of the myths and realities of depression so that health professionals might better recognise and assist the older person experiencing depression and facilitate "growth" in ageing.

Lakeman, R. (1998). Beyond glass houses in the desert: a case for a mental health 'care' system. Journal of Psychiatric and Mental Health Nursing, 5(4), 319-328.

A system of mental health care is not an unattainable goal, but it is a challenging one.. one which is necessary to pursue if we are serious about mental health.

Lakeman, R. (1998). Removing the toll bridge to compulsory treatment. Kai Tiaki: Nursing New Zealand, 4(8), 17-19.

This paper suggests that one need look no further than New Zealand mental health legislation and the medical hegemony over the compulsory assessment and treatment process to uncover barriers to nursing actualising it's potential

Lakeman, R. (1997). Dangerousness & mental illness: The implications for nursing practice. Vision, 3(4), 10-14.

Labelling a person as dangerous to others involves a prediction that the individual is likely to cause harm to another. Research suggests that there is a relationship between mental illness and violence but is unclear whether it is a cause and effect relationship. Epidemiological research informs about who has been violent but lacks precision in defining who is dangerous. Biological, psychological, environmental and social-interactional factors may all contribute to violent behaviour. The strongest current predictors of violence at present are a history of violence, a history of substance abuse and a coercive interactional style. Violence may be used in a purposeful way. It may be learned, reinforced and provoked through individual and group interaction.

Lakeman, R. (1997). Using the internet for data collection in nursing research. Computers in Nursing, 15(5), 269-275.

This article examines how the Internet may be used as a tool for data collection in nursing research. An overview of the demographic composition of the Internet population is outlined and discussed as a constraint on the type of research that can be undertaken using the Internet. Methods of data collection such as e-mail and WWW questionnaires are discussed as well as the possibility of virtual focus groups. Some of the difficulties and advantages that may confront the researcher wishing to undertake research using the Internet are outlined.

Lakeman (1997) Dangerousness and mental illness: The research and implications for nursing practice. Vision, 3(4), 10-13

This short paper was delivered at the Hawke's Bay Nurses Forum, and latter published in the Journal, Vision (Volume 3, Issue 4, 1997, pp. 10-13)

Key Points:
* Labeling a person as dangerous to others involves a prediction that the individual is likely to cause harm to another.
* Research suggests that there is a relationship between mental illness and violence but is unclear whether it is a cause and effect relationship.
* Epidemiological research informs about who has been violent but lacks precision in defining who is dangerous.
* Biological, psychological, environmental and social-interactional factors may all contribute to violent behavior.
* The strongest current predictors of violence at present are a history of violence, a history of substance abuse and a coercive interactional style.
* Violence may be used in a purposeful way. It may be learned, reinforced and provoked through individual and group interaction.

Lakeman, R. (1996). The ethics of bathing. Kai Tiaki: Nursing New Zealand, 2(2), 13-15.

This paper discusses the ethics of bathing someone against their expressed will.

Lakeman, R. (1996). Psychiatric nursing. The Internet: facilitating an international nursing culture for psychiatric nurses. Computers in Nursing, 16(2), 87-9.

The Internet consists of some ten million computers networked together. It provides a means of human communication which transcends boundaries of language, race and sex, as well as providing people with access to an unimaginable quantity of information. This paper reports on a qualitative study undertaken to explore how psychiatric nurses experienced in the use of the Internet currently use and benefit from it, how they have learned to communicate on the Internet and how they see the Internet affecting psychiatric nursing culture. The research was undertaken using electronic mail to several nursing discussion groups. The responses were analysed and are discussed according to themes that were identified from the data in response to the questions posed. Selected responses are used to illustrate the themes. The Internet may be a useful tool in facilitating a global psychiatric nursing culture based on egalitarian principles and characterised by a sense of belonging and a shared vision. The realisation of this potential is contingent on psychiatric nurses being pro-active in the use of technology and will be constrained or empowered by the creativity and vision of those who use it.

Editorials

Lakeman, R. (2011). Drugs are not the only option [Editorial]. British Journal of Wellbeing, 2(4), 5.

Lakeman, R. (2010). Epistemic injustice and the mental health service user [Editorial]. International Journal of Mental Health Nursing, 19(3), 151-153.

This editorial explores particular forms of epistemic injustice which mental health service users may be exposed to. Mental health service provision throws up some particular problems in relation to developing and sustaining just services. Like the problems which people bring with them to mental health care, justice is multifaceted and multidimensional. Whilst often it may seem that addressing injustice is too big a problem for any but the most heroic of individuals, much injustice is underpinned by testimonial injustice of various kinds which we as health professionals are implicated in perpetuating. Mental health professionals need to reflect on the way we engage with service users, consider their testimony and construct problems. To do so will have far reaching implications for creating just institutions and ultimately just societies.

 

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