Abstract: The aim of this research was to describe what factors contribute to people re-presenting to the emergency department (ED) within one week of a previous visit for intentional self-harm. Objectives identified were to describe the people using demographic and clinical features; describe and evaluate ED management; and identify possible personal or system reasons as to why people re-present to ED within one week. A retrospective observational design was selected for a period of one year. The data was collected from electronic clinical case notes. The sample consisted of 48 people with 73 presentations and re-presentations. Missing data limited the number of inferential analyses. Outcome measures were divided into information regarding the person and the presentation. This study made several discoveries: many representations (55%) occurred within one day; the exact number of people who represented many times to ED is unknown, but is far higher than reported in other studies; fewer support people were present for the second presentation; the documentation of triage and assessments by ED staff was often minimal, though frequently portrayed immense distress of this population; cultural input for Maori was missing; physical health complaints and psychosis were found with some intentional self-harm presentations; challenging behaviours occurred in at least a quarter of presentations; and the medical and mental health inpatient admission rates were approximately 50% higher for second presentations. Recommendations in regard to the use of a triage assessment tool, the practice of reviewing peoples' past presentations and the need for a mental health consultation liaison nurse in ED are made. Staff education, collaboration between services with consumer involvement and further research of this group are required. This study supports the need for holistic and expert care for people who present at emergency departments with intentional self-harm.

Abstract: This research draws on the experiences of four women whilst they were inpatients at the Mental Health Unit in Southland. The Husserlian path of phenomenology was followed and in-depth interviewing used to collect data. Colaizzi's method of analysis enabled accurate interpretation of transcripts. The overall goal of this research was to provide health professionals with an opportunity to inform their practice, based on what consumers were saying about their experience of hospitalisation. Themes emerged through participants relating their experience by using comparisons with either their outside world or previous episodes of hospitalisation. Through analysis, two fundamental structures became evident within the findings. These were 'the environment as containment' and 'the road to recovery'. The author concludes that this study raises significant issues surrounding the experience of hospitalisation at the Mental Health Unit that have implications for future research and for future service delivery.

Abstract: This paper presents the findings from research that investigated the feasibility of developing a specialty return to mental health nursing programme in New Zealand. This was achieved through a scoping of existing return to nursing programmes; a survey of non-active nurses; and stakeholder consultation via interviews or focus groups. Existing generic programmes fail to attract non-active nurses wishing to focus on mental health nursing. The non-active nurses survey found 142 nurses who presently would or might possibly return to mental health nursing and participate in a programme. Most stakeholders supported the idea of implementing such a programme. The findings from this research indicate both feasibility and enthusiasm for the introduction of return to mental health nursing programmes. It is recommended that all aspects of this course mirror the service user focused 'recovery paradigm' that is a central tenet in contemporary mental health service delivery.

Abstract: This is a descriptive study of the characteristics of depression in a sample of 121 adolescents attending an outpatient specialist adolescent mental health service in New Zealand. The adolescents were required to complete two self-report measures to assess presence of depressive symptoms, severity of depression, and particular characteristics of the depression. The findings revealed that irritability was the most common characteristic along with other interpersonal and thought processing symptoms. It is important that mental health nurses are able to identify the specific characteristics of adolescent depression that may differ from adult depression in order to manage this patient population effectively.

Abstract: The author presents the approach of a nursing team at Christchurch's Princess Margaret Hospital, in the regional specialist service for people with anorexia nervosa. This unit provides the only specialist inpatient unit in the country, consisting of a six or seven-bed facility that shares a unit with a mother and baby unit. A multidisciplinary team of psychiatric nurses, dietitians, occupational therapists, psychiatrists, psychologists and social workers all make significant contributions. The Christchurch unit uses a cognitive-behavioural therapy model (CBT) across the disciplines, a multidimensional approach incorporating psychotherapeutic, psychoeducational, biomedical and behaviourist paradigms. This occurs within a “lenient flexible approach”. Within the Unit, the eight nurses constitute what could be seen as an “intra”-disciplinary team within the wider “inter”-disciplinary or MDT team. They apply an evidence-based nursing approach with a commitment to partnership and advocacy with their patients. They use collaborative techniques for defining shared goals, and the careful management of the introduction of food. As one of the team members, the author envisages that the job of specialised nurses is to form a therapeutic alliance with patients, which takes account of the dynamic ways that patients may negotiate their own complex understandings of health, care, and recovery.

Abstract: Changes brought by the Mental Health Act (MHA) to clinical practice, and some of the problems it has created for nurses, are examined in this article. Compulsory assessment and treatment orders (CATO) and the role of Duly Authorised Officers (DAO), and moral dilemmas that can arise as a consequence of CATOs used by DAOs are examined. The requirement for DAOs to act as patient advocates and to safeguard cultural beliefs are highlighted. The MHA promotes self responsibility and a treatment philosophy rather than detention of the mentally ill.