Research by staff affiliated to the Central Mental Hospital Dundrum

Recent Submissions

  • Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists.

    O' Flynn, Padraic; O' Regan, Roisin; O' Reilly, Ken; G Kennedy, Harry; Central Mental Hospital, Dundrum (BMC Psychiatry, 2018-01-19)
    Optimising quality of life (QOL) for service users in a forensic hospital is an important treatment objective. The factors which contribute to QOL in this setting are currently unclear. The aim of this study was to analyse the predictors of QOL amongst service users within an inpatient forensic mental health hospital.
  • Factors affecting length of stay in forensic hospital setting: need for therapeutic security and course of admission.

    Davoren, Mary; Byrne, Orla; O'Connell, Paul; O'Neill, Helen; O'Reilly, Ken; Kennedy, Harry G (Springer, 2015)
    Patients admitted to a secure forensic hospital are at risk of a long hospital stay. Forensic hospital beds are a scarce and expensive resource and ability to identify the factors predicting length of stay at time of admission would be beneficial. The DUNDRUM-1 triage security scale and DUNDRUM-2 triage urgency scale are designed to assess need for therapeutic security and urgency of that need while the HCR-20 predicts risk of violence. We hypothesized that items on the DUNDRUM-1 and DUNDRUM-2 scales, rated at the time of pre-admission assessment, would predict length of stay in a medium secure forensic hospital setting.
  • Functional mental capacity, treatment as usual and time: magnitude of change in secure hospital patients with major mental illness.

    Dornan, Julieanne; Kennedy, Miriam; Garland, Jackie; Rutledge, Emer; Kennedy, Harry G (Springer, 2015)
    Decision making ability can change with time, depending on mental or physical health. Little is known about the factors that determine this change and the relationship of capacity to time. As a pilot for studies using functional mental capacities as an outcome measure, we sought to quantify this relationship measuring change over time using competence assessment tools, and rating scales for symptoms and global function.
  • Prospective cohort study of the relationship between neuro-cognition, social cognition and violence in forensic patients with schizophrenia and schizoaffective disorder.

    O'Reilly, Ken; Donohoe, Gary; Coyle, Ciaran; O'Sullivan, Danny; Rowe, Arann; Losty, Mairead; McDonagh, Tracey; McGuinness, Lasairiona; Ennis, Yvette; Watts, Elizabeth; Brennan, Louise; Owens, Elizabeth; Davoren, Mary; Mullaney, Ronan; Abidin, Zareena; Kennedy, Harry G (2015-07-10)
    There is a broad literature suggesting that cognitive difficulties are associated with violence across a variety of groups. Although neurocognitive and social cognitive deficits are core features of schizophrenia, evidence of a relationship between cognitive impairments and violence within this patient population has been mixed.
  • Efficacy of social skills training in schizophrenia: a nursing review

    Lal Yadav, Babu (Current Nursing Journal, 2015-04)
    Social skills training, a psychological approach, is used to ameliorate the deficits in social skills among patients with a severe mental illness. For the efficacy of social skills training in schizophrenia, the literature in other core psychiatric disciplines (i.e. psychology, psychiatry, etc) indicates some conflicting evidences and a limited quality of evidence in psychiatric nursing. With the exemption of a few individual nursing studies, no systematic review is available to date in psychiatric nursing literature. This systematic review of literature was undertaken to explore the efficacy of social skills training in schizophrenia
  • Efficacy of Social Skills Training in Schizophrenia: A Nursing Review

    Yadav, B L (Current Nursing Journal, 2015-04-07)
    Social skills training, a psychological approach, is used to ameliorate the deficits in social skills among patients with a severe mental illness. For the efficacy of social skills training in schizophrenia, the literature in other core psychiatric disciplines (i.e. psychology, psychiatry, etc) indicates some conflicting evidences and a limited quality of evidence in psychiatric nursing. With the exemption of a few individual nursing studies, no systematic review is available to date in psychiatric nursing literature. This systematic review of literature was undertaken to explore the efficacy of social skills training in schizophrenia.
  • Susceptibility (risk and protective) factors for in-patient violence and self-harm: prospective study of structured professional judgement instruments START and SAPROF, DUNDRUM-3 and DUNDRUM-4 in forensic mental health services.

    Abidin, Zareena; Davoren, Mary; Naughton, Leena; Gibbons, Olivia; Nulty, Andrea; Kennedy, Harry G; National Forensic Mental Health Service, Central Mental Hospital, Dublin 14, Dundrum, Ireland. (2013)
    The START and SAPROF are newly developed fourth generation structured professional judgement instruments assessing strengths and protective factors. The DUNDRUM-3 and DUNDRUM-4 also measure positive factors, programme completion and recovery in forensic settings.
  • Prospective study of factors influencing conditional discharge from a forensic hospital: the DUNDRUM-3 programme completion and DUNDRUM-4 recovery structured professional judgement instruments and risk.

    Davoren, Mary; Abidin, Zareena; Naughton, Leena; Gibbons, Olivia; Nulty, Andrea; Wright, Brenda; Kennedy, Harry G; National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. (2013)
    We set out to examine whether structured professional judgement instruments DUNDRUM-3 programme completion (D-3) and DUNDRUM-4 recovery (D-4) scales along with measures of risk, mental state and global function could distinguish between those forensic patients detained in a secure forensic hospital (not guilty by reason of insanity or unfit to stand trial) who were subsequently discharged by a mental health review board. We also examined the interaction between these measures and risk, need for therapeutic security and eventual conditional discharge.
  • DUNDRUM Restriction-Intrusion of Liberty Ladders (DRILL) Audit Toolkit

    Kennedy, Harry G; Timmons, David; Gill, Pauline; McKenna, Paul; Braham, Paul; Mullaney, Ronan (Academic Department of Psychiatry, University of Dublin, Trinity College, 2011-09)
    This series of rating 'ladders' is intended to allow a quantitative and qualitative analysis of the use of restrictive and intrusive interventions as part of the therapeutic management of violence and aggression in psychiatric hospital settings. This is an evolving handbook. The ladders are currently organised to facilitate a behavioural analysis. Context, antecedents, behaviour, interventions, consequences are conceptualised as a series of events organised in temporal sequence so that causes, interactions and effects can be considered. The complexity of analysis possible is limited by the statistical power of the numbers of cases and events available. The use of the DUNDRUM-1 triage security scale may enable some benchmarking of patient groups according to their average need for therapeutic security for comparative purposes, when combined with measures of risk such as the DASA and HCR-20, while the quantitative relational security in a given unit provides an essential further aspect of context.
  • Pillars and pathways: foundations of recovery in Irish forensic mental health care

    Gill, P; McKenna, P; O’Neill, H; Thompson, J; Timmons, D (British Journal of Forensic Practice, 2010-08)
    The Central Mental Hospital in Ireland is one of the oldest forensic mental health units in Europe. The hospital is currently in the process of transforming from a single inpatient site to a modern national forensic mental health service. Central to this transformation is the need to move from the traditional security-focused model of care to a model of recovery. The challenge incumbent within this transformation is to incorporate a sophisticated amalgamation of the patients’ needs while recognising the broad range of security requirements in a forensic setting. This paper considered that adopting an integrated care pathway (ICP) approach would provide the service with a vehicle to re-engineer our principles and systems of care. Likewise we hypothesised that the ICP would enable us to consolidate best practices such as multi- disciplinary working, structured professional judgement and the involvement of the patient and their carers. Thus far it has afforded us the opportunity to examine many aspects of the care delivered within the service. It has provided a shared understanding of key standards among clinicians, service users and carers that are necessary to implement a quality care pathway. It has certainly not been a stagnant process, and the initial work often bears no resemblance to the current process. In turn, we expect that it will continue to change as the path travelled is as important as the outcome and the ICP becomes a dynamic part of the organisation.
  • Reducing the use of seclusion for mental disorder in a prison: implementing a high support unit in a prison using participant action research.

    Giblin, Yvette; Kelly, Andy; Kelly, Enda; Kennedy, Harry G; Mohan, Damian; National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. yvette.giblin@hse.ie. (International journal of mental health systems, 2012)
    Vulnerable prisoners and mentally disordered offenders who present with risk of harm to self or others were accommodated in Special Observation Cells (SOCs) isolated from others for considerable periods of time. This practice has been criticised by the Council of Europe Committee for the Prevention of Torture. The objective of this initiative was to reduce the use of seclusion within the prison and to improve the care of vulnerable and mentally ill prisoners within the prison.
  • Implementing a court diversion and liaison scheme in a remand prison by systematic screening of new receptions: a 6 year participatory action research study of 20,084 consecutive male remands

    McInerney, Clare; Davoren, Mary; Flynn, Grainne; Mullins, Diane; Fitzpatrick, Mary; Caddow, Martin; Caddow, Fintan; Quigley, Sean; Black, Fergal; Kennedy, Harry G; O’Neill, Conor (2013-06-25)
    Abstract Background A mental health needs assessment in the Irish prison population confirmed findings from other jurisdictions showing high prevalence of severe mental illness, including psychosis amongst those newly committed. We implemented a participatory action research approach in order to provide an integrated mental health prison in-reach and court liaison service for this population. Results Following extensive consultation, a two stage screening process was developed which was supplemented by an inter-agency referral management system. During the six years 2006–2011, all 20,084 new remands to the main remand prison serving 58% of the national population were screened. Following the first stage screen, 3,195 received a comprehensive psychiatric assessment. Of these 561 (2.8%) had symptoms of psychosis – corresponding to the prior research finding – and 572 were diverted from the criminal justice system to mental health services (89 to a secure forensic hospital, 164 to community mental health hospitals and 319 to other community mental health services). Conclusions We have shown that it is possible to match research findings in clinical practice by systematic screening, to sustain this over a long period and to achieve consistent levels of diversion from the criminal justice system to appropriate mental health services. The sustained and consistent performance of the model used is likely to reflect the use of participatory action research both to find the most effective model and to achieve wide ownership and cooperation with the model of care.
  • Ultra high risk of psychosis on committal to a young offender prison: an unrecognised opportunity for early intervention.

    Flynn, Darran; Smith, Damian; Quirke, Luke; Monks, Stephen; Kennedy, Harry G; National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland. (BioMed Central, 2012-08)
    The ultra high risk state for psychosis has not been studied in young offender populations. Prison populations have higher rates of psychiatric morbidity and substance use disorders. Due to the age profile of young offenders one would expect to find a high prevalence of individuals with pre-psychotic or ultra-high risk mental states for psychosis (UHR). Accordingly young offender institutions offer an opportunity for early interventions which could result in improved long term mental health, social and legal outcomes. In the course of establishing a mental health in-reach service into Ireland's only young offender prison, we sought to estimate unmet mental health needs.
  • Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study.

    Naughton, Marie; Nulty, Andrea; Abidin, Zareena; Davoren, Mary; O'Dwyer, Sarah; Kennedy, Harry G; National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. (2012-06)
    Metacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. The aim of MCT is to facilitate symptom reduction and protect against relapse. In a naturalistic audit of clinical effectiveness we examined what effect group MCT has on mental capacity, symptoms of psychosis and global function in patients with a psychotic illness, when compared with a waiting list comparison group.
  • Prospective in-patient cohort study of moves between levels of therapeutic security: the DUNDRUM-1 triage security, DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales and the HCR-20.

    Davoren, Mary; O'Dwyer, Sarah; Abidin, Zareena; Naughton, Leena; Gibbons, Olivia; Doyle, Elaine; McDonnell, Kim; Monks, Stephen; Kennedy, Harry G; National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland. (2012-07)
    We examined whether new structured professional judgment instruments for assessing need for therapeutic security, treatment completion and recovery in forensic settings were related to moves from higher to lower levels of therapeutic security and added anything to assessment of risk.
  • Five years after implementation: A review of the Irish Mental Health Act 2001.

    Ramsay, Hugh; Roche, Eric; O'Donoghue, Brian; Lucena Clinic, Orwell Road, Rathgar, Dublin 6, Ireland. Electronic address: drhughramsay@gmail.com. (Elsevier, 2013-01)
    The Mental Health Act 2001 (MHA 2001) was implemented in November 2006. Since that time, there has been considerable research into its impact, including the impact on service provision, use of coercive practices and the perceptions by key stakeholders. Our objective is to present a summary of research into the MHA 2001 since its implementation in the Irish state in the context of international standards and practice.
  • A multi-method evaluation of a training course on dual diagnosis.

    Rani, S; Byrne, H; Training and Development Department, Central Mental Hospital, Dundrum, Dublin, Ireland. shobharanig@gmail.com (Wiley-Blackwell, 2012-08)
    A training course on dual diagnosis was developed within the Irish forensic mental health service, to bridge the gap in the lack of training on dual diagnosis in Ireland. The course was designed for service providers within mental health and addiction services. Twenty participants involving nursing, social work, police and social welfare disciplines attended the first training course. A mixed methodology research design was adapted to describe participants' evaluation of the training course. Data were collected using multiple methods: pre- and post-test, daily evaluation and focus group interviews. Quantitative data were analysed using the spss Version 16.0 and qualitative data were analysed thematically. Findings from the pre- and post-test suggest an increase in participants' knowledge of dual diagnosis and an increase in confidence in conducting groups. Daily evaluation indicates that the course content largely met participants' needs. Finally, three themes emerged from the focus group interview: increased confidence, the training course/teaching methods and personal/organizational challenges. This study implies that service providers within mental health and addiction services benefit from inter-professional, needs and skills based courses incorporating a variety of teaching methods. The way forward for future dual diagnosis training course developments would be working in partnership with service users and carers.
  • Irish psychiatric nurses' self-reported barriers, facilitators and skills for developing evidence-based practice.

    Yadav, B L; Fealy, G M; The National Forensic Mental Health Services, Central Mental Hospital, Dublin, Ireland. babu.yadav@hse.ie (2012-03)
    Evidence-based practice places an emphasis on integration of clinical expertise with available best evidence, patient's clinical information and preferences, and with local health resources. This paper reports the findings of a study that investigated the barriers, facilitators and skills in developing evidence-based practice among psychiatric nurses in Ireland. A postal survey was conducted among a random sample of Irish psychiatric nurses and survey data were collected using the Development of Evidence-Based Practice Questionnaire. Respondents reported that insufficient time to find and read research reports and insufficient resources to change practice were the greatest barriers to the development of evidence-based practice. Practice development coordinators were perceived as the most supportive resource for changing practice. Using the Internet to search for information was the highest-rated skill and using research evidence to change practice was the lowest-rated skill for developing evidence-based practice. Nurses' precursor skills for developing evidence-based practice, such as database searching and information retrieval, may be insufficient in themselves for promoting evidence-based practice if they cannot find evidence relating to their particular field of practice or if they do not have the time, resources and supports to develop their practice in response to evidence.
  • Irish psychiatric nurses' self-reported sources of knowledge for practice.

    Yadav, B L; Fealy, G M; The National Forensic Mental Health Services, Central Mental Hospital, Dublin, Ireland. babu.yadav@hse.ie (2012-02)
    Evidence-based practice (EBP) is an approach to health care in which health professionals use the best evidence available to guide their clinical decisions and practice. Evidence is drawn from a range of sources, including published research, educational content and practical experience. This paper reports the findings of a study that investigated the sources of knowledge or evidence for practice used by psychiatric nurses in Ireland. The paper is part of a larger study, which also investigated barriers, facilitators and level of skills in achieving EBP among Irish psychiatric nurses. Data were collected in a postal survey of a random sample of Irish psychiatric nurses using the Development of Evidence-Based Practice Questionnaire. The findings revealed that the majority of survey respondents based their practice on information which was derived from interactions with patients, from their personal experience and from information shared by colleagues and members of the multidisciplinary team, in preference to published sources of empirically derived evidence. These findings are consistent with those of the previous similar studies among general nurses and suggest that Irish psychiatric nurses face similar challenges to their general nursing counterparts in attaining of EBP.
  • DUNDRUM-2: Prospective validation of a structured professional judgment instrument assessing priority for admission from the waiting list for a Forensic Mental Health Hospital.

    Flynn, Grainne; O'Neill, Conor; Kennedy, Harry G (2011-07-03)
    Abstract Background The criteria for deciding who should be admitted first from a waiting list to a forensic secure hospital are not necessarily the same as those for assessing need. Criteria were drafted qualitatively and tested in a prospective 'real life' observational study over a 6-month period. Methods A researcher rated all those presented at the weekly referrals meeting using the DUNDRUM-1 triage security scale and the DUNDRUM-2 triage urgency scale. The key outcome measure was whether or not the individual was admitted. Results Inter-rater reliability and internal consistency for the DUNDRUM-2 were acceptable. The DUNDRUM-1 triage security score and the DUNDRUM-2 triage urgency score correlated r = 0.663. At the time of admission, after a mean of 23.9 (SD35.9) days on the waiting list, those admitted had higher scores on the DUNDRUM-2 triage urgency scale than those not admitted, with no significant difference between locations (remand or sentenced prisoners, less secure hospitals) at the time of admission. Those admitted also had higher DUNDRUM-1 triage security scores. At baseline the receiver operating characteristic area under the curve for a combined score was the best predictor of admission while at the time of admission the DUNDRUM-2 triage urgency score had the largest AUC (0.912, 95% CI 0.838 to 0.986). Conclusions The triage urgency items and scale add predictive power to the decision to admit. This is particularly true in maintaining equitability between those referred from different locations.

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