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This paper addresses the promise of evidence based or research informed mental health care and the reality of everyday practice. No amount of evidence seems to have a great impact on mental health policy and practice unless it is in accord with the dominant discourse of the time. Examples of approaches / projects with a positive evidence base which do or have struggled for recognition include:- psychotherapy, soteria, and open dialogue; Examples of approaches / projects with a poor or negative evidence base which persisted despite the evidence:- insulin Coma Therapy, pharmacological treatment of mild to moderate depression, and maintenance treatment in psychosis. This paper considers what shapes the dominant discourse Mental health service reform and culture and suggests that recovery ought to be a counter-cultural social movement.

Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy–based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.

This discursive paper aims to clarify what roles mental health nurses identify as being within their scope of practice in clinical settings. It also aims to highlight any consumer benefits arising from these roles. Role theory and its relationship with identity are critically discussed as a framework to explain how contemporary mental health nursing roles are poorly understood and undervalued within mental health services. In order to meet the aims of the paper literature written in the last five years by clinical mental health nurses reporting their roles, and outcomes of those roles were searched. This literature was then considered through the lens of social constructionism that premises truths are accessed and then constructed though relationship based language. Six core mental health nursing roles were identified across international settings. The MHN is a psychotherapist. The MHN is a consumer advocate. The MHN is a physical health therapist. The MHN is a psycho‐pharmacological therapist. The MHN is a relationship focussed therapist and finally the MHN is an aggression management therapist. While European and American nurses reported consumer benefit emerging from these roles those from Australia and the United Kingdom did not. The roles reported on were largely instrumental ones that offered little clarity towards the identity of our profession, nor its worth to consumers or funders of services. Mental health nurses will only have their true breadth of clinical capabilities recognized where there is a consistent construction emerging from clinicians in clinical settings on the efficacy of their clinical work.

The prevailing naive bio-pharmaco-centric approach to human distress has not been found to be helpful to most and often serves to obscure alternative ways of viewing and addressing problems.

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.

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.

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.

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

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.

We wish to congratulate Crowe et al. (2023) on their recent publication exploring the experience of psilocy-bin treatment. This paper was published a week after the Australian Therapeutic Goods Administration (TGA, 2023) approved the prescription of psilocybin for treatment-resistant depression by authorised psychia-trists under strict controls, acknowledging that patients may be vulnerable during ‘psychedelic- assisted psycho-therapy’. In Australia, the practice of psychotherapy is unregulated, undervalued, rarely provided in any form in public mental health settings, and often conf lated with subsidized brief psychological therapies in primary care (Lakeman, 2021). The medically sanctioned therapeutic use of psychedelics and empathogens may well ref lect a paradigm shift in how pharmacological treatments are viewed, and perhaps more importantly cement the im-portance of psychotherapy in the process of treatment…

The Productivity Commission and Victorian Royal Commission reports starkly outline the longstanding systemic flaws within Australian mental health services. These reports also signpost areas of opportunity for mental health nursing. These opportunities include positioning mental health nurses more prominently in community based services, delivering psychotherapeutic interventions and in early intervention roles. Additionally, opportunity exists in specific areas of need such as rural and regional workforce shortages. In short, within this era of potential reform we are almost uniquely positioned to be a major contributor, given the volume of our workforce and breadth of capability. However, those guiding policy and funding responses for reform remain mostly oblivious to our capabilities, despite assertive efforts.
One key reason for this lack of recognition is that politicians and their supporting public servants have little understanding of what a mental health nurse does, who they are and most importantly what clinical outcomes they achieve. This paper offers an overview of recent and current research detailing precisely such understandings. Data presented will demonstrate that mental health nurses have a breadth and depth of clinical capabilities in pharmacology, psychotherapy and aggression management, as well as advocacy and physical health (Hurley & Lakeman, 2020). Themes from a recent scoping review of mental health clinical roles highlight the fusion of both technical and non-technical capabilities that the mental health nurse enacts within these roles. Finally, evidence on mental health nurses under stating and minimising the value of their work will also be presented (Lakeman & Hurley, 2020).
It is challenging to make others communicate our capability and hence contribution to reform agendas. However, we do have influence on how we articulate our craft to others and should do so more often, more assertively and with greater clarity.

The seminal work of Victor Frankel in forming Logotherapy and more recent studies exploring the construct of happiness suggest that individuals need a core purpose, so as to experience contentment and well-being. This paper applies this principle to the mental health nursing profession through proposing we have been distracted from our core purpose for half a century; most often by the sparkling lure of inflated promises by pharmaceuticals. Arguably, our hegemonic relationships with other disciplines also results in MHNs responding to the purposes and philosophies of the medical and psychology disciplines, resulting in a professional depression and stagnation of growth. Additionally, roles associated with custodial care further erode the humanistic and caring drivers that initially led many to the profession.

Efforts to illuminate the contribution of MHNs have produced a plethora of consumer satisfaction and identity studies; mostly showing satisfied consumers. However, such studies capture 'what is' rather than 'what could be’ the core purpose of MHNs and are hence limiting. Forwarded is that for MHNs to recapture this purpose that they need to evolve the therapeutic relationship into a more substantial therapeutic alliance, with a deeper adoption of consumers’ views and formalised talk based intervention capabilities. Credentialed MHNs have demonstrated that they are amply qualified in providing evidence talk based treatments to those with the most complex problems. Furthermore, most have advanced training in one or more schools of psychotherapy. This future direction can return MHNs to their core purpose and possibly, professional happiness.

This paper uses Slade's (1976) explanatory model as a framework for explaining hallucinations and considering helping interventions, which may 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.

One cannot begin to make sense of coping experience without an understanding of the person's social world and how this informs and interacts with perceptions, and the attribution of personal meaning to the experience. The 1990s have been called the 'decade of the brain’. Today a person’s experience can be manipulated in a myriad of ways through the use of pharmacological agents. Because it is possible to completely ameliorate voices does not mean that we should. More than ever we need to extend our understanding of the voice hearing experience and bridge social and clinical conceptions.

This book claims to anticipate and answer all the questions readers may have about mental, emotional, or behavioural problems in young people that could be treated with medication. The potential market is the parents of the 7.5-14 million American kids (p.1) who the author claims suffer from psychiatric disorders. This is a big market which in part explains the reason for this book. Trust in psycho-pharmacological treatments and by association medicine has also been somewhat shaken in the US by the exposure of widespread off-label prescribing of psychiatric drugs to children in recent years and this text purports to offer a balanced, trustworthy source of information….

• Important pharmacological principles
• Important psychotropic medications
• Special issues with psychotropic medications
• Pro re nata (PRN) antipsychotic medication administration
• Adherence and concordance with medications
• Depot or long-acting intramuscular injectable antipsychotics
• Psychotropic medication use in special populations
• Emerging psychotropics: Ketamine
• Alternative therapies and psychopharmacology
• Consumer education
• Chapter summary