Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives (original) (raw)
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Social psychiatry and psychiatric epidemiology, 2018
Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels. A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. The process evaluation demonstrated that despite buy-in from those d...
BMC Psychiatry, 2015
Background: Formal recognition and involvement of carers in mental health services has been the focus of recent policy and practice initiatives as well as being supported by carers themselves. However, carers still report feeling marginalised and distanced from services. A prominent theme is that that they are not listened to and their concerns are not taken seriously. Compared to service user views, the reasons underpinning carers' dissatisfaction with care-planning procedures have been relatively neglected in the research literature, despite the substantial and significant contribution that they make to mental health services. The aim of the study was to explore carers' experiences of the care planning process for people with severe mental illness. Methods: Qualitative interviews and focus groups were undertaken with carers. Data were combined and analysed using framework analysis. Results: Whilst identifying a shared desire for involvement and confirming a potential role for carers within services, our data highlighted that many carers perceive a lack of involvement in care planning and a lack of recognition and appreciation of their role from health professionals. Barriers to involvement included structural barriers, such as the timing and location of meetings, cultural barriers relating to power imbalances within the system and specific barriers relating to confidentiality. Conclusions: This qualitative study led by a researcher who was a carer herself has developed the understanding of the potential role of carers within the care planning process within mental health services, along with the facilitators and barriers to achieving optimal involvement.
Systematic synthesis of barriers and facilitators to service user-led care planning
The British journal of psychiatry : the journal of mental science, 2015
BackgroundService user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.AimsTo examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.MethodSystematic evidence synthesis.ResultsSynthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.ConclusionsService user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningfu...
User and carer involvement in mental health services: from rhetoric to science
The British Journal of Psychiatry, 2003
The Department of Health has emphasised the need for a patient-centred National Health Service (NHS), and the involvement of users and carers in mental health services is often a policy recommendation (Mental Health Task Force User Group, 1995; NHS Health Advisory Service, 1997; Department of Health, 1999a,b, 2001). The Patients' Forum and Consumers in NHS Research are established national bodies concerned with stakeholder involvement. The Commission for Patient and Public Involvement in Health was established in 2003.
BMC psychiatry, 2017
People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning. Although evidence pertaining to service user and carer involvement in mental health care planning is accumulating, current understanding of how physical health is prioritised within this framework is limited. Understanding stakeholder experiences of physical health discussions within mental health care planning, and the key domains that underpin this phenomena is essential to improve quality of care. Our study aimed to explore service user, carer and professional experiences of and preferences for service user and carer involvement in physical health discussions within mental health care planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision. Six focus groups and four telephone interviews were carried out with twelve serv...
Health expectations : an international journal of public participation in health care and health policy, 2017
It has been established that mental health-care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context. To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders. Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health-care services. Fifty-four semi-structured interviews were conducted with participants and analysed utilizing a qualitative framework approach. Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning proces...
2014
Abstract This thesis is my autoethnographic account as I pursue a career as a Service User Representative with the Dorset Mental Health Forum over several years leading up to 2010. This is a period of change in both the social care and health worlds as they impact on to people suffering from mental distress. In this period are introduced Personal Budgets and a three-year pilot scheme to look at the viability of rolling out Personal Health Budgets, in which Dorset is selected as one of 20 sites nationally. There is also a change of government from a Labour administration to a coalition of the Conservative and Liberal Democrat parties, but this does not seem to have changed the planned modernisation of both social care provision and healthcare provision started by the outgoing Labour government. Also in this period we see the wide-ranging revision of the Mental Health Act 1983. My original contribution to knowledge is in describing the development of a service user representative model that works well in Dorset, UK. This thesis is not about the history and development of the mental health service user involvement but I do offer a précis of the history of service user representation for those unfamiliar with it. This thesis is laid out in roughly chronological order. I try to show how I changed my views with the help of other people over the period. I also try to explain what it is that ails me. The reason I do this is to paint a picture of a person who is in general "normal" but suffers from mental disorders that sometimes alter the way he sees the world. It is with this backdrop that I ply my trade of being representative of and to other mental health service users. I lead the reader from a consideration of method and methodology and ethics, through the precursors of my mental illness, to how that illness has been treated by the National Health Service, and how it impacts on my role. The main way that I do this is by offering a vignette of my life and then immediately afterwards analysing that vignette in the light of emergent themes. In this way, I ensure that the emergent themes are themselves based in a reality that can be accessed to some degree by the reader. There were challenges along the way including personal ones, such as having to take time out from my studies to attend courses of psychological treatment and having several heart attacks leading to hospitalisation, as well as the usual ones of finding people to contribute to my research. I end this thesis by offering a model that service users may find illuminating when setting up their own service user representation services.