Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis

Farrelly, Simone; Lester, Helen; Rose, Diana; Birchwood, Max; Marshall, Max S.; Waheed, Waquas; Henderson, R. Claire; Szmukler, George; Thornicroft, Graham

doi:10.1111/hex.12368

Cited by 84 publications

(113 citation statements)

References 33 publications

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“…There are clear indications within the participants' accounts that articulation of dissociative experiences and needs is Insights into Dissociative Identity Disorder 15 particularly difficult during periods of exacerbated distress, which further indicate the need for preventive planning and informed psychological support (Lloyd, 2015). Similar results around barriers to service user led care plans have been found elsewhere in the psychosis literature, with clinician apathy, misunderstanding as to the level of engagement required to recognise service user choices, and poor collaboration being key to undermining the process (Farrelly, et al, 2016). The participants of the current study reported struggling to find a balance in power with many ward staff that would have helped facilitate collaborative care…”

supporting

confidence: 59%

“It's not like you have PSTD with a touch of dissociation”: Understanding dissociative identity disorder through first person accounts

Parry

Lloyd²,

Simpson

2018

European Journal of Trauma & Dissociation

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supporting

confidence: 59%

“It's not like you have PSTD with a touch of dissociation”: Understanding dissociative identity disorder through first person accounts

Parry

Lloyd²,

Simpson

2018

European Journal of Trauma & Dissociation

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“…Another barrier to SDM in mental health care is a lack of trust in patients' ability to fully participate in the decision‐making process. Qualitative studies with clinicians have found that they often express concern that patients will not make optimal treatment decisions . This may be due, in part, to doubts that patients will select evidence‐based treatments (EBTs) that are recommended for their presenting concerns.…”

Section: Barriers To Sdm In Mental Health Carementioning

confidence: 99%

Shared decision‐making in mental and behavioural health interventions

Trusty

Penix

Dimmick

et al. 2019

Evaluation Clinical Practice

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Elements of shared decision‐making (ie, collaboration, patient preferences, and working alliance) have long been discussed and studied in the field of clinical psychology; however, research indicates that shared decision‐making is not typically used in clinical practice. Instead, clinicians often rely on a paternalistic approach. In this article, we provide a narrative review of the existing research supporting shared decision‐making for mental and behavioural health concerns, we discuss several barriers that impede its use in actual clinical practice, and we provide recommendations for increasing shared decision‐making when working with patients.

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“…Furthermore, it is also unknown how PBSPs, which are informed by a potentially novel model of care (PBS), might be perceived by mental health nurses who are key in care planning and delivering physical interventions (Stubbs, Leadbetter, & Paterson, ). The importance of attitudes in managing challenging situations and in reducing restrictive interventions such as restraint has been acknowledged (NHS Protect, ; RCN, ), and nurses' attitudes have been found to impact on the delivery of a range of interventions (Bee, Price, Baker, & Lovell, ; Farrelly et al, ; Price, Baker, Bee, & Lovell, ). Understanding mental health nurses' attitudes to the use of PBSPs will therefore be important in determining whether and how they can be implemented in practice.…”

Section: Introductionmentioning

confidence: 99%

The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

Clark

Lekkai

Murphy

et al. 2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint. Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan. However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. What this paper adds to existing knowledge? This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended. Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients. Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. What are the implications for practice? To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients. Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. AbstractIntroductionAn international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited.AimsTo evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care.MethodsMixed methods—quality ratings and interviews with relatives and nurses.ResultsPositive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour.DiscussionThe potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed.Implications for practiceMental health professionals implementing PBSPs should engage with relatives and p...

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Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis

Abstract: Background Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers.

Cited by 84 publications

References 33 publications

“It's not like you have PSTD with a touch of dissociation”: Understanding dissociative identity disorder through first person accounts

“It's not like you have PSTD with a touch of dissociation”: Understanding dissociative identity disorder through first person accounts

Shared decision‐making in mental and behavioural health interventions

The use of positive behaviour support plans in mental health inpatient care: A mixed methods study

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