Comparing patients’ experience of mental health services in England: a five‐Trust survey

Webb, Yvonne; Clifford, Paul; Fowler, Vanessa; Morgan, Celia J. A.; Hanson, M.

doi:10.1108/09526860010373253

Cited by 29 publications

(41 citation statements)

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“…It introduced systematic arrangements for the assessment of health and social care needs, the provision and regular review of care, crisis and contingency plans, and close monitoring and co-ordination by a named keyworker, later termed care co-ordinator (Department of Health, 1999a). The CPA has been beset by difficulties (Simpson, Miller & Bowers, 2003b): it is often disliked by clinicians (Norman & Peck, 1999), has made little impact on service users (Rose, 2001;Webb, et al, 2000), appears limited in efficacy and is associated with increased inpatient bed use (Marshall et al, 2001). Yet it remains the key policy underpinning mental health service provision in England and is now being introduced in Wales (Welsh Assembly Government, 2003).…”

Section: Background the Care Programme Approach And The Developing Romentioning

confidence: 99%

Community psychiatric nurses and the care co‐ordinator role: squeezed to provide ‘limited nursing’

Simpson

2005

Journal of Advanced Nursing

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Citation: Simpson, A. (2005). Community psychiatric nurses and the care co-ordinator role: squeezed to provide 'limited nursing'.. Journal of Advanced Nursing, 52(6), pp. 689-699. doi: 10.1111/j.1365-2648.2005.03636.x This is the accepted version of the paper.This version of the publication may differ from the final published version. Background: The Care Programme Approach (CPA) is the key policy underpinning community-focused mental health services but has been unevenly implemented and is associated with increased inpatient bed use. The care co-ordinator role is central to the CPA and is most often held by Community Psychiatric Nurses (CPNs), but there has been little research into how this role is conducted or how it impacts on the work of CPNs and their ability to meet the needs of service users. Permanent Aim:The study aimed to identify and illuminate the factors that either facilitated or constrained the ability of CPNs, in their role as care co-ordinators, to meet service users' and carers' needs.2 Methods: A multiple case study of seven sectorised community mental health teams was employed over two years using predominantly qualitative methods of participant observation, semi-structured interviews and document review.Findings: Additional duties and responsibilities specifically associated with the care co-ordinator role and multidisciplinary working, combined with heavy workloads, combined to produce 'limited nursing', whereby CPNs are unable to provide evidence-based psychosocial interventions that are recognised to reduce relapse amongst people with severe mental illness. Conclusions

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Section: Background the Care Programme Approach And The Developing Romentioning

confidence: 99%

Community psychiatric nurses and the care co‐ordinator role: squeezed to provide ‘limited nursing’

Simpson

2005

Journal of Advanced Nursing

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“…94,97 It is also important to note that most studies of service users' and carers' experiences did not involve them in study design and implementation. 70,80,81,86,[98][99][100][101][102] However, a commitment to learning more about service users' and carers' experiences resonates throughout these studies. This research tradition has also contributed significantly to the debate about whether or not policy changes that were meant to embed principles aimed at increasing service user and carer involvement in CMH practices actually resulted in the desired changes to carers' and service users' experiences.…”

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confidence: 99%

“…Overall, this corpus of research demonstrates that the introduction of the CPA has mostly failed to deliver on the promises of increasing service-user understanding 70,71,86,91 and involvement 71,75,77,86,91,92,94,98,101 in care planning and care co-ordination. Research also suggests that other fundamental aspirations of the CPA have similarly had a limited effect on the actual practices of CMH workers.…”

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confidence: 99%

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Simpson

Hannigan

Coffey

et al. 2016

Health Serv Deliv Res

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BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…48 This consists of 25 questions related to admission and treatment, ward environment and primary nurse. This is scored by adding the positive responses from each service user to give a score between 0 and 25.…”

Section: Unitmentioning

confidence: 99%

“…Quality of life was assessed using the Manchester Short Assessment of Quality of Life (MANSA); 47 the service user rates 12 aspects of their life on a scale from 1 (couldn't be worse) to 7 (couldn't be better), and a total mean score of between 1 and 7 is generated. Their experiences of care were assessed using the Your Treatment and Care (YTC) 48 questionnaire, which has been used in the UK in service user-led assessments of mental health services. The service user rates 25 items related to their care (e.g.…”

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confidence: 99%

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Killaspy

King

Holloway

et al. 2017

Programme Grants Appl Res

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BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

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Comparing patients’ experience of mental health services in England: a five‐Trust survey

Cited by 29 publications

References 1 publication

Community psychiatric nurses and the care co‐ordinator role: squeezed to provide ‘limited nursing’

Community psychiatric nurses and the care co‐ordinator role: squeezed to provide ‘limited nursing’

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

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