Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory

Michie, Susan; Pilling, Stephen; Whitty, Paula; Eccles, Martin; Johnston, Marie; Simmons, Jemma

doi:10.1186/1748-5908-2-8

Cited by 132 publications

(146 citation statements)

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“…In the current economic context, further investment in clinical psychologists seems unlikely, but a greater focus on training and supervising nurses and other staff to deliver psychological interventions has been shown to be possible in some psychosis services, 55 although problems with sustainability have also been identified. 56,57 This might include so-called 'low-intensity' psychological interventions that, although lacking a strong evidence base, may be easier for service users with complex mental health problems to engage with and assist with addressing some of the comorbidities and other issues that impede progress towards successful community discharge (e.g. anxiety management, relapse prevention, motivational interviewing).…”

Section: Discussionmentioning

confidence: 99%

“…Discharged from the rehabilitation unit 219 (66) Ready to be discharged from the rehabilitation unit 48 (14) Discharged or ready to be discharged from the rehabilitation unit 267 (80) Successfully discharged from the rehabilitation unit 187 (56) Successfully discharged or ready to be discharged from the rehabilitation unit 235 (71) The results of the further multivariable exploratory analyses are shown in Tables 25 and 26. Table 25 shows the variables associated with successful discharge at the 12-month follow-up.…”

Section: -Month Follow-up N (%)mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: -Month Follow-up N (%)mentioning

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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“…However, reviews (e.g., Campbell et al, 2015;Pavey et al, 2011) have reported the schemes to be no more effective than usual care. Pavey and colleagues identified the importance of theory in furthering our understanding of the effectiveness of ERS as causal relationships can be uncovered, providing implications for interventions (Michie et al, 2007). Such theory-based research in ERS may provide insight into the adoption and maintenance of physical activity (Baranowski & Jago, 2005).…”

Section: Introductionmentioning

confidence: 99%

Assessing the impact of autonomous motivation and psychological need satisfaction in explaining adherence to an exercise referral scheme

Eynon

O’Donnell

Williams

2016

Psychology, Health & Medicine

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“…Questi nostri risultati sono in linea con un recente studio [9] che indica nelle risorse "tempo" e "training" i due principali problemi nella implementazione delle LLGG, all'interno del dominio "contesto ambientale e risorse".…”

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Organization of psychological activities in italian cardiac rehabilitation and prevention Survey on the implementation of guidelines for psychological activities in cardiac rehabilitation and prevention

Tramarin¹,

Balestroni²,

Bettinardi³

et al. 2016

Monaldi Arch Chest Dis

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IntroduzioneLe Linee Guida (LLGG) elaborate sulla base delle evidenze scientifiche sono estesamente prodotte e proposte come strumento per il miglioramento degli standard di cura e di garanzia di accesso a trattamenti di provata efficacia. Anche nei casi nei quali le LLGG siano state oggetto di un'ampia ed efficace divulgazione e discussione, frequentemente nella fase di implementazione emergono criticità ri- The present study was developed as part of a comprehensive evaluation of the state of the art of knowledge and implementation of the Italian Guidelines for psychological activities in Cardiac Rehabilitation, published in 2003 by the Working Group of Psychology of the Italian Society of Cardiac Rehabilitation (GICR).Methods. A questionnaire was designed to collect detailed information on facilities, organization, staffing level, professional background and activities carried out by psychologists working in Italian Cardiac Rehabilitation Units (CRU). Out of 144 Italian CRU (inventory 2004), 107 reported structured psychological programmes. The questionnaires were sent by conventional mail to the referring psychologist of these 107 CRU; they were invited to participate in the survey on a purely voluntary basis.Results. Responses were received from 70 (65.4%) of 107 CRU. 55 CRU (79.8%) report a good knowledge of the published GL; 10.1% declare that the psychologists did not know the current GL. 84.5% consider the GL to be fully applicable, while 15.5% believe that they are only partly applicable. Psychological assessment is performed through clinical interview (94.3%) and psychometric tests (81.4%). 92.8% of the CRU use screening instruments in order to evaluate psychosocial risk factors, in particular anxiety and depression (64.3%). Quality of life (22.8%) and cognitive impairment (17.1%) are not routinely assessed. Educational interventions are planned in 87.1% of the CR programme and are extended to the family members (51%) as well as counselling (57%). Psychological programme includes smoking (56%) and eating behaviour (55%) group interventions. Stress management is routinely planned in 69% of the CRU. Psychological intervention tailored to individual needs of the patients is performed in 62.9% CRU. Written final reports are available in 88.6% cases. The follow-up is carried out by 48.6% of the CRU, 15.7% in a structured way.Conclusions. The survey shows wide discrepancies in the provision of psychological activities in Italian CRU. Nevertheless psychological assessment and interventions seem acceptably coherent with current national GL on CR.

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Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory

Cited by 132 publications

References 20 publications

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

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

Assessing the impact of autonomous motivation and psychological need satisfaction in explaining adherence to an exercise referral scheme

Organization of psychological activities in italian cardiac rehabilitation and prevention Survey on the implementation of guidelines for psychological activities in cardiac rehabilitation and prevention

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