From admission to discharge in mental health services: a qualitative analysis of service user involvement

Wright, Nicola; Rowley, Emma; Chopra, Arun; Gregoriou, Kyriakos; Waring, Justin

doi:10.1111/hex.12361

Cited by 57 publications

(75 citation statements)

References 28 publications

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“…The fact that legislation enables health professionals to use coercion towards patients challenges the notion of an equal partnership. For instance, in a qualitative study of user involvement Wright et al (2016) report that practice is driven by organizational logistics rather than the individual needs of the patients and raise the concern that patient voices are often lost in the system where their needs become secondary to clearing a bed for others. Consequently, a limited frame for negotiation and choice may also apply for the health professionals' who are bound to manage patient rights, legislation, patients' individual need, and the needs of a system with few resources.…”

Section: Discussionmentioning

confidence: 99%

Recovery‐oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings

Waldemar

Esbensen

Korsbek

et al. 2018

Int J Mental Health Nurs

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Despite an increasing attention towards recovery orientation in the mental health services, the provision of recovery-oriented practice is challenged in the inpatient wards. Moreover, the existing research within this area is modest and we currently have limited knowledge of how recovery-oriented practice is integrated into inpatient settings. A cornerstone of recovery-oriented practice is the collaboration, patient involvement, and choices, particularly when deciding and planning treatment options. Thus, this ethnographic study aimed to explore how recovery-oriented practice is reflected in the interactions between patients and health professionals around treatment in two mental health inpatient wards in Denmark. Participant observations were conducted in two mental health inpatient wards from November 2014 to January 2015. The Recovery Self-Assessment scale inspired the observation guide and the initial data analysis. Field notes were analysed deductively and inductively using qualitative content analysis. One theme with four subthemes emerged showing that interactions were characterized by an 'as-if collaboration' where 'negotiating on limited grounds' was an important feature of interactions, in which health professionals seemed to have superiority, acting on behalf of 'competing demands'. Patients had to navigate in a field of 'inconsistent guidance and postponed decisions' and faced tendencies of 'control and condescending communication'. The results suggest that recovery oriented values such as equal collaboration, choice and patients' personal preferences are reflected rhetorically in the interactions between patients and health professionals. However, they are negotiated within organizational logics and often overruled by competing demands.

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Section: Discussionmentioning

confidence: 99%

Recovery‐oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings

Waldemar

Esbensen

Korsbek

et al. 2018

Int J Mental Health Nurs

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“…Decisions on movement through phases of inpatient treatment will, in part, depend on the presenting symptomatology of the person, an assessment of their risk status, their needs for treatment and an assessment of their post-discharge needs such as accommodation. 178 Wright et al 179 note that at key transition points between inpatient and community services there is a tendency to lose the service user voice, which often goes unheard. They note, too, that transitions are, in effect, speeding up owing to the pressure on limited resources and increasingly shorter length of stays on inpatient mental health wards.…”

Section: Safety and Riskmentioning

confidence: 99%

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Simpson

Coffey

Hannigan

et al. 2017

Health Serv Deliv Res

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BackgroundMental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing their care. Care planning processes should be personalised and focused on recovery, with goals that are specific to the individual and designed to maximise their achievements and social integration.Objective(s)We aimed to ascertain the views and experiences of service users, carers and staff to enable us to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving 19 mental health wards in six NHS sites in England and Wales included a metanarrative synthesis of policies and literature; a survey of service users (n = 301) and staff (n = 290); embedded case studies involving interviews with staff, service users and carers (n = 76); and a review of care plans (n = 51) and meetings (n = 12).ResultsNo global differences were found across the sites in the scores of the four questionnaires completed by service users. For staff, there was significant difference between sites in mean scores on recovery-orientation and therapeutic relationships. For service users, when recovery-orientated focus was high, the quality of care was viewed highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Across all sites, staff’s scores were significantly higher than service users’ scores on the scale to assess therapeutic relationships. Staff across the sites spoke of the importance of collaborative care planning. However, the staff, service user and carer interviews revealed gaps between shared aspirations and realities. Staff accounts of routine collaboration contrasted with service user accounts and care plan reviews. Definitions and understandings of recovery varied, as did views of the role of hospital care in promoting recovery. ‘Personalisation’ was not a familiar term, although there was recognition that care was often provided in an individualised way. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.ConclusionsOur results suggest that there is positive practice taking place within acute inpatient wards, with evidence of widespread commitment to safe, respectful, compassionate care. Although ideas of recovery were evident, there was some uncertainty about and discrepancy in the relevance of recovery ideals to inpatient care and the ability of people in acute distress to engage in recovery-focused approaches. Despite the fact that staff spoke of efforts to involve them, the majority of service users and carers did not feel that they had been genuinely involved, although they were aware of efforts to keep them safe.Future workFuture research should investigate approaches that increase contact time with service users and promote personalised, recovery-focused working; introduce shared decision-making in risk assessment and management; and improve service user experiences of care planning and review and the use of recovery-focused tools during inpatient care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Some clinicians and service users have described the discharge experience as chaotic, stressful, and emotionally charged (Wright et al . ). During this period, patients are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments (Owen‐Smith et al .…”

Section: Introductionmentioning

confidence: 97%

Outcomes and feasibility of the short transitional intervention in psychiatry in improving the transition from inpatient treatment to the community: A pilot study

Hegedüs

Kozel

Fankhauser

et al. 2017

Int J Mental Health Nurs

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Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital. We conducted a quasi-experimental pilot study to determine the feasibility of the intervention, and gain insight into the effects of the STeP. Two inpatient wards at a Swiss psychiatric hospital participated in the study, and represented the intervention and control arms. Patient recruitment and baseline assessment were performed 2 weeks prior to discharge. Follow-up data were collected 1 week subsequent to discharge. Questionnaires measured coping, admission and health-care usage, self-efficacy, working alliance, experience of transition, and the number of difficulties experienced following discharge. Fourteen and 15 patients completed the follow-up assessment in the control and intervention groups, respectively. The STeP did not affect primary or secondary outcomes; however, it was shown to be feasible, and patients' feedback highlighted the importance of post-discharge contact sessions. Further research is required to improve understanding of the discharge experience, identify relevant patient outcomes, and assess the effectiveness of the intervention in an adequately-powered randomized, controlled trial.

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From admission to discharge in mental health services: a qualitative analysis of service user involvement

Cited by 57 publications

References 28 publications

Recovery‐oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings

Recovery‐oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings

Cross-national mixed-methods comparative case study of recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings (COCAPP-A)

Outcomes and feasibility of the short transitional intervention in psychiatry in improving the transition from inpatient treatment to the community: A pilot study

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