It's the talk: a study of involvement initiatives in secure mental health settings

Abstract

BackgroundA study of involvement initiatives within secure mental health services across one UK region, where these have been organized to reflect alliances between staff and service users. There is little previous relevant international research, but constraints upon effective involvement have been noted.ObjectiveTo explore and evaluate involvement initiatives in secure mental health settings.DesignA case study design with thematic analysis of qualitative interviews and focus groups.Setting and participantsData collection was carried out between October 2011 and February 2012 with 139 staff and service users drawn from a variety of secure mental health settings.FindingsOur analysis offers four broad themes, titled: safety and security first?; bringing it all back home; it picks you up; it's the talk. The quality of dialogue between staff and services users was deemed of prime importance. Features of secure environments could constrain communication, and the best examples of empowerment took place in non‐secure settings.DiscussionKey aspects of communication and setting sustain involvement. These features are discussed with reference to Jurgen Habermas's work on communicative action and deliberative democracy.ConclusionsInvolvement initiatives with service users resident in secure hospitals can be organized to good effect and the active role of commissioners is crucial. Positive outcomes are optimized when care is taken over the social space where involvement takes place and the process of involvement is appreciated by participants. Concerns over risk management are influential in staff support. This is germane to innovative thinking about practice and policy in this field.

Looking back, looking forward: Recovery journeys in a high secure hospital

“…One impediment to uptake and implementation of recovery ideals and practices among the majority staff group is the emphasis within nurse education of bio‐medical understandings of care, and the more general subordination of all disciplines under psychiatry. Arguably, these tendencies are as prominent within the relatively isolated forensic sector as in the mainstream (Chandley et al ) though, as has been noted, much progress has been made in this context and practices around involvement and recovery can in some regards be superior in certain secure settings (McKeown et al ).…”

How Best to Engage Users of Forensic Services in Research: Literature Review and Recommendations

“…Two documents summarised studies exploring professionals' experience of involving service users in research in a prison setting (Byrne, 2005;Patenaude, 2004); four were studies involving service users at each stage of the research (Livingston, Nijdam-Jones & Team P.E.E.R., 2013a;Livingston, Nijdam-Jones, Lapsley, Calderwood & Brink, 2013b;McKeown et al, 2014;McKeown et al, 2016), one was a study on communication between researchers and service users (Davidson, Espie & Lammie, 2011), and one was an evaluation of peer support in secure mental health settings carried out by people with personal experience of mental distress (Shaw, 2014). In summary, five articles focussed mainly on providing guidance for good practice (CLINKS, 2013;Faulkner, 2004;NSUN/WISH, 2011;SURGE, 2005/6), eleven were qualitative or empirical studies (Banongo et al, 2006;Davidson et al, 2011;Godin et al, 2007;Livingston et al, 2013a;Livingston et al, 2013b;McKeown et al, 2014;McKeown et al, 2016;MacInnes et al, 2011;Martin et al, 2009;Patenaude, 2004;Shaw, 2014), and seven were overviews or discussion documents (Byrne, 2005;CLINKS, 2011;Faulkner, 2007;Faulkner & Morris, 2003;INVOLVE, 2009;Sainsbury Centre, 2008;Spiers et al, 2005).…”

“…Methods suggested for providing support included setting up mentoring schemes (CLINKS, 2013), researchers working in pairs for mutual support when carrying out interviews (Faulkner & Morris, 2003), holding regular individual and group meetings between service-user researchers and the principal investigator (MacInnes et al, 2011), and having service users accompanied and supported by individual members of staff (Faulkner, 2007). The possibility that service users find their personal resources burdened by the amount of work they take on was also acknowledged (McKeown et al, 2014). Peer support schemes may also be valuable (Shaw, 2014), although the concept of peer support may be contentious amongst staff in prison or secure settings (Martin et al, 2009).…”

“…These needs were seen as arising from lack of clarity about trust and confidentiality (Faulkner, 2007;McKeown et al, 2014), difficulty in knowing when and how concerns might be raised in a forensic setting (Faulkner, 2004;MacInnes et al, 2011), and possible negative consequences resulting from a 'shared experience' with their interviewees (INVOLVE, 2009 hospital. Although the majority of the service providers surveyed indicated that the service users' experiences in the hospital had been "moderately" or "extremely" improved as a function of their participation, no significant change in scale scores on instruments measuring personal empowerment, internalized stigma, personal recovery, service engagement and therapeutic milieu were detected for the service users within the research team.…”

“…The challenge of accessing service users who might wish to assist in the co-production of research process in a forensic setting was acknowledged, and negotiation may be needed in environments where professionals act as gatekeepers to patients (Faulkner, 2004;McKeown et al, 2014). Such negotiation would need to take into account any local policies and protocols on service user involvement (NSUN/WISH, 2011).…”