Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

Abstract

BackgroundIn the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require service users to have a care coordinator, written care plan and regular reviews of their care. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care.MethodsWe conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. The study included a survey of views on recovery, empowerment and therapeutic relationships in service users (n = 448) and recovery in care coordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117) and a review of care plans (n = 33). Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method.ResultsSignificant differences were found across sites for scores on therapeutic relationships. Variation within sites and participant groups was reported in experiences of care planning and understandings of recovery and personalisation. Care plans were described as administratively burdensome and were rarely consulted. Carers reported varying levels of involvement. Risk assessments were central to clinical concerns but were rarely discussed with service users. Service users valued therapeutic relationships with care coordinators and others, and saw these as central to recovery.ConclusionsAdministrative elements of care coordination reduce opportunities for recovery-focused and personalised work. There were few common 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. Research to investigate innovative approaches to maximise staff contact time with service users and carers, shared decision-making in risk assessments, and training designed to enable personalised, recovery-focused care coordination is indicated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0858-x) contains supplementary material, which is available to authorized users.

Attitudes towards shared decision making in mental health: a qualitative synthesis

“…Simon et al, 2007;Davidson et al, 2008;Simpson et al, 2016;Street, 2009;Woltman & Whitley, 2010;Hamann et al, 2016). This may be especially important during more difficult periods and important mitigating factor against difficulties of expressing oneself clearly and not feeling able to be fully involved (Woltman & Whitley, 2010).…”

Talking about mental health nursing: a qualitative analysis of nurses’ and service users’ accounts

“…(Cameron et al, 2005;Gamble, 2006). The disparity between nurses working in acute areas experiencing chaos and pressure, whilst service users endured boredom is concerning, with notable dissatisfaction for both groups (Shattell, Andes & Thomas, 2008 (Simpson et al, 2016a), have possible protective outcomes (Cole-King & Platt, 2017) and can be shown to have some therapeutic effect (Hewitt & Coffey, 2005). These results are not specific to nursing and the issue appears to be that mental health nurses make claims about their effectiveness, but do not show specific evidence for their contribution.…”

“…Interpersonal aspects of care are highly valued by service users (Simpson et al, 2016a;Valente, 2017), as it is time with staff that is most requested. (Barker, 2000;Stenhouse, 2011;Street, 2004).…”

“…Recovery and personalisation together means that professionals would ideally be tailoring support and services to fit the specific needs of the individual; with people taking more control over their condition and lives (Simpson et al, 2016a). However, users have reported that limited collaboration has been the reality (Newman et al, 2015).…”

“…This partnership working would usually involve discussions about service users' plans for recovery, evidence based interventions, and on-going conversations provided through the context of a therapeutic relationship with the service user. However, recent research indicates that service user partnerships in practice require much improvement (Grundy et al, 2016;Simpson et al, 2016a). Equally, a shift is required in the relationships that mental health nurses have with service users in order to incorporate participation and involvement into people's care (Newman, O'Reilly, Lee, & Kennedy, 2015).…”