Recovery-focused mental health care planning and co-ordination in acute inpatient mental health settings: a cross national comparative mixed methods study

Abstract

Background Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care. Methods A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users ( n = 301) and staff ( n = 290) and embedded case studies involving interviews with staff, service users and carers ( n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method. Results For service users, when recovery-oriented focus was high, the quality of care was rated 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. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. 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. Conclusions There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning. This paper arises from a larger study published by National Institute for Health Research (Simpson A, et al, Health Serv Deliv Res 5(26), 2017). Electronic supplementary material The online version of this article (10.1186/s12888-019-2094-7) contains supplementary material, which is available to authorized users.

Cost‐effectiveness of staffing levels on conflict and containment on psychiatric wards in England

“…The production function analysis complemented these results. However, the outcomes used in the analysis were conflicts and containment rather than patient‐reported outcome measures, symptoms, functioning or length of stay, ability of staff to build positive therapeutic relationships, to work collaboratively in planning care, assessing and managing risks (Coffey et al, ). Though these outcomes are of importance in mental health settings, the results need to be treated with caution.…”

A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice

“…The purpose of acute inpatient care, however, is likely to be related to an acute and severe exacerbation of illness symptoms where the goal is to reduce these symptoms and manage any immediate health risk (such as self‐harm) for discharge then back to community care (Bower ; Coffey et al . ). Acute mental health care is likely to be episodic with the goal focussed on illness symptoms more so than on the consumer's functional life goals (Bower ; Coffey et al .…”

“…Acute mental health care is likely to be episodic with the goal focussed on illness symptoms more so than on the consumer's functional life goals (Bower ; Coffey et al . ). Hence, the environmental context is not as conducive to the development of meaningful consumer involved care planning in the acute inpatient setting because of this purpose, and because of two other factors, these being a focus on risk management and additional challenges to therapeutic engagement between consumers and mental health nurses.…”

“…For the mental health consumers' recovery across the broad daily life domains mentioned earlier, care planning will need to take place mainly in the community across a time frame that has continuity and that is based in the consumer's functional life goals (McHugh & Byrne 2012;Thornicroft, Deb & Henderson 2016). The purpose of acute inpatient care, however, is likely to be related to an acute and severe exacerbation of illness symptoms where the goal is to reduce these symptoms and manage any immediate health risk (such as self-harm) for discharge then back to community care (Bower 2005;Coffey et al 2019). Acute mental health care is likely to be episodic with the goal focussed on illness symptoms more so than on the consumer's functional life goals (Bower 2005;Coffey et al 2019).…”

“…The purpose of acute inpatient care, however, is likely to be related to an acute and severe exacerbation of illness symptoms where the goal is to reduce these symptoms and manage any immediate health risk (such as self-harm) for discharge then back to community care (Bower 2005;Coffey et al 2019). Acute mental health care is likely to be episodic with the goal focussed on illness symptoms more so than on the consumer's functional life goals (Bower 2005;Coffey et al 2019). Hence, the environmental context is not as conducive to the development of meaningful consumer involved care planning in the acute inpatient setting because of this purpose, and because of two other factors, these being a focus on risk management and additional challenges to therapeutic engagement between consumers and mental health nurses.…”