Service user experiences of community services for Complex Emotional Needs: A qualitative thematic synthesis

Rains, Sheridan; Echavé,; Rees, Helen; Scott, Alexander P.; Taylor, Billie Lever; Broeckelmann,; Steare, Thomas; Barnett, Phoebe; Cooper, Cyrus; Jeynes,; Russell,; Oram,; Rowe, W.B.; Johnson, _______

doi:10.1101/2020.10.30.20222729

Cited by 3 publications

(5 citation statements)

References 54 publications

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“…Many of these findings align with those identified in our accompanying meta-synthesis of the of the perspectives and experiences of service users with CEN (38) . For example, service users also appear to prioritise individualised care, preferring clinicians to focus on individual needs and aspirations rather than diagnosis or intervention fidelity.…”

Section: Discussionsupporting

confidence: 80%

“…Whilst reading this review, I was struck by the allegory of a mirror. The focus is on clinicians, but its sister paper with a service user focus (38) reflects the same issues. The mirror allegory goes beyond similar themes being reflected.…”

Section: Resultsmentioning

confidence: 99%

“…Some dilemmas and variations in opinion were also identified, especially regarding the balance between doing ‘too much’ or ‘too little.’ Potential positive and negative consequences were identified both for open-ended long-term input and for time-limited input, as for 24 hour availability of clinicians in specialist services. Those who advocate for long-term support may be more in tune with service users, reported often to see periods of treatment as too short and continuing support between periods of intensive therapy as lacking (38) . Whether or not services were time-limited, there was agreement that careful collaborative discharge planning was required to mitigate some of the frequently experienced challenges and help service users work towards self-sufficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians' experiences of and perspectives on good practice for providing community care for people with CEN offer valuable insight into how to better meet the needs of this population and the needs of the clinicians supporting them and are largely in harmony with the perspectives of service users (38) . In further research, a focus is now needed on how to implement these principles of good practice across the service system to improve service user outcomes and the experiences of service users and clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…This review is part of a broader programme of work conducted by the NIHR Mental Health Policy Research Unit to inform the development of NHS England specialist pathways and to strengthen the evidence base for service development in this field nationally and internationally. Other reviews include a synthesis of qualitive literature on service user perspectives on good practice (38) , systematic reviews on treatment effectiveness and cost-effectiveness (39) and a study of service typologies.…”

Section: Introductionmentioning

confidence: 99%

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Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

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Section: Discussionsupporting

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

Foye

Stuart

Trevillion

et al. 2021

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Background Service provision for people with complex emotional needs (CEN) is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users say they encounter. We use the term CEN as a working description to refer to the needs experienced by people who may have been diagnosed with a "personality disorder". Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views. Methods We used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach. Findings Main themes were: 1) Defining Best Practice, 2) Facilitators of Best Care, 3) Barriers to Best Care, 4) Systemic Challenges. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. However, major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support. Discussion Overall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that we can provide the best practice care for these individuals. Particularly prominent is the need to put in place system-wide training and support for clinicians working with CEN, encompassing generic as well as specialist services, and to challenge the stigma still experienced throughout the system. Conclusions Staff working with this service user group report that delivering best practice care services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.

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Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

Trevillion¹,

Stuart

Ocloo³

et al. 2021

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Background There is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users views and co-production exercises have had little impact on the development of treatment and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs. Methods A co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data. Results Participants reported some experiences of good practice but also of experiences of severely stigmatising treatment, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised, compassionate and trauma-informed manner. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs. Conclusions Relational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with people with relevant lived experience, their carers and the professionals who support them. Keywords Qualitative research, personality disorders, community mental health services, co-production

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Service user experiences of community services for Complex Emotional Needs: A qualitative thematic synthesis

Cited by 3 publications

References 54 publications

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

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