The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user…
Abstract
Purpose
The purpose of this paper is to provide a brief overview of the literature to date which has focused on co-production within mental healthcare in the UK, including service user and carer involvement and collaboration.
Design/methodology/approach
The paper presents key outcomes from studies which have explicitly attempted to introduce co-produced care in addition to specific tools designed to encourage co-production within mental health services. The paper debates the cultural and ideological shift required for staff, service users and family members to undertake co-produced care and outlines challenges ahead with respect to service redesign and new roles in practice.
Findings
Informal carers (family and friends) are recognised as a fundamental resource for mental health service provision, as well as a rich source of expertise through experience, yet their views are rarely solicited by mental health professionals or taken into account during decision making. This issue is considered alongside new policy recommendations which advocate the development of co-produced services and care.
Research limitations/implications
Despite the launch of a number of initiatives designed to build on peer experience and support, there has been a lack of attention on the differing dynamic which remains evident between healthcare professionals and people using mental health services. Co-production sheds a light on the blurring of roles, trust and shared endeavour (Slay and Stephens, 2013) but, despite an increase in peer recovery workers across England, there has been little research or service development designed to focus explicitly on this particular dynamic.
Practical implications
Despite these challenges, coproduction in mental healthcare represents a real opportunity for the skills and experience of family members to be taken into account and could provide a mechanism to achieve the “triangle of care” with input, recognition and respect given to all (service users, carers, professionals) whose lives are touched by mental distress. However, lack of attention in relation to carer perspectives, expertise and potential involvement could undermine the potential for coproduction to act as a vehicle to encourage person-centred care which accounts for social in addition to clinical factors.
Social implications
The families of people with severe and enduring mental illness assume a major responsibility for the provision of care and support to their relatives over extended time periods (Rose et al., 2004). Involving carers in discussions about care planning could help to provide a wider picture about the impact of mental health difficulties, beyond symptom reduction. The “co-production of care” reflects a desire to work meaningfully and fully with service users and carers. However, to date, little work has been undertaken in order to coproduce services through the “triangle of care” with carers bringing their own skills, resources and expertise.
Originality/value
This paper debates the current involvement of carers across mental healthcare and debates whether co-production could be a vehicle to utilise carer expertise, enhance quality and satisfaction with mental healthcare. The critique of current work highlights the danger of increasing expectations on service providers to undertake work aligned to key initiatives (shared decision-making, person-centred care, co-production), that have common underpinning principles but, in the absence of practical guidance, could be addressed in isolation rather than as an integrated approach within a “triangle of care”.
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Peter Nolan, Eleanor Bradley and Neil Brimblecombe
As the beliefs people hold exert more influence over their behaviour than any other single factor, the purpose of this paper is to elicit those held by service users about being…
Abstract
Purpose
As the beliefs people hold exert more influence over their behaviour than any other single factor, the purpose of this paper is to elicit those held by service users about being cared for in acute mental health settings.
Design/methodology/approach
Data were collected by means of a semi‐structured, non‐standardised, 17‐item interview schedule from an opportunistic sample of 44 respondents (18 men and 26 women) following their admission over a nine‐month period.
Findings
Findings suggest that those admitted to acute care settings harbour very different beliefs about what to expect, what is being offered and how it will affect them. While some respondents saw admission as an event simply to be endured, others saw it as a means of gaining relief, accessing better care and treatment as well as providing respite for their families. Whereas previous knowledge and experience of acute care did influence their beliefs, this was largely due to how they interpreted experiences rather than the experiences themselves. The data also suggest that service users can be assisted to reframe their beliefs by means of genuine, consistent and empathic relationships, thus putting services users in a position to derive maximum benefit from being admitted.
Originality/value
Relatively little attention has been paid to the beliefs that service users have on entry to mental health services, in comparison to that paid to problem‐identification, care planning and intervention regimens. A starting point for any health care intervention, especially mental health care, should be the identification of the beliefs held by those about to embark on treatment programmes. This area deserves much more attention than it has been given hitherto.
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Claude Besenius, Eleanor Bradley and Peter Nolan
The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic…
Abstract
Purpose
The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic medication, the route of administration, and the extent of service users' involvement.
Design/methodology/approach
A total of 26 psychiatrists and 12 nurses agreed to be interviewed in phase one of this study, concerning general aspects of prescribing. In phase two, 11 of the psychiatrists and five nurses from the first cohort took part in follow‐up interviews that focused specifically on their most recent prescribing experiences. In phase 3 of the study, 18 service users (14 male and 4 female) were recruited, during which their experiences of having medication prescribed was explored.
Findings
This interview‐based survey found that though there was some agreement between the attitudes and perceptions of prescribers and service users, there were also some important differences including differences with respect to the purposes of prescribed medication, when to prescribe, and under what conditions depot medication produces optimal results. It is not always clear to service users as to why certain medicines were prescribed nor is the information provided always understood. A considerable amount of prescribing practice is based on assumptions.
Originality/value
Even though medication (both oral and depot) has been shown to be useful in certain situations, nevertheless, the type of medication, dose and mode of administration continues to be idiosyncratic and inconsistent. This paper seeks to contribute to the debate by identifying in which pharmacological interventions for people with severe mental health problems could be improved.
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Co-production is becoming a more widely used term in mental health care in England, but it is not always clear what this means nor what the evidence base is behind particular uses…
Abstract
Purpose
Co-production is becoming a more widely used term in mental health care in England, but it is not always clear what this means nor what the evidence base is behind particular uses of the concept. The purpose of this paper is to set some of this discussion into a historical context and examine some of the relevant evidence base to begin to highlight the challenges with operationalising more co-production. This is by way of setting the scene for the other articles in this special edition of the journal. The paper then provides an overview of the other articles on co-production in this edition.
Design/methodology/approach
The paper is a short review and discussion of some key issues and evidence relevant to co-production in mental health.
Findings
Some key historical insights from other moves to transform mental health care are discussed, recognising that these developments can take a long time to reach maturity in services and practice across the whole country. The discussion of some pertinent research and of the other articles in this special edition helps to highlight what foundations the author have in place for greater co-production in mental health care, and what remains as some of the challenges and gaps in the knowledge.
Originality/value
The paper provides a historical overview of some key issues, evidence and lessons pertaining to moves to develop more co-production in mental health.
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Staffordshire's Welfare to Work Joint Investment Plan is an inter‐agency approach to improving job opportunities for disabled people and carers, emphasising the need for their…
Abstract
Staffordshire's Welfare to Work Joint Investment Plan is an inter‐agency approach to improving job opportunities for disabled people and carers, emphasising the need for their participation in this process. A partnership with Staffordshire University has enabled disabled people to acquire research skills and survey the views of other disabled people on barriers to employment and strategies to overcome them. The article shares this innovative approach to participation and welfare to work.
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Research suggests that individuals with autistic spectrum disorder (ASD) are inconsistently supported throughout the criminal justice system (CJS) in the UK. Bradley (2009…
Abstract
Purpose
Research suggests that individuals with autistic spectrum disorder (ASD) are inconsistently supported throughout the criminal justice system (CJS) in the UK. Bradley (2009) recommended the introduction of criminal justice liaison and diversion (L&D) teams to bridge the gap between the CJS and mental health services and provide a more consistent and improved quality of support for individuals with vulnerabilities, including those with autism. This study aims to explore the experiences of staff working in L&D teams who encounter individuals with ASD.
Design/methodology/approach
Interviews were conducted with ten L&D team members. Interpretative phenomenological analysis was used to gain insight into their lived experiences of working with autism in the CJS.
Findings
Interpretation of individual transcripts resulted in three super-ordinate themes: “feeling helpless and helpful in the system”, “transition to knowing” and “impact on self”. Each theme encapsulated a number of sub-themes depicting the limitations of services, difficult environments, making a difference, lack of understanding, developing understanding and the impact of these experiences on staff’s confidence, attitudes and well-being.
Practical implications
Criminal justice services are limited for people with autism. There is a lack of autism awareness by staff. Lack of awareness impacts staff attitudes and confidence. Training in autism should be provided to criminal justice staff.
Originality/value
This research highlights the limitations of services available for individuals with autism and the widespread lack of autism awareness. These concerns directly impacted participants’ confidence, attitudes and well-being. Recommendations are proposed to guide future practice and research including increasing availability of access to ASD services, enforcing mandatory autism-specific training for staff and routinely collecting service-user feedback.
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Bradley (BJ) Warren and Eleanor Odenheimer Brin
The purpose of this paper is to assess college students’ pre- and post- health-related, fitness levels, as determined by the American College of Sports Medicine’s (ACSM) five…
Abstract
Purpose
The purpose of this paper is to assess college students’ pre- and post- health-related, fitness levels, as determined by the American College of Sports Medicine’s (ACSM) five components of fitness, in a one-credit, graded college course and to objectively measure any differences between those pre- and post- health-related fitness levels.
Design/methodology/approach
In a field setting, the investigators conducted health-related, fitness assessments using the ACSM validated protocols. In addition, descriptive statistics were collected including demographic information, such as, age and sex.
Findings
Paired-sample t tests were used to calculate the pre- and post-test scores for six fitness- and health-related categories across four semesters. There were statistically significant (p<0.001) improvements in six different areas in each of the four semesters with the exception of the resting heart rate and VO2 Max measurements in the fall semester of 2014.
Originality/value
This study builds upon the current body of work tracking trends in physical activity, college courses. The results answer health promotion scientists’ call for more research on the implementation and evaluation of programmatic interventions (Domitrovich and Greendberg, 2000; Durlack, 1998; Durlak and DuPre, 2008) “in real-world settings in order to understand if and how an intervention works” (Søvik et al., 2016, p. 238). This results in addressing a research gap in assessing the effectiveness of physical activity courses in higher education (Keating et al., 2005).