Isobel Talks, Buthena Al Mobarak, Cornelius Katona, Jane Hunt, Niall Winters and Anne Geniets
Refugees and asylum seekers worldwide face numerous barriers in accessing health systems. The evidence base regarding who and what helps refugees and asylum seekers facilitate…
Abstract
Purpose
Refugees and asylum seekers worldwide face numerous barriers in accessing health systems. The evidence base regarding who and what helps refugees and asylum seekers facilitate access to and the navigation of the health system in the UK is small. This study aims to address this gap by analysing 14 semi-structured, in-depth interviews with refugees and asylum seekers of different countries of origin in the UK to identify where, when and how they came into contact with the health-care system and what the outcome of these interactions was.
Design/methodology/approach
Semi-structured, in-depth interviews were chosen as the key method for this study. In total, 14 individual interviews were conducted. A trauma-informed research approach was applied to reduce the risk of re-traumatising participants.
Findings
The paper identifies key obstacles as well as “facilitators” of refugees’ and asylum seekers’ health-care experience in the UK and suggests that host families, friends and third-party organisations all play an important role in ensuring refugees and asylum seekers receive the healthcare they need.
Originality/value
To the best of the authors’ knowledge, this is the first qualitative study in the UK that looks at comprehensive health journeys of refugees from their first encounter with health services through to secondary care, highlighting the important role along the way of facilitators such as host families, friends and third-party organisations.
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This paper aims to highlight emerging research relating to the need to recognise and address trauma in mental health service users.
Abstract
Purpose
This paper aims to highlight emerging research relating to the need to recognise and address trauma in mental health service users.
Design/methodology/approach
The author searched for papers on trauma-informed care, published in the past two years.
Findings
One paper reports ideas of service users and family members for trauma-informed mental health services. A second paper describes an online survey seeking agreement between staff and service users of early intervention services for psychosis about practices of trauma-informed care. Both papers feature themes about safety and staff having training and support for asking about and responding to trauma. A third paper reports on specific therapies for trauma with people who experience psychosis. It found some evidence for talking therapies but noted that people with a psychosis diagnosis are rarely offered such therapies.
Originality/value
These papers highlight an emerging consensus about essential components of trauma-informed care and the need for staff training and support to realise it. The exclusion of people with a psychosis diagnosis from specific trauma therapies might begin to be addressed if services were more able to recognise trauma. There is some evidence that talking therapies for childhood trauma can be helpful for people who have a psychosis diagnosis. However, evidence reviews should be broadened to include a range of distressing experiences recognised to follow childhood trauma irrespective of whether the person has a psychosis diagnosis.
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This chapter will seek to add insight on the lived experiences of women subjected to non-fatal, non-consensual violence in sex (NCVS) by men.The chapter will draw on primary…
Abstract
This chapter will seek to add insight on the lived experiences of women subjected to non-fatal, non-consensual violence in sex (NCVS) by men.
The chapter will draw on primary research conducted by the author in the Spring and Summer of 2020, comprising in-depth interviews with eight women and a survey of 84 women, all of whom had experienced NCVS, often from multiple perpetrators. It will summarize the acts to which women were subjected (often life-threatening in nature), the long-term impacts on women, and the ways in which men minimized and re-packaged their violence. It will make the case that NCVS – often dismissed as ‘rough sex gone wrong’ – is a particularly insidious form of violence against women and girls.
The chapter will highlight how women’s sense-making processes around NCVS are often hampered by legal definitions of sexual violence, which left women wondering ‘what category to put it in’. Using Fricker’s (2007) concept on ‘epistemic injustice’, it will emphasize the need for a ‘shared tools of social interpretation’ (p. 6) around NCVS, alongside any legal changes, and the importance of campaigns like We Can’t Consent To This in giving language to women’s often unspoken experiences.
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Isobel Moore, Philip John Archard and Sarah Simmonds
The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in…
Abstract
Purpose
The process of ending mental health support is often not well-attended to in practice or research, and clinicians in UK mental health services lack focused clinical guidance in this area. This paper aims to report on a service evaluation that sought to understand from clinicians working in a single adult community mental health team (CMHT) their experiences of discharge and issues arising in the process, factors considered in decision-making and what constitutes “good” endings and what support could be helpful to them in navigating this with clients.
Design/methodology/approach
Semi-structured interviews were completed with six members of the multi-disciplinary team and analysed thematically.
Findings
Clinicians described a range of criteria considered in discharge decision-making. Collaboration, planning and preparation were represented as key ingredients for “good” endings. Factors viewed as complicating discharge included complexity and changes in presentation, psychosocial contexts and re-referrals. Perceptions of clients’ feelings (resistance and dependence, fear and anger, relief and gratitude) and varying feelings evoked for clinicians (from little or no reported impact, to pride and confidence, sadness and worry) at the ending of the working relationship were reported. Suggested organisational supports for clinicians with endings and discharges involved opportunities to consult with colleagues, psychological formulation and advice and reflective supervision.
Originality/value
There has been limited empirical attention to practitioner experiences of discharge in the work of CMHTs in a UK context; this practitioner-led evaluation explored clinician perspectives.
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Amy Schlitz’s book Good Masters! Sweet Ladies! set in 1255 England is an extraordinary children’s book that explores life in a medieval village. This is not your typical storybook…
Abstract
Amy Schlitz’s book Good Masters! Sweet Ladies! set in 1255 England is an extraordinary children’s book that explores life in a medieval village. This is not your typical storybook and is not to be read in the typical fashion. As we learn from the forward, the author—a school librarian—wrote it with the intention that a group of students studying medieval history would put on a dramatization of the book. Because she did not want a couple of students to have the lead roles and the rest to have minor ones, she wrote it as a series of 23 monologues that intertwine. This lesson plan provides background information on the book and suggestions on how to use it.
Philip John Archard, Emma Giles, Isobel Moore, Sewanu Awhangansi, Siobhan Fitzpatrick, Leanne Kulik and Michelle O’Reilly
The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team…
Abstract
Purpose
The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children’s services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery.
Design/methodology/approach
Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires.
Findings
Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers’ accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children’s birth families there were more mixed and negative impressions.
Originality/value
Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised.
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Rosalind Lau and Anastasia Hutchinson
Over the past 15 years, mental health organisations have taken steps to move towards providing services that are more recovery-oriented. This review was undertaken to explore what…
Abstract
Purpose
Over the past 15 years, mental health organisations have taken steps to move towards providing services that are more recovery-oriented. This review was undertaken to explore what is known about service users’ experience of services that have introduced a recovery-oriented approach to service provision. There is limited research evaluating consumers’ lived experiences of recovery-orientated care; a scoping review was chosen to provide an overview of the available research in this area (Munn et al., 2018). The purpose of this review was to summarize and synthesize current qualitative research exploring consumers’ experience of recovery orientated mental health care provision.
Design/methodology/approach
This scoping review was undertaken as outlined by Arksey and O'Malley (2005). The five steps consisted identifying the research question; searching for relevant studies; selecting the studies; charting the studies; and collating, summarising and reporting the findings.
Findings
Three key themes emerged from this review: translation of recovery policy to practice; ward environment; and recovery principles with five subthemes: engagement; not being listened to; shared decision-making; informational needs; and supportive and collaborative relationships. The themes and subthemes identified in each of the 18 studies are presented in Table 3.
Research limitations/implications
This review highlights the different degree to which service users have received recovery-oriented recovery care. In the majority of cases, most service users reported few opportunities for nursing engagement, poor communication, inadequate information provision, a lack of collaborative care and mostly negative experiences of the ward environment. Because of the limited studies on mental health service users’ lived experiences of a recovery-oriented service, more clinical studies are needed and in different cultural contexts.
Practical implications
On hindsight, the authors should have included service users in this review process as consumer inclusion is progressively emphasised in mental health educational and research activities. This review highlights that not all studies have involved service users or consumers in their research activity.
Social implications
Service users need relevant information in a timely manner to participate in decision-making regarding their treatment and care. This review found that either no information was provided to the service users or it was provided in a limited and fragmented manner. This review also found inpatients reported limited opportunities to have meaningful participation in decision-making about their care. These findings have important social implications, as greater consumer engagement in the design and delivery of mental health services will increase community trust in the care provided. This in turn has the potential to facilitate greater community engagement in preventative mental health care.
Originality/value
This is the first review to systematically synthesis consumers perspectives on the extent to which service providers are achieving the goal of implementing recovery-orientated practice into their service provision. Despite important policy changes, the findings of this review demonstrate that more work is needed to truly operationalise and translate these principles into practice.