scholarly journals Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?

2021 ◽  
Author(s):  
Sofia Pappa ◽  
Joshua Barnett ◽  
Sally Gomme ◽  
Anthi Iliopoulou ◽  
Ivan Moore ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Lived Experience ◽  
Service User ◽  
Best Practice ◽  
Good Practice ◽  
Mental Health Provider ◽  
Service Users ◽  
Mental Health Settings ◽  
Formed Part

AbstractPersonalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide ‘Supported Decision Making in Medication’ Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber’s perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.

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

2017 ◽  
Vol 22 (3) ◽  
pp. 233-256 ◽  
Author(s):  
Emma Kaminskiy ◽  
Simon Senner ◽  
Johannes Hamann
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Service User ◽  
Service Users ◽  
Shared Decision ◽  
Qualitative Synthesis ◽  
Content Type ◽  
Mental Health Settings ◽  
Word Search

Purpose Shared decision making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users’ experiential knowledge, values and preferences. The purpose of this paper is to review the existing literature pertaining to key stakeholders’ attitudes towards SDM in mental health. It examines whether perceived barriers and facilitators differ by group (e.g. service user, psychiatrist, nurse and social worker) and includes views of what facilitates and hinders the process for service users and practitioners. Design/methodology/approach This review adopts the principles of a qualitative research synthesis. A key word search of research published between 1990 and 2016 was undertaken. Qualitative, quantitative and mixed methods studies were included. Findings In total, 43 papers were included and several themes identified for service user and practitioner perspectives. Both practitioners and service users see SDM as an ethical imperative, and both groups highlight the need to be flexible in implementing SDM, suggesting it is context dependent. A range of challenges and barriers are presented by both practitioners and service users reflecting complex contextual and cultural features within which interactions in mental health take place. There were qualitative differences in what service users and practitioners describe as preventing or enabling SDM. The differences highlighted point towards different challenges and priorities in SDM for service users and practitioners. Originality/value The presentation of nuanced views and attitudes that practitioners and service users hold represent an important and under reported area and offer insight into the reasons for the gap between idealised policy and actual practice of SDM in mental health settings.

scholarly journals Experiences of user involvement in mental health research: exploring reflections from a service user researcher using auto-ethnography

2020 ◽  
Vol 25 (3) ◽  
pp. 281-294
Author(s):  
Joanna Fox
Keyword(s):  
Mental Health ◽  
Health Research ◽  
Service User ◽  
Best Practice ◽  
User Involvement ◽  
Mental Health Research ◽  
Power Sharing ◽  
Service Users ◽  
Content Type ◽  
Auto Ethnography

Purpose User involvement in research is entering the mainstream of traditional mental health research. In practice, there are diverse ways in which the process of involvement is experienced by mental health service user researchers. This paper aims to explore two diverse experiences of involvement by the researcher. Design/methodology/approach Auto-ethnography is the research methodology used in this study; it combines a process of reflective writing and critical analysis which enables the author to explore experiences of being both a service user and academic researcher. Two accounts of the author’s involvement in mental health research are presented: one which builds on a consultation model and the other based on co-production principles. Findings Experiences of power-sharing and collaborative decision-making, alongside disempowerment, are discussed, leading to exploration of the theoretical and practical processes for promoting participation of users in research. Research limitations/implications The research is limited because it is undertaken by one individual in a local setting, and is therefore is not generalisable; however, it provides useful insights into the diverse processes of involvement that many service users experience. Practical implications Recommendations are presented to support the involvement of service users in research, with final remarks offered considering the possible future implementation of this still emerging tradition. Originality/value This paper reflects on the experiences of one service user academic involved in research and highlights diverse experiences of both empowering and disempowering involvement, providing recommendations for best practice.

scholarly journals Supported decision-making from the perspectives of mental health service users, family members supporting them and mental health practitioners

2018 ◽  
Vol 52 (9) ◽  
pp. 826-833 ◽  
Author(s):  
Renata Kokanović ◽  
Lisa Brophy ◽  
Bernadette McSherry ◽  
Jacinthe Flore ◽  
Kristen Moeller-Saxone ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Service ◽  
Health Service ◽  
Good Practice ◽  
Family Members ◽  
Mental Health Practitioners ◽  
Service Users ◽  
Moral Obligations ◽  
Health Practitioners

Background: Supporting the decision-making of mental health service users fulfils professional, ethical and moral obligations of mental health practitioners. It may also aid personal recovery. Previous research on the effectiveness of supported decision-making interventions is limited. Aims: The study aims to explore from several perspectives the barriers and facilitators to supported decision-making in an Australian context. Supported decision-making was considered in terms of interpersonal experiences and legal supported decision-making mechanisms. Methods: In all, 90 narrative interviews about experiences of supported decision-making were conducted and analysed. Participants were mental health service users who reported diagnoses of schizophrenia, psychosis, bipolar disorder and severe depression; family members supporting them and mental health practitioners, including psychiatrists. The data were analysed thematically across all participants. Results: Negative interpersonal experiences in the mental health care system undermined involvement in decision-making for people with psychiatric diagnoses and family carers. Mental health practitioners noted their own disempowerment in service systems as barriers to good supported decision-making practices. All groups noted the influence of prevailing attitudes towards mental health service users and the associated stigma and discrimination that exist in services and the broader community. They believed that legal supported decision-making mechanisms facilitate the participation of mental health service user and their family supporters in supported decision-making. Conclusions: Enabling supported decision-making in clinical practice and policy can be facilitated by (1) support for good communication skills and related attitudes and practices among mental health practitioners and removing barriers to their good practice in health and social services and (2) introducing legal supported decision-making mechanisms.

scholarly journals Life in acute mental health settings: experiences and perceptions of service users and nurses

2013 ◽  
Vol 24 (1) ◽  
pp. 90-96 ◽  
Author(s):  
D. Rose ◽  
J. Evans ◽  
C. Laker ◽  
T. Wykes
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Service User ◽  
Working Life ◽  
Service Users ◽  
Patient Interaction ◽  
Marginalised Groups ◽  
The Social ◽  
Mental Health Settings ◽  
The Uk

Background.Acute psychiatric provision in the UK today as well as globally has many critics including service users and nurses.Method.Four focus groups, each meeting twice, were held separately for service users and nurses. The analysis was not purely inductive but driven by concerns with the social position of marginalised groups – both patients and staff.Results.The main themes were nurse/patient interaction and coercion. Service users and nurses conceptualised these differently. Service users found nurses inaccessible and uncaring, whereas nurses also felt powerless because their working life was dominated by administration. Nurses saw coercive situations as a reasonable response to factors ‘internal’ to the patient whereas for service users they were driven to extreme behaviour by the environment of the ward and coercive interventions were unnecessary and heavy handed.Conclusion.This study sheds new light on living and working in acute mental health settings today by comparing the perceptions of service users and nurses and deploying service user and nurse researchers. The intention is to promote better practice by providing a window on the perceptions of both groups.

scholarly journals Understanding of the Mental Capacity Act in work with older adults exploring the “unintended consequences” for service users’ emotional wellbeing

2016 ◽  
Vol 20 (3) ◽  
pp. 151-156
Author(s):  
Matthew Graham
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Decision Making ◽  
Good Practice ◽  
Mental Capacity ◽  
Mental Wellbeing ◽  
Service Users ◽  
Emotional Wellbeing ◽  
Content Type ◽  
Mental Capacity Act

Purpose The purpose of this paper is to explore the consequences for older people’s mental wellbeing of understandings relating to the Mental Capacity Act 2005 (MCA). The MCA seeks to maximise people’s abilities to make decisions and provides a framework for decisions to be made in a person’s best interests should they lack the mental capacity to do so themselves (Graham and Cowley, 2015). Practice varies widely amongst health and social care practitioners and little is known about the nature of interventions under the MCA or the outcomes for service users’ lives and health, especially their mental health and emotional wellbeing. Design/methodology/approach By reflecting upon existing evidence this position paper offers a narrative of how practice in applying the principles of the MCA may impact upon the mental wellbeing of older people. Drawing upon court of protection judgements and existing research the author analyses the way the MCA is understood and applied and how institutional mechanisms might hinder good practice. Findings There are tensions between policy imperatives and examples of practice linked to the MCA, the spirit of the MCA and tenets of good practice. Despite efforts on promoting choice, control and rights there is growing paradoxical evidence that the MCA is used as a safeguarding tool with the consequences that it constrains older people’s rights and that it may encourage risk averse practice. The consequences of this for older people are considerable and include lack of choice, autonomy and self-determination. This discussion suggests that anxiety in relation to the application of the MCA stills exists in practice and that maximising older people’s capacity and supporting decision making is central in promoting mental health and wellbeing. Practical implications This position paper will identify how the MCA might be interpreted in action through consideration of existing evidence. This paper may lead to future research on how understandings of the MCA are constructed and what values underpin its application from conception to outcomes in relation to understandings of risk, risk aversion, decision making and the potential and need for emancipatory practice. Essentially, the paper will discuss how the MCA actually seeks to enhance the mental health and emotional wellbeing of older adults by offering a rather radical approach to understanding people’s wishes and feelings, but how attitudes may lead to misunderstandings and negative outcomes for the individual. Originality/value In a climate of serious case reviews identifying concerns and abuses in care it is imperative that understanding of the MCA inform good practice. However, what constitutes good practice requires unravelling and the agendas, requirements and attitudes of interventions need considering from an epistemological perspective as well as to project how the outcomes of decision-making impact upon the mental health of older adults. This paper will discursively add value to the narrative around how the MCA is applied in practice and how chosen practice often constructs the mental wellbeing of older adults.

scholarly journals Best practice in managing violence and related risks

2008 ◽  
Vol 32 (11) ◽  
pp. 403-405 ◽  
Author(s):  
Quazi Haque ◽  
Adrian Cree ◽  
Christopher Webster ◽  
Bushra Hasnie
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Professionals ◽  
Best Practice ◽  
Good Practice ◽  
Successful Implementation ◽  
Department Of Health ◽  
Mental Health Settings ◽  
Managing Risk ◽  
Principles Of Good Practice

SummaryBest Practice in Managing Risk is a recent Department of Health publication which provides a framework for mental health professionals working with service users to assess risk. It underpins risk assessment with principles of good practice for all mental health settings and provides a list of guides offering structure to risk management. We consider the potential issues that may influence successful implementation of this framework across services based on personal experience in the field of risk assessment.

The experiences of paid formal lived experience workers within a secure mental health service

2017 ◽  
Vol 12 (5) ◽  
pp. 313-322 ◽  
Author(s):  
Christopher A. Griffiths ◽  
Ella Hancock-Johnson
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Lived Experience ◽  
Service Use ◽  
Small Sample ◽  
Clinical Staff ◽  
Mental Health Provider ◽  
Content Type ◽  
Mental Health Settings

Purpose The purpose of this paper is to report the experience and impact of paid staff who are employed to use their lived experience of mental health issues and service use within a secure mental health provider. Design/methodology/approach A qualitative approach using semi-structured interviews and thematic analysis was employed. Findings Results from this study suggest that employing lived experience workers (LEWs) in secure mental health settings is valuable to clinical staff, service users, the employing organisation and LEWs themselves. Findings emphasised the importance of support for LEWs to enable them to fulfil their role and maintain wellbeing, and the need to consider LEWs career progression within and beyond the role. Research limitations/implications This study had a small sample size. Practical implications There is evidence to support LEWs in secure mental health settings and requirement for further understanding of their work in this environment. Specific recommendations include the need for training for clinical staff about the role of LEWs, specific LEWs role training, and regular supervision and mental health support for LEWs. Originality/value This is the first paper reporting the experience and impact of LEWs in a UK secure mental health service.

scholarly journals Shared Decision-Making: An Autoethnography About Service User Perspectives in Making Choices About Mental Health Care and Treatment

2021 ◽  
Vol 12 ◽  
Author(s):  
Joanna Fox
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Shared Decision Making ◽  
Service User ◽  
Treatment Options ◽  
Service Users ◽  
Shared Decision ◽  
Care And Treatment

Shared decision-making (SDM) between mental health medication prescribers and service users is a central pillar in the recovery approach, because it supports people experiencing mental ill-health to explore their care and treatment options to promote their well-being and to enable clinicians to gain knowledge of the choices the service user prefers. SDM is receiving increasing recognition both in the delivery of physical and mental health services; and as such, is of significance to current practice. As an expert-by-experience with over 30 years of receiving mental health treatment, I have made many choices about taking medication and accessing other forms of support. The experiences of SDM have been variable over my career as a service user: both encounters when I have felt utterly disempowered and interactions when I have led decision-making process based on my expertise-by-experience. In this article, I recount two experiences of exploring care and treatment options: firstly, a discharge planning meeting; and secondly, the choice to take medication over the long-term, despite the side effects. The article will explore both opportunities and barriers to effective shared decision-making, as well as skills and processes to facilitate this approach. The need to balance power between service users and professionals in this interaction is highlighted, including the need to respect expertise built on lived experience, alongside that of clinical expertise. This narrative is framed within an autoethnographic approach which allows me to contextualize my personal experiences in the wider environment of mental health care and support.

Anxiety Disorders’ Effect on College and University Students’ Mental Health: A Common and Growing Concern

2020 ◽  
Vol 9 (2) ◽  
pp. 82-90
Author(s):  
Matthew J. Pesko
Keyword(s):  
Mental Health ◽  
Anxiety Disorders ◽  
University Students ◽  
Best Practice ◽  
Epidemiological Studies ◽  
Student Population ◽  
Adult Student ◽  
College And University ◽  
The Past ◽  
Mental Health Settings

Anxiety disorders are commonly experienced by college and university students and should be routinely assessed in mental health settings. Epidemiological studies suggest that the burden of these illnesses has greatly expanded even over the past decade. Factors that contribute to the experience of an anxiety disorder in a young adult student population are considered herein. The best practice for evaluation and treatment of these disorders is presented based on the review of available literature in this field. Special attention is paid to the concept of resilience as it pertains to anxiety disorders in the student population.

Now they’re listening: involvement in clinical psychology training

2019 ◽  
Vol 23 (1) ◽  
pp. 23-29
Author(s):  
Laura Lea ◽  
Sue Holttum ◽  
Victoria Butters ◽  
Diana Byrne ◽  
Helen Cable ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Psychology ◽  
Health Professionals ◽  
Service User ◽  
Health Workers ◽  
Psychology Training ◽  
Service Users ◽  
Clinical Psychology Training ◽  
Content Type

PurposeThe 2014/2015 UK requirement for involvement of service users and carers in training mental health professionals has prompted the authors to review the work of involvement in clinical psychology training in the university programme. Have the voices of service users and carers been heard? The paper aims to discuss this issue.Design/methodology/approachThe authors update the paper of 2011 in which the authors described the challenges of inclusion and the specific approaches the authors take to involvement. The authors do this in the context of the recent change to UK standards for service user and carer involvement, and recent developments in relation to partnership working and co-production in mental healthcare. The authors describe the work carried out by the authors – members of a service user involvement group at a UK university – to ensure the voices of people affected by mental health difficulties are included in all aspects of training.FindingsCareful work and the need for dedicated time is required to enable inclusive, effective and comprehensive participation in a mental health training programme. It is apparent that there is a group of service users whose voice is less heard: those who are training to be mental health workers.Social implicationsFor some people, involvement has increased. Trainee mental health professionals’ own experience of distress may need more recognition and valuing.Originality/valueThe authors are in a unique position to review a service-user-led project, which has run for 12 years, whose aim has been to embed involvement in training. The authors can identify both achievements and challenges.

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