scholarly journals Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

2021 ◽  
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Jennie Parker ◽  
Janet Willars ◽  
David Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
List Type ◽  
Service Users ◽  
Diverse Range ◽  
Qualitative Interview Study ◽  
Mental Health Difficulties ◽  
Remote Care

ABSTRACTObjectivesTo explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.DesignQualitative interview study, co-designed with mental health service users and carers.MethodsWe conducted semi-structured, telephone or online interviews with a purposively constructed sample; a peer researcher with lived experience conducted and analysed interviews with service users. Analysis was based on the constant comparison method.SettingNHS secondary mental health services in England between June and August 2020.ParticipantsOf 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.ResultsExperiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments, and identification of deteriorating mental wellbeing. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.ConclusionsWhilst remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decisions about remote mental healthcare. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.ARTICLE SUMMARYStrengths and limitations of this studyStrengths include its qualitative approach in speaking to a large sample of participants with varied mental health difficulties, carers, and a diverse range of mental healthcare staff.Its novelty lies in a deep exploration of the views and experiences of remote mental healthcare during a pandemic.The methods are strengthened by the involvement of experts-by-experience and the use of peer research methods.We did not adopt a narrative method; the interviews were one-off conversations so we could not explore change as the pandemic progressed and people may have become accustomed to remote care.The study used remote methods to comply with UK lockdown regulations; this will have excluded some groups without the ability to engage remotely.

scholarly journals Remote care for mental health: qualitative study with service users, carers and staff during the COVID-19 pandemic

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e049210
Author(s):  
Elisa Liberati ◽  
Natalie Richards ◽  
Jennie Parker ◽  
Janet Willars ◽  
David Scott ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Mental Healthcare ◽  
Well Being ◽  
Comparison Method ◽  
Service Users ◽  
Qualitative Interview Study ◽  
Remote Care

ObjectivesTo explore the experiences of service users, carers and staff seeking or providing secondary mental health services during the COVID-19 pandemic.DesignQualitative interview study, codesigned with mental health service users and carers.MethodsWe conducted semistructured, telephone or online interviews with a purposively constructed sample; a lived experience researcher conducted and analysed interviews with service users. Analysis was based on the constant comparison method.SettingNational Health Service (NHS) secondary mental health services in England between June and August 2020.ParticipantsOf 65 participants, 20 had either accessed or needed to access English secondary mental healthcare during the pandemic; 10 were carers of people with mental health difficulties; 35 were members of staff working in NHS secondary mental health services during the pandemic.ResultsExperiences of remote care were mixed. Some service users valued the convenience of remote methods in the context of maintaining contact with familiar clinicians. Most participants commented that a lack of non-verbal cues and the loss of a therapeutic ‘safe space’ challenged therapeutic relationship building, assessments and identification of deteriorating mental well-being. Some carers felt excluded from remote meetings and concerned that assessments were incomplete without their input. Like service users, remote methods posed challenges for clinicians who reported uncertainty about technical options and a lack of training. All groups expressed concern about intersectionality exacerbating inequalities and the exclusion of some service user groups if alternatives to remote care are lost.ConclusionsThough remote mental healthcare is likely to become increasingly widespread in secondary mental health services, our findings highlight the continued importance of a tailored, personal approach to decision making in this area. Further research should focus on which types of consultations best suit face-to-face interaction, and for whom and why, and which can be provided remotely and by which medium.

Research watch: what really helps recovery in relation to severe mental health difficulties?

2020 ◽  
Vol 24 (1) ◽  
pp. 6-12
Author(s):  
Sue Holttum
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Design Methodology ◽  
Support Service ◽  
Health Condition ◽  
Service Users ◽  
Content Type ◽  
Inpatient Settings ◽  
Mental Health Difficulties

Purpose The purpose of this paper is to examine three recent papers on mental health services and how they support recovery following a diagnosis of a severe mental health condition. Design/methodology/approach A search was carried out for recent papers on mental health and recovery. The author selected three papers that seemed to advance understanding of not only whether, but also how recovery of a meaningful life may be best supported in mental health services. Findings One paper suggested how staff were able to support service users’ personal goals and focus on recovery in acute inpatient settings, and what got in the way. The author suggests practical ways to address the barriers. A second paper reported the testing of a new model for supporting staff in primary and secondary care to work together so that service users with a diagnosis of bipolar or schizophrenia were better supported to work towards valued goals. A third paper reviewed 40 studies of how people can experience positive change after a first diagnosis of psychosis, and how change happened. Originality/value By studying the issues in detail, all three papers show how improved support for recovery and inclusion can be implemented against the backdrop of many years of service shortcomings.

scholarly journals Funding approaches for mental health services: is there still a role for clustering?

2018 ◽  
Vol 24 (6) ◽  
pp. 412-421 ◽  
Author(s):  
Rowena Jacobs ◽  
Martin Chalkley ◽  
María José Aragón ◽  
Jan R. Böhnke ◽  
Michael Clark ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
List Type ◽  
Robust Model ◽  
Starting Point ◽  
Mental Health Activity ◽  
Health Services Need ◽  
Rapid Pace

SUMMARYFunding for mental health services in England faces many challenges, including operating under financial constraints where it is not easy to demonstrate the link between activity and funding. Mental health services need to operate alongside and collaborate with acute physical hospital services, where there is a well-established system for paying for activity. The funding landscape is shifting at a rapid pace and we outline the distinctions between the three main options – block contracts, episodic payment and capitation. Classification of treatment episodes via clustering presents an opportunity to demonstrate activity and reward it within these payment approaches. We discuss the results of our research into how well the clustering system is performing against a number of fundamental criteria. We find that, according to these criteria, clusters are falling short of providing a sound basis for measuring and financing services. Nevertheless, we argue that clustering is the best available option and is essential for a more transparent funding approach for mental healthcare to demonstrate its claim on resources, and that clusters should therefore be a starting point for evolving a better funding system.LEARNING OBJECTIVES•Understand the different payment models currently being used and proposed in mental health services in England•Understand the role of clustering in measuring mental health activity and providing a basis for funding•Understand how a robust model of clustering can benefit the provision of mental health servicesDECLARATION OF INTERESTNone.

scholarly journals Carers and co-production: enabling expertise through experience?

2015 ◽  
Vol 20 (4) ◽  
pp. 232-241 ◽  
Author(s):  
Eleanor Bradley
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Professionals ◽  
Family Members ◽  
Mental Healthcare ◽  
Service Users ◽  
Content Type ◽  
The Impact

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”.

scholarly journals Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study

2010 ◽  
Vol 197 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Swaran P. Singh ◽  
Moli Paul ◽  
Tamsin Ford ◽  
Tami Kramer ◽  
Tim Weaver ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Information Transfer ◽  
Mental Health Problems ◽  
Transition Planning ◽  
Qualitative Interviews ◽  
Mental Healthcare ◽  
Transition Process ◽  
Service Users

BackgroundMany adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS).AimsAs part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS.MethodWe identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced.ResultsOf 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health.ConclusionsFor the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.

scholarly journals Qualitative investigation of relatives’ and service users’ experience of mental healthcare for suicidal behaviour in bipolar disorder

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030335
Author(s):  
Caroline Clements ◽  
Navneet Kapur ◽  
Steven H Jones ◽  
Richard Morriss ◽  
Sarah Peters
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Suicidal Behaviour ◽  
Mental Healthcare ◽  
Service Users ◽  
Open Communication ◽  
Increased Risk ◽  
Health Services Need

ObjectivePeople with bipolar disorder are known to be at high risk of engaging in suicidal behaviours, and those who die by suicide have often been in recent contact with mental health services. The objective of this study was to explore suicidal behaviour in bipolar disorder and how this is monitored and managed by mental health services.AimsTo identify themes within relatives’ and service users’ accounts of mental healthcare, related to management and prevention of suicidal behaviour in bipolar disorder.DesignThematic analysis of 22 semistructured interviews.ParticipantsParticipants were aged 18 years or over, fluent in written and spoken English, and either had bipolar disorder with a history of suicidal behaviour, or were relatives of people with bipolar disorder who had died by suicide.SettingEngland, UK.Primary outcomeThemes identified from participants’ accounts of mental healthcare for suicidal behaviours in bipolar disorder.ResultsTwo main themes were identified. ‘Access to care’ was characterised by a series or cycle of potential barriers to care (eg, gate-keepers, lack of an accurate diagnosis) which had the potential to increase risk of suicidal behaviour if failure to access care continued over time. ‘Problems with communication’ captured the importance of maintaining open routes of communication between all parties involved in care to ensure successful monitoring and management of suicidal behaviours in bipolar disorder.ConclusionsMental health services need to be accessible and respond rapidly to people with suicidal behaviour in bipolar disorder. Open communication and inclusion of relatives in care, where appropriate, could help closer monitoring of changes in symptoms that indicate increased risk.

scholarly journals Mental health service users' and professionals' relationship with games and gaming

2018 ◽  
Vol 4 ◽  
pp. 205520761877971
Author(s):  
Hanna Hopia ◽  
Marko Siitonen ◽  
Katja Raitio
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Mental Health Professionals ◽  
Qualitative Content Analysis ◽  
Mental Healthcare ◽  
Digital Games ◽  
Service Users

Background Games and elements of gamification can be utilized in mental healthcare to provide customized interventions for the service users. However, very little evidence exists as to what kind of experiences service users and professionals have towards games and gaming, and what their perceptions of the phenomenon are. This sort of information is needed to help professionals put game-based interventions actively into practice in mental health services. Research objectives The objective is to describe the experiences and perceptions of digital games and gaming from the perspectives of mental health service users and mental health professionals. Methods In this qualitative study, data consisted of interviews of 23 mental health service users and professionals working in the mental health field. We conducted altogether 39 interviews. Sixteen of the participants were interviewed twice. Main categories and subcategories were identified using qualitative content analysis. Results The analysis revealed four distinct orientations towards games and gaming: (a) compulsive gaming; (b) closet gaming; (c) gaming as a hobby; and (d) late bloomers. Each group was characterized by different personal histories, experiences, conceptions and attitudes regarding gaming and digital games. Conclusion When attempting to implement a game-based intervention in mental health services, it is essential to recognize the different attitudes that both service users and staff exhibit concerning games and gaming. The attitudes of service users and professionals described in this study can be utilized in the implementation of game-based methods as part of care and rehabilitation in mental health services.

scholarly journals Utilizing games in the co-production of mental health services

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Katja Raitio ◽  
Marko Siitonen ◽  
Hanna Hopia
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
Digital Games ◽  
Service Users ◽  
Playing Field ◽  
Health Practitioners ◽  
One Step ◽  
Production Approach

This study analyses the application of a co-production approach in utilizing digital games and game-related methods in mental health services. The goal is to offer a real-world experiment on co-production, focusing on mental health service users, active gamers and mental health practitioners who worked together in equal ways and valued each other’s unique contributions during the experiment. The implications of a co-production approach for applying digital games in the field of mental healthcare are somewhat limited and under-explored. In this case study, seven workshop sessions were held involving service users, gamers and professionals. Participants were interviewed concerning their experiences with the activities and content of the co-production workshops. Thematic analysis of the participants’ experiences and perceptions resulted in three main themes: 1) empowering participation; 2) cooperation on a level playing field; and 3) improving self-efficacy. The experiment showed that applying a co-production approach in utilizing digital games is worth implementing in mental health services, particularly when putting novel nursing approaches and procedures into practice. Overall, co-production turned out to be a beneficial approach to introduce and implement game activities into mental healthcare; therefore, it can be taken one step further, meaning that service users’ experiences are truly valued, and they can play a crucial role in developing mental health services.

scholarly journals Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029976 ◽  
Author(s):  
Lauren Elizabeth Pass ◽  
Korey Kennelty ◽  
Barry L Carter
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mental Health Services ◽  
Health Services ◽  
Rural Areas ◽  
Service Providers ◽  
Mental Healthcare ◽  
Chronically Ill ◽  
Healthcare Services ◽  
Qualitative Interview Study

ObjectivesIndividuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults’ experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments in this population to inform future interventions delivering services.DesignWe conducted a qualitative study of barriers and facilitators to mental healthcare access. 19 interviews were analysed deductively for barriers using a modified version of Penchansky and Thomas’s theory of access as an analytical framework.SettingThis study was conducted remotely using telephonic interviews. Patients were located in various rural Iowa towns and cities.Participants15 rural Iowan older adults with multiple physical comorbidities as well as anxiety and/or depression.ResultsWe found that while patients in this study often felt that their mental health was important to address, they experienced multiple, but overlapping, barriers to services that delayed care or broke their continuity of receiving care, including limited knowledge of extant services and how to find them, difficulties obtaining referrals and unsatisfactory relationships with mental health service providers.ConclusionsOur findings indicate that intervention across multiple domains of access is necessary for successful long-term management of mental health disorders for patients with multiple chronic comorbidities in Iowa.

scholarly journals Are people-centred mental health services acceptable and feasible in Timor-Leste? A qualitative study

2019 ◽  
Vol 34 (Supplement_2) ◽  
pp. ii93-ii103 ◽  
Author(s):  
Teresa Hall ◽  
Ritsuko Kakuma ◽  
Lisa Palmer ◽  
João Martins ◽  
Harry Minas ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Mental Healthcare ◽  
Health System Strengthening ◽  
Service Users ◽  
Family Needs ◽  
Middle Income ◽  
Timor Leste

Abstract People-centred mental healthcare is an influential concept for health system strengthening and sustainable development that has been developed and promoted primarily in Western contexts. It characterizes service users, families and communities as active participants in health system development. However, we have limited understanding of how well people-centred mental healthcare aligns with the multiplicity of peoples, cultures, languages and contexts in low- and middle-income countries (LMICs). Timor-Leste, a lower-middle income country in South-East Asia, is in the process of strengthening its National Mental Health Strategy 2018–22 to align with people-centred mental healthcare. To support the implementation of this Strategy, this study investigated the acceptability and feasibility of people-centred mental health services in Timor-Leste. In-depth semi-structured individual (n = 57) and group interviews (n = 15 groups) were conducted with 85 adults (≥18 years). Participants were service users, families, decision-makers, service providers and members of civil society and multilateral organizations across national and sub-national sites. Government and non-government mental health and social care was also observed. Framework analysis was used to analyse interview transcripts and observation notes. The study found that the ecology of mental healthcare in Timor-Leste is family-centred and that government mental health services are largely biomedically oriented. It identified the following major challenges for people-centred mental health services in Timor-Leste: different sociocultural perceptions of (in)dividual personhood, including a diminished status of people with mental illness; challenges in negotiating individual and family needs; a reliance on and demand for biomedical interventions; and barriers to health service access and availability. Opportunities for people-centred mental healthcare are better available within the social and disability sectors, which focus on social inclusion, human rights and peer support. Accounting for local cultural knowledge and understandings will strengthen design and implementation of people-centred mental healthcare in LMIC settings.

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