scholarly journals Recovery-focussed leadership in the NHS

2015 ◽  
Vol 19 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Jane McLean
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Leadership Style ◽  
Service User ◽  
Design Methodology ◽  
Shared Decision ◽  
Leadership Qualities ◽  
Content Type ◽  
Support Recovery ◽  
Distribution Of Power

Purpose – The purpose of this paper is to explore the leadership qualities and behaviours required to support recovery-focussed practice in mental health. Design/methodology/approach – This paper contrasts the prevailing leadership style within the NHS with the leadership style required to support recovery-focussed practice in mental health. The underlying reasons for, and implications of, this disparity are explored. Findings – The leadership style required to support recovery-focussed practice in mental health services is one based on collaboration, empowerment, service-user led practice, autonomy, shared decision making, distribution of power, compassion, strengths, valuing, recognising and rewarding positive behaviours and using a collective approach. This is fundamentally at odds with that experienced by staff working within the NHS. Originality/value – If NHS services are genuinely to promote the recovery of those whom they serve then the leadership and culture of organisations is critical.

scholarly journals Shared decision making within the context of recovery-oriented care

2017 ◽  
Vol 22 (3) ◽  
pp. 179-190 ◽  
Author(s):  
Larry Davidson ◽  
Janis Tondora ◽  
Anthony J. Pavlo ◽  
Victoria Stanhope
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Design Methodology ◽  
Treatment Options ◽  
Service Users ◽  
Shared Decision ◽  
Content Type ◽  
Recovery Planning

Purpose The purpose of this paper is to consider the role of shared decision making (SDM) as one component of recovery-oriented care. Design/methodology/approach This paper is conceptual and reviews the literature relevant to recovery-oriented care, person-centered recovery planning (PCRP), and SDM. Findings To the degree to which SDM offers tools for sharing useful information about treatment options with service users and family members or other loved ones, it can be considered a valuable addition to the recovery-oriented armamentarium. It is important to emphasize, though, that recovery-oriented practice has a broader focus on the person’s overall life in the community and is not limited to formal treatments or other professionally delivered interventions. Within the more holistic context of recovery, SDM regarding such interventions is only one tool among many, which needs to be integrated within an overall PCRP process. More emphasis is given within the recovery-oriented care to activating and equipping persons for exercising self-care and for pursuing a life they have reason to value, and the nature of the relationships required to promote such processes will be identified. In describing the nature of these relationships, it will become evident that decision making is only one of many processes that need to be shared between persons in recovery and those who accept responsibility for promoting and supporting that person’s recovery. Originality/value By viewing SDM within the context of recovery, this paper provides a framework that can assist in the implementation of SDM in routine mental health care.

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 Measurement issues of shared decision making in mental health: challenges and opportunities

2017 ◽  
Vol 22 (3) ◽  
pp. 214-232 ◽  
Author(s):  
Lilisbeth Perestelo-Perez ◽  
Amado Rivero-Santana ◽  
Yolanda Alvarez-Perez ◽  
Yaara Zisman-Ilani ◽  
Emma Kaminskiy ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Decision Making ◽  
Mental Health Care ◽  
Shared Decision Making ◽  
Self Report ◽  
Psychometric Validation ◽  
Shared Decision ◽  
Deliberative Process ◽  
Content Type

Purpose Shared decision making (SDM) is a model of health care in which patients are involved in the decision-making process about their treatment, considering their preferences and concerns in a deliberative process with the health care provider. Many existing instruments assess the antecedents, process, or the outcomes of SDM. The purpose of this paper is to identify the SDM-related measures applied in a mental health context. Design/methodology/approach The authors performed a systematic review in several electronic databases from 1990 to October 2016. Studies that assessed quantitatively one or more constructs related to SDM (antecedents, process, and outcomes) in the field of mental health were included. Findings The authors included 87 studies that applied 48 measures on distinct SDM constructs. A large majority of them have been developed in the field of physical diseases and adapted or directly applied in the mental health context. The most evaluated construct is the SDM process in consultation, mainly by patients’ self-report but also by external observer measures, followed by the patients’ preferences for involvement in decision making. The most applied instrument was the Autonomy Preference Index, followed by the Observing Patient Involvement in Decision Making (OPTION) and the Control Preferences Scale (CPS). The psychometric validation in mental health samples of the instruments identified is scarce. Research limitations/implications The bibliographic search is comprehensive, but could not be completely exhaustive. Effort should be invested in the development of new SDM for mental health tools that will reflect the complexity and specific features of mental health care. Originality/value The authors highlight several limitations and challenges for the measurement of SDM in mental health care.

scholarly journals Referring to psychological therapy services in secondary NHS mental health services – how do mental health care professionals decide?

2020 ◽  
Vol 25 (2) ◽  
pp. 185-196
Author(s):  
Lucy Fiddick ◽  
Emily Neale ◽  
Falguni Nathwani ◽  
Kristina Bennert ◽  
James Gregory
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Thematic Analysis ◽  
Secondary Care ◽  
Service User ◽  
Mental Health Problems ◽  
Psychological Therapy ◽  
Content Type ◽  
Psychological Therapies ◽  
Therapy Services

Purpose Evidence-based psychological therapies are available for severe and enduring mental health problems, but resources and access to these are limited within England. Practitioners in community mental health teams (CMHTs) can act as gatekeepers for access to psychological therapies for those in secondary care, but little is known about how they make referral decisions. This paper aims to understand how CMHT practitioners make decisions about who to refer or not, to secondary care psychological therapy services (PTS). Design/methodology/approach A total of 11 CMHT practitioners were interviewed to understand the decision making processes underpinning their referrals or otherwise, to a PTS within NHS England. The data were analysed qualitatively using thematic analysis. Findings Thematic analysis resulted in 11 sub-themes under three main themes of the self, the organisation and wider structure and the service user. Results indicated that some participants were referred automatically for psychological therapy if a service user asked or if there was external pressure to refer, while others’ decisions were informed by contextual information such as the service user’s ability to engage or change, risk status and limited organisational resources. Originality/value This study explores the decision making of multi-disciplinary professionals referring to PTS. The findings have important implications for understanding some of the factors that can influence patient access to psychological treatment in secondary care.

Expanding the concept of shared decision making for mental health: systematic search and scoping review of interventions

2017 ◽  
Vol 22 (3) ◽  
pp. 191-213 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Erin Barnett ◽  
Juliette Harik ◽  
Anthony Pavlo ◽  
Maria O’Connell
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Information Exchange ◽  
Skills Training ◽  
Essential Elements ◽  
Central Component ◽  
Shared Decision ◽  
Content Type ◽  
Patient Motivation

Purpose Much of the existing literature on shared decision making (SDM) in mental health has focused on the use of decision aids (DAs). However, DAs tend to focus on information exchange and neglect other essential elements to SDM in mental health. The purpose of this paper is to expand the review of SDM interventions in mental health by identifying important components, in addition to information exchange, that may contribute to the SDM process in mental health. Design/methodology/approach The authors conducted a systematic literature search using the Ovid-Medline database with supplementary scoping search of the literature on SDM in mental health treatment. To be eligible for inclusion, studies needed to describe (in a conceptual work or development paper) or evaluate (in any type of research design) a SDM intervention in mental health. The authors included studies of participants with a mental illness facing a mental health care decision, their caregivers, and providers. Findings A final sample of 31 records was systematically selected. Most interventions were developed and/or piloted in the USA for adults in community psychiatric settings. Although information exchange was a central component of the identified studies, important additional elements were: eliciting patient preferences and values, providing patient communication skills training, eliciting shared care planning, facilitating patient motivation, and eliciting patient participation in goal setting. Originality/value The review indicates that additional elements, other than information exchange such as sufficient rapport and trusting relationships, are important and needed as part of SDM in mental health. Future SDM interventions in mental health could consider including techniques that aim to increase patient involvement in activities such as goal settings, values, and preference clarification, or facilitating patient motivation, before and after presenting treatment options.

Association between leadership style and decision making style in Indian organisations

2015 ◽  
Vol 34 (3) ◽  
pp. 246-269 ◽  
Author(s):  
Neha Verma ◽  
Aruna B. Bhat ◽  
S. Rangnekar ◽  
M. K. Barua
Keyword(s):  
Decision Making ◽  
Leadership Style ◽  
Design Methodology ◽  
Statistical Test ◽  
Common Method ◽  
Cross Sectional ◽  
Public And Private ◽  
Content Type ◽  
Research Questions ◽  
Practical Implications

Purpose – The purpose of this paper is to study the leadership style (LS) and decision-making style (DMS) of Indian manufacturing executives, and to explore the association between the LS and DMS. Design/methodology/approach – For this study the sample was drawn from Indian manufacturing organisations’ executives from both public and private sectors. The respondents were lower, middle and senior levels executives involved in leadership and decision-making functions. Correlation, regression and ANOVA were used to pursue the research questions. Findings – Indian manufacturing executives have shown highest rational and least avoidant in their DMSs. Transformational (TFM) leaders are found rational, while the transactional (TSL) leaders are observed to be rational and dependent. Laissez faire style has correlation with avoidant decision making and interactive dependent and avoidant styles. Research limitations/implications – The study is a cross sectional research with limitations of self-serving bias and common method variance. However, this limitation has been dealt with a statistical test. Practical implications – The study bears significant implications for Indian executives who are working on LSs and decision making. It also provides the details of decision-making behaviours of the manufacturing executives thereby suggesting the associated benefits and drawbacks of particular styles. Originality/value – This paper contributes to leadership and decision-making literature. In the recent times, no such study in Indian manufacturing context have been reported. Moreover there are few contrasting and contributing findings in this research.

scholarly journals Key issues in the process of implementing shared decision making (DM) in mental health practice

2017 ◽  
Vol 22 (3) ◽  
pp. 257-274 ◽  
Author(s):  
Shulamit Ramon ◽  
Helen Brooks ◽  
Sarah Rae ◽  
Mary-Jane O’Sullivan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Mental Health Services ◽  
Health Services ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Health Practice ◽  
Mental Health Practice ◽  
Content Type ◽  
Key Issues

Purpose This review paper will look at internationally existing publications in the English language on mental health shared decision making (SDM) implementation of a variety of interventions, including different methodologies and research methods, age groups and countries. The purpose of this paper is to provide an overview of: process, degree and outcomes of implementation; barriers and facilitators; perspectives on implementation by different stakeholders; analysis of the process of implementation in mental health services through the lenses of the normalisation process theory (NPT). Design/methodology/approach Following a targeted literature search the data were analysed in order to provide an overview of methodologies and methods applied in the articles, as well as of the variables listed above. Three different types of information were included: a content analysis of key issues, reflective understanding coming out of participating in implementation of an SDM project in the form of two narratives written by two key participants in an SDM pilot project and an NPT analysis of the process of implementation. Findings Only a minority of mental health SDM research focuses on implementation in everyday practice. It is possible and often desirable to achieve SDM in mental health services; it requires a low level of technology, it can save time once routinized, and it is based on enhancing therapeutic alliance, as well as service users’ motivation. Implementation requires an explicit policy decision, a clear procedure, and regular adherence to the aims and methods of implementation by all participants. These necessary and sufficient conditions are rarely met, due to the different levels of commitment to SDM and its process by the different key stakeholders, as well as due to competing providers’ objectives and the time allocated to achieving them. Originality/value The review indicates both the need to take into account the complexity of SDM, as well as future strategies for enhancing its implementation in everyday mental health practice. Perhaps because applying SDM reflects a major cultural change in mental health practice, current value attached to SDM among clinicians and service managers would need to be more positive, prominent and enduring to enable a greater degree of implementation.

scholarly journals A stronger voice

2015 ◽  
Vol 28 (2) ◽  
pp. 211-222 ◽  
Author(s):  
Sherrie Anne Hitchen ◽  
Graham R Williamson
Keyword(s):  
Mental Health ◽  
Service User ◽  
Design Methodology ◽  
Content Type ◽  
Steering Group ◽  
Professional Workers ◽  
Service Redesign ◽  
Local Perspectives ◽  
Gathering Data ◽  
Health Trust

Purpose – The purpose of this paper is to discuss learning about service-user and carer involvement from an action research (AR) study into self-directed support implementation in one English mental health trust. The paper promotes appointing and supporting carers and people with experience as co-researchers to obtain authentic local perspectives when undertaking service implementation or redesign. Design/methodology/approach – The researchers used an AR spiral method incorporating carers and people with mental health experience as co-researchers. The co-researchers worked alongside the lead researcher gathering data from focus groups, training sessions and other meetings over four years and attending collaborative steering group meetings alongside professional workers throughout the study. Findings – The authors suggest that participation gave co-researchers a powerful and effective voice in this service redesign. This approach revealed more authentic research data and required professionals to be more accountable for their perceptions and to make explicit their understandings throughout the study, which enabled more effective working. Steering group participation was central to securing this participation. Originality/value – The paper illustrates how carer and service-user co-researchers can be supported to benefit both mental health organisations undergoing change and to co-researchers themselves. It also identifies AR’s utility in uncovering learning as well as structuring change.

Remarkable lives: Rachel Taylor in conversation with Jerome Carson

2015 ◽  
Vol 19 (2) ◽  
pp. 73-77
Author(s):  
Rachel Taylor ◽  
Jerome Carson
Keyword(s):  
Mental Health ◽  
Positive Psychology ◽  
Service User ◽  
Design Methodology ◽  
Mental Health Problems ◽  
Meaningful Life ◽  
Content Type ◽  
Biographical Account ◽  
Practical Implications ◽  
Better Than

Purpose – The purpose of this paper is to provide a profile of Rachel Taylor. Design/methodology/approach – Rachel provides a short biographical account and is then interviewed by Jerome. In the biography the search for happiness and belonging is discussed. Findings – Rachel talks about focusing on what we are good at, what we love and how discovery can light that spark of hope that there can be better than what has gone before. Research limitations/implications – Rachel’s story shows the potential that lies not just within some of us, but all of us. It is but one story, but its message is sure to touch many. Practical implications – How do services promote hope and build resilience and wellbeing? While another service user said recovery was about “coping with your illness and having a meaningful life” (McManus et al., 2009), services have perhaps focused too much on symptom reduction and not enough on helping people find meaning and purpose. Social implications – Rachel asks the question is Positive Psychology a movement for all or is it just for the elite? Originality/value – Rachel is someone who has discovered for herself the benefits of Positive Psychology. Hopefully Rachel’s own discovery will lead to bringing this promising approach to people with mental health problems.

scholarly journals “Work with me”: service users’ perspectives on shared decision making in mental health

2017 ◽  
Vol 22 (3) ◽  
pp. 166-178 ◽  
Author(s):  
Heather Castillo ◽  
Shulamit Ramon
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Shared Decision Making ◽  
Medical Model ◽  
Service Users ◽  
Shared Decision ◽  
Content Type ◽  
User Expertise ◽  
Take Back ◽  
Legal Frameworks

Purpose While shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. The purpose of this paper to review existing developments, contemporary challenges, and evidence regarding SDM in mental health with a particular focus on the perspectives of service users. Design/methodology/approach This is a review of international papers analysed using narrative synthesis of relevant data bases. Findings The review shows significant barriers to the utilisation of SDM including ethical and legal frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance of power and feel they lack choices, being “done to” rather than “worked with”. Practical implications The paper also presents perspectives about how barriers can be overcome, and service users enabled to take back power and acknowledge their own expertise. Originality/value This review is the first with a particular focus on the perspectives of service users and SDM.

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