Impact of organisational change for leaders in mental health

Building an implementation strategy for community-based rehabilitation for mental health in Colombia

INTRODUCTION

Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies.

AIM

The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia.

METHODS

This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data.

RESULTS

A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies.

CONCLUSIONS

CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A210.

Role and Function of the Clinical Tutor in Mental Health Nursing in Ireland

The clinical tutor (CT) in mental health nursing is a role aimed at supporting the learning needs of mental health nursing students undertaking a 12-month post-registration programme. This paper aims to examine the role of the clinical tutor in mental health nursing in Ireland by describing the experience of nursing students and key service stakeholders. A qualitative descriptive design was employed using focus group discussions and semi-structured interviews. Two focus groups were conducted with 14 nursing students in the final week of their one-year programme. Semi-structured interviews were undertaken with seven service stakeholders and service leaders. Participants reported positive experiences of working with the clinical tutor and valued the role in terms of educational and pastoral support. Participants suggested the role strengthened the link between theory and practice and enhanced the relationship between the higher education institute and clinical sites. However, a lack of clarity existed in terms of role description. Participants suggested the CT role enhanced the link between the university and clinical areas providing benefits to both student and service stakeholders. Implementing similar roles may benefit post-registration mental health nursing students in other jurisdictions. Further investigation on how the role operates from the perspective of those in the post may provide more clarity and enhance the development of such roles in the future.

The impact of COVID-19 on health systems, mental health and the potential for nursing

This paper offers a perspective on nursing and lived experience responses to the COVID-19 pandemic. It charts health systems and mental health impacts with a particular focus on children and adolescents, older people and people availing of mental health services. Issues of moral distress and the nursing reaction are considered alongside psychological and social concerns which continue to rapidly evolve. The perspective of a person attending adult community mental health services and the experience of engaging with a mental health service remotely is provided. Matters of note for acute inpatient mental health nursing are highlighted and informed by the lived experience of a mental health nurse. The need for integrated health systems responses across nursing disciplines and the wider interdisciplinary team is elucidated.

Organisational contexts and practice developments in mental health peer provision in Western Australia

PURPOSE

Over the past decade, the push for recovery-oriented services has birthed a growth in the recruitment of peer providers in mental health services: Persons who live with and manage their mental health challenges and are employed to support persons currently using mental health services. The aim of this paper is to compare the responses of government and non-government organisations to the implementation of peer provision.

DESIGN/METHODOLOGY/APPROACH

Employing a qualitative study design, 15 people who supervised peer providers or who were strategically involved in peer provision were recruited using snowball sampling. Participants completed an in-depth interview that explored how peer provision services operated at their organisation and factors that shaped the way peer provision operates. The interviews were transcribed and analysed using Moore's Strategic Triangle. Synthesised member checking and researcher triangulation ensued to establish trustworthiness.

FINDINGS

The way in which peer provision operated sat along a continuum ranging from adoption (where practices are shaped by the recovery ethos) to co-option (where recovery work may be undertaken, but not shaped by the recovery ethos). Political and legal mandates that affected the operational capacities of each organisation shaped the way peer provision services operated.

RESEARCH LIMITATIONS/IMPLICATIONS

The findings of the study highlight the need to reconsider where peer provision services fit in the mental health system. Research investigating the value of peer provision services may attract the support of funders, service users and policy makers alike.

ORIGINALITY/VALUE

In employing Moore's strategic triangle to evaluate the alignment of policy (the authorising environment) with the operational capacity and practice of peer provision services (the task environment), this study found that organisational response to peer provision is largely influenced by political and legal mandates externally. The successful implementation of peer provision is mediated by effective supervision of peer providers.

What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience-based co-design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma-informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma-informed they required services to: be aware of staff well-being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.

Evaluation of a national training programme to support engagement in mental health services: Learning enablers and learning gains

WHAT IS KNOWN ON THE SUBJECT?: Patient and public involvement (PPI) is recognized as an increasingly important feature of healthcare research, education and public policy. In mental health, PPI is increasingly seen as evidence of the further democratization of services, which started with de-institutionalization in the 1960s and the recovery movement in the 1990s. While much is known about learning enablers and learning gains on generic community-based training programmes, less is known about PPI-specific programmes in mental health. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Participants at a national training programme to support the engagement of service users, their families and carers in mental health services identified training topics of greatest importance to them and reported on what they learnt and what helped their learning. Patient and public involvement training initiatives aimed at supporting the engagement of service users, their families and carers should emphasize individual needs and local contexts. Training programmes should not make artificial or actual distinctions between the programme participants who are health professionals and those who are non-professionals, such as service users. To our knowledge, this PPI initiative is the first time a national health service provider has sought to develop an engagement structure in mental health on a state-wide basis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Participants in training programmes designed to support patient and public involvement believe that such programmes should include understanding how conflict is resolved, how committees work effectively and how to develop interpersonal and facilitation skills. Training programmes in mental health involving both professional and non-professional participants requires all the participants to work together in particular at commissioning and design stages to achieve their desired outcome. The evaluation of the training programme to support the roll-out of this initiative offers lessons to others who may wish to pursue similar structures in other jurisdictions. Abstract Introduction The Irish national mental health service provider commissioned a national training programme to support a patient and public involvement (PPI) initiative in mental health services. The programme evaluation afforded an opportunity to describe the learning gains and learning enablers and the factors that support PPI in mental health. Aim We aimed to evaluate a PPI training programme across nine regional administrative units in a national mental health service. Methods We conducted a participant exit survey, using the Student Assessment of Learning Gains (SALG) instrument. We analysed the survey responses using SPSS version 24 software and applied directed content analysis to the narrative comments provided in open-ended questions. Results A total of 54 participants returned the completed questionnaire, yielding a response rate of 60%. The overall mean SALG score yielded was 3.97 (SD 0.66; range 1-5), indicating that participants reported very good to excellent gains in their learning from the programme. Participants who offered narrative comments indicated an overall positive experience but suggested that all stakeholders should work together to co-produce the training. Discussion All the stakeholders in a PPI training initiative to support the engagement of service users, their families and carers in mental health should work together to achieve their desired outcome. This requires co-production in the design, delivery and evaluation of the training initiative, and co-production can impact at both individual and local levels. Implications for Practice PPI training initiatives in mental health should retain a focus on understanding conflict resolution, committee effectiveness, interpersonal and facilitation skills. Ensuring a shared understanding of key concepts, such as co-production, is a necessary prerequisite at the co-commissioning, co-design, co-planning, co-delivery and co-assessment stages of programme development, as is the need to avoid artificial or actual distinctions between health professionals and those who are non-professionals, such as service users. Relevance statement Mental health engagement and PPI are key principles underpinning modern mental health services and may increasingly impact on wider health service provision including policy and research imperatives. This paper discusses the evaluation of a PPI training programme and offers practical insights as to how such initiatives can be improved.