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Francis CJ, Johnson A, Wilson RL. Supported decision-making interventions in mental healthcare: A systematic review of current evidence and implementation barriers. Health Expect 2024; 27:e14001. [PMID: 38433012 PMCID: PMC10909645 DOI: 10.1111/hex.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND There is a growing momentum around the world to foster greater opportunities for the involvement of mental health service users in their care and treatment planning. In-principle support for this aim is widespread across mental healthcare professionals. Yet, progress in mental health services towards this objective has lagged in practice. OBJECTIVES We conducted a systematic review of quantitative, qualitative and mixed-method research on interventions to improve opportunities for the involvement of mental healthcare service users in treatment planning, to understand the current research evidence and the barriers to implementation. METHODS Seven databases were searched and 5137 articles were screened. Articles were included if they reported on an intervention for adult service users, were published between 2008 and October 2023 and were in English. Evidence in the 140 included articles was synthesised according to the JBI guidance on Mixed Methods Systematic Reviews. RESULTS Research in this field remains exploratory in nature, with a wide range of interventions investigated to date but little experimental replication. Overarching barriers to shared and supported decision-making in mental health treatment planning were (1) Organisational (resource limitations, culture barriers, risk management priorities and structure); (2) Process (lack of knowledge, time constraints, health-related concerns, problems completing and using plans); and (3) Relationship barriers (fear and distrust for both service users and clinicians). CONCLUSIONS On the basis of the barriers identified, recommendations are made to enable the implementation of new policies and programs, the designing of new tools and for clinicians seeking to practice shared and supported decision-making in the healthcare they offer. PATIENT OR PUBLIC CONTRIBUTION This systematic review has been guided at all stages by a researcher with experience of mental health service use, who does not wish to be identified at this point in time. The findings may inform organisations, researchers and practitioners on implementing supported decision-making, for the greater involvement of people with mental ill health in their healthcare.
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Affiliation(s)
| | - Amanda Johnson
- Head of School, Dean of Nursing and MidwiferyUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Rhonda L. Wilson
- University of NewcastleNewcastleNew South WalesAustralia
- Massey UniversityPalmerston NorthNew Zealand
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Reig-Garcia G, Cámara-Liebana D, Suñer-Soler R, Pau-Perich E, Sitjar-Suñer M, Mantas-Jiménez S, Roqueta-Vall-llosera M, Malagón-Aguilera MDC. Assessment of Standardized Care Plans for People with Chronic Diseases in Primary Care Settings. NURSING REPORTS 2024; 14:801-815. [PMID: 38651474 PMCID: PMC11036219 DOI: 10.3390/nursrep14020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Aging populations are driving a shift in emphasis toward enhancing chronic disease care, reflected in Catalonia's regional plan which prioritizes standardized nursing care plans in primary care settings. To achieve this, the ARES-AP program was established with a focus on harmonizing standards and supporting routine nursing clinical decision-making. This study evaluates nurses' perceptions of ARES-AP's standardized care plans for chronic diseases. METHODS A mixed-methods approach based on an ad hoc questionnaire (n = 141) and a focus group (n = 14) was used. Quantitative data were statistically analysed, setting significance at p < 0.05. Qualitative data were explored via content analysis. RESULTS ARES-AP training was assessed positively. The resources for motivational interviewing and care plans for the most prevalent chronic diseases were rated very positively. This study identified key factors influencing program implementation, including facilitators such as structured information and nursing autonomy, barriers such as resistance to change, motivators such as managerial support, and suggested improvements such as technological improvements and time management strategies. CONCLUSIONS This study identifies areas for improvement in implementing standardized nursing care plans, including additional time, motivation, enhanced IT infrastructure, and collaboration among primary care professionals. It enhances understanding of these plans in primary care, especially in managing chronic diseases in aging populations. Further research should assess the program's long-term impact on chronic patients. This study was not registered.
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Affiliation(s)
- Glòria Reig-Garcia
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| | - David Cámara-Liebana
- Department of Nursing, University of Girona, 17003 Girona, Spain; (M.S.-S.); (M.R.-V.-l.)
| | - Rosa Suñer-Soler
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| | - Eva Pau-Perich
- ABS Cassà de la Selva, Institut d’Assistència Sanitària, 17244 Cassà de la Selva, Spain;
| | - Miquel Sitjar-Suñer
- Department of Nursing, University of Girona, 17003 Girona, Spain; (M.S.-S.); (M.R.-V.-l.)
| | - Susana Mantas-Jiménez
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
| | | | - Maria del Carmen Malagón-Aguilera
- Health and Health Care Research Group, Department of Nursing, University of Girona, 17003 Girona, Spain; (G.R.-G.); (R.S.-S.); (S.M.-J.); (M.d.C.M.-A.)
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Almansour M, AlQurmalah SI, Abdul Razack HI. Motivational interviewing-an evidence-based, collaborative, goal-oriented communication approach in lifestyle medicine: A comprehensive review of the literature. J Taibah Univ Med Sci 2023; 18:1170-1178. [PMID: 37206188 PMCID: PMC10189272 DOI: 10.1016/j.jtumed.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/07/2023] [Accepted: 03/24/2023] [Indexed: 05/21/2023] Open
Abstract
The global threat of noncommunicable diseases (NCDs) is alarmingly increasing. The health and economic burden of improper lifestyle choices is immense. Reducing modifiable risk factors has been demonstrated to significantly prevent chronic diseases. At this crucial time, lifestyle medicine (LM) has been recognized as an evidence-based medical domain applicable to NCDs. Among the tools used in LM, motivational interviewing (MI) is a patient-centered, collaborative counseling approach. In this evidence-based review article, we discuss recent literature on the application of MI in the six LM pillars defined by the British Society of LM (BSLM): healthy eating, mental wellbeing, healthy relationships, physical activity, minimizing harmful substances, and sleep. MI helps strengthen patients' motivation to ameliorate behaviorally influenced health problems, improve treatment adherence, and optimize medical interventions. Technically correct, theoretically congruent, and psychometrically sound MI interventions yield satisfactory outcomes and help improve patient quality of life. Lifestyle change is often a gradual process involving multiple efforts and setbacks. MI is based on the idea that change is a process rather than an event. Extensive literature evidence supports the benefits of MI treatment, and interest in research on MI application is increasing across all BSLM pillars. MI helps people alter their thoughts and feelings about making changes by recognizing obstacles to change. Even interventions of short duration have been reported to yield better outcomes. Healthcare professionals must understand the relevance and importance of MI in clinical practice.
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Affiliation(s)
- Mohammed Almansour
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, KSA
| | | | - Habeeb Ibrahim Abdul Razack
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, KSA
- Corresponding address. Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, KSA
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Piat M, Wainwright M, Sofouli E, Vachon B, Deslauriers T, Préfontaine C, Frati F. Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review. Syst Rev 2021; 10:134. [PMID: 33952336 PMCID: PMC8101029 DOI: 10.1186/s13643-021-01646-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 03/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Countries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services? METHODS This systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO-CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations. RESULTS Seventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed. CONCLUSION The CFIR required some adaptation for use as an implementation framework in this review. The common implementation factors presented are an important starting point for stakeholders to consider when implementing recovery-oriented services.
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Affiliation(s)
- Myra Piat
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada. .,McGill University, Québec, Canada.
| | - Megan Wainwright
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.,Department of Anthropology, Durham University, Durham, Canada
| | - Eleni Sofouli
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.,McGill University, Québec, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, C.P. 6128, succursale Centre-ville, Montreal, Québec, H3C 3J7, Canada
| | - Tania Deslauriers
- School of Rehabilitation, Université de Montréal, 7077 avenue du Parc, Montreal, QC, H3N 1X7, Canada
| | - Cassandra Préfontaine
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, QC, G8Z 4M3, Canada
| | - Francesca Frati
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, 809, Sherbrooke W, Montreal, Québec, H3A 0C9, Canada
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Lenagh-Glue J, Potiki J, O'Brien A, Dawson J, Thom K, Casey H, Glue P. Help and Hindrances to Completion of Psychiatric Advance Directives. Psychiatr Serv 2021; 72:216-218. [PMID: 33050798 DOI: 10.1176/appi.ps.202000080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychiatric advance directives (PADs) allow service users to participate in their own mental health care in the event that they have a future mental health crisis and are deemed incompetent to make decisions, but few patients complete these documents. This Open Forum reports on factors that have helped or hindered completion of PADs in New Zealand. Perceived barriers to completion include resource limitations, procedural issues, access and storage problems, and mistrust between clinicians and service users regarding implementation. Having management and nursing "champions" of the process and organizing outreach meetings for all interested parties appear to aid completion. Targeted education and training promote creation and use of PADs, address negative attitudes, and assist service users in creating these documents. Information technology support is vital to having PADs uploaded and accessed in medical records.
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Affiliation(s)
- Jessie Lenagh-Glue
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
| | - Johnnie Potiki
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
| | - Anthony O'Brien
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
| | - John Dawson
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
| | - Katey Thom
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
| | - Heather Casey
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
| | - Paul Glue
- Faculty of Law (Lenagh-Glue, Dawson) and Department of Psychological Medicine (Glue), University of Otago, Dunedin, New Zealand; Southern District Health Board, Dunedin (Potiki, Casey); Te Huataki Waiora School of Health, University of Waikato, Hamilton, New Zealand (O'Brien); Centre for Non-Adversarial Justice, Auckland University of Technology, Auckland, New Zealand (Thom)
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Raphael J, Price O, Hartley S, Haddock G, Bucci S, Berry K. Overcoming barriers to implementing ward-based psychosocial interventions in acute inpatient mental health settings: A meta-synthesis. Int J Nurs Stud 2021; 115:103870. [PMID: 33486388 DOI: 10.1016/j.ijnurstu.2021.103870] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/23/2020] [Accepted: 01/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The culture of acute mental health wards is often dominated by medical models of care despite some patient dissatisfaction with care in these settings and a demand for increased access to psychosocial interventions. Research has found that psychosocial interventions can improve a number of patient and staff outcomes, however, implementation within these settings is often challenging. OBJECTIVES The aim of this review was to provide a comprehensive synthesis of the barriers and facilitators to implementing psychosocial interventions on acute wards, in order to develop a list of recommendations for embedding psychosocial interventions within the ward culture in acute settings. METHODS Databases were systematically searched using search terms related to acute mental health wards and psychosocial intervention implementation from inception to December 2019. Thirty-nine studies (forty-three papers) that explored the implementation of psychosocial interventions on adult acute mental health wards using qualitative methods met inclusion criteria. Data relating to barriers and facilitators to implementing psychosocial interventions extracted from the results sections of the papers were synthesised using the COM-B model. RESULTS AND CONCLUSIONS We conclude that to address barriers to the implementation of psychosocial interventions, services should provide clear information to patients regarding the benefits of engagement, and additional training for staff. A shift in ward culture is required and can be achieved through the recruitment of empathic implementers, together with providing staff with protected time for delivery of psychosocial interventions with clear accountability for intervention delivery through the provision of clearly defined roles.
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Affiliation(s)
- Jessica Raphael
- Greater Manchester Mental Health NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Owen Price
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Samantha Hartley
- Pennine Care NHS Foundation Trust, Oldham, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - Katherine Berry
- Greater Manchester Mental Health NHS Foundation Trust and Manchester Academic Health Science Centre, Manchester, UK; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
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Tyler N, Wright N, Waring J. Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis. BMC Health Serv Res 2019; 19:883. [PMID: 31760955 PMCID: PMC6876082 DOI: 10.1186/s12913-019-4658-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/20/2019] [Indexed: 01/25/2023] Open
Abstract
Background The transition from acute mental health inpatient to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in these transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve. Methods The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient to community services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions relating to discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique. Results The total number of papers from which data were extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model), others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis. Conclusions The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.
| | - Nicola Wright
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK.,Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK
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Jankovic J, Richards F, Berrisford G, Priebe S. Advance statements in adult mental healthcare: an update. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYIn this article we re-examine the conclusions of our article on advance statements in adult mental healthcare that was published in 2010 in the light of new literature published in the intervening decade. We explore the results of studies on the implementation and effectiveness of advance statements in adult mental health services, and then summarise recommendations for legislative changes from the Independent Review of the Mental Health Act 1983 that are relevant for England and Wales.
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Wood L, Williams C, Billings J, Johnson S. The therapeutic needs of psychiatric in-patients with psychosis: A qualitative exploration of patient and staff perspectives. BJPsych Open 2019; 5:e45. [PMID: 31530314 PMCID: PMC6537445 DOI: 10.1192/bjo.2019.33] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Concerns are recurrently expressed that the therapeutic content of in-patient care is limited and lacking clear guidance. The perspectives of patients and staff regarding therapeutic priorities for psychiatric in-patient care have been little explored and compared. AIMS The aim of this study was to examine patient and staff perspectives on the care priorities of psychiatric in-patients with psychosis. METHOD We recruited 12 in-patients with psychosis and 12 multidisciplinary team staff. All participants undertook a semi-structured interview examining their perspectives on the therapeutic needs of people with psychosis during admission. Interviews were transcribed verbatim and thematic analysis conducted. RESULTS Three superordinate themes arose from patient interviews: 'the importance of considering social circumstances and trauma', 'managing the intra- and interpersonal impact of psychosis' and 'lack of control and collaboration in care' and three from staff interviews: 'multidisciplinary facilitators of care', 'treating complexity and incorporating social factors' and 'restrictive practices preventing quality care provision'. Comparison of patient and staff themes identified unmet needs in addressing social marginalisation, trauma and distress, and the importance of collaborative treatment process and inclusion of spirituality. CONCLUSIONS There are gaps between staff and patient perspectives on important priorities for in-patient care that may help explain persistent patient dissatisfaction with in-patient care. Findings suggest the need for coproduced work to develop and test interventions that address broader therapeutic priorities. DECLARATION OF INTEREST None.
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Affiliation(s)
- Lisa Wood
- Lecturer in Clinical Psychology and Specialist Care Pathway Lead for Acute and Inpatient Psychology, Goodmayes Hospital, North East London Foundation Trust; School of Health and Social Care, University of Essex; and Division of Psychiatry, University College London, UK
| | - Claire Williams
- Strategic Lead for Acute and Inpatient Psychology and Consultant Clinical Psychologist, Goodmayes Hospital, North East London Foundation Trust, UK
| | - Jo Billings
- Senior Clinical Lecturer and Consultant Clinical Psychologist, Division of Psychiatry, University College London, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, University College London, UK
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Wyder M, Kisely S, Meurk C, Dietrich J, Fawcett T, Siskind D, Robinson G, Crompton D. The language we use - the effect of writing mental health care plans in the first person. Australas Psychiatry 2018; 26:496-502. [PMID: 29756467 DOI: 10.1177/1039856218772251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study describes the impact of Motivational Aftercare Planning (MAP) - an intervention to increase consumer/clinician collaboration on the content of mental health recovery plans. The intervention focussed on enhancing existing discharge processes in psychiatric inpatient wards and supporting nursing staff in using motivational interviewing techniques to facilitate the completion of these plans. METHODS We conducted a qualitative thematic content analysis of the recovery plans completed throughout the study ( n = 110). Chi-squared tests were then used to compare the occurrence of themes and content identified in recovery plans pre and post the intervention ( n = 55). RESULTS The thematic content of the recovery plans shifted in focus following the intervention, with a change from third to first person language. Those completed prior to the intervention generally mentioned: decreasing symptoms of mental illness; acceptance of the illness; achieving clinical stability; risk management and treatment compliance. The recovery plans completed after the intervention focussed on: general wellness; participate in meaningful activities; community life; social roles and connections with others. CONCLUSIONS This study demonstrated that a simple time-limited, facilitated intervention resulted in a change of thematic content in recovery plans. The use of these plans and its effect on care planning will need further evaluation.
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Affiliation(s)
- Marianne Wyder
- Addiction and Mental Health Services, Metro South Health, Brisbane, QLD, and; Griffith University, The Hopkins Centre, Menzies Health Institute, Brisbane, QLD, Australia
| | - Steve Kisely
- Addiction and Mental Health Services, Metro South Health, Brisbane, QLD, Australia, and; University of Queensland, School of Medicine, Brisbane, QLD, Australia
| | - Carla Meurk
- University of Queensland, School of Public Health, Brisbane, QLD, and; Queensland Centre for Mental Health Research Policy and Epidemiology Group, Wacol, QLD, Australia
| | - Josie Dietrich
- Addiction and Mental Health Services, Metro South Health, Brisbane, QLD, Australia
| | - Teresa Fawcett
- Addiction and Mental Health Services, Metro South Health, Brisbane, QLD, Australia
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health, Brisbane, QLD and; University of Queensland School of Medicine, Brisbane, QLD, Australia
| | - Gail Robinson
- Metro North Hospital and Health Services, Brisbane, QLD, and; Griffith University, Menzies Health Institute, Brisbane, QLD, Australia
| | - David Crompton
- Addiction and Mental Health Services, Metro South Health, Brisbane, QLD, and; Griffith University, Australian Institute for Suicide Research and Prevention, Brisbane, QLD, and; Griffith University, The Hopkins Centre, Menzies Health Institute, Brisbane, QLD, Australia
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11
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Interventions for involuntary psychiatric inpatients: A systematic review. Eur Psychiatry 2018; 54:41-50. [DOI: 10.1016/j.eurpsy.2018.07.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/22/2022] Open
Abstract
AbstractBackground:Observational research has found that involuntary treatment provides limited benefits in terms of long-term clinical outcomes. Our aim was to review literature on existing interventions in order to identify helpful approaches to improve outcomes of involuntary treatment.Methods:This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement guidelines. Seven databases (AMED, PsycINFO, Embase Classic, Embase 1974–2017, CINAHL, MEDLINE, and BNI) were searched and the results were analysed in a narrative synthesis.Results:Nineteen papers describing fourteen different interventions were included. Using narrative synthesis the interventions were summarised into three categories: a) structured patient-centred care planning; b) specialist therapeutic interventions; c) systemic changes to hospital practice. The methodologies used and outcomes assessed were heterogeneous. Most studies were of low quality, although five interventions were tested in randomised controlled trials (RCTs). Preliminary evidence supports structured patient-centred care planning interventions have an effect on long-term outcomes (such as readmission), and that specialist therapeutic interventions and systemic changes to hospital practice have an effect on reducing the use of coercive measures on wards.Conclusions:This review shows that it is possible to conduct rigorous intervention-testing studies in involuntary patients, including RCTs. Yet, the overall evidence is limited. Structured patient-centred care planning interventions show promise for the improvement of long-term outcomes and should be further evaluated.
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