Comparison of a co-produced mental health service to traditional services: A co-produced mixed-methods cross-sectional study

'ALL ABOUT MY IDEAL MENTAL HEALTH SERVICE': Users, family members and experts by experience discussing a co-designed service

INTRODUCTION

Many studies have investigated patients' understandings of how to optimise mental health services. However, only a few studies in the Italian context have involved experts by experience (EbEs), who can be ex-users, family members of ex-users or current service collaborators. Their role is crucial in implementing collaborative service quality assessment projects.

METHOD

The study investigated the experience of 35 EbEs,  users, and family members who carried out a 9-month fortnightly project aimed at imagining an 'ideal service'. The facilitators of the discussion groups (two EbEs) were interviewed; written reports of each meeting were produced with relevant comments, notes and specific suggestions; and content analysis was applied.

RESULTS

The most important result concerns the effectiveness of the project management method and group leadership carried out by the two EbEs. This approach allowed for complete autonomy of the work, without professional gaze or power imbalance. Also, the ideas and specific contents focused on by the two groups offer strategies to facilitate users' entry and reception in health care centres, to reduce the stigma of mental illness, to improve the centres' physical environment, to improve organisational aspects, to keep family members actively involved and to network mental health services with other territorial services.

CONCLUSIONS

EbEs have proven to be key figures in ensuring equity of role in the service co-design process. This also concerns a context, the Italian one, where their role has not yet been recognised and legalised. Their contribution and ideas to improve services could be fundamental not only in mental health centres, but also in other health facilities, and could concern the entire service delivery process rather than being limited to quality assurance, according to a virtuous circle based on active participation and transformation of the role of users.

PATIENT OR PUBLIC CONTRIBUTION

This work resulted from close collaboration between the two EbEs who conducted the groups, users and family members, the university, and the psychiatrist in charge of the service. All of them contributed to the research. The EbEs, researchers and psychiatrist participated in the interpretation of the data and are the co-authors of this paper.

A qualitative evaluation of a co-design process involving young people at risk of suicide

BACKGROUND

Co-design is becoming common practice in the development of mental health services, however, little is known about the experience of such practices, particularly when young people are involved.

OBJECTIVE

The aim of this study was to conduct a process evaluation of the co-design which was undertaken for the development of an intervention for youth and adolescents at risk of suicide. This paper briefly outlines the co-design process undertaken during a COVID-19 lockdown and then focuses on a qualitative evaluation of the experience of taking part in a co-design process.

SETTING AND PARTICIPANTS

The evaluation involved young consumers of a public youth mental health service, their carers/parents and service delivery staff who had taken part in the co-design process.

METHOD

This study used follow-up semistructured interviews with the co-design participants to explore their experience of the co-design process. Inductive thematic analysis was used to draw out common themes from the qualitative data.

RESULTS

It was found that despite the practical efforts of the project team to minimise known issues in co-design, challenges centred around perceptions regarding power imbalance, the need for extensive consultation and time constraints still arose.

DISCUSSION

Despite these challenges, the study found that the co-design provided a human-centred, accessible and rewarding process for young people, parents and staff members, leaving them with the feeling that they had made a worthwhile contribution to the design of the new service, as well as contributing to changing practice in service design.

CONCLUSION

With sensitivity and adaptation to usual practice, it is possible to include young people with suicidal ideation, their parents/carers and professional staff in a safe and effective co-design process.

PATIENT AND PUBLIC CONTRIBUTION

The authors would like to thank and acknowledge the young people with a lived experience and their carers who participated in the co-design process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in this research.

Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes

Recent research has found that older lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have a negative attitude toward long term care services. To build upon this, we conducted a systematic review analyzing current research into the LGBTQ+ communities' perspectives and experiences of care/nursing homes. Additionally, we sought to explore the attitudes of care/nursing home staff toward providing care for LGBTQ+ residents. To conduct this study, we used the databases Embase, Medline and Web of Science, which identified 19 articles for review. From this, we were able to draw several conclusions, including that LGBTQ+ participants were concerned that they would have to conceal their identity and experience abuse. Most staff had a positive attitude toward LGBTQ+ residents, but there were exceptions to this. Despite their positive attitude, staff often lacked awareness of LGBTQ+ issues. The results of this review suggest that care/nursing homes are not welcoming environments for sexual and gender minorities, and that staff require more training to support this community. We end with innovative suggestions to tackle these issues, such as designing coproduced services with the support of LGBTQ+ communities.

Service user involvement in mental health service commissioning, development and delivery: A systematic review of service level outcomes

INTRODUCTION

Service user involvement is increasingly considered essential in mental health service development and delivery. However, the impact of this involvement on services is not well documented. We aimed to understand how user involvement shapes service commissioning, development and delivery, and if/how this leads to improved service-level outcomes.

METHODS

A systematic review of electronic databases (MEDLINE, PsycINFO, CINAHL and EMBASE databases) was undertaken in June and November 2022 for studies that incorporated patient involvement in service development, and reported service-level outcomes. Included studies were synthesised into a logic model based on inputs (method of involvement), activities (changes to service) and outputs (indicators of improvement). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed when conducting this review.

RESULTS

From 10,901 records identified, nine studies were included, of which six were judged to have used co-production or co-design approaches. Included studies described service user involvement ranging from consultation to co-production. We identified a range of outputs associated with service user involvement in service planning and delivery, and reported these in the form of a logic model. These service-level outputs included improved treatment accessibility, increased referrals and greater service user satisfaction. Longer-term outcomes were rarely reported and hence it was difficult to establish whether outputs are sustained.

CONCLUSION

More extensive forms of involvement, namely, co-design and co-production, were associated with more positive and substantial outputs in regard to service effectiveness than more limited involvement methods. However, lived experience contributions highlighted service perception outputs may be valued more highly by service users than professionals and therefore should be considered equally important when evaluating service user involvement. Although evidence of longer term outcomes was scarce, meaningful involvement of service users in service planning and delivery appeared to improve the quality of mental health services.

PATIENT OR PUBLIC CONTRIBUTION

Members of a lived experience advisory panel contributed to the review findings, which were co-authored by a peer researcher. Review findings were also presented to stakeholders including service users and mental health professionals.

Grounding co-writing: An analysis of the theoretical basis of a new approach in mental health care

This contribution aims to highlight the theoretical and epistemological premises of the co-writing experience, a practice where a clinician and a patient are mutually engaged in jointly or collaboratively writing a narrative related to the patient's experience. Unlike a typical set of therapeutic techniques, co-writing is based on sharing perspectives and meanings about the experience of crisis, recovery, and the therapeutic process. The paper identifies and briefly describes four non-clinical epistemological paradigms on which it is grounded: ethnography, values-based practice, narrative care, and phenomenology. Although they differ in several ways, at the same time, they seem to share some common features that the paper investigates and comments. For clinicians, nurses, researchers and Mental Health Service managers, attention to the users and to the improvement of their active roles represents not only a strategy for the empowerment of results, but also the access door to a different perspective which relies on a renewed conceptualization of the mental disease nature that may lead to overcoming the epistemic asymmetry between the 'expert' and the 'other' in favor of intersubjective dialogue.

Evaluating the role and effectiveness of co-produced community-based mental health interventions that aim to reduce suicide among adults: A systematic review

BACKGROUND

Suicide is a major public health risk requiring targeted suicide prevention interventions. The principles of co-production are compatible with tailoring suicide prevention interventions to meet an individual's needs.

AIMS

This review aimed to evaluate the role and effectiveness of co-produced community-based suicide prevention interventions among adults.

METHODS

Four electronic databases (PsycInfo, CINAHL, MEDLINE and web of science) were systematically searched. A narrative synthesis was conducted.

RESULTS

From 590 papers identified through searches, 14 fulfilled the inclusion criteria. Most included studies elicited the views and perspectives of stakeholders in a process of co-design/co-creation of community-based suicide prevention interventions.

CONCLUSION

Stakeholder involvement in the creation of community-based suicide prevention interventions may improve engagement and give voice to those experiencing suicidal crisis. However, there is limited evaluation extending beyond the design of these interventions. Further research is needed to evaluate the long-term outcomes of co-produced community-based suicide prevention interventions.

PATIENT AND PUBLIC INVOLVEMENT

This paper is a systematic review and did not directly involve patients and/or the public. However, the findings incorporate the views and perspectives of stakeholders as reported within the studies included in this review, and the findings may inform the future involvement of stakeholders in the design, development and delivery of community-based suicide prevention interventions for adults.

Co-Production within Child and Adolescent Mental Health: A Systematic Review

Background: Mental health services are currently experiencing much systemic and organisational change. Many countries have adopted a recovery approach to service provision through the development of national policies and frameworks. Within an Irish context, co-production has been identified as one of the four pillars required for services to become recovery orientated. However, there is a paucity of literature relating to the concept within child and adolescent mental health services. This paper aims to synthesise the peer-reviewed evidence on co-production within such services. Methods: A PRISMA compliant systematic review was undertaken. This includes how the reviewer retrieved, shortlisted, and selected studies for inclusion in the review. It outlines the inclusion/exclusion criteria and how these were further developed through the PICO framework. Finally, the methods also outline how the reviewer assessed bias and quality, as well as the process of data synthesis. Results: Two studies were included in this review, both focusing on co-production, but in different contexts within child and adolescent mental health. Two themes were identified: ‘road less travelled’ and ‘co-producing equality’. These themes and the associated sub-themes describe how co-production works in these services. Discussion: These results highlight the paucity of quality literature in co-production within child and adolescent mental health. Both studies scored poorly in terms of quality. Resulting from this review, a number of actions relating to the therapeutic environment need to be taken into account for co-production to be further implemented. Other: The reviewer has not received any funding for this paper. A protocol was not created or registered for this review.

Research on Students' Mental Health Based on Data Mining Algorithms

With the diversification and rapid development of society, people's living conditions, learning and friendship conditions, and employment conditions are facing increasing pressure, which greatly challenges people's psychological endurance. Therefore, strengthening the mental health education of students has become an urgent need of society and a hot issue of common concern. In order to solve the problems of high misjudgment rate and low work efficiency in the current mental health intelligence evaluation process, a mental health intelligence evaluation system based on a joint optimization algorithm is proposed. The joint optimization algorithm consists of an improved decision tree algorithm and an improved ANN algorithm. First, analyze the current research status of mental health intelligence evaluation, and construct the framework of mental health intelligence evaluation system; then collect mental health intelligence evaluation data based on data mining, use joint learning algorithm to analyze and classify mental health intelligence evaluation data, and obtain mental health intelligence evaluation results. Finally, through specific simulation experiments, the feasibility and superiority of the mental health intelligent evaluation system are analyzed. The results show that the system in the article overcomes the shortcomings of the existing mental health intelligence evaluation system, improves the accuracy of mental health intelligence evaluation, and improves the efficiency of mental health intelligence evaluation. It has good system stability and can meet the actual current situation, which are requirements for mental health intelligence evaluation.

Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics

Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and above all, a comprehensive knowledge of the metrics used to assess these outcomes is lacking. To fill this gap, this study aims to systematically review the extant literature to map the methods, tools and metrics used to empirically evaluate co-production in health services. The search took place in six databases: Scopus, Web of Science, Psych INFO, PubMed, Cochrane and CINAHL. A total of 2311 articles were screened and 203 articles were included in the analysis, according to PRISMA guidelines. Findings show that outcomes are mainly investigated through qualitative methods and from the lay actor or provider perspective. Moreover, the detailed categorisation of the quantitative measures found offers a multidimensional performance measurement system and highlights the impact areas where research is needed to develop and test new measures. Findings should also promote improvements in empirical data collection on the multiple faceted co-produced activities and spur the consciousness of the adoption of sustainable co-productive initiatives.

Healthy Living and Co-Production: Evaluation of Processes and Outcomes of a Health Promotion Initiative Co-Produced with Adolescents

Co-production is an approach to designing, delivering, and evaluating public services through strict collaboration among professionals and the people using services with an equal and reciprocal relationship. Health promotion initiatives that include education services rarely use the co-production approach. Nevertheless, the value of co-production is widely recognized, although it is considered a normative good, and scarce and mixed evidence is available in literature. The purpose of this paper is to provide evidence supporting the hypothesis that a co-production approach, applied to an intervention for preventing obesity, can be effective and efficient. To this end, an evaluation of the processes, outputs meant as intermediate results, and behavioral and economic outcomes of a public health-promotion initiative co-produced and co-delivered with adolescents (beFood) was conducted. Mixed methods were used, including field-observations, two self-reported questionnaires, and an opportunity–cost analysis that compared beFood to traditional approaches of public health promotion. The co-production model was successfully implemented and appears to be effective—more than 5000 adolescents were reached by only 49 co-producer adolescents, who reported behavioral changes (e.g., eating better and practicing more physical activity). The cost analysis showed that the co-production approach was also efficient, producing relevant savings and potentially making available more than 3000 h of professionals’ time. This research can support a re-thinking of public institutions’ organization, public initiatives’ design, and public servants’ role.