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Williams B, Charleston R, Innes S, McIver S. Understanding collaborative and coordinated care in a mental health and well-being context: Essential elements for effective service integration. Int J Ment Health Nurs 2024; 33:397-408. [PMID: 37849028 DOI: 10.1111/inm.13244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
Multiple system reforms in Australia, including the National Disability Insurance Scheme (NDIS), are changing mental health (MH) and disability-related service provision, whilst policy drivers continue to require service integration. This has necessitated service providers discovering new ways of working collaboratively to achieve an integrated model of care. This qualitative study examined what does and does not work to support collaborative and coordinated care (CCC), as essential components of service integration. The study sample (n = 59) included four cohorts: health and community service leaders (n = 16), staff (n = 23); MH service consumers with complex needs (n = 10), and MH carers (n = 10). Thematic analysis from interviews was applied to data from each cohort to identify overarching themes that described the lived experience of current CCC delivery. COREQ and EQUATOR guidelines were applied to reporting the findings. Themes emphasized CCC is enabled by the development and sustainability of positive working relationships, and depth of knowledge across health and community services. Unnavigable service systems, stigmatization, perceived power differentials, multiple and rapid service reforms and Fee-For-Service (FFS) models provide significant barriers to CCC. Recommendations include the need for accessible service navigation, consumer-friendly service environments, a stable workforce, standardization of knowledge across sectors, outcome measures and funding attached to CCC as part of a raft of potential changes.
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Affiliation(s)
- Bronwyn Williams
- Adult Mental Health Program, Eastern Health, Box Hill, Victoria, Australia
| | - Rosemary Charleston
- Centre for Mental Health Learning, Melbourne University, Melbourne, Victoria, Australia
| | - Stanley Innes
- Adult Mental Health Program, Eastern Health, Box Hill, Victoria, Australia
| | - Shane McIver
- The Centre for Research in Assessment and Digital Learning (CRADLE), Deakin Learning Futures (DLF), Deakin University, Melbourne, Victoria, Australia
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2
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Harvey C, Zirnsak TM, Brasier C, Ennals P, Fletcher J, Hamilton B, Killaspy H, McKenzie P, Kennedy H, Brophy L. Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis. Front Psychiatry 2023; 14:1259944. [PMID: 37779607 PMCID: PMC10539575 DOI: 10.3389/fpsyt.2023.1259944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/23/2023] [Indexed: 10/03/2023] Open
Abstract
Objective This study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs. Method We conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience. Results Beneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central. Conclusion Evidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes.
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Affiliation(s)
- Carol Harvey
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
- North West Area Mental Health, Division of Mental Health, Northern Health, Melbourne, VIC, Australia
| | - Tessa-May Zirnsak
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Brasier
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
| | | | - Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Killaspy
- Department of Epidemiology and Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Peter McKenzie
- The Bouverie Centre, School of Psychology and Public Health, La Trobe University, Brunswick, VIC, Australia
| | - Hamilton Kennedy
- Centre for Mental Health Nursing, Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia
| | - Lisa Brophy
- Social Work and Social Policy, Department of Community and Clinical Health, La Trobe University, Bundoora, VIC, Australia
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3
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Gulliver A, Morse AR, Banfield M. Cancer Survivors' Experiences of Navigating the Australian Health Care System for Physical and Mental Health Care Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3988. [PMID: 36900994 PMCID: PMC10002190 DOI: 10.3390/ijerph20053988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
People living with cancer experience many impacts on their health and mental health, and are thus likely to require ongoing health care. The aim of the current study was to investigate the health and mental health care experiences and needs of Australian cancer survivors. A total of 131 people (119 female, 12 male) with lived experience of a cancer diagnosis (at least 12 months ago) participated in an online survey collecting qualitative and quantitative data, advertised via social media groups and paid advertising. Analysis of the written responses was conducted using inductive qualitative content analysis. The findings showed that a major issue facing cancer survivors was difficulties around access to and management of services for both their mental and physical health. There was also a strong preference for increasing access to allied health care, such as physiotherapy, psychology, and remedial massage. There appear to be some inequities in the experiences of cancer survivors, particularly in accessing care. Improving the experiences of health care for physical and mental health cancer survivors should focus on increasing access to and improving the management of services, specifically allied health, through a variety of avenues, including reducing costs, increasing transport, and providing closer and more co-located services.
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Proctor SL, Gursky-Landa B, Kannarkat JT, Guimaraes J, Newcomer JW. Payer-Level Care Coordination and Re-admission to Acute Mental Health Care for Uninsured Individuals. J Behav Health Serv Res 2022; 49:385-396. [PMID: 35194730 DOI: 10.1007/s11414-022-09789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
This study determined the short- and long-term outcomes associated with payer-level care coordination, compared with care-as-usual in "high-utilizers" of acute care services in a large, publicly funded safety net system. Administrative claims data (2016-2020) were analyzed. All patients were "high-utilizers," defined by the State of Florida as either (a) 3 + more acute care episodes in a 6-month period or (b) 1 + acute care episodes in the past 6 months lasting 16 + days. Patients enrolled in care coordination (n = 178) were compared to usual care (n = 1,127) on rates of re-admission and post-discharge engagement in outpatient/residential services. Care coordination was associated with reduced rates of re-admission, significant cost savings, and enhanced engagement in post-discharge non-crisis services. In light of the observed clinical and economic benefits associated with care coordination, payers, policymakers, and administrators of acute care settings should consider potential return on investment for allocation of resources to support specialty care coordination programs.
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Affiliation(s)
- Steven L Proctor
- Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, USA. .,Department of Psychiatry and Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Brittney Gursky-Landa
- Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, USA
| | - Jacob T Kannarkat
- Department of Psychiatry & Behavioral Sciences, The University of Miami Health System, Miami, FL, USA
| | - Johnny Guimaraes
- Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, USA
| | - John W Newcomer
- Thriving Mind South Florida, 7205 Corporate Center Drive, Suite 200, Miami, FL, 33126, USA.,Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Long JC, Ruane C, Ellis LA, Lake R, Le Roux A, Testa L, Shand F, Torok M, Zurynski Y. Networks to strengthen community social capital for suicide prevention in regional Australia: the LifeSpan suicide prevention initiative. Int J Ment Health Syst 2022; 16:10. [PMID: 35130951 PMCID: PMC8822835 DOI: 10.1186/s13033-022-00524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Mental health services are fragmented in Australia leading to a priority being placed on whole-of-community approaches and integration. We describe the LifeSpan suicide prevention intervention developed by the Black Dog Institute that draws upon nine evidence-based community-wide strategies. We examined the suicide prevention Collaborative group at each site. We evaluated how the social capital of the community and service providers changed, and how the brokerage roles of the Collaborative affected integration of effort. Methods This was a two phase, explanatory mixed methods study. Participants were LifeSpan Coordinators, The Collaborative and working group members at four LifeSpan sites in New South Wales (three metropolitan/regional, one regional/rural). Quantitative social network data was collected through an online survey and analysed using Gephi software. Qualitative data through focus groups and interviews with Lifespan Coordinators and community stakeholders. Results The social network survey was administered in three sites and was completed by 83 people. Data gave quantitative evidence of increased engagement across key stakeholders in each region who had not previously been working together. Nominations of other collaborators showed this network extended beyond the formal structures of The Collaborative. LifeSpan Coordinators were empirically identified as key players in the networks. Qualitative data was collected from 53 individuals (18 interviews and five focus groups) from across all sites. Participants identified benefits of this collaborative approach including greater capacity to run activities, better communication between groups, identification of “who’s who” locally, improvement in the integration of priorities, services and activities, and personal support for previously isolated members. LifeSpan Coordinators were key to the smooth running of The Collaborative. This may represent a risk to sustainability if they left. The collaboration model that suited metropolitan sites was difficult to sustain in rural sites, but gains were seen in better coordinated postvention efforts. Conclusion LifeSpan Coordinators were noted to be exceptional people who magnified the benefits of collaboration. Geographic proximity was a potent driver of social capital. Initial engagement with local stakeholders was seen as essential but time-consuming work in the implementation phase. Coordinators reported this important work was not always acknowledged as part of their formal role. Supplementary Information The online version contains supplementary material available at 10.1186/s13033-022-00524-z.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.
| | - Colum Ruane
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.,NHMRC Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Rebecca Lake
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Anneke Le Roux
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Fiona Shand
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Michelle Torok
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, North Ryde, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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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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Zumstein N, Riese F. Defining Severe and Persistent Mental Illness-A Pragmatic Utility Concept Analysis. Front Psychiatry 2020; 11:648. [PMID: 32733295 PMCID: PMC7358610 DOI: 10.3389/fpsyt.2020.00648] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
The concept of severe and persistent mental illness (SPMI) lacks a consensual definition. Variations in definitions stem above all from different meanings about the constituent features of the concept and how to operationalize them. Our objective was to clarify the concept of SPMI and to explore the level of concept maturity through pragmatic utility (PU) concept analysis. Our findings suggest that SPMI is a partially mature concept that needs further clarification. We argue that the lack of a uniform definition is inherent to the problem: SPMI refers to a patient population rather than a disease entity, and the term has to be useful for different stakeholder purposes. Therefore, while an agreement on the principle three dimensions included in a definition may be possible (diagnosis, disability, and duration), their operationalization will have to be context-dependent and specific for the task at hand.
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Affiliation(s)
- Naomi Zumstein
- URPP "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Department of Anthropology, McGill University, Montréal, QC, Canada
| | - Florian Riese
- URPP "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Department of Geriatric Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
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Trankle SA, Reath J. Partners in Recovery: an early phase evaluation of an Australian mental health initiative using program logic and thematic analysis. BMC Health Serv Res 2019; 19:524. [PMID: 31349841 PMCID: PMC6660922 DOI: 10.1186/s12913-019-4360-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 07/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs. Methods We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively. Results We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers. Conclusions Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR’s focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations. Full report available at https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/ Electronic supplementary material The online version of this article (10.1186/s12913-019-4360-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven A Trankle
- School of Medicine, Department of General Practice, Western Sydney University, Campbelltown Campus, Building 30.3.18, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Jennifer Reath
- School of Medicine, Department of General Practice, Western Sydney University, Campbelltown Campus, Building 30.3.18, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Pelto-Piri V, Wallsten T, Hylén U, Nikban I, Kjellin L. Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden. Int J Ment Health Syst 2019; 13:23. [PMID: 30996733 PMCID: PMC6452515 DOI: 10.1186/s13033-019-0282-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Methods In this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients' feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes. Results The main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants' way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away. Conclusions Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff.
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Affiliation(s)
- Veikko Pelto-Piri
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tuula Wallsten
- 2Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden
| | - Ulrika Hylén
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Lars Kjellin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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