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Hawke LD, Sheikhan NY, Rodak T. Lived experience and family engagement in psychiatry research: A scoping review of reviews. Health Expect 2024; 27:e14057. [PMID: 38678591 PMCID: PMC11056206 DOI: 10.1111/hex.14057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/14/2024] [Accepted: 04/16/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND A growing body of research is addressing the process and science of engaging people with lived experience (PWLE) of mental health challenges and other psychiatric conditions, and family members, in research activities. OBJECTIVE This scoping review of reviews synthesizes literature reviews on the engagement of PWLE and family members in research across the field of psychiatry. METHOD Systematic searches were conducted in seven bibliographic databases. Records were independently screened first at the title and abstract level, then at the full-text level. Included were any literature synthesis studies published in English, French, or Spanish in any given year, focusing on the engagement of PWLE and/or family members in research within psychiatry. Twenty records were included. Data were extracted in a spreadsheet and codebook thematic analysis was used across the body of articles to synthesize the findings. RESULTS Aspects of PWLE engagement have been synthesized in 20 review articles reviewing 376 articles across psychiatry as a whole and several subpopulations, including youth mental health, dementia, neurodevelopmental disorders, people who use drugs, and forensic mental health. Information specific to family engagement is lacking. Barriers, facilitators, and positive impacts of PWLE engagement have been widely reported across domains of research, with a considerable degree of consensus across subpopulations. Some negative impacts and reporting challenges have also been identified. DISCUSSION This scoping review of reviews provides an overarching understanding of the current state of the science of PWLE and family engagement across psychiatry research. The findings can inform future research practices enriched with a genuine and effective engagement with PWLE and families. PATIENT OR PUBLIC CONTRIBUTION The authorship team includes members with intersecting lived experience and academic identities. Additional lived experience engagement was not conducted as part of this review.
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Affiliation(s)
- Lisa D. Hawke
- University of TorontoTorontoCanada
- Centre for Addiction and Mental HealthTorontoCanada
| | - Natasha Y. Sheikhan
- University of TorontoTorontoCanada
- Centre for Addiction and Mental HealthTorontoCanada
| | - Terri Rodak
- Centre for Addiction and Mental HealthTorontoCanada
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Ayre MJ, Lewis PJ, Phipps DL, Morgan KM, Keers RN. Towards understanding and improving medication safety for patients with mental illness in primary care: A multimethod study. Health Expect 2024; 27:e14095. [PMID: 38817038 PMCID: PMC11139968 DOI: 10.1111/hex.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Medication safety incidents have been identified as an important target to improve patient safety in mental healthcare. Despite this, the causes of preventable medication safety incidents affecting patients with mental illness have historically been poorly understood, with research now addressing this knowledge gap through a healthcare professional lens. However, patients and carers can also provide complimentary insight into safety issues, and as key stakeholders in healthcare, it is vital to consider their needs when designing effective interventions. METHODS A two-stage approach was adopted by (i) conducting three focus groups (FG) comprising 13 patients with mental illness and their carers to develop a holistic picture of medication safety in primary care with extraction of themes guided by the P-MEDS framework; (ii) conducting two separate nominal group consensus workshops with seven patients with mental illness/carers and seven healthcare professionals to identify priority areas for targeted interventions. RESULTS Seven themes were identified in the FGs: communication; trust, involvement and respect; continuity and support; access; the healthcare professional; the patient and carer; and the organisation. Priority areas identified for intervention by key stakeholders included improving communication within and between clinical services, enhancing patient support with holistic continuity of care, maximising shared decision-making and empowerment, ensuring timely access to medicines and services, strengthening healthcare professional knowledge regarding mental illnesses and associated medications, and increasing patient dignity and respect. CONCLUSION This study has developed a holistic picture of contributors to medication safety incidents affecting patients with mental illness in primary care. This theory was then used by key stakeholders to inform and generate priority recommendations for targeted interventions. These findings can be used to inform future intervention research, as they consider the needs of those who access or work within primary care services. PATIENT OR PUBLIC CONTRIBUTION An advisory group consisting of three expert patients with lived experience of mental illness was consulted on the design of both stages of this study. Patients with mental illness and/or their carers were recruited and participated in both stages of this study. Patients/carers aided with data analysis and interpretation during the patient/carer nominal group consensus workshop.
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Affiliation(s)
- Matthew J. Ayre
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
| | - Penny J. Lewis
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre (MAHSC)The University of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - Denham L. Phipps
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre (MAHSC)The University of ManchesterManchesterUK
| | - Kathy M. Morgan
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- Pharmacy DepartmentPennine Care NHS Foundation TrustManchesterUK
| | - Richard N. Keers
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, School of Health SciencesThe University of ManchesterManchesterUK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester Academic Health Science Centre (MAHSC)The University of ManchesterManchesterUK
- Pharmacy DepartmentPennine Care NHS Foundation TrustManchesterUK
- Optimising Outcomes With Medicines (OptiMed) Research UnitPennine Care NHS Foundation TrustManchesterUK
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Baker J, Kendal S, Bojke C, Louch G, Halligan D, Shafiq S, Sturley C, Walker L, Brown M, Berzins K, Brierley-Jones L, O'Hara JK, Blackwell K, Wormald G, Canvin K, Vincent C. A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-182. [PMID: 38794956 DOI: 10.3310/udbq8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s) Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John Baker
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Sarah Kendal
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Daisy Halligan
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Saba Shafiq
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Lauren Walker
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Mark Brown
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Kathryn Berzins
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Jane K O'Hara
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Gemma Wormald
- Department of Health Sciences, University of York, York, UK
| | - Krysia Canvin
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Charles Vincent
- Social Spider CIC, The Mill (Community Centre), London, UK
- Thrive by Design, Leeds, UK
- University of Oxford Medical Sciences Division, Oxford, UK
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Louch G, Berzins K, Walker L, Wormald G, Blackwell K, Stephens M, Brown M, Baker J. Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool. JMIR Form Res 2024; 8:e53726. [PMID: 38607663 PMCID: PMC11053394 DOI: 10.2196/53726] [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: 10/17/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. OBJECTIVE This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. METHODS The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. RESULTS We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, "getting worse" or "getting better"; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. CONCLUSIONS Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively.
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Affiliation(s)
- Gemma Louch
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, United Kingdom
| | - Kathryn Berzins
- Health Technology Assessment Unit, Applied Health Research Hub, Implementation and Capacity Building Team, NIHR Applied Research Collaboration North West Coast, University of Central Lancashire, Preston, United Kingdom
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Gemma Wormald
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Kirstin Blackwell
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | | | - Mark Brown
- Social Spider CIC, London, United Kingdom
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, United Kingdom
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Brierley-Jones L, Ramsey L, Canvin K, Kendal S, Baker J. Correction: To what extent are patients involved in researching safety in acute mental healthcare? RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:65. [PMID: 37559075 PMCID: PMC10410941 DOI: 10.1186/s40900-023-00469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Affiliation(s)
| | - Lauren Ramsey
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | - Sarah Kendal
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK.
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Lantta T, Duxbury J, Haines-Delmont A, Björkdahl A, Husum TL, Lickiewicz J, Douzenis A, Craig E, Goodall K, Bora C, Whyte R, Whittington R. Models, frameworks and theories in the implementation of programs targeted to reduce formal coercion in mental health settings: a systematic review. Front Psychiatry 2023; 14:1158145. [PMID: 37398581 PMCID: PMC10311067 DOI: 10.3389/fpsyt.2023.1158145] [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: 02/03/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Implementation models, frameworks and theories (hereafter tools) provide researchers and clinicians with an approach to understand the processes and mechanisms for the successful implementation of healthcare innovations. Previous research in mental health settings has revealed, that the implementation of coercion reduction programs presents a number of challenges. However, there is a lack of systematized knowledge of whether the advantages of implementation science have been utilized in this field of research. This systematic review aims to gain a better understanding of which tools have been used by studies when implementing programs aiming to reduce formal coercion in mental health settings, and what implementation outcomes they have reported. Methods A systematic search was conducted using PubMed, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science. A manual search was used to supplement database searches. Quality appraisal of included studies was undertaken using MMAT-Mixed Methods Appraisal Tool. A descriptive and narrative synthesis was formed based on extracted data. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in this review. Results We identified 5,295 references after duplicates were removed. Four additional references were found with a manual search. In total eight studies reported in nine papers were included in the review. Coercion reduction programs that were implemented included those that were holistic, and/or used professional judgement, staff training and sensory modulation interventions. Eight different implementation tools were identified from the included studies. None of them reported all eight implementation outcomes sought from the papers. The most frequently reported outcomes were acceptability (4/8 studies) and adaptation (3/8). With regards to implementation costs, no data were provided by any of the studies. The quality of the studies was assessed to be overall quite low. Discussion Systematic implementation tools are seldom used when efforts are being made to embed interventions to reduce coercive measures in routine mental health care. More high-quality studies are needed in the research area that also involves perspectives of service users and carers. In addition, based on our review, it is unclear what the costs and resources are needed to implement complex interventions with the guidance of an implementation tool. Systematic review registration [Prospero], identifier [CRD42021284959].
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joy Duxbury
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Alina Haines-Delmont
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Anna Björkdahl
- Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Tonje Lossius Husum
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Athanassios Douzenis
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elaine Craig
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Katie Goodall
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Christina Bora
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Rachel Whyte
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Whittington
- Centre for Research and Education in Security, Prisons and Forensic Psychiatry, Forensic Department Østmarka, St. Olav's Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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Averill P, Vincent C, Reen G, Henderson C, Sevdalis N. Conceptual and practical challenges associated with understanding patient safety within community-based mental health services. Health Expect 2022; 26:51-63. [PMID: 36370458 PMCID: PMC9854300 DOI: 10.1111/hex.13660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/27/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Patient safety problems stemming from healthcare delivery constitute a global public health concern and represent a pervasive barrier to improving care quality and clinical outcomes. However, evidence generation into safety in mental health care, particularly regarding community-based mental health services, has long fallen behind that of physical health care, forming the focus of fewer research publications and developed largely in isolation from the wider improvement science discipline. We aimed to investigate the state of the field, along with key conceptual and empirical challenges to understanding patient safety in community-based mental health care. METHODS A narrative review surveyed the literature to appraise the conceptual obstacles to advancing the science of patient safety in community-based mental health services. Sources were identified through a combination of a systematic search strategy and targeted searches of theoretical and empirical evidence from the fields of mental health care, patient safety and improvement science. RESULTS Amongst available evidence, challenges in defining safety in the context of community mental health care, evaluating safety in long-term care journeys and establishing what constitutes a 'preventable' safety problem, were identified. A dominant risk management approach to safety in mental health care, positioning service users as the origin of risk, has seemingly prevented a focus on proactive safety promotion, considering iatrogenic harm and latent system hazards. CONCLUSION We propose a wider conceptualization of safety and discuss the next steps for the integration and mobilization of disparate sources of 'safety intelligence', to advance how safety is conceived and addressed within community mental health care. PATIENT AND PUBLIC CONTRIBUTION This paper was part of a larger research project aimed at understanding and improving patient safety in community-based mental health care. Although service users, carers and healthcare professionals were not involved as part of this narrative review, the views of these stakeholder groups were central to shaping the wider research project. For a qualitative interview and focus group study conducted alongside this review, interview topic guides were informed by this narrative analysis, designed jointly and piloted with a consultation group of service users and carers with experience of community-based mental health services for working-age adults, who advised on key questioning priorities.
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Affiliation(s)
- Phoebe Averill
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Charles Vincent
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Gurpreet Reen
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Claire Henderson
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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