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  • Development of a peer support intervention to improve the experience and outcomes of discharge from inpatient mental health care: the role of experiential knowledge in a coproduced approach

    Repper, Julie (2021)
    OBJECTIVES: Peer support is rapidly being introduced into mental health services internationally, yet peer support interventions are often poorly described, limiting the usefulness of research in informing policy and practice. This paper reports the development of a peer support intervention that aims to improve outcomes of discharge from inpatient to community mental health care. People with experiential knowledge of using mental health services-peer workers and service user researchers-were involved in all stages of developing the intervention: generating intervention components; producing the intervention handbook; piloting the intervention. RESULTS: Systematic review and expert panels, including our Lived Experience Advisory Panel, identified 66 candidate intervention components in five domains: Recruitment and Role Description of Peer Workers; Training for Peer Workers; Delivery of Peer Support; Supervision and Support for Peer Workers; Organisation and Team. A series of Local Advisory Groups were used to prioritise components and explore implementation issues using consensus methods, refining an intervention blueprint. A peer support handbook and peer worker training programme were produced by the study team and piloted in two study sites. Feedback workshops were held with peer workers and their supervisors to produce a final handbook and training programme. The ENRICH trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328, and was overseen by an independent steering committee and a data monitoring committee.
  • Exploring the impacts of organisational structure, policy and practice on the health inequalities of marginalised communities: Illustrative cases from the UK healthcare system

    Hui, Ada (2020)
    This paper explores how organisational structure, policies and practices in healthcare can inadvertently disadvantage marginalised populations (e.g. individuals from ethnic minority backgrounds) and reinforce health inequalities. We draw upon three diverse UK healthcare settings (long term care institutions, high security hospitals and community pharmacies) to illustrate how systemic injustices negatively impact on access to care, treatment and health outcomes. The first case study considers the care of older people within nursing homes; specifically the disempowering effects of this service structure and impacts of choice reduction upon health and their access to health provision. The second case study explores the impact of security restrictions upon patients within high security hospitals, focusing particularly on the maintenance of relationships and support networks outside of the hospital. The third and final case study, draws upon a national community pharmacy medicine management service to illustrate ways in which policies and guidelines inadvertently obstruct patients' engagement with the service within a community setting. We draw upon these settings to highlight inequalities within different contexts and to illustrate the ways in which well intended services can inadvertently disadvantage marginalised communities in multiple ways.
  • Applying a new concept of embedding qualitative research: an example from a quantitative study of carers of people with later stage dementia

    Challis, David (2019)
    BACKGROUND: Qualitative methods are increasingly included in larger studies to provide a richer understanding of people's experience. This paper explores the potential of using a novel approach to embedded qualitative design as part of an observational study examining the effectiveness of home support for people in later stage dementia in England. The method involved collecting and analysing unsolicited conversational comments made by participants as they completed standardised measures. An evaluation of the method is presented using the voices of participants to illustrate its potential. METHODS: The conversations of 17 carers recruited to an observational study were audio recorded to gather commentary made while completing a structured interview. Data were interrogated using thematic analysis to investigate the feasibility of conducting an embedded qualitative study, the potential richness of the material and participants' reactions to formal questioning and participating in research. RESULTS: The findings revealed that qualitative data were available from this approach. Analysis generated three themes from carers: conflicting carer emotions; the importance of maintaining normality and agency within day-to-day life; and tensions between these desires and making use of formal services. Important issues for carers were revealed establishing the benefit of using the method. The advantages of exploiting unsolicited conversation included enhancing understanding of people's lived experience, reducing participant burden in research and easing the process of data collection. In addition, it provided an opportunity to evaluate individuals' experience of the research process. CONCLUSIONS: The findings demonstrate how unsolicited comments during structured interviews may appear incidental but can reveal important aspects of living with dementia. The method also emphasised methodological challenges for research in dementia, including the influence and impact of the research context. Further research is required to evaluate the method with other groups including people with dementia themselves.
  • Needs for care and service use in dementia: Baseline assessment of Portuguese participants in the actifcare cohort study [Portuguese]

    Orrell, Martin (2019)
    Introduction: People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments. Material and Methods: Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia. Results: People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present, were frequently due to attitudes or lack of knowledge of any or both members of the dyad. Discussion: The recruitment process was challenging, since the inclusion criteria were restrictive. Not claiming generalizability, we recruited a typical sample of Portuguese people with mild to moderate dementia and no significant formal community support. Levels and type of unmet needs found in some participants would call for formal support, were it not for problems regarding access or use. Conclusion: There are difficulties regarding timely access and effective use of formal care in dementia, along with relevant unmet needs.
  • Dementia care model: Promoting personhood through co-production

    Bosco, Alessandro; Coleston-Shields, Donna M.; Orrell, Martin (2019)
    Background Despite robust evidence on its effectiveness, current approaches that aspire to person-centred care (PCC) frequently locate people with dementia as passive recipients rather than as active agents in the care process. We define active involvement in care as ‘co-production’. In order to investigate co-production, we set out to review the evidence concerning personhood and dignity in dementia care. Method We adopted a meta-ethnographic approach to synthesise the predominantly- qualitative literature on personhood and dignity in dementia care using EMBASE, PsycINFO, and ASSIA databases. We also included relevant policy documents. Members of Patient and Public Involvement (PPI) group were consulted throughout. Results A total of 14 empirical studies were subjected to content analysis. Three themes were identified: dignity and personhood, coping with dementia, and barriers to dignity in care. The findings suggest that positive strategies and coping mechanisms are associated with superior outcomes in relation to: sense of self, dignity and quality of care. The 22 policy documents yielded six themes pertaining to co-production: the part played by the person with dementia, family, environment, behaviour, governance and law, and health care partnership. Conclusion Personhood in dementia care is enhanced through co-production, by actively participating in social, civic and political life. This is promoted through behavioural changes at the micro and macro levels of society, including providers of care being trained in co-producing care and policy makers creating opportunities with, rather than for people with dementia.
  • A feasibility trial of Power Up: Smartphone app to support patient activation and shared decision making for mental health in young people

    Hollis, Chris P. (2019)
    BACKGROUND: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and, therefore, develop evidence-based recommendations for practice. OBJECTIVE: This study aimed to determine the feasibility of undertaking a cluster randomized controlled trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health. METHODS: Overall, 270 young people were screened for participation and 52.5% (142/270) were recruited and completed baseline measures across 8 specialist child mental health services (n=62, mean age 14.66 (SD 1.99) year; 52% [32/62] female) and 2 mainstream secondary schools (n=80; mean age 16.88 [SD 0.68] years; 46% [37/80] female). Young people received Power Up in addition to management as usual or received management as usual only. Posttrial interviews were conducted with 11 young people from the intervention arms (specialist services n=6; schools n=5). RESULTS: Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported (1) their motivation for use of Power Up, (2) the impact of use, and (3) barriers to use. Out of the 142 recruited participants, 45.0% (64/142) completed follow-up measures, and the approaches to increase retention agreed by the steering group are discussed. CONCLUSIONS: The findings of this study indicate that the app is acceptable, and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized controlled trial. TRIAL REGISTRATION: NCT02552797; (Archived by WebCite at
  • Restrictive interventions in acute mental health services and their impact on accessing timely healthcare services in BME adult males: A case study of the experience of Nottinghamshire service users

    Mutepfa, Cynthia; Mercer, Joan; Horsley, Jo; O'Driscoll, Mick (2018)
    Mutepfa, C., Mercer, J., Horsley, J. & O'Driscoll, M. (2018). Restrictive interventions in acute mental health services and their impact on accessing timely healthcare services in BME adult males: A case study of the experience of Nottinghamshire service users. (Version 2). Nottingham: Nottinghamshire Healthcare NHS Foundation Trust, p. 1-18.
  • Clinical characteristics of persistent frequent attenders in primary care: Case–control study

    Patel, Shireen; Atha, Christopher; Guo, Boliang; James, Marilyn; Malins, Samuel; Sampson, Christopher J.; Stubley, Michelle; Morriss, Richard K. (2015)
    Background.Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status.Objective.To compare the mental and physical health characteristics and health status of persistent frequent attenders (FAs) in primary care, currently and over the preceding 2 years, with normal attenders (NAs) matched by age, gender and general practice.Methods.Case–control study of 71 FAs (30 or more GP or practice nurse consultations in 2 years) and 71 NAs, drawn from five primary care practices, employing standardized psychiatric interview, quality of life, health anxiety and primary care electronic record review over the preceding 2 years.Results. Compared to NAs, FAs were more likely to report a lower quality of life ( P < 0.001), be unmarried ( P = 0.03) and have no educational qualifications ( P = 0.009) but did not differ in employment status. FAs experienced greater health anxiety ( P < 0.001), morbid obesity ( P = 0.02), pain ( P < 0.001) and long-term pathological and ill-defined physical conditions ( P < 0.001). FAs had more depression including dysthymia, anxiety and somatoform disorders (all P < 0.001). Conclusions.Persistent frequent attendance in primary care was associated with poor quality of life and high clinical complexity characterized by diverse and often persistent physical and mental multimorbidity. A brokerage model with GPs working in close liaison with skilled psychological therapists is required to manage such persistent complexity.
  • Using online tools to treat alcohol misuse

    Holmes, Mark (2016)
    Many people with alcohol problems find it difficult to access traditional services, due to stigma or practical difficulties. Online tools offer the option to avoid face-to-face consultations and can be made available at convenient times, overcoming some of these issues. This article reports on two services that have increased access to alcohol services and attracted users who are less likely to access traditional services.
  • Development of a peer-supported, self-management intervention for people following mental health crisis

    Lambert, Marissa (2017)
    BACKGROUND: A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). METHODS: A five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4). RESULTS: Existing evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of the intervention by PSWs; however, the structured self-management booklet was underutilised. Modifications to the self-management intervention manual and PSWs' training were made before piloting, which confirmed the acceptability and feasibility of the intervention for testing in a future, definitive trial. CONCLUSIONS: A manualised intervention and operating procedures, focusing on the needs and priorities of the target client group, have been developed through iterative stages of intervention development and feedback for testing in a trial context. Trial Registration ISRCTN01027104 date of registration: 11/10/2012.
  • A mobile phone app to support young people in making shared decisions in therapy (power up): Study protocol

    Craven, Michael P.; Hollis, Chris P. (2017)
    BACKGROUND: Evidence suggests that young people want to be active participants in their care and involved in decisions about their treatment. However, there is a lack of digital shared decision-making tools available to support young people in child and adolescent mental health services (CAMHS). OBJECTIVE: The primary aim of this paper is to present the protocol of a feasibility trial for Power Up, a mobile phone app to empower young people in CAMHS to make their voices heard and participate in decisions around their care. METHODS: In the development phase, 30 young people, parents, and clinicians will take part in interviews and focus groups to elicit opinions on an early version of the app. In the feasibility testing phase, 60 young people from across 7 to 10 London CAMHS sites will take part in a trial looking at the feasibility and acceptability of measuring the impact of Power Up on shared decision making. RESULTS: Data collection for the development phase ended in December 2016. Data collection for the feasibility testing phase will end in December 2017. CONCLUSIONS: Findings will inform the planning of a cluster controlled trial and contribute to the development and implementation of a shared decision-making app to be integrated into CAMHS. TRIAL REGISTRATION: ISRCTN77194423; (Archived by WebCite at NCT02987608; (Archived by WebCite at
  • Can Healthcare Assistant Training (CHAT) improve the relational care of older people? Study protocol for a pilot cluster randomised controlled trial

    Schneider, Justine (2015)
    BACKGROUNDPeople aged 75 years and over account for 1 in 4 of all hospital admissions. There has been increasing recognition of problems in the care of older people, particularly in hospitals. Evidence suggests that older people judge the care they receive in terms of kindness, empathy, compassion, respectful communication and being seen as a person not just a patient. These are aspects of care to which we refer when we use the term 'relational care'. Healthcare assistants deliver an increasing proportion of direct care to older people, yet their training needs are often overlooked.METHODS/DESIGNThis study will determine the acceptability and feasibility of a cluster randomised controlled trial of 'Older People's Shoes' a 2-day training intervention for healthcare assistants caring for older people in hospital. Within this pilot, 2-arm, parallel, cluster randomised controlled trial, healthcare assistants within acute hospital wards are randomised to either the 2-day training intervention or training as usual. Registered nurses deliver 'Older People's Shoes' over 2 days, approximately 1 week apart. It contains three components: experiential learning about ageing, exploration of older people's stories, and customer care. Outcomes will be measured at the level of patient (experience of emotional care and quality of life during their hospital stay), healthcare assistant (empathy and attitudes towards older people), and ward (quality of staff/patient interaction). Semi-structured interviews of a purposive sample of healthcare assistants receiving the intervention, and all trainers delivering the intervention, will be undertaken to gain insights into the experiences of both the intervention and the trial, and its perceived impact on practice.DISCUSSIONFew training interventions for care staff have been rigorously tested using randomised designs. This study will establish the viability of a definitive cluster randomised controlled trial of a new training intervention to improve the relational care proided by healthcare assistants working with older people in hospital.TRIAL REGISTRATIONThe study was registered as an International Standard Randomised Controlled Trial ( ISRCTN10385799 ) on 29 December 2014.
  • Perceptions of treatment adherence among people with mental health problems and health care professionals

    Adams, Clive E. (2015)
    Aims: To explore patients' and mental healthcare professionals' perceptions of supportive and restrictive indicators of adherence to treatment in patients with mental health problems. Background: People with mental health problems may have difficulties adhering to their treatment, causing relapses and hospitalizations. It is, therefore, important to learn more about how patients' treatment adherence can be supported and what jeopardizes adherence. Design: A descriptive qualitative study. Methods: Nine focus groups and semi-structured interviews were conducted in Finland during 2010–2011. The patients ( n = 19) were recruited from patient associations and the healthcare professionals ( n = 42) from healthcare organizations. The data were analysed using inductive content analysis. Findings: Participants agreed that treatment adherence can be supported. Suggestions focused on treatment planning mindful of both patient involvement and needs. A structured daily routine helps patients manage their everyday issues and further facilitates adherence. On the other hand, patients found that their adherence was affected by factors related to the mental health system, including arrangements for follow-up care, access to services, the receptiveness of providers to meet patient needs and a disconnect time between hospital and community life. Conclusion: Patient adherence should already be taken into account when treatment is planned. The content of treatment should be individually designed according to the patient's activities of daily life. In addition, stressing the importance of medication and listening to the patient's opinions and experiences of taking medication may improve the patient's willingness to adhere. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
  • Listen to me, I'm talking: Involvement and recovery

    Walsh, Fran; Tickle, Anna C. (2017)
    Purpose - The purpose of this paper is to explore how those engaged in service user involvement (SUI) initiatives perceive involvement and recovery; whether involvement is related to their recovery process and, if so, how. Design/methodology/approach - An exploratory qualitative method, social constructionist grounded theory, was adopted throughout the research process. Nine semi-structured interviews were undertaken with participants who self-defined as having current or previous mental health problems and who were engaged in SUI initiatives. Findings - Most participants identified explicit links between their own experiences of SUI and recovery. These links represented a connection between the characteristics they perceived to be inherent to involvement and their personal definitions of recovery. In contrast, experiences of consultation and involvement as patient service users was limited and identified as an area for improvement. The core of the tentative grounded theory constructed suggests that individuals found in involvement elements which were concordant with and supported their own definitions of recovery and which were not apparent in their experiences as patients. Research limitations/implications - The small sample and narrow constituency of participants limit the nature of the claims made by the study. Practical implications - This study highlights the value of involvement in promoting recovery and indicates the merit of promoting meaningful involvement across the spectrum of the service user experience. Originality/value - This study offers a unique contribution to the current literature, highlighting the links made between involvement and personal recovery. © Emerald Publishing Limited.
  • Working with families affected by mental distress: Stakeholders' perceptions of mental health nurses educational needs

    Meade, Ooangh (2017)
    Family and informal caregivers provide a substantial amount of care and support to people who experience mental health problems. The aim of this study was to explore mental health nurses', students' and service users' perceptions of the knowledge, skills and attitudes that are required by mental health nurses to work with families and carers using a qualitative methodology. Three themes emerged from the data: Knowledge of the family and how mental distress affects the family; working with the family - support and education; and valuing the role of the family. The three themes demonstrate the complexity of preparing mental health nurses to work with families and carers, and the article offers recommendations about how this might be achieved.
  • Exploring the experience of polish interpreters who interpret for mental health clinicians in the UK: An interpretative phenomenological analysis

    Lofgren, Saima (2017)
    The current study explores the experiences of Polish interpreters who interpret for mental health clinicians and how Polish interpreters view the triadic relationship among themselves, the service user and the mental health clinician they work with when interpreting in a mental health setting. Six participants (four female and two male) were recruited with each taking part in a semi-structured interview. Length of time working as an interpreter in the UK National Health Service (NHS) ranged from six months to 10 years. Interviews were analysed using Interpretative Phenomenological Analysis (Smith, J. A. (2004). Reflecting on the Development of Interpretative Phenomenological Analysis and its Contribution to Qualitative Research in Psychology. Qualitative Research in Psychology, 1, 39–54. doi:10.1191/1478088704qp004oa.). Three themes emerged from the analysis of the participants’ interview transcripts. These were: (1) ‘Just a linguist?’–highlighting the confusion and complexity of the interpreting role; (2) ‘Unspoken alliances’–describing the interpreters’ experiences of the triadic relationship; (3) ‘Communicating emotional reactions’–noting the emotional impact of mental health work on interpreters. The findings of the current research emphasise that it is important for clinicians, mental health and interpreting services to take into account the emotional impact and disempowerment caused by structural systemic factors which limit the voice of the interpreter. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

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