Julie Repper

A review of the literature on peer support in mental health services

Background. Although mutual support and self-help groups based on shared experience play a large part in recovery, the employment of peer support workers (PSWs) in mental health services is a recent development. However, peer support has been implemented outside the UK and is showing great promise in facilitating recovery. Aims. This article aims to review the literature on PSWs employed in mental health services to provide a description of the development, impact and challenges presented by the employment of PSWs and to inform implementation in the UK. Method. An inclusive search of published and grey literature was undertaken to identify all studies of intentional peer support in mental health services. Articles were summarised and findings analysed. Results. The literature demonstrates that PSWs can lead to a reduction in admissions among those with whom they work. Additionally, associated improvements have been reported on numerous issues that can impact on the lives of people with mental health problems. Conclusion. PSWs have the potential to drive through recovery-focused changes in services. However, many challenges are involved in the development of peer support. Careful training, supervision and management of all involved are required.

Actively involving people with dementia in qualitative research

AIMS AND OBJECTIVES This paper aims to: • Consider the major challenges to involving people with dementia in qualitative research. • Critique a process consent framework. • Demonstrate the need for nurses and researchers to explore these issues in research and practice with people with dementia. • Consider the impact of the Mental Capacity Act 2005 on research with people with dementia. To achieve its aims, the authors will draw on current literature and use examples which explores the use of life story work with people with dementia by taking a qualitative approach. BACKGROUND There is acceptance that researchers should consider ways of actively involving people with dementia in research as participants where appropriate to answering specific research questions. Process consent methods have been advocated as an ethical way forward in recruiting and gaining consent for people with dementia, the Mental Capacity Act offers guidance to both practitioners and researchers. DESIGN AND METHOD This paper does not seek to be a comprehensive review of the current literature but is a discussion paper appraising a process consent framework against current literature and drawing on the lead authors PhD study, exploring life story work with older people with dementia. RESULTS AND CONCLUSIONS The Mental Capacity Act and process consent frameworks compliment one another, and their use should be considered when researching issues affecting older people with dementia. Researchers and practitioners should work more closely to ensure that the principles of process consent are achieved. Process consent models can equally be applied to everyday nursing practice. RELEVANCE TO CLINICAL PRACTICE Process consent models can provide an ethical and practical framework to ensure that consent is continually assessed in people with dementia with all clinical interventions. The paper also draws on literature exploring practical ways of involving people with dementia in evaluating service delivery.

Compliance or informed choice

Attempts by clinicians to increase compliance with psychotropic medication are examined critically. The ways in which attempts to increase compliance run counter to the goal of enabling people to make informed choices about their treatment are explored. An alternative approach to understanding why people behave in the way that they do is explored within the framework of health belief models of behaviour developed in relation to physical health and illness.

“The college is so different from anything I have done”. A study of the characteristics of Nottingham Recovery College

– This paper aims to describe the working of one of the first Recovery Colleges (RCs) and explore the defining characteristics. , – This study explores the ways in which an educational approach contributes to the process of recovery as observed in the Nottingham Recovery College (NRC). A mixed-method research design was adopted, combining interviews, observation and visual methods as well as analysis of quantitative data. The process contributed to the continuing development of “fidelity criteria”, or defining principles and key features, of the college. , – The NRC demonstrates the possibilities of offering an alternative approach within mental health services; one which is educationally rather than therapeutically informed. The design and operation of the college is informed by educational principles in the creation and execution of the curriculum. This is critically developed through processes of co-production and co-facilitation by those with professional and lived experience, supported by policy development, rigorous documentation and the creation of a supportive, but challenging culture and environment. Students are offered very real opportunities for involvement, progression and leadership within and beyond the college. , – Whilst building on work on education in self-management, the RCs move beyond the transmission of information to create new relationships between mental health professionals and students (rather than “service users”) – and through this, the relationship between students and their “condition” appears to be transformed. Early evidence suggests the NRC also provides a model of interaction that is distinct in educational terms. , – There is significant interest nationally and internationally in the development and operation of RCs in England. RCs present a possibility of transformation in the lives of people with long-term mental health conditions, with outcomes such as greater confidence and hope for the future in addition to widening social networks and providing opportunities for progression. They are also important in the implementation of Recovery through organisational change and the remodelling of commissioning arrangements. , – This is the first paper to be presented for publication specifically on the NRC. There is currently little published research on RCs. These are unique (and varying) organisations which are creating considerable interest nationally and internationally. An exploration of their defining characteristics will feed into subsequent larger-scale research.

Crossing boundaries. Identifying and meeting the mental health needs of Gypsies and Travellers

Background: Although little is known about the mental health of Gypsies and Travellers, their life expectancy is lower than the general population, perinatal death rates are higher, and non-UK studies of the mental health of Roma people suggest higher rates of mental disorders and suicide. Aim: To explore the mental health needs of Gypsies and Travellers in Sheffield, the extent to which services are meeting these needs and ways in which services might be improved. Method and Results: This mixed method study included: (1) A health status survey which revealed higher levels of anxiety and depression and lower social functioning than a comparison group in a local deprived area, (2) Semi-structured interviews with Gypsies and Travellers to elicit their views about mental health problems and services. Most interviewees talked about “feeling low” or “stressed” due to social and economic factors. They were unclear about the role of psychiatric services, and (3) Focus groups with service providers to explore their experiences and views about providing services for Gypsies and Travellers. They found it difficult to address the high levels of deprivation and complexity of need presented by this community partly because of limited and inaccurate information. Conclusions: The study concurs with recent calls for “joined-up” working: services need to work across boundaries to address social and economic factors underlying distress and to ensure consistency and communication between primary and secondary care. Family and community-based models of care may improve acceptability and effectiveness of services. Education, information and training are required to reduce discrimination and increase existing support to meet the mental health needs of Gypsies and Travellers.

A year of peer support in Nottingham: lessons learned

– In April 2010, Nottinghamshire Healthcare NHS trust won Regional Innovation Funding to recruit, train and employ six peer support workers in community mental health teams. At the time, practical examples of the employment of peer support workers were lacking in England. The aim of this paper is to communicate the key lessons learned in this first year of peer support in the hope that these will provide a foundation for other services to build upon., – The project was evaluated using a simple evaluation model reflecting service structure, processes and outcomes, collected through qualitative methods: documentary analysis, semi‐structured interviews and a focus group., – The peer support employment process has been broken down into its fundamental components (selection, recruitment, training, supervision relationships, recovery approach and discharge of clients) and within each of these sections a brief narrative is provided to explain some of the challenges faced. Each section ends with recommendations based on the lessons learned as a result of the pilot study., – A second paper will examine the nature of peer support: what the peers did with clients and what difference this made., – At present many mental health services are planning to employ peer support workers and this paper provides some early guidance for implementing this process in the NHS.

Co-producing social inclusion: the structure/agency conundrum

There is a raft of policy guidelines indicating that mental health nurses should be increasing the social inclusion of mental health service users. Despite this there is no universally accepted definition of social inclusion and there is a dearth of empirical evidence on the successful outcome of increasing inclusion for mental health service users. Recognizing the lack of clarity surrounding the concept we have a produced a social inclusion framework to assist mental health professionals and service users to co-produce social inclusive outcomes. Although we agree that social inclusion can be a positive aspect of recovery, we question the extent to which mental health nurses and service users in co-production can overcome the social, economic and political structures that have created the social exclusion in the first place. An understanding and appreciation of the structure/agency conundrum is required if mental health nurses are to engage with service users in an attempt to co-produce socially inclusive outcomes.

The deserving and the undeserving: Selectivity and progress in a community care service

Despite increasing evidence of the potential efficacy of community services for people with serious and ongoing mental illness, the popular media and professional literature reflect mounting concern regarding those people who do not receive the care they need. For community care services to become more accessible, acceptable and appropriate to the needs of all those people who are disabled by serious mental illness, more information is needed about the people they currently fail to serve. This study addresses this issue by examining the progress, characteristics and views of one hundred consecutive referrals to an exemplary community care service. In particular, those who were accepted for care (60%) are compared with those who themselves refused care (27%), and those who were rejected by the service (9%). The results replicate those of other studies of community care: people accepted for care showed greater improvement in many areas than those who did not get into the service. However, those people rejec...

Thinking the unthinkable: does mental health nursing have a future?

We would like to revisit the discussion articulated by Holmes (2006) from an Australian perspective and more recently by Hurley & Ramsey (2008) regarding the potential demise of mental health nursing. Currently in the UK, the Nursing & Midwifery Council (NMC) is reviewing nurse education. The NMC state that the review is required because: Changes in policy and delivery of healthcare will allow us to ensure that nursing education across all four countries enables nurses to meet the future needs of patients. (NMC 2008a)

Review of service delivery and organisational research focused on prisoners with mental disorders

This paper reports a structured review of the service development and organisational (SDO) research literature focused on prisoners with mental disorders. A large number of databases were searched, using a combined free-text and thesaurus approach. Papers were included if they had been published since 1983, were written in English, and contained research findings. Commentaries or descriptions of local service innovation were excluded. In all, 103 papers were identified that met all criteria; these were divided into 13 categories (e.g. screening, 18 papers; professional roles, 13 papers). The paper concludes that there is a clear need to consider commissioning SDO research for offenders in England and Wales in a coherent programme.