Kati Turner

Patient and Public Involvement in the Coproduction of Knowledge: Reflection on the Analysis of Qualitative Data in a Mental Health Study

Patient and public involvement in health research is increasingly well established internationally, but the impacts of involvement on the research process are hard to evaluate. We describe a process of qualitative data analysis in a mental health research project with a high level of mental health service user and carer involvement, and reflect critically on how we produced our findings. Team members not from research backgrounds sometimes challenged academic conventions, leading to complex findings that would otherwise have been missing. An essential component of how we coproduced knowledge involved retaining methodological flexibility so that nonconventional research voices in the team could situate and critique what was conventionally known. Deliberate and transparent reflection on how “who we are” informed the knowledge we produced was integral to our inquiry. We conclude that reflecting on knowledge (co)production is a useful tool for evaluating the impact of patient and public involvement on health research.

‘What difference does it make?’ Finding evidence of the impact of mental health service user researchers on research into the experiences of detained psychiatric patients

Background  Interest in the involvement of members of the public in health services research is increasingly focussed on evaluation of the impact of involvement on the research process and the production of knowledge about health. Service user involvement in mental health research is well‐established, yet empirical studies into the impact of involvement are lacking.

One size fits all: or horses for courses? Recovery-based care in specialist mental health services

IntroductionThe ‘recovery approach’ to the management of severe mental health problems has become a guiding vision of service provision amongst many practitioners, researchers, and policy makers as well as service users.MethodThis qualitative pilot study explored the meaning of ‘recovery’ with users of three specialist mental health services (eating disorders, dual diagnosis, and forensic) in 18 semi-structured interviews.ResultsThe relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. ‘Clinical’ recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness.

Section 136 of the Mental Health Act: a new literature review

Section 136 of the Mental Health Act 1983 (amended) provides police officers in the United Kingdom with the authority to remove individuals who appear to be suffering from a mental illness from any public place to a designated ‘place of safety’ for appropriate assessment. A considerable amount of research has been dedicated to investigate who is detained under this section and how it is implemented. A review of the literature revealed a high prevalence of schizophrenia, personality disorders and mania in individuals detained under Section 136 and an over-representation of black detainees. Several studies also reported poor communication between different agencies and poor levels of knowledge regarding the implementation of the section. There is a lack of qualitative research exploring detainee and professional experience of Section 136 and in particular the patient pathway to mental health care via Section 136 experienced by black detainees. Implications for clinical practice, multi-agency collaboration and future research are discussed.

‘… and they all lived happily ever after’: ‘recovery’ or discovery of the self in personality disorder?

The concept of [recovery] in mental health has moved a long way from its roots in the survivor movement. Mainstream attempts to provide a [recovery model] for all have been met with concern and dissent from the service user/survivor movement. This is particularly apparent in the context of personality disorder, where [recovery] is a hotly debated issue and full of complexities. Instead of the term [recovery], some people who identify with the issues associated with personality disorder now describe their journey as one of [self-discovey]. This article discusses these issues with particular relevance to: personality disorder and creativity; service user involvement in personality disorder service provision and research into [recovery] and personality disorder.

Producing different analytical narratives, coproducing integrated analytical narrative: a qualitative study of UK detained mental health patient experience involving service user researchers

Involvement of people who use health services as researchers is increasingly widely practised internationally, but methodological enquiry into how involvement impacts on research findings is lacking. A qualitative study of the experiences of people detained under the UK Mental Health Act (1983) used secondary analysis to explore the extent to which mental health service user researchers produced different interpretive narratives to conventional university researchers working on the same research team, and the potential to coproduce integrated analytical narrative to inform service improvement. We found we were able to articulate a range of situated analytical narratives on the detained patient experience and, through negotiating what each narrative meant in relation to the others, to coproduce an integrated analytical narrative that moved beyond what was already known about the detained patient experience. We concluded that research involving mental health service user researchers can coproduce new knowledge that might usefully inform service improvement.

Demographic and referral patterns of people detained under Section 136 of the Mental Health Act (1983) in a south London Mental Health Trust from 2005 to 2008

This study aimed to retrospectively examine demographic and referral data for all detainees under Section 136 of the Mental Health Act (1983) at a ‘place of safety’ in one London Mental Health Trust over a three-year period. Data were collected for 887 consecutive detentions and indicated a clear over-representation of black detainees compared with their representation in the local population. A high proportion of detentions (41.2%) did not result in hospital admission. Implications for practice and service user experience should be considered as long as Section 136 remains an entry point to mental health services for many black people. There are implications for interprofessional practice where Mental Health Trust resources are expended supporting Section 136 detentions in which no hospital treatment follows.

Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study

BackgroundConcepts of recovery increasingly inform the development and delivery of mental health services internationally. In the UK recent policy advocates the application of recovery concepts to the treatment of personality disorders. However diagnosis and understanding of personality disorders remains contested, challenging any assumption that mainstream recovery thinking can be directly translated into personality disorders services.MethodsIn a qualitative interview-based study understandings of recovery were explored in extended, in-depth interviews with six people purposively sampled from a specialist personality disorders’ service in the UK. An interpretive, collaborative approach to research was adopted in which university-, clinical- and service user (consumer) researchers were jointly involved in carrying out interviews and analysing interview data.ResultsFindings suggested that recovery cannot be conceptualised separately from an understanding of the lived experience of personality disorders. This experience was characterised by a complexity of ambiguous, interrelating and conflicting feelings, thoughts and actions as individuals tried to cope with tensions between internally and externally experienced worlds. Our analysis was suggestive of a process of recovering or, for some, discovering a sense of self that can safely coexist in both worlds.ConclusionsWe conclude that key facilitators of recovery – positive personal relationships and wider social interaction – are also where the core vulnerabilities of individuals with lived experience of personaility disorders can lie. There is a role for personality disorders services in providing a safe space in which to develop positive relationships. Through discursive practice within the research team understandings of recovery were co-produced that responded to the lived experience of personality disorders and were of applied relevance to practitioners.

The experiences of detained mental health service users: issues of dignity in care

BackgroundWhen mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored.MethodsThis paper reports on the experiences of 19 adult service users who were, at the time of interview, detained under a Section of the MHA. These service users had experienced coercive interventions and they gave their account of how they considered their dignity to be protected (or not), and their sense of self respected (or not).ResultsThe service users considered their dignity and respect compromised by 1) not being ‘heard’ by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom.ConclusionsDignity and respect are important values in recovery and practitioners need time to engage with service user narratives and to reflect on the ethics of their practice.

Evaluating the Prosper peer-led peer support network: a participatory, coproduced evaluation

Purpose – A range of one-to-one, group and online approaches to peer support are increasingly complementing formal mental health service delivery. Evidence is emerging of the potential benefits and challenges of peer support for individuals, communities and organisations. There is more limited evidence describing peer-led peer support networks. The paper aims to discuss these issues. Design/methodology/approach – In an evaluation of Prosper, a peer-led, peer support network and social movement, members of the network played a participatory role in the design, conduct and interpretative work of the evaluation. An online survey, one-to-one interviews and group discussions were used. Findings – The evaluation describes an evolving network with planning and development meetings constituting core activity for many members alongside a monthly training programme supporting people to set up their own activities. There were strong shared values, and consensus that Prosper could strengthen social networks, improve ...