Steven Gillard

‘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.

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.

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.

Peer Worker Roles and Risk in Mental Health Services: A Qualitative Comparative Case Study

New peer worker roles are being introduced into mental health services internationally. This paper addresses a lack of research exploring issues of risk in relation to the role. In-depth interviews were carried out with 91 peer workers, service users, staff and managers. A grounded analysis revealed protective practice in minimising risk to peer worker well-being that restricted the sharing of lived experience, and a lack of insight into how peer workers might be involved in formal risk management. Alternatively, analysis revealed potential new understandings of risk management based on the distinctive, experiential knowledge that peer workers brought to the role.

Scenarios for the future of mental health care: a social perspective

Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for mental health care in the past, this Personal View addresses what their role might be in the future. We (DG, PH, and SP) did a survey of professional stakeholders and then used a scenario planning technique in an international expert workshop to address this question. The workshop developed four distinct but not mutually exclusive scenarios in which the social aspect is central: mental health care will be patient controlled; it will target peoples social context to improve their mental health; it will become virtual; and access to care will be regulated on the basis of social disadvantage. These scenarios are not intended as fixed depictions of what will happen. They could, however, be useful in guiding further debate, research, and innovation.

The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.

Abstract Background: Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services. Aims: To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services. Method: Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes. Results: Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk. Discussion: In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery. Conclusion: A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.

Explaining health managers’ information-seeking behaviour and use

The aims of the project were to analyse the information behaviour of health service managers in decision-making, to identify the facilitators and barriers to the use of information, and to develop guidelines for improving practice. The study employed a mixed methodology in two phases - five qualitative case studies, and a national survey of managers, and NHS librarians. Managers used a variety of different sources, online, written, people/ networks, and education and training courses. Internet/online sources were very widely used, but personal contacts are more important, and there was also a heavy use of internal Trust data. Only one third found it easy to find information relevant to their work as a manager. They also found it difficult to access information either through lack of time, information overload, or not knowing where to find it. Training in information search was helpful, but those with significant expertise in search and research based sources – librarians and medical staff – reported most difficulty in finding information related to management. However, those who have studied management find it easier, indicating that grounding in management knowledge is important for effective search, selection and application.

Developing and Using Vignettes to Explore the Relationship Between Risk Management Practice and Recovery-Oriented Care in Mental Health Services:

There is a lack of literature evaluating the development and use of vignettes to explore contested constructs in qualitative health care research where a conventional interview schedule might impose assumptions on the data collected. We describe the development and validation of vignettes in a study exploring mental health worker and service user understandings of risk and recovery in U.K. mental health services. Focus groups with mental health workers and service users explored study questions from experiential perspectives. Themes identified in the groups were combined with existing empirical literature to develop a set of vignettes. Feedback focus groups were conducted to validate and amend the vignettes. Following use in research interviews, results suggested that the vignettes had successfully elicited data on issues of risk and recovery in mental health services. Further research using creative, comparative methods is needed to fully understand how vignettes can best be used in qualitative health care research.

Patient and public involvement and the implementation of research into practice.

Purpose Patient and public involvement (PPI) is increasingly central to the delivery of health services research. However, it has proved challenging to evaluate the impact of PPI on the implementation of research into clinical practice and health service delivery. The purpose of this paper is to develop and test a conceptual model explaining how PPI in the research process might impact on implementation. Design/methodology/approach A scoping review of knowledge translation and implementation science literature was performed to develop a conceptual model of the impact of PPI in research on implementation. A retrospective case study of a research project was used to illustrate the model. Findings The authors identified five domains in which PPI can impact on the implementation of research into practice. The review demonstrated that successful implementation depends on developing relational models of knowledge production, valuing experiential knowledge, engaging in collaborative practice, making use of knowledge brokers or tools for knowledge facilitation and embedding these factors into the implementation context. In the case study the authors were able to find examples that illustrated each of the five domains of the model. Originality/value The paper builds on existing endeavour to evaluate the impact of PPI in research, demonstrating that it is possible to model, conceptually, the processes whereby PPI in research might impact on practice and service delivery. By illustrating those processes through the exemplar case the authors also demonstrate the potential for the model to be “operationalised”, allowing the impacts, on practice, of PPI in research to be systematically and directly evidenced.