Location of Repository

The barriers and facilitators of supporting self care in Mental Health NHS Trusts

By Steve Gillard, Victoria Betton, Katherine Green, Barrie Holt, Mike Lucock, Stephen Miller, Virginia Minogue, Lucy Simons, Kati Turner and Sarah White

Abstract

Mental health presents challenges to the concept of self care – mental health services have been especially reluctant to share responsibility with service users, and some service users are reluctant to engage with services that they feel are disempowering. This makes mental health a particularly useful case within which to explore the barriers and facilitators of effective implementation of self care policy. \ud \ud This study integrates qualitative and quantitative methodologies in a two-stage service mapping design together with a cohort study in order to investigate the implementation of self care initiatives in mental health care from a range of stakeholder perspectives. The study will address the following aims and objectives: \ud \ud (1) To identify the main barriers/ facilitators-– organisational, team, user & carer expectations, structures and processes of self care - to effective delivery of self care in NHS mental health organisations (in terms of improved outcomes for users of self care initiatives and their carers); \ud (2) To identify learning about the implementation of self care from the mental health service experience that can be applied to other health service areas. \ud \ud Service user researchers and NHS managers will be integral members of the research team at all stages of the research process, and have been fully involved in the development of this proposal. \ud \ud The initial service mapping phase and cohort study will take place in three NHS Trust areas (Hampshire Partnership NHS Trust, Leeds Mental Health NHS Trust, South West London & St George’s Mental Health NHS Trust) selected as offering geographical and demographic contrast, as well as range of socio-economic and rural/ urban mix. \ud \ud The cohort study, with measures at baseline (referral) and 9 month follow-up, will investigate three self care initiatives (one in each trust area) selected as offering three contrasting interpretations and applications of self care. Participants in the cohort study will be 40 consecutive new referrals to each self care initiative, aged 18-65 and meeting the entry criteria of each initiative. Carers and support workers on the self care initiatives - with sampling centred on the service user sample - will also be interviewed as part of the study. \ud \ud As well as semi-structured interviews collecting qualitative data about expectations and experiences of self care, standard measures of clinical status (CORE-OM), satisfaction, empowerment, quality of life, mental health confidence, locus of control and experience of therapeutic relationship will be made of user participants, experience of care giving of carers, and experience of therapeutic relationship of support workers/ professionals. Concrete indicators of service use (9 months prior to and 9 months post referral) and engagement with the self care initiative will also be measured. \ud \ud A final national service mapping design, using an online, web based approach, will be applied to all 77 mental health Trusts in England (including PCTs that provide mental health services directly). \ud \ud The potential to generalise the findings of this study to people in other health service sectors undertaking self care will be explored firstly by triangulating our findings with existing published change management and self care literature, and secondly by comparison with the findings of SDO funded self care teams working in other areas. The potential to generalise findings to different groups of people with a mental health problem will be considered firstly by accurately describing the sample in each study site, and secondly by between site data comparison and a synthesis of data across sites

Topics: H1
Publisher: National Institute for Health Research
Year: 2010
OAI identifier: oai:eprints.hud.ac.uk:9014

Suggested articles

Preview

Citations

  1. (2007). A New Scale to Assess the Therapeutic Relationship in Community Mental Health Care: STAR. doi
  2. (2003). A systematic approach to practice-based evidence in a psychological therapies service. doi
  3. (2005). Assessing the introduction of the expert patients programme into the NHS: a realistic evaluation of recruitment to a lay-led self care initiative Primary Health Care Research and Development 6(2), doi
  4. (1983). Assessment of patient satisfaction: Development and refinement of a service evaluation questionnaire. Evaluation Program Planning. doi
  5. (2006). between Beck Depression Inventory and CORE-OM scores in routine clinical practice. doi
  6. (2001). Breaking the mould? Innovation as a strategy for corporate renewal. doi
  7. (2006). Concordance, Adherence and Compliance in Medicine Taking Centre for Health Care Research,
  8. (1993). Coping theory and research: past, present and future. doi
  9. for Health and Clinical Excellence (2004b). Management of Anxiety (Panic Disorder, with or without Agoraphobia and Generalised Anxiety Disorder)
  10. (2002). From passive subjects to equal partners: Qualitative review of user involvement in research. doi
  11. (2005). From patients to providers: prospects for self care skills trainers in the National Health Service Health Self Care data No Self Care data Total cases doi
  12. Health. (2005a) Self care – a real choice; self care support – a practical option. HMSO, London Department of Health.
  13. Health. (2006b) From values to action: The Chief Nursing Officer’s review of mental health nursing. TSO Department of Health. (2006b) Supporting People with Long Term Conditions to Self Care: A Guide to Developing Local Strategies and Good Practice.
  14. (2007). Health. (2006c) From values to action: the Chief Nursing Officer’s review of mental health nursing. TSO Department of Health.
  15. Health. (2008a) High quality care for all. NHS next stage final review. Department of Health. doi
  16. (1983). Health. (2008b) http://www.dh.gov.uk/en/SocialCare/Socialcarereform/Personalisation/inde x.htm Department of Health. (2008c) Code of Practice (revised) Mental Health Act
  17. (2002). Matrix Analysis as a Complementary Analytic Strategy in Qualitative Inquiry. Qualitative Health Research. doi
  18. (1996). Qualitative Researching (Sage: London)
  19. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990's. doi
  20. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta analytical review. doi
  21. (2009). Source: Self Care in Mental Health Survey,
  22. (2004). The development of a short instrument to identify common unmet needs in older people in general practice.
  23. (2002). The Rethink Self management Project - Summary of Initial Report. Mental Health Foundation.
  24. (2002). User-led research and evidence based medicine. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.