Patient profiles of service users with complex mental health needs: an indepth case notes analysis

Cheshire and Wirral Partnership NHS Foundation Trust (CWP) provide a wide range of community and inpatient, physical, all-age disability, and mental health care services. The Trust also provide care to a specific cohort of patients who have been defined as having complex mental health needs. This is a broad term used to describe patients who currently receive a package of care commissioned by NHS Cheshire CCG either in an inpatient or community setting, as well as new referrals into the NHS continuing healthcare service who are eligible for NHS funding. This includes patients who are detained under Section 17 of the Mental Health Act or Section 117 aftercare, or who are out of scope, have learning disabilities, are children, those living with dementia who do not have complex, or specialist needs, those with acquired brain injuries and those with physical disabilities. Mental health services for adults, as they are currently configured, have been designed to provide predominantly community-based interventions. It has long been recognised that patients with complex mental health needs cannot be adequately supported within standard service delivery models, resulting in a pressing need to consider the best models for this group of people. There is a paucity of information on the experiences of the service users themselves, particularly of those with complex presentations. The present study aimed to develop a profile of service users with complex mental health needs and provide a detailed exploration of their clinical histories

Patient Journey of Service Users with Complex Mental Health Needs: A Qualitative Study

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Perspectives of service users and carers with lived experience of a diagnosis of personality disorder: a qualitative study

Introduction: Understanding personality disorder (PD) within a population of people with complex mental health (CMH) needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high-quality care. Aim: To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out-of-area placements. Method: Semi-structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. Results: Four inter-related themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual, and Training and Knowledge of people with a diagnosis of PD. Discussion: Anti-stigma interventions for staff, research on care provision and structural changes to services including more evidence-based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. Implications for Practice: This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all health care practitioners to improve patient outcomes

The journey of service users with complex mental health needs: a qualitative study

Background: This study aimed to provide a robust picture of the journey of service users with complex mental health needs by evaluating the perspectives of service users and carers with lived experience of services and gaining clinician views about decision making in relation to this cohort. Methods: A qualitative design was used. Service users (n = 11), carers (n = 10) and clinicians (n = 18) took part in semi-structured interviews, which were transcribed verbatim and analysed using thematic analysis. Results: The following themes were identified by participants: ‘relationships with staff,’ ‘treatment options, pathways and availability,’ ‘the role of autonomy in recovery,’ ‘impact of out-of-area placements,’ and ‘specialist training for staff.’ The findings demonstrated that the journey of serviceusers can be impacted by a wide range of factors, including relationships with staff, the nature of support offered, community response, financial constraints, and organisational goals around bed pressures. Conclusions: Recommendations include the need for staff to work in partnership with service users and carers, foster autonomy, access specialised suicide prevention training, and agree discharge and contingency plans with service users. Further work is needed to deliver the best possible experience for individuals with complex mental health needs and those who care for them