The Elephant in the Room: A Theoretical Examination of Power for Shared Decision Making in Psychiatric Medication Management.

Shared decision making (SDM) is an important tool for recovery-oriented practice in mental health services. It has been defined using narrow and broad conceptualizations. One overarching theme that merges the differing models is the emphasis on a rebalancing of power, with experiential knowledge holding equal weight in the encounter, alongside more traditional “medical” forms of knowledge. Nevertheless, the concept of power and how it is enacted and shared has received relatively little attention in the wider SDM literature. Yet, it is fundamental both to the principles and models of SDM more generally and to the recovery model within mental health services more specifically. This article explores the theoretical concept of power in the context of SDM for psychiatric medication management practice. It highlights the diverse structural components of the U.K. contemporary mental health system, their intersections, and the resultant opportunities for persons to take back control and enact their agency

South Essex Recovery College Evaluation

This report covers an evaluation that took place between March 2014 and March 2015, of the South Essex Recovery College (SERC). The programme follows an adult education model that aims to deliver open, peer led recovery workshops and courses. If was set up with the primary goal to encourage people with mental health conditions to become students, enabling them to better understand their own challenges, and how they can best manage these in order to purse their aspirations. It facilitates the learning of skills that promote greater self-confidence and recovery. SERC, endeavoured to design and develop a college that embraced the values of recovery colleges elsewhere, notably in encouraging that people become experts in their own self-care, and prioritising lived experience at all stages and levels in its development. A broad evaluation framework using a mixed-methods process and outcome-oriented approach was adopted. Data was collected in a number of ways: structured self-completion questionnaires, written feedback about the programme from participants, focus groups, and follow up interviews with peer facilitators. Findings are presented against four key areas: 1) The overall management and structure of the pilot program, its organisation and growth. SERC, after a long and delayed pilot program, offers three courses, over 6 deliveries (3 x Introduction to Recovery; 2 x Taking Back Control; and 1 x Be You). It has met six of its set objectives, and compares poorly to other exemplar recovery college pilots elsewhere in the country. Areas where the recovery college showed poor performance against its set objectives was in the growth and promotion of the college, development of new courses, and volunteer recruitment. 2) The experiences of participating in the programme (process). Findings across both questionnaires and discussion as part of the focus groups demonstrate that the experience of attending the Recovery College was overwhelmingly positive, for most. Importantly, the courses offered participants tools and new skills and hope for the future, a sense of belonging, a way to meet others and make friendships. This was very important for overcoming anxieties associated with starting the course. Participants wanted a dedicated space to grow the college further, and enhance the sense of community that the college afforded. 3) Changes over time following participation (outcomes). The Questionnaire about the Process of Recovery (QPR, O’Neil et al, 2008) was used to measure a change in recovery outcomes before and after course attendance. No significant difference between QPR responses before course attendance (3.22, SD= .56) and after the course (3.45, SD=.57), t(17)= -1.694, p>.05 was found. Other bespoke questions were included to explore the student’s perceptions of how attending the course affected aspects of their personal recovery. Across all courses, 61% of students reported feeling more hopeful for the future because of attending the course. 4) The impact of peer trainers and co-production on the process and outcomes. Having peer facilitators, who themselves have experience of mental health problems, was seen as very important. Participants across both focus groups highlighted that the use of peer facilitators was a particularly helpful aspect of the course, offering increased hope for the future and feelings of being able to give back, following the course. Peer facilitators reflected on how the change in identity from student to peer facilitator was challenging, and further support and training was needed. However it was also seen as a personal achievement, rewarding and had increased personal confidence Six recommendations are provided to guide further development of the college, and act as a benchmark to measure further development and the future success of SERC

Attitudes towards shared decision making in mental health: A qualitative synthesis

Purpose: Shared decision making (SDM) prioritises joint deliberation between practitioner and service user, and a respect for service-users’ experiential knowledge, values and preferences. The purpose of this paper is to review the existing literature pertaining to key stakeholders’ attitudes towards SDM in mental health. It examines whether perceived barriers and facilitators differ by group (e.g. service user, psychiatrist, nurse and social worker) and includes views of what facilitates and hinders the process for service users and practitioners. Design/methodology/approach: This review adopts the principles of a qualitative research synthesis. A key word search of research published between 1990 and 2016 was undertaken. Qualitative, quantitative and mixed methods studies were included. Findings: In total, 43 papers were included and several themes identified for service user and practitioner perspectives. Both practitioners and service users see SDM as an ethical imperative, and both groups highlight the need to be flexible in implementing SDM, suggesting it is context dependent. A range of challenges and barriers are presented by both practitioners and service users reflecting complex contextual and cultural features within which interactions in mental health take place. There were qualitative differences in what service users and practitioners describe as preventing or enabling SDM. The differences highlighted point towards different challenges and priorities in SDM for service users and practitioners. Originality/value: The presentation of nuanced views and attitudes that practitioners and service users hold represent an important and under reported area and offer insight into the reasons for the gap between idealised policy and actual practice of SDM in mental health settings

Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions

Corrigendum: Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views

© 2022 Kaminskiy, Zisman-Ilani, Morant and Ramon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).[This corrects the article DOI: 10.3389/fpsyt.2021.678005.].Peer reviewedFinal Published versio

Individual and family experiences of loss after acquired brain injury: A multi-method investigation

After a person experiences an acquired brain injury (ABI), there can be grieving for what has been lost. Little is known about the loss felt by relatives of people with ABI. This study investigates concepts of loss among individuals with ABI and their families. Forty participants, recruited from a brain injury charity client pool, took part in a semi-structured interview. Of the participants, 17 were in dyadic relationships (53% spouses, 41% parent/child and 6% sibling relationships). They also completed the Brain Injury Grief Inventory (BIGI; Coetzer, B. R., Vaughan, F. L., & Ruddle, J. A. (2003). The Brain Injury Grief Inventory. Unpublished Manuscript. North Wales Brain Injury Service, Conwy & Denbighshire NHS Trust) as a quantitative measure of loss after ABI. Five main themes emerged from the interviews: loss of person; loss of relationships; loss of activity/ability; loss of future; unclear loss. There were distinct differences qualitatively between individuals and relatives and only two dyads experienced similar loss, but there were no significant differences in loss as measured quantitatively by the BIGI. The differences between relatives’ loss and individuals with ABIs’ loss are discussed. This research suggests that it is important when supporting families to consider individual experiences, because even though the loss originates from the same injury, the loss as experienced may substantially differ among those affected by it

Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.</jats:p

PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare.

Reducing physical intervention in mental health inpatient care is a global priority. It is extremely distressing both to patients and staff. PROactive Management of Integrated Services and Environments (PROMISE) was developed within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) to bring about culture change to decrease coercion in care. This study evaluates the changes in physical intervention numbers and patient experience metrics and proposes an easy-to-adopt and adapt governance framework for complex interventions. PROMISE was based on three core values of: providing a caring response to all distress; courage to challenge the status quo; and coproduction of novel solutions. It sought to transform daily front-line interactions related to risk-based restrictive practice that often leads to physical interventions. PROactive Governance of Recovery Settings and Services, a five-step governance framework (Report, Reflect, Review, Rethink and Refresh), was developed in an iterative and organic fashion to oversee the improvement journey and effectively translate information into knowledge, learning and actions. Overall physical interventions reduced from 328 to 241and210 across consecutive years (2014, 2015-2016 and 2016-2017, respectively). Indeed, the 2016-2017 total would have been further reduced to 126 were it not for the perceived substantial care needs of one patient. Prone restraints reduced from 82 to 32 (2015-2016 and 2016-2017, respectively). During 2016-2017, each ward had a continuous 3-month period of no restraints and 4 months without prone restrains. Patient experience surveys (n=4591) for 2014-2017 rated overall satisfaction with care at 87%. CPFT reported fewer physical interventions and maintained high patient experience scores when using a five-pronged governance approach. It has a summative function to define where a team or an organisation is relative to goals and is formative in setting up the next steps relating to action, learning and future planning.NIHR CLAHR

Codesigning a systemic discharge intervention for inpatient mental health settings (MINDS): a protocol for integrating realist evaluation and an engineering-based systems approach

© 2023 The Author(s). Published by BMJ. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Introduction: Transition following discharge from mental health hospital is high risk in terms of relapse, readmission and suicide. Discharge planning supports transition and reduces risk. It is a complex activity involving interacting systemic elements. The codesigning a systemic discharge intervention for inpatient mental health settings (MINDS) study aims to improve the process for people being discharged, their carers/supporters and staff who work in mental health services, by understanding, co-designing and evaluating implementation of a systemic approach to discharge planning. Methods and analysis: The MINDS study integrates realist research and an engineering-informed systems approach across three stages. Stage 1 applies realist review and evaluation using a systems approach to develop programme theories of discharge planning. Stage 2 uses an Engineering Better Care framework to codesign a novel systemic discharge intervention, which will be subjected to process and economic evaluation in stage 3. The programme theories and resulting care planning approach will be refined throughout the study ready for a future clinical trial. MINDS is co-led by an expert by experience, with researchers with lived experience co-leading each stage. Ethics and dissemination: MINDS stage 1 has received ethical approval from Yorkshire & The Humber—Bradford Leeds (Research Ethics Committee (22/YH/0122). Findings from MINDS will be disseminated via high-impact journal publications and conference presentations, including those with service user and mental health professional audiences. We will establish routes to engage with public and service user communities and National Health Service professionals including blogs, podcasts and short videos. Trial registration number: MINDS is funded by the National Institute of Health Research (NIHR 133013) https://fundingawards.nihr.ac.uk/award/NIHR133013. The realist review protocol is registered on PROSPERO. PROSPERO registration number: CRD42021293255.Peer reviewe