Coordinating mental health care

Hot on the heels of the publication of this paper from COCAPP, I’ve had two opportunities in recent weeks to present the content to (very select) groups, first at City, University of London and then at the South Wales Mental Health Nursing Journal Club and Seminar Group. Because I can, I thought to share the slides: so here they are, for anyone interested:

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Plan4Recovery

Here’s a post introducing the main findings paper from the Plan4Recovery study, led by Michael Coffey and funded through a Health and Social Care Wales Social Care Research Award.

Plan4Recovery used qualitative and quantitative methods to investigate the relationships between recovery, quality of life, social support and shared decision-making amongst people using social care services in Wales. The project team included mental health researchers with practitioner backgrounds, experience of using services, and of mixed methods studies. The paper, published in the journal Social Psychiatry and Psychiatric Epidemiology, is in gold open access form which makes it free to download.

For a shortcut, here’s the abstract:

Purpose

Mental health care is a complex system that includes social care organisations providing support for people with continuing needs. The relationship over time between decisional conflict, social support, quality of life and recovery outcomes across two time periods for people experiencing mental health problems in receipt of social care was investigated.

Methods

This is a mixed methods study comprised of a quantitative survey at two time points using measures of decisional conflict, social support, recovery and quality of life in a random sample (n = 122) using social care services in Wales, UK. In addition, 16 qualitative case studies were developed from data collected from individuals, a supportive other and a care worker (n = 41) to investigate trajectories of care. Survey responses were statistically analysed using SPSS and case study data were thematically analysed.

Results

Participants reported increasing decisional conflict and decreasing social support, recovery and quality of life over the two time points. Linear regression indicated that higher recovery scores predict better quality of life ratings and as ratings for social support decline this is associated with lower quality of life. Correlational analysis indicated that lower decisional conflict is associated with higher quality of life. Thematic analysis indicated that ‘connectedness and recovery’ is a product of ‘navigating the system of care’ and the experience of ‘choice and involvement’ achieved by individuals seeking help.

Conclusions

These results indicate that quality of life for people experiencing mental health difficulties is positively associated with social support and recovery and negatively associated with decisional delay.

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Observations from a small country

IMGP3076Here are two digital mementos from my trip to Australia: a photograph of a humpback whale (which breached and swam under the boat I was on for a good 45 minutes), and – more pertinently, perhaps, given the usual subject matter of this blog – the slides I used in my keynote talk at #ACMHN2018. This was the conference of the Australian College of Mental Health Nurses, held in Cairns in October 2018, and from which I have now returned home. My talk was all about mental health policy, services and nursing in Wales: which means this may actually be the only time I ever get to write about both ‘Wales’ and ‘whales’ in the same post.

Here are the slides, the material for which I’m also aiming write up as a paper:

 

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#ACMHN2018

Big thanks to the Board of Directors of the Australian College of Mental Health Nurses (ACMHN) for inviting me to speak at the 44th International Mental Health Nursing Conference, or #ACMHN2018, which took place in Cairns between 24th-26th October 2018. Never having been to Australia before, and indeed having never before left Europe, this was a big deal and I was grateful for the opportunity.

The theme for the conference was ‘mental health as a human right’, and the three days opened with a memorable welcome to country given by Yidinji tribal elder Henrietta Marrie followed by music and dance. Keynote speakers reflected well the conference theme in their talks, variously focusing on tackling health inequalities (including amongst Aboriginal people), suicide prevention in LGBQTI communities, rural mental health, human rights progress in Ireland (and more). Concurrent presentations were also very high-quality. Worth noting, too, is how the ACMHN used its conference to raise awareness of its campaign, being run in concert with other health care organisations, to demand that children and families seeking asylum and currently being held on the island of Nauru be brought to Australia.

In my keynote I elected to speak about mental health policy, services and nursing in Wales and made the point that the Welsh approach to health care is different from that found elsewhere in the UK, or in other parts of the world. To illustrate this I spoke about the Mental Health (Wales) Measure, the introduction of both future generations and safe staffing legislation and the imminent appearance of a Framework for Mental Health Nursing prepared through the All Wales Senior Nurse Advisory Group for Mental Health.

I realise that in the UK we have nothing quite like the ACMHN: a professional organisation comprised of subscribing members, which represents its field, acts as a credentialing body (nursing education in Australia being a generalist one) and which lobbies for better services and higher standards. The College has a Board and an elected president, the current incumbent being Eimear Muir-Cochrane, and employs a team including Kim Ryan as salaried chief executive officer. The ACMHN performs no trade union function (like the RCN, Unite the Union, and Unison in the UK), and does not register or regulate nurses (as the NMC does). Australia looks to have a number of colleges and associations organised along the same lines as the ACMHN, and I’ve found this site which lists bodies advancing practice and representing members in the fields of critical care, midwifery, children and young people’s nursing, and more.

#ACMHN2018 was an excellent experience, and I was pleased to meet roomfuls of fine and interesting people. For the record, #ACMHN2019 takes place in Sydney between 8th-10th October 2019, with the theme of ‘integrated care’.

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#MHNR2018 and #ACMHN2018

mosiEarlier this month I made the journey to the Science and Industry Museum in Manchester for the 24th International Mental Health Nursing Research Conference (#MHNR2018). Here’s a snip from the short piece which appeared on the Mental Health Nurse Academics UK (MHNAUK) website:

This is MHNAUK’s conference, run annually in conjunction with the RCN and with support from André Tomlin (The Mental Elf) who used social media to bring the event beyond the room.

Keynote speakers were: Dr Eleanor Longden, who talked about voice-hearing as a complex and significant experience; Professor Sonia Johnson, who spoke about the need to improve lives through improved psychosocial interventions; Professor Alan Simpson, who delivered the second annual MHNAUK lecture with a call for mental health nurses to speak up and assert their value; Professor Sir Robin Murray who spoke about biopsychosocial approaches to understanding, and treating, psychosis; and Dr Jonathan Gadsby who talked about the Critical Mental Health Nurses’ Network and invited delegates to join a discussion on conscientious objection. Concurrent sessions and symposia were packed and lively, and discussions and debates at the venue were mirrored by conference-related discussions taking place online. Podcasts with Robin Murray, Sonia Johnson, Alan Simpson and Laoise Renwick (who chaired the #MHNR2018 conference committee) can be found here on Soundcloud.

Also announced at the conference was news of Professor Mick McKeown as Skellern Lecturer for 2019, and Professor Patrick Callaghan as recipient of the Journal of Psychiatric and Mental Health Nursing Lifetime Achievement Award. Congratulations to both from all in MHNAUK, and we look forward to hearing their addresses at Kingston St George’s, London, on 13th June 2019.

#MHNR2018 closed with a date for the diary: the 25th International Mental Health Nursing Research Conference will take place on 12th-13th September 2019 at the RCN headquarters in London. More details about #MHNR2019 will be posted in due course.

This was an excellent two days, and I reflect on how far the conference showcased variety in perspectives and positions. Now, with John Baker having served a four year term as a member of the conference organising committee, expressions of interest are being sought (through MHNAUK) for an experienced mental health nurse academic to take his place. Planning for #MHNR2019 will begin in earnest towards the end of this year or early next, though as the post reproduced above states we already have our dates and venue confirmed.

Whilst we’re on the subject of conferences: earlier this year I received an invitation from Kim Ryan and the Board of Directors of the Australian College of Mental Health Nurses to speak at the 44th International Mental Health Nursing Conference. This takes place next month, in Cairns, and I’m currently in the process of writing (and rewriting) what I’m going to say. The subtitle to my talk is, ‘observations from a small country’, and I’m going to talk about the distinctiveness of mental health services and nursing in Wales and what can be learned from this. Perhaps when I’m done, and the conference has closed, I’ll post a full set of my slides here to this site.

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Care coordination as imagined, care coordination as done

IJIC aIn July 2018, in the context of writing about the COCAPP team’s newly published meta-narrative review of care planning and coordination in community mental health, I mentioned a further article which had just been accepted for publication. Today this paper has appeared online in the International Journal of Integrated Care. As with all outputs from the COCAPP study this new article is available in gold open access form, meaning that copies can be read and downloaded by anyone with an internet connection.

The paper is titled Care coordination as imagined, care coordination as done: findings from a cross-national mental health systems study. For a taster, here’s the abstract:

Introduction: Care coordination is intended to ensure needs are met and integrated services are provided. Formalised processes for the coordination of mental health care arrived in the UK with the introduction of the care programme approach in the early 1990s. Since then the care coordinator role has become a central one within mental health systems.
Theory and methods: This paper contrasts care coordination as work that is imagined with care coordination as work that is done. This is achieved via a critical review of policy followed by a qualitative analysis of interviews, focusing on day-to-day work, conducted with 28 care coordinators employed in four NHS organisations in England and two in Wales.
Findings: Care coordination is imagined as a vehicle for the provision of collaborative, recovery-focused, care. Those who practise care coordination are concerned with the quality of their relationships with service users and the tailoring of services, but limits exist to collaboration and open discussion. Care coordinators describe doing necessary work connecting people and the system of care. However, this work also brings significant administrative demands, is subject to performance management which distorts its primary purpose, and in a context of scarce resources promotes generic professional roles.
Conclusion: Care coordination must be done. However, it is not consistently being done in the way policymakers imagine, and in the real world of work can be done differently.

 

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Meta-narrative review

PLoSOneAs promised, here’s a post about a new paper from COCAPP, published last month in gold open access form in the journal PLOS ONE. Led by Aled Jones, this reports on our meta-narrative review of research into care planning and coordination in community mental health care. Meta-narrative reviews are a relatively new approach to literature reviewing, and aim to track the (potentially diverse) traditions of research found in a given field. Guidance on their production can be found here.

For those interested, here’s this new article’s abstract:

Context

In response to political and social factors over the last sixty years mental health systems internationally have endeavoured to transfer the delivery of care from hospitals into community settings. As a result, there has been increased emphasis on the need for better quality care planning and care coordination between hospital services, community services and patients and their informal carers. The aim of this systematic review of international research is to explore which interventions have proved more or less effective in promoting personalized, recovery oriented care planning and coordination for community mental health service users.

Methods

A systematic meta-narrative review of research from 1990 to the present was undertaken. From an initial return of 3940 papers a total of 50 research articles fulfilled the inclusion criteria, including research from the UK, Australia and the USA.

Findings

Three research traditions are identified consisting of (a) research that evaluates the effects of government policies on the organization, management and delivery of services; (b) evaluations of attempts to improve organizational and service delivery efficiency; (c) service-users and carers experiences of community mental health care coordination and planning and their involvement in research. The review found no seminal papers in terms of high citation rates, or papers that were consistently cited over time. The traditions of research in this topic area have formed reactively in response to frequent and often unpredictable policy changes, rather than proactively as a result of intrinsic academic or intellectual activity. This may explain the absence of seminal literature within the subject field. As a result, the research tradition within this specific area of mental health service delivery has a relatively short history, with no one dominant researcher or researchers, tradition or seminal studies amongst or across the three traditions identified.

Conclusions

The research findings reviewed suggests a gap has existed internationally over several decades between policy aspirations and service level interventions aimed at improving personalised care planning and coordination and the realities of everyday practices and experiences of service users and carers. Substantial barriers to involvement are created through poor information exchange and insufficient opportunities for care negotiation.

It’s taken far longer than it should have done to get this paper into print. PLOS ONE’s peer review and editorial processes moved at glacial pace, and we’ve agreed as a team not to submit to this journal again. As it happens, this week another COCAPP paper completed its journey through peer review, and has been accepted for publication in the  International Journal of Integrated Care. This has been a much better managed publishing experience, and once this article – which reports on what care coordinators do when they coordinate care – appears online I’ll post something here about it.

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