Time this morning for a quick post drawing attention to this new paper published in Research Involvement and Engagement reporting on our use of the nominal group technique in the now-completed RiSC study.
In this project we were interested in risk, broadly defined, for young people in inpatient mental health settings. We used a two-stage evidence synthesis, convening a stakeholder group midway through to guide us in our focus. This new article gives the detail on the process we used when the group met.
As it happens, the stakeholder meeting was a pivotal event in the life of this study, during which we were directed to find evidence on a whole range of risks which are very rarely considered in mental health services. Examples include the risks of losing contact with education, family and friends. The next step in this programme of research is a KESS2 PhD studentship which will bring to the surface all the things that child and adolescent mental health practitioners do to help young people in hospital to keep in touch. In the meantime, anyone wanting to know more about the RiSC study (should their appetite have been whetted following a read of this new article) might want to follow this link for our main findings paper and this link for our accessible summary.
Over the last year or two I’ve used this blog to publicise information about the RiSC study, an evidence synthesis into ‘risk’ for young people in mental health hospital. We’ve now produced an accessible summary, outlining what we did in this project and what we found. For a copy, click the front cover of the summary reproduced below:
This week our full report from the RiSC study, An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services, has been published in Health Services and Delivery Research. This is in gold open access form, and is free to download and read.
Here’s our plain English summary:
In our two-part study we brought together evidence in the area of risk for young people admitted to mental health hospital. First, we searched two electronic databases, finding 124 articles. Most were concerned with clinical risks, such as the risks of suicide. Using diagrams we grouped these articles together under a number of themes.
Young people who had been inpatients in mental health hospital, carers, managers and professionals helped us prioritise the types of risk we should concentrate on in the second part of our study. Our top two priorities were the risks of dislocation and contagion. We used the word ‘dislocation’ to refer to the risks of being removed from normal life, of experiencing challenges to identity and of being stigmatised. We used it to refer to the risks to friendships and families, and to education. We used ‘contagion’ to refer to the risks of learning unhelpful behaviour and making unhelpful friendships.
We searched 17 databases and a large number of websites for evidence in these areas. We asked hospital staff to send us information on how they managed these risks and we searched journals and reference lists. We identified 40 items to include in our review and 20 policy and guidance documents. The quality of the studies varied. We grouped the evidence together under seven categories.
We found little evidence to guide practice. The risks of dislocation and contagion are important, but research is needed to inform how staff might identify, assess and manage them.
This has been an excellent project to work on: a great team, and some good engagement with young people and others with a shared interest in what we’ve been up to. Next up is an accessible summary, and some writing of articles. More to follow!
Here in Wales we have the Mental Health Measure. This is a piece of legislation passed in 2010 and implemented in phases in 2012, and which is intended to improve the quality and timeliness of mental health services. Specifically, it provides for:
- primary mental health care;
- care and treatment planning and care coordination;
- the right for an automatic reassessment of needs in secondary mental health services for people discharged within the previous three years;
- advocacy in hospital.
This month the National Assembly for Wales Health and Social Care Committee has reported on its post-legislative scrutiny of the Measure. The Welsh Government has already committed to conduct a formal evaluation of the legislation through a duty to review, built in as the Measure passed into law. In pursuit of this an inception and an interim report have already appeared, with a final document due in 2016. With the Health and Social Care Committee’s report appearing this month it is clear that the Mental Health Measure is becoming seriously scrutinised.
When the Committee published its call for evidence last year the COCAPP research team submitted a response alerting Assembly Members to our ongoing study. It would have been ideal had we been able to report key findings, given that COCAPP is an examination of care planning and care coordination and is, therefore, of interest to anyone wanting to know how part 2 of the Measure (dealing with care and treatment planning) is being experienced. But the Health and Social Care Committee’s timescales and those of COCAPP were not aligned, meaning the best we could do was to draw attention to our project.
This month the Committee praises many aspects of the Measure but also makes ten recommendations. They address:
- meeting demands for primary mental health care, particularly in the case of children and young people;
- improving the collection of data to better support the evaluation of primary mental health services;
- taking action to improve the form, content and quality of care and treatment plans, with a view to increasing service user involvement and spreading best practice through training;
- making sure that rights to self-refer for reassessment are properly understood and communicated to all;
- improving staff awareness of service users’ eligibility for independent mental health advocacy in hospital;
- setting timescales for new task and finish groups reviewing the Measure, and setting out plans to respond to their recommendations;
- during evaluations of the legislation, consulting with as wide a range of people as possible using traditional and novel approaches;
- ensuring that information is available in a variety of formats, so that all groups of people are able to access this and to understand;
- following the publishing of new plans for the improvement of child and adolescent mental health services, making clear how these will be realised;
- carrying out a cost benefit analysis of the Measure.
Clearly, Assembly Members have detected evidence of an uneven pace in the development of primary mental health care across Wales, and are particularly concerned to make sure that the mental health needs of children and young people are properly identified and met in timely fashion. As a COCAPP-er, I am interested to read that the Committee thinks care and treatment planning for everyone can be improved, informed by examples of best practice and through investment in staff training. I also pick out the recommendations on improving service user collaboration, and estimating the costs and benefits of the Measure. These resonate, to me, with current concerns in Wales with prudent health care and co-production.
And as for COCAPP’s findings? Suffice to say our draft final report is now under review with the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme. More to follow in due course…
Yesterday brought a there-and-back trip to Southampton, with esteemed colleagues Nicola Evans and Deborah Edwards, for an NIHR Health Services and Delivery Research Programme welcome meeting for our RiSC project. This was an opportunity to meet with other funded researchers (and very interesting they were, too) and to learn more about how the HS&DR Programme works with investigators over the lifetime of projects and beyond. We also had the chance to present our study, and to field questions from the floor.
On its website the HS&DR Programme says that it:
aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS including research on implementation and a range of knowledge mobilisation initiatives. It will be keen to support ambitious evaluative research to improve health services.
And that it:
aims to support a range of types of research including evidence synthesis and primary research. This includes large scale studies of national importance. This means primary research projects which:
- Address an issue of major strategic importance to the NHS, with the cost in line with the significance of the problem to be investigated
- Are likely to lead to changes in practice that will have a significant impact on a large number of patients across the UK
- Aim to fill a clear ‘evidence gap’, and are likely to generate new knowledge of direct relevance to the NHS
- Have the potential for findings to be applied to other conditions or situations outside the immediate area of research
- Bring together a team with strong expertise and track record across the full range of relevant disciplines
- Will be carried out across more than one research site.
A search through the programme’s portfolio of projects turns up a raft of studies of national and international significance, including work (ongoing and completed) led by or involving nurses. Well worth a look, in my view…