In 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.
As 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:
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.
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.
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.
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.
Today I’ve been at this year’s meeting of the International Mental Health Nursing Research Conference scientific committee. This convened at the Royal College of Nursing headquarters in London. We had a good range of abstract submissions to deliberate over, and people can expect emails soon informing them of our decisions. We’re also pleased to have been able to identify our annual Mental Health Nurse Academics UK Lecturer for 2018. I dare not make an announcement on this front in this post, and shall wait for official communications to be made first.
Hopefully #MHNR2018, which takes place in Manchester in the middle of September, will be a lively and well-attended affair. There is, it has to be said, space for the conference committee to receive and deliberate over a larger number of conference abstracts than it did today. For #MHNR2019, my early request is: spread the word, and get writing. And for #MHNR2018, for people who missed the abstract submission date: do consider, if possible, participating as a delegate anyway.
Elsewhere, having been stuck in the PLOSONE editorial and peer review system for a spectacularly long period, this week’s good news on the mental health research front includes the acceptance for publication of a paper reporting the COCAPP metanarrative review of care planning and coordination. This has been lead authored by Aled Jones, and once it becomes available in the public domain I’ll post a link. Also accepted for publication this week is a paper lead authored by Jane Davies, derived from her PhD which I supported as a supervisor with Danny Kelly. Jane’s study was an investigation into choice and control in young people with cancer, and this article accepted by the European Journal of Oncology Nursingreports some of Jane’s main findings.
Talking of publications, later this week I head into a meeting of the Cardiff University Press editorial board. Up to now I haven’t written much on this site about the Press, which has been around since 2014 and supports journal publishing in diamond open access form. The Press is in the process of extending into monograph publishing, too, having struck an agreement with Ubiquity. For people looking to move their existing journal titles, or to found new ones, the Press is a good place to go and information on opportunities of this type can be found here.
In previous posts (see here and here) I’ve written about Mohammad Marie’s PhD, which investigated resilience in Palestinian community mental health nurses. A fourth paper derived from this study has just been assigned to the January 2018 issue of the journal Health. This is a review of literature, and addresses (amongst other things) the connections between resilience and the idea of ‘Samud’. By following this link a gold open access version of the paper can be downloaded for free.
On November 6th 2017 the School of Healthcare Sciences welcomed Alan Simpson from City, University of London to give a talk titled, Full-steam ahead or treading carefully? Reflections on public and patient involvement in health services research.
In warm and engaging style Alan drew on a whole programme of mental health research (including the City 128 study, Safewards, COCAPP, COCAPP-A and ENRICH) to share his experiences of involving service users at every step. Alan began with an exploration of the reasons for involving patients and the public in research, and drew on his case studies to provide examples of different methods and approaches in action. He closed with lessons learned, emphasising the importance of time, resources, flexibility, training and support, and having funds to pay people for their time and expertise.
This afternoon, seeking a break from a concentrated effort working with COCAPP data with the aim of saying something useful about how and why care coordinators coordinate care, I drifted into a Health and Care Research Wales chat on public involvement in research. One of the hashtags being used for this discussion was #WhyWeDoResearch. This initiative now has its own website, which can be found here. In the context of health care, the #WhyWeDoResearch campaign exists:
to raise research awareness and opportunities to staff, patients and the public, and to start a conversation about research between all involved.
A cause worth supporting. And, to nudge the effort along, here is a short video launched today by Health and Care Research Wales explaining what research is:
Mental Health Awareness Week 2017 has the theme of ‘surviving or thriving’, this also being the title of a new report from the Mental Health Foundation. Included in this document is a summary of research completed by NatCen, on behalf of the Mental Health Foundation, into the prevalence of mental health problems across the population and into the activities that people do to manage these.
Here’s a snip from the report, summarising the self-reported difficulties experienced by the 2,290 people who took part:
Using their NatCen data the Mental Health Foundation goes on to highlight major health inequalities. Almost three quarters of those on the lowest household income report experience of mental health difficulties, compared to six in ten of the wealthiest. A large majority of unemployed people responding reported experience of mental health problems, with women and younger people also particularly affected.
These findings are broadly in line with those reported in the most recent Mental Health and Wellbeing in England Adult Psychiatric Morbidity Survey, the data for which was collected in 2014. This is the latest in a series of studies dating back to 1993, involving (in the 2014 iteration) a sample of some 7,500 people. In the case of Surviving or thriving, the new (to me, at any rate) detail is the reporting of what actions people take to help themselves with their difficulties. Here’s another snip:
Family and friends, outdoor physical activity and hobbies look to be the three most-used strategies. I can’t say I’m surprised by this, and am reminded of the value placed in relationships with others by people taking part in COCAPP.
Elsewhere during Mental Health Awareness Week, The Guardian has published a number of pieces including this one on the shortage of mental health nurses and this one on Hafal‘s Gellinudd Recovery Centre (about which I previously blogged here). Coincidentally, this is also the month that the full and final report from COCAPP-A has been accepted for publication: well done Alan Simpson for leading this work. This mighty tome, reporting from our cross-national study into care planning and coordination in acute mental health inpatient settings, has now proceeded to the production arm of the NIHR and is scheduled to appear in gold open access form towards the end of the year. In the meantime, work is progressing to produce papers for journals. More on these to follow in due course.
Last month I had the opportunity to visit Gellinudd, the soon-to-be-opened recovery centre in Pontardawe run by the Welsh mental health charity Hafal. I was there with my Cardiff colleague Aled Jones, but also with Shu-Jen Chen (a former PhD student of mine: as an aside, follow this link for a copy of her thesis, which is on self awareness and the therapeutic use of self in Taiwanese community mental health nurses), four of her students from the College of Nursing at the Central Taiwan University of Science and Technology and one of our Cardiff mental health nursing students, Alys Jones.
Following this link takes you to the report of our visit published on the Hafal website, complete with photos. The Gellinudd Recovery Centre is opening at the beginning of 2017, and will be Wales’ first recovery college. Recovery colleges are a relatively new arrival within the mental health system; a useful introduction to them is this Centre for Mental Health briefing. The Gellinudd Recovery Centre buildings used to be an NHS hospital, and the whole is located in very pleasant woodland. Right now, Hafal is recruiting for registered nurses (and others) to work there.
Recovery, it has to be said, can mean different things to different people. This is one of the things we found in COCAPP, as we reported in our main findings paper. No shared understanding was revealed amongst people taking part in our interviews. Hafal write about what they believe ‘recovery’ means in their booklet, Recovery: the way ahead for people with severe mental illness. This is referenced in the job descriptions currently on the Hafal website as part of their current Gellinudd recruitment campaign. They place particular emphasis on empowerment, a whole person approach and progress. The term which will be used in the recovery centre to refer to people in residence is ‘guests’, and plans are in place to make the most of the centre’s green environment.
Elsewhere, #NPNR2016 is now only a few weeks away. We meet in Nottingham, and the conference promises to be an excellent one. I’ll aim to post some more about this at a later point.
This new paper you need to read. You also can, because it is published in gold open access form and is therefore free to download to anyone with an internet connection. Lead authored by Michael Coffey, and arising from the larger COCAPP study (see also here, here and here), it draws on qualitative data to examine in detail what staff, service users and carers say about risk assessment and management. Here’s the abstract:
Communication and information sharing are considered crucial to recovery-focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety.
Using data from our cross-national mixed-method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans.
Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template.
Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment.
Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.
Reported here is one of the most important sets of findings arising from the COCAPP study. Diana Rose has written a post on the article, which is scheduled to appear on the inestimable Mental Elf site next week. I’m very much looking forward to reading that.
Here’s a link to my first post for a new Cardiff University Mental Health Blog. The content will be broadly familar to people who have dipped into my personal blog in the past, insofar as I have chosen to say something general about doing mental health services research.
Working in collaboration with colleagues across the UK, including with people who have directly used services, researchers in the School of Healthcare Sciences at Cardiff University study mental health systems.
Clicking the hyperlink above, which appears beneath the brief snippet of text, will take you to the full piece. There are already some interesting other posts on the site, too, including a piece by Mike Owen written as an opener.