Tag: inpatient mental health care

Keeping in Touch

Over a period of years, with Dr Nicola Evans and Dr Becky Playle I’ve been supervising Gavin John, whose doctoral studies have focused on (as Gavin himself puts it in his thesis), the ‘interventions and processes that promote or hinder children and young
people’s connections to their education, friends and families during periods of admission to
hospital for mental health care’.

Gavin’s research has built directly on the RiSC study (see here for an accessible summary). Following a viva at the end of 2022, in February 2023 Gavin officially because ‘Dr’: very many congratulations to him! For a direct link to Gavin’s thesis, the place to go is here. And, for flavour of what Gavin did in his research and what he found, here is his summary:

Background: Existing research has identified risks to children and young people’s (CYP)
connections to their friends, family and education during periods of inpatient mental health
care. However, to date there is a dearth of research on what interventions and processes
support CYP to maintain these connections.

Aim: To explore the interventions and processes that promote or hinder children and young
people’s connections to their education, friends and families during periods of admission to
hospital for mental health care.

Method: Case study methodology was used involving the generation of qualitative and
quantitative data in a single CAMHS inpatient unit. Three outcome measures relating to
mental health, friends, family and education were completed by adolescents admitted to
hospital for care and treatment of their mental ill-health (n=26). A subset of children and
young people (n=9), their caregivers (n=6) and health, social and education practitioners
(n=11) were interviewed, multidisciplinary team (MDT) meetings were observed, and policy
and procedure documents were examined.

Results: Demographic data were collected and results from three questionnaires indicate
participants were in the abnormal banding for the total difficulties score on the Strengths and
Difficulties Questionnaire (SDQ). Participants scored highest on the global scale and trust
and communication subscales in relation to mothers in the Inventory of Parent and Peer
Attachment-Revised (IPPA-R). Highest scores were recorded on the behavioural and
emotional engagement subscales of parts A and B of the Student School Engagement
Survey (SSES). Thematic analysis of interviews (n=26), observations and documentary
analysis of policy and procedure documents identified five themes: ‘Remote connections to
friends and family’, ‘Physical connections to friends and family’, ‘Peers in hospital’, ‘Impact
on families’ and ‘Connections to education’.

Conclusion: The study highlights significant barriers to children and young people
maintaining connections to their friends, family and education during periods of inpatient
mental health care. It identifies candidate interventions to help children and young people
maintain these connections.

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COCAPP-A main findings paper

COCAPP-ACOCAPP-A, funded by the NIHR Health Services and Delivery Research Programme, investigated care planning and coordination in inpatient mental health services. It was led by Alan Simpson, and I was mighty pleased to have been part of the research team. The full, 270 page, report appeared in 2017. Now, a derived paper reporting main findings has appeared in the journal BMC Psychiatry. Lead authored by Michael Coffey this article amounts to a more modest 18 pages, which means it stands a chance of actually being read by people able to make use of it.

As a gold open access article the paper is free to download to anyone with an internet connection. As a taster, here’s the abstract:

Background: Involving mental health service users in planning and reviewing their care can help personalised care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused care.
Methods: A cross-national comparative mixed-methods study involving 19 mental health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method.
Results: For service users, when recovery-oriented focus was high, the quality of care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent.
Conclusions: There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in care planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused care planning.