scholarly journals A Realist Evaluation of a Recovery-Oriented Inpatient Service

2021 ◽  
Author(s):  
◽  
Amy Pritchard
Keyword(s):  
Qualitative Research ◽  
Mental Illness ◽  
Service User ◽  
Realist Evaluation ◽  
Inpatient Service ◽  
Service Users ◽  
Market Demand ◽  
Service Staff ◽  
Research Interviews ◽  
Congruence Model

Background: Finding effective means of supporting individuals with a mental illness in their recovery is essential. A new recovery-oriented inpatient service in South Wales, “Woodlands”, aimed to provide an environment that would support individuals with severe and enduring mental illness in their recovery. Woodlands focuses on providing a staffing group that were recovery-oriented and deliver high levels of therapeutic engagement, as well as promoting choice and responsibility to develop service-users’ skills and confidence for living in the community in the future. This thesis aimed to explain which parts of Woodlands worked, for whom and in what circumstances.Design: Three areas of Woodlands’ service delivery were evaluated. This included - Woodlands trying to establish itself as a new service, how the staffing model supported individuals in their recovery, and how service-user choice and responsibility was promoted and supported by the service. Realist evaluation and ecological systems theory were used to guide the analysis of multiple data strands. This included quantitative data routinely collected at Woodlands and qualitative research interviews. The qualitative research interviews were conducted with senior figures involved in the design of the service, staff members, service-users and commissioners who were involved in referring individuals to Woodlands.Findings: The findings of this study are multifaceted and focus on the conditions of successful or unsuccessful implementation and delivery of a new recovery-oriented inpatient service. Such conditions included there being a market demand for this type of service and having the ability to quantifiably evidence the effectiveness of the service in order to secure referrals. Several service-user and staff characteristics were identified as conditions for the successful or unsuccessful engagement with key resources at Woodlands. These individual-level conditions included service-users and staff having the confidence, skills and desire to engage or deliver these resources. The congruence model (Nadler & Tushman, 1980) was used to provide explanatory power to the findings of this thesis, focusing specifically upon Woodlands challenge of establishing itself as a provider. The findings highlight that the four facets of organisational effectiveness (the people, tasks, culture and structure), were not congruent with the service’s inputs, nor were they congruent when the service was forced to adapt its service-user criterion.Discussion: The findings are presented in a nuanced middle-range theory which uses the underpinnings of the congruence model (Nadler & Tushman, 1980). The nuanced theory captures the challenges of establishing a new mental health service, which has translatability for other services trying to establish themselves within the competitive and commercial arena of healthcare. The findings of this thesis raise the question of whether recovery-oriented care can ever truly be achieved within the confines of inpatient care and it is argued that perhaps what services are really doing is a form of contemporary rehabilitation but dressed up in the clothes of recovery.

Challenges to the Modernist Identity of Psychiatry

2013 ◽  
Author(s):  
Pat Bracken ◽  
Philip Thomas
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health System ◽  
Service User ◽  
Mental Distress ◽  
Service Users ◽  
Doctor Who ◽  
The Gaze ◽  
The Past ◽  
The World

This chapter argues that the modernist agenda, currently dominant in mainstream psychiatry, serves as a disempowering force for service users. By structuring the world of mental health according to a technological logic, this agenda is usually seen as promoting a liberation from "myths" about mental illness that led to stigma and oppression in the past. However, it is argued that this approach systematically separates mental distress from background contextual issues and sidelines non-technological aspects of mental health such as relationships, values, and meanings. This move privileges the gaze of the expert doctor who is trained to understand distress in terms of psychopathology. But, as this move empowers the doctor, it disempowers the service user. In part this is because the priorities of modernist psychiatry are generally at odds with the interests and concerns of services users, particularly those who see themselves as survivors of the mental health system. The chapter examines the implications of this for the psychiatrist's role in working with survivors towards recovery.

scholarly journals Mental illness and recovery: an interpretative phenomenological analysis of the experiences of Black African service users in England

2019 ◽  
Vol 24 (1-2) ◽  
pp. 104-118 ◽  
Author(s):  
Isaac Tuffour ◽  
Alan Simpson ◽  
Lisa Reynolds
Keyword(s):  
Qualitative Research ◽  
Mental Illness ◽  
Interpretative Phenomenological Analysis ◽  
Phenomenological Analysis ◽  
Research Approach ◽  
Service Users ◽  
Structured Interviews ◽  
Cultural Backgrounds ◽  
Black African

Background Research conceptualising recovery is predominantly Eurocentric. This paper develops the conceptualisation of recovery by Black African service users. Aims Our aim was to explore Black African service users’ experiences of recovery from mental illness and to understand how they conceptualise recovery. Methods Using a qualitative research approach and interpretative phenomenological analysis (IPA), semi-structured interviews were conducted with 12 Black African service users recovering from mental illness in England. Results Participants conceptualised recovery as a pragmatic and subjective concept distributed across a continuum of clinical, functional and spiritual dimensions, resilience, identity and their social and cultural backgrounds. Conclusions It seems critical for all stakeholders to ensure that these components are embedded in recovery-oriented services for Black African service users.

scholarly journals What can we learn from service user memoirs? Information and service user experience

2012 ◽  
Vol 36 (9) ◽  
pp. 341-344 ◽  
Author(s):  
Neil Armstrong
Keyword(s):  
Mental Illness ◽  
User Experience ◽  
Service User ◽  
Clinical Importance ◽  
Service Users ◽  
The World ◽  
Academic Publications ◽  
Service User Experience

SummaryService user memoirs are frequently reviewed in The Psychiatrist and other related journals. Some academic publications include first-hand accounts of mental ill health, and there is a lively market for autobiographical books and articles about mental illness. But clinicians already have extensive contact with service users and it might seem unlikely that they have much to gain from reading memoirs. In this article I suggest that the greater depth of reflection in published memoirs means clinicians do in fact have something to learn. I illustrate my argument by showing how memoirs cast a light on the world of information and conclude by suggesting reasons why memoirs raise issues that are of increasing clinical importance.

scholarly journals How do befriending interventions alleviate loneliness and social isolation among older people? A realist evaluation study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256900
Author(s):  
Olujoke A. Fakoya ◽  
Noleen K. McCorry ◽  
Michael Donnelly
Keyword(s):  
Older People ◽  
Social Isolation ◽  
Service User ◽  
Evaluation Study ◽  
Realist Evaluation ◽  
Service Users ◽  
Structured Interviews ◽  
One To One ◽  
The Impact

Background Befriending is a popular way in which to intervene to combat loneliness and social isolation among older people. However, there is a need to improve our understanding about how these interventions work, for whom and in which contexts, to make the best use of the increasing investment in the provision and delivery of befriending services. Methods A realist evaluation was undertaken as it focuses on uncovering causal processes and interactions between mechanisms and contextual characteristics. Five case studies of befriending programmes in Northern Ireland were studied, reflecting variation in contextual variables, service user and provider characteristics. Data was collected via service documentation and semi-structured interviews (n = 46) with stakeholders involved in the delivery and receipt of befriending interventions. Results Eight initial programme theories were generated, which were ‘tested’ in the case study analysis to uncover context-mechanism-outcome relationships. Mechanisms identified included reciprocity, empathy, autonomy, and privacy which were triggered in different contexts to support the alleviation of loneliness and social isolation. Reciprocity was ‘triggered’ in contexts where service users and befrienders shared characteristics, the befriender was a volunteer and befriending took the form of physical companionship. Contexts characterised in terms of shared experiences between befriender and service user triggered empathy. Autonomy was triggered in contexts where befriending relationships were delivered long-term and did not focus on a pre-defined set of priorities. Privacy was triggered in contexts where service users had a cognitive/sensory impairment and received one-to-one delivery. Conclusion This study improves understanding about how and why befriending interventions work. Findings indicate that services should be tailored to the needs of service users and take into consideration characteristics including mobility, impairments e.g. physical, sensory and/or cognitive, as well as the influence of service characteristics including payment for befrienders, fixed/long-term befriending relationship, one-to-one support and the impact of non-verbal communication via face-to-face delivery.

Reducing stigma and increasing empowerment in mental illness. A qualitative research

2009 ◽  
Author(s):  
Consuelo Buggiani ◽  
Stefano Castagnoli ◽  
Susanna Giaccherini ◽  
Patrizia Meringolo
Keyword(s):  
Qualitative Research ◽  
Mental Illness

THE EFFECT OF LOCATION AND FACILITIES SERVICES USER SATISFACTION CONTAINER LOADING AND UNLOADING IN PORT OF INDONESIA IV (Persero) BRANCH MERAUKE

2018 ◽  
Vol 2 (1) ◽  
Author(s):  
Tarsisius Kana
Keyword(s):  
Customer Satisfaction ◽  
Significant Relationship ◽  
User Satisfaction ◽  
Service User ◽  
Hypothesis Test ◽  
Positive Influence ◽  
Coefficient Of Determination ◽  
Service Users ◽  
Significance Level ◽  
Loading And Unloading

The Influence of Location and Facilities Against Satisfaction of Container Unloading Service User at PT Pelabuhan Indonesia IV (Persero) Merauke Branch.This study aims to determine how much influence the location and facilities to the satisfaction of service users. Locations have indicators: access, visibility, traffic and facilities have indicators: organizational characteristics and objectives, land availability and space and space requirements, flexibility, aesthetic factors, communities and the environment, construction and operation costs while service user satisfaction has indicators: customer satisfaction , dimensions of customer satisfaction, confirmation of expectations, repurchase interest, willingness to recommend, customer dissatisfaction.The method used in this research is quantitative method by using the technique of processing descriptive data, data collecting technique with interviews, questionnaires and literature study. Sampling technique used incidental sampling. The measurement using likert scale and processed using SPSS version 23 program to calculate the validity and reliability test, calculate hypothesis test that is t test, f test and coefficient of determination. The result of research shows that location and facility variables together have a positive influence on service user satisfaction at PT Pelabuhan Indonesia IV (Persero) Merauke Branch. This can be proven from the result of F count 39.984> 3.11 with significance level 0.000 ≤ 0.05, then Ho is rejected Ha accepted. Itcan be concluded there is a positive and significant relationship between location and facility to the satisfaction of service users of loading and unloading of containers at PT Pelabuhan Indonesia IV (Persero) Merauke Branch.The result of research shows that location and facility variables together have a positive influence on service user satisfaction at PT Pelabuhan Indonesia IV (Persero) Merauke Branch. This can be proven from the result of F count 39.984> 3.11 with significance level 0.000 ≤ 0.05, then Ho is rejected Ha accepted. It can be concluded there is a positive and significant relationship between location and facility to the satisfaction of service users of loading and unloading of containers at PT Pelabuhan Indonesia IV (Persero) Merauke Branch.

Now they’re listening: involvement in clinical psychology training

2019 ◽  
Vol 23 (1) ◽  
pp. 23-29
Author(s):  
Laura Lea ◽  
Sue Holttum ◽  
Victoria Butters ◽  
Diana Byrne ◽  
Helen Cable ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Psychology ◽  
Health Professionals ◽  
Service User ◽  
Health Workers ◽  
Psychology Training ◽  
Service Users ◽  
Clinical Psychology Training ◽  
Content Type

PurposeThe 2014/2015 UK requirement for involvement of service users and carers in training mental health professionals has prompted the authors to review the work of involvement in clinical psychology training in the university programme. Have the voices of service users and carers been heard? The paper aims to discuss this issue.Design/methodology/approachThe authors update the paper of 2011 in which the authors described the challenges of inclusion and the specific approaches the authors take to involvement. The authors do this in the context of the recent change to UK standards for service user and carer involvement, and recent developments in relation to partnership working and co-production in mental healthcare. The authors describe the work carried out by the authors – members of a service user involvement group at a UK university – to ensure the voices of people affected by mental health difficulties are included in all aspects of training.FindingsCareful work and the need for dedicated time is required to enable inclusive, effective and comprehensive participation in a mental health training programme. It is apparent that there is a group of service users whose voice is less heard: those who are training to be mental health workers.Social implicationsFor some people, involvement has increased. Trainee mental health professionals’ own experience of distress may need more recognition and valuing.Originality/valueThe authors are in a unique position to review a service-user-led project, which has run for 12 years, whose aim has been to embed involvement in training. The authors can identify both achievements and challenges.

scholarly journals Factors associated with higher healthcare costs in a cohort of homeless adults with a mental illness and a general cohort of adults with a history of homelessness

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathryn Wiens ◽  
Laura C. Rosella ◽  
Paul Kurdyak ◽  
Simon Chen ◽  
Tim Aubry ◽  
...  
Keyword(s):  
Mental Illness ◽  
Healthcare Costs ◽  
Service Use ◽  
Multinomial Logistic Regression ◽  
Service Planning ◽  
Inpatient Service ◽  
Homeless Adults ◽  
Targeted Interventions ◽  
Factors Associated ◽  
History Of

Abstract Background Healthcare costs are disproportionately incurred by a relatively small group of people often described as high-cost users. Understanding the factors associated with high-cost use of health services among people experiencing homelessness could help guide service planning. Methods Survey data from a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness were linked with administrative healthcare records in Ontario, Canada. Total costs were calculated using a validated costing algorithm and categorized based on population cut points for the top 5%, top 6–10%, top 11–50% and bottom 50% of users in Ontario. Multinomial logistic regression was used to identify the predisposing, enabling, and need factors associated with higher healthcare costs (with bottom 50% as the reference). Results Sixteen percent of the general homeless cohort and 30% percent of the cohort with a mental illness were in the top 5% of healthcare users in Ontario. Most healthcare costs for the top 5% of users were attributed to emergency department and inpatient service costs, while the costs from other strata were mostly for physician services, hospital outpatient clinics, and medications. The odds of being within the top 5% of users were higher for people who reported female gender, a regular medical doctor, past year acute service use, poor perceived general health and two or more diagnosed chronic conditions, and were lower for Black participants and other racialized groups. Older age was not consistently associated with higher cost use; the odds of being in the top 5% were highest for 35-to-49-year year age group in the cohort with a mental illness and similar for the 35–49 and ≥ 50-year age groups in the general homeless cohort. Conclusions This study combines survey and administrative data from two cohorts of homeless adults to describe the distribution of healthcare costs and identify factors associated with higher cost use. These findings can inform the development of targeted interventions to improve healthcare delivery and support for people experiencing homelessness.

A scoping review of the literature on the involvement of service users in personality disorder services

2014 ◽  
Vol 31 (4) ◽  
pp. 233-243
Author(s):  
L. Montgomery ◽  
M. Donnelly
Keyword(s):  
Health Policy ◽  
Personality Disorder ◽  
Scoping Review ◽  
Service User ◽  
Mental Health Policy ◽  
User Involvement ◽  
Service Users ◽  
Service User Involvement ◽  
Review Of The Literature ◽  
Policy Makers

BackgroundService user involvement is receiving increasing support from mental health policy makers, service planners and research commissioners. However, we lack a good understanding of the nature and extent to which service users are involved in personality disorder (PD) services and the effects of involvement in these services.ObjectivesTo review and appraise published sources; increase understanding about service user involvement in PD services; and highlight knowledge gaps and related issues.MethodsA scoping review methodology was adopted. Data were ‘charted’ to illustrate the landscape of writings and views and a qualitative analysis synthesized the results in terms of key emergent themes.ResultsOnly a small amount of published work was identified with significant gaps in the literature. Effects were reported mostly in terms processes and emotional and practical benefits for service users. Emergent themes were wellness and health, recruitment and support for service users.ConclusionsThis scoping review uncovered a lack of published work despite service user involvement being a key strand of health policy. There is a need for outcomes-focused research regarding service user involvement. Successful user involvement in PD services requires attention to be focused on the context, recruitment, support and ‘wellness’ of service users.

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