Search

Personal budgets aim to increase choice and independence for people with social care needs but they remain underused by people with mental health problems compared to other disability groups. The use of personal budgets may impact on families in a variety of ways, both positive and negative. This paper draws on interviews, undertaken in 2012-2013 with 18 family carers and 12 mental health service users, that explored experiences of family involvement in accessing and managing personal budgets for a person with mental health-related social care needs. The sample was drawn from three sites across England, with additional carers being recruited via voluntary sector networks. Our findings show that for many people with severe mental health needs who lack motivation and confidence to negotiate access to personal budgets, carers may provide the necessary support to enable them to benefit from this form of social care support. We illustrate the role carers may play in initiating, pursuing and maximising the level of support available through personal budgets. However, some carers interviewed considered that personal budget funding was reduced because of practitioners' assumptions about carers' willingness and ability to provide support. We also report perceived tensions between family carers and practitioners around appropriate involvement in decision-making. The study findings have implications for local authorities, practitioners and family carers in supporting the involvement of family carers in support for people with severe mental health problems., (© 2015 John Wiley & Sons Ltd.)

Background: There is an emerging evidence base about best practice in supporting recovery. This is usually framed in relation to general principles, and specific pro-recovery interventions are lacking., Aims: To develop a theoretically based and empirically defensible new pro-recovery manualised intervention--called the REFOCUS intervention., Method: Seven systematic and two narrative reviews were undertaken. Identified evidence gaps were addressed in three qualitative studies. The findings were synthesised to produce the REFOCUS intervention, manual and model., Results: The REFOCUS intervention comprises two components: recovery-promoting relationships and working practices. Approaches to supporting relationships comprise coaching skills training for staff, developing a shared team understanding of recovery, exploring staff values, a Partnership Project with people who use the service and raising patient expectations. Working practices comprise the following: understanding values and treatment preferences; assessing strengths; and supporting goal-striving. The REFOCUS model describes the causal pathway from the REFOCUS intervention to improved recovery., Conclusions: The REFOCUS intervention is an empirically supported pro-recovery intervention for use in mental health services. It will be evaluated in a multisite cluster randomised controlled trial (ISRCTN02507940)., (© The Royal College of Psychiatrists 2015.)

A wide variety of peer worker roles is being introduced into mental health services internationally. Empirical insight into whether conditions supporting role introduction are common across organisational contexts is lacking. A qualitative, comparative case study compared the introduction of peer workers employed in the statutory sector, voluntary sector and in organisational partnerships. We found good practice across contexts in structural issues including recruitment and training, but differences in expectations of the peer worker role in different organisational cultures. Issues of professionalism and practice boundaries were important everywhere but could be understood very differently, sometimes eroding the distinctiveness of the role.

This article explores how role boundaries and professional priorities in integrated mental health teams have impacted on the implementation of personalised approaches to social care support. We focus on the use of personal budgets to meet mental health-related social care needs as a key mechanism for personalised care. Drawing on 28 qualitative interviews with mental health practitioners from three local authorities in England undertaken in 2013, we report nurses', social workers', and occupational therapists' attitudes towards, and engagement with, personal budgets. Professional boundaries and competing priorities heavily influenced the extent to which personal budgets were perceived as a legitimate part of their roles. Across different professional groups, a sense emerged that personal budgets should be somebody else's job. A focus on attention to treatment, stability, and risk management often resulted in low prioritisation of personal budgets and led practitioners to avoid recommending them or to exclude service users from the process as a way to save time. Implications of the dominant medical model and the protection of traditional professional roles for the implementation of new, person-centred models of practice are discussed.

Background: Enhancing choice and control for people using services is a mental health and social-care service priority in England. Personalisation is a new policy and practice for delivery of social-care services where eligible adults are allocated a personal budget to spend to meet their agreed support needs., Aims: To describe approaches to introducing personal budgets to people with severe and enduring mental health needs, and to identify facilitators or barriers encountered., Method: Within four English local authority (LA) areas, purposively selected to provide maximum variation, semi-structured interviews were undertaken with 58 participants from LAs, NHS trusts and third-sector organisations. An Interpretive Framework analysis considered within- and across-site insights., Results: Issues arising from the implementation of personalisation for people with mental health needs are presented under two general themes: "responsibility and power" and "vision and leadership". Key challenges identified were complexities of working across NHS and LAs, the importance of effective leadership and engagement with service user representatives., Conclusions: Implementing personal budgets in mental health requires effective engagement of health and social-care systems. Change processes need strong leadership, clear vision and personal commitment, with ownership by all key stakeholders, including front-line practitioners.

Strengths assessments focus on the individual's talents, abilities, resources, and strengths. No systematic review of strengths assessments for use within mental health populations has been published. The aims of this study were to describe and evaluate strengths assessments for use within mental health services. A systematic review identified 12 strengths assessments (5 quantitative, 7 qualitative). The Strengths Assessment Worksheet (SAW) was the most widely utilized and evaluated qualitative assessment. Psychometric properties of the assessments were assessed against set quality criteria. Data on psychometric properties were available for 4 measures. The Client Assessment of Strengths, Interests and Goals (CASIG) had the strongest psychometric evidence. The SAW and CASIG assessments can be tentatively recommended within clinical practice, although the evidence for all strengths assessments is currently limited. To describe the content of the strengths assessment, the items used to operationalize the concept of strengths in each assessment were extracted and themed. Twenty-four themes were identified and organized into 3 overarching categories: individual factors, environmental factors, and interpersonal factors. These categories form the basis of an empirically based definition of strengths that could be used as a conceptual foundation for new clinical assessments.

There has been substantial research on the implementation of personal budgets across adult social care in England, but relatively little exploration of take-up within the field of mental health--and whether personal budgets are providing an effective mechanism for service users to exercise greater power, choice and control in their lives. Drawing upon in-depth interviews with fifty-two people using mental-health-related social care services and twenty-eight social work and other practitioners, undertaken for a national study in 2010-13, this paper explores experiences from their different perspectives. Inter-views were undertaken in three English local authorities which were at different stages of implementing personal budgets in mental health social care. Data were analysed using an Interpretive Framework Approach. The findings provide evidence of how personal budgets may deliver opportunities for people to take more power and control, sometimes collaboratively with practitioners, and also identify some of the barriers and challenges which can militate against such outcomes. A key factor in enabling personal budgets to support empowerment and recovery was reported to be the quality and continuity of the professional relationship--which raises particular implications for the organisation of mental health social work and the organisational cultures within which this is situated. [ABSTRACT FROM AUTHOR]

While there is substantial common ground between the ideas of self-directed support and recovery, there are also significant differences in how these ideas have been implemented in policy and practice. This paper develops an 'ideal type' model of how personal budgets may need to be set up for people with mental health difficulties if they are to be effective as a mechanism that can enable recovery. Aspects of this 'ideal type' model are then examined in relation to the reported experiences of people accessing personal budgets from a national study of the implementation of personal budgets in mental health in England. In-depth qualitative interviews were undertaken across three local authority areas with fifty-three people with serious mental health difficulties who had accessed personal budgets in 2012-13. Our findings suggest that personal budgets can support recovery thinking and processes, and can be used to mobilise relevant resources to make this possible. Key to achieving this can be co-productive and/or peer-supported processes of assessment and planning. In addition, resource allocation may need to be flexible to take account of fluctuating levels of mental distress, and budgets should be linked to recovery goals rather than assuming long-term care needs. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to reflect on the process of co-producing mental health research where work was shared between university academics, charity-based researchers and a Lived Experience Advisory Panel. Design/methodology/approach – The authors express the opinions of a research team made up of people with experience of using mental health services, being carers and being academically trained researchers from a range of health and social science disciplines. Some had experience in several areas. The paper is co-produced to provide collective reflection and recommendations. Findings – Co-production of research is not well documented in published literature. The authors believe there is scope to develop co-production approaches, but further conceptual and theoretical work is needed alongside empirical studies. A socially situated complex research project, possibly involving multi-stakeholder groups, demands flexibility in approach. Similarly to user-controlled and other emancipatory methodologies, co-production makes the democratisation of research a primary objective in order to produce better quality and more relevant studies. Co-production also addresses inequalities in power and control within research projects; this way of working does provide a healthy challenge to traditional research hierarchies. Practical implications – Lessons learned should be honestly shared to develop co-production research methods. Projects need to have a strategy for how to value different contributions and facilitate constructive relationships if discord emerges. Establishing clear project roles, expectations and process for payment are essential in developing genuine collaborative partnerships. Originality/value – It is a viewpoint paper. [ABSTRACT FROM AUTHOR]

Background: In England, personal budgets are offered to eligible people with severe mental health problems to enable them to purchase what is helpful for their quality of life or recovery. However, in-depth insight into people's own perceptions of the outcomes is lacking. Aims: To investigate people's own reporting of outcomes from using personal budgets in relation to social care needs arising from severe mental health problems. Method: A convenience sample of 47 individuals receiving personal budgets was recruited from three English local authorities. In-depth semi-structured interviews were subject to thematic framework analysis. Results: Most participants identified positive outcomes across domains interconnected through individual life circumstances, with mental health and wellbeing, social participation and relationships, and confidence and skills most commonly reported. Some needed more support than others to identify goals and make use of the personal budget to take a more active part in the society. Conclusions: Personal budgets can enable people to achieve outcomes that are relevant to them in the context of their lives, particularly through enhancing their wellbeing and social participation. Consideration should be given to distinguishing those individuals potentially requiring more support for engagement from those who can engage more independently to identify and pursue their goals. [ABSTRACT FROM AUTHOR]

Recovery has come to mean living a life beyond mental illness, and recovery orientation is policy in many countries. The aims of this study were to investigate what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support. Data collection included ten focus groups with multidisciplinary clinicians (n = 34) and team leaders (n = 31), and individual interviews with clinicians (n = 18), team leaders (n = 6) and senior managers (n = 8). The identified core category was Competing Priorities, with staff identifying conflicting system priorities that influence how recovery-oriented practice is implemented. Three sub-categories were: Health Process Priorities, Business Priorities, and Staff Role Perception. Efforts to transform services towards a recovery orientation require a whole-systems approach. [ABSTRACT FROM AUTHOR]

Purpose – To evaluate the impact of crisis house admission in terms of mental health recovery and achievement of personal goals for people using the service. Design/methodology/approach – Mental Health Recovery Star (Recovery Star) and Personal Goal Scoring data were collected at entry and exit points in routine practice as part of a bespoke support planning process from 722 adults using one of three Rethink Mental Illness Crisis Houses. The adults had mental illness diagnoses including depression, schizophrenia, bipolar disorder, personality disorder, and anxiety disorder. Findings – There were significant increases in all ten Recovery Star domains, for example: managing mental health (up 2.11 points (1-10 scale)), identity and self-esteem (up 1.56 points), trust and hope (up 1.48 points), and self-care (up 1.35 points). The analysis of Personal Goal Scoring data (scored on 1-10 scale) showed significant increases on how close people were to achieving their goals. For all goals listed there was an average increase of 2.5 point from 3 to 5.5, showing that people made progress during their stay in the service. Practical implications – Services provided by the third sector may offer an important contribution to support people's recovery and prevent admission to psychiatric hospital. Originality/value – The findings of the evaluation study support a growing body of evidence regarding the effectiveness of services offering alternatives to admission, and they highlight the value of using recovery-oriented support planning and outcome capture tools in routine practice. [ABSTRACT FROM AUTHOR]

Purpose – The physical health needs of people with mental health problems are currently under addressed and often ignored, both in training and in practice. The PRIMROSE trial intervention was designed to remedy that – focusing in particular on risk of cardiovascular disease (CVD). This paper describes how people with experience of using mental health services and carers contributed to the development of the PRIMROSE intervention. It draws out key messages for educators, researchers and practitioners. Design/methodology/approach – Using a case study approach the paper outlines how a Third sector organisation supported the study team in setting up a Lived Experience Advisory Panel (LEAP), drawing on a pre-existing model and recent thinking about service user and carer involvement in research. It is described how the approach sought to engage wider involvement of people with an interest in CVD while also offering more focused input into specifically the development of the trial intervention. Findings – An innovative approach was taken whereby a large LEAP, comprising 27 service users and carers, was supporting the development of the study mainly through e-mail and web updates and feedback, while a sub-group of the LEAP, with eight members, met three times and had a focus on inputting ideas into the development of the intervention. The creation of a LEAP proved helpful to the project, resulting in an enhanced and more relevant intervention – summed up in a series of eleven recommendations. Appointment of an independent chair of the sub-group proved invaluable and there is learning from this project for other similar initiatives. Originality/value – This study has value for others who are developing practice interventions. A range of suggestions were made which will have relevance for training, ensuring that physical health issues are not ignored. There is much to learn too from the process of this project, for the involvement of service users and carers in research, education and in practice development. [ABSTRACT FROM AUTHOR]

This article analyzes sociocultural processes of recovery in a Danish mental health service providing two years of integrated biopsychosocial treatment following first-episode psychosis. The study is based on ethnographic research in the service and person-centered involvement with 15 clients. The analysis applies Dow's [1986 American Anthropologist 88:56-69] model of universal components of symbolic healing to elucidate sociocultural aspects of therapeutic efficacy that are alternatively disregarded as placebo or nonspecific effects. It is demonstrated how staff engaged with clients to deliver "psychoeducation" that provided scientific and biomedical theories about mental illness, constituting a shared "mythic world" that was accepted as an experiential truth and used to explain clients' illness experiences. The analysis highlights the need to supplement attention in Dow's model to the healing procedure with consideration of variability in the healing process. Depending on individual responses to the intervention, the staff's professional backgrounds and staff-client relationships different recovery models were applied. One suggested "episodic psychosis" and full recovery, and the other suggested "chronic schizophrenia" and the necessity of comprehensive life adjustments to the mental illness. The recovery models influenced clients' perspectives on illness and self as they engaged in identity work, negotiating future plans and individual life projects by including also alternative systems of explanation from the wider cultural repertoire. [ABSTRACT FROM AUTHOR]