Relationships key to mental health recovery, says new study
Mental health service users saw the relationships with their care coordinators as being central to their recovery and felt that care plans were largely irrelevant, according to mental health researchers at City University London, Swansea University and Cardiff University.
The study, published in BioMed Central Psychiatry, also found that care coordinators saw care plans as a useful record but also as an inflexible administrative burden that restricted time with service users.
The researchers hope that the research will help improve cumbersome and time consuming care planning processes while enabling mental health workers more time to create meaningful therapeutic relationships, which are currently valued but limited by the focus on bureaucracy.
The study also found that risk remains a significant concern for mental health workers but appeared to be rarely discussed with service users or their carers.
Care planning and coordination is at the heart of effective mental health service delivery and is increasingly required to be personalised and focused on recovery, yet there has been little research conducted that explores these key aspects.
To find out more about how community mental health care was planned and coordinated, the team conducted a cross-national comparative study involving six NHS sites in England and Wales that included a survey of 449 service users and 205 care coordinators. They also conducted interviews with 117 managers, practitioners, service users and carers. As part of the process, service users were employed as researchers and advisors.
Speaking about the research, Alan Simpson, Professor of Collaborative Mental Health Nursing in the School of Health Sciences, said:
"Our study has highlighted two very important issues around the delivery of mental health care. Firstly, our study showed that while workers are acutely aware of the need to assess and manage risk, this is rarely discussed openly with service users or their families. This is a missed opportunity to learn from the patient's and family's perspective and to share responsibility in this important area.
"Secondly, there is clearly an issue between how service users see their relationship with care coordinators, and how this is managed. While managers and clinicians clearly see care plans as vital records of care, service users instead said that regular contact and therapeutic relationships with staff help them most in their recovery and time consuming care plans are rarely used.
"The challenge now is for us to work with clinicians and service users to test out new ways of working that maximise therapeutic contact, support collaborative working around risk and reduce the time spent completing lengthy care plan documentation that is rarely used."
Dr Michael Coffey, a specialist in research on the delivery and organisation of community mental health care at Swansea University, said:
"This is an important study, and the first to examine how community mental health care is coordinated across Wales and England.
"Care planning and coordination is at the heart of effective mental health service delivery and is increasingly required to be personalised and focused on recovery, yet there has been little research conducted that explores these key aspects.
"I'm very pleased to have had the opportunity to be part of a team involving colleagues from City University London and Cardiff University. Our collaboration is continuing to achieve exciting new evidence on how mental health services are experienced and delivered. Together with research projects we are currently running here at Swansea we hope to see this new evidence lead to positive changes for people with mental health problems."
More information: Alan Simpson et al. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study, BMC Psychiatry (2016). DOI: 10.1186/s12888-016-0858-x