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Utilising Team Recovery Implementation Plan (TRIP): embedding recovery-focused practice in rehabilitation services
- Author:
- ACHER Geraldine
- Journal article citation:
- Mental Health and Social Inclusion, 21(4), 2017, pp.240-247.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide an account of Central and North West London NHS Foundation Trust Mental Health Rehabilitation Services’ experience of utilising Team Recovery Implementation Plan (TRIP) as a framework to embed recovery-focused practice. The paper explores the challenges to creating recovery-focused services in inpatient settings and sets out how using TRIP has enabled frontline staff to work in partnership with people who use services and coproduce changes in practice and service development. Design/methodology/approach: The paper draws on the process of utilising TRIP as a methodology to embed recovery-focused practice. Findings: The account finds that using TRIP as a framework to embed recovery-focused practice supports frontline staff to work in partnership with people who use services and share responsibility for delivering recovery-oriented services, measure progress and drive change. Originality/value: The paper provides an informative account of implementing TRIP as a framework to embed recovery-focused practice in mental health rehabilitation services. It explores the challenges faced by services in creating recovery-focused services and sets out how the TRIP has been used by teams as a methodology for coproducing, co-delivering and co-reviewing action plans. The paper gives practical examples of keeping the TRIP process alive and identifies several changes to practice and service developments achieved since TRIP’s implementation. (Publisher abstract)
Unit manager perspectives of a trauma-specific programme across Scotland’s secure estate
- Authors:
- BARRON Ian, MITCHELL David
- Journal article citation:
- Journal of Children's Services, 12(4), 2017, pp.271-287.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to assess unit manager perspectives on the introduction of a group-based trauma-specific programme delivered across Scotland’s secure estate. As this was the first time such an estate-wide initiative had occurred, it was important to identify the benefits/challenges at a strategic level. Design/methodology/approach: An exploratory qualitative case study was utilised involving semi-structured interviews with five senior unit managers in three secure units to discover their perceptions of the benefits and challenges of implementing Teaching Recovery Techniques (TRT). A quasi-qualitative analysis was used to quantify and give meaning to manager responses. Inter-rater reliability of analysis was assessed. Findings: Unit managers perceived gains in trauma-informed knowledge for themselves, and knowledge and skills gains for programme workers, care staff and adolescents. Challenges involved: managing a shift in paradigm to include a trauma-specific programme; the limiting context of competitive tendering; short duration placements; and the need for psychoeducation for staff, parents and agencies. Research limitations/implications: Large sample sizes are likely to identify further issues for unit managers. Manager perceptions need directly compared with staff and adolescent perceptions and included in randomised control trials of trauma-specific programmes. Practical implications: Managers perceived that TRT needed to be delivered within trauma-informed organisations and identified the need for manager training in traumatisation, trauma recovery and organisational implications to guide strategic planning. Managers emphasised the need for psychoeducation for families, staff and agencies. Originality/value: The current study is the first in Scotland to explore unit manager experience of introducing a trauma-specific programme across the secure estate. (Publisher abstract)
Co-producing formulation within a secure setting: a co-authorship with a service user and the clinical team
- Authors:
- LEWIS-MORTON Ruth, et al
- Journal article citation:
- Mental Health and Social Inclusion, 21(4), 2017, pp.230-239.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the process of co-producing a formulation alongside a service user and the clinical team within a secure inpatient service. This paper has been co-authored by the service user and members of the multi-disciplinary team (MDT). Design/methodology/approach: An open-ended focus group discussion was facilitated with the service user and members of her MDT. The process of thematic analysis was applied to the focus group transcript. Findings: The following themes highlighted important outcomes of co-producing a formulation within a secure inpatient setting; “Meaningful Collaboration”, “Co-Produced Understanding” and a “Shift in Power Differential”. This paper demonstrates the importance of meaningful co-production within a secure inpatient service whilst also highlighting the challenges and tensions of working in a co-produced way within this context. Research limitations/implications: This paper explores the process of co-producing and developing a formulation from the perspective of one service user and their MDT within a secure inpatient setting. It would be unhelpful to extrapolate broad assumptions from this case study although this study does raise important considerations for future research and encourages an emphasis on a co-produced design and dissemination. Practical implications: This case study highlights the importance of co-production in clinical endeavours, service delivery and development perspectives and in the dissemination of this information. Originality/value: The importance of co-producing and co-authoring alongside service users have been highlighted in this paper. This approach to co-production and co-authorship is highly recommended in future research endeavours. (Publisher abstract)
The experiences of paid formal lived experience workers within a secure mental health service
- Authors:
- GRIFFITHS Christopher Alan, HANCOCK-JOHNSON Ella
- Journal article citation:
- Journal of Mental Health Training Education and Practice, 12(5), 2017, pp.313-322.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to report the experience and impact of paid staff who are employed to use their lived experience of mental health issues and service use within a secure mental health provider. Design/methodology/approach: A qualitative approach using semi-structured interviews and thematic analysis was employed. Findings: Results from this study suggest that employing lived experience workers (LEWs) in secure mental health settings is valuable to clinical staff, service users, the employing organisation and LEWs themselves. Findings emphasised the importance of support for LEWs to enable them to fulfil their role and maintain wellbeing, and the need to consider LEWs career progression within and beyond the role. Research limitations/implications: This study had a small sample size. Practical implications: There is evidence to support LEWs in secure mental health settings and requirement for further understanding of their work in this environment. Specific recommendations include the need for training for clinical staff about the role of LEWs, specific LEWs role training, and regular supervision and mental health support for LEWs. Originality/value: This is the first paper reporting the experience and impact of LEWs in a UK secure mental health service. (Publisher abstract)
Does formulation of service users' difficulties improve empathy in forensic mental health services?
- Authors:
- WILKINSON Helen, et al
- Journal article citation:
- Journal of Forensic Psychology Research and Practice, 17(3), 2017, pp.157-178.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia
The culture and values of the National Health Service and the staff that work within it have received much attention over recent years. The erosion of empathy and compassionate care toward service users has been highlighted. Psychological formulation may be one way that clinicians can understand their service users more fully, which could lead to an improvement in the empathy they express toward them. The current study investigates the effect of presenting client information in a psychological formulation on self-reported empathy in staff in medium and low secure forensic mental health services. One hundred and fifty-four staff were recruited via convenience sampling to complete self-report questionnaires measuring burnout (Maslach Burnout Inventory), state (Adapted Interpersonal Reactivity Index), and trait (Empathy Quotient) empathy. No significant difference in state empathy scores was observed among the staff in the formulated group when compared with the unformulated group. Linear multiple stepwise regressions demonstrated that trait empathy and burnout significantly predicted variance in state empathy, but the information format was not significant. It was concluded that mode of presentation in this instance did not influence the degree of empathic concern staff expressed toward a hypothetical client in a vignette. General levels of empathy and degree of burnout superseded this effect. Further research is needed on how adjusting client information formats might enhance empathy among professionals. (Publisher abstract)
Long-stay rehabilitation services: briefing
- Author:
- WRIGHT Emily M.
- Publisher:
- Centre for Mental Health
- Publication year:
- 2017
- Pagination:
- 15
- Place of publication:
- London
Based on a review of Care Quality Commission (CQC) inspection reports and interviews with experts, this briefing summarises the issues facing mental health rehabilitation services in England, which provide intensive or longer-term support for people with severe mental problems. It explores the people involved, the type and costs of services, and the way they have evolved over the last twenty years. The briefing raises concerns about long-stay rehabilitation. These include a lack of appropriate local provision of inpatient rehabilitation services, which result in out of area placements and a risk of isolation and dislocated from their local health and care services. It also found that some people are kept in services of a higher intensity than is necessary due to a lack of community services, which restricts and individuals’ independence and increases costs. A lack of oversight and regulation processes which focuses on services rather than the individual mean that some people face longer stays in inpatient services that are necessary. The paper makes a number of recommendations, including: for the Government and the NHS to provide direction for the development of local community and hospital services for people with complex mental health needs; NHS providers and clinical commissioning groups to offer local services to people requiring rehabilitation support; and for NHS providers and clinical commissioning groups maintain contact with people admitted to hospitals out of their local area. (Edited publisher abstract)
‘If you take it personally you break’ neglected voices on violence in secure units for adolescents
- Authors:
- ANDERSSON Peter, OVERLIEN Carolina
- Journal article citation:
- Social Work and Social Sciences Review, 19(3), 2017, pp.61-80.
- Publisher:
- Whiting and Birch
To a large degree, the voices of staff running daily operations in secure units for adolescents, particularly on sensitive issues such as violence and abuse, have been missing. The aim of the present paper is to make these voices heard by investigating what forms of violence staff in secure units encounter in their day-to-day work and to deepen our understanding of how they handle it. The study uses two theoretical starting points. First, the secure unit is understood in terms of Berger and Luckmann’s concept of institutionalisation, emphasising how behaviour and practices develop through well-defined roles. Secondly, inspiration is drawn from Goffman’s notion of frontstage and backstage, highlighting how staff within an institution (i.e. secure unit) enter into different roles. Fifty-three semi-structured interviews were conducted with staff at three different secure units for adolescents in Sweden. The material was organised through a thematic analysis, yielding six themes placed under two headings; ‘A violent scene? A matter of definition’ and ‘Handling violence: strategies employed’. The results show how staff describe youth as the violent party and how they suppress their own emotions. Additionally, staff articulated their own use of violence toward youth and their emotional stance, describing an interpersonal shield that protected them from violence. The results underline the importance of raising questions about the nature of violence in secure units for adolescents and how staff handle such violence in their everyday work. (Edited publisher abstract)
The PARALLEL Study (imPAct of expeRiencing Another’s seLf harm and suicidaL bEhaviour in hospitaL)
- Authors:
- HARGATE Rebecca, et al
- Journal article citation:
- Journal of Forensic Practice, 19(4), 2017, pp.258-268.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the experiences of both staff and patients in a medium-secure mental health unit of the self-harm and/or suicidal behaviour of others. Suicide and self-harm is highly prevalent in forensic settings and evidence suggests that experiencing other people’s self-harm and suicidal behaviour can lead to negative outcomes, both for staff and patients. This is particularly important in hospitals where patients are highly dependent on staff for support. Design/methodology/approach: Semi-structured interviews were conducted with five staff members and six patients in a medium-secure male mental health unit in the North of England. Data were analysed following interpretative phenomenological analysis guidelines. Findings: Three dominant themes were identified during analysis: the impact of suicide and self-harm; the role of others; and the importance of understanding and experience. Various impacts were discussed including desensitization, negative emotions and the desire to help. Other people played an important role in protecting against negative impacts, with shared experiences and peer support reported as the biggest benefits. Experiences of self-harm and suicide were found to increase understanding resulting in more positive attitudes. Additionally, the importance of training and education was highlighted. Originality/value: This paper provides an insight into the experiences of staff and patients in medium-secure male mental health unit, which has benefits to practitioners when considering support mechanisms. (Publisher abstract)
Perceptions of therapeutic principles in a therapeutic community
- Authors:
- CAPONE Georgina, et al
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 38(2), 2017, pp.60-78.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore staff and service users’ perceptions of therapeutic principles within a unique male high secure learning disability therapeutic community (LDTC). Design/methodology/approach: A qualitative approach was adopted using deductive content analysis and inductive thematic analysis. In total, 12 participants took part in a semi-structured interview to explore their perceptions of Haigh’s (2013) quintessence principles and any further additional therapeutic features in the environment not captured by the theory. Findings: All five quintessence principles were identified in the LDTC environment. Some limits to the principle of “agency” were highlighted, with specific reference to difficulties implementing a flattened hierarchy in a forensic setting. Additional therapeutic features were identified including; security and risk, responsivity, and more physical freedom which appear to aid implementation of the quintessence principles. Research limitations/implications: The study was performed within a single case study design. Therefore, results remain specific to this LDTC. However, the finding of these principles in such a unique setting may indicate Haigh’s (2013) quintessence principles are evident in other TC environments. Originality/value: This is the first research paper that has attempted to test whether Haigh’s (2013) quintessence principles are evident within a given therapeutic community. The research provides empirical evidence for the quintessence principles in a novel TC setting and suggests recommendations for future research. (Publisher abstract)
Mental Health Act: a focus on restrictive intervention reduction programmes in inpatient mental health services
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2017
- Pagination:
- 20
- Place of publication:
- Newcastle upon Tyne
This resource shares examples of good practice around reducing the use of restrictive practices from five NHS mental health trusts. The examples cover the following topics: improved leadership and governance; a programme to reduce restrictive; supporting positive behaviour; providing person-centred care; and embedding a positive and therapeutic culture. To show how the five examples relate to the Mental Health Act Code of Practice, the resource includes the appropriate standard from the Code alongside each example. (Edited publisher abstract)