Relationships key to mental health recovery, says new study

A paper has been published highlighting the key results of a major 2016 study which reveals that mental health service users see the relationships with their care coordinators as being central to their recovery and feel that care plans are largely irrelevant.

Michael CoffeyThe study, which is published in BioMed Central Psychiatry, was carried out by mental health researchers at Swansea University, City University London and Cardiff University, and coincides with Mental Health Awareness week (16-22 May 2016).

Dr Michael Coffey, a specialist in research on the delivery and organisation of community mental health care at Swansea University with researchers Professor Alan Simpson of City University London, and Drs Aled Jones and Ben Hannigan from Cardiff University, contributed to the development of the idea, the design and the conduct of the study.

Dr Coffey (pictured) 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.”

To find out more about how community mental health care was planned and coordinated, the research team from City University London, Swansea and Cardiff universities - conducted a cross-national comparative study involving six NHS sites in England and Wales that included a survey of 449 service users and 201 care coordinators. They also conducted interviews with 117 managers, practitioners, service users and carers.

Dr Coffey said: “A key feature of the study is that we worked with people who have experience of using mental health services as co-researchers on this project so that our research approach was meaningful to people who actually use services.

“The project yielded three key findings; firstly, we found that people using mental health services place substantial value on the quality of their relationships with staff in contrast to the value placed on written care plans, and although care plans are vital documents for managers and professionals, service users rarely return to them once they are complete.

“A second significant finding relates to risk. Our study showed that workers are acutely aware of the need to assess and manage risk, but that they do not routinely discuss this part of their work with service users or their families. This is a missed opportunity to learn, and to share responsibility.

“Thirdly, the study revealed that care coordinators saw care plans as a useful record but also as an inflexible administrative burden that restricted time with service users.

“This study has highlighted the need to find new ways to maximise therapeutic time with service users and staff at the same time seeking ways to reduce the administrative burden of preparing lengthy care documents. We also need to identify a method of addressing risk that is inclusive of service users and their families.

“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.”

Speaking about the research, Alan Simpson, Professor of Collaborative Mental Health Nursing at City University London, 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.”

The project reported in this article was commissioned by the National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (HS&DR 11/2004/12). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, the National Health Service (NHS) or the Department of Health.

The new paper is published on the BioMed Central website.