Collaboration as a process and an outcome: Consumer experiences of collaborating with nurses in care planning in an acute inpatient mental health unit

This qualitative study explores inpatient mental health consumer perceptions of how collaborative care planning with mental health nurses impacts personal recovery. Semi‐structured interviews were conducted with consumers close to discharge from one unit in Sydney, Australia. The unit had been undertaking a collaborative care planning project which encouraged nurses to use care plan documentation to promote person‐centred and goal‐focussed interactions and the development of meaningful strategies to aid consumer recovery. The interviews explored consumer understandings of the collaborative care planning process, perceptions of the utility of the care plan document and the process of collaborating with the nurses, and their perception of the impact of collaboration on their recovery. Findings are presented under four organizing themes: the process of collaborating, the purpose of collaborating, the nurse as collaborator and the role of collaboration in wider care and recovery. Consumers highlighted the importance of the process of developing their care plan with a nurse as being as helpful for recovery as the goals and strategies themselves. The findings provide insights into consumers’ experiences of care planning in an acute inpatient unit, the components of care that support recovery and highlight specific areas for mental health nursing practice improvement in collaboration.     

Consumer satisfaction with services in a regional psychiatric hospital: a collaborative research project in Kentucky

Consumer satisfaction with mental health services is a dimension of outcome. This report is on a university and state mental health department research project that involved development of the Kentucky Consumer Satisfaction Instrument (KY-CSI) and a retrospective, cross-sectional study designed to measure consumer satisfaction with services at a regional psychiatric hospital. Triangulation of methods guided the survey of participants (N = 189) near discharge from the hospital during a 6-month period. Research associates, who were former consumers of mental health services, collected data during face-to-face interviews. Most participants were unemployed White men. Factor analysis indicated the 19-item instrument was unidimensional; Cronbach's alpha was 0.90. Multiple regression indicated predictors of satisfaction were levels of education and diagnosis. As education increased, satisfaction decreased; participants with a diagnosis of bipolar disorder tended to be more satisfied than those with other diagnoses. Analysis of qualitative data combined with standardized summary of KY-CSI items indicated participants were most satisfied with opportunities to talk with other patients and least satisfied about lack of involvement of people with whom they lived in discharge planning. Study findings guided recommendations for quality of care and additional studies at other hospital sites.     

Perceptions of crisis care in populations who self‐referred to a telephone‐based mental health triage service

Although psychiatric crises are very common in people with mental illness, little is known about consumer perceptions of mental health crisis care. Given the current emphasis on recovery‐oriented approaches, shared decision‐making, and partnering with consumers in planning and delivering care, this knowledge gap is significant. Since the late 1990s, access to Australian mental health services has been facilitated by 24/7 telephone‐based mental health triage systems, which provide initial psychiatric assessment, referral, support, and advice. A significant proportion of consumers access telephone‐based mental health triage services in a state of crisis, but to date, there has been no published studies that specifically report on consumer perceptions on the quality and effectiveness of the care provided by these services. This article reports on a study that investigated consumer perceptions of accessing telephone‐based mental health triage services. Seventy‐five mental health consumers participated in a telephone interview about their triage service use experience. An eight‐item survey designed to measure the responsiveness of mental health services was used for data collection. The findings reported here focus on the qualitative data produced in the study. Consumer participants shared a range of perspectives on telephone‐based mental health triage that provide invaluable insights into the needs, expectations, and service use experiences of consumers seeking assistance with a mental health problem. Consumer perceptions of crisis care have important implications for practice. Approaches and interventions identified as important to quality care can be used to inform educational and practice initiatives that promote person‐centred, collaborative crisis care.     

Beliefs about using consumer consultants in inpatient psychiatric units

A key recommendation of consumer organizations and governments has been the employment of consumer consultants in inpatient psychiatric facilities, but the attitudes of mental health clinicians towards this measure remain inconsistent. The aims of this study were to examine mental health clinicians' attitudes about the role of mental health consumer consultants in inpatient psychiatric units, and to ascertain if participants' age, type of inpatient unit, or grade of staff influenced their attitudes towards consultants. The Consumer Participation and Consultant Questionnaire was used, which was adapted from the Mental Health Consumer Participation Questionnaire. A convenience sample of 47 mental health professionals from two adult inpatient psychiatric units located in a large Australian public general hospital participated in the study. The findings, overall, showed that participants supported the inclusion of consumer consultants in psychiatric units in areas that indirectly impinged on their current roles. Age, level of nurses, and place of employment did not affect their beliefs, but type of occupation was influential. Nurses were less supportive of aspects of consumer consultants' roles that overlapped with the traditional roles of the nurse. The findings have implications for clinical practice, education, and further research, and these are discussed.     

Mental health consumer perspectives of a person-centred multidisciplinary care planning meeting on a rehabilitation inpatient unit

Mental health consumers are seeking genuine involvement in the planning regarding their treatment and care; however for many consumers in inpatient mental health settings, there is not the opportunity to participate. Current research evaluating person-centred multidisciplinary care planning initiatives in inpatient settings from the consumer perspective is limited. The aim of this study was to explore the consumer perspective of a person-centred multidisciplinary care planning meeting implemented in an Australian inpatient mental health rehabilitation unit. This study used a focused ethnographic design with data collection including fieldnotes, observations of meetings and interviews. Ten individuals participated in the study, with two participating in meeting observations and eight participating in structured interviews. Participants were consumers with a mental health diagnosis admitted to a mental health rehabilitation unit for assistance with achieving their goals for community living. Findings were analysed utilizing thematic analysis. Findings showed that consumers' experiences of the care planning meetings were positive. Themes included; ‘It's about you’, ‘Making decisions and expressing opinions’, ‘Staff involvement in care planning’ and ‘Supporting consumer recovery’. These findings add the consumer perspective to the existing evidence base and support the implementation of person-centred multidisciplinary care planning meetings in inpatient mental health settings.     

Consumers in mental health service leadership: A systematic review

Contemporary mental health policies call for greater involvement of mental health service consumers in all aspects and at all levels of service planning, delivery, and evaluation. The extent to which consumers are part of the decision‐making function of mental health organizations varies. This systematic review synthesizes empirical and review studies published in peer‐reviewed academic journals relating to consumers in leadership roles within mental health organizations. The Cochrane Library, Medline, and PsycINFO were searched for articles specifically analysing and discussing consumers’ mental health service leadership. Each article was critically appraised against the inclusion criteria, with 36 articles included in the final review. The findings of the review highlight current understandings of organizational resources and structures in consumer‐led organizations, determinants of leadership involvement, and how consumer leadership interacts with traditional mental health service provision. It appears that organizations might still be negotiating the balance between consumer leadership and traditional structures and systems. The majority of included studies represent research about consumer‐run organizations, with consumer leadership in mainstream mental health organizations being less represented in the literature. Advocates of consumer leadership should focus more on emphasizing how such leadership itself can be a valuable resource for organizations and how this can be better articulated. This review highlights the current gaps in understandings of consumer leadership in mental health, including a need for more research exploring the benefits of consumer leadership for other consumers of services.     

Telephone survey of service‐user experiences of a telephone‐based mental health triage service

The participation of service users in all aspects of mental health service delivery including policy development, service planning and evaluation is increasingly an expectation of contemporary mental health care. Although there are a growing number of publications reporting service‐user perspectives in the evaluation of mental health services, little attention has been paid to the views of service users about mental health triage services. The purpose of the study reported here was to examine service‐users' (consumers and informal carers) experiences of a telephone‐based mental health triage service. Using a framework developed from the World Health Organisation's elements of responsiveness, we conducted structured telephone interviews with service users who had contacted a telephone‐based mental health triage service in regional Victoria, Australia. The main findings of the study were that consumers experienced more difficulty than carers in accessing the service and that, although most participants were satisfied, only a minority reported being involved in decision‐making. Further work is needed to improve accessibility of mental health triage services and to investigate barriers to consumer self‐referral. Professional development and practice support systems should be established to support mental health triage nurses in the development of collaborative, consumer‐focused care.     

Mental health professionals' attitudes towards consumer participation in inpatient units

Consumer participation has been a major focus in mental health services in recent years, but the attitudes of mental health professionals towards this initiative remain variable. The purpose of this study was to describe mental health professionals' attitudes towards mental health consumer participation in inpatient psychiatric units. The Consumer Participation and Consultant Questionnaire was used with a non-probability sample of 47 mental health professionals from two adult inpatient psychiatric units situated in a large Australian public general hospital. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using SPSS, Version 12. Overall, respondents had favourable attitudes towards consumer participation in management, care and treatment, and mental health planning. They were less supportive about matters that directly or indirectly related to their spheres of responsibility. The type of unit that the respondents worked in was not a factor in their beliefs about consumer participation. Recommendations are made about the development of guidelines for consumer participation in inpatient units, the educational preparation of mental health clinicians, and the need for mental health professionals to reflect on, and discuss their own beliefs and practices about, consumer participation.     

Mental health clinicians' attitudes about consumer and consumer consultant participation in Australia: A cross-sectional survey design

Abstract   The purpose of this study was to assess mental health clinicians' attitudes about mental health consumer participation in inpatient psychiatric units. A cross-sectional survey design was used with a non-probability sample of 47 clinicians in the psychiatric units of a large Australian hospital. The results showed that gender, length of time as a clinician, and how long the staff worked in the units influenced their attitudes about consumer involvement. Females were more likely than males to support consumer participation in management and consumer consultants. Less experienced staff showed greater support than more experienced staff for mental health consumer involvement in treatment-related matters and consumer consultants in units. New staff members were more likely to register agreement-to-uncertainty regarding consumer involvement in treatment-related issues, whereas established staff members were more likely to record uncertainty about this issue. The findings showed that although reports and policies promoted participation, some clinicians were reluctant to accept consumer and consultant involvement.     

Children of parents with a mental illness visiting psychiatric facilities: perceptions of staff

Children of parents with mental illness have been identified as a hidden population within mental health services, despite many clients being parents. In Australia, children of parents with a mental illness have been the focus of initiatives aimed at promoting their health and well-being and developing family-focused services. However, there has been little focus on children visiting acute inpatient mental health facilities. The aim of this study was to understand the experiences of children, their parents and carers, and staff when children visit, to better inform service planning. A qualitative exploratory research framework was used, and data were gathered through interviews. This paper presents the findings from the perspective of staff. Findings indicated that staff experienced being in a dilemma about children visiting and there were barriers to implementing family-friendly services. While staff mostly agreed in principle that children's visiting was beneficial, there was a lack of local policy and guidelines, and ad hoc arrangements existed. In addition, staff were unsure of their role with children, felt ill-equipped to talk to children about mental illness; and lacked knowledge of age-appropriate resources. Models of inpatient care need to be developed with a family focus that acknowledges the parental roles of clients and supports children visiting.     

Using and understanding consumer satisfaction to effect an improvement in mental health service delivery

Consumer satisfaction is today, widely accepted as a measure of the level and quality of service received by consumers. The aim of this survey-based study is to explore consumer satisfaction with quality of care, staff, environment and discharge in a south eastern Sydney adult acute inpatient mental health unit. A cross-sectional analysis is pursued in order to identify aspects of the patient stay, which form an associative relationship with an overall rating of consumer satisfaction on a 10-point scale. During the survey period, there were 182 discharges. Seventy questionnaires (38.5%) were returned from this group. The survey results highlight a number of areas of identified need, enabling the service to prioritize organizational systems around meeting these needs. Multiple regression analysis identified three items in the survey, which were independently significant associates of overall consumer satisfaction. They included being happy with the service provided by the consumer support worker, having support for services on discharge and feeling safe and secure on the ward. The model containing these three items accounted for 50% of the variation in overall satisfaction. Two primary interventions have been developed because survey administration which, it is hoped, will address issues raised in the survey. The interventions were the development of an admission and discharge pathway and a ward-based psychosocial intervention programme, which includes the involvement of consumer support workers.     

The impact of workplace culture on the accountability of mental health nurses to involve consumers in care planning: A focused ethnography

Recovery‐oriented mental health practice guidelines recommend regular consumer involvement in care plans, yet in many acute settings, these are not routinely created thereby compromising accountability. This study explored the impact of workplace culture on the capacity of mental health nurses to involve consumers in care planning and consequently to work accountably. A focused ethnography was undertaken in one Australian inpatient unit involving mental health nurses and other health professionals. Data were derived from in‐depth semistructured interviews with 12 nurses and 6 months of nonparticipant observation of multidisciplinary meetings and clinical handovers. Workplace culture had an impact on mental health nurses' accountability practices. A culture that prioritized reduction in length of stay resulted in less recovery‐oriented care. Health professionals who paid more attention to crisis and risk management resulted in fewer opportunities for consumer‐involved care planning.     

Involving clients in programme evaluation and research: a new methodology for occupational therapy

Eliciting client satisfaction with services has become common in mental health settings and in the planning of service delivery systems. It is also compatible with the client-centred practice of occupational therapy. The traditional approach to collecting satisfaction information involves staff interviewing clients using questionnaires developed by staff. However, there is often a lack of variability in responses and the vast majority of clients report being satisfied. A review of the literature reveals that these favourable reports may be a result of social desirability and of clients being interviewed by treatment providers who have the power to give or withhold care. This paper reviews the relationship between occupational therapy and client involvement, examines the rationale for involving clients in programme evaluation and research, reviews the limitations with traditional methods of collecting information about client satisfaction, and discusses how clients are involved in evaluation and research in today's mental health care setting.     

Consumer perspectives on quality of inpatient mental health services

This study, conducted at two public-sector psychiatric hospitals in a south-eastern state, investigated satisfaction with inpatient services and treatment outcomes among 204 hospitalized mental health consumers. A simple survey design with nonrandom sampling technique was used; instruments included the KY-CSI, the 21-item MHSIP Consumer Survey, and the CSQ-8. Respondents reported satisfaction with time available to be with other patients, staff availability, and their degree of comfort talking to staff. Areas of dissatisfaction included lack of client input into treatment planning, lack of family involvement, and lack of medication education. Providers are encouraged to include clients in all phases of treatment planning and to continue to evaluate consumer perspectives of quality services.     

Mental health nurses’ attitudes towards consumer involvement in nursing handover pre and post an educational implementation

Involving mental health consumers in nursing handover is a recent introduction to practise in acute mental health units. However, implementation must recognize that mental health care is complex and the approach needs to include recovery‐focused philosophies of practice. Evidence shows that nurses and other health professionals consider poor handover practices may be the source of adverse events; however, the views of mental health nurses about involving consumers in nursing handover have not been previously reported. The aim of this study was to identify nurses’ attitudes towards consumer involvement in handover and to measure the effect of a training programme upon these attitudes. A single‐group pre‐post‐test intervention study was undertaken. The study was conducted on the adult acute mental health inpatient unit of a major metropolitan hospital in Victoria, Australia, 2016–2017. Questionnaires were developed to capture the views of the nurses about proposed changes in the afternoon nursing handover process. A questionnaire was administered before and after the training intervention, an innovative, multi‐media education handover package. We found that training had a significant influence on mental health nurses’ attitudes towards involving consumers in the handover. Therapeutic engagement improved following training and miscommunication reduced when all players are informed and have the opportunity to engage with the information. This study has demonstrated that well‐planned education can influence nurses’ attitudes about involving consumers in the nursing handover processes.     

Police and mental health clinician partnership in response to mental health crisis: A qualitative study

Police officers as first responders to acute mental health crisis in the community, commonly transport people in mental health crisis to a hospital emergency department. However, emergency departments are not the optimal environments to provide assessment and care to those experiencing mental health crises. In 2012, the Northern Police and Clinician Emergency Response (NPACER) team combining police and mental health clinicians was created to reduce behavioural escalation and provide better outcomes for people with mental health needs through diversion to appropriate mental health and community services. The aim of this study was to describe the perceptions of major stakeholders on the ability of the team to reduce behavioural escalation and improve the service utilization of people in mental health crisis. Responses of a purposive sample of 17 people (carer or consumer advisors, mental health or emergency department staff, and police or ambulance officers) who had knowledge of, or had interfaced with, the NPACER were thematically analyzed after one‐to‐one semistructured interviews. Themes emerged about the challenge created by a stand‐alone police response, with the collaborative strengths of the NPACER (communication, information sharing, and knowledge/skill development) seen as the solution. Themes on improvements in service utilization were revealed at the point of community contact, in police stations, transition through the emergency department, and admission to acute inpatient units. The NPACER enabled emergency department diversion, direct access to inpatient mental health services, reduced police officer ‘down‐time’, improved interagency collaboration and knowledge transfer, and improvements in service utilization and transition.     

Development and evaluation of a training program in peer support for former consumers

While mental health policy in Australia promotes the involvement of mental health consumers in service planning, implementation and evaluation, little has been reported on the training required for the new roles that consumers are being expected to undertake. In this study, 10 former consumers of mental health services participated in a 16-week training program in peer support. The impact of the program on the psychological well-being of the participants was assessed using a battery of self-evaluation questionnaires and focus group interviews. Findings suggest that exposure to people with acute mental health problems (i.e. inpatients), did not, in this instance, adversely impact on the psychological well-being of the participants. Barriers to consumer participation in the mental health field are discussed and recommendations for the content and structure of future consumer peer support training initiatives are proposed.