The development of an evaluation questionnaire for the Newcastle Crisis Assessment and Home Treatment Service: finding a way to include the voices of service users

Treating mental health crises at home: Patient satisfaction with home nursing care

WHAT IS KNOWN ON THE SUBJECT?: Most studies have focused on whether hospital admissions have been reduced by the introduction of crisis services, rather than focusing on how these services are employed. Research has also shown that home assistance decreases costs and increases the level of patient satisfaction, thereby being more efficient in terms of the cost/effectiveness ratio than is traditional hospital care. Patient satisfaction with nursing care has long been identified as a key element of quality of care; however, satisfaction with nursing care among patients and families receiving crisis resolution at home has not been studied yet. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: There is limited research on patient satisfaction with CRHTTs. This study provides new insights and data including that on relationships between patient satisfaction and the teams' attention to person-centred mental health care. The difference between this study and other studies on patient satisfaction with crisis resolution home treatment teams is that this study focused on patients' and families' satisfaction with the nursing care provided by crisis resolution home treatment teams rather than with the general service provided. This study is the first of its kind with such a focus. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research has both academic and clinical implications. Patients' and their families' satisfaction with nursing care is an integral aspect for evaluating mental health services, and this is especially important regarding services provided by crisis resolution home treatment teams because such teams are currently being introduced in countries such as Spain. Closely examining patients and families' satisfaction with nursing care can also foster improvements in current practices. Nurses in crisis teams might need to focus on equalizing power relations, which the data gathered in this study suggests is most important to patient satisfaction. ABSTRACT: Introduction Crisis resolution home treatment teams (CRHTT) provide short-term, intensive home treatment to people experiencing mental health crises. Patient satisfaction has long been identified as a key element of quality of care; however, satisfaction with nursing care as part of this service has not been studied yet. Aim To assess patients' and their families' satisfaction with the nursing care provided through a home care program offered by a hospital in Catalonia which administers person-centred care. Method A mixed methods research design was conducted. A cross-sectional study including quantitative survey data and qualitative interview data with a phenomenological focus was conducted. Results Twenty interviews were conducted. Patients and relatives reported high satisfaction that seems to be related to the person-centred nature of the care. Discussion The findings provide new insights, including how home treatment tends to equalize power relations between nurses and patients/the patient's family members, and how nurses increase sensitivity when focusing on service users' needs and priorities, leading to high patient and family satisfaction. Implications for practice This research has both academic and clinical implications. It highlights what mental health patients and their families value most about home care and interactions with nurses, and also drives improvements in current practices.

Engaging patients to improve quality of care: a systematic review

BACKGROUND

To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services.

METHODS

We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients' experiences of being engaged.

RESULTS

Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign-discrete products largely derived from low-level engagement (consultative unidirectional feedback)-whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients' experiences of the engagement process (n = 12; 25%). While most experiences were positive-increased self-esteem, feeling empowered, or independent-some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made.

CONCLUSIONS

Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients' experiences of the engagement process and whether these outcomes translate into improved quality of care.

REGISTRATION

N/A (data extraction completed prior to registration on PROSPERO).

Experiences of mental health services by people with intellectual disabilities from different ethnic groups: a Delphi consultation

BACKGROUND

Patient experience of those accessing mental health services has been found to be different between ethnic groups. Although the needs of people with intellectual disabilities (ID) from different ethnic communities are being increasingly recognised, little has been published about their experiences of mental health services. The aim of this study was to establish whether there are any differences in the experiences of people with ID and mental health problems from two ethnic communities in South London.

METHOD

A two-round Delphi process was utilised. White British and Black or Black British service users from a specialist community-based mental health service for adults with ID completed a specially compiled questionnaire. Statements on participants' experiences, including satisfaction with care, staff members' attitudes, cultural awareness and level of support, were rated using a Likert scale.

RESULTS

Twenty-four out of 32 participants (75%) completed both rounds of the Delphi consultation. Consensus (≥80% agreement with the group median) was reached for 20 items in the White group and five items in the Black group. All responses that reached consensus were positive about the services that were being received. The Black group were less positive about a range of their experiences, including the use of medication.

CONCLUSIONS

People with ID from two ethnic groups were able to successfully complete a Delphi consultation regarding their experiences of mental health services. Broad consensus on positive experiences of services was reached in the White group but not for the Black participants.

Crisis resolution and home treatment: structure, process, and outcome - a literature review

ACCESSIBLE SUMMARY

• During the last ten years there has been a major change in developing mental health services generally, and crisis resolution and home treatment (CRHT) services especially. Many Western countries have made a shift in perspective from in-hospital care to home treatment. The new approach is based on treating people who experience mental health crises in their homes instead of through hospitalization. • Most of the published articles on CRHT focus on structural issues pertaining to the development of home treatment services, and on macro-level outcomes such as cost-effectiveness and admission rates. These have political, economic, and practical implications. Few articles describe clinical intervention methods used in home treatment. • This paper explores how home treatment is described as an essential intervention method in crisis resolution at home in relation to three key characteristics of CRHT, which are being mobile, working in the service user's home, and working together with the person's family and network. • There remains a need for further research describing specific characteristics of home treatment, different clinical interventions that are used by CRHT teams, and the directions with which clinical interventions need to be developed further. It is critical to investigate what makes the interventions of the CRHT teams different from the hospital care, and how this affects the service users, the family and the networks, and the professionals.

ABSTRACT

The objective of this paper is to explore and systematize the existing knowledge regarding the structure, process, and outcome of crisis resolution and home treatment (CRHT) as a form of community mental health service. Data sources are published peer-reviewed articles. Our study selection is systematic search for peer-reviewed articles written in English and Norwegian published between January 2000 and December 2008. Data are extracted from review of published articles on the subject of CRHT team and home treatment. We identified 35 articles including 6 reviews, consisting of quantitative and qualitative studies. The knowledge regarding CRHT focuses on three areas: (1) structure in terms of the standards, organization, and development; (2) process in terms of clinical interventions; and (3) outcome in relation to cost-effectiveness and admission rates. While the structural issues were presented and discussed a great deal, there is a paucity of articles on clinical intervention methods in home treatment as well as a limited attention on outcomes at the micro-level. There is a need for further studies regarding the clinical work of CRHT teams from the home treatment perspective.

Service users' experiences with help and support from crisis resolution teams. A literature review

BACKGROUND

Services for crisis resolution provided by home treatment teams are recent developments in the mental health care scene. There is a lack of systematized reviews in the service users' responses to these services.

AIM

To systematize the existing knowledge regarding the service users' experiences with crisis resolution and home treatment (CR/HT) teams in order to explore ways to develop this form of service further.

METHOD

A systematic review of the periodical literature and research reports on CR/HT was carried out for the period from January 1995 to January 2009.

RESULTS

A total of 13 papers, one RCT review and two reports were identified, including both qualitative and quantitative studies. Although these studies provided few in-depth details, three major themes as the characteristics of CR/HT teams are extracted as: (a) access and availability, (b) being understood as "normal" human beings, and (c) dealing with crises in an everyday life context.

CONCLUSIONS

The findings suggest that the key positive characteristics of help in crisis situations are intrinsically tied to the values and principles undergirding CR/HT services. The commitment to community-based services, the philosophy of partnership, and user-empowerment seem to the base from which these three themes of positive experiences emerged.

Consumer participation in mental health in Australia: what progress is being made?

OBJECTIVE

Historically, people living with mental illness have had limited chance to participate in mental health services other than as patients. This has led to serious negative consequences for their health and wellbeing. Recent public policy has aimed at redressing this situation. This paper sets out to investigate the 'state of play' regarding consumer participation in mental health services.

CONCLUSIONS

Consumer participation is not a common topic in the recent literature, despite the significant public policy push to promote it. Although the vision of public policy is for consumers to be at the centre of decision making, the changes are understandably slow in coming. The implications for the practice of psychiatry, and therefore mental health services, of the demands for meaningful participation are profound. They challenge some of the social covenants under which mental health services have historically been delivered. Traditionally, people living with a mental illness have not had their rights respected. In recent times, the College has developed policies that aim to ensure that the rights of people living with a mental disorder are respected. These policies also acknowledge that effective health care requires collaboration with consumers.

Expanding roles within mental health legislation: an opportunity for professional growth or a missed opportunity?

This paper aims to highlight both the necessity, and the way forward for mental health nursing to integrate proposed legislative roles into practice. Argued is that community mental health nursing, historically absent from active participation within mental health law in the UK, is faced with new and demanding roles under proposed changes to the 1983 Mental Health Act of England and Wales. While supporting multidisciplinary training for such roles, the imperative of incorporating nursing specific values into consequent training programs is addressed through the offered educative framework. This framework explores the issues of power, ethics, legislative thematics and application to contemporary service structures.

Mental health crisis at home: service user perspectives on what helps and what hinders

This paper presents data which emerged during the process of a participatory research study to identify the perspectives of previous users of a home treatment service. Feedback was sought in order to establish the criteria for the development of a service evaluation questionnaire. Seven themes emerged from the data which were then used as a framework for the evaluation questionnaire. These themes have also been used within this paper to present what our participants told us was important to them when they received a service at home at a time of mental health crisis. Although what is described here is the experience of one group of service users in the North of England, we hope that the views of these participants will create a resonance with providers of other home treatment services and expand the knowledge about which aspects of care at home during mental health crisis are viewed as helpful and those aspects which are not.