Collaborative research between users and professionals: peaks and pitfalls

State of the Art of Participatory and User-led Research in Mental Health in Brazil: A Scoping Review

Background

Participatory research denotes the engagement and meaningful involvement of the community of interest across multiple stages of investigation, from design to data collection, analysis, and publication. Traditionally, people with first-hand experience of psychiatric diagnoses, services users and those living with a psychosocial disability have been seen objects rather than agents of research and knowledge production. This, despite the ethical and practical benefits of their involvement. The state of the art of knowledge about participatory research in mental health Brazil is poorly understood outside of its local context. The purpose of this article was to conduct a scoping review of participatory and user-led research in mental health in Brazil.

Findings

We identified 20 articles that met eligibility criteria. Participation in research was not treated as separate from participation in shaping mental health policy, driving care, or the broader right to fully participate in societal life and enjoy social and civil rights. Studies identified several obstacles to full participation, including the biomedical model, primacy of academic and scientific knowledge, and systemic barriers. Our extraction, charting, and synthesis yielded four themes: power, knowledge, autonomy, and empowerment.

Implications of the work

Participation in this context must address the intersecting vulnerabilities experienced by those who are both Brazilian and labeled as having a mental illness. Participatory research and Global South leadership must foreground local epistemologies that can contribute to the global debate about participation and mental health research.

From participants to partners: reconceptualising authentic patient engagement roles in youth mental health research

The value of involving people with lived experience in the research process (ie, patient engagement) is increasingly being recognised within youth mental health research. The wide-reaching benefits of patient engagement have been documented in the literature, including the empowerment of patients, improvement of research outcomes, and increased relevance of research findings. Although various models exist to guide patient engagement, there are key concepts that deserve exploration to ensure the authentic implementation of these models and development of patient roles. Our Personal View aims to: identify and discuss barriers to patient engagement roles in the context of youth mental health research; consider how key concepts of relational empowerment, fluidity, and flexibility can address some of these barriers; and provide tangible recommendations for implementing authentic patient engagement throughout the research process.

Informed consent, genomic research and mental health: A integrative review

BACKGROUND

Research on genomics has increased while the biobank activities are becoming more common in different countries. In the mental health field, the questions concerning the potential participants' vulnerability as well as capacity to give the informed consent can cause reluctancy in recruiting persons with mental health problems, although the knowledge and understanding of mental health problems has remarkable changed, and practice is guided with inclusive approaches, such as recovery approach.

AIM

The aim of this study was to describe the current knowledge of informed consent practices in the context of genomic research on mental health from the nurses' viewpoint.

METHODS

An integrative review was conducted with search from seven international databases. Data consist 14 publications which were analyzed with thematic analysis.

ETHICAL CONSIDERATIONS

Ethical requirements were respected in every phase of the research process.

FINDINGS

Most of the papers were published in USA and between 2000-2010. Eight reports were categorized as discussion papers, four qualitative studies and one quantitative study. The thematic analysis provided information on five themes: complexity with the capacity to consent, mixed emotions towards participation, factors influencing the decision to participate, nurses' informed consent process competence and variations between consent procedures.

DISCUSSION

In the informed consent practices, there are various aspects which may affect both the willingness to participate in the study and the informed consent process itself. Implications for practice, education, research, and policies are discussed.

CONCLUSION

There is a need for more updated international research on the topic in the context of different international and national guidelines, legislation, and directives. This study provided a viewpoint to the more collaborative research activities with people with lived experiences also in this field of research following the ideas of recovery approach.

"It's a life you're playing with": A qualitative study on experiences of NHS maternity services among undocumented migrant women in England

BACKGROUND

Undocumented migrant women experience complex barriers to maternity services, are less likely to receive the recommended level of maternity care, and have poorer obstetric outcomes than non-migrant women. There are concerns increasing restrictions on entitlement to health services have a detrimental impact on access to services and obstetric outcomes, particularly among undocumented migrant women. The study aimed to investigate the experiences of undocumented migrant women who have been pregnant in England, and factors affecting access to care and health outcomes.

METHODS

We conducted in-depth semi-structured interviews June-December 2017 with a purposive sample of migrant women born outside the UK (aged>18) who had experiences of pregnancy and undocumented status (without permission to reside) in the UK, recruited through Doctors of the World (DOTW) UK. Interpreting services were used on request. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval: Imperial College London Research Ethics Committee (ICREC reference: 17IC3924).

RESULTS

Semi-structured interviews were conducted with 20 participants, 10 of whom had their first antenatal appointment after the national target of 13 weeks, and nine of whom reported complications. Themes defining women's experiences of pregnancy included: restricted agency, intersecting stressors, and an ongoing cycle of precarity, defined by legal status, social isolation, and economic status.

CONCLUSIONS

This study provides new evidence of women's experiences of pregnancy in the UK in the context of increasingly restrictive health policies including charging and data sharing. Six recommendations are made to ensure the UK and other migrant receiving countries work towards reducing inequalities and achieving national and global targets for maternal and child health and universal health coverage.

A participatory study of patient views on psychotherapy for complex post-traumatic stress disorder, CPTSD

BACKGROUND

A new diagnosis of Complex Post-traumatic Stress Disorder, CPTSD, is included in ICD-11 which was adopted in May 2019 by the World Health Organisation, WHO. In addition to the symptoms of PTSD, CPTSD includes emotional dysregulation, negative self-concept, and disturbances in relationships. It may be a helpful diagnosis for trauma survivors with experiences of human mistreatment such as torture and abuse.

AIMS

This study explores the views of patients in the community on psychotherapy for the diagnosis of CPTSD, taking a qualitative, participatory approach.

METHOD

Twenty-four former patients from an NHS secondary mental health service in London interviewed each other about their treatment. Participants also collaborated in data analysis. All had a diagnosis of PTSD, with additional symptoms of CPTSD identified at assessment.

RESULTS

The key factor in recovery was rebuilding relationships, beginning with the therapist. Groupwork was helpful in promoting relationships with others, as it may result in shame reduction. Involvement in the wider community through peer support groups was also valuable.

CONCLUSIONS

The rebuilding of relationships based on trust was an active mechanism of change and recovery from CPTSD. Participants felt that sufficient time, at least one year of psychotherapy with weekly sessions, was needed.

Value and learning from carer involvement in a cluster randomised controlled trial and process evaluation - Organising Support for Carers of Stroke Survivors (OSCARSS)

BACKGROUND

Patient, Carer and Public Involvement (PCPI) should be embedded in health care research. Delivering PCPI can be challenging, but even when PCPI is carried out it is rarely reported resulting in lost opportunities for learning. This paper aims to describe PCPI in the OSCARSS study, a pragmatic-cluster randomised controlled trial with an embedded economic and process evaluation.

METHODS

A carer research user group (RUG) co-developed OSCARSS to evaluate how to best deliver support to caregivers of stroke survivors. The PCPI activity involved regular meetings and preparatory work, from the initial conceptualisation of the study through to dissemination. Written reports, structured group discussions and individual interviews were carried out with the RUG and researchers to capture the added value and learning. This paper was co-authored by two of the RUG members with contributions from the wider RUG and researchers.

RESULTS

The core six members of the caregiver RUG attended the majority of the meetings alongside three researchers, one of whom was the co-chief investigator. PCPI was instrumental in changing many aspects of the research protocol, design and delivery and contributed to dissemination and sharing of good practice. There were challenges due to the emotional toll when PCPI members shared their stories and the extensive time commitment. Positive experiences of learning and fulfilment were reported by the individual researchers and PCPI members. Wider organisational administrative and financial support facilitated the PCPI. The researchers' existing positive regard for PCPI and the clear focus of the group were key to the successful co-design of this research.

CONCLUSIONS

The value and learning from the PCPI collaborative work with the researchers was of benefit to the study and the individuals involved. Specific PCPI influences were a challenge to pinpoint as successful co-design meant the researchers' and carers' contributions were intertwined and decision-making shared.

Embodying Experiences with Nature in Everyday Life Recovery for Persons with Eating Disorders

Eating disorders can be understood as attempts to manage a problematic relationship with one’s own body. The objective of this qualitative study was to explore and discuss perspectives of embodying “experiences with nature” related to recovery in everyday life for persons experiencing eating disorders. The study was carried out in the context of a hermeneutic phenomenological approach. Eight participants with an interest in nature and friluftsliv (outdoor pursuits), and with experiences with bulimia nervosa and/or binge-eating disorders, were interviewed twice. Interviews took place in nature, in combination with a “going together” method. The results reveal how the participants highlighted experiences with nature as accentuating feelings of calmness and an engagement of the senses. Participants described nature as a non-judgmental environment that also provided room for self-care. This article explores the implications of everyday life perspectives on nature in recovery, as well as of an integrated focus on body and mind in experiences with eating disorders. The article concludes with an emphasis on how participant’s embodying experiences with nature enabled a (re)connection with one’s own body.

'Dignity and respect': An example of service user leadership and co-production in mental health research

This paper explores the methodological aspects of a user‐led study investigating mental health service user experiences of targeted violence and abuse (often called 'hate crime'). 'Keeping Control' was a 16‐month qualitative study, undertaken in the context of adult safeguarding reforms in England. By collecting data on service user concepts and experiences, the research sought to address a gap in research and practice knowledge relating to targeted violence, abuse and hostility against people with mental health problems. In this paper, we discuss the significance of the design and methodology used for this study, with a particular focus on the interviews with service users. The research was both user‐led and carried out in collaboration with practitioners and academics, a form of research co‐production. Our aim is to inform researchers, practitioners and policymakers about the value of user leadership in co‐productive research with practitioners, particularly for a highly sensitive and potentially distressing topic.

Facilitators and barriers to co-research by people with dementia and academic researchers: Findings from a qualitative study

BACKGROUND

Public and patient involvement (PPI) is now established in dementia research. Barriers and facilitators to engagement from family carers and people in early stages of dementia have been explored. However, specific barriers and facilitators to co-research with people with dementia have not previously been investigated.

OBJECTIVE

To discover the facilitators of, and barriers to, involving people with dementia as co-researchers, from the perspectives of people with dementia, gatekeepers (family caregivers, ethics committee members, service providers) and researchers.

DESIGN

Thematic analysis of data from individual interviews about the co-research experience.

RESULTS

Four themes emerged from interviews with 19 participants (five people with dementia): "getting one's head round it" (assumptions about research and dementia; different forms of language); practicalities (eg transport; accessibility of communication); "this feeling of safety" (perceptions of danger, protectiveness and opportunities for building trust); and motivations ("making a difference" and "keeping doing").

CONCLUSIONS

Findings both replicate and extend previous knowledge on PPI in dementia. Cognitive capacity of potential co-researchers with dementia is only a part of the picture, with attitudes and expectations of researchers, gatekeepers and people with dementia also forming barriers. Researcher education, adequate resourcing, and both creativity and flexibility are needed to support recruitment of co-researchers with dementia and to enable meaningful co-research.

Power, Privilege and Knowledge: the Untenable Promise of Co-production in Mental "Health"

This paper examines the concept and practice of coproduction in mental health. By analyzing personal experience as well as the historical antecedents of coproduction, we argue that the site of coproduction is defined by the legacy of the Enlightenment and its notions of "reason" and "the cognitive subject." We show the enduring impact of these notions in producing and perpetuating the power dynamics between professionals, researchers, policy makers and service users within privileged sites of knowledge production, whereby those deemed to lack reason-the mad and the racialized mad in particular-and their knowledge are radically inferiorised. Articulating problems in what is considered knowledge and methods of knowing, we argue that modern "psy" sciences instantiates the privilege of reason as well as of whiteness. We then examine how the survivor movement, and the emergent survivor/mad knowledge base, duplicates white privilege even as it interrogates privileges of reason and cognition. Describing how we grapple with these issues in an ongoing project-EURIKHA-which aims to map the knowledge produced by service users, survivors and persons with psychosocial disabilities globally, we offer some suggestions. Coproduction between researchers, policy makers and those of us positioned as mad, particularly as mad people of color, we argue, cannot happen in knowledge production environments continuing to operate within assumptions and philosophies that privilege reason as well as white, Eurocentric thinking. We seek not to coproduce but to challenge and change thinking and support for psychosocial suffering in contexts local to people's lives.

Patient involvement in improving the evidence base on mental health inpatient care: the PERCEIVE programme

Background

Despite the movement towards care in the community, 40% of the NHS budget on mental health care is still attributed to inpatient services. However, long before the Francis Report highlighted grave shortcomings in inpatient care, there were reports by service user groups on the poor quality of these services in mental health. The programme provides a particular focus on the inclusion of the patient’s perspective in the development and evaluation of evidence.

Objectives

To understand how changes to inpatient care affect the perceptions of the ward by service users and staff by using stakeholder participatory methods.

Design

The programme consisted of four work packages (WPs). (1) Lasting Improvements for Acute Inpatient SEttings (LIAISE): using participatory methods we developed two new scales [Views On Therapeutic Environment (VOTE) for staff and Views On Inpatient CarE (VOICE) for service users]. (2) Client Services Receipt Inventory – Inpatient (CITRINE): working with nurses and service users we developed a health economic measure of the amount of contact service users have with staff. The self-report measure records interactions with staff as well as the number of therapeutic activities attended. (3) Delivering Opportunities for Recovery (DOORWAYS): a stepped-wedge randomised controlled trial to test if training ward nurses to deliver therapeutic group activities would improve the perception of the ward by service users and staff. A total of 16 wards were progressively randomised and we compared the VOICE, VOTE and CITRINE measures before and after the intervention. A total of 1108 service users and 539 staff participated in this trial. (4) Bringing Emergency TreatmenT to Early Resolution (BETTER PATHWAYS) was an observational study comparing two service systems. The first was a ‘triage’ system in which service users were admitted to the triage ward and then either transferred to their locality wards or discharged back into the community within 7 days. The second system was routine care. We collected data from 454 service users and 284 nurses on their perceptions of the wards.

Main outcome measures

The main outcomes for the DOORWAYS and BETTER project were service user and staff perceptions of the ward (VOICE and VOTE, respectively) and the health economic measure was CITRINE. All were developed in WPs 1 and 2.

Results

We developed reliable and valid measures of (1) the perceptions of inpatient care from the perspectives of service users and nurses (VOICE and VOTE) and (2) costs of interactions that were valued by service users (CITRINE). In the DOORWAYS project, after adjusting for legal status, we found weak evidence for benefit (standardised effect of –0.18, 95% CI 0.38 improvement to 0.01 deterioration;p = 0.062). There was only a significant benefit for involuntary patients following the staff training (N582, standardised effect of –0.35, 95% CI –0.57 to –0.12;p = 0.002; interactionp-value 0.006). VOTE scores did not change over time (standardised effect size of 0.04, 95% CI –0.09 to 0.18;p = 0.54). We found no evidence of an improvement in cost-effectiveness (estimated effect of £33, 95% CI –£91 to £146;p = 0.602), but resource allocation did change towards patient-perceived meaningful contacts by an average of £12 (95% CI –£76 to £98;p = 0·774). There were no significant differences between the triage and routine models of admission in terms of better perceptions by service users (estimated effect 0.77-point improvement in VOICE score on the triage ward;p = 0.68) or nurses (estimated effect of 1.68-point deterioration in VOTE on the triage ward;p = 0.38) or in terms of the cost of the length of care provided (£391 higher on triage;p = 0.77).

Strengths and limitations

We have developed measures using methods involving both service users and staff from mental health services. The measures were developed specifically for acute inpatient services and, therefore, cannot be assumed to be useful for other services. For instance, extensions of the measures are under construction for use in mother and baby units. The strength of the BETTER PATHWAYS and DOORWAYS projects is the large-scale data collection. However, we were testing specific services based in inner city areas and stretching to inner urban areas. It may be that different effects would be found in more rural communities or in different types of inpatient care.

Future work

Our database will be used to develop an understanding of the mediating and moderating factors for improving care quality.

Trial registration

Current Controlled Trials ISRCTN06545047.

Funding

This project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 7. See the NIHR Journals Library website for further project information.

From problem people to addictive products: a qualitative study on rethinking gambling policy from the perspective of lived experience

BACKGROUND

Previous research has shown that government and industry discussions of gambling may focus on personal responsibility for gambling harm. In Australia, these discussions have largely excluded people with lived experience of problem gambling, including those involved in peer support and advocacy.

METHODS

We conducted 26 in-depth interviews with people with current or previous problem gambling on electronic gaming machines (EGMs) involved in peer support and advocacy activities, using an approach informed by Interpretive Policy Analysis and Constructivist Grounded Theory.

RESULTS

Participants perceived that government and industry discussed gambling as safe and entertaining with a focus on personal responsibility for problem gambling. This focus on personal responsibility was perceived to increase stigma associated with problem gambling. In contrast, they described gambling as risky, addictive and harmful, with problem gambling resulting from the design of EGMs. As a result of their different perspectives, participants proposed different interventions to reduce gambling harm, including reducing accessibility and making products safer.

CONCLUSIONS

Challenging the discourses used by governments and industry to describe gambling, using the lived experience of people with experience of gambling harm, may result in reduced stigma associated with problem gambling, and more effective public policy approaches to reducing harm.

Researching recovery from psychosis: a user-led project

Aims and Method

Involvement of service users in the research process and examination of recovery from psychosis are two topics that have generated recent interest within the research community. This user-led study examines the subjective experience of recovery in people with experience of psychosis. Seven interviews were analysed using interpretative phenomenological analysis and several themes emerged from the data.

Results

Recovery from psychosis was found to be a complex and idiosyncratic process, which often involved rebuilding life, rebuilding self and hope for a better future (each of these themes consisted of sub-themes).

Clinical Implications

The importance of continuity of care, the need for greater choice in approaches aimed at alleviating distress, access to stories of recovery and encouragement, and the importance of more individualised recovery care plans are among factors highlighted.

Outcomes identified and prioritised by consumers of Partners in Recovery: a consumer-led study

BACKGROUND

Recovery oriented service provisions means focusing on outcomes that are important to consumers themselves rather than to clinicians or services. Partners in Recovery (PIR) is an Australia-wide initiative designed to provide service coordination and brokerage for individuals with severe and persistent mental illness. One PIR service engaged a consumer-led research team to evaluate the service from the perspective of consumers. This consumer-led study was established to explore PIR consumers' perceptions of outcomes they achieved through their involvement with PIR.

METHODS

Data were collected through semi-structured interviews exploring participants' views about and experiences with PIR. Data analysis occurred simultaneously with data collection using constant comparative analysis.

RESULTS

Twenty consumers participated. They reported experiencing valued outcomes in six domains: feeling supported; feeling more hopeful and positive about the future; improved mental clarity, focus and order in life; getting out of the house and engaging in positive activity; having a better social life; and improved physical health.

CONCLUSIONS

Exploring outcomes achieved by PIR consumers, from their own perspective provides a nuanced understanding of the contribution these programs can have in supporting individuals' recovery. Findings from this study highlight the kinds of outcomes consumers achieve when engaged with service coordination and brokerage services. Findings also suggest that outcome measures used in these types of services should focus on recovery outcomes as well as met and unmet needs.

A synthesis of the evidence on peer research with potentially vulnerable adults: how this relates to dementia

BACKGROUND

There is limited literature around peer research in dementia. This study aims to identify the benefits, the risks and the practical challenges and to develop a model of good practice in peer research with people with dementia.

METHODS

We searched on PsycInfo, PubMed and Google Scholar for empirical investigations or discussion papers on peer research. Given the limited literature in the field of dementia, we included studies with groups who share similar demographics (older people), experience of stigma (mental health service users) and exclusion from research (people with learning disabilities). We applied no restrictions on language and publication date.

ANALYSIS

We identified three themes: the potential benefits, the potential risks and the practical challenges of peer research. We developed a model of good practice. The European Working Group of People with Dementia reviewed our paper and added to our findings.

RESULTS

We included seven papers. Potential benefits of peer research included enriched data and empowering people with dementia. Potential risks included power differentials between researchers and issues of representativeness. The practical issues for good practice included the training of peer researchers, defining involvement and roles, working with cognitive impairment and considering resource implications. The European Working Group of People with Dementia emphasised the importance of equality issues.

CONCLUSION

Involving people with dementia in peer research can generate several benefits, including empowerment and opportunities for inclusion for the peer researchers and the research participants living with dementia, challenging academics' traditional views on research processes and gathering enhanced research data. There remains a need for further research on the impact of peer research in dementia studies. Copyright © 2016 John Wiley & Sons, Ltd.

Service user governors in mental health foundation trusts: accountability or business as usual?

CONTEXT

National Health Foundation Trusts present opportunities for individual mental health service users to be active in the governance of trusts. This is one of a range of mechanisms for patient and public involvement and one which promotes an individual rather than collective approach to involvement.

OBJECTIVE

Within the context of a broader study of the impact of service user involvement in mental health services, the objective of this article was to explore the experience of service user governors in foundation trusts and their capacity to hold boards to account.

DESIGN, SETTING AND PARTICIPANTS

The Council of Governors in three foundation trusts were observed for a year. Focus groups with service user governors were undertaken in each trust.

RESULTS

Service users had different expectations and understandings of the role and approached it in different ways. Key themes that emerged concerned: the role of a governor, conduct and content of meetings, agenda setting, relationships and representation.

DISCUSSION AND CONCLUSIONS

The experiences of mental health service user governors need to be understood within the complex environment of patient and public involvement in general and of mental health service user involvement in particular. The dislocation of the service user governor role from other forms of service user activity and involvement result in confusion about how notions of holding a trust to account and representation of other service users can be addressed within a boundaried institutional environment.

[The Citizen Committee as a co-management strategy in participatory research in the field of mental health in Quebec]

The theme of users' rights has become a central issue in contemporary debate on mental health. Drawing from the experiences of "Comitê Cidadão" (Citizen Committee), consisting of users and family members in an international research alliance between Brazil and Canada, an attempt is made to discuss the effects of the experience of co-management of the so-called Autonomous Medication Administration (GAM - Gestão Autônoma da Medicação) participatory research project on these individuals. By means of a detailed description of the background of the Committee and interviews and analysis of the voice transcriptions of its members, the problems raised by the relation of dialogue between scientific knowledge and users' knowledge are examined in a methodological approach of participatory research. As a result of the research, it was established that the experience of the Citizens Committee in co-management of health research can be propitious to the increase in the degree of autonomy, greater empowerment and the exercise of leadership and citizenship, with the consequent emergence of subjects with rights.

User and researcher collaborations in mental health in low and middle income countries: a case study of the EMPOWER project

BACKGROUND

Increasing recognition has been given to the interaction of users and researchers in shaping the perspective and practice of mental health care. However, there remains very little evidence exploring how this interaction works, particularly in low and middle income countries. The aim of this study was to explore experiences of how users and researchers worked together to communicate research, using a case study of the EMPOWER project.

METHODS

The study followed a case-study approach. EMPOWER was a project that sought to strengthen the capacity of user organizations in India, Kenya, Nepal and Zambia by encouraging user-researcher collaborations to communicate research findings in the four countries. A qualitative research method was applied for this study, with semi-structured interviews conducted with seven people: two researchers, one communications developer, and four user group members (one from each of the four countries). Data were analyzed using thematic analysis.

RESULTS

The findings indicated positive perceptions of the collaboration between researchers and users. Key themes were partnership and support, the value of the personal experience of users and their knowledge of the target audiences, and empowerment. Key challenges related to differences in levels of education and technical knowledge and the lack of payments to users.

CONCLUSIONS

This exploratory study provides insight to help understand collaborative processes for communicating mental health research. It highlights many positive outcomes from the EMPOWER collaboration but also highlights the need for more in-depth research on this issue.

Service user involvement in the evaluation of psycho-social intervention for self-harm: a systematic literature review

Background

The efficacy of interventions and treatments for self-harm is well researched. Previous reviews of the literature have highlighted the lack of definitively effective interventions for self-harm and have highlighted the need for future research. These recommendations are also reflected in clinical guidelines published by the National Institute for Health and Clinical Excellence ( NICE, 2004 ) which also call for service user involvement in studies of treatment efficacy.

Aims

A systematic review was undertaken to determine: a) what contributions service users have made to the evaluation of psycho-social interventions; b) by what methods have service users been involved; c) in what ways could service user involvement supplement empirical evidence for interventions.

Methodology

Electronic searches were completed on the 28th January 2011 of the Medline (1950–present), Web of Science (1898–Present), Web of Science (including Science Citation Index and the Social Science Citation Index), the Cochrane database of systematic reviews, and Psychinfo (1979–present) databases using a combination of 13 search terms. References were independently sifted according to set criteria by two of the authors to ensure inter-rater reliability.

Results

Sixty-five references were included in the review. Of these, 59% of studies were empirically based, and 26% used qualitative data collection methods to gather service user narratives. Only 8% of studies used a mixed-methodology to combined qualitative and quantitative data collection. No studies featured service user involvement.

Conclusion

Service user involvement is a rarity in the evaluation of psycho-social interventions, despite its use being mandated by the National Institute for Health and Clinical Excellence and evidenced as effective in other areas of mental health ( Leader, 1998 ). The authors make a number of recommendations for future involvement in future self-harm research.

The mental health strategy for Europe: why service user leadership in research is indispensable

Recent European mental health strategies and programmes declare service user involvement to be essential in the development and evaluation of policy and services. In light of the announcement in March 2011 by the World Health Organization Regional Office for Europe of a forthcoming new mental health strategy for Europe, we propose that service user leadership in research is the most effective way of enhancing such involvement and consider what is required to broaden initiatives across Europe.

Negotiating the coresearcher mandate - service users' experiences of doing collaborative research on mental health

PURPOSE

Traditionally, the voices of service users have been silent in research into mental health issues. A Norwegian research network, however, recognizes the importance of involving service users as coresearchers and initiated a training program in research methodology and design intended to empower them as active participants in research projects. In this article, we explore how these coresearchers with a mental health service user background experience their participation in projects as well as in attending the training: What is it like being a service user coresearcher in collaborative studies on issues in mental health? How do coresearchers negotiate their roles and mandate?

METHOD

We used focus groups as our data collection method, transcribed the group discussions verbatim, and analyzed the transcriptions using qualitative methodology. We then took the preliminary analyses back to the participants for discussion, auditing, and reanalysis.

RESULTS

We identified themes that represent important social processes around which the participants developed a consensual understanding: self-definition, constructive differentiation and negotiations.

CONCLUSION

Our findings generate hypotheses on how participatory research into mental health issues can be fruitfully organized, in a way that empowers service users to active and constructive participation.

A model for developing outcome measures from the perspectives of mental health service users

It is becoming increasingly recognized that conventionally derived outcome measures in mental health research are problematic. This is both because of the methodology used and because a 'good' outcome is framed from the perspective of clinicians and researchers. This paper describes a methodology for developing outcome measures for use in large studies entirely from the perspective of mental health service users. It is a mixed methods model starting with a participatory and qualitative methodology and proceeding to psychometric testing. At all stages, the researchers are themselves mental health service users. In the first phase of the model, focus groups are convened comprising people who have received the treatment or service being measured. The focus groups meet twice resulting in a draft mixed-methods questionnaire devised from thematic analysis of the focus group data. This is then taken to expert panels, again comprising individuals who have received the treatment or service being evaluated for refinement. Following this, a feasibility study is conducted with N ∼ 50 participants and changes made iteratively to the questionnaire in light of feedback. The final measure is subject to psychometric testing both to ensure it is robust and to explore similarities and differences with conventionally derived measures.

Developing partnerships in mental health to bridge the research-practitioner gap

PURPOSE

An overview of approaches used in contemporary mental health research to consider when coordinating research agendas is presented. Connections between the research-practice gap and evidence-based practice are explored. Collaboration, as a key concept and practice, is investigated particularly in relation to community and consumer participation in mental health research.

CONCLUSIONS

Non-commensurate belief systems, inadequate infrastructure, and institutional tendencies maintain the status quo and constitute significant impediments to widespread planned and integrated research programs.

PRACTICE IMPLICATIONS

Communication and trust building between researchers and practitioners is central to developing effective collaborations that can deliver more effective health care.

Service-user involvement in forensic mental health care research: areas to consider when developing a collaborative study

BACKGROUND

Although service-users are increasingly involved in the conduct of research in mental health settings, involvement in forensic mental health settings is limited.

AIMS

 This paper looks at the factors perceived by professionals and service-users as important for developing collaborative research in forensic mental health settings.

METHOD

Following a collaborative research project undertaken in three forensic mental health units, the researchers involved in the project (professionals and service-users) reviewed factors perceived as important for developing service-user research in secure settings.

RESULTS

 Three broad themes were identified. The main issues considered within these themes were detailed.

CONCLUSIONS

 Service-users in forensic mental health settings are able to have full involvement in research.

'What difference does it make?' Finding evidence of the impact of mental health service user researchers on research into the experiences of detained psychiatric patients

BACKGROUND

Interest in the involvement of members of the public in health services research is increasingly focussed on evaluation of the impact of involvement on the research process and the production of knowledge about health. Service user involvement in mental health research is well-established, yet empirical studies into the impact of involvement are lacking.

OBJECTIVE

To investigate the potential to provide empirical evidence of the impact of service user researchers (SURs) on the research process.

DESIGN

The study uses a range of secondary analyses of interview transcripts from a qualitative study of the experiences of psychiatric patients detained under the Mental Health Act (1983) to compare the way in which SURs and conventional university researchers (URs) conduct and analyse qualitative interviews.

RESULTS

Analyses indicated some differences in the ways in which service user- and conventional URs conducted qualitative interviews. SURs were much more likely to code (analyse) interview transcripts in terms of interviewees' experiences and feelings, while conventional URs coded the same transcripts largely in terms of processes and procedures related to detention. The limitations of a secondary analysis based on small numbers of researchers are identified and discussed.

CONCLUSIONS

The study demonstrates the potential to develop a methodologically robust approach to evaluate empirically the impact of SURs on research process and findings, and is indicative of the potential benefits of collaborative research for informing evidence-based practice in mental health services.

Narrating uncertainties about treatment of mental health conditions

BACKGROUND

Integration of patient views in mental health service planning is in its infancy despite service provision being clearly dominated by narratives from professional consultations and medical records. We wished to clarify perceptions of uncertainty about mental health conditions from a range of provider and user perspectives (patients, carers, parents, mental health service providers) and understand the role of narratives in mental health research.

AIMS

(1) To explore the utility of qualitative research methods, particularly narrative content analysis in mental health research, and (2) identify aspects of uncertainty in mental health service users and providers.

MATERIAL

Four hundred and six free text responses were considered as one element of an existing questionnaire about uncertainties about mental health treatments, collected from mental healthcare users and providers through charities, the Mental Health Research Network in Wales, health professionals and websites. Free text responses were analysed using narrative content analysis, an elaborate and rigorous research technique that involves groups of analysts working independently and together over extended group sessions.

FINDINGS

Three main themes emerged across respondent groups: "medication and treatment options", "objectification and marginalisation of patient" and "integrity of service delivery". Within these, patients embraced the opportunity to write about their illness at length, whilst carers' and parents' main concerns were about how patients were dealing with their illnesses, the services they were getting and the side effects of treatments. Carers and patients' parents perceived themselves to be the 'go-between', carrying messages between patients and professionals, in order to enable services to function. Mental health service providers and professionals considered uncertainties surrounding medication and treatment from an 'evidence-base' perspective, concentrating on medication choices and the adoption of new approaches to care rather than patient need and expectation. Patients wanted to know what alternatives were available to the drug regimes they were on and felt their opinions were rarely listened to. As a consequence patients felt marginalised by the health systems there to support them and by society as a whole.

CONCLUSIONS

Narrative content analysis can help distil large amounts of free text data and enable their successful interpretation. Listening to patients' voices should become an integral part of routine service evaluation and may help bring patient expectation more in line with service organisation and delivery towards an optimal delivery of care.

Barriers to patient involvement in health service planning and evaluation: an exploratory study

OBJECTIVE

Patient involvement in health service planning and evaluation is considered important yet not widely practiced. This study explored stakeholder beliefs about patient participation in performance indicator selection to better understand hypothesized barriers.

METHODS

Interviews with 30 cancer patients and health professionals from two teaching hospitals were analyzed qualitatively.

RESULTS

All groups believed patients, not members of the public, should be involved in the selection of indicators. Ongoing, interactive methods such as committee involvement, rather than single, passive efforts such as surveys were preferred. Health professionals recommended patients assume a consultative, rather than decision-making role. Older patients agreed with this.

CONCLUSION

Variable patient interest, health professional attitudes, and a lack of insight on appropriate methods may be limiting patient involvement in this, and other service planning and evaluation activities. More research is required to validate expressed views among the populations these stakeholders represent, and to establish effective methods for engaging patients.

PRACTICE IMPLICATIONS

Efforts to encourage a change in health professional attitude may be required, along with dedicated organizational resources, coordinators and training. Methods to engage patients should involve deliberation, which can be achieved through modified Delphi panel or participatory research approaches.

Attitudes of patients with schizophrenia to psychiatric research

Objective. To examine how patients with schizophrenia spectrum disorders view psychiatric research and what influences their readiness to participate. Methods. A sample of 83 patients with schizophrenia spectrum disorders was examined using a specific self-report questionnaire designed for the purpose of the study. Results. Most patients (97%) approved at least "a little" of psychiatric research in general. There was a tendency to approve of psychosocial rather than biological research subjects (e.g., research on the role of traumatic life events was approved by 95% of patients as compared to 72% in the case of genetics and 76% in the case of medication studies). Reasons to participate were mainly altruistic, only a minority found that monetary incentives were important. Another important reason was to improve individual chances of recovery. A large majority (95%) found it important to get sufficient information prior to the start but also to receive the results of the study. Conclusion. Patients' capability of critically appraising psychiatric research as well as their role in the research process should inform future research to ensure a more cooperative practice.

Demystifying research and evidence-based practice for consumers and carers: development and evaluation of an educational package

Increasingly, consumers and carers are involving themselves in many aspects and levels of mental health services. However, one area in which active involvement has been less prominent is research. This paper describes an educational initiative that sought to increase consumers' and carers' understanding of the way research is conducted and its role in evidence-based practice. Information regarding participants' attitudes towards research, knowledge about research practice and participation was also examined. The findings provide evidence that workshop attendance increases knowledge and encourages participation in future research projects, particularly when participants have confidence in the researcher.

Challenging conventional practice: placing consumers at the centre of the research enterprise

Without evidence, clinicians may inadvertently be providing treatment that is not necessarily best for some consumers. If consumers, carers, and staff have different views about what type of services are best and which treatments are most effective, it is in all our interests to know more about these differences and find common ground. This article provides an overview of factors that require consideration and action for collaborative research to be successful. Actively involving consumers and carers in mental health research may improve the quality of research and has the potential to enhance clinical outcomes. However, a range of challenges must be overcome, which include insufficient training, extra time requirements, stress and non-representativeness, and the impact on research projects, consumers, and researchers. These factors apply equally to carers and, arguably, staff. With sufficient motivation, commitment, and funds for the requisite time, all of these disadvantages could be overcome or at least minimized.