We’ve selected a range of case studies which illustrate some of the different approaches teams are taking to improve mental health services – from harnessing peer support, to a proactive approach to safety issues, to introducing more person-centred approaches to care, including shared decision-making, self-management support and recovery colleges.
1. Use shared decision making in mental health
Camden Child and Adolescent Mental Health Services (CAMHS) and the Anna Freud Centre ran a project as part of our Closing the Gap through Changing Relationships programme. They wanted to use shared decision making to support young people with mental health problems and their families to make informed choices and become active partners in their treatment.
The project was very successful, proving that shared decision making is not just a powerful tool for physical health issues. Clinicians reported that using shared decision making radically changed the way they interacted with service users, making relationships more open and transparent. Young people reported feeling more engaged and involved in their care, more able to take responsibility for their actions, and more committed to following care plans they’d been involved in developing. The team found evidence of improved outcomes in individual cases and anecdotal evidence from nurses in an outpatient unit suggested that shared decision making led to fewer incidences of aggressive behaviour.
2. Identify safety issues and reduce harm
Two projects are just getting started as part of our Closing the Gap in Patient Safety programme. Hertfordshire Partnership University NHS Foundation Trust wants to reduce suicide and self harm among people using community mental health services. They are using a prospective hazard analysis tool and human factors training to help staff gain patient safety skills and enable care teams to identify and solve their own safety issues. A key feature will be improving communication skills and team working in order to strengthen the safety culture, improve service user satisfaction and reduce harm. Read more about the Safer care pathways in mental health services project.
A project led by the University of Central Lancashire is seeking to minimise harm by reducing the use of physical restraint on people being treated in acute mental health settings. They are using the ‘Six Core Strategies UK’ to help address factors that lead to aggression and violence from patients (including staff characteristics such as negative interactional styles and poor communication skills) and improve policies around use of restraint. They are aiming for a 40% reduction in the use of restraint among acute wards within eight mental health trusts by June 2016. Read more about the 6CS-UK project.
3. Empower people with depression to self-manage
Through our Co-creating Health programme, two sites (Torbay Care Trust and Devon Partnership Trust, and South West London and St Georges Mental Health NHS Trust) worked to introduce self-management support for people with depression. They both used the Co-creating Health model to embed self-management by providing an education programme for service users and training for health care professionals, while also changing how services were delivered.
The projects showed that supporting self-management in this way had a positive impact on people’s lives, increasing their confidence and ability to manage their mental health. Service users who attended the courses had less contact with primary care services and reduced psychiatric symptoms. South West London and St George’s data also showed a reduction in occupied bed days – suggesting that people felt more able to self-manage their condition and avoid crisis situations.
4. Use peer support to enhance recovery
Nottinghamshire Healthcare NHS Trust led a pioneering project to introduce peer support for people with mental health issues. The project trained and employed people with personal experience of mental health problems to use their experiences, coping strategies and community connections in a mutually supportive relationship with peers.
Peer supporters provided ongoing support and completed personal recovery plans with all service users. Evaluation showed that this project contributed to a 14% reduction in inpatient stays, saving around £260,000. The peer support workers were also able to influence team practices and had a positive impact on the organisation’s focus on recovery. The work has contributed to the development of new national guidance, accredited training and occupational standards for peer support workers in mental health services. Read more about the peer support project.
5. Educate to support resilience and recovery
A project led by 2Gether NHS Foundation Trust also harnessed the power of peer support when they created three ‘pop-up’ Recovery Colleges. Their project was designed to provide hope, knowledge and practical skills in self-care to people with long-term mental health needs through an educational programme focused on recovery.
Courses were designed and taught by people with lived experience of mental health problems. They helped service users build skills in self-care, deepen their knowledge about recovery, explore their possibilities and aspirations, and gain confidence. The courses have been described as ‘life-changing’ by students: 94% said they felt more hopeful after attending the course and 91% said they had greater knowledge and self-awareness.
The ‘pop up’ model made it easier to provide access to the courses across a large rural area. Taster days and three courses were run across Gloucestershire and Herefordshire, as well as Recovery Space Days where students worked with local artists, physical therapists and mindfulness coaches. Following on from this project the team now plan to set up a Youth Recovery College, teaching recovery skills to younger people with mental health problems. Read more about the Coaching for recovery project.