Supporting physical activity through co-production in people with severe mental ill health (SPACES): protocol for a randomised controlled feasibility trial.

BACKGROUND: Severe mental ill health (SMI) includes schizophrenia, bipolar disorder and schizoaffective disorder and is associated with premature deaths when compared to people without SMI. Over 70% of those deaths are attributed to preventable health conditions, which have the potential to be positively affected by the adoption of healthy behaviours, such as physical activity. People with SMI are generally less active than those without and face unique barriers to being physically active. Physical activity interventions for those with SMI demonstrate promise, however, there are important questions remaining about the potential feasibility and acceptability of a physical activity intervention embedded within existing NHS pathways. METHOD: This is a two-arm multi-site randomised controlled feasibility trial, assessing the feasibility and acceptability of a co-produced physical activity intervention for a full-scale trial across geographically dispersed NHS mental health trusts in England. Participants will be randomly allocated via block, 1:1 randomisation, into either the intervention arm or the usual care arm. The usual care arm will continue to receive usual care throughout the trial, whilst the intervention arm will receive usual care plus the offer of a weekly, 18-week, physical activity intervention comprising walking and indoor activity sessions and community taster sessions. Another main component of the intervention includes one-to-one support. The primary outcome is to investigate the feasibility and acceptability of the intervention and to scale it up to a full-scale trial, using a short proforma provided to all intervention participants at follow-up, qualitative interviews with approximately 15 intervention participants and 5 interventions delivery staff, and data on intervention uptake, attendance, and attrition. Usual care data will also include recruitment and follow-up retention. Secondary outcome measures include physical activity and sedentary behaviours, body mass index, depression, anxiety, health-related quality of life, healthcare resource use, and adverse events. Outcome measures will be taken at baseline, three, and six-months post randomisation. DISCUSSION: This study will determine if the physical activity intervention is feasible and acceptable to both participants receiving the intervention and NHS staff who deliver it. Results will inform the design of a larger randomised controlled trial assessing the clinical and cost effectiveness of the intervention. TRIAL REGISTRATION: ISRCTN: ISRCTN83877229. Registered on 09.09.2022.

Caregiving and receiving experiences in UK community mental health services during COVID-19 pandemic restrictions: A qualitative, co-produced study.

WHAT IS KNOWN ON THE SUBJECT?: At the outset of the COVID-19 pandemic, little was known about ways of delivering registered nurse practice within CMHTs under restrictions associated with a global pandemic. Emerging research focused on broad healthcare staff wellbeing during the pandemic. Qualitative research explored the overall response of COVID-19 on people with existing health needs or remote working more specifically. Over the past 2 years studies have emerged detailing experiences but no studies have used qualitative research to understand community mental health nurses and service users experience of services. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This co-produced qualitative study is the first to explore the changes to CMHT care from the experience of service users and nurses later in the COVID-19 pandemic. The study questions whether recovery-based approaches are possible in a hybrid way of working. The findings identify challenges for nurses' well-being and work-life boundaries when working from home. The study adds to historical professional narratives of mental health nursing. WHAT ARE THE IMPLICATIONS FOR PRACTICE: While hybrid approaches developed in response to COVID-19 restrictions may offer more choice these approaches need further co-produced evaluation on the impact of recovery-focused care and therapeutic relationships. Mental health nurses need to review how future hybrid working continues to impact nurses' mental health and emotional safety. Nurses and service users need to raise awareness within society and policy on the impact that COVID-19 had on people with existing mental health conditions. ABSTRACT: Introduction Community Mental Health Team responses to COVID-19 included fundamental service delivery adaptations. Aim/Question Our co-produced study sought to understand which service delivery changes experienced by service users and registered nurses were helpful or unhelpful to caregiving and receiving. Method Qualitative semi-structured interviews were undertaken with 10 service users and 13 registered nurses from 3 NHS England sites. Co-produced throughout, people with lived experience of mental health services and nurses wishing to improve their research experience undertook interviews following training. Data were analysed thematically. Findings Care radically changed from in-person to large phone or video contact. This reportedly altered therapeutic relationship building and raised questions about whether recovery-focused care was possible. Hybrid working was viewed as helpful but raised challenges for nurse wellbeing. Discussion Changes to care delivery challenged the fundamentals of recovery-focused interventions and therapeutic relationships. Service users and nurses well-being consequently suffered. The impact of the pandemic on people with existing mental health conditions was poorly acknowledged in the media. Implications for Practice Recovery-focused interventions and relationship building need evaluating in the light of ongoing hybrid working. Teams need to consider the well-being of nurses engaged in complex service-user interactions from home.

Relational practice in health, education, criminal justice, and social care: a scoping review.

BACKGROUND: Establishing and maintaining relationships and ways of connecting and being with others is an important component of health and wellbeing. Harnessing the relational within caring, supportive, educational, or carceral settings as a systems response has been referred to as relational practice. Practitioners, people with lived experience, academics and policy makers, do not yet share a well-defined common understanding of relational practice. Consequently, there is potential for interdisciplinary and interagency miscommunication, as well as the risk of policy and practice being increasingly disconnected. Comprehensive reviews are needed to support the development of a coherent shared understanding of relational practice. METHOD: This study uses a scoping review design providing a scope and synthesis of extant literature relating to relational practice focussing on organisational and systemic practice. The review aimed to map how relational practice is used, defined and understood across health, criminal justice, education and social work, noting any impacts and benefits reported. Searches were conducted on 8 bibliographic databases on 27 October 2021. English language articles were included that involve/discuss practice and/or intervention/s that prioritise interpersonal relationships in service provision, in both external (organisational contexts) and internal (how this is received by workers and service users) aspects. RESULTS: A total of 8010 relevant articles were identified, of which 158 met the eligibility criteria and were included in the synthesis. Most were opinion-based or theoretical argument papers (n = 61, 38.60%), with 6 (3.80%) critical or narrative reviews. A further 27 (17.09%) were categorised as case studies, focussing on explaining relational practice being used in an organisation or a specific intervention and its components, rather than conducting an evaluation or examination of the effectiveness of the service, with only 11 including any empirical data. Of the included empirical studies, 45 were qualitative, 6 were quantitative, and 9 mixed methods studies. There were differences in the use of terminology and definitions of relational practice within and across sectors. CONCLUSION: Although there may be implicit knowledge of what relational practice is the research field lacks coherent and comprehensive models. Despite definitional ambiguities, a number of benefits are attributed to relational practices. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021295958.

Discourses of compassion from the margins of health care: the perspectives and experiences of people with a mental health condition.

BACKGROUND: Evidence supports the positive influence of compassion on care experiences and health outcomes. However, there is limited understanding regarding how compassion is identified by people with lived experience of mental health care. AIM: To explore the views and experiences of compassion from people who have lived experience of mental health. METHODS: Participants with a self-reported mental health condition and lived experience of mental health (n = 10) were interviewed in a community setting. Characteristics of compassion were identified using an interpretative description approach. RESULTS: Study participants identified compassion as comprised three key components; 'the compassionate virtues of the healthcare professional', which informs 'compassionate engagement', creating a 'compassionate relational space and the patient's felt-sense response'. When all these elements were in place, enhanced recovery and healing was felt to be possible. Without the experience of compassion, mental health could be adversely affected, exacerbating mental health conditions, and leading to detachment from engaging with health services. CONCLUSIONS: The experience of compassion mobilises hope and promotes recovery. Health care policymakers and organisations must ensure services are structured to provide space and time for compassion to flourish. It is imperative that all staff are provided with training so that compassion can be acquired and developed.