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1.
BMC Res Notes ; 14(1): 320, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419155

RESUMO

OBJECTIVES: Peer support is rapidly being introduced into mental health services internationally, yet peer support interventions are often poorly described, limiting the usefulness of research in informing policy and practice. This paper reports the development of a peer support intervention that aims to improve outcomes of discharge from inpatient to community mental health care. People with experiential knowledge of using mental health services-peer workers and service user researchers-were involved in all stages of developing the intervention: generating intervention components; producing the intervention handbook; piloting the intervention. RESULTS: Systematic review and expert panels, including our Lived Experience Advisory Panel, identified 66 candidate intervention components in five domains: Recruitment and Role Description of Peer Workers; Training for Peer Workers; Delivery of Peer Support; Supervision and Support for Peer Workers; Organisation and Team. A series of Local Advisory Groups were used to prioritise components and explore implementation issues using consensus methods, refining an intervention blueprint. A peer support handbook and peer worker training programme were produced by the study team and piloted in two study sites. Feedback workshops were held with peer workers and their supervisors to produce a final handbook and training programme. The ENRICH trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328, and was overseen by an independent steering committee and a data monitoring committee.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Aconselhamento , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Saúde Mental , Revisões Sistemáticas como Assunto
2.
JMIR Ment Health ; 8(5): e25528, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042603

RESUMO

BACKGROUND: Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. OBJECTIVE: The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. METHODS: A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. RESULTS: The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). CONCLUSIONS: The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.

3.
Front Psychiatry ; 11: 589731, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33192738

RESUMO

Background: Recorded Recovery Narratives (RRNs) describing first-person lived experience accounts of recovery from mental health problems are becoming more available. Little is known about how RRNs can be used in clinical practice and clinical education. Aims: The aim of this paper is to enable implementation planning for RRN interventions by identifying determinants of uptake. The objective was to identify opportunities, barriers, and enablers to the uptake of RRN interventions in clinical practice and education. Method: Three phases of focus groups were conducted with multi-professional mental health clinicians. Phase 1 (4 groups, n = 25) investigated current and possible uses of RRNs, Phase 2 (2 groups, n = 15) investigated a specific intervention delivering recovery narratives. Phase 3 (2 groups, n = 12) investigated clinical education uses. Thematic analysis was conducted. Results: RRNs can reinforce the effectiveness of existing clinical practices, by reducing communication barriers and normalizing mental health problems. They can also extend clinical practice (increase hope and connection, help when stuck). Clinical considerations are the relationship with care pathways, choice of staff and stage of recovery. In educational use there were opportunities to access lived experience perspectives, train non-clinical staff and facilitate attitudinal change. Barriers and enablers related to design (ability to use online resources, accessibility of language, ability to individualize choice of narrative), risk (triggering content, staff skills to respond to negative effects), trust in online resource (evidence base, maintenance), and technology (cost of use, technology requirements). Conclusions: RRNs can both improve and extend existing clinical practice and be an important educational resource. RRNs can improve engagement and hope, and address internalized stigma. Beneficially incorporating RRNs into clinical practice and education may require new staff skills and improved technological resources in healthcare settings. Future work could focus on the use of peer support workers views on RRN use and how to avoid unnecessary and unhelpful distress. Trial Registration Number: Work in this paper has informed three clinical trials: ISRCTN11152837; ISRCTN63197153; ISRCTN76355273.

4.
Medicine (Baltimore) ; 99(10): e19192, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150057

RESUMO

INTRODUCTION: In the period shortly after discharge from inpatient to community mental health care, people are at increased risk of self-harm, suicide, and readmission to hospital. Discharge interventions including peer support have shown potential, and there is some evidence that community-based peer support reduces readmissions. However, systematic reviews of peer support in mental health services indicate poor trial quality and a lack of reporting of how peer support is distinctive from other mental health support. This study is designed to establish the clinical and cost effectiveness of a peer worker intervention to support discharge from inpatient to community mental health care, and to address issues of trial quality and clarity of reporting of peer support interventions. METHODS: This protocol describes an individually randomized controlled superiority trial, hypothesizing that people offered a peer worker discharge intervention in addition to usual follow-up care in the community are less likely to be readmitted in the 12 months post discharge than people receiving usual care alone. A total of 590 people will be recruited shortly before discharge from hospital and randomly allocated to care as usual plus the peer worker intervention or care as usual alone. Manualized peer support provided by trained peer workers begins in hospital and continues for 4 months in the community post discharge. Secondary psychosocial outcomes are assessed at 4 months post discharge, and service use and cost outcomes at 12 months post discharge, alongside a mixed methods process evaluation. DISCUSSION: Clearly specified procedures for sequencing participant allocation and for blinding assessors to allocation, plus full reporting of outcomes, should reduce risk of bias in trial findings and contribute to improved quality in the peer support evidence base. The involvement of members of the study team with direct experience of peer support, mental distress, and using mental health services, in coproducing the intervention and designing the trial, ensures that we theorize and clearly describe the peer worker intervention, and evaluate how peer support is related to any change in outcome. This is an important methodological contribution to the evidence base. TRIAL REGISTRATION: This study was prospectively registered as ISRCTN 10043328 on November 28, 2016.


Assuntos
Transtornos Mentais/terapia , Alta do Paciente , Transferência de Pacientes/economia , Grupo Associado , Serviços Comunitários de Saúde Mental , Análise Custo-Benefício , Humanos , Transtornos Mentais/psicologia , Qualidade de Vida , Fatores de Risco , Medicina Estatal , Reino Unido
5.
Br J Psychiatry ; 216(6): 301-307, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31992375

RESUMO

BACKGROUND: Peer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects. AIMS: To conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems. METHOD: We systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications. RESULTS: A total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues. CONCLUSIONS: Peer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings.


Assuntos
Transtornos Mentais/psicologia , Grupo Associado , Apoio Social , Trabalho/psicologia , Adulto , Humanos
6.
Soc Psychiatry Psychiatr Epidemiol ; 55(3): 285-293, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31177310

RESUMO

PURPOSE: The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. METHODS: Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). RESULTS: The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. CONCLUSION: The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.


Assuntos
Aconselhamento , Saúde Mental , Grupo Associado , Adulto , Atitude do Pessoal de Saúde , Alemanha , Humanos , Índia , Israel , Serviços de Saúde Mental , Inquéritos e Questionários , Tanzânia , Uganda
7.
PLoS One ; 14(12): e0226201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31834902

RESUMO

BACKGROUND: Mental health recovery narratives are stories of recovery from mental health problems. Narratives may impact in helpful and harmful ways on those who receive them. The objective of this paper is to develop a change model identifying the range of possible impacts and how they occur. METHOD: Semi-structured interviews were conducted with adults with experience of mental health problems and recovery (n = 77). Participants were asked to share a mental health recovery narrative and to describe the impact of other people's recovery narratives on their own recovery. A change model was generated through iterative thematic analysis of transcripts. RESULTS: Change is initiated when a recipient develops a connection to a narrator or to the events descripted in their narrative. Change is mediated by the recipient recognising experiences shared with the narrator, noticing the achievements or difficulties of the narrator, learning how recovery happens, or experiencing emotional release. Helpful outcomes of receiving recovery narratives are connectedness, validation, hope, empowerment, appreciation, reference shift and stigma reduction. Harmful outcomes are a sense of inadequacy, disconnection, pessimism and burden. Impact is positively moderated by the perceived authenticity of the narrative, and can be reduced if the recipient is experiencing a crisis. CONCLUSIONS: Interventions that incorporate the use of recovery narratives, such as peer support, anti-stigma campaigns and bibliotherapy, can use the change model to maximise benefit and minimise harms from narratives. Interventions should incorporate a diverse range of narratives available through different mediums to enable a range of recipients to connect with and benefit from this material. Service providers using recovery narratives should preserve authenticity so as to maximise impact, for example by avoiding excessive editing.


Assuntos
Transtornos Mentais/reabilitação , Recuperação da Saúde Mental/tendências , Saúde Mental/normas , Modelos Estatísticos , Narração , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Feminino , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
8.
BMC Psychiatry ; 19(1): 413, 2019 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864315

RESUMO

BACKGROUND: Mental health recovery narratives are a core component of recovery-oriented interventions such as peer support and anti-stigma campaigns. A substantial number of recorded recovery narratives are now publicly available online in different modalities and in published books. Whilst the benefits of telling one's story have been investigated, much less is known about how recorded narratives of differing modalities impact on recipients. A previous qualitative study identified connection to the narrator and/or to events in the narrative to be a core mechanism of change. The factors that influence how individuals connect with a recorded narrative are unknown. The aim of the current study was to characterise the immediate effects of receiving recovery narratives presented in a range of modalities (text, video and audio), by establishing the mechanisms of connection and the processes by which connection leads to outcomes. METHOD: A study involving 40 mental health service users in England was conducted. Participants were presented with up to 10 randomly-selected recovery narratives and were interviewed on the immediate impact of each narrative. Thematic analysis was used to identify the mechanisms of connection and how connection leads to outcome. RESULTS: Receiving a recovery narrative led participants to reflect upon their own experiences or those of others, which then led to connection through three mechanisms: comparing oneself with the narrative and narrator; learning about other's experiences; and experiencing empathy. These mechanisms led to outcomes through three processes: the identification of change (through attending to narrative structure); the interpretation of change (through attending to narrative content); and the internalisation of interpretations. CONCLUSIONS: This is the first study to identify mechanisms and processes of connection with recorded recovery narratives. The empirically-based causal chain model developed in this study describes the immediate effects on recipients. This model can inform selection of narratives for use in interventions, and be used to support peer support workers in recounting their own recovery narratives in ways which are maximally beneficial to others.


Assuntos
Pesquisa Empírica , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Recuperação da Saúde Mental , Modelos Psicológicos , Medicina Narrativa/métodos , Adolescente , Adulto , Idoso , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Recuperação da Saúde Mental/tendências , Serviços de Saúde Mental/tendências , Pessoa de Meia-Idade , Narração , Medicina Narrativa/tendências , Pesquisa Qualitativa , Estigma Social , Adulto Jovem
9.
Ann Glob Health ; 85(1)2019 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-30951270

RESUMO

BACKGROUND: Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. OBJECTIVES: To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. METHODS: UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders' perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines.Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.


Assuntos
Saúde Global , Transtornos Mentais/reabilitação , Recuperação da Saúde Mental , Serviços de Saúde Mental , Grupo Associado , Apoio Social , Transtorno Bipolar/reabilitação , Assistência à Saúde Culturalmente Competente , Transtorno Depressivo Maior/reabilitação , Alemanha , Humanos , Ciência da Implementação , Índia , Israel , Participação do Paciente , Transtornos Psicóticos/reabilitação , Esquizofrenia/reabilitação , Participação dos Interessados , Tanzânia , Uganda , Reino Unido
10.
Can J Psychiatry ; 64(6): 405-414, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30595039

RESUMO

OBJECTIVE: Recovery Colleges are widespread, with little empirical research on their key components. This study aimed to characterize key components of Recovery Colleges and to develop and evaluate a developmental checklist and a quantitative fidelity measure. METHODS: Key components were identified through a systematized literature review, international expert consultation (n = 77), and semistructured interviews with Recovery College managers across England (n = 10). A checklist was developed and refined through semistructured interviews with Recovery College students, trainers, and managers (n = 44) in 3 sites. A fidelity measure was adapted from the checklist and evaluated with Recovery College managers (n = 39, 52%), clinicians providing psychoeducational courses (n = 11), and adult education lecturers (n = 10). RESULTS: Twelve components were identified, comprising 7 nonmodifiable components (Valuing Equality, Learning, Tailored to the Student, Coproduction of the Recovery College, Social Connectedness, Community Focus, and Commitment to Recovery) and 5 modifiable components (Available to All, Location, Distinctiveness of Course Content, Strengths Based, and Progressive). The checklist has service user student, peer trainer, and manager versions. The fidelity measure meets scaling assumptions and demonstrates adequate internal consistency (0.72), test-retest reliability (0.60), content validity, and discriminant validity. CONCLUSIONS: Coproduction and an orientation to adult learning should be the highest priority in developing Recovery Colleges. The creation of the first theory-based empirically evaluated developmental checklist and fidelity measure (both downloadable at researchintorecovery.com/recollect ) for Recovery Colleges will help service users understand what Recovery Colleges offer, will inform decision making by clinicians and commissioners about Recovery Colleges, and will enable formal evaluation of their impact on students.


Assuntos
Lista de Checagem/normas , Educação não Profissionalizante , Pesquisa sobre Serviços de Saúde , Transtornos Mentais/reabilitação , Serviços de Saúde Mental/normas , Educação de Pacientes como Assunto/normas , Instituições Acadêmicas/normas , Adulto , Inglaterra , Humanos , Reprodutibilidade dos Testes
11.
J Psychiatr Ment Health Nurs ; 25(9-10): 558-568, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30372573

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users. There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self-determination which seems to conflict with risk management. A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm. Risk dominates the work of mental health professionals and undermines individualized care. Service users are subject to increased surveillance and medication as a result. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users. Mental health professionals should question the centrality of risk to their practice. ABSTRACT: Introduction The emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. Aim To explore how practitioners, experience potential tensions arising from delivering recovery-orientated care and enforcing containment. Method This paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. Results Risk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. Discussion Hilgartner's (1992, Organizations, uncertainties and risk (pp. 39-53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practice To undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role.


Assuntos
Serviços Comunitários de Saúde Mental , Pessoal de Saúde , Hospitais Psiquiátricos , Transtornos Mentais/terapia , Saúde do Trabalhador , Relações Profissional-Paciente , Medição de Risco , Adulto , Feminino , Humanos , Masculino
12.
Int J Ment Health Nurs ; 27(3): 1137-1148, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29280259

RESUMO

Despite significant changes to mental health services, nurses remain the professional group most likely to be in close contact with people who experience mental health problems. A core part of the contemporary identity of the mental health nurse is one who is able to provide acceptance and support for an individual's recovery through the therapeutic relationship. Yet there have always been some tensions with the mental health nursing role that can appear to challenge this relational focus. An increasing prominence of risk management in mental health care can position mental health nurses as responsible for enacting restrictions and has reignited interest in the role of mental health professionals in social control. This paper reports on one part of a multiple case study, which aimed to explore mental health professionals' experiences of such tensions in the context of decision-making. Interviews and observations were undertaken in acute ward and assertive outreach settings. Findings suggested that risk dominated decision-making to such an extent it defined the way service users were understood and treated. A distant relationship between professionals and service users helped to create and maintain this situation. There needs to be a greater focus on service users' subjective experiences in the decision-making process to challenge the definition of people with mental health problems as risky.


Assuntos
Transtornos Mentais/enfermagem , Relações Enfermeiro-Paciente , Enfermagem Psiquiátrica , Humanos , Entrevistas como Assunto , Transtornos Mentais/terapia , Papel do Profissional de Enfermagem/psicologia , Medição de Risco
13.
Work ; 52(4): 921-34, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26599676

RESUMO

BACKGROUND: The British Army has over 100 career employment groups to which recruits may apply. The Infantry is one of these career employment groups; it accounts for 25% of the overall strength. It is of concern that Infantry recruit attrition within the first 12 weeks of training remains consistently above 30% . Poor selection methods that lead to the enlistment of unsuitable recruits have negative financial and personal consequences, but little is known about the personal experiences of those who fail. OBJECTIVE: The aim of this research was to understand why infantry recruits choose to leave and explore the personal experiences of those that fail. METHODS: This study draws on qualitative data from the second phase of a larger mixed method study. The foci of this paper are the findings directly related to the responses of recruits in exit interviews and their Commanding Officers' training reports. An exploratory qualitative, inductive method was used to generate insights, explanations and potential solutions to training attrition. RESULTS: What the data describes is a journey of extreme situational demands that the recruits experience throughout their transition from civilian life to service in the British Infantry. It is the cumulative effect of the stressors, combined with the recruit being dislocated from their established support network, which appears to be the catalyst for failure among recruits. CONCLUSION: There are clearly defined areas where either further research or changes to current practice may provide a better understanding of, and ultimately reduce, the current attrition rates experienced by the Infantry Training Centre.


Assuntos
Militares/psicologia , Reorganização de Recursos Humanos , Estresse Psicológico/psicologia , Adaptação Psicológica , Adolescente , Adulto , Humanos , Solidão , Masculino , Cultura Organizacional , Seleção de Pessoal , Condicionamento Físico Humano/psicologia , Pesquisa Qualitativa , Reino Unido , Adulto Jovem
14.
J Ment Health ; 20(4): 392-411, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21770786

RESUMO

BACKGROUND: Although mutual support and self-help groups based on shared experience play a large part in recovery, the employment of peer support workers (PSWs) in mental health services is a recent development. However, peer support has been implemented outside the UK and is showing great promise in facilitating recovery. AIMS: This article aims to review the literature on PSWs employed in mental health services to provide a description of the development, impact and challenges presented by the employment of PSWs and to inform implementation in the UK. METHOD: An inclusive search of published and grey literature was undertaken to identify all studies of intentional peer support in mental health services. Articles were summarised and findings analysed. RESULTS: The literature demonstrates that PSWs can lead to a reduction in admissions among those with whom they work. Additionally, associated improvements have been reported on numerous issues that can impact on the lives of people with mental health problems. CONCLUSION: PSWs have the potential to drive through recovery-focused changes in services. However, many challenges are involved in the development of peer support. Careful training, supervision and management of all involved are required.


Assuntos
Transtornos Mentais/reabilitação , Serviços de Saúde Mental/estatística & dados numéricos , Grupo Associado , Grupos de Autoajuda/estatística & dados numéricos , Apoio Social , Humanos , Transtornos Mentais/psicologia , Resultado do Tratamento
15.
J Ment Health ; 20(1): 89-97, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21271829

RESUMO

BACKGROUND AND AIM: An English mental health trust implemented a strategy to dispel the stigma surrounding mental illness and service users. The purpose of this study was to evaluate its impact. METHOD: A questionnaire was mailed to 600 service users, selected at random, to evaluate the campaign's impact. Factor analysis of 243 responses yielded three factors which could be interpreted in relation to service users' perceptions of: public attitudes towards mental illness, service users' relationships with staff and other inter-personal relationships. RESULTS: Significant improvement was found in service users' perceptions of public attitudes towards mental illness. This can cautiously be related to the main thrust of the campaign. No change was found in the other two factors, which supports the inference that the campaign specifically influenced users' experience of public portrayals of mental illness. CONCLUSIONS: This study indicates that certain aspects of stigma may be amenable to change through a targeted campaign. While users' experience of public attitudes may be improved, at least in the short-term, other aspects of stigma did not appear to be amenable to change through community-level interventions. Different dimensions of stigma seem to demand different approaches. The intra-psychic roots of stigma may be the hardest elements to change.


Assuntos
Promoção da Saúde , Transtornos Mentais/psicologia , Estereotipagem , Humanos , Serviços de Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Reino Unido
16.
J Clin Nurs ; 19(13-14): 1935-43, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20920020

RESUMO

AIMS AND OBJECTIVES: This paper aims to: • Consider the major challenges to involving people with dementia in qualitative research. • Critique a process consent framework. • Demonstrate the need for nurses and researchers to explore these issues in research and practice with people with dementia. • Consider the impact of the Mental Capacity Act 2005 on research with people with dementia. To achieve its aims, the authors will draw on current literature and use examples which explores the use of life story work with people with dementia by taking a qualitative approach. BACKGROUND: There is acceptance that researchers should consider ways of actively involving people with dementia in research as participants where appropriate to answering specific research questions. Process consent methods have been advocated as an ethical way forward in recruiting and gaining consent for people with dementia, the Mental Capacity Act offers guidance to both practitioners and researchers. DESIGN AND METHOD: This paper does not seek to be a comprehensive review of the current literature but is a discussion paper appraising a process consent framework against current literature and drawing on the lead author's PhD study, exploring life story work with older people with dementia. RESULTS AND CONCLUSIONS: The Mental Capacity Act and process consent frameworks compliment one another, and their use should be considered when researching issues affecting older people with dementia. Researchers and practitioners should work more closely to ensure that the principles of process consent are achieved. Process consent models can equally be applied to everyday nursing practice. RELEVANCE TO CLINICAL PRACTICE: Process consent models can provide an ethical and practical framework to ensure that consent is continually assessed in people with dementia with all clinical interventions. The paper also draws on literature exploring practical ways of involving people with dementia in evaluating service delivery.


Assuntos
Demência , Participação do Paciente , Pesquisa Qualitativa , Humanos , Consentimento Livre e Esclarecido
17.
Int J Older People Nurs ; 5(2): 148-58, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20925716

RESUMO

BACKGROUND: Person-centred care has been linked with quality of care but difficulties remain in person-centred care being implemented in care practice. This study explores the use of life story work to enhance person-centred care with people with dementia. AIMS AND OBJECTIVES: The study investigates how life story work is: understood and developed in practice; experienced by all participants and affects the delivery and outcomes of care. DESIGN AND METHODS: The experience of older people with dementia, family carers and care staff in using life story work was explored within an NHS Health and Social Care Trust. A multiple case study design was adopted within a constructivist approach. Semi-structured interviews, observation, conversations were employed. FINDINGS: Life story work has the potential to: enable care staff to see the person behind the patient; allow family carers to uphold their relatives' personhood; enable the voice of the person with dementia to be heard, verbally and non-verbally; be enjoyable for all concerned and enable the person with dementia to feel proud about themselves and their lives. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Life story work has the potential to enhance person-centred care for older people with dementia and their families. Taking a practice development approach ensures that life story work can be implemented sensitively and is sustained in practice.


Assuntos
Demência/enfermagem , Narração , Assistência Centrada no Paciente , Idoso de 80 Anos ou mais , Feminino , Enfermagem Geriátrica , Humanos , Masculino , Pessoalidade
19.
Health Soc Care Community ; 16(3): 271-81, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18416717

RESUMO

The explosion of interest in young people as carers over the last decade and a half conceals the fact that there are still no reliable estimates of the number of young people with caregiving responsibilities. This is even more problematic in circumstances where the 'looked after' person has a mental health problem. In this study, we reflect on what can be done to identify, assess and support young people in these circumstances. We draw on selected findings from a study that has been examining the constituents of good assessment practice in work with family carers supporting relatives with mental health problems. The study embraces different carer groups but this paper concentrates on the experiences of young carers at one study site where Barnardo's and partner organisations had developed a joint initiative targeting young people who are looking after parents and relatives with mental health problems. Following a review of the literature about young people as carers, the paper describes how Barnardo's worked to support them through its young carers projects. Based on face-to-face interviews with the young people (N = 10) caring for a mother with mental health problems, the main part of the paper provides an account of how they talk about, make sense of and evaluate the support they have received through this combined initiative. The findings underscore the value of one particular young carers project, and provide clues about what lessons may be transferable to other similar projects.


Assuntos
Cuidadores/psicologia , Saúde Mental , Psicologia do Adolescente , Apoio Social , Adolescente , Criança , Feminino , Humanos , Entrevistas como Assunto , Masculino , Reino Unido
20.
Int J Nurs Stud ; 44(3): 511-9, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16842793

RESUMO

BACKGROUND: Health policy requires consumer involvement in services, research and education but little is known about how consumers are being involved in healthcare education, the effect on learning and practice, nor how involvement initiatives are being evaluated. OBJECTIVES: To describe methods of involving consumers in healthcare education, discuss ways in which initiatives have been evaluated, and identify areas for development in education, practice and research. DESIGN: All papers reporting specific initiatives involving consumers in health care worker training and education were included. Viewpoint articles and studies of consumers training consumers were excluded. DATA SOURCES: Cinahl, Medline, Assia, PsycINFO, British Nursing Index, Social Science Citation Index, citations from reference lists, relevant websites and personal communication with key people known to be working in this area. REVIEW METHODS: A narrative approach was taken with categorisation of data to reflect objectives of selected studies; method of involvement; process issues and evaluation. RESULTS: Thirty-eight papers were included; most provide small-scale qualitative studies of mental health service users and focus on process rather than outcome. Various methods of involvement are described and consumers consistently prioritise the need for training in interpersonal skills over 'technical' skills. There is little research into organisational strategies and no studies investigate the effect of consumer involvement on practice. Two studies indicated that students exposed to consumer involvement demonstrate more empathic understanding and better communication skills. CONCLUSIONS: There is tentative evidence that consumer involvement in training enhances workers' skills in the manner prioritised by consumers. However, if consumer involvement in training and education is to facilitate services that reflect the priorities of the people using them, it must be developed in partnership with service providers; further research is needed to explore the impact of consumer involvement and to track the development of organisational consumer involvement strategies, also systems for supporting consumers need to be established, including training for both consumers and staff.


Assuntos
Atitude do Pessoal de Saúde , Participação da Comunidade/métodos , Pessoal de Saúde , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Participação do Paciente/métodos , Competência Clínica , Participação da Comunidade/psicologia , Tomada de Decisões Gerenciais , Medicina Baseada em Evidências , Grupos Focais , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Humanos , Pesquisa em Educação de Enfermagem , Avaliação de Processos e Resultados em Cuidados de Saúde , Participação do Paciente/psicologia , Projetos de Pesquisa , Materiais de Ensino/normas , Reino Unido
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