Working to improve inpatient psychiatric units in Coventry Warwickshire Partnership Trust
Work conducted in the School’s clinical psychology group is changing clinical practice in inpatient psychiatric units in Coventry Warwickshire Partnership Trust. Qualitative research exploring the experience of hospitalisation for young people with psychosis has been the basis for an innovative piece of service development recently conducted in collaboration with Coventry and Warwickshire Partnership Trust (CWPT). This work is particularly exciting because it actively involves young people with psychosis, their family members, and clinical staff, in service design. The initial research was conceived and supervised by Dr Michael Larkin and Dr Lizzie Newton, who then went on to use ‘impact’ funding from the University and from CWPT to develop and implement an action-planning event. At this event, service users, family members and staff worked together, to plan changes to inpatient services.
Using qualitative research to highlight areas for service development
Three doctoral researchers from the clinical psychology training program in the School (Jess Colin, Kelly Fenton, Gareth Hickman) conducted projects which explored the experiences of young people with psychosis, their family members, and inpatient staff, in relation to hospitalisation. This is an important population, because they are likely to be entering the mental health system for the first time, often at a point of crisis, and because they are likely to be young adults who are still being 'parented.' As we know from other research (some of it conducted by Max Birchwood's group within the School) this 'first onset' period is critical for the long-term outcomes of people with psychosis. A positive experience of services is likely to facilitate future engagement, and thus allow young people to benefit from the multi-disciplinary interventions which can improve their long-term recovery. Our research showed that hospitalisation in early psychosis could be distressing and confusing for the young person and their family, while staff felt frustrated that the inpatient environment was not more ‘therapeutic,’ and that they themselves were not able to spend more time working therapeutically with young people. Families felt poorly informed, and excluded from this critical stage in their young person’s care. The research allowed service users, parents and staff to express their concerns and experiences (both positive and negative) , which could then be shared more formally with Trust managers. To read more about some of the things which they said, you click on the link to see the team’s presentation which was given at the BPS conference of the Division of Clinical Psychology, in Birmingham in December 2011.
Converting the research work to ‘Experience-based design’
Senior colleagues at Coventry and Warwickshire Partnership Trust were keen to use the research as a catalyst for developing inpatient services to better meet the needs of people with early psychosis and to improve some of the things highlighted as difficulties by the research. With the help of the funding from the School and from CWPT, Dr Larkin and Dr Newton set about using the research projects to form the basis of an ‘Experience-Based Design’ process. This is model of collaborative working which has been championed by the NHS Institute for Innovation and Improvement. This is the first time it has been used in a mental health context.
The process involved Dr Larkin and Dr Newton facilitating a large number of 'feedback groups. ' At each of these, the findings from the research projects were presented, and the attendees were invited to say what their 'priorities for change' would be. In total, feedback was received from over 20 groups, involving hospital staff, community staff, managers, family members and service-users. This allowed the views of over 150 stakeholders to be heard, and it meant that a strong consensus was generated. Six key areas were consistently identified as priorities for service design, and these were taken forward to the action-planning event:
- Pathways in and out
- Providing staff with a rewarding and well-supported role
- Communicating with families and service-users
- Recovery-focused practice
- Creating a positive environment for everyone in it
- Recognising and sharing good practice across professions and services
Working together to develop ‘action plans’
On the 18th March, Dr Larkin and Dr Newton facilitated an action-planning event (pictured) at the Welcome Centre in Coventry. They were supported by postgraduates from the School’s PhD and MRes programs (Gemma Unwin, Rebecca Craddock and Joshua Muggleton), and by colleagues from Coventry and Warwickshire Partnership Trust. This event was the critical point in the development of a shared consensus for service development, based on research, and involving all key stakeholders. The event brought together 50 representatives from service-users and families, hospital and community mental health staff, and managers as equal partners, to work together to develop clear plans to address the six prioritised areas for improvement. The University and their collaborators in CWPT are at the cutting edge of service-user involvement in this respect: while the national user involvement agenda has made great progress in terms of involving service-users and families in committees and other structures, it is not yet standard practice to work in this collaborative way.
Each group developed action plans for future developments, which include ideas as wide-ranging as a flowchart poster (to help staff to communicate with service-users and families about the place which inpatient care takes in the typical 'journey' through services), and a program of protected 'set aside' time to allow staff to do more therapeutic work with service-users on the wards. These action plans will be handed over to a steering group, which involves Trust staff and service-users and family members, at a meeting in May. The University will remain involved, however: a postgraduate student from the School will return to the Trust in a year's time, to evaluate progress on the plans, and in the meantime a series of publications are planned, to report upon the research findings, and the action-planning process.