The barriers and facilitators of supporting self care in Mental Health NHS Trusts

Mental health presents challenges to the concept of self care – mental health services have been especially reluctant to share responsibility with service users, and some service users are reluctant to engage with services that they feel are disempowering. This makes mental health a particularly useful case within which to explore the barriers and facilitators of effective implementation of self care policy.

This study integrates qualitative and quantitative methodologies in a two-stage service mapping design together with a cohort study in order to investigate the implementation of self care initiatives in mental health care from a range of stakeholder perspectives. The study will address the following aims and objectives:

(1) To identify the main barriers/ facilitators-– organisational, team, user & carer expectations, structures and processes of self care - to effective delivery of self care in NHS mental health organisations (in terms of improved outcomes for users of self care initiatives and their carers);
(2) To identify learning about the implementation of self care from the mental health service experience that can be applied to other health service areas.

Service user researchers and NHS managers will be integral members of the research team at all stages of the research process, and have been fully involved in the development of this proposal.

The initial service mapping phase and cohort study will take place in three NHS Trust areas (Hampshire Partnership NHS Trust, Leeds Mental Health NHS Trust, South West London & St George’s Mental Health NHS Trust) selected as offering geographical and demographic contrast, as well as range of socio-economic and rural/ urban mix.

The cohort study, with measures at baseline (referral) and 9 month follow-up, will investigate three self care initiatives (one in each trust area) selected as offering three contrasting interpretations and applications of self care. Participants in the cohort study will be 40 consecutive new referrals to each self care initiative, aged 18-65 and meeting the entry criteria of each initiative. Carers and support workers on the self care initiatives - with sampling centred on the service user sample - will also be interviewed as part of the study.

As well as semi-structured interviews collecting qualitative data about expectations and experiences of self care, standard measures of clinical status (CORE-OM), satisfaction, empowerment, quality of life, mental health confidence, locus of control and experience of therapeutic relationship will be made of user participants, experience of care giving of carers, and experience of therapeutic relationship of support workers/ professionals. Concrete indicators of service use (9 months prior to and 9 months post referral) and engagement with the self care initiative will also be measured.

A final national service mapping design, using an online, web based approach, will be applied to all 77 mental health Trusts in England (including PCTs that provide mental health services directly).

The potential to generalise the findings of this study to people in other health service sectors undertaking self care will be explored firstly by triangulating our findings with existing published change management and self care literature, and secondly by comparison with the findings of SDO funded self care teams working in other areas. The potential to generalise findings to different groups of people with a mental health problem will be considered firstly by accurately describing the sample in each study site, and secondly by between site data comparison and a synthesis of data across sites.