Stories of assertive outreach Team mental health patients

Student thesis: Doctoral Thesis

Abstract

Background:
Patient care is suffering, with disjointed care pathways that leave mental health patients in limbo as they transition through services. Organisational boundaries have become hurdles, difficult for both patients and professionals to navigate and overcome. NHS England and NHS Improvement aim to deliver a transformation in adult mental health services by 2023/24, building on the progress made to date towards achieving the recommendations set out in the Five Year Forward View for Mental Health. The aim is to support patients in accessing whole person, personalised physical and mental health care, housing, advocacy, welfare advice and employment support. This in turn is hoped to encourage engagement with services whilst decreasing the risk of poorer mental health and reducing health inequalities and unwarranted variations in care. While there is substantial research about collaborative working in mental health nursing and care, there is a paucity of evidence based on the experiences of the patients in this context.

Aim:
The research aimed to gain insight into and develop an understanding of the uniqueness of individual experiences, derived from mental health patients’ stories of recovery in the context of collaborative working within an assertive outreach community mental health team.

Methods:
Twelve patients who were in receipt of care from a local adult mental health outreach service in the UK, were purposively sampled to give information-rich insights of their experience of treatment and recovery in a collaborative assertive outreach team environment. The narrative approach was used to generate patients’ stories, with the data gathered and analysed thematically to determine both convergences and divergences in these stories.

Key findings:
Ten themes emerged: identity, transition from Child and Adolescent Mental Health Services – (CAMHS) to Adult Mental Health – (AMH); between AMH teams; between care coordinators; between medications; personal circumstances; from mental health professional to a mental health patient; transgender transition, hope and in-betweenness. Being a mental health patient was described as a locked position that encouraged feelings of inbetweenness which impacted on patient engagement.

Discussion:
Collaboration was viewed by patients as an important social function in mental health care. However from literature, there is no common acceptable term used to describe this simplest form of working together. This is an advantage as no agencies are excluded from the joint working process. Narratives showed how collaboration served a function in patient recovery. However, this was obscured by the complexities of in-betweenness experienced by patients in the context of multi-agency working. Inbetweenness, was best described as a place of indecision or having choices, which importantly supported the construction of solutions to life’s problems. Collaboration occurred at several levels, beginning with the patients engaging with the notion of having a mental illness and then accepting support from mental health services, as they transitioned through the mental health services. Patients suggested that improving transitional care through collaborative working that is characterised by good communication links, will facilitate not only recovery but also mental health promotion and mental illness prevention.

Conclusion:
Whilst collaboration has numerous benefits for patient and their recovery, it presents a range of challenges for patients as they transition through mental health services. A concept built in this research is of inbetweenness, which is characterised by multiplicity of challenges which mental health patients face. Patients viewed collaboration as dynamic and ambiguous, with the language of collaboration concealing much of the complexity that exists in mental health care. Patients’ perspectives identified by this research, can be embedded in culture changes that enhance patient recovery at clinical practice, policy and further research levels.
Date of Award2021
Original languageEnglish
SupervisorRebecca Stores (Supervisor), Nikki Jarrett (Supervisor), Graham Noyce (Supervisor), Kieron Hatton (Supervisor) & Karen Jennifer Burnell (Supervisor)

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