The journey of service users with complex mental health needs: a qualitative study.

Background: This study aimed to provide a robust picture of the journey of service users with complex mental health needs by evaluating the perspectives of service users and carers with lived experience of services and gaining clinician views about decision making in relation to this cohort. Methods: A qualitative design was used. Service users (n = 11), carers (n = 10) and clinicians (n = 18) took part in semi-structured interviews, which were transcribed verbatim and analysed using thematic analysis. Results: The following themes were identified by participants: 'relationships with staff,' 'treatment options, pathways and availability,' 'the role of autonomy in recovery,' 'impact of out-of-area placements,' and 'specialist training for staff.' The findings demonstrated that the journey of serviceusers can be impacted by a wide range of factors, including relationships with staff, the nature of support offered, community response, financial constraints, and organisational goals around bed pressures. Conclusions: Recommendations include the need for staff to work in partnership with service users and carers, foster autonomy, access specialised suicide prevention training, and agree discharge and contingency plans with service users. Further work is needed to deliver the best possible experience for individuals with complex mental health needs and those who care for them.

Perspectives of service users and carers with lived experience of a diagnosis of personality disorder: A qualitative study.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Personality disorder is a serious mental health condition affecting up to 52% of psychiatric outpatients and 70% of inpatients and forensic patients. People with a diagnosis of personality disorder have higher morbidity and mortality than those without. Service users and carers reported a lack of training for staff in the management of individuals with a diagnosis of personality disorder, particularly with regard to self-harm and suicidal behaviours. Staff burnout creates barriers to compassionate person-centred care for individuals with a diagnosis of personality disorder as staff struggled to accommodate the nature of the presentation when under significant emotional, psychological and professional strain caused by understaffing and lack of support. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper adds new knowledge by informing services of ways to improve care provision from the perspectives of both carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with a diagnosis of a personality disorder should be adopted, and personality disorder training introduced for all healthcare practitioners, to improve patient outcomes. ABSTRACT: INTRODUCTION: There is limited understanding of the experience of people with complex mental health (CMH) needs, including those with a diagnosis of personality disorder (PD) and carers of those individuals. Little is known about carers of those in inpatient forensic settings, yet it has been identified that they may have additional needs when compared to general carers. Research highlights that community carer support services were perceived as inadequate and out-of-area placements were described as putting an added strain on ability to support loved ones. Understanding PD within a population of people with CMH needs and how a diagnosis described as PD impacts on care and treatment experience is vital to providing high-quality care. AIM: To evaluate the care experience of service users and carers with lived experience of a diagnosis of PD and out-of-area placements. METHOD: Semi-structured interviews were conducted with six service users and four carers to explore the experiences and perspectives of people with a diagnosis of PD. Interviews were audio recorded and thematically analysed. RESULTS: Four interrelated themes were developed; Influence of a diagnosis of PD on Staff, Early and Appropriate Intervention, Recognition of the Individual and Training and Knowledge of people with a diagnosis of PD. DISCUSSION: Anti-stigma interventions for staff, research on care provision and structural changes to services including more evidence-based therapy for individuals with a diagnosis of PD may help reduce disparate treatment and improve prognosis for recovery. IMPLICATIONS FOR PRACTICE: This paper informs services of ways to improve care provision from the perspective of carers and service users. A more holistic and less medicalised approach to the treatment of problems associated with diagnoses of PD should be adopted, and PD training for all healthcare practitioners to improve patient outcomes.

Mindfulness intervention for foundation year doctors: a feasibility study.

BACKGROUND: Mindfulness has been shown to reduce stress and burnout in medical students and healthcare professionals. This is a quality improvement study which assessed the feasibility of conducting a full-scale evaluation of a mindfulness intervention among UK foundation doctors to reduce stress and burnout. METHODS: This is an uncontrolled before and after study taking place in a single university teaching hospital. The RE-AIM framework which comprises of five dimensions including Reach, Adoption, Effectiveness, Implementation, and Maintenance was used to guide this assessment. The intervention was a 6-week 'Mindfulness in the Workplace' course. The primary measure was change in self-reported levels of stress immediately before and after the course. Additional measures explored the subjective experiences of participating doctors through the use of questionnaires handed out before and after the course. RESULTS: All 20 places on the course were filled from the population of 108 foundation doctors at the trust with an equal number of foundation year 1 (n = 10) and foundation year 2 (n = 10) doctors. Sixteen participants (80%) attended one or more sessions. The median baseline stress score of the participants was 6.5 (range = 2 to 9). The median post-course stress score was 5.0 (range = 2 to 8). The Mann-Witney test indicated that the stress levels of participants were significantly lower at the end of the course compared to baseline, U = 74.50, p = .04. Additional measures suggested that the intervention may be associated with some other potential promising benefits for doctors including greater wellbeing, improved working life, and more satisfactory relationships with patients. Implementation of this intervention requires further work at the institutional level because only 35% of participants completed the full intervention, the main barrier being work commitments. CONCLUSION: This is the first programme of research to evaluate the feasibility of trialling and implementing a modified 'Mindfulness in the Workplace' intervention for foundation junior doctors in the UK. Based on the findings from this study, we conclude that this intervention is promising but further modifications are required such as the use of validated outcome measures and improving delivery aspects before this intervention programme is trialled among foundation doctors in the UK.