National Institute of Health Research

HS&DR - 13/10/75: Cross-national comparative study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A)

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Project title Cross-national comparative study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A)
Research type Primary Research
Status Research in progress
Start date July 2014
Publication date

September 2016

This is the estimated publication date for this report, but please note that delays in the editorial review process can cause the forecast publication date to be delayed.

Cost £ 452,354.00
Chief Investigator Professor Alan Simpson
Co-investigators Dr Michael Coffey (Swansea University), Ms Alison Faulkner (Independent Service User Researcher), Dr Ben Hannigan (Cardiff University), Dr Aled Jones (Cardiff University), Dr Sally Barlow (City University London), Dr Jitka Vseteckova (The Open University), Dr Mark Haddad (City University London), Dr Karl Marlowe (City University London)
Contractor City University London
Plain English summary Serious concerns have been identified in relation to care planning, patient involvement and consent to treatment in mental health wards, including for patients detained under the Mental Health Act. Evidence is needed to develop approaches to care planning that ensure patients are treated with dignity, are involved in their own care and that helps them recover. We propose to undertake a study of how care planning is organised in inpatient mental health settings. We will look at the relevant research evidence; then run the study in England and Wales as policies are slightly different in the two countries. We will look at care planning across six different NHS sites to compare different organisations. Four sites are in England and two in Wales, selected to reflect variety in geography and population and include a mix of rural, urban and inner city settings providing routine inpatient care. Within each of these sites, we will look at care planning in detail on six mental health wards. We are already looking at care planning in six community mental health services in another study and intend to pull the results from the two studies together to suggest solutions that work across the whole system. A large sample of service users (total 300), inpatient staff (total 300) and informal carers (total 150) will be surveyed with questionnaires about their views of acute mental health care and care planning, practices that aid recovery, therapeutic relationships and empowerment. We will look at care planning policies and audits in the organisations and conduct 60 detailed interviews with managers, consultant psychiatrists, ward staff and informal carers about local policies and practices. In each site we will also select one inpatient ward and invite a total of 36 service users to participate in interviews about their experiences of care planning and discuss their care plans and about how involved they were in care planning. We will also ask 60 service users about to be discharged if we can review their care plans to see whether they show evidence of good practice. With the agreement of patients and staff, we also hope to attend and observe ward rounds and other care planning meetings. All participants will be given information about the study and asked to give written consent to take part and they may decline to do so if they wish. This will not impact on their care, treatment or employment in any way. When we conduct our analysis we will be comparing approaches across England and Wales, between the six organisations and within the six different wards. We will look for examples where care planning works best and identify what makes the difference. We intend that the results will enable us to describe the aspects of care planning that are important in promoting personal recovery and use these to inform service developments. The research team has vast experience of running research studies and of being mental health practitioners and service users. We have previously researched care planning and inpatient and community mental health services. Service user researchers will also be involved in all aspects of the study. The costs for the study have added value as we propose to undertake preparations for the study, such as obtaining ethical approval, for free as we complete our community study. This means the funding is primarily for salary and travel costs to collect and analyse the data and write-up the final reports.
Scientific summary Background: Serious concerns have been identified in relation to care planning, patient involvement and consent to treatment in mental health wards, including for those patients detained under the Mental Health Act. Further evidence is needed to develop care planning interventions that embed dignity, recovery and participation for all people using inpatient mental health care. Design: We propose to undertake a cross-national comparative study of recovery-focused mental health care planning in inpatient settings. This two-phase exploratory mixed methods study will produce theory and empirical evidence to complement that developed in our current study of community mental health services to inform a future whole systems intervention study. The study is guided by a theoretical framework emphasising the connections between different levels of organisation (macro/meso/micro). In phase 1 we study the macro-level through the comparative analysis of English and Welsh policy contexts. In phase 2 concurrent quantitative and qualitative data will be collected at 6 NHS Trust/Health Board case study sites (meso-level) and within each site, a single micro-level mental health ward will be selected to provide in-depth qualitative data related to care planning processes. Phase 1: We will extend our current meta-narrative mapping review (Wong et al 2013) of English and Welsh policies and the international literature on personalised recovery-oriented care planning and coordination in community settings to include inpatient settings. We will provide a review of evidence that is useful, rigorous and relevant for service providers and decision-makers and to inform Phase 2. Phase 2: We are employing a concurrent transformative mixed methods approach with embedded case studies (Creswell 2009: 215). We will conduct six in-depth meso-level case study investigations across contrasting NHS Trusts in England (n=4) and Local Health Boards in Wales (n=2), selected to reflect variety in geography and population and include a mix of rural, urban and inner city settings providing routine inpatient care. A large sample of service users (total n=300), inpatient staff (n=300) and informal carers (n=150) will be surveyed about perceptions of acute mental health care and care planning, recovery oriented practices, therapeutic relationships and empowerment using validated questionnaires. Documents and interviews with managers, consultant psychiatrists, ward staff and informal carers (n=60) will also be generated relating to local contexts, policies and practices. In each site we will also select a single inpatient ward and conduct a series of case studies embedded within each organisational case study, to explore care planning in detail. We will invite a sample of service users (total n=36) to participate in in-depth interviews about care planning and structured narrative reviews of their care plans; undertake a structured review of anonymised care plans for a further sample (n=60) of consecutively discharged patients; and conduct observation of care planning processes (n= 18). Framework method will be employed to integrate and compare textual and statistical summaries of qualitative and quantitative analyses within each case study site, informed by the theoretical framework focused on recovery and personalisation. Armed with our set of six within-case analyses we will then conduct a cross-case analysis to draw out key findings from across all sites.
Documents

Specification Document (PDF File - 96.8 KB)

Protocol (PDF File - 806.9 KB)

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