The PhD Abstracts below were published in MSo Volumes 6, 7 & 8.

Involvement in practice

An examination of the multiple influences on the construction of service user involvement in mental health care planning
Dr Sarah Robens, Peninsula College of Medicine and Dentistry

The involvement of mental health service users and their carers plays a central role in the policy behind the Care Programme Approach, the system for the management of care for people with mental illness.  Since the 1990s there has been a shift in health and social care towards increasing the control service users have over their care.  This is done through the use of different care planning mechanisms in particular.  Within the Care Programme Approach, care plans define the package of care, and this care is monitored through six monthly reviews of the care plan. Care planning and reviewing is a process in which service users and carers are supposed to be fully involved but evidence shows that this involvement is not happening.

This evidence was reflected in the concerns of a mental health service user group in Devon, who designed this study with a steering group made up of mental health service users, carers and mental health professionals.  The study seeks to fill the gap in the literature, which highlights that there are problems with mental health service user involvement in care planning but fails to explain the nature of the problems.  Through the use of non-participant observation and in-depth interviewing, this study examined involvement in practice, outlining how it is created and what influences it, both positively and negatively.

The observational data pointed towards involvement as dynamic in nature and further analysis outlined the detail of how involvement changes during a review.  In so doing, what emerged was analysis of how involvement is created through the interaction of different stakeholders at the review.  A number of different methods are identified through which involvement is enabled, restricted and self-created.  The interview data outlined people’s experiences of involvement, and identified key bridges and barriers to involvement that relate to structural and interactional issues.  Through both sets of data, the importance of the care coordinator in enabling involvement is emphasised, acting as they do within a set of structures that restrict service user involvement.  Further discussion of this data used the theory of Giddens to outline how involvement is the product of structuration, being produced when structure is put into practice through the actions of individuals.

Coming out of these findings is the implication that for service user involvement to become meaningful requires a re-working of care planning systems to move away from a professionally-led system to one which is truly centred in service user needs and wishes.  The other implication is that care coordinators need a greater understanding of how they can enable or restrict involvement through their actions, and this thesis provides the evidence on which to build this knowledge.

Dr Sarah Robens, Peninsula College of Medicine and Dentistry
sarah.robens@nhs.net


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Abstracts are published here as provided by the author and in the order in which we receive them.