Abstract Purpose: The aim of this study was to explore how Community Mental Health Teams (CMHT) staff responded to delivering a service in a crisis. Background: The pandemic forced rapid and innovative change to care delivery. Knowledge about staff experiences may contribute to different approaches to managing staff during future pandemics and could be used in the design and implementation of interventions to support frontline mental health staff working to deliver community services. Methods: A qualitative semi-structured interview approach was adopted. Twenty-one staff from a CMHT in the North West of England, UK were recruited and interviewed remotely. Interviews took place in June and July 2020, three months after the UK entered its first national lockdown. Results: Analysis identified the approaches used by staff, from senior leadership down to those on the frontline, to try to make the service work in difficult circumstances. At every level of the organization staff talked about the challenges and strategies arising from a desire to deliver a service during the pandemic. The data is discussed under four headings; ‘senior trust managers trying to make it work’, ‘individuals making it work’, ‘making it work as a team’; and ‘making it work through working at home’. Clear communication of messages proved key across all areas, to ensure that government guidelines were followed, and that contact with service users and care delivery was directed at keeping people safe. Conclusion: In this study it was clear that the initial response to the pandemic involved the imposition of boundaries on staff by the Trust senior leadership to ensure the most vulnerable service users received a service while staff were kept safe. The data raises questions about how these boundaries were determined and whether the same outcome could have been achieved through involving staff more in the making of decisions about the delivery of services.
Background: The concept of recovery is contested throughout the existing literature and in mental health services. Little research exists that gives voice to service user perspectives of recovery.Aim: This paper explores how service users in two recovery oriented services run by the National Health Service in North West England talked about recovery and what it meant to them.Method: 14 service users accessing these services took part in semi-structured qualitative interviews focusing on the concept of recovery. Data were analysed using an interpretive phenomenological analysis approach.Results: Service users talked about recovery as a dynamic, day to day process as well as an outcome; specifically related to being discharged from inpatient settings. A number of factors including relationships and medication were cited to have the potential to make or break recovery.Conclusions: The study highlights the continued dominance of the biomedical model in mental health services. Service users appear to have internalised staff and services' understanding of recovery perhaps unsurprisingly given the power differential in these relationships. Implications for clinical practice are explored.
Suicide is a growing global public health problem that has resulted in an increase in the demand for psychological services to address mental health issues. It is expected that 1 in 6 people on a waiting list for mental health services will attempt suicide. Although suicidal ideation has been shown to be linked to a higher risk of death by suicide, not everybody openly discloses their suicidal thoughts or plans to friends and family or seeks professional help before suicide. Therefore, new methods are needed to track suicide risk in real time together with a better understanding of the ways in which people communicate or express their suicidality. Considering the dynamic nature and challenges in understanding suicide ideation and suicide risk, mobile apps could be better suited to prevent suicide as they have the ability to collect real-time data.This study aims to report the practicalities and acceptability of setting up and trialing digital technologies within an inpatient mental health setting in the United Kingdom and highlight their implications for future studies.Service users were recruited from 6 inpatient wards in the north west of England. Service users who were eligible to participate and provided consent were given an iPhone and Fitbit for 7 days and were asked to interact with a novel phone app, Strength Within Me (SWiM). Interaction with the app involved journaling (recording daily activities, how this made them feel, and rating their mood) and the option to create safety plans for emotions causing difficulties (identifying strategies that helped with these emotions). Participants also had the option to allow the study to access their personal Facebook account to monitor their social media use and activity. In addition, clinical data (ie, assessments conducted by trained researchers targeting suicidality, depression, and sleep) were also collected.Overall, 43.0% (80/186 response rate) of eligible participants were recruited for the study. Of the total sample, 67 participants engaged in journaling, with the average number of entries per user being 8.2 (SD 8.7). Overall, only 24 participants created safety plans and the most common difficult emotion to be selected was feeling sad (n=21). This study reports on the engagement with the SWiM app, the technical difficulties the research team faced, the importance of building key relationships, and the implications of using Facebook as a source to detect suicidality.To develop interventions that can be delivered in a timely manner, prediction of suicidality must be given priority. This paper has raised important issues and highlighted lessons learned from implementing a novel mobile app to detect the risk of suicidality for service users in an inpatient setting.
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