Search results

People with complex health conditions must often navigate landscapes of uncoordinated public, private and voluntary health-care providers to obtain the care they need. Complex health conditions frequently transcend the scope of typical health-care service systems. The purpose of this paper is to explore and characterize such unique assemblages of actors and services as “user-defined ecosystems”.

Building on literature on customer ecosystems, this paper introduces the concept of the user-defined ecosystem (UDE). Using an abductive approach, the authors apply the concept in an interpretive, qualitative study of ten families with special needs children.

This study uncovers complex UDEs, where families actively combine a broad range of services. These ecosystems are unique for each family and extend beyond the scope of designed service ecosystems. Thus, the families are forced to assume an active, coordinating role.

This paper shows how to identify ecosystems from the user’s point of view, based on the selected user unit (such as a family) and the focal value-creating function of the ecosystem for the user.

This paper highlights how service providers can support and adapt to UDEs and, thus, contribute to user value and well-being. This can be used to understand users’ perspectives on service and systems in health and social care.

This study develops the concept of the UDE, which represents a customer-focused perspective on actor ecosystems and contrasts it with a provider-focused and a distributed perspective on ecosystems. This study demonstrates the practical usefulness of the conceptualization and provides a foundation for further research on the user’s perspective on ecosystems.

This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services.

A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having “major” relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes.

There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery.

This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English.

This review makes a unique contribution, highlighting that, to the best of the authors’ knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary.

The New Ways of Working (NWW) initiative was launched in 2004 to build a more flexible and skilled mental health workforce. This paper explores the journey through inpatient care under a new acute care team (ACT) model, piloted in Mersey Care NHS Trust as part of the redesign of services under the NWW. Fourteen service users were interviewed face‐to‐face, using an interview schedule of open‐ended questions administered by service user and carer interviewers. Service user perspectives on the admission process and inpatient care were reported as predominantly negative. Service user perspectives on the discharge process and aftercare were reported as predominantly positive. The need for clear and unambiguous care pathways, adequate information, good communication, and to have continuity of care and positive relationships with staff emerged as key themes.

While shared decision making (SDM) in general health has proven effectiveness, it has received far less attention within mental health practice with a disconnection between policy and ideals. The purpose of this paper to review existing developments, contemporary challenges, and evidence regarding SDM in mental health with a particular focus on the perspectives of service users.

This is a review of international papers analysed using narrative synthesis of relevant data bases.

The review shows significant barriers to the utilisation of SDM including ethical and legal frameworks, accountability and risk. The medical model of psychiatry and diagnostic stigma also contributes to a lack of professional acknowledgement of service user expertise. Service users experience an imbalance of power and feel they lack choices, being “done to” rather than “worked with”.

The paper also presents perspectives about how barriers can be overcome, and service users enabled to take back power and acknowledge their own expertise.

This review is the first with a particular focus on the perspectives of service users and SDM.

Service user involvement is crucial in education and training as it can add a unique perspective and promote better practice. This paper provides an example of service user involvement in all aspects of the training. The involvement will be considered from the perspectives of the service user and a student. Implications and issues for practice are discussed.

The concept of personal recovery is now a key pillar of service delivery. It aims to support individuals to flourish and establish a new identity following an acute episode or diagnosis. This view of recovery is unique to each person on that journey. However, there has been a significant focus on measuring these experiences. This paper aims to explore the influence of social constructionism on the concept of recovery within an Irish context, seeking to understand the influence of language, discourse and power on service users’ experiences.

A qualitative, interpretivist methodology was adopted for this case study design. Semi-structured interviews were conducted with 12 service users. Thematic analysis was chosen as the method of analysis.

Personalising recovery did not always lead to the removal of biological symptoms, but with the appropriate supports, individual’s recovery journey was greatly enhanced. On the contrary, personal recovery places overwhelmingly responsibility on the individual to succeed, largely driven by neoliberal discourse. This focus on individualism and the pressure to succeed was further experienced when people sought to re-integrate into society and participate in normalised social order. Ultimately, for many service users, they viewed personal recovery as an unfulfilled promise.

It is not a representative sample of service users within an Irish context.

To the best of the authors’ knowledge, this is the first study to explore influence of social constructionism on the concept of personal recovery within a mental health service context.

The purpose of this paper is twofold: first, assess the effects of the peers’ recovery narratives on service users’ perceived mental health recovery; and second, explore various stakeholders’ perspectives on the program, specifically its facilitators and barriers.

The study used a convergent mixed-method design. First, a pre-test post-test design was used with service users to evaluate the peer recovery narrative program. They completed the Recovery Assessment Scale (RAS) and participated in qualitative interviews that explored perspectives on their mental health recovery before and after the program. Second, a cross-sectional design was used to explore stakeholder groups’ perspectives on the recovery narrative program immediately after listening to the narratives.

While findings show that there was no statistical difference between scores on the RAS before and after the peer narratives, thematic analysis revealed a change in service users’ understanding of recovery post-narratives. Other stakeholder groups confirmed this change. However, some healthcare professionals questioned the universal positive effects of the peer recovery narrative program on service users. Stakeholders agreed that beyond effects of the peer recovery narrative program on service users, there were also positive effects among the peers themselves.

To the authors’ knowledge, this is the first Canadian study, and one of the first studies to rely on mixed-methods and various stakeholder groups to evaluate the impact of peer recovery narratives on service users. The research, thus, fills a knowledge gap on peer recovery narratives.

This paper aims to conceptualise the residential and psychiatric hospital as a space where criminality and social harms can emerge. Because of recent media scandals over the past 10 years concerning privately-owned hospitals, this study examines the lived experiences of service users/survivors, family members and practitioners to examine historic and contemporary encounters of distress and violence in hospital settings.

The study consists of 16 biographical accounts exploring issues of dehumanising and harmful practices, such as practices of restraint and rituals of coercive violence. A biographical methodology has been used to analyse the life stories of service users/survivors (n = 9), family members (n = 3) and professional health-care employees (n = 4). Service users/survivors in this study have experienced over 40 years of short-term and long-term periods of hospitalisation.

The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. Practitioners recalled comprehensive experiences of violence within historic mental hospitals, although violence that may be considered criminal appeared to disappear from hospitals after the Mental Health Act (1983). These reports of criminal violence and coercive abuse appeared to be replaced with dehumanising and harmful procedures, such as practices of restraint.

The data findings offer a unique interpretation, both historical and contemporary, of dehumanising psychiatric rituals experienced by service users/survivors, which are relevant to criminology and MAD studies. The study concludes by challenging oppressive psychiatric “harms” to promote social justice for service users/survivors currently being “treated” within the contemporary psychiatric system. The study intends to conceptualise residential and psychiatric hospitals as a space where criminality and social harms can emerge. The three aims of the study examined risk factors concerning criminality and social harms, oppressive and harmful practices within hospitals and evidence that violence occurs within these institutionalised settings. The study discovered that institutional forms of violence had changed after the deinstitutionalisation of care. These reports of violence include dehumanising attitudes, practices of restraint and coercive abuse.

This study aimed to explore how forensic mental health service users make sense of their past adverse experiences. Secondly, it aimed to explore whether service users considered their adverse experiences to be related to their current stay in a forensic mental health setting.

Interpretative phenomenological analysis was used to analyse interviews with eight service users in low and medium secure care. Six of the participants were male and two were female.

Four super-ordinate themes emerged from the data: “Living amongst adversity”; “Managing adverse experiences”; “Making sense of going into secure care”; and “Coping with the past in the present”. All participants referred to multiple adverse experiences throughout their lives and used harmful coping strategies to manage these. Individual differences in how they related their past experiences to their detention in secure care were evident.

Author guidelines state that this section is optional. Implications for clinical practice are discussed at length in the discussion section.

This study offers an insight into the way in which forensic mental health service users make sense of their past traumas in relation to their current admission to secure services. To the best of the authors’ knowledge, no research has previously addressed this from the perspective of service users.

The purpose of this paper is to address a knowledge gap on advocacy outcomes from mental health service users’ perspective, and the implications for evaluating advocacy impact. The studies discussed highlight challenges for measuring the outcomes of advocacy, but underline the importance of doing so, and of involving service users alongside other stakeholders in co-designing evaluation systems.

The paper uses findings from three qualitative studies of independent advocacy involving focus groups and interviews with: 30 African and African Caribbean men who were mental health service users; 90 “qualifying patients” in a study of Independent Mental Health Advocate services; and nine young women in children and adolescent mental health services (CAMHS).

A comparative analysis and synthesis of findings from three studies identifies four common dimensions: how mental health advocacy is conceptualised and understood; how service users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacy outcomes. Advocacy outcomes were conceptualised as increasing involvement, changing care and treatment and supporting personal development. There was evidence of advocacy acting to empower mental health service users, and of broader impacts on service regimes and policies. However, there was limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen as important.

Few researchers have focused primarily on the perspectives of people using independent mental health advocacy, or on the experience of “advocacy as empowerment”, and none have done so across diverse groups. This analysis adds insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems.