Abstract
To measure change in service user involvement in secure mental health units, before and after the implementation of recovery-oriented practice. Quasi-experimental study pretest-posttest design with non-equivalent comparison groups. Data were collected from May 2018 to December 2019 in four medium-/high-security units in Norway. Two intervention units that implemented recovery-oriented practice were compared with two comparison units that did not. Data were obtained using anonymous questionnaires at baseline and at 6-month follow-up. For intervention units, data were also obtained at a 12-month follow-up to measure sustainability of improvements over time. Twenty inpatients ('patients'; intervention group: 10, comparison group: 10) and 141 members of frontline staff ('service providers'; intervention group: 92, comparison group: 49) participated at baseline. Mann-Whitney U-tests and independent sample t-tests were applied at the group-level to analyse changes in mean scores in groups. Among patients in the intervention units, findings indicated no improvements after 6months, but significant improvements after 12months in terms of patients' opportunities to participate in formulating their individual care plans, to influence decision-making about therapy and to receive information about complaint procedures. Opportunities to participate in discussions about medication and treatment regimens did not improve. After 6months, service providers in the intervention units reported an increase in democratic patient involvement, patient collaboration and management support, but not in carer involvement and assisted patient involvement. The improvements in democratic patient involvement and management support were sustained over time. No changes were found in the comparison groups. The patients and the service providers reported a higher degree of service user involvement after implementing recovery-oriented practice. Specific work is needed to ensure patients' involvement in all domains. The findings are encouraging with respect to the potential to increase empowerment in a restricted setting through the implementation of recovery-oriented practice.
Highlights
Involvement of service users in their mental health care is a major priority, and the recovery model has been identified as the guiding framework in many countries (Department of Health, 2014; Norwegian Directorate of Health, 2014; Saxena et al, 2015)
Tambuyzer et al (2014) found four main arguments for patient involvement in mental health care: (1) it is a fundamental right of citizens and ‘the right thing to do’, (2) it contributes to empowerment, quality of life and satisfaction with health, (3) it enhances the quality of mental health care and (4) it is advocated to meet governmental or funding requirements or to increase the initiative's legitimacy
The present study examines how patients and service providers evaluate the degree of service user involvement before and after the implementation of recovery-oriented practice
Summary
Involvement of service users in their mental health care is a major priority, and the recovery model has been identified as the guiding framework in many countries (Department of Health, 2014; Norwegian Directorate of Health, 2014; Saxena et al, 2015). Secure units are responsible for patients with the highest security and treatment needs (Urheim & VandenBos, 2006) These include mentally ill people whose behaviour represents a risk to themselves and others. It has been argued that the perspectives of patients in secure settings are as important as the perspectives of other patients about their illness and care (Marklund et al, 2020), and it is probably that they will respond positively to increased opportunities to be involved in their own treatment (Livingston et al, 2013). Marklund et al (2020) found that patients in secure settings understood what they needed to recover, but their experience was that this understanding was not taken into consideration They documented the patients’ ‘need for empowerment in a restricted life’
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
