Understanding experiences of and preferences for service user and carer involvement in physical health care discussions within mental health care planning

Penny Bee,Andrew Grundy,Nicola Small,Karina Lovell,Chris Gibbons,Helen Brooks,Rebecca Pedley

doi:10.1186/s12888-017-1287-1

Abstract

BackgroundPeople with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning. Although evidence pertaining to service user and carer involvement in mental health care planning is accumulating, current understanding of how physical health is prioritised within this framework is limited. Understanding stakeholder experiences of physical health discussions within mental health care planning, and the key domains that underpin this phenomena is essential to improve quality of care. Our study aimed to explore service user, carer and professional experiences of and preferences for service user and carer involvement in physical health discussions within mental health care planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision.MethodsSix focus groups and four telephone interviews were carried out with twelve service users, nine carers, three service users with a dual service user and carer role, and ten mental health professionals recruited from one mental health Trust in the United Kingdom. Data was analysed utilising a thematic approach, analysed separately for each stakeholder group, and combined to aid comparisons.ResultsNo service users or carers recalled being explicitly involved in physical health discussions within mental health care planning. Six prerequisites for effective service user and carer involvement in physical care planning were identified. Three themes confirmed general mental health care planning requirements: tailoring a collaborative working relationship, maintaining a trusting relationship with a professional, and having access to and being able to edit a living document. Three themes were novel to feeling involved in physical health care planning discussions: valuing physical health equally with mental health; experiencing coordination of care between physical-mental health professionals, and having a physical health discussion that is personalised.ConclusionsHigh quality physical health care discussions within the care planning process demands action at multiple levels. A conceptual framework is presented which provides an evidence-based foundation for service level improvement. Further work is necessary to develop a new patient reported outcome measure to enable meaningful quantification of health care quality and patient experience.

Highlights

People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning
Six prerequisites for effective service user and carer involvement in physical health discussions within care planning emerged from the data; three of which confirmed general care planning requirements and three which were novel themes, or those that had specific relevance to physical health discussions
Through a collaborative working relationship, there was the potential for service users and carers to feel empowered, and more confident to become involved in tailoring their physical health elements of the care plan

Summary

Introduction

People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning. The Implementation Plan aims to provide improved continuity and coordination of care, and enhanced relational support between health and social care or between primary and secondary care service providers by bringing together physical and mental health care to benefit people with severe mental illness [4]. In response to the Taskforce, promises have been made to deliver more integrated physical and mental health care, to provide NHS care that is cost efficient, of a higher quality, and more personalised to service users of mental health services [5, 6]. Many physical health checks, such as vital cholesterol and blood glucose checks to prevent the onset of long-term physical health conditions, are not completed by mental health professionals, with many service users being referred on to physical health specialists in primary care [3, 7]

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