Wounds in mental health care: The archetype of a ‘wicked problem of many hands’ that needs to be addressed?

Abstract

Aim: This paper explores wound care for people living with mental health difficulties from a nursing perspective and considers what can be done to improve it.Objective: To analyze policy and practice relating to wound care for people experiencing mental ill health using the ideas of ‘wicked problems’ and ‘problems of many hands’Methods: Policy and practice analysis informed by theory.Results: Recent UK policy is to ensure parity of esteem so that people with mental ill-health receive the same quality of care as those with physical ill-health. However, the provision of physical care to people experiencing mental ill health, including the provision of wound care, constitutes a ‘problem of many hands’ arising in the context of the mental health system being a complex one replete with wicked problems. Wicked problems are resistant to solutions and problems of many hands are complex and multifaceted, and involve the interplay of different actors. Addressing problems of many hands in this context requires systems thinking and solutions enabling different people to work collaboratively.Conclusions: The wound care of people experiencing mental ill health has been largely overlooked, as it transcends the domains of mental health and tissue viability policy and practice. A strong system level approach is needed to improve care, characterized by closer interprofessional teamworking.HighlightsThe wound care of people experiencing mental ill-health is largely overlooked.People with mental illness receive their wound care from tissue viability nurses.Wound care can be conceptualized as a ‘problem of many hands’.System level policies are needed to improve this aspect of health care.