Mental Health Care Planning Research Articles

Evaluating the Use of Trauma‐Informed Mental Health Assessment Measures in Care Planning for Children and Adolescents in Out‐of‐Home Residential Care in Singapore

Children and young people (CYP) within the Child Welfare System (CWS) often experience a range of trauma‐related difficulties. However, systematic use of evidence‐based measures to support mental health assessment and care planning appeared to be lacking within CWS in Singapore. This study evaluated the use of evidence‐based measures to inform care planning in out‐of‐home residential care in Singapore. Participants were 65 CYP in care. Measures consisted of the Child PTSD Symptom Scale for DSM‐5 (CPSS‐5), Assessment Checklist for Children (ACC) and Adolescents (ACA), Child Behavior Checklist (CBCL) and Youth Self‐Report (YSR). Care plans were identified based on the measures' clinical criteria and validated against the Child and Adolescent Needs and Strengths (CANS) and Adverse Childhood Experience (ACE) questionnaire. More intensive measurement‐based care plans were associated with higher service needs and lower strengths on the CANS, and higher ACE exposure. However, there was limited support for the validity of care plans when evaluated against the CANS and ACE questionnaire. Methodological implications for mental health assessment are discussed. Compared to service‐allocation‐as‐usual, measurement‐based care plans identified more cases that may require intensive psychological intervention. Overall, study findings provided some support for the use of assessment measures to supplement care planning in residential care.‘This study evaluated the use of evidence‐based measures to inform care planning in out‐of‐home residential care in Singapore’Key Practitioner Messages A comprehensive approach to care planning for CYP in out‐of‐home residential care should include the use of multi‐informant evidence‐based mental health assessment measures. The use of mental health assessment measures may reduce information gaps and complement the use of service needs assessment tools. Measurement‐based care planning may provide added value to supplement existing standard psychological care planning practices in out‐of‐home residential care.

Is there a missing-middle in Australian mental health care?

The term 'missing-middle' has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the 'missing-middle' term, founded on qualitative and quantitative research. Despite the widespread use of the term 'missing-middle' for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the 'missing-middle' care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to 'missing-middle' programmes that may not improve Australian public health outcomes.

The Consortium of Australian Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA): Aims, model, outputs, and implications for clinical academic advocacy.

We describe an independent model of clinical academic mental health services research that is able to provide synthesised views for medico-political organisations that are engaged in advocacy for national and state evidence-based policy and planning of mental healthcare. CAPIPRA focuses on independent research and policy analysis using publicly available datasets on population mental health at national and state/territory levels, published in international and national peer-reviewed journals (>50 papers since 2019). We partner with medico-political organisations in evidence-based advocacy across a wide range of issues.

The Emperor's New Clothes: Head-to-Health Centres expand in the absence of evaluation of efficacy.

To discuss concerns about the Australian federal government announcement of further funding expansion of the Adult Mental Health Centres (AMHCs), now known as Head-to-Health centres. The expansion of AMHCs prior to evaluation recapitulates the policy predicaments and perils of the headspace federal-infrastructure allied-health private-practice model. Comprehensive evidence-based mental healthcare planning and practice is needed, rather than stand-alone services of unclear efficacy. We describe the principles of such an approach based upon an evidence-based Health Needs Assessment.

Use of medicines in adults with autism spectrum disorder in Australia

AbstractUse of psychotropic medicines such as antipsychotics, antidepressants, and anxiolytics is common in children with autism spectrum disorder (ASD); however, very little is known about medicine use in adults with ASD. This pilot project aimed to describe medicines use in Australian adults with ASD. We conducted a retrospective analysis of mental health care plan records for adults with a confirmed diagnosis of ASD from a single metropolitan psychology practice. One hundred and twenty one of the 168 participants (72%) were taking at least one medicine. Fifty‐nine of the 168 persons whose care plans were reviewed (35%) were taking an antidepressant, the most frequently prescribed psychotropic medicine. Twenty‐three (14%) were prescribed a medicine for airways disease, most commonly salbutamol. Antipsychotics were used by 11% and anxiolytic/hypnotics by 10%. The most commonly used antidepressants were sertraline and escitalopram (21 and 19% of antidepressant users, respectively). The most commonly used antipsychotics were quetiapine and risperidone (32% and 27%, respectively). This pilot project has highlighted that use of psychotropic medicines is common in adults with ASD.

A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory.

The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument-the Description and Evaluation of Services and Directories-DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.

Engagement of mental health service users and carers in care planning - Is it meaningful and adding value?

Consider whether mental health service users and carers meaningfully engage in care planning and whether care planning adds value to patient care. A review of the meta-analyses and systematic reviews of service users and carers identified many barriers to their meaningful engagement in care planning. No research has demonstrated any measurable benefits or positive outcomes linked to mental health care planning.

Patient needs four years after first psychiatric hospitalization in a Brazilian cohort.

Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.

Understanding Nursing Turnover: The Case of Home Health Care

Only a few studies of nursing turnover have examined post-acute home health care. This study examines factors that are associated with home health licensed nurse turnover using linked employee-level and patient-level data from one of the five largest home health companies in the US. The data include variables from human resources and payroll systems, visit logs, discharge records, physical and mental health assessments, care plans, and patient encounters and is organized at the employee-day level. We measured turnover using human resources data, including measures of voluntary and involuntary job separation, and from exit interviews that allow classification of whether turnover was associated with agency-related factors (e.g., pay, schedule, supervisor, coworkers) versus personal factors (e.g., family needs, relocation). In bivariate and multivariate analyses, explanatory variables included nurse demographics, patient population characteristics, and the degree to which nurses can delegate tasks to home care aides. We found a downward trend in turnover for licensed nurses between 2016 and 2019. Attrition in the first year was 34% for full-time nurses and 45% for part-time nurses, most of it occurring in the first 180 days of employment. The rate of voluntary turnover was nearly four times as great as involuntary turnover. We found that agency factors accounted for 26% of monthly turnover on average, while personal factors accounted for 74%. In states in which licensed nurses could delegate more tasks to home care aides, turnover rates were slightly higher than in states with little delegation.

Trajectories of Depressive Symptoms among Multicultural Adolescents in Korea: Longitudinal Analysis Using Latent Class Growth Model.

The purpose of this study was to investigate the trajectory of depressive symptoms in multicultural adolescents using longitudinal data, and to identify predictive factors related to depressive symptoms of multicultural adolescents using latent class analysis. We used six time-point data derived from the 2012 to 2017 Multicultural Adolescents Panel Study (MAPS). Latent growth curve modeling was used to assess the overall features of depressive symptom trajectories in multicultural adolescents, and latent class growth modeling was used to determine the number and shape of trajectories. We applied multinomial logistic regression analysis to each class to explore predictive factors. We found that the overall slope of depressive symptoms in multicultural adolescents increased. Latent class analysis demonstrated three classes: (1) high-increasing class (i.e., high intercept, significantly increasing slope), (2) moderate-increasing class (i.e., moderate intercept, significantly increasing slope), and (3) low-stable class (i.e., low intercept, no significant slope). In particular, we found that the difference in the initial intercept of depressive symptoms determined the subsequent trajectory. There is a need for early screening for depressive symptoms in multicultural adolescents and preparing individual mental health care plans.

Process evaluation of a district mental healthcare plan in Nepal: a mixed-methods case study.

The PRogramme for Improving Mental Health carE (PRIME) evaluated the process and outcomes of the implementation of a mental healthcare plan (MHCP) in Chitwan, Nepal. To describe the process of implementation, the barriers and facilitating factors, and to evaluate the process indicators of the MHCP. A case study design that combined qualitative and quantitative methods based on a programme theory of change (ToC) was used and included: (a) district-, community- and health-facility profiles; (b) monthly implementation logs; (c) pre- and post-training evaluation; (d) out-patient clinical data and (e) qualitative interviews with patients and caregivers. The MHCP was able to achieve most of the indicators outlined by the ToC. Of the total 32 indicators, 21 (66%) were fully achieved, 10 (31%) partially achieved and 1 (3%) were not achieved at all. The proportion of primary care patients that received mental health services increased by 1200% over the 3-year implementation period. Major barriers included frequent transfer of trained health workers, lack of confidential space for consultation, no mental health supervision in the existing system, and stigma. Involvement of Ministry of Health, procurement of new psychotropic medicines through PRIME, motivation of health workers and the development of a new supervision system were key facilitating factors. Effective implementation of mental health services in primary care settings require interventions to increase demand for services and to ensure there is clinical supervision for health workers, private rooms for consultations, a separate cadre of psychosocial workers and a regular supply of psychotropic medicines.

Evaluation of mental health stigma on medical education: an observational study with Portuguese medical students.

Background:The Portuguese mental health care plan emphasizes that health care professionals can be a source of stigma against people with mental illness enhancing self-stigma and leading to a decrease in the search for help and adherence to treatment.Methods:In this exploratory study, we surveyed 111 first and last year students from the Faculty of Medicine of the University of Porto, Portugal, using the Portuguese version of the Attribution Questionnaire AQ-27 to assess the attitudes toward mental illness.Results:The students showed a significant difference in the segregation dimension, and in some items related with pity and coercion in the end of the course. These results express a positive will to integrate people with mental illness in community, a decrease of pity and a valorization of the pharmacological treatment in this kind of disease. The previous personal experience of psychiatric problems decreases the level of segregation and psychological problems increase the motivation to help.Conclusion:Final-year students express more positive and less discriminatory attitudes toward people with severe mental illness than first-year students. This is likely due to education and contact opportunities promoted throughout the medical school, as well as due to the experience of having gone to a psychology or psychiatric consultation. Knowledge of stigma levels of future medical doctors is therefore crucial for the prevention of attitudes that could condition the provision of medical care.

The excess economic burden of mental disorders: findings from a cross-sectional prevalence survey in Austria

Information about the scope of mental disorders (MDs), resource use patterns in health and social care sectors and economic cost is crucial for adequate mental healthcare planning. This study provides the first representative estimates about the overall utilisation of resources by people with MDs and the excess healthcare and productivity loss costs associated with MDs in Austria. Data were collected in a cross-sectional survey conducted on a representative sample (n = 1008) between June 2015 and June 2016. Information on mental health diagnoses, 12-month health and social care use, medication use, comorbidities, informal care, early retirement, sick leave and unemployment was collected via face-to-face interviews. Generalised linear model was used to assess the excess cost of MDs. The healthcare cost was 37% higher (p = 0.06) and the total cost was twice as high (p < 0.001) for the respondents with MDs compared to those without MDs. Lost productivity cost was over 2.5-times higher (p < 0.001) for those with MDs. Participants with severe MDs had over 2.5-times higher health and social care cost (p < 0.001) and 9-times higher mental health services cost (p < 0.001), compared to those with non-severe MDs. The presence of two or more physical comorbidities was a statistically significant determinant of the total cost. Findings suggest that the overall excess economic burden on health and social care depends on the severity of MDs and the number of comorbidities. Both non-severe and severe MDs contribute to substantially higher loss productivity costs compared to no MDs. Future resource allocation and service planning should take this into consideration.

Experts\u2019 perceptions on the use of visual analytics for complex mental healthcare planning: an exploratory study

BackgroundHealth experts including planners and policy-makers face complex decisions in diverse and constantly changing healthcare systems. Visual analytics may play a critical role in supporting analysis of complex healthcare data and decision-making. The purpose of this study was to examine the real-world experience that experts in mental healthcare planning have with visual analytics tools, investigate how well current visualisation techniques meet their needs, and suggest priorities for the future development of visual analytics tools of practical benefit to mental healthcare policy and decision-making.MethodsHealth expert experience was assessed by an online exploratory survey consisting of a mix of multiple choice and open-ended questions. Health experts were sampled from an international pool of policy-makers, health agency directors, and researchers with extensive and direct experience of using visual analytics tools for complex mental healthcare systems planning. We invited them to the survey, and the experts’ responses were analysed using statistical and text mining approaches.ResultsThe forty respondents who took part in the study recognised the complexity of healthcare systems data, but had most experience with and preference for relatively simple and familiar visualisations such as bar charts, scatter plots, and geographical maps. Sixty-five percent rated visual analytics as important to their field for evidence-informed decision-making processes. Fifty-five percent indicated that more advanced visual analytics tools were needed for their data analysis, and 67.5% stated their willingness to learn new tools. This was reflected in text mining and qualitative synthesis of open-ended responses.ConclusionsThis exploratory research provides readers with the first self-report insight into expert experience with visual analytics in mental healthcare systems research and policy. In spite of the awareness of their importance for complex healthcare planning, the majority of experts use simple, readily available visualisation tools. We conclude that co-creation and co-development strategies will be required to support advanced visual analytics tools and skills, which will become essential in the future of healthcare.Graphical abstract

Evaluation of Proactive Community Case Detection to Increase Help Seeking for Mental Health Care: A Pragmatic Randomized Controlled Trial.

The Community Informant Detection Tool (CIDT) is a vignette- and picture-based method of proactive case detection to promote help seeking for persons with depression, psychosis, alcohol use disorder, and epilepsy. The authors evaluated the effectiveness of the CIDT to increase help-seeking behavior in rural Nepal, where a district mental health care plan was being implemented. Twenty-four health facilities were randomly assigned to one of two methods for training their all-female cadre of community health volunteers: standard training or standard training that included the CIDT. The authors compared the number of patients with depression, psychosis, alcohol use disorder, and epilepsy who were registered in the routine health information system prior to and 6 months after the training. At health facilities where volunteers received CIDT training, 309 patients were registered as having depression, psychosis, alcohol use disorder, or epilepsy, compared with 182 patients at facilities where volunteers received standard training. The median number of patients registered was 47% greater at facilities where CIDT training was included (24 patients) than at facilities with standard training (16 patients) (p=0.04, r=0.42). The difference in the number of registered patients remained significant when the analysis factored in the population catchment (N=18 patients [CIDT] versus N=14 [standard] per 10,000 population; p=0.05, r=0.40). The median number of patients registered as having a mental illness was 47% greater at primary care facilities in which community health volunteers used the CIDT than at facilities where volunteers received standard training. Proactive case finding holds promise for increasing help seeking for mental health care.

Impact of a district mental health care plan on suicidality among patients with depression and alcohol use disorder in Nepal.

BackgroundLarge scale efforts to expand access to mental healthcare in low- and middle-income countries have focused on integrating mental health services into primary care settings using a task sharing approach delivered by non-specialist health workers. Given the link between mental disorders and risk of suicide mortality, treating common mental disorders using this approach may be a key strategy to reducing suicidality.Methods and findingsThe Programme for Improving Mental Health Care (PRIME) evaluated mental health services for common mental disorders delivered by non-specialist health workers at ten primary care facilities in Chitwan, Nepal from 2014 to 2016. In this paper, we present the indirect impact of treatment on suicidality, as measured by suicidal ideation, among treatment and comparison cohorts for depression and AUD using multilevel logistic regression. Patients in the treatment cohort for depression had a greater reduction in ideation relative to those in the comparison cohort from baseline to three months (OR = 0.16, 95% CI: 0.05–0.59; p = 0.01) and twelve months (OR = 0.31, 95% CI: 0.08–1.12; p = 0.07), with a significant effect of treatment over time (p = 0.02). Among the AUD cohorts, there were no significant differences between treatment and comparison cohorts in the change in ideation from baseline to three months (OR = 0.64, 95% CI: 0.07–6.26; p = 0.70) or twelve months (OR = 0.46, 95% CI: 0.06–3.27; p = 0.44), and there was no effect of treatment over time (p = 0.72).ConclusionThe results provide evidence integrated mental health services for depression benefit patients by accelerating the rate at which suicidal ideation naturally abates over time. Integrated services do not appear to impact ideation among people with AUD, though baseline levels of ideation were much lower than for those with depression and may have led to floor effects. The findings highlight the importance of addressing suicidality as a specific target–rather than an indirect effect–of treatment in community-based mental healthcare programs.

Review of mental healthcare plans under way

Review of mental healthcare plans under way

Wounds and mental health care: system thinking

Purpose This paper considers how the quality of wound care delivered to people experiencing mental ill health can be improved at the system level in line with the global focus on improving population health. The purpose of this paper is to identify how the quality of wound care delivered to mental health care service users can be improved at a population level through system thinking informed by boundary theory. Design/methodology/approach This paper is a critical analysis of practice underpinned by systems thinking and boundary theory. Findings Tissue viability care and mental health care have different professional cultures and identities that are manifest in the way that they are organised and deliver care. If improvements in wound care-related outcomes at a population level are to be achieved, then it is important that the wound care needs of people experiencing mental ill health are addressed. Systems thinking and boundary theory provide a useful conceptual framework for informing quality improvement for people experiencing mental ill health at a population level. Integrated care plans are a useful mechanism for delivering comprehensive care that brings about wound healing and recovery from mental ill health. Social implications Integrated wound and mental health care plans transcend the professional boundaries that exist between tissue viability and mental health care services. Improvements in the quality and safety of care delivered to people with wounds who also utilise mental health services can be achieved through the use of integrated care plans. Health care policy and organisation need to meet the wound-related needs of people using mental health services. Originality/value There has been a focus on improving many aspects of wound care in line with the global focus on grand convergence in population health, but there has been very little emphasis on improving the wound-related outcomes of people that use mental health services. Systems thinking and boundary theory provide a useful framework for understanding how wound care for people experiencing mental ill health can be improved at a population level. Integrated care plans are a useful way of ensuring that safe high-quality wound care is consistently delivered to people experiencing mental ill health.

Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal

BackgroundDespite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal.MethodsThe repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE).ResultsThe proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes.ConclusionThe study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.

Training to enhance user and carer involvement in mental health-care planning: the EQUIP research programme including a cluster RCT

Background Service users and carers using mental health services want more involvement in their care and the aim of this research programme was to enhance service user and carer involvement in care planning in mental health services. Objectives Co-develop and co-deliver a training intervention for health professionals in community mental health teams, which aimed to enhance service user and carer involvement in care planning. Develop a patient-reported outcome measure of service user involvement in care planning, design an audit tool and assess individual preferences for key aspects of care planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and carer-involved care planning. Disseminate resources to stakeholders. Methods A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the priorities underpinning involvement in care planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of care planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental health professionals from both the usual-care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention). Results The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of care planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for care are included in the care plan’. The training was delivered to 304 care co-ordinators working in community mental health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and carers, finding a failure of training to become embedded in routine care. Limitations Our pragmatic study was designed to improve service user and care involvement in care planning among routine community mental health services. We intervened in 18 sites with &gt; 300 care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population. Conclusions We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and carer involvement in care planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results. Future work Research should focus on developing and evaluating new organisational initiatives in addition to training health-care professionals to address contextual barriers to service and carer involvement in care planning, and explore co-designing and delivering new ways of enhancing service users’ and carers’ capabilities to engage in care planning. Trial registration Current Controlled Trials ISRCTN16488358. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.