Service User Consultation Research Articles

A71Evaluation of a co-produced Simulation Based Perinatal Mental Health Programme

NHS England’s Long-Term Plan for Mental Health highlights need to develop PNMH services and train staff ensuring service user involvement [1]. Women experiencing PNMH disorders often initially present to non-specialist healthcare professionals (NSHCP), meaning that they need specific training in assessment and management of PNMH disorders. A co-produced and co-facilitated simulation-based training programme in perinatal mental health was developed in 2019 by Sussex Partnership Specialist Perinatal Service in conjunction with University Hospital’s Sussex Simulation team. Primary Aim: Evaluate self-reported changes in confidence and competence of learners attending perinatal mental-health (PNMH) simulation training across multiple domains relating to assessment and management of PNMH problems. Secondary Aims: Evaluate impact of service user co-facilitation on PNMH simulation training; Assess whether participant demographics reflect training’s target professional groups. Service User Consultants (SUCs) were employed as faculty members and trained in simulation facilitation alongside professional faculty. Scenarios were developed in a multidisciplinary workshop, and aligned to the Health Education England (HEE) Competency framework in PNMH. Courses were co-facilitated by a Perinatal Psychiatrist and SUC. Data on participants’ confidence and knowledge across the competency framework domains was collated using a survey monkey questionnaire, pre and post-course. 242 responses were collected from participants from more than ten different staff groups e.g. junior doctors, (18%), health visitors (17%) & midwives (26%). Participant confidence improved significantly across all training domains. 93.5% of participants graded contribution of SUCs either useful or very-useful. 99.2% found the simulation training useful or very-useful, with all participants agreeing their future practice would consequently change. The simulation-based training programme increased confidence and understanding of NSHCPs from across the PNMH care pathway, on a number of domains set by HEE PNMH competency framework. Participants were overwhelmingly in support of SUC involvement in the provision of valuable training which resembled real-life clinical encounters via scenarios.

Service user experiences of a physical health group for people experiencing psychosis, designed following service user consultation

Psychosis is associated with physical health comorbidities. Exercise and a healthy diet can improve cardiometabolic risk and mental wellbeing. This study explores the feasibility, acceptability, and experiences of a physical health group for clients experiencing psychosis. The group was developed and refined following consultation with service-users and culturally appropriate peer support workers. It included eight weekly sessions. The aims of the group were to provide psychoeducation on healthy living and to build motivation to engage in healthy living. Attendance, completion, and satisfaction were recorded to determine feasibility and acceptability of local service delivery. Clients took part in follow-up qualitative interviews to understand experiences of attending the group. Interviews were analysed using thematic analysis. Twenty-five clients were referred to the group. Overall, 10 clients enrolled in the group. Clients who enrolled in the group attended a median of 4.5 sessions. The mean satisfaction score for all sessions combined was 9.15/10 [SD 1.18]. Seven individual interviews were conducted. Two themes emerged. 1) Positive views towards the group, with clients feeling more aware of the benefits of healthy living, and clients finding the group setting motivating. 2) Considerations when planning healthy living support, which reflected subthemes in difficulties maintaining healthy living and concerns that the group should not be about weight loss. Investigations were limited to one mental health provider. It was feasible and acceptable to implement a healthy living group for clients with psychosis in a community mental health team, and this intervention was met with positivity.

Development and Validation of the WHO Rehabilitation Competency Framework: A Mixed Methods Study

ObjectivesTo identify the competencies, behaviors, activities, and tasks required by the rehabilitation workforce, and their core values and beliefs, and to validate these among rehabilitation professionals and service users. DesignMixed methods study, involving a content analysis of rehabilitation-related competency frameworks, a modified Delphi study, and a consultation-based questionnaire of service users. SettingDesk-based research. ParticipantsParticipants who completed the first (N=77; 47%) and second (N=68; 67%) iterations of the modified Delphi study. Thirty-seven individuals participated in the service user consultation. Collectively, the participants of the mixed methods study represented a significant range of rehabilitation professions from a broad range of countries, as well as both high- and low-income settings. InterventionsNot applicable. Main Outcome MeasuresNot applicable. ResultsThe mixed methods study resulted in the inclusion of 4 core values, 4 core beliefs, 17 competencies, 56 behaviors, 20 activities, and 62 tasks in the Rehabilitation Competency Framework. The content analysis of rehabilitation-related competency frameworks produced an alpha list of competencies, behaviors, activities and tasks (“statements”), which were categorized into 5 domains. The final iteration of the modified Delphi study revealed an average of 95% agreement with the statements, whereas the service user consultation indicated an average of 87% agreement with the statements included in the questionnaire. ConclusionsDespite the diverse composition of the rehabilitation workforce, this mixed methods study demonstrated that a strong consensus on competencies and behaviors that are shared across professions, specializations, and settings, and for activities and tasks that collectively capture the scope of rehabilitation practice. The development of the Rehabilitation Competency Framework is a pivotal step toward the twin goals of building workforce capability to improve quality of care and strengthening a common rehabilitation workforce identity that will bolster its visibility and influence at a systems-level.

Cognitive mediation in people with dementia: Development, structural, and construct validity of the first dementia-specific measure.

Anxiety and depression are common and deleterious comorbidities in people living with dementia (PLWD). Cognitive behavioural therapy (CBT) is one of the few promising treatments; however, it is unclear whether PLWD have the necessary prerequisites to engage in this. Having an understanding of cognitive mediation, that a thought mediates the relationship between an antecedent event and its emotional consequence, is key for engaging with CBT and is also a critical component of emotion regulation. There are no measures of this construct validated for PLWD. This study aims to adapt and validate an existing measure for this population. A secondary aim is to assess its applicability in older adults (OA) without a recognised neurocognitive impairment. A measure of cognitive mediation was adapted via expert and service user consultation for use in PLWD. A total of 102 PLWD and 77 OA without neurocognitive impairments completed the adapted measure along with two measures of emotion recognition and reasoning. Factor structure was examined separately in both samples, and the measure reduced, with convergent validity assessed. A final measure of 10 items (named the CM-Dem) was subject to factor analysis yielding a single factor solution. The measure showed good psychometric properties in PLWD, including good model fit, high internal consistency, inter-rater reliability, and moderate convergent validity with related constructs. In contrast, poor validity was found in OA, especially a lack of convergent validity. The CM-Dem has clinical and research utility as a measure of cognitive mediation in PLWD, but less so in OA.

PRECiS (Patient Reported Evaluation of Cognitive State): psychometric evaluation of a new patient reported outcome measure of the impact of stroke

Objective: Determine the psychometric properties of PRECiS (Patient Reported Evaluation of Cognitive State): A new patient-centred, patient reported outcome measure for perceived impact of cognitive problems, developed through qualitative work, systematic review and service user consultation. Design: An observational study exploring acceptability, internal consistency, construct validity, inter-rater reliability and test-retest reliability, with opportunistic qualitative data on sensitivity to change. Setting: Home visits in the community. Participants: Stroke survivors with self-reported cognitive difficulties and informal carers. Measures: The 27 item PRECiS was self-completed with support, and proxy completed by informal carers. We collected descriptive cognitive screening test data, and measures of overall stroke impact, mood and activities of daily living to explore construct validity. Results: Data were collected from 159 (visit 1) and 66 (visit 2) stroke survivors and 86 informal carers. PRECiS showed good acceptability (no missing values or floor/ceiling effects, minimal skewness); high internal consistency (α = 0.94, indicative of potential redundancy); with moderate to strong construct correlations in the directions hypothesised (0.40 to 0.74). An intraclass correlation coefficient of 0.85 indicated good test-retest reliability. Where self-reported change had occurred from visit 1 to 2, PRECiS appeared sensitive. Using carers as proxy respondents is not supported by this analysis (inter-rater ICC = 0.43). Conclusions: PRECiS is a patient-centred, practical and reliable measure assessing perceived impact of cognitive problems from the unique perspective of stroke survivors.

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement.

The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions. To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are. We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association's electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders. To address the topic's complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback. We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research. Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations. We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK. This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068. The National Institute for Health Research Health Technology Assessment programme.

Should weight loss and maintenance programmes be designed differently for men? A systematic review of long-term randomised controlled trials presenting data for men and women: The ROMEO project

We systematically reviewed the randomised controlled trial (RCT) evidence for long-term (≥12 months) weight management interventions for obese men in contrast to women to help understand whether programmes should be designed differently for men. We searched 11 databases up to October 2014. Twenty-two RCTs reported data separately for men and women in weight loss or weight maintenance interventions. We found men were under-represented in RCTs of weight loss interventions open to both sexes. Men comprised 36% of participants (4771 from 13,305 participants). Despite this, men were 11% (95% CI 8-14%, p<0.001) more likely to be trial completers compared to women. The trials did not report service user consultation and none were designed to investigate whether men and women responded differently to given interventions. Our meta-analysis of 13 trials showed no significant difference in weight loss between men and women, either for weight loss in kg (p=0.90) or percentage weight loss (p=0.78), although men tended to lose more weight with intensive low fat reducing diets, with or without meal replacements, and structured physical activity/exercise programmes than women. Orlistat was less beneficial for men for weight maintenance. Individual support and tailoring appeared more helpful for men than women. We found evidence that men and women respond differently to, and have different preferences for, varying types of weight management programme. We suggest that it is important to understand men's views on weight loss, as this is likely to also improve the uptake and effectiveness of programmes for men.

Service user- and carer-reported measures of involvement in mental health care planning: methodological quality and acceptability to users.

Background: Increasing service user and carer involvement in mental health care planning is a key healthcare priority but one that is difficult to achieve in practice. To better understand and measure user and carer involvement, it is crucial to have measurement questionnaires that are both psychometrically robust and acceptable to the end user.Methods: We conducted a systematic review using the terms “care plan$,” “mental health,” “user perspective$,” and “user participation” and their linguistic variants as search terms. Databases were searched from inception to November 2012, with an update search at the end of September 2014. We included any articles that described the development, validation or use of a user and/or carer-reported outcome measures of involvement in mental health care planning. We assessed the psychometric quality of each instrument using the “Evaluating the Measurement of Patient-Reported Outcomes” (EMPRO) criteria. Acceptability of each instrument was assessed using novel criteria developed in consultation with a mental health service user and carer consultation group.Results: We identified eleven papers describing the use, development, and/or validation of nine user/carer-reported outcome measures. Psychometric properties were sparsely reported and the questionnaires met few service user/carer-nominated attributes for acceptability. Where reported, basic psychometric statistics were of good quality, indicating that some measures may perform well if subjected to more rigorous psychometric tests. The majority were deemed to be too long for use in practice.Discussion: Multiple instruments are available to measure user/carer involvement in mental health care planning but are either of poor quality or poorly described. Existing measures cannot be considered psychometrically robust by modern standards, and cannot currently be recommended for use. Our review has identified an important knowledge gap, and an urgent need to develop new user and carer measures of care-planning involvement.

Priorities of Staff and Service Users in Mental Health Assessment: A Q Methodological Study

Service users’ first contact with UK National Health Service (NHS) mental health services has been shown to impact on treatment and outcomes. However, there is no consensus as to what constitutes Initial Assessment (IA) and there appear to be disparities between professionals’ and service users’ views. Using a Q methodology approach, the research aims to explore clinicians’ and service users’ views of IA within community mental health services. Four service user consultants and six clinicians completed a questionnaire to elicit views on the topic. In conjunction with a search of the literature on IA, this produced a set of fifty five statements derived by content analysis, which provided the basis of the Q sort. A sample of mental health professionals and services users (N = 21) completed the Q sort. Factor analysis identified four factors which represented the different points of view about IA. These were interpreted and named as “standardised and person-centred”, “efficiency of process”, “positive and self-contained relationship”, and; “supply vs. demand”. The findings highlighted differences in how participants viewed the clinician’s role, decision making, and topics discussed within IA. However, in contrast to previous research there were similarities across different professional groups and service users. The clinical impact of these findings is also explored.

Colour consultation with dementia home residents and staff

Purpose – Government guidelines promote service user consultation without providing extensive advice on people in later dementia. “Seen as too difficult to involve, they are effectively excluded from […] influenc(ing) service provision”, especially institutional care residents (Clare and Cox, 2003, p. 936). This hard-to-reach group presents methodological challenges. The purpose of this paper is to explore innovative approaches, offering even those with fragmented or lost speech the opportunity to contribute to decisions about their care. Design/methodology/approach – This specialist dementia home consultation included staff and every resident, irrespective of the level of their communication impairment. Consultation on potential colour schemes took the form of a ballot. Staff helped develop an unpatronising, person-centred approach. Visual aids supported communication, de-emphasising the spoken word and promoting inclusion. Findings – The majority of residents appeared to express an opinion on the potential decor. Others chose a colour while not necessarily grasping the context. The approach engaged all except four. Research limitations/implications – Even people with moderate/advanced dementia may be enabled to participate in consultation. Further research needs to refine methodology to include everyone and clarify the interpretation of results. Practical implications – Service providers may widen their expectations of inclusivity in consultation exercises. Originality/value – This consultation is important to researchers and practitioners because it explores ways of communicating, which avoid privileging the spoken word, revealing seldom-recognised abilities in people with moderate/advanced dementia.

Implementing video conferencing in mental health practice

The aim of this paper is to provide an overview of the evidence base regarding the use of video conferencing (VC), implementation issues, policies, procedures, technical requirements and VC etiquette. The paper is based on a literature review of VC within the mental health sector and the authors' experience in implementing VC. Six themes emerged from the literature review: applications of VC, VC assessments, treatment, training and supervision, practitioner anxiety, and VC administrative processes. The results of the review support the use of VC in mental health services. Guidelines for the implementation of VC are discussed, including the importance of staff and service user consultations, training in the use of VC, clear guidance for staff with regards to usage, confidentiality and data protection policies, and VC etiquette. Challenges that can arise when implementing VC in a mental health context are also discussed. Arguably, it is not the technology, but the cultural change it represents to staff which seems to be the most important factor regarding successful implementation.

The violent offender treatment programme: service user consultation and evaluation

PurposeThe Violent Offender Treatment Programme (VOTP) is a cognitive programme which aims to reduce risk of recidivism of mentally disordered offenders. Research has examined the use of various assessment tools to explore the effectiveness of the programme. Examination of service user feedback in relation to mental health service provision and violence risk has not been conducted. This study aims to explore service users' experiences of the VOTP.Design/methodology/approachInterpretative phenomenological analysis was utilised to explore interviews of seven service users' experiences of the VOTP, within a high secure psychiatric hospital.FindingsFour broad themes were found: consistency, learning and application, the group experience, and programme structure. Findings indicate participants held positive views of the VOTP. They could relate to the material covered and felt this had enhanced their ability to manage violence and aggression. Recommendations to improve the programme included simplifying programme material, maintaining patient motivation, and ensuring effective communication.Research limitations/implicationsThe service users whose risk had substantially reduced and thus left the hospital were not included in this study. In addition, there were restrictions on the patients available as current mental health had to be taken into account. Implications include the importance service users place on group process.Originality/valueExamining service user feedback in relation to mental health service provision had not previously been completed. Findings may be beneficial to other treatment programmes for violence and other group based psychological treatments in similar settings.

The effectiveness of the service user consultant role in specialist personality disorder services

Purpose – This qualitative study considers the roles of service user consultants (SUCs) in six of the original 11 Department of Health (DH) Community Personality Disorder (PD) pilot services; how these roles differ from the active participation traditionally encouraged in therapeutic communities (TCs) around responsibility for self and others; how a service user (SU) becomes a SUC; what responsibilities they hold; the views of both staff members and SUCs on the role and the benefits and difficulties it creates; and how the role could be developed in a service‐specific and general way. It is of particular interest to consider the amount of time for which the SUC role is seen to be beneficial, and what support a SUC would need to leave the role.Design/methodology/approach – Two qualitative interview schedules were developed to investigate issues highlighted in previous literature, one designed to be answered by staff members, another developed with a SUC from Cumbria for SUCs and administered by telephone. ...

Self-help therapy and recovery in psychosis: methodological considerations and service user involvement in a partially randomised preference trial

A new Recovery Guide for people with experience of psychosis has been developed (Barrowclough et al, 2009), drawing on existing cognitive behavioural interventions and founded on collaborations between service users, psychologists, researchers and healthcare professionals. This poster showcases the involvement of ‘experts by experience’ in the design, delivery and evaluation of this Recovery Guide, and the therapeutic structure that supports its use. The project has input from service users by various methods, including service user researchers, a service user reference group and service user consultants. Previous work has highlighted the strong and rational preferences that people experiencing psychosis hold about their potential treatment options (Gerrard et al, 2009); service users were presented with detailed information about the Recovery Guide and about different levels of therapeutic intervention to support it (low support= telephone cognitive behavioural therapy; high support= as low support, plus group sessions facilitated by a cognitive behavioural therapist and service user researcher). Findings revealed that most would be willing to take part in a trial of psychological treatments, whether as participants receiving extra therapeutic support or receiving treatment as usual only and assisting with the progress of the research. Participants also held strong feelings about which option they would prefer to receive. Participant preferences of this kind have not been taken into account in previous psychological treatment trials for psychosis. The poster describes the trial currently being implemented to evaluate the Recovery Guide; STAR-T (Self-help Therapy and Recovery-Trial), is an NIHR-funded preference trial in which participants can elect to join their treatment option of choice, or be randomly allocated to a condition. The trial emphasises the value of choice for people experiencing psychosis, and the poster will also discuss the methodological considerations necessary to support such a preference trial. The trial also benefits from the involvement of two service user researchers, who have personal experience of psychosis, and a panel of service user consultants. The ways in which this input has helped shape the design, implementation and evaluation of the trial will be outlined.

Challenging behaviour: service user consultation

Purpose – This purpose of this paper is to seek service users' opinions in order to assist the development of the challenging behaviour strategy (CBS) being developed by Worcestershire Mental Health Partnership Trust.

Psychiatric in-Patients Away From Home: Accounts by People With Intellectual Disabilities in Specialist Hospitals Outside Their Home Localities

Background This study reflects a growing concern with the placement of people with intellectual disabilities and complex mental health problems in out of area placements at a distance from their families and communities. Materials and methods We interviewed service users (n = 17) living in out of area in-patient psychiatric units using a semi-structured interview as part of a service user consultation process. The questions addressed safety and security, food, facilities, day time activities, education, opportunities for socialization, clinical, cultural and religious needs, carer involvement and access to information. Service users were also asked where they would prefer to live if they were to leave the hospital. Results Although there were some positive stories, service user responses suggested limited opportunities for engagement in therapeutic or educational experiences, for building supportive relationships with staff or other residents, for developing religious and cultural identities or for enhancing family relationships. Conclusions Whilst many of the issues raised by participants will be familiar to critics of institutional care, being placed at a distance from home is likely to put an additional strain on relationships with family members and limit opportunities to engage in practices valued by specific ethnic minorities. Commissioners and managers of community intellectual disability services should bear in mind the perspective of service users with complex mental health needs, and take seriously the drawbacks in placing individuals out of area.

Toolkit for assessing the readiness of local safeguarding children boards: origins, ingredients and applications

A central plank in the transformation of children's services in England and Wales is the creation on a statutory footing of Local Safeguarding Children Boards in every local authority area. The focus of the boards will be on the promotion, multiagency coordination and scrutiny of services to safeguard and promote children's welfare. They replace Area Child Protection Committees, which were judged to be ineffective. This paper presents the origins, ingredients and applications of an audit and preparation Toolkit designed to support the establishment of the new boards. The Toolkit was developed from the findings of a survey of 204 members of 16 ACPCs by the first author, and has been tested and refined through work with a large number of ACPCs. This survey identified problematic aspects of interagency collaboration that will need remedying if the new boards are to succeed where the previous committees failed. These include: the board's strategic relationship to wider children's planning fora; operational definition of the term ‘safeguarding’; collective accountability; level of membership; performance management capacity; service user consultation. The ingredients of the Toolkit are described in relation to the findings of the survey. The paper concludes with a discussion of the applications and approaches to be considered in using the Toolkit. Copyright © 2005 John Wiley & Sons, Ltd.

‘The Squeaky Wheel gets the Grease’: A Case Study of Service User Engagement in Service Development

This paper discusses the practicalities and limitations of establishing a service user consultation group to guide service developments, based on the evaluation of a podiatry patient panel in South Yorkshire. It describes the specific difficulties in recruiting a representative panel of service users, and the gradual acculturation of the panel from a group of challenging activists to unpaid members of the podiatry department.

Gaining young people's perspectives

Support for LearningVolume 19, Issue 4 p. 154-154 Gaining young people's perspectives Peter Gray, Corresponding Author Peter Gray works as a freelance consultant to local and national government on policy and provision for special educational needs (including those with behavioural, social and emotional difficulties). He has an extensive back ground as a practitioner, researcher and service manager. Peter has a range of publications, including two edited books published by Routledge, Challenging Behaviour in Schools (1994) and Working with Emotions (2002). He is a member of a number of national advisory groups and is currently Chair of NASEN's Policy Subcommittee. The Special Needs Consultancy, 105 Tavistock Drive, Nottingham NG3 5BE, Email: PGray15695@aol.com Research and Evaluation Unit, Disability Rights Commission, 3rd Floor, Fox Court, 14 Grays Inn Road, London WC1X 8HN, Email: research@drc.gb.orgSearch for more papers by this authorLouca-Mai Wilson, Corresponding Author Louca-Mai Wilson is a research officer at the Disability Rights Commission (DRC). She is responsible for commissioning and managing education and other research to inform the work of the DRC. Louca-Mai has a back ground in disability research in the voluntary sector and local government, as well as research commissions on service user consultation and several years experience as a support worker. She is a member of several advisory groups and is on the core group of the Nuffield Foundation Review of 14–19 Education and Training. The Special Needs Consultancy, 105 Tavistock Drive, Nottingham NG3 5BE, Email: PGray15695@aol.com Research and Evaluation Unit, Disability Rights Commission, 3rd Floor, Fox Court, 14 Grays Inn Road, London WC1X 8HN, Email: research@drc.gb.orgSearch for more papers by this author Peter Gray, Corresponding Author Peter Gray works as a freelance consultant to local and national government on policy and provision for special educational needs (including those with behavioural, social and emotional difficulties). He has an extensive back ground as a practitioner, researcher and service manager. Peter has a range of publications, including two edited books published by Routledge, Challenging Behaviour in Schools (1994) and Working with Emotions (2002). He is a member of a number of national advisory groups and is currently Chair of NASEN's Policy Subcommittee. The Special Needs Consultancy, 105 Tavistock Drive, Nottingham NG3 5BE, Email: PGray15695@aol.com Research and Evaluation Unit, Disability Rights Commission, 3rd Floor, Fox Court, 14 Grays Inn Road, London WC1X 8HN, Email: research@drc.gb.orgSearch for more papers by this authorLouca-Mai Wilson, Corresponding Author Louca-Mai Wilson is a research officer at the Disability Rights Commission (DRC). She is responsible for commissioning and managing education and other research to inform the work of the DRC. Louca-Mai has a back ground in disability research in the voluntary sector and local government, as well as research commissions on service user consultation and several years experience as a support worker. She is a member of several advisory groups and is on the core group of the Nuffield Foundation Review of 14–19 Education and Training. The Special Needs Consultancy, 105 Tavistock Drive, Nottingham NG3 5BE, Email: PGray15695@aol.com Research and Evaluation Unit, Disability Rights Commission, 3rd Floor, Fox Court, 14 Grays Inn Road, London WC1X 8HN, Email: research@drc.gb.orgSearch for more papers by this author First published: 13 October 2004 https://doi.org/10.1111/j.0268-2141.2004.00340.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume19, Issue4November 2004Pages 154-154 RelatedInformation

Working with Mental Health Service Users to Change Mental Health Services

During the last ten years in the UK, service user consultation and collaboration has gradually entered the vocabulary of people providing and purchasing mental health services. However, we are not convinced that much needed change in mental health services will be achieved as a function of increased commitment to market consumerism. We argue here that service user consultation and collaboration should take account of the effects of social inequalities on mental health and on mental health services. This perspective highlights the need for fundamental change in mental health services, and helps us to appreciate the strength of resistance to change, and to understand some of the dynamics involved. We describe here how this perspective has motivated and shaped our own efforts to collaborate responsibly with service users to change mental health services.