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International Journal of Mental Health Systems
Published in: International Journal of Mental Health Systems 1/2017

Open Access 01-12-2017 | Research

Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views of service users, carers and professionals

Authors: Helen Brooks, Kamelia Harris, Penny Bee, Karina Lovell, Anne Rogers, Richard Drake

Published in: International Journal of Mental Health Systems | Issue 1/2017

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Abstract

Background

As a response to evidence that mental health service users and carers expect greater involvement in decisions about antipsychotic medication choice and prescribing, shared decision-making (SDM) has increasingly come to be viewed as an essential element of person-centred care and practice. However, this aspiration has yet to be realised in practice, as service users and carers continue to feel alienated from healthcare services. Existing understanding of the factors affecting the use of tools to support SDM is limited to inter-individual influences and wider factors affecting potential implementation are underexplored.

Aim

To explore the potential use of a tool designed to enhance collaborative antipsychotic prescribing from the perspectives of secondary care mental health service users, carers and professionals.

Methods

We conducted a qualitative study (semi-structured interviews and focus groups) using a convenience sample of 33 participants (10 mental health service users, 10 carers and 13 professionals) involved in antipsychotic prescribing in one Trust in the North of England. Participants were asked about the potential implementation of a tool to support SDM within secondary mental health services. Framework analysis incorporating the use of constant comparative method was used to analyse the data.

Results

The study identified a divergence in the views of service users and professionals, including a previously undocumented tendency for stakeholder groups to blame each other for potential implementation failure. This dissonance was shaped by meso and macro level influences relating to paternalism, legislative frameworks, accountability and lack of resources. Participants did not identify any macro level (policy or structural) facilitators to the use of the tool highlighting the negative impact of mental health contexts. Our study indicated that inter-individual factors are likely to be most important to implementation, given their potential to transcend meso and macro level barriers.

Conclusions

Consideration of the meso and macro level influences identified areas for potential intervention, including challenging professionals’ and service users’ perceptions of each other, rebalancing the notion of accountability within services and introducing new means for service user feedback on the quality of SDM. Multi-level strategies for facilitating the implementation of tools to support SDM are also presented.
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Metadata
Title
Exploring the potential implementation of a tool to enhance shared decision making (SDM) in mental health services in the United Kingdom: a qualitative exploration of the views of service users, carers and professionals
Authors
Helen Brooks
Kamelia Harris
Penny Bee
Karina Lovell
Anne Rogers
Richard Drake
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal of Mental Health Systems / Issue 1/2017
Electronic ISSN: 1752-4458
DOI
https://doi.org/10.1186/s13033-017-0149-z

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