Researching community mental health care experiences from the uk

Cardiff School of Nursing and Midwifery Studies

Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd

Researching community mental health care: experiences from the UK

Dr Ben HanniganReader in Mental Health Nursing




Summarised, this is what I do:

• Use social scientific ideas to understand policy, practice, and the organisation and delivery of mental health services, particularly in the community

• Using qualitative methods, study mental health work and the experiences of people using services

• Collaborate with colleagues on large-scale, mixed methods, studies and conduct evidence reviews

• Teach mental health nurses and supervise research students



I blog about my work (and other things besides)

http://benhannigan.com/



How did we get to where we are now?

• Ad hoc community care developments• New opportunities for workers• 1970s: interprofessional, locality, CMHTs

as a preferred, but contested, model• 1980s and 1990s: interrelated network

of community care and hospitals, with resources tied up in institutions

• Competing policy imperatives, lack of clarity around agency and organisational responsibilities, concerns over underfunding and risk

(Hannigan 1999; Hannigan and Allen 2006)

The water tower at Warlingham Park Hospital

Photo taken by Roger Haworth, licensed for reuse

Ty Siriol, Caerphilly

Photo taken by John Grayson, licensed for reuse



Work and workers: findings from an ethnographic investigation and a survey

Health and Social Care: • Mental health systems populated by a complex mix of

occupation, fulfilling roles in fluid ways reflecting local organisational features (Hannigan and Allen 2011)…

• …with relatively invisible contributions being made by workers (paid and unpaid) on the periphery (Hannigan and Allen, in press)

All Wales CMHN stress study:• High levels of stress and burnout (Burnard et al 2000;

Coyle et al 2000; Edwards et al 2000a, 2000b, 2001; Fothergill et al 2000; Hannigan et al 2000)



What about policy and services from around the turn of the century?

Wicked problems in complex systems:• Unprecedented policy activism from the late 1990s• Mental health as a complex and ‘untamed’ arena, replete

with ‘wicked problems’• Rapid changes in problem formulation and solution…• …beginning with a focus on the failure of community

care…• …and then problems with everyday working practices...• …and more recently moving towards a concern with public

mental health (Hannigan and Coffey 2011)



What about policy and services from around the turn of the century?

New law, new roles:• Approved mental health professionals (Coffey and

Hannigan, in press)Mental health systems: the case of crisis services• New teams and services in the community…• …underpinned by a disputed evidence base• High-quality care, but…• …triggering significant ‘waves of consequences’

(Hannigan, in press)



New projects: COCAPP

Simpson A., Hannigan B., Coffey M., Jones A., Faulkner A., Jančová J. Cross-national comparative study of recovery-focused mental health care planning and coordination. NIHR HS&DR Programme

• A mixed methods study combining a meta-narrative mapping and policy analysis with the generation of quantitative and qualitative data

• Concerned with the relationships between care planning, care coordination, recovery and personalisation




• Meta-narrative mapping: how care planning and coordination is conceptualised in different research traditions; key theories; preferred designs; main findings

• Data generation in six sites in England and Wales:– questionnaires (Recovery Self Assessment Scale; Scale

To Assess the Therapeutic Relationship; Empowerment Scale)

– interviews with key informants, document review– interviews with service users, carers and care

coordinators, and review of care plans




• Project Advisory Group and Lived Experiences Advisory Group

• Recruitment of Services User Research Assistants, with roles including recruitment and interviewing of participants

• Fieldwork to commence in the Spring



New projects: RiSC

Hannigan B., Edwards D., Evans N., Gillen E., Pryjmachuk S., Trainor G. and Longo M. An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services (CAMHS). NIHR HS&DR Programme

• A two phase evidence synthesis in the area of risk for young people moving into, through and out of mental health hospital

• Phase 2 review informed by the views and experiences of people working in, and using, CAMHS



References and reading

Burnard P., Edwards D., Fothergill A., Hannigan B. and Coyle D. (2000) Community mental health nurses in Wales: self-reported stressors and coping strategies. Journal of Psychiatric and Mental Health Nursing 7 (6) 523-528Coffey M. and Hannigan B. (in press) New roles for nurses as approved mental health professionals in England and Wales: a discussion paper. International Journal of Nursing StudiesCoyle D., Edwards D., Hannigan B., Burnard P. and Fothergill A. (2000) An exploration of the coping strategies used by community psychiatric nurses in Wales. Nursing and Health Sciences 2 (1) 59-67Edwards D., Burnard P., Coyle D., Fothergill A. and Hannigan B. (2000a) Stress and burnout in community mental health nursing: a review of the literature. Journal of Psychiatric and Mental Health Nursing 7 (1) 7-14




Edwards D., Burnard P., Coyle D., Fothergill A. and Hannigan B. (2000b) Stressors, moderators and stress outcomes: findings from the all-Wales community mental health nurse study. Journal of Psychiatric and Mental Health Nursing 7 (6) 529-538Edwards D., Burnard P., Coyle D., Fothergill A. and Hannigan B. (2001) A stepwise multivariate analysis of factors that contribute to stress for mental health nurses working in the community. Journal of Advanced Nursing 36 (6) 805-813Fothergill A., Edwards D., Hannigan B., Burnard P. and Coyle D. (2000) Self-esteem in community mental health nurses: findings from the all-Wales stress study. Journal of Psychiatric and Mental Health Nursing 7 (4) 315-321Hannigan B. (1999) Joint working in community mental health: prospects and challenges. Health and Social Care in the Community 7 (1) 25-31Hannigan B. (in press) Connections and consequences in complex systems: insights from a case study of the emergence and local impact of crisis resolution and home treatment services. Social Science & Medicine




Hannigan B. and Allen D. (2006) Complexity and change in the United Kingdom’s system of mental health care. Social Theory & Health 4 (3) 244-263Hannigan B. and Allen D. (2011) Giving a fig about roles: policy, context and work in community mental health care. Journal of Psychiatric and Mental Health Nursing 18 (1) 1-8Hannigan B. and Allen D. (in press) Complex caring trajectories in community mental health: contingencies, divisions of labor and care coordination. Community Mental Health Journal doi: 10.1007/s10597-011-9467-9 Hannigan B. and Coffey M. (2011) Where the wicked problems are: the case of mental health. Health Policy 101 (3) 220-227Hannigan B., Edwards D., Coyle D., Fothergill A. and Burnard P. (2000) Burnout in community mental health nurses: findings from the all-Wales stress study. Journal of Psychiatric and Mental Health Nursing 7 (2) 127-134



Contact

Email:• [email protected]:• http://www.cardiff.ac.uk/sonms/contactsandpeople/

academicstaff/hannigan-ben-overview_new.htmlBlog: • http://benhannigan.com

Documents

Researching community mental health care experiences from the uk