Ben Hannigan Horatio Festival 2014 - Mental health nursing, complexity and change

School of Healthcare Sciences

Ysgol Gwyddorau Gofal Iechyd

Dr Ben Hannigan Reader in Mental Health Nursing

School of Healthcare SciencesCardiff University

UKEmail: [email protected]

Web: http://www.cardiff.ac.uk/people/view/39197-hannigan-benBlog: benhannigan.comTwitter: @benhannigan

Mental health nursing, complexity and change

http://www.cardiff.ac.uk/people/view/39197-hannigan-ben

http://benhannigan.com/

https://twitter.com/benhannigan



Aim

• To draw cumulative insights from a series of interconnected studies into changing systems of mental health care, the work of nurses and the experiences of users



Study 1: background

• Community mental health care as a post-war phenomenon

• Initially ad hoc developments in the UK

• New opportunities for nurses, social workers and others to assert claims to fulfil roles in the workplace

• Interprofessional, locality, community mental health teams from the middle of the 1970s



Study 1: focus, design and methods

• A social scientific investigation into work and organisation in community mental health care

• Access secured to two contrasting case study sites in Wales, and to a CMHT in each

• Ethnographic fieldwork over 22 months

• Background data generated through interviews, documentary review and observations

• Six prospective, micro-level, case study ‘trajectories’ examined



Key findings [1]

• Work is sensitive to local organisational features, and gaps can grow between the public claims professions make about their contributions and the actual roles which their members fulfil

• In one site, immediate contextual features shaped work towards the fulfilment of expanded roles

• In the other, roles stayed close to those asserted in formal jurisdictions



Key findings [2]

Studying the unfolding trajectories of people using services laid bear the relatively invisible contributions made by:

• professionals on the periphery (e.g., pharmacists);

• support workers;

• unpaid lay carers and service users.



Study 2: background

• Mental health as a complex, contested, field

• Improving mental health and wellbeing, and developing mental health systems, now a global and UK priority

• Community crisis resolution and home treatment (CRHT) services as one solution to some of the system’s ‘wicked problems’



Study 2: focus, design and methods

• An investigation into the system impact of crisis resolution and home treatment services, and into work, roles and user experiences

• Access secured to a single CRHT team in Wales, in its second year of operation

• Background data generated through interviews, documentary review and observations

• Four retrospective, micro-level, case study trajectories examined



Key findings [1]

• A high-quality service exerting a powerful impact across the locality

• Parts of the system closed to release resources, staff movements leaving holes elsewhere, needy service users being cared for by the least experienced workers

• Unexpected increases in workload, and disputes over eligibility for crisis care



Key findings [2]

• In a fast-moving workplace the work which was done, how and by whom reflected wider jurisdictions and a patterning by organisational forces

• Variable shift-by-shift team composition and requirements to undertake assessments of new referrals while also providing home treatment shaped the work of some



Key findings [3]

• ‘Critical junctures’ as pivotal moments within longer trajectories: punctuating periods characterised by uncertainty

• As contingencies come to the fore, individual actions have a higher-than-usual chance of affecting future, enduring, arrangements



Reflections

• Occupational groups will seek to preserve their places in competitive workplaces, but their work is sensitive to change in wider systems (e.g., to demands for greater flexibilities at times of austerity)

• Groups can appear and disappear

• Much mental health work is relatively hidden

• Trajectories are subject to tilting, triggered by features peculiar to the health and illness experience and by features associated with the system

• Solutions to wicked problems are contested, and exert waves of consequences across systems



References and reading

Coffey M. and Hannigan B. (2013) New roles for nurses as approved mental health professionals in England and Wales: a discussion paper. International Journal of Nursing Studies 50 (10) 1423-1430

Hannigan B. (2013) 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 93 212-219

Hannigan B. (2013) What studies into systems tell us about mental health work and services at a time of austerity. Mental Health Nursing 33 (6) 13-15

Hannigan B. (2014) ‘There’s a lot of tasks that can be done by any’: findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services. Health: an Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 18 (4) 406-421

Hannigan B. and Allen D. (2006) Complexity and change in the United Kingdom’s system of mental health care. Social Theory & Health 4 (3) 244-263

Hannigan 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) 1-8

Hannigan B. and Allen D. (2013) Complex caring trajectories in community mental health: contingencies, divisions of labor and care coordination. Community Mental Health Journal 49 (4) 380-388

Hannigan B. and Coffey M. (2011) Where the wicked problems are: the case of mental health. Health Policy 101 (3) 220-227

Hannigan B. and Evans N. (2013) Critical junctures in health and social care: service user experiences, work and system connections. Social Theory & Health 11 (4) 428-444

Health & Medicine

Ben Hannigan Horatio Festival 2014 - Mental health nursing, complexity and change