BackgroundFormal recognition and involvement of carers in mental health services has been the focus of recent policy and practice initiatives as well as being supported by carers themselves. However, carers still report feeling marginalised and distanced from services. A prominent theme is that that they are not listened to and their concerns are not taken seriously. Compared to service user views, the reasons underpinning carers’ dissatisfaction with care-planning procedures have been relatively neglected in the research literature, despite the substantial and significant contribution that they make to mental health services. The aim of the study was to explore carers’ experiences of the care planning process for people with severe mental illness.MethodsQualitative interviews and focus groups were undertaken with carers. Data were combined and analysed using framework analysis.ResultsWhilst identifying a shared desire for involvement and confirming a potential role for carers within services, our data highlighted that many carers perceive a lack of involvement in care planning and a lack of recognition and appreciation of their role from health professionals. Barriers to involvement included structural barriers, such as the timing and location of meetings, cultural barriers relating to power imbalances within the system and specific barriers relating to confidentiality.ConclusionsThis qualitative study led by a researcher who was a carer herself has developed the understanding of the potential role of carers within the care planning process within mental health services, along with the facilitators and barriers to achieving optimal involvement.

BackgroundSevere mental illness is a major driver of worldwide disease burden. Shared decision-making is critical for high quality care, and can enhance patient satisfaction and outcomes. However, it has not been translated into routine practice. This reflects a lack of evidence on the best way to implement shared decision-making, and the challenges of implementation in routine settings with limited resources. Our aim was to test whether we could deliver a practical and feasible intervention in routine community mental health services to embed shared decision-making for patients with severe mental illness, by improving patient and carer involvement in care planning.MethodsWe cluster randomised community mental health teams to the training intervention or usual care, to avoid contamination. Training was co-delivered to a total of 350 staff in 18 teams by clinical academics, working alongside patients and carers. The primary outcome was the Health Care Climate Questionnaire, a self-report measure of ‘autonomy support’. Primary and secondary outcomes were collected by self-report, six months after allocation.FindingsIn total, 604 patients and 90 carers were recruited to main trial cohort. Retention at six months was 82% (n = 497). In the main analysis, results showed no statistically significant difference in the primary outcome between the intervention and usual care at 6 months (adjusted mean difference -0.064, 95% CI -0.343 to 0.215, p = 0.654). We found significant effects on only 1 secondary outcome.ConclusionsAn intervention to embed shared decision-making in routine practice by improving involvement in care planning was well attended and acceptable to staff, but had no significant effects on patient outcomes. Enhancing shared decision-making may require considerably greater investment of resources and effects may only be apparent over the longer term.

This study investigated patient perspectives on staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. Our framework of barriers and enablers provides indicators of organizational/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de-escalation techniques.

BackgroundPatient and public involvement in research (PPIR) may improve trial recruitment rates, but it is unclear how. Where trials use PPIR to improve design and conduct, many do not communicate this clearly to potential participants. Better communication of PPIR might encourage patient enrolment, as trials may be perceived as more socially valid, relevant and trustworthy. We aimed to evaluate the impact on recruitment of directly advertising PPIR to potential trial participants.MethodsThis is a cluster trial, embedded within a host trial (‘EQUIP’) recruiting service users diagnosed with severe mental illness. The intervention was informed by a systematic review, a qualitative study, social comparison theory and a stakeholder workshop including service users and carers. Adopting Participatory Design approaches, we co-designed the recruitment intervention with PPIR partners using a leaflet to advertise the PPIR in EQUIP and sent potential participants invitations with the leaflet (intervention group) or not (control group). Primary outcome was the proportion of patients enrolled in EQUIP. Secondary outcomes included the proportions of patients who positively responded to the trial invitation.ResultsThirty-four community mental health teams were randomised and 8182 service users invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR = 0.75, 95% CI = 0.53 to 1.07, p = 0.113). For the secondary outcome of positive response, the intervention was not effective, with 7.3% of potential participants in the intervention group responding positively versus 7.9% of the control group (adjusted OR = 0.74, 95% CI = 0.53 to 1.04, p = 0.082). We did not find a positive impact of directly advertising PPIR on any other outcomes.ConclusionTo our knowledge, this is the largest ever embedded trial to evaluate a recruitment or PPIR intervention. Advertising PPIR did not improve enrolment rates or any other outcome. It is possible that rather than advertising PPIR being the means to improve recruitment, PPIR may have an alternative impact on trials by making them more attractive, acceptable and patient-centred. We discuss potential reasons for our findings and implications for recruitment practice and research.Trial registration numbersISRCTN, ISRCTN16488358. Registered on 14 May 2014.Study Within A Trial, SWAT-26. Registered on 21 January 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1718-1) contains supplementary material, which is available to authorized users.

Accessible summaryWhat is known on the subject? There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning.Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning.There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co‐facilitators. What does this paper add to existing knowledge? A co‐produced and co‐delivered training package on service user‐ and carer‐involved care planning was acceptable to mental health professionals.Aspects of the training that were particularly valued were the co‐production model, small group discussion and the opportunity for reflective practice.The organizational context of care planning may need more consideration in future training models. What are the implications for practice? Mental health nurses using co‐production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging.On the basis of the results reported here, we encourage mental health nurses to use co‐production approaches more often.Further research will show how clinically effective this training is in improving outcomes for service users and carers. AbstractBackgroundThere is limited evidence for the acceptability of training for mental health professionals on service user‐ and carer‐involved care planning.AimTo investigate the acceptability of a co‐delivered, two‐day training intervention on service user‐ and carer‐involved care planning.MethodsCommunity mental health professionals were invited to complete the Training Acceptability Rating Scale post‐training. Responses to the quantitative items were summarized using descriptive statistics (Miles, 2013), and qualitative responses were coded using content analysis (Weber, 1990).ResultsOf 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median ‘acceptability’ score = 34/36; median ‘perceived impact’ score = 22/27). There were six qualitative themes: the value of the co‐production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response.DiscussionThe training was found to be acceptable and comprehensive with participants valuing the co‐production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training.Implications for practiceMental health nurses should use co‐production models of continuing professional development training that involve service users and carers as co‐facilitators.