Development and preliminary testing of an online tool to assess social inclusion and support care planning in mental health supported accommodation

Abstract

Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Enabling social inclusion is an important aspect of recovery-based practice, and improves quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people who have mental health problems. Previous research has suggested that the SInQUE could also help to support care planning focused on enabling social inclusion in routine mental health practice. Objectives: To develop an online version of the SInQUE for use in mental health supported accommodation services, and examine its acceptability and perceived usefulness as a tool to support care planning with service users. Methods: i) A lab-testing stage to assess the acceptability of the SInQUE tool through 'think- aloud' testing with six supported accommodation staff; ii) A field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was employed in one London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff who used the tool were conducted and analysed using thematic analysis. Use of the SInQUE was compared with two other local authority areas, one urban and one rural, where the tool was made available for use but no implementation strategy was employed. Results: In total, 17 staff used the SInQUE with 28 different service users during the implementation period (about 10% of all service users living in supported accommodation in the study area). Staff and service users we interviewed felt that the SInQUE was collaborative, comprehensive, and user-friendly. Staff deemed the tool relevant to their role. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help to identify individuals' priorities regarding different aspects of social inclusion through prompting in-depth conversations and tailoring specific support to address areas where service users would like to be more included. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable need across the borough, that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool, that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, take-up rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers.

‘Finding a Relationship’ Conversations Between Mental Health and Social Care Staff, and Service Users

“…The survey questionnaire then asked whether the participant helped service users to find a relationship and if so, how; any barriers and facilitators they experienced in having 'finding a relationship' conversations with service users; any training and other support they had received in this area; as well as their opinions on particular methods of helping service users to find relationships. The matrices for rating particular barriers, and methods of helping service users, were created referencing staff responses in a recent focus group study [40]. The full survey questionnaire is provided in Appendix A.…”

“…[49] Not done in my service -This is not something that is done in my practice. [7] -In 20 years I've not witnessed this [40] Take service user's lead -If sex or romantic relationships are specifically raised as an identified issue, this will be explored, formulated and any barriers discussed. Intimate/family relationships is a part of the care plan, however it rarely is a priority to focus on within the time frame.…”

“…[52] Skills building (indirect) -By working on the individual to build skills mentioned above that‚Äôs as far as we should go [13] -Maybe some skills support around going on dates e.g conversationa dn social interaction [33] -Support with social skills, ensuring the person is being treated for symptoms that may affect confidence etc, or functioning, addressing sexual side effects or symptoms as well. Improving self-esteem, [48] Needing more knowledge in this area -more knowledge around this [27] -I don't know, and probably should [30] -Training [40] -No [41] -Unsure [56] Organisational change -improving policies and access to material to meet needs [54] Should not be part of MHP role -I do not think it should be part of my role [9] Step 2: Creating overarching themes for each of seven qualitative questions.…”

“…In addition to stigma, reasons for not seeking an intimate relationship include the direct effects of symptoms such as poor self-esteem and low motivation; medication side effects such as extinguished libido [39], and lack of opportunity to meet potential partners, particularly while being an inpatient [30,40]. It is also important to note the potential damaging effect of intimate relationships for those with mental illness.…”

“…Despite these key obstacles however, service users recognise both "being lonely" and a "lack of a significant relationship" as being direct barriers to their recovery [30]. And, when asked about this directly, many service users express a desire for help in attaining an intimate relationship [40], despite this being rarely offered [42].…”