Overcoming barriers to implementing ward-based psychosocial interventions in acute inpatient mental health settings: A meta-synthesis

Raphael, Jessica; Price, Owen; Hartley, Samantha; Haddock, Gillian; Bucci, Sandra; Berry, Katherine

doi:10.1016/j.ijnurstu.2021.103870

Cited by 41 publications

(56 citation statements)

References 80 publications

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“…This setting is also characterised by short admissions, difficult cases and a high level of risk (Rethink, 2004; Smith et al, 2015). One review has recently been published, which has examined the implementation of broader indirect and direct psychosocial interventions in this setting (Raphael et al, 2021). This review identified that service users should be provided with clear information on the benefits of the psychosocial intervention, that training for staff delivering the interventions is required and organisational support is needed for the delivery of interventions.…”

Section: Introductionmentioning

confidence: 99%

“…The barriers specific to inpatient wards are associated with the acute nature of service user's difficulties and the physical environment that service users are restricted to. Some barriers and facilitators overlapped with those found in the broader psychosocial interventions delivered in inpatient settings systematic review(Raphael et al, 2021) including staff needing protected or dedicated time, and organisational support being required, to deliver psychological However, additional factors were identified specific to NICE recommended psychological interventions specifically focusing on the adaptations required to delivery therapy for the acute population and brief admissions(Heriot-Maitland et al, 2014;…”

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confidence: 99%

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A systematic review of the implementation of psychological therapies in acute mental health inpatient settings

Evlat

Wood

Glover

2021

Clin Psychology and Psychoth

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Objectives: Research has demonstrated that psychological therapies are not routinely delivered in acute mental health inpatient settings despite being recommended by the National Institute for Health and Care Excellence (NICE) guidelines. This study aimed to identify the barriers and facilitators to implementing psychological therapies in acute mental health inpatient settings.Methods: A systematic review and narrative synthesis was undertaken. Primary studies were included if they examined the implementation of a NICE recommended psychological therapy in acute psychiatric inpatient settings and were of any study design. Four databases were searched for eligible studies (MEDLINE, CINAHL Plus, PsycINFO and Embase) and Google Scholar.Results: A total of 16 studies (a mixture of both qualitative and quantitative methodologies) were included in the review, and the majority evaluated the implementation of Cognitive Behaviour Therapy. Overall, the literature was deemed to be of poor to moderate quality. The main barriers to the implementation of psychological therapy were the busy nature of the ward, multi-disciplinary professionals not being suitability trained and the acute nature of service users mental health difficulties. Facilitators to implementation included the adaptation of interventions to be specifically delivered in the acute inpatient setting, training of multi-disciplinary professionals, leadership support with the delivery of psychological therapies and prioritising the therapeutic relationship.Conclusions: There is a requirement for senior management to prioritise the implementation of psychological therapies and update clinical guidelines to describe modifications necessary to implement psychological therapies in acute inpatient settings.Future research should improve their methodological quality and continue to develop the evidence base of brief psychological therapies in acute inpatient settings.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

A systematic review of the implementation of psychological therapies in acute mental health inpatient settings

Evlat

Wood

Glover

2021

Clin Psychology and Psychoth

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“…Factors that facilitated the delivery of supervision sessions, which were ideas generated with supervisors during the trial, included delivering some supervision sessions via online platforms when supervisors and facilitators were based at different sites, scheduling all supervision sessions in the diary in advance of intervention delivery commencing and training a second supervisor if one supervisor was feeling overburdened. The commitment of service managers to deliver interventions and the supervision structure to support it is also key and involving these individuals during the design or set up phase helped to ensure this commitment as highlighted in previous studies (Raphael et al, 2021).…”

Section: Supervision Deliverymentioning

confidence: 99%

The implementation of Journeying through Dementia: Strategies to run a successful pragmatic multicenter trial of a complex intervention

et al. 2021

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Objective: A key challenge in delivering pragmatic trials of complex interventions is effective implementation within the study period and beyond. We describe a trial of an intervention to improve quality of life in mild dementia (Journeying through Dementia), describe some of the challenges raised in terms of implementation, and illustrate the methods used to ensure effective implementation. Method:The intervention was delivered by staff within local services and supervised by more experienced clinicians within those services in order to test the intervention in real-world settings and establish the potential for future embedding into practice.Researchers delivered training sessions for all facilitators and supervisors, met at regular intervals with intervention supervisors, and provided feedback on summaries of intervention sessions created by facilitators. We conducted a thematic analysis of the content of meetings and written correspondence between the researchers and intervention supervisors regarding implementation issues.Results: Key themes relating to difficulties with implementation were: staff absences and staff leaving posts; participant lack of engagement with intervention; difficulties with delivery of supervision; difficult group dynamics; lack of time to deliver the intervention; and lack of adherence to the intervention and its ethos. Conclusion:We provide guidance for researchers involved in the trialing of other complex interventions in how these challenges might be overcome. These include: recruiting additional staff to deliver the intervention; having clear protocols in place for managing staff absences; using supervision to problem solve participant attendance at intervention sessions and difficult group dynamics; monitoring staff engagement in supervision and addressing problems with engagement with staff and managers when this occurs; giving staff ring-fenced time to deliver the intervention and engage in supervision; and regular monitoring and feedback in relation to the content of the This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Given these gaps in knowledge, the first stage of this programme of research aimed to investigate barriers and facilitators to delivering therapy in inpatient settings with the end goal of developing an intervention protocol to maximise access to psychological therapy and psychologically-informed care on inpatient settings. This research took the form of: a) a review of 51 studies implementing psychosocial interventions on acute mental health wards [17]; b) a large qualitative study of 26 staff, 22 patient and 12 carer perspectives on inpatient therapy using semistructured interviews; and c) two pilot studies where we implemented draft intervention protocols and used interviews to elicit stakeholder views on what aspects of Keywords: Cluster trial, Psychological therapy, Acute mental health, Inpatient, Process evaluation, Health economic analysis the intervention and its delivery worked or did not work in practice [18]. The findings have resulted in the development of a model of how to deliver therapy on patient wards called TULIPS (Talk, Understand and Listen for In-Patient Settings).…”

Section: Introductionmentioning

confidence: 99%

A cluster randomised controlled trial of a ward-based intervention to improve access to psychologically-informed care and psychological therapy for mental health in-patients

et al. 2022

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Background There is good evidence that psychological interventions improve patient well-being and independent living, but patients on acute mental health wards often do not have access to evidence-based psychological therapies which are strongly advised by NICE guidance for severe mental health problems. The overall aim of this programme of work is to increase patient access to psychological therapies on acute mental health inpatient wards. Stage one of the programme (which is complete) aimed to identify barriers and facilitators to delivering therapy in these settings through a large qualitative study. The key output of stage one was an intervention protocol that is designed to be delivered on acute wards to increase patient access to psychologically-informed care and therapy. Stage two of the programme aims to test the effects of the intervention on patient wellbeing and serious incidents on the ward (primary outcomes), patient social functioning and symptoms, staff burnout, ward atmosphere from staff and patient perspectives and cost effectiveness of the intervention (secondary outcomes). Methods The study is a single blind, pragmatic, cluster randomised controlled trial and will recruit thirty-four wards across England that will be randomised to receive the new intervention plus treatment as usual, or treatment as usual only. Primary and secondary outcomes will be assessed at baseline and 6-month and 9-month follow-ups, with serious incidents on the ward collected at an additional 3-month follow-up. Discussion The key output will be a potentially effective and cost-effective ward-based psychological intervention that increases patient access to psychological therapy in inpatient settings, is feasible to deliver in inpatient settings and is acceptable to patients. Trial Registration number ClinicalTrials.gov Identifier: NCT03950388. Registered 15th May 2019. https://clinicaltrials.gov/ct2/show/NCT03950388

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Overcoming barriers to implementing ward-based psychosocial interventions in acute inpatient mental health settings: A meta-synthesis

Cited by 41 publications

References 80 publications

A systematic review of the implementation of psychological therapies in acute mental health inpatient settings

A systematic review of the implementation of psychological therapies in acute mental health inpatient settings

The implementation of Journeying through Dementia: Strategies to run a successful pragmatic multicenter trial of a complex intervention

A cluster randomised controlled trial of a ward-based intervention to improve access to psychologically-informed care and psychological therapy for mental health in-patients

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