Participation in mental healthcare: a qualitative meta-synthesis

Abstract

BackgroundFacilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care.MethodsElectronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs.ResultsThe synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy.ConclusionsThis meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.

Patients' perspectives on care pathways and informed shared decision making in the transition between psychiatric hospitalization and the community

“…Research has provided evidence of the benefits of increased patient involvement and raised the visibility of the service user, redefining integrated care and moving beyond policy aspiration . A study about patients' knowledge and the power imbalance in the doctor‐patient relationship supports our findings that patients need knowledge and power to participate in a shared decision‐making process .…”

“…Research has provided evidence of the benefits of increased patient involvement and raised the visibility of the service user, redefining integrated care and moving beyond policy aspiration. [9][10][11] A study about patients' knowledge and the power imbalance in the doctor-patient relationship supports our findings that patients need knowledge and power to participate in a shared decision-making process. 12 The study offered several recommendations for enhancing this by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners (GPs).…”

Comparison of a co‐produced mental health service to traditional services: A co‐produced mixed‐methods cross‐sectional study

“…) and has been mitigated in our study by the use of the assembly as the main place to make decisions. The assembly represents the core method of the centre, MCC participants always represented the majority, and researchers were challenged by the assembly to avoid the use of jargon and to share knowledge and power, which is critical for the implementation of co‐production (Stomski & Morrison ). Moreover, the assembly facilitated the process of systematically considering stakeholders' views, including family members, which are rarely efficiently involved in collaborative research (Kara ).…”

Participatory action research to pilot a model of mental health service user involvement in an Ethiopian rural primary healthcare setting: study protocol

“…The importance of involvement of service users and their caregivers (hereafter referred to as 'service-users') at all levels of the mental health system has been recognised globally [1,2]. The concept of involvement (alternatively referred to as participation or engagement) [3][4][5] is defined as "a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change" [6].…”

“…Methods for service-user involvement have been criticized for the lack of a participatory approach/inclusivity, and being unable to move beyond a tokenistic mode of participation [1,2,26,29]. One promising approach to address these criticisms is Participatory Action Research (PAR).…”