Service user experiences of a novel in‐reach rehabilitation and recovery service for people with profound and enduring mental health needs

Abstract

This article provides an organizational case study using exploratory qualitative and visual research methods. We address the research question: What are the experiences of service users who use a novel in‐reach rehabilitation and recovery service for people with severe and enduring mental health needs? Fifteen purposefully sampled service users were recruited from across a Service that is novel in embedding community sectors within inpatient provision. The sample reflects approximately the demographic of the Service and comprises: 10 men, 5 women; 12 white British, 3 ethnic minority; aged 18–60 years; and across inpatient care and supported community living. Photo‐elicitation was used to enrich data collection through lightly structured interviews focused on the images brought by participants. Interview transcripts were analysed using interpretative phenomenological analysis. Analysis indicates that participants oriented towards four ‘meta‐questions’: What does mental well‐being mean to you? What difficulties have you encountered? What do you appreciate about the Service? What do you need for change to occur? We also identified six themes which told the story of a journey. The journey begins with challenge and moves towards making connections with others. Here, power dynamics are often experienced and addressed in the development of a greater sense of independence. This then provides opportunities for raised awareness around possibilities of recovery and a new‐found hope. Our three main conclusions are all relevant to clinical practice: service users (a) place great importance on building relationships; (b) aspire to make informed choices throughout their recovery journey; and (c) desire greater transparency regarding treatment options.

Staff experiences of a novel in‐reach rehabilitation and recovery service for people with profound and enduring mental health needs

“…In order to become familiar with the content of each interview, the first author created a pen-portrait (see King & Horrocks, 2012) of each participant which captured the main issues around which their narrative cycled. Each transcript was read and reread several times and, through discussion between the first and third author, comparisons were then made between pen portraits to identify commonalities and differences (see also Smith, 2019). This allowed the identification of how participants oriented towards five 'meta-questions' independent of the data collection procedure and eight thematic foci derived from the data set.…”

“…The aim of this was to retain the idiographic focus whilst being able, also, to extrapolate meaningfully across the group (Smith et al, 2009). Rigour and credibility were facilitated by ongoing discussions of the developing analysis with the third author, a professor in psychology with experience in qualitative and visual methods, and the study Steering Group that represented a range of stakeholders, which included the second author, NHS Head of Research & Development (Leeds and York Partnership NHS Foundation Trust), as well as other representatives of NHS, community voluntary sector and service user groups (see also Smith, 2019).…”

“…The redesign created a service that offers a stepped intensive pathway through inpatient care to support better the transition and reintegration of service users into the community (Barnes & Dilks, 2014). Hence, NHS inpatient and independent community voluntary organizations were brought together to provide holistic community care packages with links to colleges, community groups and volunteering opportunities (see Smith, 2019). The Service consists of 36 inpatient beds across an inpatient 'ward-environment' and an inpatient staffed 'house-environment' located on the same site away from NHS acute care, and supportive living in the community with the input of Service staff for up to 6 months after hospital discharge.…”

Interviews and interviewing techniques.

“…I have supervised several research projects using image-led interviews in which traditionally hard-to-reach demographics have been enthused about the activity and used their images to help convey meaningful experiences. This includes interviewees such as men with low income (Jestico, 2021), people with profound and enduring mental health challenges (P. Smith et al, 2021), and youth in recovery from substance addiction (Madill et al, 2019). Sometimes brought images are used by participants as a prompt to talk about an actual event or person.…”

Experiences and challenges faced by community mental health workers when providing care to people with mental illness: a qualitative study

“…These worsen patients' conditions and contribute to burnout and turnover among CMHWs [32][33][34]. Previous qualitative studies have mostly explored the potential value and practical experience of CMHWs in CMHS from the perspective of the patient or family [28,29,[35][36][37][38]. It is important and necessary to find out the challenges of CMHS in China from the perspective of CMHWs.…”