Wounds in mental health care: The archetype of a ‘wicked problem of many hands’ that needs to be addressed?

Abstract

This paper explores wound care for people living with mental health difficulties from a nursing perspective and considers what can be done to improve it. Objective: To analyse policy and practice relating to wound care for people experiencing mental ill health using the ideas of 'wicked problems' and 'problems of many hands' Methods: Policy and practice analysis informed by theory. Results: Recent UK policy is to ensure parity of esteem so that people with mental ill-health receive the same quality of care as those with physical ill-health. However, the provision of physical care to people experiencing mental ill health, including the provision of wound care, constitutes a 'problem of many hands' arising in the context of the mental health system being a complex one replete with wicked problems. Wicked problems are resistant to solutions and problems of many hands are complex and multifaceted and involve the interplay of different actors. Addressing problems of many hands in this context requires systems thinking and solutions enabling different people to work collaboratively. Conclusions: The wound care of people experiencing mental ill health has been largely overlooked, as it transcends the domains of mental health and tissue viability policy and practice. A strong system level approach is needed to improve care, characterised by closer interprofessional teamworking.

Public marketing to face wicked problems: theoretical essay for conceptual model construction

“…In the field of political science, researches have been revisited the wicked problem literature, considering the growth of the increasing complex reality. Papers have investigated several perverse contexts, such as mental health problems (Samuriwo & Hannigan, 2020 ), the Covid-19 pandemic (Radin, 2020 ), water governance (Kirschke et al, 2019 ), among others. All these contexts shows advances in discussions about wicked problems (Head, 2018 ; Termeer et al, 2019 ), through which we seek to understand the governmental factors that make these problems especially difficult to be addressed by policy makers, public managers and/or policy scholars (Head & Alford, 2015 ).…”

Parity of esteem and systems thinking: a theory informed qualitative inductive thematic analysis

“…All healthcare systems are complex and arguably the field of mental health is even more complex [ 12 ], with ‘contested ideas, shared responsibilities and limited evidence to guide interventions and service improvements’ [ 13 ]. Moreover, the physical care of people with mental health conditions is complex because disparate teams of health care professionals in different locations deliver these two elements of patient care, this separation reduces continuity of care and inhibits recovery [ 14 ].…”