Service user involvement in in-patient mental health services

Abstract

The main objective with this thesis is to improve the understanding of user involvement in inpatient mental health services. This thesis conceptualizes and operationalizes service user involvement into variables that can be empirically measured. This thesis also assesses the implications of conducting the intervention program “Service user involvement in practice.” The program was implemented in order to increase attention to user involvement and to develop current user involvement practices in inpatient departments in two community mental health centers (CMHCs). In paper 1, multiple items to measure user involvement were developed, validated, and empirically tested with service providers in one CMHC. In paper 2, we used cross-sectional data from service providers in inpatient departments in five CMHCs. The study investigates if providers’ reports of user involvement vary between organizational contexts and ascertains if a provider’s characteristics affect the reports. In the intervention stage, both qualitative and quantitative data were collected. The qualitative data were used in paper 3 and provided insight into both inpatients’ and providers’ experiences with user involvement. In paper 4, we used quantitative survey data from providers and inpatients to study the possible effect of the intervention program “Service user involvement in practice” on reports of user involvement. The study design was quasi-experimental, involving inpatient departments in five CMHCs. Two CMHC took part in the intervention program while three CMHCs participated as comparisons. In paper 1, the Service User Involvement in Mental Health (SUIM) Scale was developed with 30 items and four subscales: “Democratic patient involvement,” “Assisted patient involvement,” “Carer involvement,” and “Management support.” The cross-sectional data in paper 2 showed that user involvement at the departmental and individual level could be measured with three subscales or variables: “assisted patient involvement,” “patient collaboration,” and “organizational user involvement.” The first two variables were derived from the Service User Involvement in Mental Health (SUIMH) Scale, while “organizational user involvement” is a selection of items from the Consumer Participation Questionnaire (CPQ) (Kent & Read, 1998). The data also revealed that reports of user involvement at the departmental level were low, but there were differences among CMHCs. Providers reported more often user involvement at the individual level, and providers’ work shifts arrangements impacted on these reports. The qualitative data in paper 3 revealed that user involvement is a complex matter in inpatient mental health care. Providers and patients hold different perspectives on several issues related to user involvement and involvement in treatment and care. In paper 4, the quantitative survey data from providers showed that there were significant changes in three of the user involvement variables: “organizational user involvement,” “patient collaboration,” and “carer involvement.” There were no significant differences between patients in the intervention and comparison groups with regard to their experiences with treatment and care. The results in this thesis shows that service user involvement from providers’ perspective can be measured with the following variables: “patient collaboration,” “assisted patient involvement,” “carer involvement,” “management support,” and “organizational user involvement.” Attention should be paid to the relatively few reports of “organizational user involvement” and that there are variations among institutions with regard to implementation user involvement. The study results suggest that an intervention program can turn attention to and increase competence about user involvement among providers and inpatients but that more work is needed to increase patients’ selfadvocacy.