Carer involvement in treatment of people with severe mental illness is supported by decades of research evidence and recommended by national and international mental health care guidelines. However, it is inconsistently implemented. Experiences of carers are particularly negative when patients are hospitalised as carers often feel excluded from information and decisions about treatment in hospital settings. We aimed to develop simple clinical procedures that can be implemented in NHS routine care and support clinicians in involving carers in treatment from first admission.
Our development work (described in case study 2014/15), informed the subsequent design of an intervention - a training programme and a manual in which standardised clinical procedures and the required communication and facilitation skills for chairing meetings with carers and patients are described.
This training manual was developed based on: a) a systematic literature review on barriers and facilitators for carer involvement in mental health treatment (http://dx.doi.org/10.1136/bmjopen-2014-006108); b) focus groups with frontline clinicians, and patients and carers who had a recent experience of being admitted to hospital or supporting someone who was hospitalised (https://doi.org/10.1186/s12888-017-1259-5).
Thirty-one patients and carers received the intervention in a feasibility study, reporting positive experiences.
We continued to train clinicians at East London NHS Foundation Trust and so far 71 clinicians (nine medical professionals, 62 nursing staff) have received training. The training normally takes one hour and can be delivered one-to-one or in groups. To fit with schedules of busy professionals, we found flexibility was key, e.g. opportunistically adding the training to already planned away days or team meetings.
This online training programme will be disseminated to four sites in different parts of England. There are plans to make this online training available to NHS professionals across the country after this testing phase.
Contribution of CLAHRC North Thames
The CLAHRC funded a full-time researcher, and supplied project costs. These resources have enabled co-development of the programme, with carer and service user representatives playing an important role in shaping the design and the delivery of training.
The CLAHRC has supported two successful applications to NIHR streams: NIHR Doctoral Research Fellowship, ‘The Involvement of Family and Friends in Inpatient Mental Health Care: What Do Patients Want?’; NIHR Program Development Grant aimed to improve practice and outcomes of involuntary hospital admissions in England (ImprovE study, RP-DG-1214-10004).
What happened next?
We aim to make this training widely available across the NHS with attribution to East London NHS Foundation Trust. To encourage further dissemination, researchers at CLAHRC NT are developing an online training package which will include materials from our face-to-face training and role playing videos. During the forthcoming reporting period and CLAHRC extension, this online training programme will be disseminated to four sites in different parts of England: a) Tees, Esk and Wear valleys NHS Trust; b) Devon Partnership NHS Trust; c) Cornwall Partnership NHS Foundation Trust and d) East London NHS Foundation Trust. There are plans to make this online training available to NHS professionals across the country after this testing phase.