Centre for Mental Health Research

Our research investigates and evaluates different models or approaches to mental health service delivery and organisation and new, innovative ways of providing care. We employ a range of approaches and multiple research methods, often combining policy and literature reviews, large scale questionnaire surveys, fine-grained qualitative interviews, focus groups, documentary analysis and observation, and employ detailed case studies. We have experience in synthesising and triangulating data to provide illuminating insights into complex issues.

Our studies often emerge from topical challenges and issues facing service managers and clinicians or are identified by service users and carers. We frequently work in collaboration with service users as researchers alongside clinical staff in real world healthcare settings. Recently, this has included studies funded by the National Institute of Health Research into care planning and coordination in both community and inpatient mental health settings; investigations of new mental health nurse liaison roles in primary care; and the use of serious games to explore issues of risk in service users in forensic mental health settings.

Research Studies

Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study (COCAPP)

In the UK, concerns about safety and fragmented community mental health care led to the development of the care programme approach in England and care and treatment planning in Wales. Processes are required to be collaborative, recovery-focused and personalised but have rarely been researched. We aimed to obtain the views and experiences of stakeholders involved in community mental health care and identify factors that facilitate or act as barriers to personalised, collaborative, recovery-focused care.

We conducted a cross-national comparative study employing a concurrent transformative mixed-methods approach with embedded case studies across six service provider sites in England and Wales. Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and framework method.

The research was led by the Centre’s Professor Alan Simpson conducted in collaboration with colleagues at City and the universities of Cardiff and Swansea. It was funded by the National Institute for Health Research Health Services and Delivery Research Programme (HS&DR 11/ 2004/12). The views and opinions expressed are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

Results have been published in a reports and peer-reviewed papers and presented at numerous conferences and have been discussed with NHS England to inform a review of community mental health care.

Key COCAPP publications:

Simpson, A., Hannigan, B., Coffey, M., Barlow, S., Cohen, R., Jones, A., Všetečková, J., Faulkner, A., Thornton, A. and Cartwright, M. (2016). Recovery-focused care planning and coordination in England and Wales: A cross-national mixed methods comparative case study. BMC Psychiatry, 16(1) . doi:10.1186/s12888-016-0858-x.

Coffey, M., Cohen, R., Faulkner, A., Hannigan, B., Simpson, A. and Barlow, S. (2017). Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning. Health Expectations, 20(3), pp. 471–483. doi:10.1111/hex.12474.

Simpson, A., Hannigan, B., Coffey, M., Jones, A., Barlow, S., Cohen, R., Všetečková, J. and Faulkner, A. (2016). Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP). Health Services and Delivery Research, 4(5), pp. 1–190. doi:10.3310/hsdr04050.

Related publications:

Coffey, M., Hannigan, B. and Simpson, A. (2017). Care planning and co-ordination: imperfect solutions in a complex world. Journal of Psychiatric and Mental Health Nursing. doi:10.1111/jpm.12393.

Drummond, C. and Simpson, A. (2017). 'Who's actually gonna read this?' An evaluation of staff experiences of the value of information contained in written care plans in supporting care in three different dementia care settings. Journal of Psychiatric and Mental Health Nursing. doi:10.1111/jpm.12380.

Cross-national mixed methods comparative case study of recovery-focused mental health care planning and coordination in acute inpatient mental health settings (COCAPP-A)

Mental health service users in acute inpatient wards, whether informal or detained, should be involved in planning and reviewing care. Care planning processes should be personalised and focused on recovery, where goals are individual to the person and designed to maximise their achievements and social integration. We aimed to obtain the views and experiences of service users, carers and staff to identify factors that facilitated or acted as barriers to collaborative, recovery-focused care and make suggestions for future research.

We conducted a cross-national comparative mixed methods study involving 19 mental health wards in six NHS sites in England and Wales included a meta-narrative synthesis of policies and literature; a survey of service users and staff; embedded case studies involving interviews with staff, service users and carers; and a review of care plans and meetings.

The research was led by Professor Alan Simpson and conducted in collaboration with colleagues at City and the universities of Swansea and Cardiff. It was funded by the National Institute for Health Research Health Services and Delivery Research Programme (HS&DR 13/10/75). The views and opinions expressed are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.

The results will be published in a report and journal paper presented at a number of international conferences later this year.

East London NHS Foundation Trust (ELFT) has reviewed and revised the existing Care Programme Approach (CPA) process and policy jointly with its four Local Authority partners in East London and three Local Authorities in Luton and Bedfordshire and introduced a new process for planning, documenting and reviewing mental health care. This incorporates the DIALOG+ tool as a framework to underpin the architecture of the new eCPA form. DIALOG+ has been rigorously tested in ELFT and promotes a recovery-focused approach that was otherwise not integral to existing CPA processes. Key benefits in using DIALOG+ as a clinical outcomes tool is that it encourages discussions between the staff member and service user on self-management and crisis planning, explores options that are agreed between staff and service users and promotes a more empowering and therapeutic method for engagement.  The inclusion of ‘My Recovery Plan’ alongside ‘My Safety Plan’ have replaced ‘risk management’ concepts.

A team of researchers led by Professor Alan Simpson are working with clinicians, managers and service users in ELFT to evaluate the impact of the innovative care planning process on service users’ experiences of involvement in the care planning process, the quality of the therapeutic relationships with their care coordinators, the recovery-focus of the care planning process and on clinical outcomes.

Research methods include the use of officially collected data, questionnaire surveys of services users and interviews with service users, carers and clinicians and structured reviews of care plans. The process of implementation of the new CPA will be informed by i-PARIHS framework, which has been used for retrospective and prospective implementation evaluations. Results are expected in mid-2018.

Safewards is an evidence-based nurse-led intervention proven to reduce levels of conflict and containment on acute inpatient mental health wards. The Safewards model is derived from a programme of research led by Professor Len Bowers, recently of King’s College London and previously at City, University of London, and informed by the research efforts of many others around the world. Whilst at City, Professor Bowers and colleagues reviewed over a thousand previous studies by other researchers and conducted research on how to reduce conflict and containment, including some of the largest ever studies of acute inpatient care, comparing 136 wards in the City- 128 study, examining change over a four year period in one Trust in the Tompkins Acute Ward Study, and testing an intervention in the City Nurses study. At City, Professor Alan Simpson and members of SUGAR (Service User and carer Group Advising on Research) contributed to the development of the Safewards intervention. At King’s Prof Bowers led other studies that informed the Safewards model.

Full details of the Safewards model, supporting evidence and the cluster randomised controlled trial that reported a 15% decrease in the rate of conflict and a 24% decrease in the rate of containment can be found here: http://www.safewards.net/.

The Safewards research was funded by the National Institute for Health Research Programme Grant for Applied Research (HS&DR 11/ 2004/12). The views and opinions expressed are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health.RP-PG-0707-10081

Publication:

Bowers, L., James, K., Quirk, A., Simpson, A., SUGAR., Stewart, D. and Hodsoll, J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial. International Journal of Nursing Studies, 52(9):  1412–1422. doi:10.1016/j.ijnurstu.2015.05.001.