Impact in Qualitative Research: Gracie Tredget on integrating physical and mental healthcare
An evaluation of physical healthcare in adult community mental health teams within a South London Mental Health Trust
Gracie is a Programme Manager based within the Mind and Body Programme at King’s Health Partners. Gracie’s background in management consulting and psychology, has led her to work alongside various private and public sector organisations to develop, improve and deliver services that support adults living with mental health problems, their families and reduce inequalities within local communities. In 2019, Gracie accepted the Mind Network Partnership and Profile Excellence Award for contributions to collaborative partnerships within the UK’s voluntary sector to improve early intervention and prevention-based approaches for adults living with common mental health problems.
Adults diagnosed with a severe mental illness (SMI), such as schizophrenia, are at greater risk of premature death compared to the general population largely as a result of physical health problems and adverse risk factors, such as social economic status and adverse health behaviours, such as smoking. Research suggests this risk could be reduced with the introduction of annual physical health checks. In 2014, the National Institute for Health and Care Excellence issued guidance for the provision of annual physical health checks for adults with SMI with care shared between primary and secondary services. The guidance sets out that secondary care teams are responsible for carrying out annual physical health assessments and follow up care for patients with SMI under care of mental health team for less than 12 months and / or whose conditions has not yet stabilised. Despite this clear guidance, little is known about how staff working within mental health services feel about providing physical healthcare within their roles, and the impact this has on service user experience within mental health services.
South London and Maudsley NHS Foundation Trust (SLaM) set out to understand what barriers may be impacting on their staff, service users and carers that may limit, delay, or prevent physical health checks being completed in a timely way. The Integrating our Mental and Physical Healthcare Systems (IMPHS) project team were commissioned to conduct a qualitative service evaluation to investigate further what may be happening within adult community mental health teams, and produce a set of recommendations to improve routine practice.
We wanted to gather a wide range of staff perspectives to obtain a general view and not to draw comparisons between professional groups, teams, or services, and set out to explore which barriers and facilitators contributed to five main areas of interest:
- The approach and practice of staff towards physical healthcare
- The use of physical health systems and tools
- The physical health knowledge and skills used by staff
- The perceptions and attitudes of staff towards physical healthcare within the Trust
- The experiences and outcomes of service users and carers
Our evaluation had six core stages:
Stage 1: We consulted staff within adult community mental health teams to identify key roles that work closely with patients with concurrent mental and physical health problems to be involved in the evaluation.
Stage 2: We established an expert by experience working group, made up of patients, carers and adult community mental health team staff, to help design and deliver the evaluation activities.
Stage 3: We conducted 23 semi-structured interviews, 8 focus groups and 8 observations with a total of 50 participants. All interviews were conducted with current SLaM staff, while focus groups included a mixture of staff, as well as service users and carers.
Stage 4: We presented our findings back to the community mental health team staff, service users and carers that participated in the evaluation process, and worked with them to co-develop recommendations.
Stage 5: We shared the final recommendations with wider adult community mental health team staff across the organisation, to identify recommendation priorities to be presented back to SLaM.
Stage 6: We worked with SLaM to review the recommendations and agree an action plan to realise each one within the organisational strategy for Physical Healthcare.
The evaluation identified five main themes and related subthemes relating to staff, patients and carers experience of physical healthcare within adult community mental health team services. These findings led to the development of the following recommendations:
- Clear organisational vision and strategy for physical healthcare, supported by clear communication of this to staff, patients, carers, and partner organisations e.g., primary care.
- Accessible policy that outlines the responsibilities of the organisation, community services and staff when supporting the physical health of adults with an SMI.
- A comprehensive training programme that addresses generic and specific competencies for staff in key roles within community teams.
- A competency monitoring system that supports managers to continue to develop knowledge and skills of staff in practice.
- Streamlined processes and systems that can appropriately support staff in their roles to be able to provide effective physical healthcare to patients and their families as well.
These findings have informed a Physical Health Improvement Strategy within SLaM, which has involved working with the Trust’s Physical Health Team to translate the evaluation findings into practice using the Knowledge-into-Action Framework (Graham et al, 2006). The strategy aims to work with the organisation to identify opportunities for improvement in physical healthcare practice within routine mental health services provided for adults living with an SMI.
By working with two leading Mental Health Trusts, we hope the impact of this project is to achieve parity in physical healthcare practice across services in South East London by clarifying the physical health support for patients with SMI accessing adult community mental health team services, and a framework that can support mental health organisations to deliver this as part of routine practice. We have also secured funding to expand the project within SLaM and another partner organisation, Oxleas NHS Foundation Trust. The hope from this work is that it will improve how staff approach physical healthcare, and ultimately improve the care experiences and health outcomes of patients receiving that support within mental health settings.
Funding information: This project was delivered as part of the Integrating our Mental and Physical Healthcare Systems (IMPHS), funded by the Maudsley Charity, delivered at South London and Maudsley NHS Foundation Trust (SLaM) in partnership with the Centre for Implementation Science at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.
For more information about the evaluation, development of recommendations of translation of work into practice, please contact the author on gracie [dot] tredget [at] slam [dot] nhs [dot] uk.