Introduction: Policy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.
Methods: A five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.
Results: Three personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey. Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.
Conclusion: While our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.
Funding: The National Institute for Health Research Health Services and Delivery Research programme.
Copyright © Queen’s Printer and Controller of HMSO 2015. This work was produced by Pinfold et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
- Plain English summary
- Scientific summary
- Network mapping
- In-depth network interviews
- Organisational perspectives from health and social care leaders
- The role of practitioners in personal networks of people with severe mental illness
- Case studies
- The community health network approach
- Appendix 1 Lived experience reflections on community health network: project report
- Appendix 2 Interview guide: stakeholder interviews (series 1)
- Appendix 3 Service user participant demographics
- Appendix 4 Resource Generator United Kingdom (RGUK)
- Appendix 5 Health Resource Generator (HRG)
- Appendix 6 Community Health Network name generator
- Appendix 7 Name interpreter cards and emotional closeness map
- Appendix 8 Data exclusions
- Appendix 9 Data cleaning
- Appendix 10 Dendrogram created using agglomerative clustering approach
- Appendix 11 Frequency table based on clustered variables used to name each cluster
- Appendix 12 Regression models
- Appendix 13 Qualitative schedule: service user interview (series 2)
- Appendix 14 Practitioner schedule 2
- Appendix 15 Interview schedule: stakeholder interviews (series 2)
- List of abbreviations
Consideration of the Influence of Place on Access to Employment for Persons With Serious Mental Illness in Northeastern OntarioKL Rebeiro Gruhl et al. Rural Remote Health 12, 2034. PMID 22839731.The study highlights the influence of geography and human resources to the implementation of best practice employment services and supports for persons with SMI. Importan …
New Ways of Working in Mental Health Services: A Qualitative, Comparative Case Study Assessing and Informing the Emergence of New Peer Worker Roles in Mental Health Services in EnglandS Gillard et al. PMID 27466663. - ReviewKey barriers to, and facilitators of, peer worker role adoption were identified, including valuing the differential knowledge and practice that peer workers brought to th …
Outcomes Assessment for People With Long-Term Neurological Conditions: A Qualitative Approach to Developing and Testing a Checklist in Integrated CareF Aspinal et al. PMID 25642533. - ReviewMany of the outcomes that are important to service users with LTNCs are not addressed in validated ‘outcome measures’. This has implications for commissioners and practit …
How Has the Impact of 'Care Pathway Technologies' on Service Integration in Stroke Care Been Measured and What Is the Strength of the Evidence to Support Their Effectiveness in This Respect?D Allen et al. Int J Evid Based Healthc 6 (1), 78-110. PMID 21631815.Implications for practice There is some evidence that ICPs may support certain elements of service integration in the context of stroke care. This seems to be as a result …
Primary Care Research Team Assessment (PCRTA): Development and EvaluationYH Carter et al. Occas Pap R Coll Gen Pract (81), iii-vi, 1-72. PMID 12049028.The pilot project has been very successful and recommendations have been made to progress to a UK scheme. Management and review of the scheme will remain largely the same …