CRITICAL REVIEW - Lack of choice and voice of people with lived experience in mental health services

Type: Assignments

Subject: Mental Health

Subject area: Nursing

Education Level: Masters Program

Length: 6 pages

Referencing style: Others (Include in instructions)

Preferred English: AU English

Spacing Option: Double

Instructions: start off with practises that you are proposing and then think about how in relation to this particular practises that you are focusing on how would we enhance use this scenario for the critical reflection. clinical reviews are done behind closed doors, the person ( consumer/patient ) has very little choice and voice. so how could we do clinical review differently. example such as co-created notes ( writing about me without me. )

Focus: co-created notes ( writing about me without me. ) 

http://www.indigodaya.com/writing-about-me-without-me/ apa 7 referencing

Introduction

People with mental illness have high rates of physical disorder than the general population. This is because of the risks of physical illness and the limited access to healthcare. Different approaches are used to address the discrepancy in health conditions and quality of life among individuals with mental illness. Collaborative care provides access to treatment, reduces the general medical services, increased mental health symptom management as well as enhances experiences of receiving care. The focus of this paper is to explore how co-created notes through the inclusion of people with lived experience in the care of mental health illness improves the trust and relationship with the physician and eventually boosts the recovery process. 

Summary of the issue

The recovery process of mental health patients has exhibited a slow progression coupled with barriers all around. This research identifies that a collaborative model can be adopted in mental health facilities to address the common barriers in the sector. The collaborative care model (CCM) is one of the approaches that come in handy to counter the issue. The model involves an ongoing relationship between the specialized clinicians offering comprehensive care for the patients. Quality indicator for collaborative care recommends the inclusion of people with lived experience (PWLE) to play major roles in evaluating and improving the CCMs. 

PWLE are experts by experience in diagnostic and health conditions. There is a campaign that policy should not be made without the full participation of members from their affected groups. Writing about us without us is a concept that shows how the affected parties have their records and information in records that they are not aware of how they were concluded (Vojtila, Ashfaq & Ampofo, 2021). They just find their reports and information especially in the hospital records even when they were not consulted about the same. This shows how the service users and the people with lived experience in mental health lack a voice in the recovery-oriented process when they have been noted as major actors in aiding the mentally ill individuals to have a successful recovery. 

The PWLE use their experience as knowledge and they have various roles in the mental health community including decision-making in their care. They also act as navigators in the mental health system to provide advocacy and empowerment as a support system. These individuals also have leadership roles in social policy, treatment development, and education. Therefore, the inclusion of the knowledge and experience of PWLE in the mental health service needs to be among the priorities to address the issues in the mental health sector. 

A critical review of the best practice 

Various approaches can be adopted to help promote a recovery-oriented service. Co-creation of health records is one major aspect that can boost the recovery process. in this respect, a mental health physician can actively involve their patient in the note takin and recording process. Talking the patient through the notes and information out on records is essential to create a harmonious environment where the person with lived experience understands and appreciates what is included in the records. Typically, people with mental illness experience stigma and other challenges in their treatment and recovery process due to their limited participation in the intervention. Co-creation can create a physical environment that is safe and welcoming where the service users can freely express their emotions and be tolerated (Storm, Fortuna, Brooks & Bartels, 2020). There should also be policies and procedures that are based on the assumption that mental health patients have been affected by trauma. Creating an environment for openness and transparency where clients feel safe is one major goal for co-creation of information. It is also recommended to review the eligibility criteria to be sure it does not unnecessarily exclude the clients from the services. When the eligibility criteria become a barrier for service users, they should be assisted to find alternatives to get the services. Reducing the barriers helps support the clients in their recovery and eliminates the possibility of trauma. 

The mental health facilities should also support the clients in every aspect of the services. Soliciting input and participation from the clients sends a message of partnerships and recovery. Interviewing the clients about the suggestions for improving the policies and procedures can be an option. It can also be appropriate to commit to hiring former clients and create a visible peer support and leadership roles within the agency. This can be incorporating the people with lived and living experience in the services. According to Breault et al. (2018), the PWLE have knowledge about the system and how it operates, they have evidence from practice about the issues affecting the service users and can use their experience to help address the issues. 

Statement summary of best practice

Collaborative care through co-creation is the most recommended approach to practice. This collaboration should be between the mental health professionals and the people with lived experience. PWLE are known to have their own experience that they use as knowledge to help facilitate a recovery-oriented process for the mental healthcare system. It is the approach that ensures the people with lived experience have a choice and voice in the mental health services. 

Reflecting on barriers and enablers

Recovery-oriented practice is set to be successful when it emerges as an organizational priority. It also stands a chance for success when the leadership in the organization supports it and staff members are trained and well aware of the tools and experiences that enhance personal recovery. Organizations may have the best intentions in the establishment of recovery-oriented practice. however, specific and persistent barriers can impede the implementation of practice guidelines if they are not well addressed. Most of the barriers relate to competing priorities or stigma. 

Barriers 

The health process priorities may be a barrier in the recovery-oriented practice. Mental health is persistently dominated by the clinical language and tasks, hierarchical power imbalances, and the obligations of risk management. this issue can be addressed through job descriptions and performance management that are defined to include recovery-oriented practices. It will help develop the expectations that these are part of the role. There is a business priority as a barrier where the financial issues and state funding priorities are at odds with the recovery-oriented practice. In other cases, these may emphasize the process indicators (Gooding, McSherry & Roper, 2020). Institutions need to prioritize and seek funding opportunities that entail people with lived and living experiences of mental health issues. Another issue is that the staff may not necessarily see recovery as a function of their professional role. The choice is usually dictated by an individual’s personality and values. It is critical to recruit and select workers with open minds to delivering services differently and are keen to empower service users to select their paths. 

Stigma in mental health is also a major barrier that impedes the implementation of recovery-oriented practice procedures. The mental health practices may take shape and healthcare professionals may not immediately appreciate them as stigmatizing. The mental health facilities may consider the access to outdoor as a privilege. This is a form of structural stigma that needs to be acknowledged and rectified. Collaboration with people who have lived and have living experience through the co-production and hiring them as experts can highly enhance the recovery plans and challenge the stigmatizing processes. 

Enablers 

Co-production and lived experience- co-production permits the service users to engage in the process by making contributions and additional perspectives on the features and delivery of treatment. It positions people with lived and living experiences of mental health issues and illness while empowering them to share them. The co-production further helps challenge stigma as it reduces the power hierarchy inherent within the medical model. Organizations can leverage their co-design to build a common language, shape the physical environment and develop programming as well as share the decision-making. 

Mental health institutions need to recognize the issue, define the problem and create the most suitable solution. Incorporating the lived and living experiences comes with specific benefits to service users. One, there is access where the service users may not attain the same access to physical space as the providers. The physical space needs to be accessible to everyone using the space. The access is set to enhance the sense of inclusion and self-determination and also minimize the use of compliance and privilege (Le Boutillier et al., 2015). The services should also be in a safe environment that has a community feeling and not a sense that it exists as a treatment space only. There should be policies in this environment that include the mechanisms for flexible rules that normalize citizenship entitlements. 

Conclusion

The current healthcare system is coupled with a challenge as people with mental illness become worried on what is documented in the hospital records and whether they are accurate or true. This is contributed by the inconsistent collaboration between primary care and specialized mental healthcare. The efforts to bridge this gap are seen through the collaborative care approach through co-creation of notes that mental health facilities embrace as an option to improve the experience of service users. 

References

Breault LJ, Rittenbach K, Hartle K, Babins-Wagner R, de Beaudrap C, Jasaui Y. (2018). People with lived experience (PWLE) of depression: describing and reflecting on an explicit patient engagement process within depression research priority setting in Alberta, Canada. Res Involvement Engagement, 4(1):37

Gooding, P., McSherry, B., & Roper, C. (2020). Preventing and reducing 'coercion' in mental health services: an international scoping review of English-language studies. Acta psychiatrica Scandinavica, 142(1), 27–39. https://doi.org/10.1111/acps.13152

Le Boutillier, C., Slade, M., Lawrence, V., Bird, V. J., Chandler, R., Farkas, M., Harding, C., Larsen, J., Oades, L. G., Roberts, G., Shepherd, G., Thornicroft, G., Williams, J., & Leamy, M. (2015). Competing priorities: Staff perspectives on supporting recovery. Administration and Policy in Mental Health and Mental Health Services Research, 42(4), 429-438. https://doi.org/10.1007/s10488-014-0585-x

Storm M, Fortuna K, Brooks J, Bartels S. (2020). Peer Support in Coordination of Physical Health and Mental Health Services for People With Lived Experience of a Serious Mental Illness. Frontiers Psychiatry. epub.

Vojtila, L., Ashfaq, I., Ampofo, A. (2021). Engaging a person with lived experience of mental illness in a collaborative care model feasibility study. Res Involv Engagem 7, 5. https://doi.org/10.1186/s40900-020-00247-w