Pilot success improving mental health of patients in secure settings
In-patients of secure mental health settings may now receive better forensic mental health care after an innovative pilot, led by Canterbury Christ Church University academic, improves the quality of life and recovery of patients.
Forensic mental health care is the provision of mental health services for people living with mental disorders who are offenders, or at risk of offending. Patients include often difficult, dangerous and extremely vulnerable people, whose behaviours present a risk to themselves and others. In-patient care normally takes place in secure, locked environments and patients can be difficult for professionals to assess and treat whilst also addressing legal, security and public safety issues.
Professor Douglas MacInnes, Professor of Mental Health in the School of Nursing, was granted almost £250,000 from the National Institute of Health Research (NIHR) to lead on The Comquol Study. The project introduced a structured communication approach to health care meetings which put patients’ perspectives at the heart of the discussions about their care. This proved successful in developing therapeutic relationships between patients and professionals in these secure settings.
Professor MacInnes, said: “The Comquol Study approach has helped to develop collaborative and trusting relationships where the patient can identify their own areas of concern and express where they want help or support to develop their own solutions to problems.
“Due to many clinical and practical reasons, there have been only a few small scale studies examining psychosocial interventions or the therapeutic relationship between clinicians and service users in secure mental health facilities, even though Best Practice Guidelines state the therapeutic alliance between staff and patients is at the centre of high-quality care and treatment in secure settings.
“The results of the study showed the trial design appears viable as the basis for a large full-scale trial. We are now working with our collaborative partners to develop an application for a nationwide study.”
There are two parts to the intervention, the first is an application on a computer tablet used to guide discussions between nursing staff and patients, helping to identify any concerns the patient may have. This is then followed by counselling, an approach better known in the industry as Solution Focused Brief Therapy, used to examine these concerns.
In addition to an increase in patients’ quality of life, therapeutic engagement, recovery and perceptions about the ward atmosphere also improved, with less disturbed behaviour recorded over time. Patients’ feedback on the pilot, outlined the importance of staff-patient relationships in influencing their quality of life. The nurses reported being positive about the intervention as it provided a structure by which to engage with patients and methods to enable the patients develop skills to alleviate problems.
The study was supported by the NIHR and collaborative partners in the research were Kent and Medway NHS and Social Care Partnership Trust, Oxleas NHS Foundation Trust, Institute of Psychiatry, London and Queen Mary University, London. The Comquol Study report has been published in BMC Psychiatry journal.
Professor MacInnes is also about to begin working on his next project, led by The University of Central Lancashire, Supporting family carers of individuals in secure services (forensic carers), which has been awarded £30,000 from NHS England.
Notes to Editor
Canterbury Christ Church University
Canterbury Christ Church University is a modern university with a particular strength in higher education for the public services.
With 17,000 students across Kent and Medway, its courses span a wide range of academic and professional subject areas.
- 95% of our UK undergraduates were in employment or further studies six months after completing their studies*.
- We are one of the South East’s largest providers of education, training and skills leading to public service careers.
*2013/14 Destination of Leavers from Higher Education survey