Researching community mental health care experiences from the uk

Cardiff School of Nursing and Midwifery Studies
Ysgol Astudiaethau Nyrsio a Bydwreigiaeth Caerdydd

Researching community mental
health care: experiences from the UK
Dr Ben Hannigan
Reader in Mental Health Nursing
Cardiff School of Nursing and Midwifery
Studies


Summarised, this is what I do:

• Use social scientific ideas to understand policy, practice,
and the organisation and delivery of mental health
services, particularly in the community
• Using qualitative methods, study mental health work and
the experiences of people using services
• Collaborate with colleagues on large-scale, mixed
methods, studies and conduct evidence reviews
• Teach mental health nurses and supervise research
students


I blog about my work (and other things
besides)


How did we get to where we are now?

• Ad hoc community care developments
The water tower at
• New opportunities for workers Warlingham Park Hospital
• 1970s: interprofessional, locality, CMHTs Photo taken by Roger Haworth,
as a preferred, but contested, model licensed for reuse

• 1980s and 1990s: interrelated network
of community care and hospitals, with
resources tied up in institutions
• Competing policy imperatives, lack of
clarity around agency and organisational
responsibilities, concerns over
underfunding and risk Ty Siriol, Caerphilly
(Hannigan 1999; Hannigan and Allen 2006) Photo taken by John Grayson,
licensed for reuse


Work and workers: findings from an
ethnographic investigation and a survey
Health and Social Care:
• Mental health systems populated by a complex mix of
occupation, fulfilling roles in fluid ways reflecting local
organisational features (Hannigan and Allen 2011)…
• …with relatively invisible contributions being made by
workers (paid and unpaid) on the periphery (Hannigan
and Allen, in press)
All Wales CMHN stress study:
• High levels of stress and burnout (Burnard et al 2000;
Coyle et al 2000; Edwards et al 2000a, 2000b, 2001;
Fothergill et al 2000; Hannigan et al 2000)


What about policy and services from around
the turn of the century?
Wicked problems in complex systems:
• Unprecedented policy activism from the late 1990s
• Mental health as a complex and ‘untamed’ arena, replete
with ‘wicked problems’
• Rapid changes in problem formulation and solution…
• …beginning with a focus on the failure of community
care…
• …and then problems with everyday working practices...
• …and more recently moving towards a concern with
public mental health (Hannigan and Coffey 2011)


What about policy and services from around
the turn of the century?
New law, new roles:
• Approved mental health professionals (Coffey and
Hannigan, in press)
Mental health systems: the case of crisis services
• New teams and services in the community…
• …underpinned by a disputed evidence base
• High-quality care, but…
• …triggering significant ‘waves of consequences’
(Hannigan, in press)


New projects: COCAPP

Simpson A., Hannigan B., Coffey
M., Jones A., Faulkner A., Jančová
J. Cross-national comparative
study of recovery-focused mental
health care planning and
coordination. NIHR HS&DR
Programme

• A mixed methods study combining a meta-narrative mapping and policy
analysis with the generation of quantitative and qualitative data
• Concerned with the relationships between care planning, care
coordination, recovery and personalisation



• Meta-narrative mapping: how care planning and
coordination is conceptualised in different research
traditions; key theories; preferred designs; main findings
• Data generation in six sites in England and Wales:
– questionnaires (Recovery Self Assessment Scale; Scale
To Assess the Therapeutic Relationship; Empowerment
Scale)
– interviews with key informants, document review
– interviews with service users, carers and care
coordinators, and review of care plans



• Project Advisory Group and Lived Experiences Advisory
Group
• Recruitment of Services User Research Assistants, with
roles including recruitment and interviewing of
participants
• Fieldwork to commence in the Spring


New projects: RiSC

Hannigan B., Edwards D., Evans N.,
Gillen E., Pryjmachuk S., Trainor G. and
Longo M. An evidence synthesis of risk
identification, assessment and
management for young people using
tier 4 inpatient child and adolescent
mental health services (CAMHS). NIHR
HS&DR Programme

• A two phase evidence synthesis in the area of risk for young people moving
into, through and out of mental health hospital
• Phase 2 review informed by the views and experiences of people working in,
and using, CAMHS


References and reading

Burnard P., Edwards D., Fothergill A., Hannigan B. and Coyle D. (2000)
Community mental health nurses in Wales: self-reported stressors and coping
strategies. Journal of Psychiatric and Mental Health Nursing 7 (6) 523-528
Coffey M. and Hannigan B. (in press) New roles for nurses as approved mental
health professionals in England and Wales: a discussion paper. International
Journal of Nursing Studies
Coyle D., Edwards D., Hannigan B., Burnard P. and Fothergill A. (2000) An
exploration of the coping strategies used by community psychiatric nurses in
Wales. Nursing and Health Sciences 2 (1) 59-67
Edwards D., Burnard P., Coyle D., Fothergill A. and Hannigan B. (2000a) Stress and
burnout in community mental health nursing: a review of the literature. Journal
of Psychiatric and Mental Health Nursing 7 (1) 7-14


Edwards D., Burnard P., Coyle D., Fothergill A. and Hannigan B. (2000b) Stressors,
moderators and stress outcomes: findings from the all-Wales community mental
health nurse study. Journal of Psychiatric and Mental Health Nursing 7 (6) 529-
538
Edwards D., Burnard P., Coyle D., Fothergill A. and Hannigan B. (2001) A stepwise
multivariate analysis of factors that contribute to stress for mental health nurses
working in the community. Journal of Advanced Nursing 36 (6) 805-813
Fothergill A., Edwards D., Hannigan B., Burnard P. and Coyle D. (2000) Self-
esteem in community mental health nurses: findings from the all-Wales stress
study. Journal of Psychiatric and Mental Health Nursing 7 (4) 315-321
Hannigan B. (1999) Joint working in community mental health: prospects and
challenges. Health and Social Care in the Community 7 (1) 25-31
Hannigan B. (in press) Connections and consequences in complex systems:
insights from a case study of the emergence and local impact of crisis resolution
and home treatment services. Social Science & Medicine



Hannigan B. and Allen D. (2006) Complexity and change in the United Kingdom’s
system of mental health care. Social Theory & Health 4 (3) 244-263
Hannigan B. and Allen D. (2011) Giving a fig about roles: policy, context and work
in community mental health care. Journal of Psychiatric and Mental Health
Nursing 18 (1) 1-8
Hannigan B. and Allen D. (in press) Complex caring trajectories in community
mental health: contingencies, divisions of labor and care coordination.
Community Mental Health Journal doi: 10.1007/s10597-011-9467-9
Hannigan B. and Coffey M. (2011) Where the wicked problems are: the case of
mental health. Health Policy 101 (3) 220-227
Hannigan B., Edwards D., Coyle D., Fothergill A. and Burnard P. (2000) Burnout in
community mental health nurses: findings from the all-Wales stress study.
Journal of Psychiatric and Mental Health Nursing 7 (2) 127-134


Contact
Email:
• hanniganb@cardiff.ac.uk
Web:
• http://www.cardiff.ac.uk/sonms/contactsandpeople/acad
emicstaff/hannigan-ben-overview_new.html
Blog:
• http://benhannigan.com

Researching community mental health care experiences from the uk

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