Clients' or Service Users' Experiences

An account of community mental health teams’ activities would be ill- informed and incomplete without clients’ perspectives. There is a considerable literature documenting clients’ experiences of mental health services and much of it has been collated as a set of recommendations for improvement (National Collaborating Centre for Mental Health 2012). Understandably, this focuses upon shortcomings and structural problems such as waiting times, attitudes of staff and flexibility, rather than “what works.” Community mental health team clients have varying perspectives on their care. A particularly insightful group are those who have had experience of acute crisis, have been provided for by a CRHT and have recovered. They are in a position to reflect upon the experience and recall what was and what was not helpful. A 2010 review of published clients’ experiences of CRHT identified 13 papers, 1 RCT review and 2 reports (Winness et al. 2010) . Disappointingly, these provided few in-depth details. Characteristics of the experience that were valued included ready access and availability, being understood as a “normal” human being and readiness to deal with crises in an everyday life context. A later investigation (Shaw and Stapleton 2010 ; Middleton et al. 2011) adds to this literature and sheds further light on what CRHT service users do or do not find helpful.

Accounts of such experiences are usually obtained by a clinician or a professional researcher but this introduces a particular perspective which can distort them (Charon 2004; Godin et al. 2007). To minimise this effect (Mishler 1986; Clark et al. 1999) Lester et al. 2006; Rose et al. 2006), and in support of their ambition to conduct a piece of mental health research, a group of service users were enabled to interview subjects who had recently had the experience of being provided for by a CRHT team. NHS Research Ethics approval was obtained. Thirty-six interviews were conducted, all by individuals who had been or who were currently in receipt of mental health services. The interviewed sample comprised 13 males with a mean age of 42.9 years and 23 females with a mean age of 44.3 years. Transcripts were analysed by two processes conducted in parallel and blind to one another. One was conducted by a group drawn from the service user interviewers and supported by a research consultant and the other by a postdoctoral career social scientist with formal qualitative research training. This person had had no prior contact with the primary data or involvement in running the study. A broadly defined grounded theory (avoiding a priori assumptions) approach to identifying the phenomenology (subjective experiences) of interviewees’ interactions with the team was adopted by both. The service user researchers chose to consider the transcripts stage by stage, as the interview proceeded through the respondent’s recollections of their “journey,” and then aggregated these into an overall view of “What helps recovery?” and “What hinders recovery?”. The academic sought answers to “What was helpful?” and “What was unhelpful?” from the transcripts as a whole. She found little consistency amongst them at the level of specific actions or inactions, and sought common themes at a higher or more abstract level.

The service user researchers’ analysis summarised the influences aiding recovery as:

• • Reassurance: Knowing that there was someone who understood what was happening and was available either in person or by phone.
• • Positive relationships: The experience of non-judgemental consistency, acceptance and understanding.
• • Involvement in the process: An experience of control, making their own decisions and having choice in what was done to or for them.
• • Practical support: Assistance with household tasks, shopping, cleaning, gardening and childcare, which relieved pressure.
• • Access and flexibility: Feeling that support was available from professional services, family or friends when it was needed and in an appropriate form.

Influences hindering recovery were:

• • Unhelpful attitudes and behaviour: Anything, particularly relational factors that interfered with any of the above, helpful relational issues.
• • Unmet expectations: Disappointed, unrealistically high expectations as a result of misleading information.
• • Lack of continuity: Where this was experienced, it hindered development of an effective supporting relationship with the team.
• • Lack of appropriate or sufficiently well-organised follow-up: A common experience was poor availability of follow-up provision such as psychological therapy or other services. The experience was an unhelpful one when involvement with CRHT had to end before another indicated provision could become available.

The academic was less drawn to the mechanics of service provision and more to the subjective experiences different activities and contacts evoked. Her analysis distilled the transcripts to central roles for whether or not contact with the team or informal carers had resulted in a sense of feeling safe, accepted and understood.

Just knowing somebody was there for you was nice. And that’s what the CRHT team did when they got involved. They were a constant reassurance ... the fact that they understood or seemed to understand what I was going through was really reassuring, and the fact that I could contact them at any time was also helpful. Although I didn’t do it, I knew I could if I needed to ... and also to know that other people were like that as well. Because they would say, ‘This is what other people have told me’, and you think ... ‘You’re not just on your own with it’. Female, 53 years old