Study of the use of Personal Narratives for Reducing Restraint v. 1
Research type
Research Study
Full title
A Mixed-Method Investigation of a Psychological Formulation Program for Reducing Use of Restrictive Intervention in a Mental Health Inpatient Setting
IRAS ID
227356
Contact name
Emma Kaminskiy
Contact email
Sponsor organisation
Cambridgeshire and Peterborough NHS Foundation Trust
Duration of Study in the UK
0 years, 4 months, 29 days
Research summary
Research Summary
Restrictive interventions (physical restraint, safe holds, and rapid tranquilisation) are used within inpatient mental health wards when a service user poses a risk to themselves or others. Government guidance mandates restrictive interventions are last resort given their incompatibility with recovery (Bonner, Lowe, Rawcliffe, & Wellman, 2002). Previous research within Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) found that service users believe improved therapeutic relationships and communication are key to reducing restrictive intervention (Wilson, Rouse, Rae, & Kar Ray, 2017). Therapeutic relationships can improve through the use of a commonplace psychological practice by clinical psychologists, called psychological formulation (Lewis-Morton et al., 2017). (Upon suggestion of the study’s advisory group, ‘personal narrative’ is used in participant-facing materials, as it is more accessible.)Psychological formulation is the process of collaborating with practitioners to develop a shared understanding of service users’ mental health difficulties in order to work out ways in which to support them in their recovery using psychological evidence. Little evidence-based research has been conducted on its effects.
This research involves two studies to examine the usefulness of psychological formulation practices within the CPFT inpatient mental health environment.
The first study involves evaluating a pilot psychological formulation training program by comparing outcomes between two wards within CPFT, one which receives the training and another which doesn’t. Outcomes include the rate of restrictive interventions, as well as effects on service users and staff. A questionnaire on organisational readiness for change will explore the enablers and barriers for change according to all staff members on each ward.
The second study involves interviews with service users and practitioners from the two wards. This study explores experiences surrounding treatment, the effect of psychological formulation on restrictive interventions and other outcomes, as well as enablers and barriers to change in the context of the inpatient environment.
Summary of Results
There is currently little research exploring positive practice within specialist inpatient services for service users (SUs) with a diagnosis of borderline personality disorder (BPD). One possible support for positive practice with SUs with a diagnosis of BPD is psychological formulation, which is a process used by mental health practitioners to collaboratively understand and identify ways forward for service users.
This research used both qualitative and quantitative research methods (specifically, a methodology called Mixed Methods-Case Study) to investigate positive practice within Poppy ward, a positive practice specialist inpatient ward. Two streams of research were undertaken: Stream 1 involved an interview-based case study with six service users and 10 staff members, where positive practices and their barriers were discussed. Stream 2 involved an investigation of the acceptability of the model of psychological formulation developed for this research (the Personal Narrative Mode, PNM) for SUs and practitioners. Stream 2 involved a qualitative focus group with seven Poppy staff and an online phase of research with practitioners and SUs from across England. The online phase of research involved eight qualitative interviews while 26 questionnaires were completed.
Findings from the research indicated that positive practice was defined by staff and SUs as good relationships, staff specialist training and knowledge, and sharing responsibility for risk and recovery. Care-planning was seen as collaborative, but staff found the process lacks meaning. The PNM was suggested to address this. Logistical and other barriers hindered its implementation at Poppy; however, the online phase confirmed general acceptability. Participants reported support would be required to address the risk of narrative for staff and SUs. Overlap across participants and research phases identified both implementation challenges (e.g., staff resistance and barriers to collaboration) and ways to address them.
The contribution to knowledge includes: 1) explanatory factors of positive experiences in a specialist context; 2) acceptability of the PNM, which possibly addresses less positive practice (aversion to narrative; theoretical incoherence of care-planning); and 3) challenges of applying new practices in a specialist inpatient context and recommendations for their management.REC name
North West - Liverpool Central Research Ethics Committee
REC reference
18/NW/0212
Date of REC Opinion
15 Jun 2018
REC opinion
Further Information Favourable Opinion