Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis

Jordan Troup; Billie Lever Taylor; Luke Sheridan Rains; Eva Broeckelmann; Jessica Russell; Tamar Jeynes; Chris Cooper; Thomas Steare; Zainab Dedat; Shirley McNicholas; Sian Oram; Oliver Dale; Sonia Johnson

doi:10.1371/journal.pone.0267787

Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis

Jordan Troup, Billie Lever Taylor, Luke Sheridan Rains^*, Eva Broeckelmann, Jessica Russell, Tamar Jeynes, Chris Cooper, Thomas Steare, Zainab Dedat, Shirley McNicholas, Sian Oram, Oliver Dale, Sonia Johnson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of ‘personality disorder’) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion, most with samples given a ‘personality disorder’ diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

Original language	English
Article number	e0267787
Journal	PLoS ONE
Volume	17
Issue number	5 May
DOIs	https://doi.org/10.1371/journal.pone.0267787
Publication status	Published - 5 May 2022

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Clinician perspectives on what_TROUP_Published5May2022_GOLD VoR CC BYFinal published version, 995 KBLicence: CC BY

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Troup, J., Taylor, B. L., Rains, L. S., Broeckelmann, E., Russell, J., Jeynes, T., Cooper, C., Steare, T., Dedat, Z., McNicholas, S., Oram, S., Dale, O., & Johnson, S. (2022). Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis. PLoS ONE, 17(5 May), Article e0267787. https://doi.org/10.1371/journal.pone.0267787

@article{1ce1d5c27d0e4b41b4f8a243e31c8368,

title = "Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis",

abstract = "Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of {\textquoteleft}personality disorder{\textquoteright}) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion, most with samples given a {\textquoteleft}personality disorder{\textquoteright} diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.",

author = "Jordan Troup and Taylor, {Billie Lever} and Rains, {Luke Sheridan} and Eva Broeckelmann and Jessica Russell and Tamar Jeynes and Chris Cooper and Thomas Steare and Zainab Dedat and Shirley McNicholas and Sian Oram and Oliver Dale and Sonia Johnson",

note = "Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted by the NIHR Policy Research Unit (PRU) in Mental Health (grant no. PR-PRU-0916-22003). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or its arm{\textquoteright}s length bodies, or other government departments. This report is based on independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm{\textquoteright}s length bodies, and other Government Departments. Publisher Copyright: Copyright: {\textcopyright} 2022 Troup et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2022",

month = may,

day = "5",

doi = "10.1371/journal.pone.0267787",

language = "English",

volume = "17",

journal = "PLoS ONE",

issn = "1932-6203",

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number = "5 May",

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Troup, J , Taylor, BL, Rains, LS, Broeckelmann, E, Russell, J, Jeynes, T, Cooper, C, Steare, T, Dedat, Z, McNicholas, S, Oram, S, Dale, O & Johnson, S 2022, 'Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis', PLoS ONE, vol. 17, no. 5 May, e0267787. https://doi.org/10.1371/journal.pone.0267787

TY - JOUR

T1 - Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs

T2 - A qualitative thematic meta-synthesis

AU - Troup, Jordan

AU - Taylor, Billie Lever

AU - Rains, Luke Sheridan

AU - Broeckelmann, Eva

AU - Russell, Jessica

AU - Jeynes, Tamar

AU - Cooper, Chris

AU - Steare, Thomas

AU - Dedat, Zainab

AU - McNicholas, Shirley

AU - Oram, Sian

AU - Dale, Oliver

AU - Johnson, Sonia

N1 - Funding Information: This paper presents independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted by the NIHR Policy Research Unit (PRU) in Mental Health (grant no. PR-PRU-0916-22003). The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or its arm’s length bodies, or other government departments. This report is based on independent research commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm’s length bodies, and other Government Departments. Publisher Copyright: Copyright: © 2022 Troup et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2022/5/5

Y1 - 2022/5/5

N2 - Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of ‘personality disorder’) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion, most with samples given a ‘personality disorder’ diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

AB - Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) (who may have a diagnosis of ‘personality disorder’) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion, most with samples given a ‘personality disorder’ diagnosis. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

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U2 - 10.1371/journal.pone.0267787

DO - 10.1371/journal.pone.0267787

M3 - Article

C2 - 35511900

AN - SCOPUS:85129998263

SN - 1932-6203

VL - 17

JO - PLoS ONE

JF - PLoS ONE

IS - 5 May

M1 - e0267787

ER -

Clinician perspectives on what constitutes good practice in community services for people with complex emotional needs: A qualitative thematic meta-synthesis

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