Journey to an ideal ward round in mental health services

On behalf of the Critical Value Based Practice Network

The idea of shared decision making in mental health care is a well-established marker of good practice. The basic premise being that relevant professionals, people who are using mental health services and their family or friends should contribute meaningfully to the process of decision-making in terms of both deliberation and outcome. There are examples of practices, which adopt these principles, having a great impact on both the experience and outcome of contact with mental health services (e.g. Open Dialogue). However, this is not the common experience and most people feel ill-informed about, let alone involved in the decision-making process. Contributing to this problem, are the structures and environments where decisions are made. Ward rounds and multi-disciplinary meetings are identified as the key decision-making forums. Yet, the culture and rituals of these forums often act as an obstruction to shared decision-making.

In a piece of research conducted by the University of Nottingham, nurses expressed their dissatisfaction with the way in which decisions were made in in-patient mental health services. Despite perceiving themselves as the professional group who had most knowledge about the person using mental health services, they described themselves as merely the implementers of unpopular decisions made by more powerful professionals (Stacey et al., 2016). Additionally, all professional groups, people who use services, and their families and friends participating in the research, agreed that current decision-making forums were not fit for purpose and led to dissatisfactory outcomes for all. However, it was conceded that the legal and accountable function of these forums meant an alternative was difficult to consider.

A co-produced participatory action research project, led by the Involvement Centre within Nottinghamshire Healthcare NHS Foundation Trust, took on the challenge to identify recommendations for an ‘ideal ward round’. Through extensive data collection and collaborative analysis the findings were distilled into 12 recommendations underpinned by a decision-making model which accounted for the challenges of implementing shared decision-making in areas of practice which incorporated compulsory care (Stacey et al., 2015). Educational tools to disseminate this approach have been developed and are currently being rolled out locally as part of a wider agenda to promote ‘meaningful admission’. We recognise that organisational, professional and regulatory body commitment to this agenda is required if we are to see the ward round rituals change to a forum where decisions can be shared.

We would like to share our resources and welcome those who are interested in our journey to the ideal ward round to get in touch.

• Journey to an Ideal Ward Round in Mental Health Services
• Shared Decision-Making in Mental Health Practice

References

Stacey, G., Felton, A., Morgan, A., Stickley, T., Willis, M., Diamond, B., Houghton, P., Johnson, B. and Dumanya, J. (2016) A critical narrative analysis of shared decision-making in acute inpatient mental health care. Journal of Interprofessional Care. Vol. 30. No. 1. https://doi.org/10.3109/13561820.2015.1064878.

Stacey, G., Felton, A., Houghton, P., Hui, A., Morgan, A., Shutt, J., Diamond, B., Willis, M.E.H. and Stickley, T. (2015) Informed, involved and nfluential: the 3 Is model of shared decision-making in mental health care. Mental Health Practice. Vol. 19. No. 4. https://journals.rcni.com/mental-health-practice/informed-involved-and-influential-three-is-of-shared-decision-making-mhp.19.4.31.s20.