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      Supporting carers to improve patient safety and maintain their well‐being in transitions from mental health hospitals to the community: A prioritisation nominal group technique

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          Abstract

          Introduction

          Carers of people with mental illness may face distinct challenges, including navigating fragmented health and social services during discharge from mental health hospitals. Currently, limited examples of interventions that support carers of people with mental illness in improving patient safety during transitions of care exist. We aimed to identify problems and solutions to inform future carer‐led discharge interventions, which is imperative for ensuring patient safety and the well‐being of carers.

          Methods

          The nominal group technique was used which combines both qualitative and quantitative data collection methods in four distinct phases: (1) problem identification, (2) solution generation, (3) decision making and (4) prioritisation. The aim was to combine expertise from different stakeholder groups (patients, carers and academics with expertise in primary/secondary care, social care or public health) to identify problems and generate solutions.

          Results

          Twenty‐eight participants generated potential solutions that were grouped into four themes. The most acceptable solution for each was as follows: (1) ‘Carer Involvement and Improving Carer Experience’ a dedicated family liaison worker, (2) ‘Patient Wellness and Education’ adapting and implementing existing approaches to help implement the patient care plan, (3) ‘Carer Wellness and Education’ peer/social support interventions for carers and (4) ‘Policy and System Improvements’ understanding the co‐ordination of care.

          Conclusion

          The stakeholder group concurred that the transition from mental health hospitals to the community is a distressing period, where patients and carers are particularly vulnerable to safety and well‐being risks. We identified numerous feasible/acceptable solutions to enable carers to improve patient safety and maintain their own mental wellbeing.

          Patient and Public Contribution

          Patient and public contributors were represented in the workshop and the focus of the workshop was to identify the problems they faced and co‐design potential solutions. Patient and public contributors were involved in the funding application and study design.

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          Most cited references19

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          Physical and mental health effects of family caregiving.

          Adverse-and even positive-outcomes in a chronic stress experience.
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            Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis

            Informal caregiving is an integral part of the care of people with severe mental illness, but the support needs of those providing such care are not often met. To determine whether interventions provided to people caring for those with severe mental illness improve the experience of caring and reduce caregiver burden. We conducted a systematic review and meta-analyses of randomised controlled trials (RCTs) of interventions delivered by health and social care services to informal carers (i.e. family or friends who provide support to someone with severe mental illness). Twenty-one RCTs with 1589 carers were included in the review. There was evidence suggesting that the carers' experience of care was improved at the end of the intervention by psychoeducation (standardised mean difference −1.03, 95% CI −1.69 to −0.36) and support groups (SMD =–1.16, 95% CI −1.96 to −0.36). Psychoeducation had a benefit on psychological distress more than 6 months later (SMD =–1.79, 95% CI −3.01 to −0.56) but not immediately post-intervention. Support interventions had a beneficial effect on psychological distress at the end of the intervention (SMD =–0.99, 95% CI −1.48 to −0.49) as did problem-solving bibliotherapy (SMD =–1.57, 95% CI −1.79 to −1.35); these effects were maintained at follow-up. The quality of the evidence was mainly low and very low. Evidence for combining these interventions and for self-help and self-management was inconclusive. Carer-focused interventions appear to improve the experience of caring and quality of life and reduce psychological distress of those caring for people with severe mental illness, and these benefits may be gained in first-episode psychosis. Interventions for carers should be considered as part of integrated services for people with severe mental health problems.
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              Patient safety in inpatient mental health settings: a systematic review

              Objectives Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. Design Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. Results Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. Conclusions Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO registration number CRD42016034057.
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                Author and article information

                Contributors
                Role: Research Assistant
                Role: Senior Lecturer
                Role: Research Associate
                Role: Research Fellow
                Role: Lecturer
                Role: Senior Clinical Lecturer
                Role: Professor
                Role: Senior Research Associate
                Role: Associate Professor
                Role: Research Fellownatasha.tyler@manchester.ac.uk
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                08 July 2023
                October 2023
                : 26
                : 5 ( doiID: 10.1111/hex.v26.5 )
                : 2064-2074
                Affiliations
                [ 1 ] Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health The University of Manchester Manchester UK
                [ 2 ] NIHR Greater Manchester Patient Safety Translational Research Centre The University of Manchester Manchester UK
                [ 3 ] NIHR School for Primary Care Research The University of Manchester Manchester UK
                [ 4 ] Department of Primary Care and Mental Health The University of Liverpool Liverpool UK
                [ 5 ] Division of Pharmacy and Optometry, Centre for Pharmacoepidemiology and Drug Safety The University of Manchester Manchester UK
                [ 6 ] NIHR Greater Manchester Patient Safety Translational Research Centre Manchester Academic Health Science Network Manchester UK
                [ 7 ] Suicide, Risk and Safety Research Unit Greater Manchester Mental Health NHS Foundation Trust Manchester UK
                [ 8 ] Social Care and Society, School of Health Sciences The University of Manchester Manchester UK
                [ 9 ] Population Health Sciences Institute Newcastle University Newcastle UK
                [ 10 ] School of Psychology University of Leeds Leeds UK
                Author notes
                [*] [* ] Correspondence Natasha Tyler, PhD, Research Fellow, NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.

                Email: natasha.tyler@ 123456manchester.ac.uk

                Author information
                http://orcid.org/0000-0002-7153-5745
                http://orcid.org/0000-0003-1623-6029
                http://orcid.org/0000-0001-8257-1090
                Article
                HEX13813
                10.1111/hex.13813
                10485304
                37421272
                08b39eea-23e2-4d38-9b73-ce38afaba463
                © 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 June 2023
                : 01 February 2023
                : 22 June 2023
                Page count
                Figures: 2, Tables: 4, Pages: 11, Words: 7315
                Funding
                Funded by: NIHR Three Research Schools Mental Health , doi 10.13039/501100013374;
                Award ID: MH032
                Funded by: NIHR Greater Manchester Patient Safety Translational Research Centre
                Award ID: PSTRC‐2016‐003
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                October 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.3 mode:remove_FC converted:08.09.2023

                Health & Social care
                care transitions,carers,discharge,inpatient services,mental health,nominal group technique

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