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The gap between theory and practice in mental health treatment

A blog by Duncan Purslow

Laura Lord and Nicola Gale (both of the University of Birmingham) wrote a paper "Subjective experience or objective process: ”Understanding the gap between values and practice for involving patients in designing patient-centred care " for the Journal of Health Organization and Management, Vol. 28 Iss: 6, pp.714 – 730 (2014).

According to their paper patient-centred care and patient involvement are increasingly central concepts in health policy in the UK, however, there is little consensus regarding their definition or how to achieve “patient-centred” care in everyday practice or involving patients in service redesign initiatives. The purpose of their paper was to explore these issues from the perspective of key stakeholders within National Health Service (NHS) hospitals in the UK through semi-structured interviews, covering a range of topics related to service redesign, conducted with 77 key stakeholders across three NHS Trusts in the West Midlands. In total, 20 of these stakeholders were re-interviewed 18 months later. Data were managed and analysed using the Framework Method.

While patient-centred care and patient involvement were regularly cited as important to the stakeholders, a gap persisted between values and reported practice. This gap is explained through close examination of the ways in which the concepts were used by stakeholders, and identifying the way in which they were adapted to fit other priorities identified by the organizations. The value placed on positive subjective experience was weighed against concerns over the objective measurement of the patients as they move through the system meaning patient-centred values fail to translate into improved practice.

The paper described and explained a previously unarticulated tension in health organisations between values and practice in patient-centred care and patient involvement in service redesign. 

Published by Emerald Group Publishing Limited the project was funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme though it should be pointed out the views expressed in this publication were not necessarily those of the NIHR, the Department of Health, NHS Partner Trusts, University of Birmingham or the CLAHRC-BBC Management Group.

This is an issue that would seem to have implications for all parts of both mental health and social care, be it for the conditions of service users in mental health or for patients cared for in homes and receiving treatment for dementia in that sector and the treatment they receive.

More recently at an inaugural lecture by Professor Paul Burstow on ‘the treatment gap’, given at the Barber Institute, complementary to the events on Mental Health Day this year, has drawn attention to the difference that exists in treatment practice and theory. Appointed as Professor of Mental Health Policy at Birmingham University in May to oversee the setting up of a new commission on mental health, his career includes work at the Tavistock Clinic and as a Minister in the previous Conservative-Liberal coalition government

He argued that expanding services is not sufficient but the need is for ‘appreciation of the whole person’ and to address the (social) causes of mental illness. This was done largely with slides referencing published documents such as that in 2010 on the overuse of anti-psychotic medicine. ‘No Health Without Mental Health’ was published while he was a minister for care services and he focussed on the need for parity with physical health as in the ‘Five Year Forward View’ (2014) integrating physical, mental and social care.

His presentation included a film of the ‘Time to Change’ promotion (in which one quote of a service user was ‘honesty as a strength’), with contributions from those diagnosed for mental health conditions not only in the workplace.

The challenge also is that there are likely to be three million over 65s with long term conditions by 2018. Prevention was also highlighted (see a document by the LSE on the economic case for prevention), as well as early intervention and early diagnosis and the importance of social relationships.

A link to a summary of the lecture can be found at: http://www.birmingham.ac.uk/research/perspective/mental-health-awareness-day-2016.aspx

What would seem to be an issue here is not only what is meant by ‘patient-centred care’ but there would seem to be a need for further clarification both in the literature and in practice for addressing the understanding of the ‘wellbeing’ which is rightfully required in the treatment given to those with a mental health illness.

The diagram from ‘the Science of Wellbeing’ by Huppert et al illustrates the improvement that needs to be made in some cases of care towards greater wellbeing of these patients.


 3rd January 2017