Service users at the heart of service evaluation USER FOCUSED MONITORING

Historical context of mental health user evaluation in the UK Comes from: Ground breaking research emanating from the emancipation and disability movements of the 60’s and 70’s (Turner and Beresford, 2005) Increasingly vociferous user movement of the 70’s and 80’s Requirement from Department of Health to include the views, wishes and experiences of those who use services in the creation and delivery of services (National Service Framework,1999 and the NHS Plan 2000)

What is User Focused Monitoring? A particular model of service evaluation led by people who have received mental health ‘treatment’ or services. This model was initially developed at Sainsbury Centre for Mental Health by Diana Rose in1996, and has been further developed by other projects since.

Doing it for real principles: a summary 1.Citizen participation that is not tokenistic 2.Independence: user-controlled projects 3.Robust evaluation and research processes that meet National Research Ethics Services standards 4.Commitment to change through implementation and continuing dialogue with commissioners and services 5.Securely and adequately funded to ensure sustainability 6.A group process

1. DECIDE which services to evaluate 2. DEVELOP questions 3. CARRY OUT interviews 6. INFORM/ INVOLVE staff and service users 7. ACT on the findings ongoing SUPPORT recruitment and training 5. PRODUCE report 4. ANALYSE data

Examples of UFM evaluations In-Patient services across one or more hospitals Crises services The concept of crisis in mental health The Care Programme Approach: how socially inclusive is it? Homelessness and mental health A critical look at the Masters in Nursing Science Looking at Outreach Services Diet at day centres Etc.

Where else can UFM be used? UFM can also be used in: –Other areas of health: e.g. Drug and alcohol services –Housing, including: Supported housing Using young and older tenants

USER FOCUSED MONITORING The Experiences of the Care Programme Approach in Bristol: How socially inclusive is it? BRISTOL

What were the aims and objectives of the study? –To evaluate how the Care Programme Approach (CPA) in Bristol is helping to support the achievements of secondary mental health service users’ needs and aspirations –To elicit Bristol service users’ experiences of CPA with a view to gain a detailed picture of the process in Bristol –To explore whether CPA in Bristol actively engages in a meaningful way with the concept of social inclusion

Summary of the main findings (1) SOCIAL INCLUSION and THE CPA PROCESS INFORMATION Many still were not sure whether they had a care plan and less than two thirds of Community sample knew who their care coordinator was. This was also reflected in people’s reported lack of knowledge about the process and about what is available to people in the community or in terms of services. The Trust leaflets about CPA, were largely unknown to the vast majority of the participants we talked to. INVOLVEMENT There was a recurrent lack of involvement in the process People were usually happy with how their care coordinator coordinated their care but for some there was evidence of poor communication between mental health professionals. However there was also evidence that, on an interpersonal level, satisfaction with mental health workers was good overall. People felt that their care coordinator in particular took their views and suggestions into account. The situation changed with care plan meetings where they felt views and suggestions were far less often taken into consideration, in particular at the reviews.

Summary of the main findings (2) CARE PLANNING TOWARDS SOCIAL INCLUSION Community participants were more likely to be asked by mental health workers if they needed help with activities related to work or training issues than with activities linked to sports and leisure In-Patients were rarely asked about the help and support they would need to prepare for activities in the community that would help them to feel more socially included The case of Forensic participants was different. A number of them were regularly involved in activities in the community (e.g. courses) and they benefited from greater onsite input linked to occupational activities Participants overall seemed more likely to get help if the difficulty was discussed with a mental health worker and if it had been recorded in the person’s care plan. This indicates that mental health services have a very important role in identifying these problems and brokering suitable support

Conclusions (Summary) CPA is not fulfilling its potential in promoting social inclusion for service users in Bristol. Overall CPA is a process that is still largely owned by mental health services rather than by service users, in particular in terms of practical arrangements (meetings), information about the process, and decision making. When the CPA process worked well, and people were properly involved, the outcomes were positive. When it was not working well, people were left on the fringes of inadequate support.

Projects keep in touch and support each other Offer of support to new projects (information, training etc) Publications, including A Guide to Setting up a UFM Project, 2007, London: SCMH On going building of links with like-minded organisations and user groups Future developments for the tool and the model User Focused Monitoring Network

For all documents related to User Focused Monitoring wpKHAL6H9FWP Contact Anne-Laure Donskoy UFM Network Coordinator User Focused Monitoring Network