title: Whole systems working and acute inpatient psychiatry: an exploratory study.
abstract: The concept of 'whole system' working is fundamental to contemporary policy and consequently to practice and service development within UK mental health services. This paper reports on an exploratory study of the meaning of the 'whole system' to staff working within adult mental health services in North Wales, conducted within a broader practice development project. A focus group was used to collect data from a multiprofessional group drawn from two acute inpatient wards, Community Mental Health Teams (CMHTs) and an assertive outreach team. Thematic analysis generated three themes central to effective whole system working in adult mental health services. Discussion on the efficacy of the whole system gave rise to an understanding that this whole system varies in its effectiveness in responding to people with differing clinical presentations. Furthermore, it appears that under certain circumstances, the whole system may work to shift responsibility in order to manage worker's anxiety more adroitly than, for example, working creatively to respond to people's needs. The paper concludes that whilst by no means exhaustive or complete, these three themes enable critical reflection, discussion and identification of practice development challenges that may facilitate more effective whole system working and better services in North Wales and possibly in other settings.
authors.affiliation: University of Bradford, UK. nickbowles@preferredfutures.co.uk
authors.forename: N
authors.initials: N
authors.lastname: Bowles
authors.forename: A
authors.initials: A
authors.lastname: Jones
mesh_terms: D000208:Acute Disease; D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000517:prevention & control / Q000523:psychology; D003156:Community Mental Health Services / Q000458:organization & administration; D003159:Community-Institutional Relations; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017144:Focus Groups; D006801:Humans; D001523:Mental Disorders / Q000451:nursing*; D008605:Mental Health Services / Q000458:organization & administration*; D009723:Nurse-Patient Relations; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration*; D011567:Psychiatric Department, Hospital / Q000458:organization & administration; D012944:Social Support; D014852:Wales; D016526:Workload / Q000523:psychology