title: Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England.
abstract: BACKGROUND
  Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems.
  
  
  METHODS
  A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together.
  
  
  RESULTS
  Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health.
  
  
  CONCLUSIONS
  Service delivery components - e.g. peer support groups, personal planning - advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.
authors: Section of Mental Health, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK. sgillard@sgul.ac.uk
authors: Steve
authors: S
authors: Gillard
authors: Katie
authors: K
authors: Adams
authors: Christine
authors: C
authors: Edwards
authors: Mike
authors: M
authors: Lucock
authors: Stephen
authors: S
authors: Miller
authors: Lucy
authors: L
authors: Simons
authors: Kati
authors: K
authors: Turner
authors: Rachel
authors: R
authors: White
authors: Sarah
authors: S
authors: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000379:methods* / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000592:standards*; D003627:Data Interpretation, Statistical; D004739:England; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care; D012017:Referral and Consultation; D012648:Self Care / Q000592:standards*; D012720:Severity of Illness Index; D012923:Social Class; D012944:Social Support; D011795:Surveys and Questionnaires