Qandeel is a PhD student at the University of Leeds supervised by Professor Rebecca Lawton, Dr Sarah Alderson, and Ed Breckin. Her research interests include patient safety, de-implementation and mental health care. Qandeel’s PhD research project looks at the de-implementation of low value practices in mental health care and she is particularly interested in looking at this from the service user’s perspective.
The use of healthcare practices with little or no benefit is a widespread problem, as evidence shows 20-25% of all healthcare provided is unnecessary or harmful. These potentially unsafe practices are known as low value care. Although there has been some progress in de-implementing low value care in primary and acute settings, little research has looked at low value practices in mental health care. With mental health services currently experiencing huge demands and a lack of resources it is has become increasingly important to de-implement low value care in this area. Therefore, this study aims to identify practices in mental health care that are potential targets for de-implementation.
A Qualitative exploratory research design was used. 15 peer support workers were recruited from 5 different mental health charities to take part in interviews. The interviews were semi-structured and involved in-depth discussions about experiences of ineffective and wasteful care. Interviews were conducted online and lasted 30-90 minutes. The data was subject to abductive thematic network analysis which incorporates the principles of abductive theory of method, thematic network analysis, and thematic analysis.
The findings show 3 main practices peer support workers consider to be low value: (1) long term use of antidepressants, (2) physical restraint and (3) enhanced observations. Participants viewed these practices as ineffective, wasteful, and even harmful for the service user. They also made recommendations for how low value practices could be de-implemented. This included removing, reducing, restricting or replacing practices with more effective and safe alternatives.
This study identifies potential targets for de-implementation in mental health care from the perspective of peer support workers. De-implementing harmful or unnecessary care could help free up the vital resources needed to provide safe, high quality mental health care.