Lee Marklew, a Case Manager in the Assertive Outreach Team at Leeds & York Partnerships NHS Foundation Trust, has been awarded a research scholarship from the Florence Nightingale Foundation to undertake the fifth year of his PhD. The title of his study is: Making sense of Community Treatment Orders: the service-user experience.
This is the second time NHS Professionals has sponsored Lee’s research scholarship so we wanted to catch up with him to find out how his project has progressed.
What made you reapply for a scholarship with the Florence Nightingale Foundation?
The Florence Nightingale Foundation has supported me with annual scholarships throughout my five-year, part-time PhD. I am indebted to NHS Professionals for their sponsorship of years four and five of my PhD. I reapplied because the Foundation was so supportive, encouraging and challenging; not only in terms of the research project but also within associated activities, such as conference participation, networking events and forums. It also provided me with the opportunity to contribute to some of the prestigious Foundation nursing ceremonies, including the Florence Nightingale Commemoration Service.
What is a Community Treatment Order?
A Community Treatment Order is a legal measure that allows mental health teams to impose compulsory supervision on a patient after they have been discharged from an involuntary stay in hospital.
What are the aims of your research?
The aim of the research is to explore the meaning, understanding and experience of Community Treatment Orders (CTOs) for mental health service-users. It will generate a conceptual model that will help guide practitioners to achieving more effective CTO interventions and support.
Why did you choose to conduct your research on this topic?
Community Treatment Orders (CTOs) for mental health service-users have been controversial since their introduction in 2008, with over 14,000 used to date with their proportionate use increasing each year. CTOs are clinically and ethically tricky as failure to comply with treatment in the community may mean compulsory return to hospital and enforced treatment. They are widely used in my team and I have direct experience of their implementation with variable, unpredictable and sometimes surprising responses. Despite being used in many countries for many years the majority of published research has resulted in conflicting evidence and confusion. There have been no in-depth qualitative studies interpreting and analysing the impact of CTOs on service-users. I recognised a need to further investigate how service-users experience and make sense of CTOs.
How has the project developed since you started? What methods have you used so far?
The project has progressed as scheduled in my original proposal and is still on time to be completed at the end of the 2014/15 academic year. Data has been collected using semi-structured interviews with diaries and photo-journals used to help produce responses. The photo-journals were introduced as it was anticipated that diaries would not be a popular choice for service-users. In fact, cameras proved to be the less popular choice, with all participants choosing to use diaries and only three service-users taking photographs. Interpretative Phenomenological Analysis (IPA), an approach to psychological qualitative research, was then used to analyse the data.
Have you faced any challenges?
The first challenge was gaining ethical approval to undertake the research with such a potentially vulnerable group of service-users. However, full ethical approval was granted with assurances that the researcher would liaise with the appropriate care team to ensure that participants could engage with the research and receive any emotional support should the interviews cause distress or difficulty. The second challenge was the sheer volume of data created by 18 interviews with ten participants – my audio typing isn’t as quick as I thought! Transcription and subsequent analysis was a very lengthy process. However, doing it all myself forced me to become ‘immersed in the data’ and enabled the identification of patterns, threads and themes. A further challenge and notable feature of the interviews was that all the participants used metaphor to describe some of their more difficult experiences. These metaphors required differing levels of interpretation but also provided indicators of the important elements of the participant’s experience and guided the development of themes and clusters.
What do you hope to achieve?
I hope that the study will generate a themed structure that helps demonstrate and explain how CTOs impact on the daily lives of service-users and how they make sense of this approach to their treatment. I then hope to use existing theory to develop a conceptual model that may improve the therapeutic potential in the CTO experience and act as a guide for clinicians in developing more effective CTO interventions. This model may also help practitioners and service-users avoid the need for CTOs and enable quicker discharge for service-users, subject to this type of legislation.
What are your future plans after completing your research?
I hope to complete the research by October 2015 and would like to continue with a combination of qualitative research and clinical work – bridging the theory/practice gap.
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