Experimental Staffing Models in Inpatient Acute Mental Health Services. A Longitudinal Comparative Study of Occupational Therapy Services
DOI:
https://doi.org/10.5708/EJMH.18.2023.0006Keywords:
Occupational Therapy/Therapist, Staffing models, Experimental staffing, Inpatient wards, Mental HealthAbstract
Introduction: An NHS Mental Health Trust in England recently used an experimental staffing model by including Occupational Therapists (OT) in the staff numbers on ten working age adult acute inpatient wards.
Aims: This study aims to compare different staffing models involving occupational therapists and make recommendations for preferred staffing models.
Methods: This is a longitudinal comparative study of archived patient and multi-disciplinary electronic records and data collected from Kent and Medway NHS and Social Care Partnership Trust. Areas of analysis included quantitative data and qualitative coding and theming, covering the period February 2016-June 2019 during the experimental staffing model, and July 2019-March 2021, when the model ended and teams were Occupational Therapy-led. Full ethical approval and consent was gained in 2020 from the Trust and University to request and access data to complete this research.
Results: This experimental staffing model resulted in less delivery of Occupational Therapy specific interventions, resulting in poorer retention rates and impacting on patient and student experiences. Since working in Occupational Therapy led teams, the quality of Occupational Therapy interventions, job retention, student experiences, patient care and safety have improved.
Conclusions: The recommended staffing model for working age acute mental health wards has Occupational Therapists embedded in OT-led teams. Staffing tools need to be developed that involve Allied Health Professional leaders and this field needs more research.
References
Ashby, S., E., Ryan, S., Gray, M., & James, C. (2013). Factors that influence the professional resilience of occupational therapists in mental health practice. Australian Occupational Therapy Journal, 60(2), 110–119.
https://doi.org/10.1111/1440-1630.12012
Bate, S., Marriot, T., & Vanstone, A. (2019). The Transition to an Occupational Therapy-Led Service. OT News, 27(4), April.
https://viewer.joomag.com/occupational-therapy-news-otnews-april-2019/0520065001554901598?short&
Birken, M., & Bryant, W. (2019). A Photovoice study of user experiences of an occupational therapy department within an acute inpatient mental health setting. British Journal of Occupational Therapy, 82(9), 532–543.
https://doi.org/10.1177/0308022619836954
Care Quality Commission. (n.d.). Effective staffing case studies. Retrieved August 10, 2022, from
https://www.cqc.org.uk/publications/themed-work/effective-staffing-case-studies
Care Quality Commission. (n.d.). Provider Inspection Reports. Retrieved March 6, 2020, from
https://www.cqc.org.uk/provider/RXY/reports
Care Quality Commission. (n.d.). Provider Inspection Reports. Retrieved May 19, 2021, from
https://www.cqc.org.uk/provider/RXY/reports
Clarke, V., & Braun, V. (2006). Teaching thematic analysis: Overcoming challenges and developing strategies for effective learning. The Psychologist, 26(2), 120–123.
Crawford, G., Johnson, S., Morris, S., & Steeples, S. (1992). Are norms the Key to Manpower Planning? British Journal of Occupational Therapy, 55(2), 49–52.
https://doi.org/10.1177/030802269205500204
Davies, L. (2015). Extended working hours model for occupational therapy service on mental health wards. In College of Occupational Therapists 39th Annual Conference & Exhibition and Specialist Section – Work Annual Conference: 30 June – 2 July 2015, Brighton, Centre Brighton, Sussex. British Journal of Occupational Therapy, 78(8, Supplement), 1–131.
https://doi.org/10.1177/0308022615583236
Department of Health. (2007). Mental Health: New Ways of Working for Everyone. Developing and sustaining a capable and flexible workforce. (Progress Report. Report no. 7938).
https://www.nscap.org.uk/doc/NWW for Everyone.pdf
Eldridge, D., McFrederick, M., & Barber, P. (2015). Safe Staffing – “Therapeutic Staffing Levels”. Trust Board Report. Report no. TBI/15-16/069, 24 September. South East - Local NHS Trust.
Fisher, A, G. (2014). Occupation-centred, occupation-based, occupation-focused: Same, same or different? Scandinavian Journal of Occupational Therapy, 21(sup1), 162–173.
https://doi.org/10.3109/11038128.2014.952912
Fortune, T. (2000) Occupational Therapists: Is our therapy truly occupational or are we merely Filling Gaps? British Journal of Occupational Therapy, 63(5), 225–230.
http://dx.doi.org/10.1177/030802260006300507
Gilburt, H. (2020, March 10). Securing money to improve mental healthcare...but no staff to spend it on.
https://www.kingsfund.org.uk/blog/2019/10/mental-health-staff-shortage
Health Education West Midlands. (n.d.). The Mental Health Staffing Framework. Retrieved May 3, 2021, from
https://www.england.nhs.uk/2015/06/mh-safe-staffing/
Health Education England. (n.d.). Reducing Pre-registration Attrition and Improving Retention. The ‘Impact of COVID-19 on Students’ Survey Key Findings. Retrieved May 1, 2021, from
https://www.hee.nhs.uk/our-work/reducing-pre-registration-attrition-improving-retention
Kelly, S. (2020, December 11). Archival research: Using data in social science research [Video]. Sage Research Methods.
https://www.doi.org/10.4135/9781526442895
Kunze, H., Becker, T., & Priebe, S. (2004) Reform of Psychiatric services in Germany: hospital staffing directive and commissioning of community care. Psychiatric Bulletin, (28)6, 218–221.
http://dx.doi.org/10.1192/pb.28.6.218
Lloyd, C., and Williams, P, E. (2010). Occupational therapy in the modern adult acute mental health setting: a review of current practice. International Journal of Therapy and Rehabilitation, 17(9).
https://doi.org/10.12968/ijtr.2010.17.9.78038
Ma, E., Kritsimali, A., Olby-Clements, B., Boyd, K., & Demirbasa, B. (2022). Innovative Staffing Solutions to Nursing Shortages in Acute Mental Health Inpatient wards. Mental Health Nursing, 43(2), 103–110.
https://doi.org/10.1080/01612840.2021.1961331
Mahase, E. (2020). Workforce crisis has left mental health staff at “breaking point” as demand rises. British Medical Journal, 368(88).
https://doi.org/10.1136/bmj.m88
Mind. (n.d.). Mental health crisis care services ‘under-resourced, understaffed and overstretched’. Retrieved December 10, 2021, from: https://www.mind.org.uk/news-campaigns/news/mental-health-crisis-care-services-under-resourced-understaffed-and-overstretched/
Mind. (n.d.). Hospital treatment for your mental health. Retrieved December 10, 2021, from:
https://www.mind.org.uk/information-support/guides-to-support-and-services/crisis-services/treatment-in-hospital/
Munro, S., & Baker, J. (2007). Outcomes associated with skill mix interventions in acute mental health wards: A synthesis of evidence. The Journal of Mental Health Training, Education and Practice, 2(3), 25–33.
http://dx.doi.org/10.1108/17556228200700018
NHS England. (2013). NHS Services, Seven Days a Week Forum. Summary of Initial Findings. Report no. 00889.
https://www.england.nhs.uk/midlands/wp-content/uploads/sites/46/2019/05/forum-summary-report.pdf
NHS England. (n.d.). How to ensure the right people, with the right skills, are in the right place at the right time. Retrieved March 7, 2021, from:
https://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf
NHS England. (2016). The Five Year Forward View for Mental Health. A report from the independent Mental Health Taskforce to the NHS in England.
https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
NHS England. (n.d.). AHPs into Action: Using Allied Health Professionals to transform health, care and wellbeing. Retrieved May 1, 2021, from:
https://www.england.nhs.uk/publication/ahps-into-action/
NHS England. (2019a). The NHS Long Term Plan.
https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf
NHS England. (2019b). Developing allied health professional leaders: a guide for trust boards and clinicians.
https://www.england.nhs.uk/wp-content/uploads/2021/04/nhsi-developing-ahp-leaders-print.pdf
Robertson, E. (1984). The role of the Occupational Therapist in a Psychotherapeutic Setting. British Journal of Occupational Therapy, 47(4), 106–110.
https://doi.org/10.1177/030802268404700403
Royal College of Occupational Therapists. (n.d.). Occupational Therapists facilitate recovery for those with mental health problems. Occupational Therapy Evidence, Fact sheet. Retrieved August 13, 2022, from:
https://www.rcot.co.uk/files/fact-sheet-mental-health
Royal College of Occupational Therapists. (n.d.). RCOT contributes to new CPD principles in health and social care. Retrieved May 1, 2021, from:
https://www.rcot.co.uk/news/rcot-contributes-new-cpd-principles-health-and-social-care
Samele, C., Frew, S., & Urquía, N. (n.d.). Mental health Systems in the European Union Member States, Status of Mental Health in Populations and Benefits to be Expected from Investments into Mental Health. European profile of prevention and promotion of mental health (EuroPoPP-MH). Retrieved December 5, 2022, from:
https://health.ec.europa.eu/system/files/2016-11/europopp_full_en_0.pdf
Shorten, C., & Crouch, R. (2014). Acute Psychiatry and the Dynamic Short-Term Intervention of the Occupational Therapist. In C. Crouch, & V. Alers (Eds.), Occupational Therapy in Psychiatry and Mental Health (5th ed., pp. 115–125). Wiley Blackwell.
http://dx.doi.org/10.1002/9781118913536.ch8
Simpson, A., Bowers, L., Alexander, J., Ridley, C., & Warren, J. (2005). Occupational Therapy and Multidisciplinary Working on Acute Psychiatric Wards: The Tompkins Acute Ward Study. British Journal of Occupational Therapy, 68(12), 545–551.
https://doi.org/10.1177/030802260506801203
Verheij, R., A., Curcin, V., Delaney, B., C., & McGilchrist, M., M. (2018). Possible sources of bias in Primary Care Electronic Health Record Data Use and Reuse. Journal of Medical Internet Research, 20(5), e185.
https://doi.org/10.2196/jmir.9134
Whiteford, G., Jones, K., Weekes, G., Ndlovu, N., Long, C., Perkes, D., & Brindle, S. (2020). Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation. British Journal of Occupational Therapy, 83(1), 52–61.
https://doi.org/10.1177/0308022619865223
World Health Organisation. (n.d.). WHO says governments spend only 2% of budgets on mental health. Retrieved December 11, 2022, from:
https://www.openaccessgovernment.org/who-budget-on-mental-health/130792/
Published 2023-04-28
How to Cite
