EQUIP

EQUIP RCT: Enhancing the Quality of User Involved Care Planning in Mental Health Services

Study Aim (overall programme grant): To enhance service user and carer involvement in care planning in mental health services.

RCT Objectives: To co-develop and co-deliver a training intervention for health professionals in community mental health teams (CMHTs) and to evaluate the clinical and cost effectiveness of the training.

Methods: A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the priorities underpinning involvement in care planning. Data from focus groups and interviews were combined and analysed using framework analysis. Results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention.

The clinical and cost effectiveness of the training was evaluated using a pragmatic cluster trial with cohort (service user and carer) and cross-sectional samples. A process evaluation was undertaken alongside the trial.

Results: The training was delivered to 304 care co-ordinators working in CMHTs in 10 NHS Trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 carers. Training was positively evaluated. Results showed no statistically significant difference on the primary or secondary outcomes at 6-month follow up. Overall, the training intervention was not cost effective compared to the control of no training.

Conclusions: We co-developed and co-delivered a training intervention, developed a unidimensional measure of service user and carer involvement in care planning and an audit tool. Despite a high level of satisfaction with the training no significant effect was found. There was a failure of training to become embedded and normalised due to a lack of organisational readiness to accept change.