Communication in Mental Health
Projects
Co-designing and piloting the first UK whole-school solution-focused programme to improve student and staff mental wellbeing
City St George’s Lead: Professor Rose McCabe
Funder: Barts Charity, £70,985
Duration: October 2024 to January 2025
Schools are witnessing rapid increases in child mental wellbeing problems and demand cannot be met by specialist mental health services. School staff are not currently trained in approaches to support wellbeing, however upskilling staff in solution focused approaches offers a promising approach to improve communication and wellbeing. Whole-school approaches are recommended and programmes developed through co-design can promote greater acceptance and buy-in from staff and students.
Aim: To co-design a whole-school solution focused programme with students, staff, parents and carers at a large, all-through school in England. Methods: the programme was developed using primarily qualitative methods informed by the human-centred design approach.
Staff interviews (n=10), student focus groups (n=3), and extensive engagement work over a two-year period explored stakeholder needs. Subsequently, student and staff co-design workshops (n=4) aimed to develop the programme structure, content, and implementation strategy.
Results: 101 participants contributed to the co-design process (65 staff; 21 students; 15 parents). Priorities included supporting staff to effectively manage behaviour and improving student-staff communication and overall school climate. A multi-component programme based on solution focused principles was developed, including whole-school activities, plus individual student work. A study testing the prototype is warranted.
EPIC: Epistemic Injustice in Healthcare
City St George’s Lead: Professor Rose McCabe
Funder: Wellcome Trust, £30,214
Duration: September 2023 to August 2029
When people express their opinion, we judge their credibility. Such judgments are often corrupted by stereotypes and biases, ones that often target women, people of colour, or psychiatric patients. Once their testimonies are deprived of credibility, people are silenced and therefore deprived of power. This is epistemic injustice (EI), an injustice done to someone in their capacity as knower. PIs Carel and Kidd were the first to study EI in healthcare by identifying epistemically unjust ways of conceiving of illness and treating ill persons (2014). However, much work remains to be done. First, there are understudied forms of structural and intersectional EI in healthcare. Second, there is a need for detailed study of actual cases of EI in healthcare. Third, there is little research on developing effective ameliorative strategies for EI. Fourth, the conceptual resources associated with EI have not been made available to scholars outside philosophy, and EI has not been sufficiently informed by their work. EPIC proposes to tackle these issues via an ambitious 6-year research project. Its goal is to create a step-change in EI research by: 1. filling lacunae in epistemic injustice theory (namely, structural and intersectional epistemic injustice). 2. providing four detailed case studies of epistemic injustice in healthcare and disability. 3. developing strategies of amelioration informed by an intersectional conception of epistemically unjust practices. 4. engaging with medical humanities, social science and clinical researchers and communities to introduce them to EI, initiating dialogue about its theoretical and practical possibilities. This project is novel in its aim to demonstrate how large-scale social institutions can be fundamentally transformed into drivers of social and epistemic justice. It fills a research lacuna and will also serve as a model for other projects aimed at other fundamental institutions of contemporary human life.
Find out more here: Epistemic injustice in healthcare
The Role of Staff and Team Communication in Reducing Seclusion, Restraint and Forced Tranquilisation in Acute Inpatient Mental Health Settings
City St George’s Lead: Professor Rose McCabe
Funder: NIHR / DHSC Department of Health and Social Care, £241,867.38
Duration: April 2022 to December 2024
Over 100,000 patients are admitted to acute mental health wards annually, 40% involuntarily. Wards are under incredible pressure due to high bed occupancy rates and staff shortages. Only patients who are extremely unwell are admitted, experiencing symptoms of psychosis (hearing voices), mania or severe depression. In England, 80% of nurses report experiencing patient aggression. Staff manage aggression through communication; talking to patients to try to calm down their aggression. This technique is called de-escalation. However, often de-escalation is unsuccessful, leading to restraint, seclusion and forced tranquilisation of patients. This study will be the first to examine staff and team communication in mental health wards, identifying the communication that leads to successful de-escalation. Four acute inpatient mental health wards will be recruited; two with low and two with high rates of restraint. Sixty-four de-escalations will be video recorded (32 successful, 32 unsuccessful) Staff and team communication will be analysed from video using established tools. Statistical analysis will identify the specific communication that leads to successful de-escalation. Ward observations will examine how teams discuss and plan for patient aggression. One-to-one interviews with patients (n=16) and staff (n=20) will examine their experience of de-escalation.
Find out more here: The Role of Staff and Team Communication in Reducing Seclusion, Restraint and Forced Tranquilisation in Acute Inpatient Mental Health Settings - NIHR Funding and Awards
Hospiscare Fellowship: Improving communication about hospices
City St George’s Lead: Professor Rose McCabe
Funder: Hospiscare, £47,940
Duration: January 2022 to March 2025
The Hospiscare Fellowship is focused on 'The use of language to enable earlier referral to a hospice’
Research Team:
- Ann Rhys (Hospiscare, Exeter)
- Rose McCabe (City, University of London)
- Victoria Land (City, University of London)
The objectives are to:
- Identify the challenges (according to interviewees) in making referrals to a hospice service.
- Explore the language used by healthcare professionals (HCPS, hereon) when discussing hospice care
- Identify ways of enabling earlier referrals/changing language/overcoming barriers
- Draw out learning from practice during the covid pandemic that may inform practitioner behaviour as the hospice service changes to meet current requirements.