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Staff-level intervention improves functionality, unmet needs among mental health teams

REFOCUS — an intervention for improving staff behaviors, staff-patient relationships and patient personal recovery — increased functionality and reduced staff-perceived needs among adult mental health teams in England.

“An orientation towards supporting personal recovery is national mental health policy in England and Wales and throughout much of the English-speaking world,” study researcher Mike Slade, PhD, of Kings College London, and colleagues wrote in The Lancet Psychiatry. “In this context, personal recovery is defined as a way of living a satisfying, hopeful and contributing life even with limitations caused by illness. Programs are underway internationally to support pro-recovery system transformation. Despite this progress, policy is markedly in advance of research and practice. It is becoming clear that supporting personal recovery will also involve change in staff-patient relationships, treatments and outcomes.”

Researchers randomized 27 community-based adult mental health teams to usual treatment or usual treatment plus REFOCUS intervention, a team-level intervention to support personal recovery. Patient recovery was assessed at baseline and one year later using the Questionnaire about Processes of Recovery (QPR).

There was no difference in QPR scores between the intervention and control groups (40 vs. 40.6; adjusted difference = 0.68; P = .58), according to intention-to-treat analysis.

Regarding secondary outcomes, functioning (adjusted difference = 6.96; 95% CI, 2.8-9.2) and staff-rated unmet needs (adjusted difference = 0.8; 95% CI, 0.2-1.4) improved among the intervention group. These improvements remained after adjusting for covariates.

Teams that had higher participation had greater changes in staff-rated behavior that supported patient recovery (adjusted difference = – 0.4; 95% CI, – 0.7 to – 0.2). Further, mental health teams with higher participation had higher QPR interpersonal scores among patients at follow-up (adjusted difference = – 1.6; 95% CI, – 2.7 to – 0.5).

Compared with the control group, patients in the intervention group had £1,062 less in adjusted costs.

“From the staff perspective, efforts to support recovery may lead to improved functioning and may also reduce unmet need for people with psychosis (though not from the patient perspective). It is plausible that conversations between staff and patients about values, treatment preferences and strengths will translate over time into changes in functioning and assessed need,” Slade and colleagues wrote. “Fully supporting recovery may therefore require interventions across the whole mental health service, including the patient as an active partner and involving a combination of evidence-based patient-level interventions, team-level interventions such as REFCOUS and organizational transformation approaches.” – by Amanda Oldt

Disclosure: Slade reports receiving support from National Institute for Health Research Biomedical Research Center for Mental Health, Maudsley NHS Foundation Trust and King’s College London. Please see the full study for a list of all other authors’ relevant financial disclosures.