Mental Health Nurses’ Experiences of the Use of Psychosocial Interventions in Ireland: A Multiple Case Study

Abstract

Background Traditionally, the focus for mental health service delivery in Ireland has involved a medically orientated approach. This research has taken place at a time when mental health professionals are now assumed to provide recovery-orientated care by statute as well as policy. Within a recovery practice, psychosocial interventions (PSI) are recognised and recommended internationally as they primarily focus on improving a client?s mental health and preventing relapse. In the Irish mental health context, there is a dearth of information on the use of PSI and in particular the barriers to and/or facilitating factors supporting the delivery of PSI in the reality of day-to-day practice across a range of mental health care settings. Given the changes introduced by recent Irish policy reforms and the move toward recovery-orientated practice, the urgency to conduct new research on how mental health nurses (MHNs) construct their use of PSI has never been more crucial.

Aim This study aimed to explore appropriately trained MHNs? experiences of using PSI in their care of persons with a mental health problem.

Methodology Consistent with the goal of understanding experience, a multiple case study methodology comprising four cases guides the study, which is situated within an interpretive paradigm. Data were gathered using semi-structured interviews and observations with 40 PSI-trained MHNs and analysed thematically using Spradley?s and Ritchie & Spencer?s frameworks, supported by NVivo (10) software. A within-case analysis followed by a cross-case analysis of all data provided meticulous knowledge of each case.

In the course of the analysis, three overarching themes emerged:

I. PSI-trained MHNs? understanding and use of PSI; II. Facilitating factors supporting the use of PSI by PSI-trained MHNs; III. Obstacles limiting the use of PSI by PSI-trained MHNs.

Findings Overall, the findings conveyed that participants were receptive toward PSI, but cited many common obstacles that curtailed their daily PSI work. These obstacles, as noted in the findings, included excessive workloads/caseloads, lack of education and booster training, service users fluctuating mental health conditions, increasing demands on time, existing biomedical influences and inconsistency of staff and poor leadership, shaped by the climate of the work environment. Additionally, the busyness of MHNs? roles can distract them from documenting care; there was more emphasis on doing routine tasks and hence an under-reporting of PSI care activities. The findings also reported that a supportive organisational culture where clinical leadership and clinical supervision were available alongside PSI guidelines all played a role in determining if PSI were implemented.

Conclusions This multiple case study adds to the evidence by revealing both the barriers and facilitating factors to PSI implementation. Apart from organisational constraints, there is still a persistent PSI vacuum and a lack of established psychosocial skill practices in an Irish context. Arguably, it is MHNs? professional duty to raise the dialogue around PSI and be mindful of their intention behind what they do in their day-to-day work, so that the meaning of PSI engagement does not remain nebulous.