Community mental health services need to be more effective for people with Complex Emotional Needs (CEN) according to a study by NIHR Mental Health Policy Research Unit at Kings College London and University College London.
The research has identified major limitations in support within the community for people living with CEN, with improvements needed in four general areas: staff understanding, interpersonal connection, consistency of care, and adaptability and accessibility of care.
The researchers suggest that ‘relational practice’, which focuses on establishing and maintaining longer-term therapeutic relationships and taking in individuals’ wider social needs would improve community mental health services and reduce demands on other parts of the health service.
The research was published in BMC Psychiatry.
A diverse range of 30 people from across England living with CEN were interviewed. The participants all had a diagnosis of a ‘personality disorder’ or had accessed services designed for people with this diagnosis, for example, people who self-harmed. The researchers used the term CEN during their study because of the negative impact and associations with the term ‘personality disorder’ for both service users and healthcare professionals.
A range of experiences of community practice were recorded in the study, from ‘abusive, damaging’ to ‘phenomenal’. Although some service users reported examples of positive care, the majority reported negative experiences of mental health care in the community.
Dr Kylee Trevillion, the lead author of the study from Kings College, said: ‘Our study shows that people living with CEN feel that community services are not often providing the kind of care that people need. CEN relates to more than a single experience or factor, and good care needs to reflect this. Relational practice looks at the whole person, sees the interconnectedness of their experiences, and seeks to work with the service user to help them manage their lives.’
Participants reported feeling poorly supported, misunderstood and sometimes stigmatised due to their experiences. Some service users felt treatments and techniques suggested to them were designed for people with less complex needs.
To date, those receiving community mental health support have very little influence on the interventions and care they receive and the researchers suggest this needs to change.
Shirley McNicholas, Women’s Lead for Camden and Islington Foundation NHS Trust, who was involved in the research, said: ‘We must acknowledge and validate the experiences people have had that bring them to services and adapt our ways of thinking and behaving to demonstrate our understanding of these experiences and the way they can shape a person’s whole being.’
Dr Oliver Dale, a co-author of the study, added: ‘If there is one message that leaders in health and social care take from this study, it is the importance of ensuring people with CEN have the opportunity for long term therapeutic relationships. Whilst such relationships are not easy, the experience of specialist services is that appropriately supported clinicians can provide the continuity of care necessary to provide meaningful help.’
