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The author(s) declare that they have no competing interests.
SG was principal investigator and led on the design, implementation and writing up of the research. KA undertook data collection and analysis, contributed to writing up the research and brought a carer’s perspective to the project. CE led on the organisational component of the study, contributing to study design, analysis and writing up the research. ML led the North of England study site and contributed to analysis and checking drafts of the manuscript. SM led the London study site, provided clinical oversight for the study, provided guidance on writing up the research and checked drafts of the manuscript. LS led the South of England site, supported service user researcher involvement in the study and contributed to analysis and writing up the research. KT brought a service user researcher perspective to study design, data collection, analysis and writing. RW undertook data collection and analysis, and contributed to writing up the research. SW developed and undertook the statistical analysis for the research and led on writing up that analysis. All authors read and approval the final manuscript.
Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems.
A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together.
Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services). These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision making around medication are important issues in supporting self-care in mental health.
Service delivery components – e.g. peer support groups, personal planning – advocated in generic self-care policy have value when implemented in a mental health context. Support for self-care in mental health should focus on core, mental health specific qualities; issues of control, enabling staff-service user relationships and shared decision making. The broad empirical basis of our research indicates the wider relevance of our findings across mental health settings.