New research conducted with people with complex emotional needs (CEN) has identified limitations in the support community mental health services provide.
Thirty people from across England who live with CEN shared their experiences of accessing community mental health services, and overall findings found improvements could be made in: staff understanding, interpersonal connection, consistency and continuity in care, and adaptability and accessibility in care.
The study – from King’s College London and University College London, produced jointly with people with lived experience of CEN – found that while there was some evidence of positive experiences, especially in specialist services for people with CEN, respondents reported many negative experiences of care.
Some found that they were met with stigmatising attitudes from staff, while others reported that staff lacked knowledge and understanding about the nature of the condition, preventing them from providing good care.
Other respondents felt that they weren’t listened to, that previous traumatic experiences were not recognised, and that the treatments and techniques suggested to them were designed for people with less complex needs.
Specialist services for people with a ‘personality disorder’ diagnosis are seen as of good quality by some service users. However, they also tend to be hard to access and strictly time-limited. The people with the most severe difficulties often found it hard to stick to the rules of these specialist services.
“While there were pockets of good experiences reported, our study shows that people living with CEN feel that community services are not often providing the kind of care that people need,” said Dr Kylee Trevillion, the study’s first author from King’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN).
“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.”
Study participants shared a desire to see staff treat them in a non-stigmatising and compassionate way that recognised their individuality.
The researchers suggest that ‘relational practice’, which focuses on establishing and maintaining longer-term therapeutic relationships that look at the individual’s wider social needs alongside their health and psychological needs would improve the support for service users within the community and reduce the demands on other parts of the healthcare service.
Dawn Allen, founder of Making Mental Health Positive and one of the paper’s authors with relevant lived experience, said: “’It is important for health professionals to include, with the consent of the patient, the family members when supporting and working with someone with complex emotional needs.
“Relatives are an important part of the process to help the person live a more fulfilling life and encourage the carer to understand the challenges they will face.”
Shirley McNicholas, women’s lead for Camden and Islington Foundation NHS Trust and the founder of Drayton Park Women’s Crisis House and Resource Centre, said: “Throughout the process of conducting this research, collaboration with people who have lived experience of using services was fundamental, ensuring that their voice had a central role.
“This is an essential principle in trauma-informed approaches which were referred to throughout the research; to be trauma informed 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.”
