PARTNERS3

Applying knowledge gained from PARTNERS2, a research study developing a collaborative care model for people with severe mental health needs
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Aim

To enhance the pilot phase of the NHSE Community Mental Health Framework (CMHF) transformation programme by applying knowledge gained from PARTNERS2 (a research study developing a collaborative care model for people with severe mental health needs); and gain evidence regarding the core components required to inform policy specification for the successful delivery of place based mental health care by bringing together the voluntary sector, primary care, and specialist mental health services.

Background

The PARTNERS model of care was co-designed with service users and carers to address the physical, social, and emotional needs of people with severe mental illness (SMI) to receive better support in primary care. The person-centred goal- and coaching-based approach involves Care Partners working with individuals with SMI, with the intensity of support flexing according to need. The CMHF transformation programme in England aims to address the gaps in care, including for those with SMI, through bringing together primary care, the voluntary sector, and specialist mental health services. Taking learning from our randomised controlled trial and the process evaluation of the PARTNERS complex intervention we wanted to test out supporting delivery of PARTNERS in the context of a transforming system.

Objectives

  1. To apply learning from core components of the PARTNERS intervention – supervision, training in coaching approaches, and integration of care – within two systems which are part of the CMHF transformation process.
  2. To evaluate and refine theory for how practice, training and supervision support personalisation and integration of care.
  3. To develop policy and practice guidance for supervision, personalisation and integration of care for individuals with significant mental health problems.

Methods

We identified potential Integrated Care Systems that were interested in adopting PARTNERS and supported them to identify Care Partners. We held a series of workshops with two systems, adapted the PARTNERS model to their settings, trained practitioners, and provided meta-supervision. Concurrently, we undertook a realist evaluation with the systems to explore further uncertainties in the PARTNERS programme theory, informed by the Consolidated Framework for Implementation Research (CFIR). Data collection involved semi-structured interviews with System Change Leads, supervisors, and trained intervention practitioners or ‘Care Partners’, augmented by observations within localities and across different practitioner roles and experience, as well as the collection of practitioner-generated data. The study duration was 12 months.

Research questions

  1. How can supervision, alongside personalisation and coaching approaches, be integrated into practice in the context of a community mental health transformation programme?
  2. What enables implementation of the PARTNERS2 intervention and what are the lessons for policy?

Results and conclusions

Our approach was to support system leaders to identify suitable workers to take on the roles of Care Partner and Supervisor, to provide them with training in the PARTNERS model, and to work with a System Change Lead to set up further support. The training team included lived experience and practitioner advisors with an understanding of PARTNERS; the training and ongoing system level external support were valued. Most staff liked the idea of person-centred approaches, but the flexibility required in applying the model was challenging. We found several factors significantly slowed down progress towards practitioners routinely providing PARTNERS care. These included the loss of appointed staff due to COVID-19 workload pressures, research governance complications, weak links with general practices and a lack of proactive pathways into care for people with SMI due to service re-organisation.


While the proactive PARTNERS approach is in keeping with the values and ambitions of systems and practitioners it was not seen as being in line with local Community Mental Health Framework transformation which tended to favour short term responsive interventions. The longer-term and whole-person care needed for a significant proportion of those with SMI may require more incentives. Training with supervision, and system leadership and external support are likely to be needed to embed the kind of personalised proactive ongoing support needed to address health and wellbeing needs of people with SMI.
Read the NIHR report (PDF)

External collaborators