Mental health gatekeeping

Oxleas Spirit Study Logo

Leads

Claire Tobias (biography)
claire.tobias@nhs.net

Jackie Waghorn
jackiewaghorn@nhs.net

Academic support
John Foster
J.H.Foster@greenwich.ac.uk

Evidence base for use of MI in brief interactions

Expanding MI to the treatment of major mental health problems is appealing as it assists in addressing key clinical issues such as ambivalence and lack of engagement (Westra et al, 2011). MI has also been shown to be effective in short interactions (Hettema et al, 2005) and can be used in conjunction or as a prelude to other treatments and therapies (Flynn, 2011).  This infers suitability of MI practice to acute mental health services where client interactions are more likely to be brief.  MI skills such as open ended questions, reflective listening and use of affirmations and summaries can assist mental health staff to ensure clients feel listened to and that their views are respected.  These are valuable tools and skills when working in challenging environments and support the development of therapeutic nurse client interactions, which are essential to establishing safe and trusting relationships, and fundamental to mental health nursing as they lay the foundation for all future interventions (Reynolds 2008). 

The nature of working with individuals presenting in mental health crisis is often complex and difficult.  It is vital that clients feel listened to and fully understood, and that the practitioner has the opportunity to maximise on the time they spend with the client in a positive way.    A review of MI use in mental health services found MI is most commonly practiced in an adapted manner (Arkowitz et al, 2008).  This offers practitioners flexibility in their approach to MI and the opportunity to use the core skills and techniques of MI even when a ‘pure’ MI approach may be difficult to achieve. 

There is some existing research evidence on the use of MI by nurses in emergency departments in the USA.  Baumann (2012) stated that the use of MI with people going through an emergency helps them become aware of issues of ambivalence that may have been preventing them making changes in their life. He also suggests MI can help emergency nurses to better understand their patients and use strategies and techniques to help individuals make positive changes.

Research has also been undertaken to explore nurses’ experience of using MI skills and techniques.  Brobeck et al (2011) conducted a qualitative study describing the experience of using MI for health promotion by nurses in primary health care.  The nurses in the study described MI as a demanding intervention requiring practice and focus, but found it beneficial in clarifying the nursing role within health promotion.  It was also reported to be beneficial to the nurse client relationship by increasing understanding of the client’s circumstances leading to an increased empathy and respect for clients.

Currently there is a lack of evidence available in the research literature about the use or experience of practitioners using Motivational Interviewing with individuals in mental health crisis.  This research proposal is to conduct qualitative reserach exploring the experiences of mental health practitioners using MI when working with individuals in mental health crisis.

Description

This study will explore the experiences of mental health practitioners working in mental health liaison and home treatment teams in the use of Motivational Interviewing with individuals presenting in mental health crisis.

Research question

How do mental health practitioners working in mental health liaison and home treatment teams experience using Motivational Interviewing with individuals presenting in mental health crisis?

Methodology

A qualitative approach (grounded theory) will be utilised.

Research Design

  1. Semi structured focus groups for mental health liaison practitioners and practitioners from home treatment teams

Analysis

  1. Transcribe and conduct coding and qualitative thematic analysis of focus group data
  2. Review analysis of emerging themes

References

Arkowitz, H., Westra, H., Miller, W. & Rollnick, S. (eds) (2008). Motivational Interviewing in the Treatment of Psychological Problems. New York: Guilford Press.

Baumann, SL (2012) Motivational Interviewing for Emergency Nurses
Journal of Emergency Nursing.
38(3) 254-257

Brobeck, E., Bergh, H., Odencrants, S., Hildingh, C. (2011) Primary healthcare nurses' experiences with motivational interviewing in health promotion practice. Journal of Clinical Nursing, 20, 3322-3330.

Flynn, H (2011). Setting the Stage for the Integration of Motivational Interviewing With Cognitive Behavioural Therapy in the Treatment of Depression.
Cognitive and Behavioral Practice
18 (2011) 46-54.

Hettema, J., Steel, J., & Miller W. R. (2005) Motivational interviewing.
The Annual Review of Clinical Psychology
1, 91-111.

Reynolds, B. (2008) Developing Therapeutic One to One Relationships in Barker, P (eds) Psychiatric and Mental Health Nursing: The Craft of Caring (2nd Edn). Florida: Francis Taylor Group

Westra, HA, Aviram, A, Doell, FK (2011). Extending Motivational Interviewing to the Treatment of Major Mental Health Problems: Current Directions and Evidence. The Canadian Journal of Psychiatry.  56 (11) 643-650.