Mental health rehabilitation

Oxleas Spirit Study Logo


Mel Bunyan

Nicola Smedley

Academic support
John Crowley

Title of the proposal

Improving the Experience of Service Users in Inpatient Rehabilitation:

An exploration of the impact of motivational interviewing training on staff-patient interactions and patient experience in inpatient mental health rehabilitation settings.

Abstract and summary

Motivational interviewing (MI) is a person-centred, directive counselling approach focusing on resolving ambivalence about behaviour change, based on partnership and honouring autonomy rather than expert - recipient roles. It is well researched with a strong evidence base primarily from alcohol studies but with successful application in many other areas. MI training and supervision approaches have been implemented and evaluated in many settings but not in inpatient rehabilitation.

The literature on inpatient rehabilitation (rehab) settings, despite their provision by almost all NHS Trusts, is very limited.  Anecdotally, staff in inpatient rehab settings find it difficult to motivate service users to engage with the programme and change problem behaviours.  MI may be a useful way to enhance communication and improve the experience of service users.  MI fits well with current concerns about putting patients first in the NHS and with the recovery model.

This will be an exploratory study to evaluate the impact of a two day team training and on-going group supervision in MI for staff on interactions between staff and clients, immediately after training and after a three month period.  The aim will be for staff to use MI 'spirit' (partnership, acceptance, compassion and evocation) in all their interactions with service users. This will be measured using a mixture of quantitative and qualitative approaches and service users will be supported to participate by research assistants, who have themselves been users of mental health services.

The objectives

The objective is:

To evaluate the MI training and supervision being rolled out by the Trust in the inpatient rehab units by:

  • Assessing whether staff are able demonstrate MI "spirit" after the training package and at three month follow up compared to before, using a questionnaire measure of the recipient's experience of interactions with staff and examples of narrative from diaries, clinical notes and shift handover sessions
  • Assessing the impact of the MI training package immediately after and at three month follow up on service user's overall experience of being on the unit using "patient experience" questionnaire measures
  • Assessing changes in unit functioning immediately after the training package and at three month follow up compared to before through rates of PRN medication use, staff sickness and incidents.