Research with service users has made me a better social worker

Working in mental health, there is often an elephant in the room when talking with service users, namely the Mental Health Act (MHA). 

My insight, skills and confidence in having these sometimes difficult conversations have improved through leading a research study into the MHA and the research experience positively impacted on my wider practice. 

As a mental health social worker in a crisis team and Approved Mental Health Professional (AMHP), my research area is close to my practice. The aim of the research was to explore the service user experience of MHA assessments. It came about following a suggestion from a service user which resulted in a light bulb moment.

The study involved qualitative interviews about a recent MHA assessment and revealed a lack of discussion with service users about this bewildering and distressing experience. Also, their accounts highlighted the importance of information and understanding about their experience.   

I have had conversations with co-researchers throughout the study, actively listening to the participants' stories and discussing findings with service users, which has added to my understanding of their perspective.

My motivation for the research was to promote positive change within MHA assessments, thinking it is about system and culture change rather than my own practice. But undertaking the research has shown I was wrong. It has increased my confidence that I have expertise within my research area. This conviction stems from having to defend my ideas and findings to my peers, and the rigour within research to evidence all parts of the process.

I find this high level examination of your thinking is rare in social work practice. An unexpected result for me is a greater implementation of the learning from the research, such as having those difficult conversations and positive risk taking. 

Truly listening 

I developed different listening skills as a researcher when interviewing participants, which I call truly listening. Usually, I like to offer practical solutions, however, during these interviews I had to stop that. 

Initially I found this difficult and my concern was the participant would feel bad. One interview that showed this to be the opposite was with a woman describing her distressing experience in a health suite waiting to be seen by AMHP and doctors. Her account was emotional to hear and I felt awful that I could not offer insights, solutions or views during the interview. 

Afterwards, she commented how helpful it was having someone just listen. Subsequently, I talk less and encourage more opportunities to discuss these experiences and others.   

Service user perspectives

My prespective has changed through the research and I am now asking in my team: “How would that feel for… [person being supported]?” Before this, I mistakenly believed I was service user focused and prided myself on this value. 

Incorporating new and often challenging perspectives has been hard but rewarding. Initially, I disregarded some statements raised by the participants, such as concern about lack of private rooms in the general hospital, as just the way it is. 

However, one service user described feeling everyone “was all ears” in such a setting and that it was private business, saying they’d “rather be interviewed in the car park”. It made him feel not listened to and contributed to an overall a negative experience. 

Through truly listening, I have had to stop and really think from a service user perspective. An example of how this has changed practice is I do more to encourage my team to be creative to prevent the use of warrants and police. Listening to the experience of having police coming to your house and dragging you out of it has motivated me to work with our AMHP team to use this process less. 

Through truly listening, one notable difference I found during the research interviews was that I imagined more the participant’s experience than within my usual social work interactions. One example is the participants’ powerful descriptions of health S136 suites as horrible, clinical, lacking dignity and increasing distress. 

Being able to imagine another’s perspective is an important social work skill that enables better empathy. Increased understanding and empathy of the service user experience has motivated me to discuss the impact of this environment on their mental wellbeing widely in my organisation and have sought ways to improve these suites. 

The images from their descriptions of the health S136 suite were particularly powerful, even though I had visited some of the suites myself. Also, being able to see through the distressed service user eyes has motivated me to discuss widely about how these suites impact on the service user and to seek to change them. 

I have been awarded a Quality Improvement Fellowship two days a week for a year and will be focusing on MHA assessments and section 136 suites. 

Engaging in difficult conversations 

Through truly listening to people’s experiences, it became clear they appreciated honest conversations around MHA assessments.

Social work academic Professor Harry Ferguson talks about child protection work and advocates similar conversations, stating, “much more openness is required about the authoritative role and fully acknowledgement of conflict at the heart of such relationships”. 

I have become more confident in asking about previous experiences and having these ‘difficult’ conversations. For example, one study participant discussed how she was fearful that if she was honest she would be detained. In contrast, the team believed she should be supported at home. This conversation increase her engagement with the team which had been difficult previously. 

Another participant had been referred for MHA assessment by his community team and when I looked at his notes I found she was not informed of the assessment. As the team’s role is to prevent admission, I visited with a colleague to see if she could be supported at home instead. Initially he was very angry, which was understandable, and I was able to sit with his feelings. After time he was able to engage in a collaborative plan, which addressed his care team concerns of his mental health. This difficult conversation avoided a MHA assessment and possible detention as his greater anger could have made it difficult to offer alternatives. 

The learning

With increasing social care research opportunities, it is important for social care services to encourage staff to seek these opportunities as it provides wider benefits than creating evidence for our practice. Undertaking the research has made me a better practitioner in many different ways.

Louise is a mental health social worker in a recovery college and the first social worker to gain a health-based PhD fellowship from the National Institute of Health Research. She is on the editorial board for th Critical AMHP blog and the steering group for the NIHR research incubator for the NIHR research incubator for mental health social care