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Title: What psychological theory does not teach us about life on acute mental health wards : an exploration of human rights using a mixed methods research design
Author: Davis Le Brun, Stephanie
ISNI:       0000 0004 8505 7195
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2019
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This thesis explores human rights on acute mental health wards from the view of health professionals and service users. The theoretical framework chosen is the theory of planned behaviour (Ajzen, 1988; 1991) for which there is an emerging evidence-base for its use with staff teams (Perkins et al., 2007). Mental health professionals' intention to work using a human rights-based approach will be presented, as will service users' perceptions on whether they feel cared for with this approach. The thesis comprises two papers; a systematic literature review and an empirical paper. Alice Donald (2012) from the Human Rights and Social Justice Research Institute has provided an extensive guideline on evaluating human rights-based approaches in health care. Part of a five-year programme in conjunction with the British Institute of Human Rights (BIHR), the Department of Health, and a number of National Health Service (NHS) Trusts, the Human Rights in Healthcare Programme (, 2011- 2012) aimed to assist NHS Trusts to put human rights into practice in different areas of their work. The guideline outlines nine case studies of previous evaluations of human rights-based interventions in a range of health care settings. The case studies are predominantly within learning disability, older adult or physical health settings, with one within a high security forensic mental health hospital. There is a lack of evaluation in human rights-based approaches in adult mental health, in particular acute inpatient mental health services. All of the example evaluations published on the programme's website were studied during the design phase of the thesis, with consideration given to how previous work could be adapted for this population. Chapter one is a systematic literature review that aims to explore how the theory of planned behaviour acts as a framework to understand staff team intentions and behaviours towards certain decisions, specifically focussing on staff teams in mental health settings. This chapter does not have a human rights focus, the primary aim is to introduce the psychological theory chosen and understand how it has been implemented in a novel way. Human rightsbased approaches will be introduced in chapter 2. Thirteen papers are systematically identified, quality assessed and reviewed. Data regarding the three constructs of the theory of planned behaviour; attitude, subjective norm and perceived behavioural control, is narratively synthesised. An evaluation into how the theory of planned behaviour can be used to guide intervention is also offered. The review comments on the range of predicting variables and methodologies used in the 13 papers. Results are discussed in detail and limitations and clinical implications are outlined. Chapter two is an empirical paper that uses the theory of planned behaviour in a novel way to explore mental health professionals' intentions to work using a human rights-based approach on acute mental health wards. The paper outlines the process of constructing a theory of planned behaviour measure, the recruitment and data collection process and the quantitative data analysis. It also reports findings from service users' perspectives of their care on acute mental health wards and whether they feel staff support them using a human rights-based approach. This section of the report is a mixed methods design, reporting both categorical quantitative data and qualitative feedback analysed using content analysis. The findings are discussed in relation to existing literature, with the aim of identifying future recommendations and clinical implications. It is important to note that the term 'service user' has been used throughout the thesis to refer to individuals that have experienced an inpatient stay on an acute mental health ward. Using this term keeps the thesis consistently in line with formal documents such as National Institute for Health and Care Excellence guidelines, however there is an understanding that some individuals may choose to use different terms (see McLaughlin, 2009; Simmons, Hawley, Gale & Sivakumaran, 2010). Those who participated in consultation were asked to give their preferred term, resulting in a resounding response for 'patient'. Therefore, the consultation section of the empirical paper is named 'consultation with previous patients'. It did not feel appropriate to use this language throughout the document, as they cannot be considered a collective voice for all individuals with shared experiences.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral