Title: Experience based investigation and Co-design of approaches to Prevent and reduce Mental Health Act Use: (CO-PACT)
Funder: Department of Health and Social Care

Abstract: Background: The Independent Review of the Mental Health Act (MHA) recommended more research to explain increasing levels of compulsory admission, ethnic inequalities in MHA use, and learning from lived experience. Research Question: What explains the rise in MHA use, especially for black and minority ethnic groups who are over-represented in use, and underrepresented in experience based participatory research? What co-designed preventive approaches may be acceptable and feasible to implement? Aims: To understand the causes of rising levels of MHA detentions and co-design preventive approaches based on the experiences of service users, carers and professionals. To develop an epistemic community to inform policy on MHA use. Objectives: To use a creative participatory research method called photovoice to understand ethnically diverse service users , carers and professionals explanations for the causes of - and preventive approaches to reduce - compulsory admissions in adult mental health services. To use experience based co-design to devise a systems approach to reduce MHA use that considers these in-depth and diverse explanations. To assess whether participatory research empowers and positively impacts the lives of service users and carers, and professional practice. To undertake preliminary economic analyses of proposed approaches, including costs and potential benefits. To prepare practice and policy briefings based on findings, and build capacity for further research and implementation. Methods: This 25 month project combines photovoice and experience based co-design, to inform systems re-design to reduce use of the MHA. WP1: Photovoice workshops will be conducted in 7 cities with service users (aged 18-65; of diverse ethnicities), who have experienced at least one MHA section in the preceding year (20 per city). Participants will attend three workshops, the first will introduce the concept of using images to capture experience. The second and third workshops will capture reflections and biographical perspectives on causes of MHA use and prevention. Carers may accompany service users. 20 professionals nationally will undertake the same process in a combined group. The information will be captured in visual and audio recordings and subjected to content and thematic analysis. WP2: The WP1 findings will be shared in experienced based co-design meetings (three in each of the seven cities, each with 5 service users, 5 carers and 5 professionals). The co-design involves discussion around cognitive and emotional touch points and actions to improve experiences and re-design journeys. A fourth meeting will bring together all attendees from across the 7 cities to consider programme theories and logic models. WP3a: We will survey participants about the experience of taking part, impacts on confidence, empowerment, and changes in practice. WP3b: We will conduct an impact analysis of the PPI. WP4: We will perform preliminary economic analyses (costs and benefits) of the proposed approaches. WP5: The team will synthesise findings in briefings, recommend further policy research and describe implementation facilitators and barriers. Patient and Public Involvement PPI is integral to design and delivery of all stages. Dissemination and Impact We will arrange public displays of images to stimulate wider discussion and host a knowledge exchange conference to inform policy.

Lay abstract: Aims The research will ask people about their experiences of compulsory admission to hospital using a law that is called the Mental Health Act. People from black and ethnic minority communities more often experience this. We want to find ways of reducing care like this. Background The Mental Health Act allows professionals to admit people to hospital against their will. People from black and minority ethnic communities are more likely to get care this way. This can be distressing, reduces trust, and is costly. The government s review of these laws recommended more research to understand the rise in use of compulsory care. The review asked for the views of service users, carers and mental health staff. Design and methods We will work with mental health services in London, Manchester, Leeds, Birmingham, Bradford, Oxford and Derby. Service users will be of diverse ethnic backgrounds, and aged between 18 and 65. In each city, we will recruit 20 service users who have experienced at least one compulsory admission to hospital in the previous year. We will use a creative process involving photography to capture their experiences. The first meeting will explain the approach. We will ask people to take photos about their experiences of compulsory admission. In two more meetings, we will ask people to add titles, captions, or descriptions to tell their stories. We want know what may prevent compulsory care. The captions can be written, or audio or video recordings. Twenty mental health staff from across the seven cities will do the same. In each city, we will share this information with five service users, five carers and five staff members. Staff can be psychiatrists, psychologists, social workers, nurses, police, lawyers, commissioners, and policy experts. This group will meet three times and design a new approach, to reduce the number of people receiving compulsory care. A fourth meeting will bring everyone together to consider their experience when they tried to apply the approach, specifically what works, for whom and how. We will ask everyone how they found working on the project using a questionnaire. They will be able to write freely. This will help us understand what helped and if anything changed for them. Using information about changes in care or practice, we will estimate costs and benefits. Patient and Public Involvement Service users and carers are involved throughout. They helped us design the research. They will help deliver it and share the findings. Dissemination We will share the findings in photo exhibitions, by social media, by writing articles for academic journals and the press, and in public events.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: MENTAL HEALTH