title: Clinical psychology and mental health service user involvement
Creators: name: Roberts, Amanda
Publisher: name: University of Liverpool Repository
Year: 2015

description: This thesis comprises three interconnected chapters: a systematic literature review (chapter one); empirical paper (chapter two); and an extended discussion (chapter three) which incorporates an accessible version of the research findings, and a future research proposal. The systematic review aims to find, describe and critique the empirical evidence for the impact of mental health service user involvement on the design, delivery, commissioning or evaluation of mental health services. Secondary objectives are to ascertain whether any attempts have been made to apply psychological theory and whether clinical psychologists are involved in the research. The review implements a comprehensive, replicable search strategy and identifies 11 studies published between 1997 and 2014. The included studies highlight both positive and negative impacts at individual (e.g., for service users and service providers) and strategic (e.g., for services and organisations) levels. Process issues, barriers and resistance to the implementation of involvement were also found. No studies applied psychological theory. Clinical psychologists were involved in a small portion of the studies. The review does not support previous reports that user involvement lacks an evidence base. A small empirical evidence base for involvement was found. However, the majority of studies were poorly reported and had significant methodological flaws. None of the 11 studies included in the review had applied psychological theory to its findings. Therefore, this review applied psychological theories of power and empowerment, attitudes, stigma and intergroup contact to the impact and barriers reported in the included studies. The methodological limitations of the included studies and the review process were discussed. The review concludes with a discussion of the clinical implications, implications for clinical psychologists and areas for future research. It is important that the findings of the systematic review are considered in light of the numerous implications and limitations and, therefore, interpreted tentatively. The empirical paper provides empirical research designed and conducted to investigate the attitudinal and organisational barriers to involvement. In utilising the psychological therapist-client dyad, the research aims to ascertain whether there are relationships between psychological therapists’ explicit attitudes to mental illness, implicit attitudes to service user involvement, and perceptions of organisational culture. It establishes whether there are relationships between these and the quality of the client-rated therapeutic alliance. The research employs a cross-sectional design comprising 28 psychological therapist-client dyads within two North West NHS Trusts in the UK. The study found that therapists’ explicit attitudes to mental illness and implicit attitudes to service user involvement were, on the whole, positive. Most therapists perceived the organisational culture of the NHS as market-driven and results-orientated. Counter to expectation, no significant relationships were found between therapists’ explicit attitudes to mental illness, implicit attitudes to service user involvement, and client-rated alliance, and the hypotheses were unsupported. The empirical paper concludes with a discussion of the possible reasons for the lack of significant findings, with reference to methodological, theoretical, and ethical considerations, and clinical implications. The extended discussion initially provides a brief overview of the preceding chapters. It then discusses methodological and ethical considerations, research paradigms and the nature of evidence, clinical psychology, leadership and user involvement and policy. It suggests that clinical psychologists’ skills as scientist-practitioners make them well placed to research, formulate, theorise and provide psychological understandings of user involvement and its impacts and barriers. It concludes with the suggestion that the input of clinical psychologists into service user involvement strategy at individual, organisational and strategic levels could be synonymous with a recently proposed paradigm-shift for the profession of clinical psychology.