title: The importance of relationships in facilitating service development: learning from early experience
Creators: name: McFadyen, Anne
Publisher: name: University of Glasgow
Year: 2023

description: This essay brings together nine publications relevant to service development and delivery in NHS liaison psychiatry and infant mental health services. Key theoretical concepts are introduced to provide a framework for my thinking as I present publications in chronological order. The research studies presented include both quantitative and qualitative methodologies. Overall the thesis represents a mixed methodological approach to the topic of service development and delivery from a relational perspective and informed by our understanding of early child development. Part 1 focuses on my early research in both adult and child psychiatry liaison in general hospitals, where the findings supported the hypothesis that good interprofessional relationships can lead to more appropriate referrals. Retrospective analyses of referral patterns documented change over time: the service for adults received an increased number of referrals of patients who had not harmed themselves and this was associated with an increase in the diagnosis of potentially treatable psychiatric conditions. A similar shift in the pattern of referrals to a child psychiatry liaison service was observed, with children being increasingly referred for psychological help in relation to their management of physical illness or for investigation of non-organic physical problems. In Part 2, two publications describing parent-infant relationships are discussed. In the first of these papers, this relationship was examined in the context of infants’ admissions to neonatal intensive care. The narratives of mothers are described, with attention paid to the ways in which their stories were told as well as to the emerging themes, which included the ways in which the current experiences of all participants are both shaped by, and shape, other relationships, and past experience and beliefs. These reflexive loops are similar to those described by attachment theorists in relation to the continual re-shaping of inner working models. The second of these papers examines the usefulness of psychoanalytic infant observation and its potential to be used in both quantitative and qualitative research. Recent research related to infant mental health service development and access are presented in Part 3. A needs assessment exercise carried out in one health board found that infants and their parents, or parents-to-be, were less likely to be referred to specialist services or receive enhanced health visiting services if they lived in areas of socioeconomic deprivation. This finding was discussed with professionals who were interviewed about their views on infant mental health both individually and in purposively paired focus groups. Thematic analysis identified issues related to perceived barriers and enablers to service development, and to systems and gaps. The latter themes were also examined though the lens of candidacy which allowed an exploration of patients’ journeys into services. Babies rely on others to access services and may be disadvantaged if key family members and professionals do not appreciate the value of an infant mental health service offering early support and intervention. In a further study, a sample of general practitioners working in the most deprived areas of Scotland described, in qualitative interviews, how they valued the development of infant mental health services and encouraged good communication and professional relationships to support this. Underpinning this essay is the theme of early development and it is proposed that learning from and building upon what we know about the development of early relationships can inform service development. Good relationships at all levels are fundamental to successful and sustainable service development and delivery.