Care planning for aggression management in a specialist secure mental health service: user involvement

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.

Building bridges between user and designer: co-creation, immersion and perspective taking

Designing for users rather than with users is still a common practice in technology design and innovation as opposed to taking them on board in the process. Design for inclusion aims to define and understand end-users, their needs, context of use, and, by doing so, ensure that end-users are catered for and included, while the results are geared towards universality of use. We describe the central role of end-user and designer participation, immersion and perspective to build user-driven solutions. These approaches provided a critical understanding of the counterpart role. Designer(s) could understand what the user’s needs were, experience physical impairments, and see from other’s perspective the interaction with the environment. Users could understand challenges of designing for physical impairments, build a sense of ownership with technology and explore it from a creative perspective. The understanding of the peer’s role (user and designer), needs and perspective enhanced user participation and inclusion.