A further Cochrane Systematic Review – Qualitative Protocol– is available on the factors that influence participation in physical activity for people with bipolar disorder.
Main objective: To identify the factors that create barriers or facilitate physical activity for people with a diagnosis of bipolar disorder from the perspectives of service users, carers, service providers and practitioners to help inform the design and implementation of interventions that promote physical activity.
The overall aim of this review is to identify, appraise, and synthesise qualitative research evidence on the barriers and facilitators to engaging in physical activity in general lifestyle settings or as part of an intervention designed to increase physical activity for people with bipolar disorder. This will allow us to identify factors that create barriers and facilitators of physical activity in this population to inform the development, design, and implementation of future interventions. We will communicate our findings to public health commissioners and other stakeholders.
McCartan CJ, Yap J, Firth J, Stubbs B, Tully MA, Best P, Webb P, White C, Gilbody S, Churchill R, Breedvelt JJF, Davidson G. (2020) Factors that influence participation in physical activity for people with bipolar disorder: a synthesis of qualitative evidence. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD013557. DOI: 10.1002/14651858.CD013557.
Our paper on the key components of supporting and assessing decision making ability was published today in the International Journal of Law and Psychiatry.
People’s ability to make decisions may be impaired for a wide range of reasons, including by mental health problems and learning disabilities. Individual autonomy, the ability to make decisions about our own lives, is a fundamental tenet of democratic societies. This has been reinforced by laws governing substitute and supported decision making and most significantly by the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). Article 12 of the UNCRPD requires everyone to have equal recognition before the law and, to achieve this, the necessary support and safeguards must be available. There has been considerable debate about the important theoretical and philosophical issues involved and growing research about the practice complexities of supporting and assessing decision making ability or mental capacity. This article aims to present some of the key components of the support and assessment process to inform further service development and training in this area. The key components were identified as part of a qualitative, participatory research project which explored the decision making experiences of people with mental health problems and/or learning disabilities. The conventional approach to the assessment of capacity is to consider four main components, whether the person is able to: understand, retain, use and weigh, and communicate the information needed to make the decision at that time. The findings from this research study suggest that people generally don’t usually talk about their experiences of decision making in terms of these four components and approaches to supporting people to make decisions don’t necessarily break the support down to explicitly address the assessment process. However, considering support for all aspects of the functional test may be helpful to ensure it is as comprehensive as possible. The challenges involved in providing effective support and assessing decision making ability are discussed and the article concludes with some of the implications for training, service development and practice.
Webb, P., Davidson, G., Edge, R., Falls, D., Keenan, F., Kelly, B., McLaughlin, A., Montgomery, L., Mulvenna, C., Norris, B., Owens, A. & Shea-Irvine, R. (2020) Key components of supporting and assessing decision making ability, International Journal of Law and Psychiatry, 72, C, 101613. https://doi.org/10.1016/j.ijlp.2020.101613
An interesting, and useful, Cochrane Systematic Review – Qualitative Protocol – is now available on the factors that influence participation in physical activity for anxiety and depression:
Main objective: To identify the factors that create barriers or facilitate physical activity for people with a diagnosis of anxiety or depression from the perspectives of service users, carers, service providers and practitioners to help inform the design and implementation of interventions that promote physical activity.
The overall aim of this review is to identify, appraise, and synthesise qualitative research evidence on the barriers and facilitators to engaging in physical activity in general lifestyle settings or as part of an intervention designed to increase physical activity for people with anxiety and depression. This will allow us to identify factors that create barriers and facilitators of physical activity in this population to inform the development, design, and implementation of future interventions. We will also integrate the findings from the QES with the two associated effectiveness reviews (Cooney 2014; Larun 2006). We will communicate our findings to public health commissioners and other stakeholders.
McCartan, C., Yap, J., Firth, J., Stubbs, B., Tully, M., Best, P., Webb, P., White, C., Gilbody, S., Churchill, R., Breedvelt J.J.F., Davidson, G. (2020). Factors that influence participation in physical activity for anxiety and depression: a synthesis of qualitative evidence. Cochrane Database of Systematic Reviews Issue 3. Art. No.: CD013547. DOI: 10.1002/14651858.CD013547.
Great to see that our first paper on supported decision-making has been published in Health and Social Care in the Community!
This article presents the findings from a qualitative, participatory research project which explored how people with intellectual disabilities and/or mental health problems have, or have not been, supported to make their own decisions. The aim of the research is to help inform how supported decision‐making, as required by Article 12 of the UN Convention on the Rights of Persons with Disabilities, can be effectively operationalised. The project provides an overview of experiences of support as well as identifying which supports are valued. It was conducted between July 2017 and July 2018 and was a partnership between disabled people, service providers and a University. It involved peer researchers interviewing 41 people with mental health problems and/or intellectual disabilities, in community settings, about their experiences and views of support. The key findings include that decision‐making is a central aspect of people’s lives. Participants discussed the positive role which decision‐making can have but also how it felt when they were not supported to make their own decisions. Participants said that there were three main things that make decision‐making harder: the type of decision; the role of other people; and what the outcome might be. Time was consistently identified as a very important factor. In terms of support, people said that they would like: practical support including more accessible information; emotional support including someone to talk to; and sometimes the options to choose from. There was very little mention of existing, more formal processes of support such as advance decisions or care planning. The peer researcher aspect of the project was valued by participants. The main implications of the research are for how support for decision‐making should be provided including the need for an individualised approach as the support needed varies across decisions, time and people.
Webb, P., Davidson, G., Edge, R., Falls, D., Keenan, F., Kelly, B., McLaughlin, A., Montgomery, L., Mulvenna, C., Norris, B., Owens, B., Shea Irvine, R. (2020) Service users’ experiences and views of support for decision making. Health Soc Care Community. 00:1–10. https://doi.org/10.1111/hsc.12961
People with severe mental health problems have a shorter life expectancy and a higher risk of developing some medical conditions. An empowering programme that increases levels of physical activity may play a role in reducing this mortality gap (Mental Health Foundation blog post).
Interested in reading about a research programme which encourages people with serious and enduring mental ill health to be more physically active?
If you are, download our new report here
Support for decision making needs to be individualised.
Our co-produced research report on supported decision making for people with intellectual disabilities and mental ill health made a number of recommendations.
Take a look at page 44 of the report for further information.
Davidson, G. Edge, R., Falls, D., Keenan, F., Kelly, B., McLaughlin, A., Montgomery, L., Mulvenna, C., Norris, B., Owens, A., Shea Irvine, R. and Webb. P. (2018) p. 44
- Our co-produced research report is now available on supported decision making with people with intellectual disabilities and mental ill health.
- An easy read report is also available.
Decision making is a central aspect of people’s lives. Participants discussed the positive role which decision making can have in their life but also how it felt when they are not supported to make their own decisions.
Participants said there were three things that make decision making harder: the type of decision; the role of other people; and what the outcome might be.
Time was consistently identified as a very important factor in making decisions.
In terms of support, people said they would like: practical support including more accessible information; emotional support including someone to talk to; and sometimes the options to choose from.
The peer researcher aspect of the project strengthened the research process and was valued by participants. This is an evolving area of research practice that needs further critical exploration of the issues involved.
Davidson, G. Edge, R., Falls, D., Keenan, F., Kelly, B., McLaughlin, A., Montgomery, L., Mulvenna, C., Norris, B., Owens, A., Shea Irvine, R. and Webb. P. (2018) p. 6
Our four peer researchers gave a wonderful presentation of findings so far for the supported decision making research project at the Knowledge Exchange Seminar (KESS), Parliament Buildings, Stormont, Belfast on the 7th February 2018.
A policy briefing, the slides and a video of their talk is now available!
Our research team will be giving a presentation on Supported decision making – experiences, approaches and preferences at the Knowledge Exchange Seminar, Long Gallery, Parliament Buildings, Stormont on the 7th February 2018.
So why not take a look at the abstract and register to attend if you are around?
Making decisions about your own life is a key aspect of independence, freedom and human rights. Mental health law has previously allowed compulsory intervention even when a person has the decision making ability to decline intervention. This discriminates against those with mental health problems and intellectual disabilities. In May 2016 the Mental Capacity Act (Northern Ireland) became statutory law, although may not be implemented until 2020. In contrast to other countries this law will replace rather than be in parallel to a mental health law. This is a unique and progressive development which seeks to address the discrimination of separate mental health law. A core principle of the new Act is that people are “not to be treated as unable to make a decision…unless all practicable help and support to enable the person to make a decision about the matter have been given without success” (Article 1(4)).
There are people who, without support, would be assessed as incapable of making certain decisions but with the appropriate support are capable of making those decisions, and so to not provide that support infringes their rights, undermines their autonomy and reinforces their exclusion from society. There is very limited research evidence available about people’s experience of the range of approaches provided to support decision-making; what approaches work for whom; and what people’s preferences are for support. This evidence is urgently needed to inform the Code of Practice for the new Act and the wider implementation process.
This presentation provides a summary of findings from a research project which explored how people have, or have not been, supported to make their own decisions. It was funded by Disability Research on Independent Living and Learning (DRILL) and used a coproduction approach between disabled people, Praxis, Mencap and Queen’s. The project involved peer researchers interviewing 20 people with mental health problems and 20 people with intellectual disabilities, to gain an in-depth understanding of their experiences of supported decision-making and their preferences and ideas for how decision-making should be supported in the new legal framework.
Hammersley, M. (2014) The limits of social science. Causal explanation and value relevance
In this short book, Hammersley argues for a social science which eschews grand theorising in favour of the explanation of social phenomena. Drawing inspiration from Max Weber and referring to a range of social theorists and philosophers, Hammersley encourages social scientists to re-think what they are actually doing as researchers in order to create a social science which generates knowledge which is both reliable and valid. Some readers might, of course, reply that there are no problems with social research as an intellectual endeavour, but Hammersley’s purpose seems to be to awake us from our slumbers. This is a task in which he partially succeeds. Hammersley is not, for example, opposed to causal analysis in the social sciences, but argues that we should raise our game by adopting ‘within-case and cross-case analysis’. He also prioritises explanation over theorising with the proviso that ‘all purpose’ explanations are not possible because explanations are ‘always answers to particular questions’. He also argues that value conclusions cannot be derived from evidence, and offers convincing arguments why this might be the case. The consequence of Hammersley’s position is that social research should be limited to making ‘factual’ statements rather than ‘value’ claims. Although much of the book is theoretical, the author grounds his views by referring to social mobility research and to work on the English riots of 2011.
What I most enjoyed about this book is that Hammersley encourages the reader to think hard about social research practice. He is, for example, unconvinced by the view that there is a direct relationship between research and policy outcomes. On the contrary, he says that the relationship is ‘highly mediated and contingent’. Moreover, he recognises that different social science disciplines employ different methods of explanation. One has only to think of the very different approaches of the experimental psychologist and of the historian to appreciate that he has a point. But such explanatory pluralism in the social sciences has a disturbing consequence. If there is no agreed threshold which all social scientists have to meet in order to generate valid and reliable knowledge, then how do these disciplines differ from vocations like investigative or data journalism? In addition, Hammersley draws a sharp distinction between ‘facts’ which are of interest to the social scientist and ‘value claims’ which should be of interest to policymakers and think tanks. If true, it is very hard to see how social researchers can make the case for funding their work in a cultural environment which does not recognise that knowledge has value in itself. Hammersley recognises this point but does not offer any solutions.
This book is not a paean to social science as it is currently practised and will be, to use Hammersley’s own word, a ‘deflationary’ read for some. If, however, you want to read something which may question your preconceptions, this book is a good place to begin.
Review originally published in Research Matters, December 2015