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MENTAL HEALTH OFFICER SERVICES: STRUCTURES AND SUPPORTS

CHAPTER TWO: METHODOLOGY

METHODOLOGICAL APPROACH

2.1 The research was conducted over six months, beginning in January 2003. The methodological approach to this research was exploratory and involved employing a combination of quantitative and qualitative data collection and analysis techniques. Quantitative data were collected in order to allow direct comparisons, where possible, with previous research regarding MHO capacity, deployment and use of legislation and also to provide an efficient summary of the views of MHO practitioners. It was also considered essential to include mechanisms to collect qualitative data to elicit information on complex organisational and operational issues that had not been investigated in detail before and to explore the perceptions and experiences of those with direct professional involvement in local MHO services. An Advisory Group comprising representatives from the British Association of Social Workers (BASW), the Association of Directors of Social Work (ADSW), the Scottish Executive and the Mental Welfare Commission (MWC) oversaw the project. One of the key tasks of the Advisory Group was to discuss and agree the methodological approach with the SDC research team.

DATA COLLECTION

2.2 The first stage of the study involved the identification of key named service managers in each local authority (LA) to act as the main point of contact for the SDC research team and as a link person between the SDC researchers and other LA staff. The Director of Social Work in each LA was asked to nominate a service manager who had an overview and sound working knowledge of the local MHO service to enable them to respond on behalf of the LA. This was undertaken on the understanding that the identified contacts' details would be kept on a database and that they were likely to be approached in the future for follow up work and/or research beyond this study, in relation to the implementation of the MHA (2003).

2.3 Following the identification of link people, data collection commenced and was conducted using four techniques.

A national mapping survey

2.4 A mapping exercise was undertaken in order to investigate the models of MHO service provision which have evolved across all Scottish local authorities. A mapping proforma was devised in consultation with the Advisory Group to collect data that would provide a profile of each LA's MHO service. The research team held initial discussions with the ADSW Mental Health Subgroup to refine the main themes of the study and to inform the development of the research instrument to be used for the survey of local authorities. The mapping proforma covered the following key operational areas:

• Organisational structure of the MHO service
• Activity in relation to use of the MHA (1984)
• LA capacity
• Operational processes
• Links and relationships within the LA and with external agencies
• Training and professional development of MHOs
• Supervision and support
• Technical support
• Local audit and monitoring arrangements
• Gearing up to meet new demands in light of the new MHA (2003)

2.5 The mapping proforma was sent to the nominated link person in each LA by post and in electronic format when preferred by the respondent. Each link person took responsibility for completing and returning the proforma by post or email within a four-week timescale.

Telephone interviews with local service managers

2.6 Telephone interviews were conducted with each link person in each LA, to assess the extent to which the existing service was perceived to be able to meet existing and anticipated future demands. Each link person was interviewed using a semi structured telephone interview. These interviews were designed to build on the mapping exercise and explored in more detail key issues emerging from the local responses in the mapping proformas.

2.7 The following key areas were covered in the interview schedule:

• Impact of specific local features of MHO service structures on the standard of service that local authorities can provide, including:
  • Size and geography of population served
  • Service structure, including out of hours arrangements
  • Links and relationships within the LA, including access to legal advice and advice on management of the property and finances of service users
  • Links and relationships with external agencies and services
  • Training and professional development
  • Support and supervision and mechanisms to ensure MHOs are kept up to date
  • Operational processes and links with assessment and care management
• The main challenges arising from the new responsibilities created by new legislation
• How money allocated to the implementation of the new Act would be apportioned
• Steps required both locally and nationally to enhance the capacity and readiness of the MHO service to provide a response in line with new legislative requirements

Postal questionnaire to MHO practitioners

2.8 A short postal questionnaire was distributed to all MHO practitioners via the Scottish Executive MHO newsletter with a return envelope to the SDC research team. This questionnaire was anonymous to protect the confidentiality of respondents and was intended to provide an additional perspective from those MHOs working on the ground to complement the views of service managers gathered via the mapping exercise and telephone interviews.

2.9 The questionnaire focussed on key issues relating to workload, support and supervision, training and job satisfaction. It encompassed the following main themes:

• MHO experience and deployment
• Administrative, technical and transport support
• Support in high risk situations
• Supervision and line management
• Workload management
• Arrangements for out of hours MHO service provision
• Training
• Job satisfaction
• Liaison with health service colleagues

Focus groups with MHO practitioners and health care professionals

2.10 A series of five focus group discussions was conducted with MHO and health care practitioners drawn from across Scotland. These focus groups introduced a more in depth and evaluative component to the research by exploring key aspects of MHO service delivery from practitioner perspectives. The focus groups were carefully planned with the Advisory Group who guided decisions about the number, composition and themes of the focus groups.

2.11 Four of the focus groups involved MHO practitioners and the fifth group involved a range of health professionals (including community psychiatric nurses (CPNs), General Practitioners (GPs), psychiatrist, nurses and management staff).

2.12 The approach to data collection through focus groups allowed exploration of the themes of the research in greater depth and provided insight into and understanding of the perceptions and experiences of participants. The groups were designed to examine current issues and challenges and to explore the support in place and needed to enable practitioners to deliver the MHO service they felt was required.

Focus groups for MHOs

2.13 These four focus groups were run using the same format of discussion based around a case study vignette (Annex 1). The case study prompted focus group members to consider specific aspects of the MHO role in response to the same case scenario and promoted wider discussion. The case study was sufficiently broad to generate discussion in relation to four different MHO working environments, one of which was allocated to each focus group:

MHO work within a multi-agency team

• Working as an MHO in an urban environment (with particular attention to out of hours arrangements)
• Working as an MHO in remote and rural areas
• Working as an MHO with specialist client groups and clients with complex needs

2.14 Four weeks before the date of the first MHO focus group, an invitation letter and timetable detailing the theme, date, time and venue of each of the four focus groups was sent to each local link person, for distribution to MHO colleagues. In addition, the invitation letter was circulated through BASW to its members and through ADSW. MHOs were asked to volunteer to participate in the focus groups by indicating which focus group, appropriate to their working environment, they were able to attend. Volunteering MHOs were then selected on a 'first come, first served' basis. The groups had a minimum of seven and a maximum of 16 participants at each, totalling 39 MHO participants. Two focus groups were held in Stirling, one in Glasgow and the fourth in Lanarkshire.

Multidisciplinary focus group

2.15 The fifth focus group was attended by nine healthcare workers from a local authority covering both urban and rural areas. A number of professionals including CPNs from out of hours teams and Community Mental Health Teams, GPs, consultant psychiatrists, inpatient nurse managers and LHCC managers were invited to volunteer to attended the focus group and were selected on a 'first come, first served' basis. Each of the professional groups invited participated in the group. Discussion at this focus group centred on the following questions:

• Understanding of the functions that MHOs perform
• Access to MHOs
• Quality of communication between MHOs and other professionals
• Opportunities to network and share information with MHOs
• Mechanisms to resolve differences of opinion when working with MHOs
• Contact with MHOs in relation to the AWIA legislation

DATA ANALYSIS

2.16 The qualitative analysis aimed to develop concepts and themes from the data collected. Qualitative data from the mapping proforma, telephone interviews and practitioner questionnaires were analysed using staged content analysis, with reference to the key themes and categories used to guide the data collection and sub-themes were then developed from this. Focus group discussions were tape recorded, to allow the production of a detailed report of each discussion for analysis which again focussed down on key themes and significant statements. Where possible, comparisons were drawn between the perspectives of service managers and individual MHO practitioners. The responses to the postal surveys were coded and collated using Access and SPSS databases.

2.17 Quantitative data analysis was undertaken using SPSS and MS Excel. Analysis set out to identify trends and to give a descriptive shape to MHO organisational structures and descriptive statistics were generated on SPSS to achieve this. Where possible, comparisons were drawn between the quantitative data gathered in this study and that of previous studies to assess change and progress over time in the development of MHO service structures and supports.

LIMITATIONS OF THE METHODOLOGICAL APPROACH

Exploratory nature of the study

2.18 The study has collected a considerable volume of information on the structure, capacity and key characteristics of local MHO services. It has also examined the ways in which MHO services in different authorities across Scotland operate in practice, from the perspectives of service managers, MHOs practitioners and, to a limited extent, health care practitioners.

2.19 The research has investigated models of MHO service provision and highlights essential components for MHO services in providing a professional, responsive service that can address local needs and take account of current and new legislative requirements.

2.20 The methodological approach to this research was exploratory and descriptive. The research was able to profile and characterise MHO services across Scotland, with particular attention to structure and organisation. The study has considered MHO services from the management perspective and from the perspective of practitioners. Through this approach points of divergence and convergence between these two sets of perspectives have been highlighted.

2.21 However caution must be exercised in interpreting findings on a number of counts:

• Practitioner participation was based on self selection and this may have skewed the responses
• There are difficulties in capturing dynamic processes and relationships in a mapping exercise, which can at best provide a snap shot
• Gaps remain in monitoring data, which, coupled with the 'hidden' nature of aspects of MHO work, make it difficult to quantify activity meaningfully
• The distribution of the questionnaire to MHO practitioners may not have been fully comprehensive, and this may have precluded the participation of a considerable number of MHOs. The newsletter in which the questionnaire was enclosed was not distributed directly to individual MHOs, but was sent in bulk to each LA for local distribution to MHOs and this may have caused delays. The mailing of the issue which contained the questionnaire was also subject to unforeseen delay, which was outwith the control of the researchers
• As noted earlier the research was conducted at a time when the MHA (2003) was still following its course through the Scottish Parliament. Therefore respondents were not in a position to make informed judgements about the detailed implications of implementation, although there had been an extensive and inclusive consultation process on the proposed new measures

2.22 The use of mixed data collection methods means that the findings generated by the different methods have to be interpreted appropriately. The focus groups and telephone interviews were intended to provide in depth qualitative information on experiences and perceptions. Therefore the findings do not indicate the number of respondents who presented a particular view. In contrast the mapping exercise and the practitioner survey produced data which are more readily quantifiable.

STRUCTURE OF THE REPORT

2.23 The findings from the research are reported by considering firstly the results from the mapping of local MHO services and from the telephone interviews with nominated contacts from each local authority, in Chapters Three and Four. Chapter Three examines MHO service structures and organisation, Chapter Four MHO service development. The report then moves on to report the results of the practitioner survey in Chapter Five and the focus groups in Chapter Six. Chapter Seven provides an analysis of key themes and draws out the main conclusions of the research, with reference to previous research and to the wider policy and practice context.

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