For the purposes of the investigation into collaboration in mental health care, we undertook a SCOT analysis of the concept at an individual level in an effort to better understand what it is that makes up collaboration as we understand it at present. Our aim was to establish a collection of findings that would provide a solid basis upon which collaboration could be further expanded upon, and perhaps even develop the concept to the point where it has a more clarified purpose mental health practice both nationally and internationally.
The first of the headings is strengths, and under this section a vast number of findings were made, significantly surpassing those discovered as challenges in terms of numbers. This alone immediately suggests a desirability to collaborative practice, however, due consideration to each finding is of the utmost importance, for only when a detailed understanding of the strengths has been gathered and juxtaposed against challenges will one be able to hold a sagacious perspective.
One of the most striking findings under strengths is the potential for changes on outcome measurements by further relating them to service user experiences. To allow the service user a more personalised benchmark for wellness not only coincides with the ideologies of the recovery movement, but restores the absent balance of power between professionals and the service user group. Of course, there will be inherent disagreement on these measure of outcome, but a possible solution may be found in other strengths of collaboration noted in the analysis- an increase in trust between diverse individuals and the acceptance of service users as equal, but different. The resultant suggestion is that to solve new issues that emanate from collaborative practice, further collaboration rather than reduced collaboration is the solution.
The incorporation of student experiences into the analysis revealed that collaboration, particularly between service users and students directly, may enhance the student’s understanding of mental health difficulties. A commensurate action in response to this could be that, as at present there is little to no inclusion of service users’ stories in the early stages of mental health nursing training, that the addition of such stories would provide a dimension to their training that is currently missing.
Some other findings of the analysis include a probable increase in respect for personal testimonies and an abatement of jargonistic phrasings or labelling terminologies. Thus there appears to be an overarching theme which can be seen when the strengths of collaboration in mental health care are collectively viewed- that the divide between mental health practitioners and service users, which may stem from opposing perspectives, is narrowed by the adaptation of a mentality that endears the practice of including the service user themselves as an equal part of the mental health care team.
Looking at the challenges uncovered through the SCOT analysis, we can see that there are a good deal of findings which are in direct opposition to those under the strengths heading. The first of these is that there is an implicit eventuality that where service user views are different to those of the professionals, that they may be written off as part of the illness or as representative of a lack of understanding of key issues. This could be interpreted as the fundamental challenge to effective collaboration, as how can two parties coordinate when they value one another’s input?
This challenge is compounded by other factors that can be viewed as weakening to collaborative practice, such as previous negative experiences of engagement or either party feeling outnumbered and resultantly unheard. Either of these factors could be contributory to intimidatory feelings, whereby one’s motivation to engage in collaboration is diminished. Without a platform to be heard on and the sensation of a listening audience, it could be argued that any individual would grow hesitant in voicing their opinion, of affording themselves the added vulnerability that comes with the sacrifice of a solidified belief in the name of reaching a point where collaboration is achievable.
One might conclude that the preeminent theme of challenges to individual collaboration is precisely that which the strengths deny, that there will always be profound differences in the beliefs of the groups which compose the mental health care system, and that regardless of efforts to reach a shared viewpoint, there will always be a dissidence that cannot be mediated.
The second arm of the SCOT analysis deals with the opportunities and threats, in other words the ways in which collaboration may be enhanced or obstructed. The opportunities we found in the analysis can, in some cases, be seen as in strongly correlated with findings within the previous two headings. One such finding is that to bolster collaboration, the mental health service must move to blur the distinctions of the producer and consumers of care, through a reconfiguration of service development and delivery. This can be seen to connect with changes in outcome measure as mentioned under strengths, and from it can be inferred another opportunity- the establishment of common goals.
It might appear to be a basic idea, but to have agreed upon and realistic goals could almost be viewed as a core prerequisite for collaboration, though in practice it could easily be overlooked. Having a set goal may enable further opportunities for collaboration, for example overall benefits to the mental health of service users through a process of self-actualisation by means of taking on the challenge of involvement in care, as is noted in the SCOT analysis. From here there may be many more occasions in which care involvement become available, such as potential work as Peer Support or even influence over the objectives of research projects by indicating what is most relevant to service users themselves.
There is an apparent phenomenon that can be observed when focussing on the opportunities to collaboration. Seemingly there is a self-propagating cycle of enhancement upon enhancement when efforts are made to improve the practice of collaboration. It is as though by opening one door, multitudes of others become available. The findings under the opportunities heading raise a strong argument in favour of an increased emphasis on collaboration amongst those involved with the mental health services.
When looking towards potential threats to collaboration, there is a demonstrable pattern which can be observed. The absence of structure, clarity and boundaries all prove invariably detrimental to the efficacy of collaboration. The findings within the SCOT analysis range from disparities in service user wants and needs between individuals within the cohort to a lack of fair delegation of workloads. Other notable findings include the possible instance where a service user is uncomfortable in sharing their story with enough detail that would be required for the genesis of highly personalised care and the chance that professionals may be unwilling to accept experience over expertise as the superior influence over treatment choices.
Each of these point towards the predominant threat to collaboration being, quite simply, how little it has been formally introduced as a component of mental health care. Given the lack of a governing body or affirmed set of guidelines, it might be suggested that without an evidence base and clinically tried results, collaboration as a concept on mental health care will remain in its infancy.