Systematic synthesis of barriers and facilitators to service user-led care planning

Abstract

Background: Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.

Aims: To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.

Method: Systematic evidence synthesis.

Results: Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.

Conclusions: Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.

Fig. 1

Theoretical framework for evidence synthesis.

Fig. 2

Flow of studies through the review.

Fig. 3

Overview of care planning barriers (−) and facilitators (+).