Mental health articles

OF mental health care and mentally ill

What is ‘engagement’?

Engagement can be defined broadly as providing a service that is experienced by service users (including carers) as acceptable, accessible, positive and empowering. If clients perceive a mental health service in this way they are more likely to use it. Creating such a service has implications for both the quality of the relationships that service users have with their individual workers and also for the nature of the services of which these workers are a part.

At a personal level, each client has their own opinion of mental health services that are influenced by factors such as their past experience, ethnicity and culture, needs, difficulties, strengths and aspirations, and the sense that they make of their own experience of mental ill-health, and what helps. Establishing and maintaining relationships with clients that are experienced as helpful is fundamental to engagement. To do this requires nurses to learn about their clients’ unique perspectives and to respect them as valid and meaningful. Respect for the client’s viewpoint provides the basis for collaborative working and open negotiation around informed choices for care and treatment. Service users value mental health nurses as a professional group  and nurses are well placed to improve mental health care practice by virtue of their relatively high contact with clients through their care coordination role and their traditional emphasis on forming long-term therapeutic relationships with clients. As ‘natural allies’, nurses are able to develop a good understanding of their clients’ wider lives and aspirations, and to gain insights into their problematic experiences of services and social deprivation. These insights are the starting point for engagement. At an organizational level the engagement agenda has contributed to the implementation of new approaches to service delivery that have taken into account service users’ criticisms of traditional mental health services. Examples of these approaches include assertive outreach, home treatment and crisis services in the community, separate community services for black and ethnic minority service users and psychosocial interventions for psychosis. Service users have also created their own ‘selfhelp’ services and are increasingly involved in the design, delivery and appraisal of services. Mental health professionals are now required to share their power with users. Joint-working between statutory mental health, voluntary and social services sectors, particularly with regard to meeting social needs (such as supported housing), is also now recognized as being crucial for effective engagement. The notion of ‘recovery’ (that people with severe mental illness have the right to and are capable of leading rewarding lives through employment, education and leisure/social opportunities when given access, choice and support) supports the development of partnerships between service users and mainstream organizations to promote greater social inclusion. If engagement is to be achieved, nurses need to demonstrate their commitment to these organizational and ideological changes.

Critical appraisal of one’s own work with clients and of the wider service within which individual nurses operate (for example, team and locality service) is essential. Challenging and changing practice in response to the needs and criticisms of service users and involving them in this process needs to be seen as a fundamental part of a service that engages effectively with its clients.

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