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PROactive Management of Integrated

Services & Environments



Shula Ramon

Professor of Interprofessional Health and Social Studies, ARU

Professor Shula Ramon is a clinical psychologist and social worker by her training, who has been researching recovery and social inclusion in mental health, often applying a participatory action research approach. She leads the RfPB funded Shared Decision Making in Psychiatric Medication Management project in partnership with CPFT.

Mary Jane O’Sullivan

Clinical Lead, CRHTT, CPFT

Mary Jane obtained a degree in Experimental Psychology at the University of Cambridge before training as a Mental Health Nurse. She has worked in Acute Care in Cambridge for 19 years where she has been part of the Crisis Team since 2006.  After qualifying as a Registered Nurse Prescriber in 2010, Mary Jane joined the ShIMME project (Shared Involvement in Medicines Management Education), a service user initiated research project into Shared Decision Making.  Since 2014, Mary Jane has taken a lead on promoting Shared Decision Making throughout CPFT.

Therapeutic Letters to Bridge the Gap

ShIMME (Shared Involvement in Medication Management Education)

This study aimed to develop and evaluate the feasibility, acceptability and impact of group-based training for service users and clinicians to encourage shared decision making (SDM) relating to the prescription and management of psychiatric medication.  The project was guided by participatory principles, and was a collaboration between academics, service users and practitioners.

The study was conducted in community and assertive outreach services for adults with severe and enduring mental health problems (mainly schizophrenia and bipolar disorder) in Cambridgeshire and Peterborough NHS Foundation Trust.

Following a literature review and consultation groups with local service users, psychiatrists and multi-disciplinary care co-ordinators, a working group of practitioners and service users designed a programme of training in SDM to be delivered to separate groups of service users, psychiatrists and care co-ordinators. Training involved a variety of group-based and participatory learning techniques, discussion of videoed consultation scenarios, role-playing and use of a web-site to support self-study and provide links to relevant information and resources.     

Key Findings: 12 months after Shimme training, service users report:

Reduced decisional conflict about medication (Decisional Conflict Scale, total score (primary outcome p<0.014))

Feeling more informed (p<0.002) and clearer about what was important to them (p<0.01) re: medication (DSC subscores)

That psychiatrists encourage decisional involvement more (OPTION scale; p=0.02)

No changes in their attitudes to medication (Drug Attitude Inventory)

No changes in therapeutic relationship quality were reported by service users or practitioners (STAR).

As a result of the study’s findings, SDM has become a CPFT policy to be implemented across all pathways. Hence our current work focuses on implementation in a variety of ways. One of these ways entails designing better ways to capture SDM work between clinicians and service users in the form of a letter summarising such shared work from the clinician to the service user, which can also be shared with relevant others. In my presentation within the Closing the Gaps session I will elaborate on the options which have been developed by Mary Jane O’sullivan, who is carrying out key implementation activities of SDM within the trust.

Further information can be obtained from Prof. Shula Ramon (shula.ramon@anglia.ac.uk)