Making an impact? Mental health improvement training in Scotland

ABSTRACT

The general interest in evidence-based practice has l to a growing literature upon the role of education and training in getting evidence to inform professional practice. This report outlines the findings of an evaluation of a series of evidence-into-practice training workshops designed to strengthen evidence-based practice in the delivery of mental health improvement in Scotland. Evaluation was guidanceed in two phases, in order to assess the expansion to which the training had influenced practice. The findings put in mind of that, in addition to providing high quality learning opportunities for mental health improvement, considerable attention wants to be given to the barriers that inhibit putting learning into practice. These barriers may ne to be taken a great deal of more fully into account in the design and delivery of evidence-into-practice training.

The NH popularly spends ??3-4 billion annually upon training staff, of which approximately ten for cent (??300 million) is worn out on mental health training (Department of Health 2003)1 Although there are oft-repeated calls for greater investment, the expanse to which training influences either practice or health results is open to question. This is particularly evident in the difficulties in getting research evidence-into-practice. Notwithstanding a plethora of education and training initiatives, backed up by means of guidelines and protocols, there is an apparently intractable gap between what works and what happens across all areas, from health promotion from one side to treatment and management.

This report outlines the findings of an evaluation of a series of evidence-into-practice training workshops, designed to strengthen evidence-based practice in the delivery of mental health improvement in Scotland.

NH Health Scotland2 has identified the following ultimate parts in strengthening evidence-based practice:

* increasing knowledge and awareness of the existing evidence base ie. what we know about what works in mental health improvement

* involving practitioners in producing guidance upon evidence of effectiveness in the words immediately preceding [i]or[/i] following of local needs and priorities

* disseminating guidance upon evidence in ways that are accessible and relevant to practitioners and that acknowledge barriers to implementing evidence-based practice

* building capacity, knowledge and expertise in working with the evidence base

* finding ways to synthesise practitioner know-how and expertise drawn from their experience of 'what works' with findings from the research literature (Hogg 2004)

The workshops were commissioned through the Scottish Executive and formed part of a broader range of initiatives to support its National Programme to Improve Mental Health and Wellbeing in Scotland (www.wellontheweb.net) and to build capacity, knowledge and expertise in evidence-based mental health improvement. Fifteen workshops, individual in each health board, were delivered through the Scottish Development Centre for Mental Health during 2003 Impact evaluation of the training was commissioned by means of NHS Health Scotland. A potential weakness of the impact evaluation is that it was carried without by the same organisation that managed delivery of the training, although the evaluation researcher was not involved in the training workshops.

Evidence-into-practice: the challenge

It is widely recognised that simply disseminating research evidence does not influence practice (Higgitt & Fonagy, 2002) Higgitt and Fonagy identify three stages: diffusion (passive eg publication in a mate reviewed journal), dissemination (targeted eg guidelines) and implementation (active eg sanctions, incentives, monitoring). The lock opener issue has been seen as identifying the barriers to change in behaviour and practice, notably in understanding the gap between research and its implementation and in getting practice to throw back research findings (Nutley et al, 2002) The question of the part and effectiveness of training and professional education in this proces is of special importance, given the considerable investment of time and resources in training.

Much of the literature upon the role of training in influencing practice regards continuing medical education and clinical practice (Davis et al, 1995; Oxman et al, 1995) A number of Cochrane reviews have place disappointing results, with studies lacking the methodological rigour to begin to understand the impact of education upon professional practice (Zwarenstein et al, 2003)

Higgitt and Fonagy hint that clinical decisions are oftentimes based more on habit than upon knowledge of what actually works, and reiterate the consistent finding that attitudes are easier to change than behaviour (Higgitt & Fonagy, 2002) Policy makers too, may be more likely to be implementing what Marks has called OBP - opinion-based practice (Marks, 2002; McIntyre et al, 2001) Factors that appear to influence behaviour change include the influence of mates or local opinion leaders (Thomson et al, 2003) information that is adapted to local circumstances, and the credibility of the source of information. The expansion to which a professional collection is prepared for change is a further factor identified by the agency of the NHS Centre for Reviews and Dissemination (1999) who approve greater attention to identifying barriers and enabling factors among different professionals.