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Helen Killaspy

Helen KillaspyHelen Killaspy, PhD is Professor and Honorary Consultant in Rehabilitation Psychiatry, Division of Psychiatry, University College London (UCL).

Her research focuses on services and interventions for people with complex mental health problems. She is Chief Investigator for a national programme of research funded for five years (2012-2017) through a NHR Research Programme Grant for Applied Research – the Quality and Effectiveness of Supported Tenancies (QuEST) project.
The programme is investigating the quality and outcomes associated with specialist supported accommodation for people with mental health problems across England.  It complements her previous NIHR Programme Grant (2009-2015) that investigated quality and outcomes for users of inpatient mental health rehabilitation services, the Rehabilitation Effectiveness for Activities for Life (REAL) project.

Interview with Helen Killaspy

Curious as we are about the ideas of Helen Killaspy on the implemention of rehabilitation, we asked her two questions.

Which factors are essential for implementing rehabilitation interventions? And how could one best address these?

Killaspy: My view on implementation is that:

a) rehabilitation interventions need to be realistic i.e. based on the likely resources and skill level of existing staff – it’s not good trying to implement something very specialist when you don’t have enough specialist staff to do it

b) staff need to be trained in the new skill in a “hands on” way where appropriate so they gain real confidence in it – going off to a training course and then coming back and trying to implement the new skill in an existing service is usually unsuccessful

c) if the new skill needs some adaptation within the service in terms of its usual processes and/or structures then the service managers need to be on board otherwise nothing will happen

d) supervision of some sort is usually essential to ensure that the new skills continue to be employed in the way they were meant to be (i.e. to stop dilution of the new skill/model) and to keep staff doing the new skill. New things tend to get forgotten soon after training and the team staff tend to revert back to their usual way of doing things, so having someone providing regular supervision who asks staff about their practice of the new skill and provides a space for them to discuss any challenges is key to keeping it going.

Can you give an example of a good practice in the United Kingdom?

Killaspy: I think what the UK has that works very well is the whole system rehabilitation care pathway – it includes inpatient and community based services provided by the statutory and non-statutory sector that can treat and support people throughout the course of their recovery. With this pathway in place, two thirds of people with complex psychosis (who are the vast majority of those who use rehabilitation services) are able to achieve and sustain successful community living (meaning that once out of hospital they don’t get readmitted and about half will progress over time to more independent community accommodation). Other countries don’t seem to have this kind of pathway, or at least they don’t conceptualise their services in this kind of way. We are still researching what the most effective individual treatments and complex interventions are for people with complex psychosis that should be delivered in this pathway. So far we have identified that Recovery Based Practice is important – that is reassuring because any good rehabilitation service will already be doing this to some degree.  The Recovery approach has been strongly encouraged across all mental health services in the UK in more of a political than evidence based way (in fact until our recent cohort study there wasn’t any empirical evidence that Recovery based practice leads to better outcomes). This means that it hasn’t been implemented with any systematic training or supervision. Whilst this probably needs to be addressed, its popularity suggests that it “chimes” with people as being a good way to do clinical work. In our national survey of inpatient rehab services we found that one third employed ex-service user in capacity on the unit – that is a really strong marker of Recovery Based Practice.