Why do Working -Age People with Mental Health Needs Enter Long -Term Care

This study analyses the process by which health and social care professionals decide to recommend working-age people with mental health needs enter long-term residential or nursing care. This type of intervention means that the person is removed from their community and the life they have known because of the need to offer them, and wider society, support and protection. There is little or no existing research into this topic area so this study, its findings and recommendations will contribute to new knowledge about the inevitability of such admissions and potential for alternatives to them.

The thesis employs a mixed method grounded theory methodology to analyse the case records of 72 people recommended for admission (and currently living in long-term care)
underpinned by a constructivist ontology and interpretivist epistemology. The data was analysed to yield a model of the decision-making process.

The study finds that four main themes contribute to the decision making: people are admitted because of the risk they pose, the protection they require, the resources they consume and the need to maintain their strengths. The admission arises from behaviours which constitute risk to the person or others for which there is no recourse to criminal law. Although the study is primarily concerned with the social constructs of this behaviour, it is noted that the primary diagnosis of the study population is psychotic-type illness. The admission arose from a lack of contract, assurance or trust between the assessing professional and the assessed person that they would or could desist from these high-risk behaviours.

Theoretically the data analysis and findings were found to be congruent with satisficing, which is an extant theory which best explains the data. As the assessing professional cannot contract with the assessed person, they find a solution which is satisfactory and sufficient which is ultimately admission to long-term care. The professionals need to steward resources for the wider health system ensure that care arrangements are sustainable for individuals and vulnerable groups. Professionals achieve this balance via of bounded reality which incorporates their professional identity, training and culture and the situations and organisations within which they work.

The study makes recommendations for education, practice policy and further research.

• Education - That social and market forces impacting on front-line professionals are understood and clearly stated so they are overtly aware of how satisficing may impact on practice, so they act as conscious agents of this.
• Practice – That professional curiosity is maintained and the willingness to optimise as opposed to satisfice by strength-building interventions is maintained and further developed.
• Policy – That reliance upon short-term immediate solutions is replaced with an appetite to explore more variety of efficient, effective solutions which bring about long-term recovery by providing intensive support which can be “stepped down”.
• Research – That the way professionals develop “trust” and contract with people they work with is better understood to promote person-centred practice and co-production.