Community mental health workers’ experiences of care-coordinating hospital discharge of patients with a diagnosis of mental health conditions into community mental health integrated services in the Northwest of England

Ndoro, Samuel and Swarbrick, Caroline and Perez Algorta, Guillermo (2025) Community mental health workers’ experiences of care-coordinating hospital discharge of patients with a diagnosis of mental health conditions into community mental health integrated services in the Northwest of England. PhD thesis, Lancaster University.

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Abstract

The significance of community mental health workers' roles in care-coordinating the hospital discharge of patients with a diagnosis of mental health conditions is globally recognised, yet empirical research on their experiences remains scarce. Indeed, no studies were found that specifically explored this important topic to understand the experiences of community mental health workers care-coordinating patient hospital discharge into community mental health services. This study adds to existing knowledge through a qualitative evidence synthesis of literature and an empirical intrinsic case study. Guided by constructivist inquiry, the study focused on the co-construction of meaning in understanding experiences of community mental health workers who care-coordinate patient hospital discharge and to synthesise existing literature on this topic. Two theoretical lenses informed the study: Ecological Systems Theory, which provided a framework to understand the multi-level influences on community mental health workers’ experiences, and Normalisation Process Theory, which was used to provide an in-depth understanding of how care coordination practices are normalised and embedded in discharge processes. Two interrelated components comprised the study: a literature review and empirical research, The literature review included 16 peer-reviewed papers for thematic synthesis based on relevance to community mental health and contribution to the understanding of community mental health workers' experiences of care coordination of patient hospital discharge. Thomas and Harden’s (2008) three-stage thematic synthesis approach was followed to analyse the literature, resulting in the development of four key themes and 15 subthemes: 1. Duties and responsibilities of community mental health workers; 2. Challenges and enablers of care coordination 3. Multidisciplinary team working in care coordination 4. Hospital discharge into community mental health integrated services. These findings indicate patterns and insights across different contexts, providing an in-depth understanding of the experiences and perspectives captured in the studies, which were further explored in the empirical phase. Empirical data were collected through semi-structured interviews, which were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's (2024) reflective thematic analysis to enable the identification of patterns across participants’ narratives. Data analysis resulted in 13 subthemes and four major themes: 1. Experiences of collaborative working; 2. Challenges and enablers to care coordination; 3. Experiences of organisational system and culture; and 4. Community mental health workers’ personal experiences of professional growth. This study’s findings offer a significant contribution, providing information on poor communication, shortage of staff, substantial patient caseloads, lack of community mental health services, and challenges in care-coordination of patient hospital discharge. In addition, the current study highlights the importance of collaborative working while also recognising its limitations, such as the restricted geographical focus. The strengths of the research, underpinned by the use of two theoretical lenses, contribute to the existing body of knowledge. Further studies to inform community mental health practice, as well as implications for community mental health research policy, are recommended.