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Systematic synthesis of barriers and facilitators to service user-led care planning

  • Penny Bee (a1), Owen Price (a1), John Baker (a1) and Karina Lovell (a1)



Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice.


To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur.


Systematic evidence synthesis.


Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes.


Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs.

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This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.

Corresponding author

Penny Bee, School of Nursing, Midwifery and Social Work, University of Manchester; Oxford Road, Manchester M13 9PL, UK. Email:


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This work was funded by the UK NIHR Programme Development Grant Scheme.

Declaration of interest




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Systematic synthesis of barriers and facilitators to service user-led care planning

  • Penny Bee (a1), Owen Price (a1), John Baker (a1) and Karina Lovell (a1)


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Systematic synthesis of barriers and facilitators to service user-led care planning

  • Penny Bee (a1), Owen Price (a1), John Baker (a1) and Karina Lovell (a1)
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How can we best equip service users with the knowledge and understanding to lead their own care planning? And what advantages can this bring to patients suffering from mental ill health?

Rachel A Cichosz, Medical Student, Cardiff University
07 September 2015

Bee et al (2015) explored some possible reasons for the lack of user-led care planning in mental health services and why, despite evidence that service users would like more involvement in decisions about their care, there has been little change in clinical practice (Care Quality Commission, 2009). It is important that patients feel empowered to be involved in joint decision making and a key aspect of this is their own confidence that they have sufficient knowledge and resources to make the ‘right’ decisions. The question is, how can we best equip service users with this knowledge?

Several studies confirm that service users receive insufficient information to enable them to have a meaningful contribution to discussions about their care (Bee et al, 2015). At a time when Mental Health Resources are under stress, it is easy to see how this aspect of care could be neglected. Simply explaining to patients where they can find reliable information on their condition, should they choose to, is a quick and easy way of helping them to build evidence- based knowledge whilst engaging them in their own care.

It is important to remember that there are clear advantages for patients as well as health care professionals. Increased autonomy can lead to increased patient satisfaction, with evidence that involvement in care planning increases compliance and aids recovery (Thompson and McCabe, 2012). Increased compliance can reduce clinical and economic burdens (Thompson and McCabe, 2012). The next step is researching and educating mental health professionals on the importance of service user knowledge and how they can best help with this.


Bee. P., Price. O., Baker. J. and Lovell. K. 2015. Systematic Synthesis of Barriers and Facilitators to Service User-Led Care Planning. The British Journal of Psychiatry. 207:104-114.

Care Quality Commission. 2009. Survey of Mental Health Inpatient Services. Care Quality Commission.

Thompson. L. and McCabe. R. 2012. The Effect of Clinician-Patient Alliance and Communication on Treatment Adherence in Mental Health Care: A Systematic Review. BMC Psychiatry. 12:87.

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