An exploration of acceptability of a collaboratively developed model of formulation

Abstract

Collaborative, recovery-oriented psychological interventions are in demand within mental health settings, but layers of barriers can impede their implementation, particularly within acute services. Psychological formulation is a recovery-oriented, collaborative process involving the development of a shared understanding of a service user’s mental health difficulties. Psychological formulation has the potential to support a shift away from the embedded medical model; however, few, if any, frameworks have involved service users at the development stage. This study examines the acceptability of a collaboratively developed model of psychological formulation, piloted with staff within a specialist inpatient setting as well as a wider sample of individuals involved in delivering or receiving mental health services. A theory-driven and collaboratively developed psychological formulation model was developed (the ‘Personal Narrative Model’) and acceptability was evaluated with (1) acute inpatient staff working on an adult ward, and (2) a wider sample of professionals and individuals with lived experience. A focus group (n = 7), surveys (n = 26), and interviews were conducted (n = 8) and analysed using reflexive thematic analysis. The formulation model demonstrated promising acceptability although it was not meaningfully implemented within the acute setting. Three overarching themes are presented from the data: 1) the value of collaborative formulation, 2) implementation barriers, and 3) ‘selling’ and embedding change. Although there is an appetite for more contextualised ways of viewing and supporting mental health, underlying practical, cultural, and attitudinal barriers exist. Practical recommendations are shared for future researchers or practitioners seeking to embed psychological interventions within their applied settings.