PhD defence: Erlend Rinke Maagerø-Bangstad

Erlend Rinke Maagerø-Bangstad has followed a PhD in Person-centred Health Care, by Faculty of Health and Soscial Sciences.

The dissertions title:«Competence for improved services – a qualitative study of the impact of competence development endeavors and tools aimed at staff in mental health services cooperating with service users that can be threatening and/or violent”

About the dissertation

When compared to many other occupational groups mental health workers are more often exposed to threats and violence at the workplace. The negative consequences of workplace violence are manifold and negatively affect the victims, their colleagues, the mental health organizations, the society, as well as the service users, both in the short and the long term.

Healthcare and social workers often want more knowledge about threats and violence and increased competence in effective ways to prevent and manage unwanted situations at work. Additionally, when managers of mental health services intervene following acts of threats or violence against staff, educational activities are often favored.

Since 2010 The Agency of Health in Oslo Municipality have offered staff in community mental health services a series of competence development activities and supportive competence development tools in the prevention and management of staff directed threats and violence.

The thesis consists of three studies inquiring into the effect of the various activities and tools. The first study explores competence development among participants in two general courses for mental health workers. The other study explores what effect locally based education and training session aimed at staff in supportive housing in mental health services have. The third, and last study, explores managers in mental health services’ perspectives on and experiences of competence development among their staff from participating in various courses and competence development activities.

The findings show that participants both in the general courses and the locally based competence development activities experienced competence development and expanded their understandings of practices in encounters with threats and violence from service users.

The managers also confirmed a development of staff competence following participation in education and training. This contributed to staff and the services being enabled in collaboration amongst themselves, with the specialized mental health services, as well as the service uses in the prevention and management of workplace threats and violence.

The managers also experienced staff taking more responsibility in work assignments both parties previously saw as the managers responsibilities in the prevention and management of threats and violence at the workplace. On the other hand, managers also experienced that competence development among staff resulted increased expectations from employees to put more effort into the prevention and management of threats and violence in the services and to implement new strategies and routines.  

The studies included in the thesis have developed knowledge about what mental health workers’ competence in the prevention and management of staff directed threats and violence consists of, but also what practices are to be preferred in encounters with threats and violence from service users.

Traditionally, threats and violence from service users in mental health services have been countered by increased control and other authoritarian interventions, in line with zero tolerance policies prioritizing negative sanctions.

Contrary to this, the thesis concludes that the most efficacious and well-founded preventive efforts are rooted in seeing violence as a meaningful expression of disempowerment on the service user’s behalf, cooperation with service users, and staff being aware and sensitive of the person’s wishes and needs in endeavoring solution of unwanted incidents.

The thesis has implications for informal competence development activities in community mental health services. Maagerø-Bangstad and colleagues have per example found that the chance of competence development activities being successful depend on the education and training being part of an intended and planned process at each workplace, most of the staff participating together in the activities and that the activities take vantage in participants’ preexisting ways of seeing practice.

The implications for mental health practice are that the findings indicate that mental health services’ efforts at preventing and managing staff directed threats and violence in the future should be developed in line with recovery and person-centred practices promoting cooperation with and involvement of individual service users.