Introducing the Needs in Recovery Assessment (NiRA) into clinical practice: a pilot study in a metropolitan tertiary mental health service.

The Needs in Recovery Assessment (NiRA) is a valid and reliable assessment tool designed to facilitate a discussion between mental health service users and mental health clinicians about a broad array of needs. It can be used in its paper-based form (NiRA) or as an electronic form (eNiRA). The NiRA/eNiRA includes three sections: Sections 1 and 2 are completed in an initial appointment and Section 3 is completed in a follow-up appointment that should be conducted 1-2 weeks after the initial assessment. Section 1 is presented in six sections. Each section is dedicated to a category of need (i.e. practical needs; daily activity needs; physical health needs; informational needs; emotional & psychological needs and relationship needs). Within these categories are a list of items of need that can be rated on a scale of 1 (no need) and 5 (urgent need). Section 2 of the NiRA/eNiRA is used to prioritise the unmet needs that have been identified in Section 1. In this section, the service user and clinician are tasked with discussing an approach for meeting the need, identifying obstacles and barriers to meeting that need as well as planning the involvement of other individuals and/or organisations who may be able to assist. Section 3 is designed to facilitate a follow-up appointment where the progress towards meeting needs is discussed and where any further assistance required to meet needs can be arranged. The process for mental health service user participants will involve participating in face-to-face discussions with mental health clinicians. Clinicians, including Psychiatrists, Psychologist, Mental Health Nurses, Occupational Therapists and Social Workers who work in a multi-disciplinary mental heatlh team will be responsible for initiating an assessment using the NiRA. Mental health service users will be invited to participate in a discussion about their needs that will be guided by the questions on the NiRA. In the first appointment, Sections 1 and 2 will be completed. A service user will be able to attend follow-up discussions relating to their needs as required, and would be able to return to all applicable sections of the NiRA throughout the time they are admitted under the mental health team. For mental health clinician participants, involvement will include reading a brief training package (expected time commitment of one hour) and undertaking one in-person training session that will last one hour. This training session will provide information about the NiRA and allow clinicians to explore the tool, practice using the tool and ask questions about the tool. Mental health clinicians will be tasked with using the NiRA to facilitate discussions about unmet needs with mental health service users who are admitted to the service. Clinicians will be required to explain the NiRA to service users and to document responses. Participating in a discussion with clinicians about unmet needs using the NiRA will not be compulsory for service users who are admitted to the unit, but we will be encouraging clinicians to invite all service users to do so. The aim will be to recruit 80% of the service user cohort to participate and complete two assessment interviews where the NiRA is used. The number of times that the NiRA will be used with each service user is anticipated to vary significantly based on length of admission to the unit, the type and severity of needs that are being experienced and the engagement of the service user with the service. We would be asking clinicians to use the tool a minimum of two times with service users so that both Sections 1 and 2 can be completed and to ensure appropriate follow-up regarding needs is undertaken.