Ensuring high quality Oyster Care for people experiencing severe and persistent mental illness – A three-phase development of a quality monitoring tool

Introduction: Oyster Care is an innovative care model designed to meet the needs of people experiencing severe and persistent mental illness—a population often overlooked by the healthcare system and at heightened risk due to caregivers either persisting with ineffective therapeutic interventions or discontinue care altogether. The model encourages caregivers to engage in creative, out-of-the-box thinking, enabling them to move beyond conventional protocol to improve the person’s sense of meaning, well-being and quality of life. In recent years, the adoption of Oyster Care’s principles has gained momentum within Flemish mental healthcare. Consequently, there is an increasing recognition of the need for an evidence-based tool that can translate the conceptual framework of Oyster Care into practice, providing caregivers with clear, actionable guidance on its core principles. Methods A mixed methods study was conducted from 2021 to 2023. The first research phase involved a literature review and a qualitative study aimed at understanding the models’ principles. The second phase focused on translating these principles into validated, operational indicators through a Delphi expert consensus process. In the final phase, experts were tasked with selecting the most relevant validated indicators for Oyster Care. Results 79 indicators of high-quality Oyster Care were developed. These indicators were grouped into 24 sub-themes, which were organized under eight overarching themes: The care process; The somatic pillar; The psychological pillar; The social pillar; The existential pillar; End-of-life care; Team vision, culture, and development; The living environment. The SCV-I demonstrated 97% for clarity and 93% for relevance. Discussion The monitoring tool is designed for use in Flemish mental health hospitals and psychiatric nursing homes. A pilot study is currently underway to evaluate the practical use of the tool. The monitor has the potential to support future research measuring the impact of Oyster Care on health outcomes. Conclusion A practical monitoring tool was developed to support the implementation of Oyster Care within mental health services in Flanders. The tool offers a structured framework that enables teams to implement the model as intended, engage in ongoing reflection and improvement of their practices, and inform resource allocation and treatment decisions.