Oyster Care for persons experiencing severe persistent mental illness in residential mental health care: a pilot implementation study

Introduction: People experiencing severe and persistent mental illness often have complex needs that are not adequately addressed within existing healthcare systems. The Oyster Care model represents a context-specific application of palliative psychiatry that emphasises holistic, relational and creative care to support autonomy, dignity and well-being among this population. To translate the conceptual foundation of Oyster Care into residential mental health practice and to support its consistent implementation in day-to-day use, an Oyster Care monitoring tool was developed, along with a peer review process based on audit and feedback principles. This pilot study explores the experiences of mental health professionals with these strategies to inform the future embedding of Oyster Care into Flemish residential mental health care.Methods: This study was conducted in four mental health facilities in Flanders. A procedure was developed to integrate the Oyster Care monitoring tool and the peer review process into clinical practice. A qualitative research design was used to explore mental health professionals’ experiences with these strategies, in order to gauge their feasibility and acceptability. Data were collected through non-participant observations, focus groups and individual interviews.Results: The integration of Oyster Care monitoring and the peer review process acts as a catalyst for the implementation of the care model in routine use, guiding and reflecting on care practices while promoting critical reflection, dialogue and knowledge exchange. This study highlights the value of Oyster Care as both a conceptual framework and a broader practice movement, enabling professionals to deliver high-quality care to people experiencing SPMI with renewed motivation and a shared sense of purpose.Conclusion: Oyster Care embodies a bottom-up approach in which healthcare professionals take responsibility for reflective practices and continuous improvement, while top-down support remains essential to assure progress and coherence. Supportive policy measures are needed to strengthen professional identity and enable teams to advocate for the needs of this vulnerable population. Furthermore, it is crucial to align implementation strategies with the operational realities of clinical settings to ensure the sustainable implementation of Oyster Care and maximise the impact on care delivery and patient outcomes.