scholarly journals Personality disorder co-morbidity in primary care ‘Improving Access to Psychological Therapy’ (IAPT) services: a qualitative study exploring patient perspectives on treatment experience

2020 ◽  
pp. 1-15
Author(s):  
Gary Lamph ◽  
John Baker ◽  
Tommy Dickinson ◽  
Karina Lovell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Personality Disorder ◽  
Qualitative Study ◽  
Patient Group ◽  
Stepped Care ◽  
Research Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Co Morbidity

Abstract Background: High numbers of people present with common mental health disorders and co-morbid personality disorder traits in primary care ‘Improving Access to Psychological Therapies’ (IAPT) services in England and they receive sub-optimal treatments. No previous studies have explored the treatment experiences or needs of this patient population in England. Aims: This qualitative study explored the treatment experiences of patients (n = 22) with common mental health difficulties and co-morbid personality disorder as indicated by a score of 3 or more on the ‘Standardised Assessment of Personality – Abbreviated Scale’ (SAPAS) in receipt of primary care-based IAPT treatment. Method: A qualitative health research approach was used. Qualitative individual face-to-face semi-structured interviews were conducted. All interviews were audio recorded, data were transcribed verbatim and analysed using a framework analysis approach. Results: Findings revealed a need to adapt away from prescriptive cognitive behavioural therapy (CBT) treatment models towards more flexible, personalised and individualised treatment with this patient group. Time to emotionally offload, build a therapeutic relationship and link past experiences to presenting problems were highlighted as important. Conclusions: For the first time, the needs and treatment experiences of this patient group have been explored. This paper provides a unique patient experience insight that should be considered when exploring new approaches to working with and developing effective interventions via a stepped care approach.

scholarly journals Psychological Therapy for Postnatal Depression in UK Primary Care Mental Health Services: A Qualitative Investigation Using Framework Analysis

2019 ◽  
Vol 28 (12) ◽  
pp. 3519-3532
Author(s):  
Holly Hadfield ◽  
Suzanne Glendenning ◽  
Penny Bee ◽  
Anja Wittkowski
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Postnatal Depression ◽  
Psychological Therapy ◽  
Negative Consequences ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Parenting Support ◽  
Psychological Therapies ◽  
Current Psychological

Abstract Objectives Postnatal depression (PND) can have negative consequences for mother and infant. Current psychological therapies are effective in treating depression but improvements in mother-infant outcomes have not yet been established. We aimed to capture mothers’ experiences of therapy for PND with a focus on parenting-related outcomes. We also sought their views on including parenting support within interventions. Methods Fourteen mothers who received psychological therapy in the United Kingdom’s National Health Service (NHS) participated in semi-structured interviews. Data were audio-recorded, transcribed, coded and analysed using Framework Analysis. Results Three main themes were identified: ‘The experience of therapy’, ‘Therapy outcomes’ and ‘Views about parenting interventions for postnatal depression’. The main themes were underpinned by other themes. Overall the findings revealed that mothers perceived therapy as helpful in improving mood, confidence as a parent and relationship with their infant. Mothers valued the process of normalising their experiences within group therapy and by their therapists because it reduced any shame and stigma associated with PND. Mothers thought parenting support within therapy would be acceptable if delivered collaboratively. Conclusions Primary care-based psychological therapy for PND was perceived as helpful and acceptable. It clearly met some of the mothers’ goals, especially if their beliefs about being a ‘bad mother’ was challenged and modified. Barriers to engagement, such as childcare issues and therapist’s knowledge about perinatal mental health, would also need to be overcome. Finally, mother-infant interventions should be further explored as an adjunct treatment option.

scholarly journals A Family-Focused Intervention for Parental Mental Illness: A Practitioner Perspective

2021 ◽  
Vol 12 ◽  
Author(s):  
Mairead Furlong ◽  
Christine Mulligan ◽  
Sharon McGarr ◽  
Siobhan O'Connor ◽  
Sinead McGilloway
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Qualitative Study ◽  
Child Protection ◽  
Service Providers ◽  
Controlled Trial ◽  
Parental Mental Illness ◽  
Structured Interviews ◽  
Mental Health Settings

Background: Parental mental illness (PMI) is common and can lead to children developing mental disorders. Family Talk (FT) is a well-known and widely implemented intervention designed to reduce the risk of transgenerational psychopathology. However, given the research to practise “gap,” very little qualitative research, to date, has investigated practitioner experiences in implementing FT. This study aimed to explore the practitioner-perceived barriers and facilitators to the implementation and sustainability of FT within mainstream mental health settings.Methods: This qualitative study was nested within a randomised controlled trial (RCT) of Family Talk [N = 86 families (139 parents, 221 children)] within 15 adult (AMHS), child (CAMHS), primary care mental health, and child protection sites in Ireland. Semi-structured interviews and focus groups were undertaken with a purposive sample of clinicians (n = 31) and managers (n = 10), based on their experiences of implementing FT. Interview data were transcribed verbatim, analysed using constructivist grounded theory, and informed by Fixsen's implementation science framework.Results: Service providers highlighted a number of benefits for approximately two thirds of families across different diagnoses and mental health settings (AMHS/CAMHS/primary care). Sites varied in their capacity to embed FT, with key enablers identified as acquiring managerial and organisational support, building clinician skill, and establishing interagency collaboration. Implementation challenges included: recruitment difficulties, stresses in working with multiply-disadvantaged families, disruption in delivery due to the COVID-19 global pandemic, and sustainability concerns (e.g., perceived fit of FT with organisational remit/capacity, systemic and cultural barriers to change).Conclusion: This study is only the second qualitative study ever conducted to explore practitioner experiences in implementing FT, and the first conducted within the context of an RCT and national research programme to introduce family-focused practise (FFP) for families living with PMI. The findings illuminate the successes and complexities of implementing FFP in a country without a “think family” infrastructure, whilst highlighting a number of important generalisable lessons for the implementation of FT, and other similar interventions, elsewhere.

scholarly journals An exploration of GP care in outreach settings for people experiencing homelessness: a qualitative study

2021 ◽  
pp. BJGP.2020.0749
Author(s):  
Victoria Hirst ◽  
Fiona Cuthill
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Access To Health Care ◽  
Health Care Services ◽  
Community Outreach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Care Services ◽  
Outreach Services ◽  
Gp Care

Background: Although people experiencing homelessness (PEH) have the worst health outcomes in society, they have a low uptake of primary care services. GP outreach has developed as a way of increasing access into primary care but little is known about the experience of patients receiving care in this way. Aims: 1) To explore homeless patients’ experiences of GP care in community outreach settings in UK; 2) To seek staff/volunteer views on the strengths and weaknesses of the GP community outreach services. Design and setting: A qualitative study with PEH and staff/volunteers working in 3 different community outreach settings in the UK. Method: Individual semi-structured interviews with 22 PEH and two focus groups with key staff/volunteers. Data was analysed thematically using framework analysis. Findings: GP outreach services better enabled PEH to access medical care and staff/volunteers valued GP support to promote, and facilitate access to, health care services. In particular, findings illuminate the high value that PEH placed on the organisational environment of the GP outreach service. Valued aspects of GP outreach were identified as: 1) comfortable, safe and engendered a sense of belonging; 2) convenient, opportunistic and a one stop shop; and, 3) being heard, having more time and breaking down barriers. Conclusion: Organisational environment is important in enabling PEH to engage with GP services. The physical and organisational environment of the outreach settings were the most important factors: they created a space between the GP and patients where professional barriers were flattened and facilitated a therapeutic relationship.

scholarly journals GP views on their role in bullying disclosure by children and young people in the community: a cross-sectional qualitative study in English primary care

2019 ◽  
Vol 69 (688) ◽  
pp. e752-e759
Author(s):  
Laura Condon ◽  
Vibhore Prasad
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young People ◽  
Qualitative Study ◽  
Health Concern ◽  
Health Consequences ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Children And Young People ◽  
Being Bullied

BackgroundBullying among children and young people (CYP) is a major public health concern that can lead to physical and mental health consequences. CYP may disclose bullying, and seek help from a GP. However, there is currently little research on GPs’ views on and perceptions of their role in dealing with disclosures of bullying in primary care.AimTo explore GPs’ views about their role in dealing with CYPs’ disclosures of being bullied, especially factors that have an impact on GPs’ roles.Design and settingIn this cross-sectional qualitative study, semi-structured interviews were conducted with GPs in primary care in England from October to December 2017.MethodPurposive sampling was used to achieve variation in GP age, professional status in practice, profile of the patients served by the practice, practice size and location, and whether the GPs considered themselves to be actively in research or teaching.ResultsData from 14 semi-structured interviews revealed three main themes: remaining clinically vigilant; impact of bullying in schools; and training and guidance on dealing with bullying and cyberbullying. GPs felt that dealing with disclosures of bullying and cyberbullying came down to their clinical experience rather than guideline recommendations, which do not currently exist, and that bullying was a precipitating factor in presentations of CYPs’ mental health issues.ConclusionGPs feel they have a role to play in managing and supporting the health of CYP who disclose being bullied during consultations. However, they feel ill-equipped to deal with these disclosures because of lack of professional development opportunities, and guidance on treating and managing the health consequences of being bullied.

GPs’ and patients’ views on recovery from psychosis

2014 ◽  
Vol 19 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Seamus Ryan ◽  
Anne Rogers ◽  
Helen Lester
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Multiple Perspectives ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Peer Supervision ◽  
Content Type ◽  
Whole Person ◽  
Clinical Interest

Purpose – Recovery is a key organising principle underlying mental health services, but remains under-researched in primary care. The purpose of this paper is to explore what recovery from psychosis means from multiple perspectives, the role of primary care in fostering recovery, and interventions that might enhance its promotion in primary care. Design/methodology/approach – A total of 20 patients who had experienced psychosis and 24 General Practitioners (GPs) with varying expressed interest in mental health participated in semi-structured interviews, and were invited to two subsequent mixed focus groups. Data were analysed using Framework Analysis. Findings – Recovery was conceptualised by GPs without a specialist clinical interest in mental health as improvements in symptomatic outcomes, by GPs with a special interest as improvements in social or functional outcomes, and by patients as a process involving a “whole person” approach. Both GPs and patients highlighted benefits of primary care including continuity, accessibility, and the role primary care professionals can play in supporting patients’ families, and helping patients expand social support networks. Despite feeling “fobbed off” at times, patients desired a shift in responsibility for psychosis from secondary to primary care. Practical implications – Reflective peer supervision meetings for GPs and patient-led training might improve primary care's ability to provide a more recovery-focused environment. Originality/value – This study provided original and valuable findings regarding how GPs viewed their own role in promoting recovery from psychosis. This study also provided original findings regarding how patients viewed the role of primary care in promoting recovery from psychosis.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

2020 ◽  
pp. 009121742097799
Author(s):  
Krista Schultz ◽  
Sharan Sandhu ◽  
David Kealy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Care Physician ◽  
Population Based ◽  
Borderline Personality ◽  
Care Physician ◽  
Cross Sectional

Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

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