Opinions of healthcare professionals on the definition of severe mental illness: a qualitative study

ObjectivesThe side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI).DesignA qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants’ views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison.SettingsParticipants recruited through primary care and one mental health trust in the West Midlands.ParticipantsInterviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses.ResultsAwareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this.ConclusionsThis study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.

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Opinions of healthcare professionals on the definition of severe mental illness

Anales del Sistema Sanitario de Navarra ◽

10.23938/assn.0065 ◽

2015 ◽

Vol 38 (1) ◽

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Healthcare Professionals ◽

Definition Of

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Facing a blind alley - Experiences of stress-related exhaustion: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-038230 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038230

Author(s):

Sara Alsén ◽

Lilas Ali ◽

Inger Ekman ◽

Andreas Fors

Keyword(s):

Mental Illness ◽

Qualitative Study ◽

Sick Leave ◽

Personal Identity ◽

Healthcare Professionals ◽

Careful Consideration ◽

Blind Alley ◽

Existential Issues ◽

Frequent Reason ◽

Improve Health

IntroductionMental illness is a major concern in many countries. In Sweden, stress-related mental illness is currently the most frequent reason for sick leave.ObjectiveThis study aimed to explore patients’ experiences of stress-related exhaustion.DesignA qualitative study with interview data analysed using a phenomenological hermeneutic method.SettingParticipants were selected from public primary healthcare centres in a larger city in western Sweden.ParticipantsSeven women and five men on sick leave from work due to stress-related exhaustion were included in the study.FindingsStress-related exhaustion was experienced as a loss of access to oneself and one’s context and feelings of being trapped and lost in life. The condition had a significant impact on personal identity, raised existential issues and was interpreted as facing a blind alley. Participants described a mistaken direction in life, being forced to stop, change direction and act differently.ConclusionStress-related exhaustion is a challenging, life-changing existential experience that involves a crisis with an opportunity for new insights. Careful consideration of patients’ narratives together with the expertise of healthcare professionals can be combined to improve health and optimise recovery based on individual’s situation.

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Recognition and response to life-threatening situations among women with perinatal mental illness: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2018-025872 ◽

2019 ◽

Vol 9 (3) ◽

pp. e025872 ◽

Cited By ~ 2

Author(s):

Abigail Easter ◽

Louise Michelle Howard ◽

Jane Sandall

Keyword(s):

Mental Health ◽

Mental Illness ◽

Qualitative Study ◽

Service Provision ◽

Healthcare Professionals ◽

Perinatal Period ◽

Professional Culture ◽

Near Miss ◽

Prescribe Medication ◽

Life Threatening

ObjectiveMental illness has persistently been found to be a leading cause of death during pregnancy and the year after birth (the perinatal period). This study aims to explore barriers to detection, response and escalation of mental health-related life-threatening near miss events among women with perinatal mental illness.DesignQualitative study.ParticipantsHealthcare professionals (HCP) working in psychiatry, maternity and primary care (n=15) across community and hospital maternity and perinatal services within the UK.MethodsIn-depth semistructured interviews were conducted with a range of healthcare professionals working with women during the perinatal period. An iterative process of inductive and deductive thematic analysis, informed by systems theories of healthcare and the Three Delays model, was employed to analyse the data.ResultsThree overarching themes were identified: recognition of severity, communication of risk and service provision and access to treatment. Differing perspectives of mental illness severity influenced how life-threatening situations among women with perinatal mental illness were described, recognised and communicated between teams. Under-resourced mental health service provision, particularly within emergency and specialist perinatal mental health services, unclear thresholds for escalating care and poor infrastructure for sharing information all contributed to delays in a timely response to crisis situations. Reluctance to prescribe medication or admit women to psychiatric hospital, stigma and missed appointments created further delays.ConclusionsResponse and escalation of care for life threatening near miss events among women with mental illness is strongly influenced by professional culture and understandings of mental illness embedded within different healthcare disciplines. Focusing on how differences in organisational and professional culture contribute to the recognition of severe mental illness and interdisciplinary communication may help facilitate clearer co-ordination between teams.

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