scholarly journals Heard, known and safe in general practice? An interview study with patients with severe and persistent mental illness

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0201
Author(s):  
Nancy Jennifer Sturman ◽  
Ryan Williams ◽  
Marianne Wyder ◽  
Johanna Lynch
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
General Practice ◽  
Physical Health ◽  
Mental Healthcare ◽  
Health Issues ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Persistent Mental Illness ◽  
Community Mental Health Clinics

BackgroundAlthough GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues.AimTo explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice.Design & settingPatient participants were recruited from community mental health clinics in Brisbane, Australia.MethodIndividual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity.Results16 interviews were conducted by one author (RW), average duration 29 minutes. Three overarching themes were identified: being heard; being known; and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect negative attitudes to mental illness in GPs who actively engage predominantly with their physical health.ConclusionSome GPs play central roles in patients’ mental healthcare. Barriers for others need further exploration, and may include time, confidence and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in theirgeneral practice consultations.

A description of a community-based treatment program designed to address physical health issues associated with severe and persistent mental illness

2017 ◽  
Vol 13 (1) ◽  
pp. 31
Author(s):  
Ron Tankel, BS, CTRS
Keyword(s):  
Mental Illness ◽  
Physical Health ◽  
Group Process ◽  
Health Program ◽  
Mental Health Program ◽  
Health And Wellness ◽  
Health Issues ◽  
Community Based ◽  
Persistent Mental Illness ◽  
Supportive Group

This article describes the ongoing impact of a community-based mental health program to address physical health issues associated with severe and persistent mental illness (SPMI). This program developed over a period of 6 years in response to clients' increased participation and motivation. As participants' level of physical wellness improved, there was a demand for more advanced and varied levels of activity. This article demonstrates that people with SPMI responded positively to a structured and supportive group process for improving physical health and wellness.

scholarly journals Teachers’ Perceptions of Student Mental Health in Eastern China: A Qualitative Study

2021 ◽  
Vol 18 (14) ◽  
pp. 7271
Author(s):  
Min Yao ◽  
Paul Kadetz ◽  
Aissata Mahamadou Sidibe ◽  
Yedong Wu ◽  
Jiameng Li ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Secondary School Teachers ◽  
Eastern China ◽  
Mental Health Training ◽  
Health Issues ◽  
Structured Interviews ◽  
Student Mental Health ◽  
Teachers Perceptions ◽  
Mental Health Issues

In China, primary and secondary school teachers, known as ban zhu ren, have pastoral responsibility for the students in their class. The aim of this preliminary study is to identify how ban zhu ren perceive the mental health of their students, and how they have acted on these perceptions. Content analysis was used to organize the data and distinguish categories or themes derived from in-depth semi-structured interviews conducted with 27 ban zhu ren from Zhejiang and Anhui provinces. Frequencies of informant responses were used to identify the areas of agreement and disagreement across identified categories and themes among the informants. The results illustrate that the informants consider issues, such as not paying attention in class (n = 14), not getting along well with classmates (n = 12), and excessive gaming (n = 11) to be indicative of mental illness, although these would commonly be considered normal adolescent behaviors. Fifteen informants admitted that they found it difficult to work with student mental health issues, and 18 felt they had inadequate or non-existent training. However, all informants stated that they had intervened with what they perceived to be students’ mental health issues, although only 9 informants had referred students for professional help. The informants reported that they were reluctant to provide referrals, due to the stigmatization they believed students would experience if given a diagnosis of mental illness. We conclude that among our informants there is a lack of agreement on what behavioral and mental health issues are, and that informants may be confusing what are, in actuality, non-conformist or non-compliant (yet often normal), adolescent behaviors with mental illness due to insufficient mental health training.

Experiences of Persons Living with Severe and Persistent Mental Illness

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Dalena Van Rooyen ◽  
Kegan Topper ◽  
Nontembeko Grycelda Shasha ◽  
Juanita Strümpher
Keyword(s):  
Mental Health ◽  
South Africa ◽  
Mental Illness ◽  
Rural Communities ◽  
Primary Healthcare ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
Eastern Cape ◽  
Healthcare Facilities ◽  
Persistent Mental Illness

The mental healthcare needs of individuals suffering from mental illness, especially those with severe and persistent mental illness, are neglected and often misunderstood in South African rural communities. The purpose of the study was to explore and describe experiences of persons living with severe and persistent mental illness and those of their families in respect of mental health services provided by primary healthcare facilities in rural Eastern Cape, South Africa. A qualitative, descriptive, exploratory research design was utilised. Convenience sampling was used to select primary healthcare facilities in the rural Emalahleni sub-district of the Chris Hani Health District in the Eastern Cape. Purposive sampling was used to recruit persons living with severe and persistent mental illness (n = 18) and their family members (n = 11). A total of 29 in-depth, unstructured individual interviews were conducted using an audio recorder. Tesch’s thematic analysis was used to identify themes from the data. Two central themes emerged from the data, namely the challenges in accessing primary healthcare services, and the inadequate provision of mental healthcare. Primary healthcare in rural South Africa needs to be better prioritised by national government to deal with mental healthcare. Improvements in infrastructural and staff capacity are needed to improve access and availability of mental healthcare services in rural communities. Nursing education programmes should better integrate mental healthcare into curricula, especially rural mental healthcare. Cost-effective, evidence-based, culturally-sensitive mental health innovations focusing on the mental health needs throughout the person’s life course should be implemented.

Whose insight is it anyway?

2017 ◽  
Vol 41 (S1) ◽  
pp. S582-S582
Author(s):  
M. Sewell ◽  
V. Mondello ◽  
T. Styles ◽  
D. Paul ◽  
D. Vecchio
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Pilot Project ◽  
Health Issues ◽  
Structured Interviews ◽  
Mixed Methods Approach ◽  
Mental Health Issues ◽  
Competing Interest ◽  
Western Australian ◽  
Community Patients

IntroductionThere is little research comparing patients’ views with those of their treating psychiatrists. In a survey of patients’ views conducted in 1993 for MIND (UK) by Rogers, Pilgrim and Lacey only 10% saw their problems in terms of mental illness. This highlights the tension between psychiatric codifications of mental abnormalities and explanations provided by patients themselves.AimsThis pilot project explores the perceptions of mental health issues in patients and their psychiatrists in a regional Western Australian setting.MethodsA mixed methods approach including semi-structured interviews of patients and their treating psychiatrists. Recruiting 5 consecutive people in the categories of involuntary in-patients, voluntary in-patients, patients on CTO, community patients and their psychiatrists.Questions asked of the patients were:– Why are you here?– What problems do you have?– What can be done?– What control do you have?– What control do other people have?Psychiatrists were asked similar questions. Responses were recorded, transcribed and thematically analyzed to reveal key themes. Quotations are used to illustrate points participants wished to make.ResultsWe report on differences in understanding in both groups. This study reveals areas for further enquiry.ConclusionsConsiderable diversity is revealed. A key conclusion is that insight is a concept relevant both for treated and treating.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Promoting physical health among people with enduring mental illness: a qualitative study of healthcare providers’ perspectives

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e044855
Author(s):  
Claire Collins ◽  
Pearse Finegan ◽  
Marie O'Shea ◽  
James Larkin ◽  
Ivana Pericin ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Qualitative Study ◽  
Physical Health ◽  
Service Providers ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
Management Communication ◽  
Health Service Providers ◽  
Regular Contact

BackgroundPeople with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy—accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.AimTo establish Irish service providers’ perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.Design and settingQualitative study of healthcare providers—general practitioners (GPs) and members of the community mental health teams—in Ireland.ParticipantsGPs and mental health service providers.MethodsQualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.ResultsParticipants considered that the physical health of people with EMI is not currently regularly addressed by the patient’s GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants’ view, a barrier to improvement is the present funding approach.ConclusionThe evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.

Comment: ‘Devining’ The Role of the Consultant Psychiatrist in a Public Mental Health Service

1998 ◽  
Vol 32 (5) ◽  
pp. 612-615 ◽  
Author(s):  
Alan Rosen
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Public Mental Health ◽  
Consultant Psychiatrist ◽  
Persistent Mental Illness ◽  
Public Mental Health Service ◽  
Key Players ◽  
Recovery Program

We admitted to ourselves, …and to our colleagues that we cannot treat people with severe and persistent mental illness as independent practitioners, and asked to be key players on the multidisciplinary team (Extract from A 12-Step Recovery Program for Psychiatrists [1]).

The health service contact patterns of people with psychotic and non-psychotic forms of severe mental illness in New South Wales, Australia: A record-linkage study

2021 ◽  
pp. 000486742110314
Author(s):  
Rachael C Cvejic ◽  
Preeyaporn Srasuebkul ◽  
Adrian R Walker ◽  
Simone Reppermund ◽  
Julia M Lappin ◽  
...  
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Illness ◽  
Health Service ◽  
Confidence Interval ◽  
Physical Health ◽  
Severe Mental Illness ◽  
New South ◽  
Service Utilisation ◽  
South Wales

Objective: To describe and compare the health profiles and health service use of people hospitalised with severe mental illness, with and without psychotic symptoms. Methods: We conducted a historical cohort study using linked administrative datasets, including data on public hospital admissions, emergency department presentations and ambulatory mental health service contacts in New South Wales, Australia. The study cohort comprised 169,306 individuals aged 12 years and over who were hospitalised at least once with a mental health diagnosis between 1 July 2002 and 31 December 2014. Of these, 63,110 had a recorded psychotic illness and 106,196 did not. Outcome measures were rates of hospital, emergency department and mental health ambulatory service utilisation, analysed using Poisson regression. Results: People with psychotic illnesses had higher rates of hospital admission (adjusted incidence rate ratio (IRR) 1.26; 95% confidence interval [1.23, 1.30]), emergency department presentation (adjusted IRR 1.17; 95% confidence interval [1.13, 1.20]) and ambulatory mental health treatment days (adjusted IRR 2.90; 95% confidence interval [2.82, 2.98]) than people without psychotic illnesses. The higher rate of hospitalisation among people with psychotic illnesses was driven by mental health admissions; while people with psychosis had over twice the rate of mental health admissions, people with other severe mental illnesses without psychosis (e.g. mood/affective, anxiety and personality disorders) had higher rates of physical health admissions, including for circulatory, musculoskeletal, genitourinary and respiratory disorders. Factors that predicted greater health service utilisation included psychosis, intellectual disability, greater medical comorbidity and previous hospitalisation. Conclusion: Findings from this study support the need for (a) the development of processes to support the physical health of people with severe mental illness, including those without psychosis; (b) a focus in mental health policy and service provision on people with complex support needs, and (c) improved implementation and testing of integrated models of care to improve health outcomes for all people experiencing severe mental illness.

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

scholarly journals The DELTA® nursing measure: Its development and testing for nursing utility

2013 ◽  
Vol 18 (1) ◽  
Author(s):  
Hendrik J. Loubser ◽  
Judith C. Bruce ◽  
Daleen Casteleijn
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Content Analysis ◽  
Health Outcomes ◽  
Mental Healthcare ◽  
Mental Health Outcomes ◽  
Psychiatric Nurses ◽  
Multidisciplinary Teams ◽  
Analysis Techniques ◽  
Care Plans

In the specialised nursing field of acute mental illness nurses expressed a need to measure and evaluate their patients’ mental-health outcomes both empirically and routinely. The aim was to develop and test a measurement tool, named the DELTA nursing measure, which could be embedded routinely into the nursing process and care plans, enabling the psychiatric nurses to score and evaluate their patients’ acute mental-health outcomes. A qualitative, exploratory study design was used to address two sequential objectives. Firstly, qualitative data that described observable behaviours in patients with acute mental illness were collected from psychiatric nurses (n = 5) who were experienced in acute mental healthcare. The data were analysed using inductive content analysis techniques to design and construct the DELTA nursing measure. In the second objective, the nursing utility of the DELTA nursing measure was studied. This was done by training and testing a new team of psychiatric nurses (n = 25) working in a 116-bed acute psychiatric hospital, in the application of the DELTA nursing measure. After 30 months a focus group (n = 6) representing this team was held to explore their perceptions and experiences of the nursing utility of the newly-developed measure. The descriptive data were analysed using deductive content analysis techniques. The outcome of the DELTA nursing measure as a routine nursing measure of acute mental illness provided good results. The nursing-utility characteristics have confirmed positive responses with regard to its acceptance, usefulness and confidence as a worthwhile tool to be used in expediting nursing services in acute mental healthcare. The positive responses to the DELTA nursing measure are noteworthy. It has the potential to add substantial value to the mental health care field in nursing by adding a measurable dimension to patient outcomes, a much needed requirement by patients, multidisciplinary teams and healthcare funders.In die gespesialiseerde verplegingsveld van akute psigiatrie het verpleegkundiges ’n behoefte uitgespreek om roetineweg pasiënte se geestesgesondheidsuitkomste empiries te meet en te evalueer. Die doel van die studie was om ’n meetinstrument, genoemd die ‘DELTA nursing measure’, te ontwikkel en toets wat ingebed kan word in die verplegingsproses en versorgingsplan en wat psigiatriese verpleegkundiges in staat kan stel om roetine-weg die pasiënte se akute geestesgesondheidsuitkomste te meet en te evalueer. ’n Kwalitatiewe, eksploratiewe studie ontwerp is gebruik om twee opeenvolgende doelwitte aan te spreek. Eerstens is kwalitatiewe data wat observeerbare gedrag in pasiënte met akute geestessiektes beskryf ingesamel van psigiatriese verpleegkundiges (n = 5) wat ervaring het in akute geestesgesondheidsorg. Die data is geanaliseer met induktiewe inhouds analiese tegnieke om die ontwerp en konstruksie van die ‘DELTA nursing measure’ te bewerkstellig. In die tweede doelwit was die ‘DELTA nursing measure’ se bruikbaarheid vir verpleging bestudeer. Om dit te doen was ’n nuwe span psigiatriese verpleegkundiges (n = 25) wat werksaam was in ’n 116-bed akute psigiatriese hospitaal opgelei en getoets in die gebruik van die ‘DELTA nursing measure’. Na 30 maande is ’n fokusgroep (n = 6) gehou wat verteenwoordigend was van die span om hulle persepsies en ervarings van die nuut-ontwikkelde meetskaal se bruikbaarheid te eksploreer. Beskrywende data is met behulp van deduktiewe inhouds tegnieke geanaliseer. Die uitkoms van die ‘DELTA nursing measure’ as ’n routine verplegingmeetskaal vir die bepaling van akuutheid in psigiatrie het baie goeie resultate opgelewer. Die bruikbaarheidseienskappe het positiewe response bevestig dat aanvaarding, betroubaarheid en vertroue bereik is en dat dit ’n nuttige instrument is om die verplegingsdiens te bevorder. Die positiewe response op die ‘DELTA nursing measure’ is merkwaardig. Dit het die potensiaal om ’n betekenisvolle bydrae te lewer tot die psigiatriese verplegingsveld omdat dit ’n meetbare dimensie toevoeg tot pasient uitkomste, ’n hoogs-benodigde vereiste van pasiënte, multidissiplinêre spanne en gesondheidsorgbefondsers.

Monitoring the physical health of individuals with serious mental illness

2008 ◽  
Vol 25 (3) ◽  
pp. 108-115
Author(s):  
Majella Cahill ◽  
Anne Jackson
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Health Monitoring ◽  
Service Providers ◽  
Psychiatric Service ◽  
Service Users ◽  
Effective Models

AbstractDeveloping effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring.

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