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

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Author(s)
Sturman, Nancy Jennifer
Williams, Ryan
Wyder, Marianne
Lynch, Johanna
Griffith University Author(s)
Year published
2021
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BACKGROUND: Although 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. AIM: To explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice. DESIGN & SETTING: Patient participants were recruited from community mental health clinics in Brisbane, Australia. METHOD: Individual semi-structured interviews were conducted with a convenience sample of patients. ...
View more >BACKGROUND: Although 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. AIM: To explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice. DESIGN & SETTING: Patient participants were recruited from community mental health clinics in Brisbane, Australia. METHOD: Individual 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. RESULTS: 16 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. CONCLUSION: Some 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.
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View more >BACKGROUND: Although 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. AIM: To explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice. DESIGN & SETTING: Patient participants were recruited from community mental health clinics in Brisbane, Australia. METHOD: Individual 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. RESULTS: 16 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. CONCLUSION: Some 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.
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Journal Title
BJGP Open
Copyright Statement
© 2021 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License (http://creativecommons.org/licenses/by/4.0/). Published by BJGP Open. For editorial process and policies, see: https://bjgpopen.org/authors/bjgp-open-editorial-process-and-policies
Subject
General practice
Public policy
Health policy
Psychology
General practice
mental disorders
physician-patient relations