Constraints Perceived by Psychiatrists Working in Community Mental Health Services. Development and Pilot Study of a Novel Instrument

Galeazzi, Gian Maria; Mackinnon, Andrew; Curci, Paolo

doi:10.1007/s10597-007-9099-2

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…In spite of this, our review show that there are no studies that assess whether guaranteeing the choice of the PMHP in the real world is really that difficult. Addressing the perceived constraints may result in more choice options to reach therapeutic goals in a collaborative framework with patients (Galeazzi, Mackinnon & Curci, 2007).…”

Section: Discussionmentioning

confidence: 99%

Users’ choice and change of allocated primary mental health professional in community-based mental health services: A scoping review

Rioli

Ferrari

Henderson

et al. 2020

Int J Soc Psychiatry

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Background: The recovery model in mental health care emphasizes users’ right to be involved in key decisions of their care, including choice of one’s primary mental health professional (PMHP). Aims: The aim of this article was to provide a scoping review of the literature on the topic of users’ choice, request of change and preferences for the PMHP in community mental health services. Method: A search of the PubMed, Cochrane Library, Web of Science and PsycINFO for papers in English was performed. Additional relevant research articles were identified through the authors’ personal bibliography. Results: A total of 2,774 articles were screened and 38 papers were finally included. Four main aspects emerged: (1) the importance, for users, to be involved in the choice of their PMHP; (2) the importance, for users, of the continuity of care in the relationship with their PMHP; (3) factors of the user/PMHP dyad influencing users’ preferences; and (4) the effect of choice on the treatment outcomes. Conclusion: While it is generally agreed that it is important to consider users’ preferences in choosing or requesting to change their PMHP, little research on this topic is available. PMHPs’ and other stakeholders’ views should also be explored in order to discuss ethical and practical issues.

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Section: Discussionmentioning

confidence: 99%

Users’ choice and change of allocated primary mental health professional in community-based mental health services: A scoping review

Rioli

Ferrari

Henderson

et al. 2020

Int J Soc Psychiatry

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“…), the medical consultation model (Fischer & Ereaut ), risk assessments/mitigation (Galeazzi et al . ) and resource constraints (Lilly et al . ).…”

Section: Discussionmentioning

confidence: 99%

Therapeutic relationships between mental health service users with psychotic disorders and their clinicians: a critical interpretive synthesis

Farrelly

Lester

2014

Health Soc Care Community

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This work was undertaken as part of the first author's self-funded PhD. A poster of a preliminary stage of this work was presented at the ENMESH conference in Ulm, Germany, June 2011. What is known about this topic• Current treatment and outcomes for individuals with psychotic disorders in community settings are far from satisfactory.• Hopeful and respectful therapeutic relationships (TRs) may be linked with improved outcomes for this group, but significant conceptual confusion exists regarding the components of TRs in community settings. What this paper adds• Therapeutic relationships require mutual trust, respect and shared decision-making; however, in the community, contextual factors beyond one-on-one interactions are barriers to the development of TRs.• Service users (SUs) and clinicians have different, possibly opposing, needs in interactions. SUs want to feel respected and helped. Clinicians prioritise protection of self and other, over interactions characteristic of TRs.• Clearer statement of purpose of interactions in secondary settings is required. AbstractIndividuals with schizophrenia and other psychotic disorders remain among the most marginalised in our communities. There has been increasing criticism of the current state of clinical treatment of such individuals as technological developments in medication provide little, if any, improvement in the lived experiences of mental health service users (SUs). In this context, there is a call for a re-orientation away from medication in the treatment of 'common factors' such as the therapeutic relationship (TR). The TR is well researched in psychotherapy settings; however, the components of beneficial TRs in the treatment of individuals with psychotic disorders are poorly understood. A critical interpretive synthesis was conducted to determine the current understanding of the TRs between individuals with psychotic disorders and their clinicians in community case management settings. A search of MEDLINE, PsycINFO, EMBASE and Social Policy and Practice Databases and grey literature between 1990 and 2011 identified 13 papers to be included in the synthesis. Three key components of beneficial TRs were identified: mutual trust, demonstration of mutual respect and shared decision-making. However, the synthesis revealed that such interactions are difficult to achieve in routine practice. The main barrier identified was a lack of clarity regarding the goal of interactions, which in turn created stakeholders with poorly defined roles and possibly oppositional needs. In this context of ambiguity, clinicians appear to de-emphasise interactions characteristic of beneficial TRs, and prioritise interactions that protect the SU and themselves in the case of a relapse. Structural symbolic interactionism is used to interpret these findings. For interactions characteristic of TRs to be prioritised in the treatment of individuals with psychotic disorders, a clearer evidence base for the importance of the TR and a clear statement of purpose of treatment are required.

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“…Nursing assessment was associated with expert power acquired through duration of clinical experience and contrasted with instant legitimacy conferred on junior doctors through position power (French & Raven 1959). This was the context in which individuated nursing assessment fed into medical decision-making processes characterised by brief interviews and risk aversion (Galeazzi et al 2007). The examples participants gave of team-based assessment as opposed to ultimately medical decision-making were localised and in the minority (Seale et al 2007b).…”

Section: Discussionmentioning

confidence: 99%

In the know: cognitive and social factors in mental health nursing assessment

MacNeela

Pearce

Treacy

et al. 2010

Journal of Clinical Nursing

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Cognitive and social aspects of nursing decision-making have been considered apart from one another, whereas cognitions about mental health conditions are, in fact, applied in a pragmatic, task-oriented organisational system. Nurses believed that spending time with the service user led to a privileged position of knowledge in comparison with doctors ('knowing the person'), but this knowledge is frequently applied to the task of 'knowing the patient', assessing the person as a source of risk and danger.

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Constraints Perceived by Psychiatrists Working in Community Mental Health Services. Development and Pilot Study of a Novel Instrument

Cited by 10 publications

References 18 publications

Users’ choice and change of allocated primary mental health professional in community-based mental health services: A scoping review

Users’ choice and change of allocated primary mental health professional in community-based mental health services: A scoping review

Therapeutic relationships between mental health service users with psychotic disorders and their clinicians: a critical interpretive synthesis

In the know: cognitive and social factors in mental health nursing assessment

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