Continuity of care as experienced by mental health service users - a qualitative study

Abstract

BackgroundPeople who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care.MethodsIn the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis.ResultsFollowing the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care.ConclusionsA discrepancy between aspects of continuity that are essential for service users and their experiences of actual practice was revealed. The valid evidence generated in the present collaborative study therefore offers knowledge to policy makers, professionals and service users that may be of help in their future efforts in orienting primary care, mental health, addiction and welfare services towards recovery.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2719-9) contains supplementary material, which is available to authorized users.

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

“…A study on 323 patients just discharged from psychiatric hospital following compulsory treatment for severe psychosis showed that more frequent changes in the key mental health professional were associated with longer hospital stays (Puntis, Rugkåsa & Burns, 2016). Accordingly, a qualitative study on 10 service users of mental health centres showed that changes in the allocated PMHP were experienced as setbacks in treatment, giving rise to negative feelings (Biringer, Hartveit, Sundfør, Ruud, & Borg, 2017). Even in team-based mental health services, the continuity of the individual relationship with one case manager seemed to play an important role for users' comfort level; users often expressed their preference for working with a particular case manager over others (Stanhope & Matejkowski, 2010).…”

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis

“…By offering support before and beyond the inpatient stay, healthcare professionals can emphasize care needs before discharge and address or follow-up with those needs in the community setting. This combination of elements prior to and after discharge fulfils patients' desire for continuity of care (19) and is considered helpful (20) and promising in supporting the effective transition from hospital to community.…”

A qualitative study exploring the barriers and facilitators of implementing a cardiovascular disease risk reducing intervention for people with severe mental illness into primary care contexts across England: the ‘PRIMROSE’ trial.

“…It is possible that one-to-one contact with the same HCP enabled patients to feel more comfortable, more trusting of primary care professionals and therefore more likely to engage with the intervention. The value of continuity of care for people with SMI is supported in other work where ongoing personal relationships with family, friends and different healthcare professionals facilitate trust and are central for mental health recovery (24,25). This may explain ndings from the trial that the PRIMROSE intervention was associated with lower costs due to reduced psychiatric admissions (16).…”