General practitioners' attitudes to psychiatric and medical illness

Lawrie, Stephen M.; Martin, Karen; Mcneill, G. P.; Drife, Jenny; Chrystie, P.; Reid, Ann; Wu, Pensée; Nammary, S.; Ball, Jude

doi:10.1017/s0033291798007004

Cited by 78 publications

(61 citation statements)

References 7 publications

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“…A large majority of GPs have no postgraduate mental health training and they often have negative opinions about providing care for people with schizophrenia. 99 GPs believe that they contribute little to the care of people with serious mental illness in general and that the incidence of FEP is too low to warrant more active involvement. 100 Lester et al 101 recruited 110 practices to assess the effect of an educational intervention for GPs on referral rates to early intervention services and on DUP for young people with FEP.…”

Section: Discussionmentioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Singh

Islam

Brown

et al. 2013

Programme Grants for Applied Research

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“…Indeed, surveys of mental health service users have revealed a relatively high prevalence of stigma and discrimination from healthcare professionals (Wahl, 1999). Although several studies have found that medical students and doctors often regard psychiatric patients as difficult and unrewarding to treat (Nielsen & Eaton, 1981;Lawrie et al, 1998), other research has reported that medical students' attitudes towards mental illness and psychiatry become more positive following undergraduate training (Creed & Goldberg, 1987;Singh et al, 1998), particularly where that training involves both patient contact and education about the effects of stigma (Corrigan & Penn, 1999). Given the labour-intensive nature of existing anti-stigma interventions (Pinfold et al, 2003) and the power of audiovisual media to influence societal constructions of mental illness (Wahl, 1995), researchers have postulated that documentary films depicting people diagnosed with mental health problems may offer a more efficient approach to reducing stigma and discrimination among student groups (Penn et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Anti-stigma films and medical students' attitudes towards mental illness and psychiatry: randomised controlled trial

Kerby

Calton²,

DiMambro

et al. 2008

Psychiatr. bull.

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Aims and MethodTo explore the feasibility of a randomised controlled trial of the effects of two anti-stigma films on medical students' attitudes to serious mental illness and psychiatry. Attitudes to serious mental illness, perceived dangerousness, social distance and psychiatry, were measured before and after watching the films and at 8 weeks.ResultsIntervention films significantly improved general attitudes to serious mental illness and social distance, with a trend towards reducing perceived dangerousness. These effects appeared to attenuate during the students' clinical placements, suggesting a possible interaction with their clinical experiences.Clinical ImplicationsOur results suggest both that it may be possible to conduct a substantive trial of the effects of the intervention films on a larger cohort of medical students and that the films may be effective in reducing stigmatising attitudes in medical students.

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“…There is also evidence that a majority of GPs have no postgraduate mental health training; that they often have negative opinions about providing care for people with schizophrenia; 12 that they believe they contribute little to the care of people with serious mental illness in general; and that the incidence of first-episode psychosis is too low to warrant more active involvement. 13 A training-needs analysis devised and distributed by the current study team to GPs across Birmingham also identified knowledge uncertainties around diagnosing first-episode psychosis and worries on how to phrase questions about hallucinations.…”

Section: Introductionmentioning

confidence: 99%

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

Lester¹,

Birchwood²,

Freemantle³

et al. 2009

Br J Gen Pract

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Delays in accessing care for young people with a first episode of psychosis are significantly associated with poorer treatment response and higher relapse rates. AimTo assess the effect of an educational intervention for GPs on referral rates to early-intervention services and the duration of untreated psychosis for young people with first-episode psychosis. Design of studyStratified cluster randomised controlled trial, clustered at practice level. SettingBirmingham, England. MethodPractices with access to the three early-intervention services in three inner-city primary care trusts in Birmingham were eligible for inclusion. Intervention practices received an educational intervention addressing GP knowledge, skills, and attitudes about first-episode psychosis. The primary outcome was the difference in the number of referrals to earlyintervention services between practices. Secondary outcomes were duration of untreated psychosis, time to recovery, use of the Mental Health Act, and GP consultation rate during the developing illness. ResultsA total of 110 of 135 eligible practices (81%) were recruited; 179 young people were referred, 97 from intervention and 82 from control practices. The relative risk of referral was not significant: 1.20 (95% confidence interval [CI] = 0.74 to 1.95; P = 0.48). No effect was observed on secondary outcomes except for 'delay in reaching early-intervention services', which was statistically significantly shorter in patients registered in intervention practices (95% CI = 83.5 to 360.5; P = 0.002). ConclusionGP training on first-episode psychosis is insufficient to alter referral rates to early-intervention services or reduce the duration of untreated psychosis; however, there is a suggestion that training facilitates access to the new specialist teams for early psychosis. Keywordseducation; primary health care; psychosis. INTRODUCTIONDuring the last two decades, the importance of intervening as early as possible when a young person develops a first episode of psychosis has become accepted internationally. This has been underpinned by studies demonstrating that young people with first-episode psychosis experience lengthy delays between the onset of psychotic symptoms and receipt of treatment (duration of untreated psychosis) of up to 2 years, 1-3 and that delays in accessing care are significantly associated with poorer treatment response. 4 There is a limited evidence base in this area of primary care, but GPs may be key to the identification and management of first-episode psychosis, as they are usually the first point of patient contact, 5 their involvement in the management of psychosis is associated with a reduction of the use of the Mental Health Act, 6 and they are the most common final referral agent to early-intervention services.7 However, early detection presents challenges as psychosis can take several months to emerge, 8 and may be difficult to distinguish from normal adolescent behaviour and substance misuse.9,10 There can be changes in

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General practitioners' attitudes to psychiatric and medical illness

Cited by 78 publications

References 7 publications

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study

Anti-stigma films and medical students' attitudes towards mental illness and psychiatry: randomised controlled trial

REDIRECT: cluster randomised controlled trial of GP training in first-episode psychosis

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