Surgical experience for patients with serious mental illness: a qualitative study

Abstract

Background People with serious mental illness (SMI) have significantly worse surgical outcomes compared to the general population. There are many contributing factors to this complex issue, however consideration of the surgical experience from the patient’s own perspective has never been undertaken. This lack of understanding prevents the provision of truly patient centred care and may limit the impact of potential improvement initiatives. Therefore this study aims to describe and better understand the surgical experience from the perspective of patients with SMI. Methods Within this qualitative study, semi-structured, audio-recorded interviews were conducted between August 2019 – June 2020, with 10 consenting participants with SMI who had surgery in the previous 2 years. A thematic analysis approach was used to explore both the positive and negative aspects of the participant’s surgical experience commencing from pre-operative consultation to hospital discharge and follow-up. Results Four main themes and related subthemes emerged including i) the perceived lack of mental ill health recognition, ii) highly variable patient and clinician interactions, iii) the impact of healthcare services, and iv) strategies for improvement. Conclusion Surgical patients with SMI want to be treated like everyone else whilst still having their mental ill health acknowledged and proactively managed despite this rarely occurring, which is valuable information for all surgical teams to consider and learn from. Participants were able to describe several readily implementable strategies to potentially improve their care and overall surgical experience, and as such highlight considerable opportunities for these to be tested and evaluated for this underserved patient group.

Acceptability and face validity of two mental health screening tools for use in the routine surgical setting

“…In contrast, several psychiatrists indicated that due to the known mistrust of the health system and fear of stigmatization, patients with SMI will not respond truthfully to the tool no matter what is included, resulting in false negatives. Whilst these challenges are well known [ 25 ] and important to highlight, none of the mental health consumers in this study reported being unwilling to use the tool, which is in line with the feedback previously highlighted regarding surgical patients with SMI wanting to have their mental health acknowledged [ 9 ]. The brevity and accuracy of the K10 has also been demonstrated as being a suitable tool for screening SMI in the general population [ 26 ].…”

“…Although limited, there is evidence to show that even modest preoperative psychological interventions can have favourable effects on surgical patient outcomes by matching a range of interventions to the needs of the patients [ 8 ]. In addition, and perhaps most critically, patients with SMI have described their support and desire for having the status of their mental health acknowledged prior to surgery and identified screening as a potential solution [ 9 ]. Currently there are no known mental health screening tools designed specifically for use in the routine surgical setting that cover a broad range of psychological conditions and symptoms.…”

Severe Mental Illness: A Contraindication to Watchful Waiting in Hernia Management?

“…Surgeons are more likely to overlook comorbid psychiatric disorders than physical comorbidities. They infrequently ask about patients’ mental health and report low confidence in caring for patients with mental health issues [ 20 ]. Educational initiatives must be undertaken to enlighten surgeons on the unique needs of this disadvantaged population to improve surgical outcomes.…”

Disparities in Emergency Care Among Patients with Mental Illness

“…[17][18][19][20][21][22][23] Systemrelated factors result in the healthcare system systematically failing to prevent, identify and treat physical diseases. 12,24,25 Also, health professionals, including surgeons and emergency care professionals, still demonstrate stigmatising behaviours towards patients with severe mental illness [26][27][28][29] which may explain some of the described variation.…”

“…21,22,116,126,129,[131][132][133] For patients with mental health, stigma may be a particular problem. 26,27,134 . Likewise, diagnostic overshadowing, i.e., 'assuming that a symptom is due to co-existing mental health conditions rather than exploring the cause of the patient's symptoms' is being reported for this patient groups.…”