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

Abstract

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.

Experiences, opinions and current policies on users’ choice and change of the allocated primary mental health professional: a survey among directors of community mental health centers in the Emilia-Romagna region, Italy

“…Moreover, the hope that a new psychiatrist will change the prescribed psychotropic medications was commonly recognised as the main motivation prompting a request to change the PMHP. This result is in line with our previous findings [25], but no other scientific analysis on this topic has been performed so far to our knowledge. It is logical to think that if shared decisions about medication were better implemented, disagreement about medication regimen between users and psychiatrists would be a less likely reason for requesting a change of PMHP.…”

“…A random allocation of users to PMHPs (so-called "fixed-rota") is by far the most common method; according to such a method, users, as well as professionals, do not generally have a say in the initial match user/PMHP. This finding corresponds with results of our focus group based qualitative study on the same topic that was conducted in Modena in 2017 [25] and with results of other studies on this topic [20,22].…”

“…First, although the process of allocating and changing PMHPs in CMHCs was explored in order to address the level of service users' involvement, we did not interview service users in this study. However, this was the object of a specific focus group study conducted by the authors that will be reported elsewhere [25]. Second, the present survey was based on an electronic questionnaire; respondents were asked to answer the questionnaire, which was sent by e-mail.…”

“…Furthermore, a qualitative study that was recently conducted by the authors of this study involving users, caregivers and PMHPs in the Modena area (Northern Italy) [25] found that neither users nor professionals were generally involved in the initial choice of the PMHP and that no official written guideline on these topics was available in the investigated area.…”

“…Meanwhile, in Italy, despite the presence of a long tradition of community-centred provision of mental health [21], users generally cannot choose their PMHP in CMHCs [22]. A preliminary scoping review [23] showed that little research is available on these topics. According to this review, users would prefer to be allowed to express their preferences in terms of choosing their own PMHP [24].…”