Defining when specialised mental health care is needed: a focus group study

Abstract

BackgroundShared understanding between GPs and hospital specialists concerning when patients need specialised mental health care is important to ensure patients receive appropriate care. The large amount of rejected referrals often indicates a lack of such shared understanding.AimTo explore how patient representatives, GPs, and mental health specialists understand ‘need for specialised mental health care’, meaning that primary care is no longer sufficient.Design & settingThis qualitative study was conducted in western Norway. The study has a service user-involved research design in which GPs and patient representatives participated in all stages of the research process.MethodSix semi-structured focus group interviews were conducted. The groups were homogenous as they included only the perspectives of either GPs, mental health specialists, or patient representatives. Data were analysed using thematic analysis.ResultsThe need for specialised mental health care was assessed using two continuums: (a) the patient’s level of functioning and symptoms; and (b) characteristics of the healthcare system and the patient’s informal support networks. Assessment along these continuums were often overruled by the evaluation of expected usefulness of specialised mental health care. In addition, all participants reported they often adapted their definition of need to fit other stakeholders’ interpretations of need.ConclusionEvaluation of need for specialised mental health care is complex and depends on several factors. This may explain some of the current challenges that exist with regard to equity and timely access to appropriate healthcare interventions.

Engagement with emotional concerns in general practice: a thematic analysis of GP consultations

“…Determining what is an appropriate level of engagement is difficult and this is highlighted in the above examples of the dynamic discussion that occurs within consultations. Physical symptoms taking precedence, 1 , 25 time limitations, 1 and confidence 26 may influence the level of engagement in a consultation. For example, headaches can be a symptom of underlying pathology and impact quality of life, therefore warranting further discussion.…”

Challenges in Adopting Recovery-oriented Practices in Specialized Mental Health Care: “How Far Should Self-Determination Go; Should One be Allowed to Perish?”

“…In this article, specialized mental health care refers to secondary care provided by health care specialists in psychiatric hospitals and district psychiatric centers. Treatment in these settings is provided when primary health care is no longer deemed sufficient for the patient's needs (Nymoen et al, 2020). Norwegian legislation and guidelines prioritize patient treatment in specialized mental health care in relation to the intensity and frequency of symptoms and functional level and the expected impact of treatment on the patient's quality of life (Norwegian regulations of priority between patients in health care, 2000; The Norwegian Directorate of Health 2015).…”

“…Norwegian legislation and guidelines prioritize patient treatment in specialized mental health care in relation to the intensity and frequency of symptoms and functional level and the expected impact of treatment on the patient's quality of life (Norwegian regulations of priority between patients in health care, 2000; The Norwegian Directorate of Health 2015). Usually, specialized mental health care is considered the appropriate level of treatment if patients are assessed to have limited ability to function in daily life, have symptoms of psychosis and/or are at risk of self-harm or risk of harming others (Nymoen et al, 2020).…”

Measuring the Effect of the Early assessment Team (MEET) for patients referred to outpatient mental health care: a study protocol for a randomised controlled trial

“…One study points to possible weaknesses in the prevailing Norwegian model, as it found low agreement between the teams when comparing triage decisions based on written referrals [ 17 ]. Another weakness observed in today’s triage process is that there is often no common understanding between the referrer and the hospital specialist regarding the necessity of more specialised treatment [ 18 ].…”