Fragmented Pathways to Care

Abstract

Using qualitative methods, this study examined how, and under what circumstances, suicidal men used mental health services. In particular, the analyses focused on fragmented pathways to care. Fifteen men with a history of suicidal and aggressive behaviors and a diagnosis of borderline personality disorder and/or antisocial personality disorder participated in semistructured interviews that consisted of questions about their mental health status and experiences with mental health and addiction services. Interviews were taped and transcribed. An iterative, inductive qualitative analytic process was used. Men followed a cyclical pattern wherein negative experiences with health care providers were said to be followed by avoidance of health care settings, crisis, and then by involuntary service utilization. Men identified five health care provider and three personal practices, and two types of episodes they believed to contribute to their fragmented pathways to care. Implementation of specialized interventions, and providing patients with more information and more opportunity to participate in decisions, may improve interactions between patients and providers and improve patients' mental health status.

Qualitative Analysis of Resources and Barriers Related to Treatment of Borderline Personality Disorder in the United States

“…Inadequate knowledge regarding BPD may lead to inappropriate treatment-seeking, poor implementation of treatment plans, and misallocation of mental health resources (7, 26, 28). These outcomes often result in diminished patient confidence in service providers and reduced likelihood of seeking treatment (9). …”

“…For instance, Strike and colleagues explored the circumstances of health service use among suicidal men with BPD and found that prior negative experiences with healthcare providers frequently contributed to avoidance of healthcare settings and “fragmented pathways” to care (9). Other research has examined perceived lack of supportive services for caregivers and family members (6).…”

Patients’ Experiences of Emergency Hospital Care Following Self-Harm: Systematic Review and Thematic Synthesis of Qualitative Research

“…Although the experiences of hostile and gentle care demonstrate the varied and contrasting experiences available to patients, they do not exist as a binary. Many patients reported to have negative and positive experiences simultaneously (Brown & Kimball, 2013;Nehls, 1999;Spandler, 1996;Strike et al, 2006). Importantly, as Chandler (2016) highlights, accounts of gentle care can actually serve to reinforce and even magnify negative clinical encounters, being used "to underline the power of the 'horror stories.'…”

“…Sub-theme: Impact on future disclosure and help-seeking. Seven studies explored how individuals' negative encounters with clinicians made them less inclined to engage in future disclosure or help-seeking (Chandler, 2016;Harris, 2000;Hausmann-Stabile et al, 2017;Hunter et al, 2013;Kirkland, 2000;Owens et al, 2016;Strike et al, 2006). Such encounters were equally evidenced across different age groups, genders, and the presenting behaviors.…”

“…With regard to treatment provision, only a small number of studies provided a comprehensive breakdown of the different aspects of the care pathway or specified the medical professionals encountered. Where studies disassembled care components, two considered psychosocial assessments (Horrocks et al, 2005;Hunter et al, 2013), nine referenced the point of admission (Chandler, 2016;Ghio et al, 2011;Hausmann-Stabile et al, 2017;Holliday, 2012;Horrocks et al, 2005;Manning et al, 2015;Mitten et al, 2016;Owens et al, 2016;Strike et al, 2006), and nine reported on discharge and the continuity of care (Chandler, 2016;Crockwell & Burford, 1995;Harris, 2000;Hausmann-Stabile et al, 2017;Horrocks et al, 2005;Hunter et al, 2013;Kirkland, 2000;Owens et al, 2016;Strike et al, 2006). Understanding of care experiences are further restricted by the number of countries in which studies were conducted (n = 7), and further comparative research is required to assess the relevance of the synthesis to a wider range of health care systems.…”