Personal continuity versus specialisation of care approaches in mental healthcare: experiences of patients and clinicians—results of the qualitative study in five European countries

Abstract

Background The current debate on organisation of the mental health care raises a question whether to prioritise specialisation of clinical teams or personal continuity of care. The article explores the experiences of patients and clinicians regarding specialisation (SC) and personal continuity (PCC) of care in five European countries. Methods Data were obtained via in-depth, semi-structured interviews with patients (N = 188) suffering from mental disorders (F20-49) and with clinicians (N = 63). A maximum variation sampling was applied to assume representation of patients and of clinicians with different characteristics. The qualitative data from each country were transcribed verbatim, coded and analysed through a thematic analysis method. Results Many positive experiences of patients and clinicians with the PCC approach relate to the high quality of therapeutic relationship and the smooth transition between hospital and community care. Many positive experiences of patients and clinicians with the SC approach relate to concepts of autonomy and choice and the higher adequacy of diagnosis and treatment. Clinicians stressed system aspects of providing mental health care: more effective management structure and higher professionalization of care within SC approach and the lower risk of disengagement from treatment and reduced need for coercion, restraint, forced medication or involuntary admission within PCC. Conclusions Neither the PCC, nor the SC approach meets the needs and expectations of all patients (and clinicians). Therefore, future reforms of mental health services should offer a free choice of either approach, considering that there is no evidence of differences in patient outcomes between PCC and SC approaches. Keywords Mental health care organisation • Functional system • Integrated system All authors declare that the submitted work has not been published before (neither in English nor in any other language) and that the work is not under consideration for publication elsewhere.

Continuity of care and a functionally split system of care

“…Likewise, the traditional model also made the supervision of junior doctors and the ward/s more difficult. Klingemann et al (2020) found that a functionally split model of care has benefits, specifically managerial and professional.…”

“…Thus, although the move to a functionally split system has addressed some of the issues evident in inpatient units’ other issues are yet to be addressed or have emerged as a result of system changes. Thus, both systems are differentially beneficial with neither meeting the needs of all stakeholders (Klingemann et al, 2020).…”

“…A split system of care has increased the need for coercive and involuntary treatment (Klingemann et al, 2020). While the demands associated with more patients being admitted under the Mental Health Act are also harder to fulfil under a split system.…”

“…Clearly, treatment that is voluntary is preferential and better for the patient. Furthermore, patients are more engaged with their treatment and are less likely to require coercive treatment under a COC model of care (Klingemann et al, 2020).…”

“…Overall findings have been mixed regarding whether a system based upon COC is more beneficial than a functionally split system of care; with research finding no difference between the two systems when a range of aspects are considered (Giacco et al, 2018; Klingemann et al, 2020). As previously mentioned, neither system meets the needs of all stakeholders; however, a functionally split system is weighted in favour of administrative and organizational-level factors.…”