Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation

Allan, Stephanie; Bradstreet, Simon; McLeod, Hamish J.; Gleeson, John; Farhall, John; Lambrou, Maria; Clark, Andrea; Gumley, Andrew

doi:10.1192/bjo.2019.88

Cited by 12 publications

(11 citation statements)

References 33 publications

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“…Concern centered on fears of clinicians and services responding to changes in clinical states in unwanted ways, such as changes to medications when reporting low mood. This has been reported in other studies [ 29 , 30 ], reflecting the importance of considering the role of, and response to, personal clinical information collected in daily life from users of clinical services.…”

Section: Discussionsupporting

confidence: 64%

Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study

Valentine¹,

McEnery²,

Bell³

et al. 2020

JMIR Ment Health

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Background A small number of studies have found that digital mental health interventions can be feasible and acceptable for young people experiencing first-episode psychosis; however, little research has examined how they might be blended with face-to-face approaches in order to enhance care. Blended treatment refers to the integration of digital and face-to-face mental health care. It has the potential to capitalize on the evidence-based features of both individual modalities, while also exceeding the sum of its parts. This integration could bridge the online–offline treatment divide and better reflect the interconnected, and often complementary, ways young people navigate their everyday digital and physical lives. Objective This study aimed to gain young people’s perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment. Methods This qualitative study was underpinned by an end-user development framework and was based on semistructured interviews with 10 participants aged 19 to 28 (mean 23.4, SD 2.62). A thematic analysis was used to analyze the data. Results Three superordinate themes emerged relating to young people’s perspectives on the design and implementation of a blended model of care in first-episode psychosis treatment: (1) blended features, (2) cautions, and (3) therapeutic alliance. Conclusions We found that young people were very enthusiastic about the prospect of blended models of mental health care, in so far as it was used to enhance their experience of traditional face-to-face treatment but not to replace it overall. Aspects of blended treatment that could enhance clinical care were readily identified by young people as increasing accessibility, continuity, and consolidation; accessing posttherapy support; strengthening the relationship between young person and clinician; and tracking personal data that could be used to better inform clinical decision making. Future research is needed to investigate the efficacy of blended models of care by evaluating its impact on the therapeutic alliance, clinical and social outcomes, cost-effectiveness, and engagement.

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Section: Discussionsupporting

confidence: 64%

Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study

Valentine¹,

McEnery²,

Bell³

et al. 2020

JMIR Ment Health

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“…Similar to previous findings, participants’ accounts showed that decision-making was influenced by broader contextual factors (Allan et al, 2020), including high caseloads, perceived expectations from society and accountability with risk management a priority. Concerns about blame were raised, in accordance with previous research (Henderson et al, 2010).…”

Section: Discussionsupporting

confidence: 83%

Mental Health Professionals’ Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis

et al. 2021

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Advance Statements enable mental health patients to have their preferences considered in treatment decisions in the event of losing capacity, but their uptake is poor. This is for complex and often conflicting reasons and factors related to service user, clinician, and institutional priorities, which influence clinical practice. A Foucauldian discourse analysis approach was used to explore how 13 mental health clinicians positioned their role in relation to Advance Statements. Five positions emerged from the data: taking account of peoples’ wishes, enabling people to have their say (to a point), we know what’s best, firefighting with risk, and leverage and liability. Discursive practices demonstrated and reinforced power relations between patients, clinicians, and wider systems. These findings highlight the challenge of legitimizing the knowledge of patients and need for a cultural shift at a systems level, which recognizes the ways Advance Statements meet the needs of all stakeholders.

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“…The use of digital technology in the treatment, management, and support of psychotic disorders has been an area of interest to the digital mental health field for some time (Allan et al., 2020; 2018, 2019; Bell et al., 2018; Bradstreet, Allan, & Gumley, 2019; Lal, Nguyen, & Theriault, 2018; Lim et al., 2019). Due to the early age of onset and symptom severity, psychotic disorders can significantly impact a person’s psychological and functional life trajectory (Bucci et al., 2018).…”

Section: Introductionmentioning

confidence: 99%

Young people’s experience of online therapy for first‐episode psychosis: A qualitative study

et al. 2021

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Objectives This study aimed to understand how young people with first‐episode psychosis experienced online therapy on a Moderated Online Social Therapy (MOST) platform known as Horyzons. Methods Semi‐structured in‐depth qualitative interviews were conducted with 12 young people who had previously participated in Horyzons, a randomized controlled trial (RCT) of a long‐term digital intervention for first‐episode psychosis. Interviews were analysed using a phenomenological approach. Results This study found that the online therapy experience for first‐episode psychosis was idiosyncratic, taking on different meaning for different users. The relatively fixed therapeutic content led to experiences that included on‐demand help‐seeking, positive distraction, revision, generalization and translation, and normalization. We also found that although the experience of online therapy was motivating to some, it was overwhelming for others. Conclusions The self‐directed and flexible nature of the Horyzons online therapy gave some young people a sense of welcomed control over their mental health journey, and others felt overwhelmed by the high level of choice. Feeling overwhelmed by the level of choice appeared to interrupt their engagement with the platform, and thus their overall ability to use the intervention meaningfully. We also found that on‐demand help‐seeking and positive distraction were two functions unique to young people through online therapy and may have been related to the significant reduction in the number of overall presentations by young people to emergency departments and a non‐significant trend for lower hospitalizations due to psychosis in the intervention group of the Horyzons RCT. Practitioner points Young people used online therapy for on‐demand support to help deal with distress. Young people used online therapy to distract themselves from distress in a positive way. Some young people valued the flexibility of online therapy, which increased their motivation to engage with it. Some young people were overwhelmed by the amount of choice available to them via online therapy, which decreased their motivation to engage.

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Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation

Cited by 12 publications

References 33 publications

Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study

Blended Digital and Face-to-Face Care for First-Episode Psychosis Treatment in Young People: Qualitative Study

Mental Health Professionals’ Positions in Relation to Advance Statements: A Foucauldian Discourse Analysis

Young people’s experience of online therapy for first‐episode psychosis: A qualitative study

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