Audit as discovery: context and complexity in secondary-to-primary care mental health service users

Abstract

The authors report on what began as an audit-based study comparing individual and collective profiles of users of a primary care mental health service with those formerly presented in local secondary care services, but which subsequently incorporated more descriptive, practice-near material. Demographic, risk, health and social need factors were identified from 36 service users who had previously been receiving a service from a crisis resolution or community mental health team, or from a psychology service. Depression and/or anxiety characterised the mental health problems of the majority of primary care service users, although all were experiencing complex, multiple adversities. Risk factors were similar between the services, as were health and social care needs, suggesting that primary care service users' quality of life was little different than when seen earlier in secondary care. Collectively, primary care service users had marked difficulties with psychological health, daily occupation, physical health, money, unemployment and personal and social isolation. At the individual level, however, ‘complexity’ as an untidy, dynamic amalgam of interacting internal and external factors was evident but inadequately captured by the audit methodology, the latter being too remote from user and worker contexts, so a case illustration was added. Recognition of context-based complexity may more usefully inform practitioners' interventions than talking therapies or evidence-based practice alone.