Abstract
BackgroundAlthough GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues.AimTo explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice.Design & settingPatient participants were recruited from community mental health clinics in Brisbane, Australia.MethodIndividual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity.ResultsSixteen interviews were conducted by one author (RW), with an average duration of 29 minutes. Three overarching themes were identified: being heard, being known, and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known, and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect GPs who predominantly engage with their physical health to have negative attitudes to mental illness.ConclusionSome GPs play central roles in patients’ mental health care. Barriers for others need further exploration, and may include time, confidence, and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in their general practice consultations.
Highlights
Despite the high prevalence of mental health issues in general practice consultations [1] and reports that many mental health consumers and carers use their GP as their primary mental health support [2], the role of the general practitioner in the care of patients with severe and persistent mental illness remains contested.On the one hand, it has been argued that the expertise and skillset of general practitioners is inadequate to provide adequate care for these clients or patients without additional psychiatric training [3, 4]
Design and Setting Patient participants were recruited from community mental health clinics in Brisbane, Australia
General practice; mental disorders; physician-patient relations How this fits in Many general practitioners care for people who suffer from the impacts of severe and persistent mental illness, and this has been described as core business for general practice
Summary
Despite the high prevalence of mental health issues in general practice consultations [1] and reports that many mental health consumers and carers use their GP as their primary mental health support [2], the role of the general practitioner in the care of patients with severe and persistent mental illness remains contested.On the one hand, it has been argued that the expertise and skillset of general practitioners is inadequate to provide adequate care for these clients or patients ( referred to as “patients”) without additional psychiatric training [3, 4]. Care of people with severe mental illness has been described as core business for general practice [9], and general practitioners are well placed to integrate and coordinate the multiple community services with which many patients are engaged, a well-known difficulty in delivering health and social care to vulnerable clients with complex needs [10,11,12]. It is important to understand patient expectations and experiences of general practitioner roles in their mental health, and identify opportunities for improving care. Aim To explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice. Patients may suspect negative attitudes to mental illness in GPs who actively engage predominantly with their physical health
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