Identifying the patient perspective of the quality of mental healthcare for common chronic problems: a qualitative study

Abstract

To identify which aspects of quality are important to individual patients with common chronic mild-to-moderate mental health problems presenting to general practice and the best method of involving patients with chronic mental health problems in the research process, and to contrast the relevance of a generic questionnaire developed previously with these individual patient narratives. Qualitative interviews with 16 patients in Chester and Manchester were subjected to thematic analysis. Six key themes were identified in relation to the individual patient experience set against a generic patient experience: (1) the healthcare system provides a generic 'one size fits all' service, which is incompatible with an individual patient's experience and sense of being as an individual and that privileges medical over social care; (2) patients with mild-to-moderate mental health problems often have feelings of powerlessness and of being 'lost' in a system that is more responsive to severe and acute episodes of illness than to chronic morbidity; (3) patients often have unmet needs in relation to the distress of living with mild-to-moderate mental health problems; (4) there are substantial quality deficits in primary care for people with mild-to-moderate chronic mental health problems; (5) general practitioners are rated highly, and the attributes of a good general practitioner can be identified; patients also value continuity of care; (6) engaging people with common chronic mental health problems in the research/policy process requires generic assessment of quality using questionnaires supplemented with more in-depth methods, such as interviews and focus groups. Interviewees highlighted substantial quality deficits in service provision for people with chronic mental health problems. Involving patients with chronic mild-to-moderate mental health problems in the research/policy process requires multiple user involvement strategies, including questionnaires but supplemented with interviews and discussion groups. Patients with common chronic mental health problems have a clear view about what constitutes quality general practice/practitioner care but highlighted quality deficits for people with chronic mental health conditions.