Abstract
BackgroundThe 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.MethodsData 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.ResultsMany 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.ConclusionsNeither 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.
Highlights
IntroductionThe current debate on the organisation of the mental health care system raises a question whether to prioritise specialisation of clinical teams by separation of inpatient and outpatient care or personal continuity of care approach where the same primary clinician is responsible for an individual patient within hospital and community services [2,3,4,5,6]
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 personal continuity of care approach (PCC) and SC approaches
We have identified a number of positive experiences related to different features of personal continuity of care, which are perceived by patients as advantages
Summary
The current debate on the organisation of the mental health care system raises a question whether to prioritise specialisation of clinical teams by separation of inpatient and outpatient care or personal continuity of care approach where the same primary clinician is responsible for an individual patient within hospital and community services [2,3,4,5,6]. Both approaches have their own stakeholders and both prevail in different countries as a result of mental health care reforms having significant consequences in each country in terms of allocation of resources and service organisation [5, 7,8,9]. The article explores the experiences of patients and clinicians regarding specialisation (SC) and personal continuity (PCC) of care in five European countries
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