Staff experiences of encountering and treating outpatients with substance use disorder in the psychiatric context: a qualitative study

Elisabeth Petersén,Anna Thurang,Anne H Berman

doi:10.1186/s13722-021-00235-9

Elisabeth Petersén, Anna Thurang + Show 1 more

Open Access

https://doi.org/10.1186/s13722-021-00235-9

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Abstract

BackgroundHigh comorbidity exists between mental illness and substance use disorders (SUD). Patients in psychiatry living with problematic alcohol or drug consumption can experience a sense of exclusion, where seeking help for SUD can be perceived as stigmatizing. The aim of this study is to illuminate staff experiences of encountering patients with SUD within the psychiatric outpatient context.MethodsThe study was exploratory, with a qualitative design. Interviews with outpatient psychiatry managers and focus groups with clinical staff focused on the experience of encountering patients with SUD. Data were evaluated using content analysis inspired by phenomenological-hermeneutic methodology.ResultsThree themes were identified and each illuminated by two sub-themes. Bridging the organizational gap included sub-themes of having an established collaboration and facing difficulties in the collaboration; Having beliefs about the patient you encounter included sub-themes of working with patients who are exposed to prejudicial thoughts and expressing prejudicial thoughts about the patient. Striving to achieve a therapeutic alliance included sub-themes of having a feeling of developing together and supporting the patient towards recovery.ConclusionA life-world perspective, used to interpret results, indicated that caring for patients with SUD in psychiatry was perceived as difficult, where collaboration between psychiatry and addiction care was often experienced as problematic. Based on these findings, we believe that the current gap between the psychiatry and addiction care could be reduced to some extent by offering patients digital treatment for SUD. In this way, patients could remain under the care of their regular psychiatric clinic without having to physically visit SUD services. Thus, a virtual bridge could be established to bring psychiatry and addiction care closer to each other for the patients’ benefit.

Highlights

High comorbidity exists between mental illness and substance use disorders (SUD)
Naïve understanding Caring for patients in psychiatry with SUD was perceived by participants as difficult
This study contributed findings based on content and phenomenological-hermeneutic analysis of interviews with unit managers for psychiatric outpatient clinics as well as focus group interviews with staff working in psychiatric outpatient clinics

Summary

Introduction

High comorbidity exists between mental illness and substance use disorders (SUD). The clinical picture is further complicated by the problems that patients with comorbidity often show in other areas, such as finance, housing and social contacts. These patients often receive interventions from several different caregivers including social services [6]. This happens despite research showing that integrated treatment, addressing all the patient’s conditions, can lead to more consistent improvement in treatment outcomes [7]. The healthcare professional-patient relationship has been found to greatly influence the patient’s chance of responding positively to rehabilitation and treatment offered for substance use [10]. Patients’ engagement can be related to their inner motivation to change, which depends on their personal experiences, physical health or lack of experienced ability to manage their life situation [12, 13]

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