Medication Optimisation and Safety in the Community Following Mental Health Hospital Discharge: Early Insights from a Qualitative Interview Study

Problem

For those with mental illness medication safety issues are common following mental health hospital discharge. The importance of networks of stakeholders and agencies in supporting safe discharge from acute care is understood, with earlier work characterising the medication ‘work’ carried out by patients and carers and social network support for medicines management post discharge . There is, however, little in the way of research that focuses upon post-discharge medication safety for patients with mental illness in the community. This study aimed to explore the perspectives of people with lived experience, their carers and community based health professionals, of medicine taking, knowledge transfer and care following mental health hospital discharge. We aimed to understand the influence of social processes, practices and support networks upon medication safety.

Approach

People with lived experience of mental illness who had at least one discharge from mental health inpatient care in the last 5 years, their carers and healthcare staff working in the community were recruited to the study. Recruitment was via social media and the professional networks of the research team.Semi-structured interviews were conducted online with a range of stakeholders to explore medication use and safety post-discharge. Questions focused on medication related activities, knowledge transfer practice, support needs and key challenges and facilitators of medication safety in primary care following discharge. Thematic analysis of early interviews was conducted to capture how supporting communities, sharing of knowledge between actors and the ‘medication work’ of carers influenced safe and optimal medication practices in primary care post-hospital discharge.

Findings

Early insights from thirteen interviews conducted with eight healthcare professionals and five carers suggested a fragmented and disrupted network of care provision. This could include diversion of responsibility and lack of collaboration across professional and organisational boundaries. Interprofessional communication about patients medications was reliant upon sociotechnical systems that included different methods of knowledge transfer involving variable access to patient health records and multiple agencies (for example community mental health teams, and support workers) Carers, often family members, undertook care-coordination roles and medication work including providing support for, and monitoring, safe medicine use. This involved supporting with medicines taking and adherence. Challenges included disruptions involving changes to medicines, concerns about non-adherence and subsequent post-discharge deterioration of health for patients. Carers themselves relied upon a network of support from other family members, other carers and healthcare professionals.

Consequences

Further insight is needed from people with lived experience to understand their perspectives. We plan to conduct further interviews and subsequently undertake workshops with a range of stakeholders to co-design a practical framework guiding medicines optimisation and safety in the community following discharge from inpatient mental health services. The framework and supporting ‘user guide’ will be intended for use by health professionals and patients/carers.