UNderstanding SErvices for people with Complex MENtal Health Difficulties (UNSEEN): a mixed methods study

Problem

This work aimed to understand the experience of GPs and people with complex mental health difficulties. We used the term complex mental health difficulties as a broad term to include to personality disorders, the consequences of trauma and persistent depression. People with complex mental health diffiulties frequently experience poor care as they are seen as too complex for services such aimed at common mental disorders but not serious enough for specialist mental health teams. We aimed to examine how general practices can better identify people with complex mental health difficulties and integrate primary care and specialist psychological input. Objectives related to (1) GP’s perceptions of complex mental health difficulties, (2) patient experience, particularly of general practice, (3) using electronic health data to facilitate better recognition of complex mental health difficulties (4) synthesising the findings to provide guidance for practices.

Approach

We conducted a mixed methods study. This presentation will describe two qualitative workstreams: (1) interviews with 11 GPs’ to understand how they recognise and provide care for people with complex mental health difficulties; 2) interviews with 19 people with complex mental health difficulties about their experience of primary care and its relationship with specialist psychological services. Both sets of interviews were analysed using reflexive thematic analysis. A third workstream relating to electronic health records has been submitted separately. We then triangulated all three studies. People with lived experience contributed to study materials, analysis, and reporting.

Findings

The results will present a triangulation of the findings from the two interview studies and the database study. Key themes included (1) Complexity: both professionals and people with lived experience recognised this, but there was no common language for communicating it; (2) Experience of trauma: this was recognised by professionals and those with lived experience as central, but by the professionals as outside their scope and by the patients as something often handled badly; (3) Diagnosis: professionals were agnostic or negative about diagnoses such as personality disorder; those with lived experience included people who had found diagnosis valuable and affirming (if handled well).

Consequences

This research surfaced important but frequently hidden issues relating to the care of people with complex mental health difficulties. These issues still largely remain "Unseen"