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‘In Sight, Out of Mind’: The Experiences of the Compliantly Engaged Community Psychiatric Out-Patient

Community Mental Health Journal volume 48, pages 574–583 (2012)Cite this article

Abstract

Research on engagement within community-based psychiatric services in the UK has mainly focussed on factors related to those ‘at risk’ of non-attendance or non-compliance, with the tacit assumption that those in regular attendance are largely content and hence not a priority. The present study systematically explored the experiences and views of 25 people with severe and enduring mental illness who had regularly attended out-patient settings for more than 5 years. Regular attendance at consultations was not synonymous with satisfaction—in fact it masked varying levels of unmet needs and ‘de-humanisation’. In order to establish and maintain non-coercive community services that prioritise ‘recovery’ above illness and ‘risk’ containment, it is essential that the experiences of people in established and apparently ‘less troublesome’ therapeutic relationships are also taken into account and integrated into policy and practice.

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References

  • Adams, J., & Drake, R. (2006). Shared decision-making and evidence-based practice. Community Mental Health Journal, 42(1), 87–105.

    PubMed  Article  Google Scholar 

  • Benbow, S. M. (2008). New ways of working: Power, responsibility and pounds. Psychiatric Bulletin, 32(5), 195–196.

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Article  Google Scholar 

  • Burgess, D., Fu, S., & van Ryn, M. (2004). Why do providers contribute to disparities and what can be done about it? Journal of General Internal Medicine, 19(11), 1154–1159.

    PubMed  Article  Google Scholar 

  • Burns, T. (2004). Community Mental Health Teams: A guide to current practices. New York: Oxford University Press.

    Google Scholar 

  • Chase, M., Zinken, J., Costall, A., Watts, J., & Priebe, S. (2010). ‘These psychiatrists rate themselves as gods’: Disengagement and engagement discourses of people living with severe mental illness. Communication & Medicine, 7(1), 43–53.

    Article  Google Scholar 

  • Compton, M. T. (2005). Barriers to initial outpatient treatment engagement following first hospitalization for a first episode of non affective psychosis: A descriptive case series. Journal of Psychiatric Practice, 11(1), 62–69.

    PubMed  Article  Google Scholar 

  • Compton, M. T. (2010). Mental illness in 2010: Putting the recovery model into practice. Retrieved from: http://www.medscape.com/viewarticle/730233.

  • Corbin, J. M., & Strauss, A. L. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory. London: Sage Publications Inc.

    Google Scholar 

  • Davidson, L. (2003). Living outside mental illness: Qualitative studies of recovery in schizophrenia. New York: New York University Press.

    Google Scholar 

  • Davidson, L., & Strauss, J. S. (1992). Sense of self in recovery from severe mental illness. British Journal of Medical Psychology, 65(2), 131–145.

    PubMed  Article  Google Scholar 

  • Deegan, P. (1996). Recovery as a journey of the heart. Psychiatric Rehabilitation Journal, 19(3), 91–97.

    Google Scholar 

  • Deegan, P., & Drake, R. (2006). Shared decision making and medication management in the recovery process. Psychiatric Services, 57(11), 1636–1639.

    PubMed  Article  Google Scholar 

  • Department of Health. (2002). Community Mental Health Teams: Mental health policy implementation guide. London: Department of Health. Retrieved from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4085759.

  • Department of Health. (2005). New ways of working for psychiatrists: Enhancing effective, person-centred services through new ways of working in multidisciplinary and multiagency contexts (final report ‘but not the end of the story’). London: Department of Health. Retrieved from http://www.dh.gov.uk/assetRoot/04/12/23/43/04122343.pdf.

  • Department of Health. (2007). New ways of working for everyone: A best practice implementation guide. London: Department of Health. Retrieved from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079102.

  • Department of Health. (2011). No health without mental health: A cross-government mental health outcomes strategy for people of all ages. London: Department of Health. Retrieved from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124058.pdf.

  • Dziopa, F., & Ahern, K. J. (2009). What makes a quality therapeutic relationship in psychiatric/mental health nursing: A review of the research literature. The Internet Journal of Advanced Nursing Practice, 10(1). Retrieved from: http://www.ispub.com/journal/the_internet_journal_of_advanced_nursing_practice/volume_10_number_1_8/article/what_makes_a_quality_therapeutic_relationship_in_psychiatric_mental_health_nursing_a_review_of_the_research_literature.html.

  • Farkas, M. (2007). The vision of recovery today: What it is and what it means for services. World Psychiatry, 6(2), 68–74.

    PubMed  Google Scholar 

  • Farkas, M., Gagne, C., Anthony, W., & Chamberlin, J. (2005). Implementing recovery oriented evidenced based programmes: Identifying the critical dimensions. Community Mental Health Journal, 41(2), 141–158.

    PubMed  Article  Google Scholar 

  • Garety, P. A., & Rigg, A. (2001). Early psychosis in the inner city: A survey to inform service planning. Social Psychiatry and Psychiatric Epidemiology, 36(11), 537–544.

    PubMed  Article  CAS  Google Scholar 

  • Killapsy, H., Banerjee, S., King, M., & Lloyd, M. (1999). Non-attendance at psychiatric outpatient clinics: Communication and implications for primary care. The British Journal of General Practice, 49(448), 880–883.

    Google Scholar 

  • Killapsy, H., Banerjee, S., King, M., & Lloyd, M. (2000). Prospective controlled study of psychiatric out-patient non-attendance—Characteristics and outcomes. British Journal of Psychiatry, 176(2), 160–165.

    Article  Google Scholar 

  • Laing, R. D. (1990). The divided self: An existential study in sanity and madness. Middlesex, England: Penguin Books.

    Google Scholar 

  • Lelliott, P. (2008). Time for honest debate and critical friends. Commentary on… New ways of working. Psychiatric Bulletin, 32(2), 47–48.

    Article  Google Scholar 

  • Lester, H., & Gask, L. (2006). Delivering medical care for patients with serious mental illness or promoting a collaborative model of recovery? British Journal of Psychiatry, 188(5), 401–402.

    PubMed  Article  Google Scholar 

  • Mitchell, A. J., & Selmes, T. (2007). Why don’t patients attend their appointments? Maintaining engagement with psychiatric services. Advances in Psychiatric Treatment, 13(6), 423–434.

    Article  Google Scholar 

  • National Workforce Programme (NWP). (2009). ‘MOVING ON’ from New Ways of Working to a creative, capable workforce. Retrieved from: http://www.newwaysofworking.org.uk/.

  • O’Brien, A., Fahmy, R., & Singh, S. P. (2009). Disengagement from mental health services. A literature review. Social Psychiatry and Psychiatric Epidemiology, 44(7), 558–568.

    PubMed  Article  Google Scholar 

  • Priebe, S., Fakhoury, W., & Watts, J. (2003). Assertive Outreach teams in London: Patient characteristics and outcomes. Pan-London Assertive Outreach Study, Part 3. British Journal of Psychiatry, 18(2), 148–154.

    Article  Google Scholar 

  • Priebe, S., Watts, J., Chase, M., & Matanov, A. (2005). Processes of disengagement and engagement in assertive outreach patients: A qualitative study. The British Journal of Psychiatry, 187(5), 438–443.

    PubMed  Article  Google Scholar 

  • Ridgway, P. (2001). Restorying psychiatric disability: Learning from first person recovery narratives. Psychiatric Rehabilitation Journal, 24(4), 335–343.

    PubMed  CAS  Google Scholar 

  • Royal College of Psychiatrists. (2009). Community Mental Health Teams. Retrieved from: http://www.rcpsych.ac.uk/mentalhealthinfo/treatments/communityteams.aspx.

  • Scottish Recovery Network. (2009). Scottish Recovery Indicator. Retrieved from: http://www.scottishrecoveryindicator.net/.

  • Shattell, M. M., McAllister, S., Hogan, B., & Thomas, S. P. (2006). “She took the time to make sure she understood”: Mental health patients’ experiences of being understood. Archives of Psychiatric Nursing, 20(5), 234–241.

    PubMed  Article  Google Scholar 

  • Shattell, M. M., Starr, S. S., & Thomas, S. P. (2007). ‘Take my hand, help me out’: Mental health service recipients’ experience of the therapeutic relationship. International Journal of Mental Health Nursing, 16(4), 274–284.

    PubMed  Article  Google Scholar 

  • Shepherd, G., Boardman, J., & Burns, M. (2010). Implementing recovery: A methodology for organisational change. London: Sainsbury Centre for Mental Health.

    Google Scholar 

  • Spencer, E., Birchwood, M., & McGovern, D. (2001). Management of first-episode psychosis. Advances in Psychiatric Treatment, 7(2), 133–140.

    Article  Google Scholar 

  • Tait, L., Birchwood, M., & Trower, P. (2003). Predicting engagement with services for psychosis: Insight, symptoms and recovery style. The British Journal of Psychiatry, 182(2), 123–128.

    PubMed  Article  Google Scholar 

  • Torrey, W., Rapp, C., van Tosh, L., McNabb, C., & Ralph, R. (2005). Recovery principles and evidence-based practice: Essential ingredients of service improvement. Community Mental Health Journal, 41(1), 91–100.

    PubMed  Article  Google Scholar 

  • Vize, C., Humphries, S., Brandling, J., & Mistral, W. (2008). New ways of working: Time to get off the fence. Psychiatric Bulletin, 32(2), 44–45.

    Article  Google Scholar 

  • von Korff, M., Gruman, J., Schaefer, J., Curry, S. J., & Wagner, E. H. (1997). Collaborative management of chronic illness. Annals of Internal Medicine, 127(12), 1097–1102.

    Google Scholar 

  • Warner, R. (2010). Does the scientific evidence support the recovery model? The Psychiatrist, 34, 3–5.

    Article  Google Scholar 

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Acknowledgments

We are especially grateful to all the participants who took part in the study. Many thanks also to Elaine Chase and Stephen Ogunremi for fruitful discussions on earlier drafts, and to the anonymous reviewers who helped to strengthen the manuscript.

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Affiliations

  1. Department of Psychology, University of Portsmouth, King Henry Building, King Henry I Street, Portsmouth, Hampshire, UK

    Mike Chase, Lynn Lansbury, Justin Hansen, Ana Ambrose, Chris Thomas, Clare Wilson & Alan Costall

  2. Department of Psychology, University of Surrey, Guildford, UK

    Andrea Malden

Authors
  1. Mike Chase
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  2. Andrea Malden
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  3. Lynn Lansbury
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  4. Justin Hansen
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  5. Ana Ambrose
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  6. Chris Thomas
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  7. Clare Wilson
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  8. Alan Costall
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Correspondence to Mike Chase.

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Chase, M., Malden, A., Lansbury, L. et al. ‘In Sight, Out of Mind’: The Experiences of the Compliantly Engaged Community Psychiatric Out-Patient. Community Ment Health J 48, 574–583 (2012). https://doi.org/10.1007/s10597-011-9414-9

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  • DOI: https://doi.org/10.1007/s10597-011-9414-9

Keywords

  • Engagement
  • Out-patient
  • Therapeutic relationship
  • Qualitative
  • Identity
  • Recovery movement