`Please see and advise': a qualitative study of patients' experiences of psychiatric outpatient care

Abstract

Background: Patient evaluations have become a sensitive indicator of service delivery and the quality of care. In this study they point to a lack of clarity surrounding the role of outpatient psychiatry in relation to primary care, raising questions about the effective integration of services for patients whose needs straddle the boundaries of primary and specialist care. Methods: Interviews with a consecutive series of 100 new referrals to two outpatient clinics compared their expectations of treatment with their subsequent experiences of psychiatric care. Patients' perception of progress was compared with clinical assessments. Follow-up interviews explored the reasons why patients tended to lapse from care. Results: The majority of patients (74%) hoped for more effective responses to often long-standing problems which had previously been treated with limited success. In approximately one-third of cases this expectation was met; the remainder reported psychiatric intervention was less than helpful (20%), or were unable to say whether it had helped or not. Most of these patients perceived little difference between psychiatric supervision and treatment offered by their GP. Seemingly impersonal consultations and failure to engage with underlying problems contributed to the high drop-out rate. Conclusion: The findings indicate a relatively poor fit between the role of the outpatient service and the circumstances that commonly lead to psychiatric referral. The implications are considered in relation to alternative options for managing psychosocial problems within primary care.