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Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

BACKGROUND: Individuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision...

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Autores principales: Foye, Una, Stuart, Ruth, Trevillion, Kylee, Oram, Sian, Allen, Dawn, Broeckelmann, Eva, Jeffreys, Stephen, Jeynes, Tamar, Crawford, Mike J., Moran, Paul, McNicholas, Shirley, Billings, Jo, Dale, Oliver, Simpson, Alan, Johnson, Sonia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796601/
https://www.ncbi.nlm.nih.gov/pubmed/35090418
http://dx.doi.org/10.1186/s12888-022-03711-x
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author Foye, Una
Stuart, Ruth
Trevillion, Kylee
Oram, Sian
Allen, Dawn
Broeckelmann, Eva
Jeffreys, Stephen
Jeynes, Tamar
Crawford, Mike J.
Moran, Paul
McNicholas, Shirley
Billings, Jo
Dale, Oliver
Simpson, Alan
Johnson, Sonia
author_facet Foye, Una
Stuart, Ruth
Trevillion, Kylee
Oram, Sian
Allen, Dawn
Broeckelmann, Eva
Jeffreys, Stephen
Jeynes, Tamar
Crawford, Mike J.
Moran, Paul
McNicholas, Shirley
Billings, Jo
Dale, Oliver
Simpson, Alan
Johnson, Sonia
author_sort Foye, Una
collection PubMed
description BACKGROUND: Individuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision for this population is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users encounter. Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views. METHODS: We used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach. FINDINGS: Main themes were: 1) Acknowledging the heterogeneity of needs: the need for a person-centred care approach and flexibility when working with CEN, 2) ‘Still a diagnosis of exclusion’: Exploring the healthcare provider-level barriers to providing care, and 3) Understanding the exclusionary culture: exploring the system-based barriers to providing care for CEN. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. Major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support. DISCUSSION: Overall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that best practice care is provided for people with CEN. Particularly prominent is the need to put in place systemwide training and support for clinicians working with CEN, encompassing generic and specialist services, and to challenge the stigma still experienced throughout the system. CONCLUSIONS: Staff working with this service user group report that delivering best practice care requires services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.
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spelling pubmed-87966012022-01-31 Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study Foye, Una Stuart, Ruth Trevillion, Kylee Oram, Sian Allen, Dawn Broeckelmann, Eva Jeffreys, Stephen Jeynes, Tamar Crawford, Mike J. Moran, Paul McNicholas, Shirley Billings, Jo Dale, Oliver Simpson, Alan Johnson, Sonia BMC Psychiatry Research BACKGROUND: Individuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision for this population is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users encounter. Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views. METHODS: We used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach. FINDINGS: Main themes were: 1) Acknowledging the heterogeneity of needs: the need for a person-centred care approach and flexibility when working with CEN, 2) ‘Still a diagnosis of exclusion’: Exploring the healthcare provider-level barriers to providing care, and 3) Understanding the exclusionary culture: exploring the system-based barriers to providing care for CEN. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. Major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support. DISCUSSION: Overall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that best practice care is provided for people with CEN. Particularly prominent is the need to put in place systemwide training and support for clinicians working with CEN, encompassing generic and specialist services, and to challenge the stigma still experienced throughout the system. CONCLUSIONS: Staff working with this service user group report that delivering best practice care requires services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision. BioMed Central 2022-01-28 /pmc/articles/PMC8796601/ /pubmed/35090418 http://dx.doi.org/10.1186/s12888-022-03711-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Foye, Una
Stuart, Ruth
Trevillion, Kylee
Oram, Sian
Allen, Dawn
Broeckelmann, Eva
Jeffreys, Stephen
Jeynes, Tamar
Crawford, Mike J.
Moran, Paul
McNicholas, Shirley
Billings, Jo
Dale, Oliver
Simpson, Alan
Johnson, Sonia
Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
title Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
title_full Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
title_fullStr Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
title_full_unstemmed Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
title_short Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
title_sort clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8796601/
https://www.ncbi.nlm.nih.gov/pubmed/35090418
http://dx.doi.org/10.1186/s12888-022-03711-x
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