Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study
Abstract 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 pr...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-01-01
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| Series: | BMC Psychiatry |
| Online Access: | https://doi.org/10.1186/s12888-022-03711-x |
| _version_ | 1818300276072775680 |
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| author | Una Foye Ruth Stuart Kylee Trevillion Sian Oram Dawn Allen Eva Broeckelmann Stephen Jeffreys Tamar Jeynes Mike J. Crawford Paul Moran Shirley McNicholas Jo Billings Oliver Dale Alan Simpson Sonia Johnson |
| author_facet | Una Foye Ruth Stuart Kylee Trevillion Sian Oram Dawn Allen Eva Broeckelmann Stephen Jeffreys Tamar Jeynes Mike J. Crawford Paul Moran Shirley McNicholas Jo Billings Oliver Dale Alan Simpson Sonia Johnson |
| author_sort | Una Foye |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-13T05:04:32Z |
| format | Article |
| id | doaj.art-01e7f82760d3443cbc0f198f8545e0f0 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-13T05:04:32Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-01e7f82760d3443cbc0f198f8545e0f02022-12-21T23:58:42ZengBMCBMC Psychiatry1471-244X2022-01-0122111310.1186/s12888-022-03711-xClinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative studyUna Foye0Ruth Stuart1Kylee Trevillion2Sian Oram3Dawn Allen4Eva Broeckelmann5Stephen Jeffreys6Tamar Jeynes7Mike J. Crawford8Paul Moran9Shirley McNicholas10Jo Billings11Oliver Dale12Alan Simpson13Sonia Johnson14NIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonNIHR Mental Health Policy Research Unit Complex Emotional Needs Lived Experience Working Group, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonCentre of Psychiatry, Imperial College LondonCentre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of BristolChair of the Complex Emotional Needs Research Group, Freelance ConsultantNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonWest London Mental Health TrustNIHR Mental Health Policy Research Unit, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonChair of the Complex Emotional Needs Research Group, Freelance ConsultantAbstract 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.https://doi.org/10.1186/s12888-022-03711-x |
| spellingShingle | Una Foye Ruth Stuart Kylee Trevillion Sian Oram Dawn Allen Eva Broeckelmann Stephen Jeffreys Tamar Jeynes Mike J. Crawford Paul Moran Shirley McNicholas Jo Billings Oliver Dale Alan Simpson Sonia Johnson Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study BMC Psychiatry |
| 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 |
| url | https://doi.org/10.1186/s12888-022-03711-x |
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