Identifying the patient perspective of the quality of mental healthcare for common chronic problems: a qualitative study

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Abstract
Objectives: To identify which aspects of quality are important to individual patients with common chronic mild-to-moderate mental health problems presenting to general practice and the best method of involving patients with chronic mental health problems in the research process, and to contrast the relevance of a generic questionnaire developed previously with these individual patient narratives. Methods: Qualitative interviews with 16 patients in Chester and Manchester were subjected to thematic analysis. Results: Six key themes were identified in relation to the individual patient experience set against a generic patient experience: (1) the healthcare system provides a generic `one size fits all' service, which is incompatible with an individual patient's experience and sense of being as an individual and that privileges medical over social care; (2) patients with mild-to-moderate mental health problems often have feelings of powerlessness and of being `lost' in a system that is more responsive to severe and acute episodes of illness than to chronic morbidity; (3) patients often have unmet needs in relation to the distress of living with mild-to-moderate mental health problems; (4) there are substantial quality deficits in primary care for people with mild-to-moderate chronic mental health problems; (5) general practitioners are rated highly, and the attributes of a good general practitioner can be identified; patients also value continuity of care; (6) engaging people with common chronic mental health problems in the research/policy process requires generic assessment of quality using questionnaires supplemented with more in-depth methods, such as interviews and focus groups. Interviewees highlighted substantial quality deficits in service provision for people with chronic mental health problems. Involving patients with chronic mild-to-moderate mental health problems in the research/policy process requires multiple user involvement strategies, including questionnaires but supplemented with interviews and discussion groups. Conclusion: Patients with common chronic mental health problems have a clear view about what constitutes quality general practice/practitioner care but highlighted quality deficits for people with chronic mental health conditions.