Complex mental health difficulties: a mixed-methods study in primary care.

Abstract

The term 'complex mental health difficulties' describes long-term difficulties with emotional regulation and relationships, including personality disorders, complex trauma, and dysthymia. People with complex mental health difficulties often experience episodic and crisis-related care. To understand how general practices can better recognise people with complex mental health difficulties and provide the best care. A concurrent mixed-methods study was conducted with three components: two qualitative studies and a database study. People with lived experience of complex mental health difficulties were consulted throughout the study. Qualitative interviews with GPs and people with complex mental health difficulties were conducted and transcripts analysed using thematic analysis. For the database element a retrospective case-control analysis was conducted using the Connected Bradford database. Integration of results was conducted using 'following the thread' and triangulation methods. In the GP interviews, four overarching themes were identified: the challenges of complex mental health difficulties; role expectations; fragmented communication, fragmented care; and treatment in the primary care context. In the lived experience interviews, four main themes were identified: 'How I got here'; varied care experiences; traversing mental health services; and 'being seen'. In the database study element, approximately 3040 (0.3% of the database population of approximately 1.2 million) records met our criteria for complex mental health difficulties, suggesting significant undercoding. The most informative feature was the count of unique psychiatric diagnoses. From the triangulation process, five meta-themes were identified: complexity of mental health difficulties; experience of trauma; diagnosis; specialist services; and GP services. The current organisation of care and lack of an acceptable language for complex mental health difficulties means that patients' needs continue to go unrecognised and 'unseen'.