Recovery from psychosis in primary care

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Abstract

This thesis entitled ‘Recovery from psychosis in primary care’ was submitted by Seamus Ryan to The University of Manchester for the degree of Doctor of Philosophy (PhD) in the Faculty of Medical and Human Sciences on June 29th, 2011. It aimed to explore personal definitions and experiences of recovery from psychosis for service users (SUs) and general practitioners (GPs), as well as indentify factors which might promote or hinder recovery in a primary care context, and identify interventions which might be required to enhance the promotion of recovery in primary care. A review of existing literature pertaining to the concept of ‘recovery’ was undertaken, and differing conceptualisations of ‘recovery’ were analysed and synthesised through the use of a Critical Interpretive Synthesis. Semi-structured interviews were conducted with 24 GPs and 20 SUs. Two mixed focus groups were also carried out as follow-ups with 5 GPs and 5 SUs. The data was analysed using a modified grounded theory approach. Factors reported to promote recovery in primary care included: autonomy, choice, and empowerment for SUs in treatment decisions; signposting of peer-supported groups and services by GPs; enhancement of SUs’ social support networks by GPs; advocacy and independent analysis provided by GPs; a whole-person approach to recovery (social and biomedical); less stigmatising environment of primary care; and families of SUs and GPs working together in collaboration, often having built up a trusting relationship over time through continuity of care. The following potential interventions for enhancing recovery in primary care were identified: SU-led training for GPs regarding psychosis knowledge and attitudes; raising GPs’ awareness of local services and groups by encouraging service managers and group organisers to visit GP practices; establishing GP peer supervision forums; improving access to GPs with a Special Interest in Mental Health (GPwSIs); shifting a greater degree of responsibility for recovery from psychosis to primary care from secondary care; reinforcing amongst GPs an awareness of the important role which primary care can play in promoting recovery; facilitating continuity of care within large practices where feasible; and encouraging GPs to alert SUs to seriousness of potential side-effects of medication before and during treatment. The implications of the findings for policy, practice, and future research were discussed.

Keyword(s)

bipolar; critical interpretive synthesis; general practitioner; grounded theory; primary care; psychosis; qualitative; recovery; schizophrenia; serious mental illness; service user; social contructionism

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