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Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation

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journal contribution
posted on 01.01.2020, 00:00 authored by Stephanie Allan, Simon Bradstreet, Hamish J McLeod, John Gleeson, John Farhall, Maria Lambrou, Andrea Clark, Andrew Gumley, John Ainsworth, Sandra Bucci, Shon Lewis, Mathew Machin, Alison YungAlison Yung, Mario AlvarezJiminez, Sue Cotton, Reeva Lederman, Max Birchwood, Swaran Singh, Ancrew Thompson, Andrew Briggs, Chris Williams, Paul French, Graeme MacLennan, Cathy Mihalopoulos, John Norrie, Matthias Schwannauer, Frank Reilly, Lesley Smith, Suresh Sundram
Background
Relapse prevention strategies based on monitoring of early warning signs (EWS) are advocated for the management of psychosis. However, there has been a lack of research exploring how staff, carers and patients make sense of the utility of EWS, or how these are implemented in context.

Aims
To develop a multiperspective theory of how EWS are understood and used, which is grounded in the experiences of mental health staff, carers and patients.

Method
Twenty-five focus groups were held across Glasgow and Melbourne (EMPOWER Trial, ISRCTN: 99559262). Participants comprised 88 mental health staff, 21 patients and 40 carers from UK and Australia (total n = 149). Data were analysed using constructivist grounded theory.

Results
All participants appeared to recognise EWS and acknowledged the importance of responding to EWS to support relapse prevention. However, recognition of and acting on EWS were constructed in a context of uncertainty, which appeared linked to risk appraisals that were dependent on distinct stakeholder roles and experiences. Within current relapse management, a process of weighted decision-making (where one factor was seen as more important than others) described how stakeholders weighed up the risks and consequences of relapse alongside the risks and consequences of intervention and help-seeking.

Conclusions
Mental health staff, carers and patients speak about using EWS within a weighted decision-making process, which is acted out in the context of relationships that exist in current relapse management, rather than an objective response to specific signs and symptoms.

History

Journal

BJPsych Open

Volume

6

Issue

1

Article number

e3

Pagination

1 - 7

Publisher

Cambridge University Press

Location

Cambridge, Eng.

ISSN

2056-4724

Language

English

Publication classification

C1 Refereed article in a scholarly journal