Professionals' Perceptions of the Establishment of a Specialized Brief Therapy Unit in a District Psychiatric Centre - a Qualitative Study

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2020 Nov 21

PMID 33218329

Citations 1

Authors

Hilde V Markussen

Lene Aasdahl

Marit B Rise

Affiliations

Soon will be listed here.

Abstract

Background: Increasing mental health problems and scarce treatment resources put pressure on mental health services to make innovations in service provision, such as developing differentiated services adapted to different needs. One innovation in differentiated service provision is brief or short-term treatment to patients with moderate mental health problems. Implementing a new unit in an organization usually faces many potential barriers and facilitators, and knowledge on how the professionals providing the services perceive the implementation of innovative approaches in mental health services is scarce. The aim of this study was therefore to explore the professionals' perceptions of how the establishment of a specialized brief therapy unit had affected the organization, especially the everyday work in the outpatient clinics.

Methods: Eleven professionals, five men and six women, took part in individual interviews. All participants were between 40 and 60 years old and had leading or coordinating positions in the organization. Their professional backgrounds were within psychology, nursing and medicine, most of them specialists in their field. Data was analyzed according to Systematic text condensation.

Results: The professionals' experiences represented four main themes: (1) The brief therapy unit was perceived as successful and celebrated. (2) The general outpatient clinics, on the other hand, were described as "forgotten". (3) The establishment process had elucidated different views on treatment in the outpatient clinics - and had set off (4) a discussion regarding the criteria for prioritizing in mental health services.

Conclusion: Providing targeted treatment to patients with moderate mental health problems, while having a concurrent aim to solve broader problems in mental health services, entails a discussion regarding resource use and the appropriate level of treatment provision. Professionals should be more involved when innovative efforts are implemented, and the criteria for success must be conceptualized and evaluated. Longitudinal research on the implementation of innovative efforts in the services should include professionals' and service users' perspectives.

Citing Articles

Perceived benefits and challenges one year after receiving brief therapy in a district psychiatric centre. An exploration of patients' and GPs' experiences: A qualitative study.

Markussen H, Aasdahl L, Viksveen P, Rise M PLoS One. 2024; 19(12):e0312513.

PMID: 39715166 PMC: 11666029. DOI: 10.1371/journal.pone.0312513.

References

May C, Mair F, Finch T, MacFarlane A, Dowrick C, Treweek S . Development of a theory of implementation and integration: Normalization Process Theory. Implement Sci. 2009; 4:29. PMC: 2693517. DOI: 10.1186/1748-5908-4-29. View

Sadeniemi M, Pirkola S, Pankakoski M, Joffe G, Kontio R, Malin M . Does primary care mental health resourcing affect the use and costs of secondary psychiatric services?. Int J Environ Res Public Health. 2014; 11(9):8743-54. PMC: 4198988. DOI: 10.3390/ijerph110908743. View

Peters K, Halcomb E . Interviews in qualitative research. Nurse Res. 2015; 22(4):6-7. DOI: 10.7748/nr.22.4.6.s2. View

De Geest R, Meganck R . How Do Time Limits Affect Our Psychotherapies? A Literature Review. Psychol Belg. 2019; 59(1):206-226. PMC: 6625551. DOI: 10.5334/pb.475. View

Cohen J, Marecek J, Gillham J . Is three a crowd? Clients, clinicians, and managed care. Am J Orthopsychiatry. 2006; 76(2):251-9. DOI: 10.1037/0002-9432.76.2.251. View

Hayes S, Luoma J, Bond F, Masuda A, Lillis J . Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2005; 44(1):1-25. DOI: 10.1016/j.brat.2005.06.006. View

Kroenke K, Unutzer J . Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care. J Gen Intern Med. 2017; 32(4):404-410. PMC: 5377893. DOI: 10.1007/s11606-016-3967-9. View

Abbass A, Kisely S, Town J, Leichsenring F, Driessen E, De Maat S . Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev. 2014; (7):CD004687. PMC: 11129844. DOI: 10.1002/14651858.CD004687.pub4. View

Birken S, Lee S, Weiner B . Uncovering middle managers' role in healthcare innovation implementation. Implement Sci. 2012; 7:28. PMC: 3372435. DOI: 10.1186/1748-5908-7-28. View

10.

Ringard A, Saunes I, Sagan A . The 2015 hospital treatment choice reform in Norway: Continuity or change?. Health Policy. 2016; 120(4):350-5. DOI: 10.1016/j.healthpol.2016.02.013. View

11.

Gutierrez-Colosia M, Salvador-Carulla L, Salinas-Perez J, Garcia-Alonso C, Cid J, Salazzari D . Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatr Sci. 2017; 28(2):210-223. PMC: 6998926. DOI: 10.1017/S2045796017000415. View

12.

Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P . The Lancet Commission on global mental health and sustainable development. Lancet. 2018; 392(10157):1553-1598. DOI: 10.1016/S0140-6736(18)31612-X. View

13.

van Mens K, Lokkerbol J, Janssen R, van Orden M, Kloos M, Tiemens B . A Cost-Effectiveness Analysis to Evaluate a System Change in Mental Healthcare in the Netherlands for Patients with Depression or Anxiety. Adm Policy Ment Health. 2017; 45(4):530-537. PMC: 5999158. DOI: 10.1007/s10488-017-0842-x. View

14.

Kimberly J, Cook J . Organizational measurement and the implementation of innovations in mental health services. Adm Policy Ment Health. 2007; 35(1-2):11-20. DOI: 10.1007/s10488-007-0143-x. View

15.

Shapiro D, Barkham M, Stiles W, Hardy G, Rees A, Reynolds S . Time is of the essence: A selective review of the fall and rise of brief therapy research. Psychol Psychother. 2003; 76(Pt 3):211-35. DOI: 10.1348/147608303322362460. View

16.

Altmann U, Thielemann D, Zimmermann A, Steffanowski A, Bruckmeier E, Pfaffinger I . Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies. Front Psychol. 2018; 9:748. PMC: 5964296. DOI: 10.3389/fpsyg.2018.00748. View

17.

Cape J, Whittington C, Buszewicz M, Wallace P, Underwood L . Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regression. BMC Med. 2010; 8:38. PMC: 2908553. DOI: 10.1186/1741-7015-8-38. View

18.

Dekker J, Molenaar P, Kool S, van Aalst G, Peen J, de Jonghe F . Dose-effect relations in time-limited combined psycho-pharmacological treatment for depression. Psychol Med. 2005; 35(1):47-58. DOI: 10.1017/s0033291704002685. View

19.

Proctor E, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B . Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2008; 36(1):24-34. PMC: 3808121. DOI: 10.1007/s10488-008-0197-4. View

20.

Dryden-Palmer K, Parshuram C, Berta W . Context, complexity and process in the implementation of evidence-based innovation: a realist informed review. BMC Health Serv Res. 2020; 20(1):81. PMC: 6998254. DOI: 10.1186/s12913-020-4935-y. View