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

Allan, S., Bradstreet, S. , McLeod, H. J. , Gleeson, J., Farhall, J., Lambrou, M., Clark, A. and Gumley, A. I. (2020) Perspectives of patients, carers and mental health staff on early warning signs of relapse in psychosis: a qualitative investigation. BJPsych Open, 6(1), e3. (doi: 10.1192/bjo.2019.88) (PMID:31826793) (PMCID:PMC7001464)

Abstract

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.

• Item Type: Articles
• Additional Information: This study was supported by NHS Research Scotland, through the Chief Scientist Office and the Scottish Mental Health Research Network. This project was funded in the UK by the National Institute for Health Research Health Technology Assessment Programme (project number 13/154/04) and in Australia by the National Heath Medical Research Council (APP1095879).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bradstreet, Dr Simon and McLeod, Professor Hamish and Farhall, Professor John and Allan, Ms Stephanie and Clark, Miss Andrea and Gumley, Professor Andrew
• Authors: Allan, S., Bradstreet, S., McLeod, H. J., Gleeson, J., Farhall, J., Lambrou, M., Clark, A., and Gumley, A. I.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing; College of Science and Engineering > School of Psychology
• Journal Name: BJPsych Open
• Publisher: Royal College of Psychiatrists
• ISSN: 2056-4724
• ISSN (Online): 2056-4724
• Published Online: 12 December 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in BJPsych Open 6(1): e3
• Publisher Policy: Reproduced under a Creative Commons License