Providing care during early warning signs and relapse in psychosis: exploring mental health staff perspectives using grounded theory methods

Beedie, Sara (2019) Providing care during early warning signs and relapse in psychosis: exploring mental health staff perspectives using grounded theory methods. D Clin Psy thesis, University of Glasgow.

Abstract

Objectives: Episodes of relapse in psychosis can have profound adverse consequences for service users and their families. Efforts to prevent relapse, or minimise its impact, may be supported by the recognition of early warning signs (EWS). However, several challenges exist to both service users’ help-seeking and services’ provision of care during these periods. It is important that this context is understood if novel interventions are to be effectively implemented in practice. This study therefore aimed to explore staff experiences of providing care at times of EWS or relapse of psychosis.

Design: The study was part of an on-going trial of an intervention for early signs monitoring (EMPOWER: ISRCTN 99559262). Data collection and analysis were informed by grounded theory methods.

Methods: Five mental health key workers in community mental health teams were interviewed about their experiences of providing care during EWS or relapse. Pre-existing focus group transcripts were also used to check and further refine developing categories.

Results: Keyworkers framed their practice around EWS as intertwined with their relationships with service users. Decision making around care at these times was influenced by the keyworkers’ appraisals of trust, wider social support networks and constructed knowledge of the service user. EWS episodes were experienced as opportunities for learning for both keyworker and service user. In this way, keyworkers described potential for more attuned care and improved service user expectations of service response to EWS. However, where service users were perceived to lack insight, or did not engage in reflection on past episodes, encouraging earlier help seeking was appraised as difficult or impossible.

Conclusion: Keyworkers experience long-term relationships and their knowledge of the service user as key in the provision of care during early relapse. Implications for the development of interventions for early relapse are discussed.

• Item Type: Thesis (D Clin Psy)
• Qualification Level: Doctoral
• Keywords: Psychosis, mental health staff, qualitative methods, relapse, early warning signs, therapeutic relationships.
• Subjects: B Philosophy. Psychology. Religion > BF Psychology
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Supervisor's Name: Gumley, Professor Andrew
• Date of Award: 2019
• Embargo Date: 18 October 2021
• Depositing User: Dr Sara Beedie
• Unique ID: glathesis:2019-75102
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 01 Nov 2019 13:19
• Last Modified: 06 Dec 2019 15:31
• Thesis DOI: 10.5525/gla.thesis.75102
• URI: https://theses.gla.ac.uk/id/eprint/75102