A Qualitative Evaluation of the Quality of Assessments for the Psychological Medicine in Primary Care Service: A Patient Perspective

Abstract

Aims. Background: Psychological Medicine in Primary Care, Stockport works with people with persistent physical symptoms and personality difficulties whose psychological needs cannot be met by existing services due to complexity. The service views the assessment process as a therapeutic intervention in its own right and utilises a relational, formulation-based approach over 2 to 5 sessions. A letter including this formulation is sent following assessment to both the patient and their GP.

Aims:

1. 1. To evaluate the quality of the assessments from a patient perspective.

2. 2. To improve the quality of the assessments in order to improve patient care and the support offered to patients.

Methods

A short questionnaire with open questions was created. Thirty-two patients assessed by the service took part in semi-structured interviews by means of a short telephone discussion after consent was taken. Three independent investigators reviewed their responses and performed thematic analysis, using an inductive and recursive approach.

Results

Theme 1: The understanding of the service and awareness of the referral affects the perception of the assessment.

Theme 2: There can be therapeutic gain in the assessment process, which appears to be mediated by the relationship with the assessors including:

• • Emotional catharsis

• • Having a wider perspective of personal issues

• • Developing new coping mechanisms

• • Regaining a sense of agency

• • Gaining a sense of hope

• • Developing a better understanding of emotions

• • Having a different experience to past encounters with mental health services

Theme 3: The relationship with the assessor plays an important role in the experience of the assessment process, and is mediated by skills of the assessor, including:

• • Active listening

• • A sense of thoroghness; not feeling rushed

• • Sensitive use of verbal and non-verbal communication

• • An empathic, non-judgmental approach

• • A warm, professional approach

• • Open, clear, collaborative communication

• • A consistent approach

• • Validation

• • Psychological containment

Patient perception of the degree of attunement in these areas appears to lend itself to a sense of psychological trust and safety in the process.

Theme 4: The outcome of the assessment can lead to various emotional responses which can play a role in how people perceive the assessment process

Theme 5: The assessment letter is considered an important part of the assessment by many, but not all, participants

Conclusion

Psychiatric assessment can be a therapeutic intervention in its own right and a collaborative, relational approach can help to facilitate this.