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Rebecca Godderis

Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in…

Abstract

Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in labeling theory, which highlights the conflict-based nature of diagnosis. The goal of this research is to examine the utility and benefits of diagnosis to psychiatrists' everyday work.

Methodology – Using institutional ethnography (IE), I undertook a small-scale interview-based study that documented the diagnostic processes of three psychiatrists in Calgary, Alberta, Canada. The IE-based goals of the study were to: (1) identify what texts were employed during the diagnostic process, (2) map sequences of action and text that coordinated psychiatric decision-making, and (3) theorize the utility of diagnosis for the everyday work of psychiatrists.

Findings – The analysis demonstrates how diagnosis can be understood as a valuable work process that produces a standardized diagnostic story in order to bring an individual's experiences of distress into relation with psychiatrists' daily practices, and institutional discourses more generally.

Limitations – Although IE-based research does not depend on large sample sizes for analytic accuracy, results from the current study need to be replicated because of the limited number of interview participants and to examine whether the diagnostic process is generalizable to other settings.

Social implications – This research challenges the idea that standardization through diagnosis is a negative process and highlights the value of diagnostic decision-making in the daily work of psychiatrists.

Details

Sociology of Diagnosis
Type: Book
ISBN: 978-0-85724-575-5

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Article

Sue Holttum

– The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services.

Abstract

Purpose

The purpose of this paper is to consider four recent articles relating to how included service users are in decision making about their medication in mental health services.

Design/methodology/approach

One article describes conversations between a psychiatrist and service users about medication. The second paper describes a study in which young people were supported with the aim of developing their confidence to challenge medication decisions. The third paper reports on interviews with both professionals and service users about medication decisions. The fourth paper presents a theory of how the wider context can affect medication decision making in mental health.

Findings

The first paper shows how a psychiatrist can persuade service users to accept medication decisions. The second paper shows how some young people can challenge medication decisions if they have the right support. The third paper illustrates how both professionals and service users may doubt service users’ ability to decide about medication, and pessimistically suggests that shared decision making may be unrealistic. In contrast to this, the fourth paper offers hope of changing how mental health services are organised in order to enable service users to be more empowered about medication decisions.

Originality/value

A model of shared decision making is being imported into mental health from physical health. These four papers illustrate problems with a simple transfer from physical to mental health. The present paper points to differences in apparent awareness of different clinical researchers of the need to tackle service users’ disempowerment in mental health care, showing how some researchers are tackling this.

Details

Mental Health and Social Inclusion, vol. 20 no. 3
Type: Research Article
ISSN: 2042-8308

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Article

Rockwell Schulz, Chris Girard, Iskander Enikeev, Stephen Harrison and Ma Xiemin

Begins from the premiss that job satisfaction among caring professionals is important not only for its own sake, but also for its effect on service outcomes. Presents…

Abstract

Begins from the premiss that job satisfaction among caring professionals is important not only for its own sake, but also for its effect on service outcomes. Presents empirical results, from four very different countries, which suggest that management‐influenced variables can help to ameliorate job dissatisfaction arising from factors such as resource constraints. Develops the thesis that cross‐cultural comparisons are a valid instrument for assessing the effect of management efforts which contribute to psychiatric satisfaction and feelings of autonomy. Establishes the need for more cross‐national investigation of the relationship of management to worker job satisfaction.

Details

Journal of Management in Medicine, vol. 7 no. 6
Type: Research Article
ISSN: 0268-9235

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Article

Shailesh Kumar

In most cases job satisfaction serves as a protective factor against burnout and the negative consequences of stress at work. Psychiatrists are reported to experience high…

Abstract

In most cases job satisfaction serves as a protective factor against burnout and the negative consequences of stress at work. Psychiatrists are reported to experience high prevalence of burnout yet their ability to enjoy work and derive satisfaction from it appears not to be impaired. This paper examines this anomaly and the factors that may affect job satisfaction. The consequences of job satisfaction on variables such as staff retention is examined and a comparative account of various rating scales for job satisfaction is presented.

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Mental Health Review Journal, vol. 13 no. 3
Type: Research Article
ISSN: 1361-9322

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Article

Harriet Greenstone and Amy Burlingham

This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients…

Abstract

Purpose

This study aims to explore current attitudes among doctors working in psychiatry, with regard to their perceived role and their confidence in managing their patients’ physical health problems.

Design/methodology/approach

A 20-item electronic questionnaire was distributed to doctors working in psychiatry within two large UK mental health trusts in 2018. Quantitative analysis was conducted, alongside qualitative analysis of free-text comments made by participants.

Findings

Many participants perceived their physical examination skills to have deteriorated since working in psychiatry (78 per cent). Participants were questioned on which professional group should hold responsibility for managing the physical health of patients under psychiatric services. A minority felt it should be psychiatrist-led (5 per cent), followed by general practitioner (GP)-led (42 per cent) and then shared responsibility (47 per cent). The majority felt there should be more focused training on physical health in the Core (72 per cent) and Advanced (63 per cent) psychiatry training. Key themes from a framework analysis of qualitative data included potential barriers to shared care, psychiatrists’ concerns regarding their experience and confidence in managing physical health, reasons in favour of shared responsibility, ideas for training and suggestions for improving the current situation.

Originality/value

Psychiatric patients may engage less well with health services, yet psychiatric medication often impacts significantly on physical health. In this context, there is often a blurring of role boundaries between a psychiatrist and a GP, and there is considerable variation between individual teams. There is a consistent call for more physical health training opportunities for psychiatrists and for mental health services to more proactively promote the physical health of their patients.

Details

The Journal of Mental Health Training, Education and Practice, vol. 15 no. 3
Type: Research Article
ISSN: 1755-6228

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Article

Rohit Gumber, John Devapriam, David Sallah and Sayeed Khan

The purpose of this paper is to ascertain the current competencies and training needs for being an expert witness of trainees (CT3, ST4-6) and career grade psychiatrists

Abstract

Purpose

The purpose of this paper is to ascertain the current competencies and training needs for being an expert witness of trainees (CT3, ST4-6) and career grade psychiatrists (consultants and staff grade, associate specialist and specialty doctors) in a UK health and well-being Trust.

Design/methodology/approach

This was completed through an online survey, developed by the authors, of all career grade and trainee psychiatrists within the Trust.

Findings

Only 9 per cent of respondents reported that they felt they had adequate training to feel competent as an expert witness. Despite low levels of training and confidence, 73 per cent of respondents had written an expert report. As well as shortage of training opportunities for psychiatrics acting as expert witnesses, the findings indicated increasing fear of litigation and lack of direct experience of court proceedings during training.

Practical implications

Doctors need to be offered formal training opportunities including simulated training, ideally organised within Trust, Continuing Professional Development (CPD) committees or Education committees. Implementation of the RCPsych report guidance into speciality curricula and CPD opportunities for doctors would ensure a robust curriculum-based delivery of these essential skills.

Originality/value

A wealth of guidance is available for expert witnesses, but no previous study had identified the specific training issues and overall confidence in competency to act as an expert witness amongst psychiatrists. It will be valuable to all psychiatrists involved in court work and organisations involved in training psychiatrists, especially in light of recent relevant court cases and removal of expert witness immunity.

Details

Journal of Forensic Practice, vol. 16 no. 4
Type: Research Article
ISSN: 2050-8794

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Article

R. Schulz, C. Girard, S.R. Harrison and A.C.P. Sims

Findings from a 1987 survey of work satisfaction among 193consultants and junior doctors in psychiatry in Yorkshire are reported.While nearly two‐thirds of doctors report…

Abstract

Findings from a 1987 survey of work satisfaction among 193 consultants and junior doctors in psychiatry in Yorkshire are reported. While nearly two‐thirds of doctors report they are generally satisfied, a substantial number of consultants and junior doctors are dissatisfied with their resources, status and autonomy, and professional relationships. Regression analysis suggests that controlling for psychiatrists′ personal and professional characteristics and variables related to district management are important in explaining differences in perceived clinical autonomy and work satisfaction among psychiatrists. Opportunities for district management to help improve psychiatrist satisfaction are proposed, and the relevance of the recent White Paper Working for Patients is examined.

Details

Journal of Management in Medicine, vol. 5 no. 2
Type: Research Article
ISSN: 0268-9235

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Article

Sally Pidd

The New Ways of Working national programme was started by psychiatrists (through the Royal College of Psychiatrists) when it became apparent that the roles they were being…

Abstract

The New Ways of Working national programme was started by psychiatrists (through the Royal College of Psychiatrists) when it became apparent that the roles they were being asked to carry out were unrealistic in their demands. This had contributed to a drop in recruitment and early retirement for psychiatrists in post. The New Ways of Working programme led to a reconfiguration of mental health services in many areas and an increase in the numbers of psychiatrists as well as improved levels of job satisfaction.This paper describes some of the challenges that still need to be met if New Ways of Working is to be fully implemented.

Details

The Journal of Mental Health Training, Education and Practice, vol. 4 no. 2
Type: Research Article
ISSN: 1755-6228

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Article

Claude Besenius, Eleanor Bradley and Peter Nolan

The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic…

Abstract

Purpose

The aim of this paper is to ascertain the attitudes and experiences of psychiatrists, nurse prescribers, and service users with regard to the prescription of antipsychotic medication, the route of administration, and the extent of service users' involvement.

Design/methodology/approach

A total of 26 psychiatrists and 12 nurses agreed to be interviewed in phase one of this study, concerning general aspects of prescribing. In phase two, 11 of the psychiatrists and five nurses from the first cohort took part in follow‐up interviews that focused specifically on their most recent prescribing experiences. In phase 3 of the study, 18 service users (14 male and 4 female) were recruited, during which their experiences of having medication prescribed was explored.

Findings

This interview‐based survey found that though there was some agreement between the attitudes and perceptions of prescribers and service users, there were also some important differences including differences with respect to the purposes of prescribed medication, when to prescribe, and under what conditions depot medication produces optimal results. It is not always clear to service users as to why certain medicines were prescribed nor is the information provided always understood. A considerable amount of prescribing practice is based on assumptions.

Originality/value

Even though medication (both oral and depot) has been shown to be useful in certain situations, nevertheless, the type of medication, dose and mode of administration continues to be idiosyncratic and inconsistent. This paper seeks to contribute to the debate by identifying in which pharmacological interventions for people with severe mental health problems could be improved.

Details

The Journal of Mental Health Training, Education and Practice, vol. 7 no. 1
Type: Research Article
ISSN: 1755-6228

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Article

Kanthee Anantapong and Anthea Tinker

Although there is substantial evidence about the association between frailty and mental illnesses in older people, there is currently little evidence about how this is…

Abstract

Purpose

Although there is substantial evidence about the association between frailty and mental illnesses in older people, there is currently little evidence about how this is integrated into psychiatric clinical practice. The purpose of this paper is to explore the attitudes of a sample of psychiatrists in the UK about the concept and assessment of frailty in their clinical practice.

Design/methodology/approach

This research used a qualitative approach with semi-structured interviews. Interview schedules and transcripts were analysed using thematic analysis. NVivo software and an audit trail were used for the data analysis.

Findings

There were ten respondents (all psychiatrists) in this study. From the interviews, it appeared that some respondents were not be fully familiar with existing concepts of frailty. However, from their perspectives, frailty appeared to be multidimensional, reversible and for some could be enhanced by older people’s ability. Negative stereotypes of being frail could undermine the accessibility to appropriate assessment and care. Existing multidisciplinary assessments, with some adjustments to the particular needs of psychiatric patients, can be used to establish a frailty index.

Originality/value

The concept of frailty, especially those concerning its multidimensional and homeostatic nature, should be further examined to make it more applicable to psychiatric practice. Without much more effort, frailty could be assessed within current psychiatric practices. This could constitute a care plan tailored for frail people with a psychiatric illness, so as to improve the outcomes of their treatment and quality of life.

Details

Working with Older People, vol. 23 no. 4
Type: Research Article
ISSN: 1366-3666

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