An interpretive descriptive study: the exploration of the determinants influencing the use and provision of services for older people with functional mental illness.

Wells, Julia

Abstract

The overall aim of this research study was to explore the determinants influencing the use and provision of services for older people with functional mental illness (FMI). The prevalence of FMI (i.e. illnesses such as depression, bipolar disorder, schizophrenia, personality disorder and anxiety disorders) in older adults is notable; however, it has received less research and attention in national and international policy than dementia. Globally, depression is the leading cause of illness burden in older people, affecting one in five people over the age of 60. Older adults with FMI may have a life expectancy of up to twenty years less than the rest of the population. There is little qualitative research exploring the use and provision of services for older people with FMI. To address this, this study first undertook an integrative review of literature between the 31st October 2017 to 31st October 2022. The review findings then underpinned two phases of data collection and analysis for this interpretive study. Phase One focused on healthcare professionals, and comprised a focus group with three healthcare professionals and three separate interviews with individuals. Phase Two consisted of interviews with various individuals: four older people with FMI, one family carer and two healthcare professionals. Data were collected using semi-structured interviews conducted between the 18th November 2019 and the 19th June 2020. Reflexive thematic analysis was used to analyse and synthesise data. The Availability, Accessibility, Acceptability and Quality Framework (United Nations International Children's Emergency Fund, 2019) was used during the thematic analysis process to help interpret the findings. Three key concepts were generated from this study: 1) Impact of "place" on the person with FMI; 2) Relationship-building with the person with FMI; and 3) Managing FMI in everyday life. It emerged that older people with FMI, living in remote and rural areas, at times choose not to access support for their mental health even if these services were perceived to be accessible and available to them. This was due to travel, and acceptability of FMI in the context of stigma, stoicism and being independent. However, healthcare professionals felt that general professionals were also treating older people with FMI in remote and rural areas, and preventing onward referral to secondary care. Older people with FMI living in urban areas were perceived by healthcare professionals to be more likely to access secondary services for their mental health. Furthermore, relationship-building with healthcare professionals was found beneficial by older people, as they felt accepted, felt that healthcare was more accessible and found that talking was particularly beneficial towards their recovery. To healthcare professionals, relationship-building was more complex, enabling robust assessment and management of risk of self-harm or risk to others. This speaks to the importance of taking time to build relationships as a component of quality care. Finally, it emerged that healthcare professionals introduced several quality, available interventions to older people with FMI, to help them manage FMI in everyday life. This included guided discovery, goal setting, distraction techniques and use of the Wellness and Recovery Plan. This highlights how healthcare professionals can provide accessible, quality interventions to older people with FMI to improve their resilience and recovery journey. The findings of this study add to our understanding of FMI and older people, in three areas in particular: 1) The importance of connections between the place where people experience FMI and those who offer support; 2) The importance of relationship-building for the management of and recovery from FMI; 3) The focus on managing FMI in everyday life, which is a key outcome for older people, carers and healthcare professionals, and which affects how each individual experiences their recovery journey. Combined, these three concepts influence decisions made by older people with FMI and their carers in terms of accessing mental health services - and further influence the decisions made by healthcare professionals when planning interventions and delivering services. This study makes several recommendations for practice: 1) Educators should highlight the benefits of relationship-building to a person's recovery and the importance of preparing healthcare professionals to undertake complex risk assessments; 2) Commissioners and service designers should consider the impact that place has on the experiences of older people with FMI living in remote and rural areas, compared to urban areas - services should be designed for people based upon accessibility and availability, regardless of location; 3) Healthcare professionals should recognise that face-to-face first assessments contribute to relationship-building with older people with FMI and their family carers, before virtual follow up by telehealth; 4) Policymakers and service commissioners need to consider and establish pathways to support the needs of older people with FMI who are in crisis, to ensure quality care and support; 5) Healthcare professionals have a key role as educators to older people with FMI and their family carers by highlighting the interventions that can be used to aid recovery; 6) Healthcare professionals and service planners need to consider the contextual importance of availability, acceptability, accessibility and quality issues in services for those experiencing and supporting FMI in older people.

Citation

WELLS, J. 2023. An interpretive descriptive study: the exploration of the determinants influencing the use and provision of services for older people with functional mental illness. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2571430

• Thesis Type: Thesis
• Deposit Date: Nov 6, 2024
• Publicly Available Date: Nov 6, 2024
• DOI: https://doi.org/10.48526/rgu-wt-2571430
• Keywords: Older people; Mental illness; Mental health; Healthcare services; Rural communities
• Public URL: https://rgu-repository.worktribe.com/output/2571430
• Award Date: Mar 31, 2023