Key stakeholders' experiences and expectations of the care system for individuals affected by borderline personality disorder: An interpretative phenomenological analysis towards co-production of care.

BACKGROUND: The diagnosis of borderline personality disorder (BPD) consists of extreme emotional dysregulation and long-term disability when left untreated. It is associated with ineffective use of health care systems and mismanaged care in emergency departments, which can result in a revolving door phenomenon of urgent system usage, poor treatment outcomes, or patients falling out of care entirely-all of which primarily affect patients with BPD as well as their caregivers and clinicians. This crisis must be addressed with a comprehensive understanding of key stakeholder perspectives on the challenges of the system and potential solutions. OBJECTIVE: This study explored the perspectives of three key stakeholder groups (i.e., patients, clinicians, and caregivers) in relation to their experiences with and future expectations of the care system for those affected by BPD. METHODS: Four patients with BPD, three generalist clinicians with experience treating BPD, and three caregivers of individuals with BPD participated in individual semi-structured interviews. Participants were asked about their experiences with the current healthcare system and their suggestions for improvement. Responses were analyzed using interpretative phenomenological analysis. FINDINGS: In-depth analysis of the qualitative data revealed twelve shared themes and three themes that were unique to each key stakeholder group. These themes are discussed and used to inform recommendations for promising practices, policies, and training in this area. CONCLUSION: Findings support the importance of a comprehensive mental health system approach for improving the accessibility, effectiveness, and acceptability of the management and treatment of BPD.

Clinicians' Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. OBJECTIVE: This study (1) explored clinicians' experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians' intentions to offer telepsychology after the COVID-19 pandemic. METHODS: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. RESULTS: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (ß=0.46; P<.001) and telephone services (ß=0.35; P<.001) after the pandemic. Social influence (ß=0.24; P=.004) and facilitating conditions (ß=0.19; P=.03) additionally predicted the intention to use telephone services. CONCLUSIONS: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities.

Psychiatric hospital experiences that support and frustrate emerging adults' psychological needs: A self-determination theory perspective.

AIM: There are international efforts to implement developmentally appropriate and youth-oriented mental health services for emerging adults to increase treatment engagement and the success of early intervention. While significant progress has been made in developing community service models, limited research has focused on how to design psychiatric inpatient settings that promote the recovery of emerging adults. The present study attempts to address this knowledge gap through a qualitative exploration of hospital experiences that influence psychological need satisfaction and frustration, as defined by self-determination theory (SDT). METHODS: Inpatients (N = 104) from an emerging adult psychiatry unit were interviewed regarding hospital experiences that related to satisfaction or frustration of SDT needs for autonomy, competence, and relatedness. RESULTS: A basic interpretative qualitative analysis highlighted six key aspects of the hospital experience relevant to these needs: (a) social interactions, (b) freedom of behaviour and access, (c) programs and activities, (d) treatment collaboration and choice, (e) restraining/unpleasant hospital practices, and (f) progress, symptoms, and functioning. The findings support SDT's emphasis on the importance of autonomy support, structure, and involvement for need satisfaction. CONCLUSIONS: The study sheds light on aspects of the hospital milieu that may be essential to recovery-oriented inpatient care and on experiences that may be distinctly important for emerging adults, such as support for independence and the opportunity to relate to same-age co-patients experiencing similar mental health problems and life circumstances.

Identification of psychiatric inpatient recovery trajectories using routine outcome monitoring with emerging adults.

Early intervention for emerging adults with addiction and mental health disorders is beneficial for long-term recovery. The present study investigated the utility of routine outcome monitoring during acute inpatient hospitalization for identifying emerging adults at risk of poor outcomes. This is a retrospective study using latent class growth analysis (LCGA) to identify patient groups with different recovery trajectories, with additional analyses to clarify the characteristics of these trajectory groups. The results identified four patient groups: Rapid responders (38%), gradual responders (34%), high distress non-responders (9%), and low distress non-responders (19%). The high distress non-responding group is characterized by behaviours and disorders associated with ambivalent care seeking: Voluntary admission, longer length of stay, lower service satisfaction, higher outpatient service utilization, elevated risk of emergency department presentation and hospital readmission, and depression/personality disorder diagnosis. The low distress group is characterized by behaviours and disorders associated with treatment rejection: Involuntary admission, shorter length of stay, reduced post-discharge service utilization, and psychotic disorder diagnosis. The results have implications for identifying at-risk youth and developing stepped-care models for more effective and efficient inpatient care.

The relation between psychological need satisfaction in acute psychiatric hospital and recovery among emerging adults: A self-determination theory approach.

OBJECTIVE: Mental illness and addiction are prevalent during emerging adulthood and are associated with poorer functioning and quality of life. Research supports early intervention for enhancing recovery, though emerging adults frequently disengage from services, reducing effectiveness of early care. Research on self-determination theory shows healthcare climates that support psychological needs for autonomy, competence, and relatedness foster sustained engagement in treatment and health-promoting behaviors. The present study hypothesized that more need satisfying (and less frustrating) psychiatric hospital experiences would relate to various indicators of recovery among emerging adults. METHODS: One-hundred four emerging adults from an acute psychiatric inpatient unit completed an adapted questionnaire measuring need satisfaction in the hospital and surveys of treatment attitudes, illness identity, and wellness during the 3rd week of their hospital stay. Six-month postdischarge service utilization data were obtained through electronic health databases. RESULTS: A more need satisfying hospital experience was associated with greater autonomous motivation for treatment, more positive attitudes toward medications and services, more adaptive illness identification, and greater well-being. Greater need frustration was related to less autonomous and more controlled motivation for treatment, less positive attitudes toward medications and services, less adaptive illness identification, and lower well-being. While neither need satisfaction nor frustration related to subsequent visits to the emergency department or rehospitalization, a need frustrating hospital experience related to fewer attended community appointments during the 6 months following discharge. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Hospital experiences that satisfy (and do not frustrate) the psychological needs of emerging adults may promote recovery and treatment engagement. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Bridging the Gap in Community Care for Patients With Borderline Personality Disorder: Protocol for Qualitative Inquiry Into Patient, Caregiver, and Clinician Perspectives on Service Gaps and Potential Solutions for Severe Emotion Dysregulation.

BACKGROUND: Borderline personality disorder (BPD) is characterized by severe emotion dysregulation that is often complicated by comorbid diagnoses, deliberate self-harm, and chronic suicidal ideation. Unfortunately, current care pathways for individuals with BPD are strained by limited resources, inadequate training, and an overuse of emergency departments and crisis teams. Such barriers result in delayed access to effective treatment, which increases risk of deterioration, disability, and morbidity. A first step toward addressing these limitations of the current care pathway is to understand key stakeholders' lived experiences in this pathway and their perspectives on potential solutions. OBJECTIVE: The purpose of this paper is to present a protocol for a study that explores the lived experiences of the current care pathway from the perspectives of patients with BPD, as well as their caregivers and clinicians. METHODS: A qualitative approach is most appropriate for the exploratory nature of the research objective. Accordingly, 3 to 6 patients with a diagnosis of BPD, 3 caregivers of individuals with BPD, and 3 clinicians of patients diagnosed with BPD will be invited to participate in individual, semistructured interviews that focus on service experiences. RESULTS: It is anticipated that results will yield insight into the lived experiences of patients with BPD, caregivers, and clinicians and provide a better understanding of the perceived gaps in services and potential solutions. Results are expected to be available in 12 months. CONCLUSIONS: This paper describes a protocol for a qualitative study that seeks to understand the lived experiences and perspectives of key stakeholders (patients, caregivers, and clinicians) on the current care pathway for BPD. Results will provide a basis for future research in this area and will have the potential to inform training, practice, and policy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14885.

Family Members' Perspectives of Health Care System Interactions With Suicidal Patients and Responses to Suicides: Protocol for a Qualitative Research Study.

BACKGROUND: Suicide is a major cause of preventable death globally and a leading cause of death by injury in Canada. To support people who experience suicidal thoughts and behaviors and ultimately prevent people from dying by suicide, it is important to understand the individual and familial experiences with the health care system. OBJECTIVE: This study aims to explore how suicide victims, and their family members, interacted with the health care system. METHODS: We will invite family members of 6 to 8 suicide victims to participate in the study by sharing their perspectives on both their relative's as well as their own interactions with the health care system. Interviews will take place in-person and will be audio recorded, transcribed, and analyzed thematically. RESULTS: The results of the study are expected to be available in 12 months. We expect the results to shed light on the experiences of suicide victims and their family members with the health care system. CONCLUSIONS: Our study results may inform practice, policy, and further research. They may shape how members of the health care system respond to people who are at risk of suicide and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/13797.