Early recognition method for patients with schizophrenia or bipolar disorder in community mental health care: Illness insight, self-management and control

Abstract

Aims and objective: To investigate how participating in the early recognition method treatment strategy affect illness insight and management, in patients with schizophrenia or bipolar disorder in community mental healthcare.

Background: The current practice in mental healthcare focus on shared decision-making and self-managing capacity, but poor insight is a predictor of poor adherence and dropout. Engagement in illness management and recovery predict the treatment response.

Design: Semi-structured interviews with a phenomenological-hermeneutic approach.

Methods: We conducted 36 semi-structured interviews with 26 patients. The interviews were conducted before and after participating in the intervention using the early recognition method strategy. The analysis was based on Ricoeur's theory of interpretation: Naive reading, structural analysis, interpretation and discussion. The COREQ checklist was used as reporting guideline.

Results: The experience of participating in treatment as usual and early recognition method revealed two main themes. The first theme 'patient care' describes how dialogue and collaboration increase awareness of the illness and how to gain control. The second theme 'insight and experience' describes how illness affects personality and self-image, and how insight entails control and self-confidence.

Conclusion: Managing life with severe mental illness is complex and challenging. However, the experience of guidance, support and collaboration between patient and nurse are essential to improve these circumstances.

Relevance to clinical practice: A systematic approach to the patient' symptoms, as in the early recognition method strategy, enhances knowledge of the individual patient' symptoms, both for nurse and patient. A knowledge that is significant for meeting individual treatment needs. Therefore, applying this strategy is likely to enhance collaboration and improve treatment outcome.

Keywords: Relapse prevention; bipolar disorder; community mental healthcare; individualised intervention; patient involvement; risk management; schizophrenia; shared decision-making.