Problems in psychiatric care of 'difficult patients': a Delphi-study

Area of Science:

• Psychiatry
• Healthcare Management
• Clinical Psychology

Background:

• Non-psychotic chronic patients often present ambivalent attitudes towards psychiatric care.
• These patients are frequently managed in non-specialized services, posing unique challenges for staff.
• Difficulties in managing these patients can negatively impact the quality of care provided.

Purpose of the Study:

• To identify specific problems encountered by psychiatric professionals when dealing with non-psychotic chronic patients.
• To establish a foundation for developing improved or alternative care strategies in non-specialized settings.

Main Methods:

• A modified five-phase Delphi study was employed.
• Three expert groups, each with eight participants, were involved in identifying and prioritizing judgments.

Main Results:

• A total of 46 distinct problems were identified by the expert groups.
• Some identified problems were specific to certain subgroups, while others were relevant across the entire group.

Conclusions:

• A comprehensive program integrating service-level coherence with enhanced interprofessional support is beneficial.
• Strategies like regular supervision and shared caseloads can improve care in non-specialized psychiatric services.