[Oyster care: a qualitative study to explore the experiences of caregivers]

Deinstitutionalization of care is an important trend in the mental healthcare landscape. However, due to the severity and chronicity of their condition, treating persons with a severe and persistent mental illness (SPMI) in community services is difficult. This puts them at risk of being the victim of therapeutic persistence in residential care: they are repeatedly exposed to the same treatment, without achieving the desired results. To counter this, the concept of oyster care was developed.

To explore the experiences of caregivers who work with patients with an SPMI, and how they integrate oyster care into their work based on these experiences.

12 caregivers working at a ward for patients with an SPMI participated in an individual, qualitative, semi-structured interview. The interviews were subjected to a thematic analysis.

Caregivers indicated that they found working with SPMI patients challenging but experience job satisfaction at the same time. Regarding the concept of oyster care, it appeared this concept was mainly developed ‘bottom-up’, and that various tools and guidelines had already been distilled from good practices. From the results of this study, several recommendations could be made to improve the quality of care to patients with an SPMI.

At policy level, there are still several opportunities regarding oyster care. These opportunities mainly concern a more targeted organization of people and resources. This encompasses offering non-verbal therapies (music therapy, creative therapy, psychomotor therapy, etc.), expanding the presence of physicians on the ward, converting isolation rooms into seclusion areas, and providing sufficient trained staff so that care providers can take the time that patients with an SPMI need. Validating these opportunities could contribute to providing a higher quality of care that better meets the needs of patients who, because of complex mental suffering with resistance to standard treatments, find it difficult to find their place within (and outside) long-term mental healthcare. In addition, such initiatives could have a positive impact on the workload experienced by caregivers and, consequently, on staff retention, which is currently problematic at wards for patients with an SPMI.