Impact Factor:1.137 | Ranking:21/36 in Social Sciences, Biomedical | 81/136 in Public, Environmental & Occupational Health | 5-Year Impact Factor:1.396Source:2012 Journal Citation Reports® (Thomson Reuters, 2013)
Many patients with depression do not recover despite medication or therapy. Individuals with treatment resistant depression often have co-morbid anxiety, personality difficulties and drug or alcohol misuse and have been characterised as difficult, heartsink or problem personalities by general practitioners. Yet critical studies of interaction in medical settings suggest that the context may have a role in constructing the patient. A total of 12 audio-recorded routine consultations were analysed following guidelines for qualitative analysis of medical discourse. The interpretation focused on ways in which the context and structure of primary care consultations in a UK setting construct difficult encounters, which may lead to patients with treatment resistant depression being seen as difficult to manage in various ways. Three overarching observations were that presentation of multiple problems in multiple domains clash with the consultation format; that patients’ atypically high level of activity in a time-limited setting prevents patient-centred work; that the question and answer format restricts multifaceted discussions of social and emotional problems, preventing shared understandings emerging. However, although interactions appear uneasy, they are repaired and may be moderately palliative. Suggestions are made for re-orienting general practitioner work with treatment resistant depression towards long-term goal setting outside of the traditional consultation structure in order to develop shared understandings. © 2013 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC
Showing posts with label treatment. Show all posts
Showing posts with label treatment. Show all posts
Monday, November 11, 2013
Friday, November 8, 2013
'There's a lot of tasks that can be done by any': Findings from an ethnographic study into work and organisation in UK community crisis resolution and home treatment services
Impact Factor:1.137 | Ranking:21/36 in Social Sciences, Biomedical | 81/136 in Public, Environmental & Occupational Health | 5-Year Impact Factor:1.396Source:2012 Journal Citation Reports® (Thomson Reuters, 2013)
Ben Hannigan hanniganb{at}cardiff.ac.uk Cardiff University, UKAcross the United Kingdom, large numbers of crisis resolution and home treatment services have been established with the aim of providing intensive, short-term care to people who would otherwise be admitted to mental health hospital. Despite their widespread appearance, little is known about how crisis resolution and home treatment services are organised or how crisis work is done. This article arises from a larger ethnographic study (in which 34 interviews were conducted with practitioners, managers and service users) designed to generate data in these and related areas. Underpinned by systems thinking and sociological theories of the division of labour, the article examines the workplace contributions of mental health professionals and support staff. In a fast-moving environment, the work which was done, how and by whom, reflected wider professional jurisdictions and a recognisable patterning by organisational forces. System characteristics including variable shift-by-shift team composition and requirements to undertake assessments of new referrals while simultaneously providing home treatment shaped the work of some, but not all, professionals. Implications of these findings for larger systems of work are considered. © 2013 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC
Ben Hannigan hanniganb{at}cardiff.ac.uk Cardiff University, UKAcross the United Kingdom, large numbers of crisis resolution and home treatment services have been established with the aim of providing intensive, short-term care to people who would otherwise be admitted to mental health hospital. Despite their widespread appearance, little is known about how crisis resolution and home treatment services are organised or how crisis work is done. This article arises from a larger ethnographic study (in which 34 interviews were conducted with practitioners, managers and service users) designed to generate data in these and related areas. Underpinned by systems thinking and sociological theories of the division of labour, the article examines the workplace contributions of mental health professionals and support staff. In a fast-moving environment, the work which was done, how and by whom, reflected wider professional jurisdictions and a recognisable patterning by organisational forces. System characteristics including variable shift-by-shift team composition and requirements to undertake assessments of new referrals while simultaneously providing home treatment shaped the work of some, but not all, professionals. Implications of these findings for larger systems of work are considered. © 2013 SAGE Publications. Los Angeles, London, New Delhi, Singapore and Washington DC
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