How physical illness is diagnosed for people with a mental health condition
Background
People with a mental health condition often suffer from poor physical health, for a variety of reasons. The way physical illness is identified and diagnosed in this group is likely to play an important role and needs further exploration.
This study sets out to examine how physical illnesses are diagnosed for people who have a mental health condition, either in emergency departments or with their GP. We are interested in how people with a mental health condition access care when they are worried about their physical health. We are also keen to explore the experiences of family members and clinical members of staff contributing to the diagnostic process.
Through this multi-method study, we hope to gain a better understanding of some of the interpersonal, organisational, and system-level challenges associated with making a timely and accurate diagnosis of physical illness for people with a mental health condition.
Approach
This study is informed by principles of peer research. Protocol development, data collection, and data analysis are being conducted by a team that includes a McPin lived-experience researcher. Additionally, a group of experts-by-experience (made up of service users and carers) who contributed to the development of the study, will take part in data analysis, and are involved in decision-making about the study through regular meetings.
The study has two main theoretical guides. The first is the construct of candidacy, which centres on the idea that access to healthcare is shaped by patients’ sense of being suitable ‘candidates’ for receiving healthcare, as well as clinicians’ behaviours, organisational resources, and institutional forces. The second is the Safer Dx framework – a framework that highlights the technical, patient-related, and process-related variables that are likely to influence diagnostic decision-making.
The study has three workstreams.
- Workstream 1 is a systematic review of the literature that aims to assess the available epidemiological evidence on missed, wrong, or delayed diagnosis relating to physical illness in people with mental health conditions.
- In workstream 2, we will conduct ethnographic research in emergency departments and acute medical units. Using observations, informal conversations, and interviews, we will look at how diagnoses are formed and communicated, starting from the triage process, in acute care settings.
- In workstream 3, we will focus on primary care: we will interview GPs, patients, and family members to examine experiences of seeking and forming a physical health diagnosis for people with a mental health condition.
Taken together, these workstreams will help us learn about ‘candidacy for diagnosis’ (the idea that access to healthcare is shaped by patients’ sense of being suitable ‘candidates’ for receiving it) in acute and primary care. They will address both physical illness that may require an emergency response and the kind of symptoms that may point to a chronic health condition, such as heart or circulatory disease.
Following this work, we plan to develop a simulation-based study aimed at developing ideas and proposals about how to improve the diagnosis of physical illness for those with mental health conditions.
Watch and listen to find out about early insights from the project:
Funding and ethics
This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is independently led by THIS Institute, in partnership with the McPin Foundation and the Cambridge and Peterborough Foundation Trust.
The study was reviewed by East of England – Essex Research Ethics Committee. Ethics approval for workstream 3 will be sought in summer 2023.