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An evaluation of communication barriers and facilitators at the time of a mental health diagnosis: a survey of health professional practices

Published online by Cambridge University Press:  24 January 2017

A. C. Milton ,
B. Mullan ,
C. MacCann  and
C. Hunt
A. C. Milton*
Affiliation:
School of Psychology, The University of Sydney, Sydney, Australia
B. Mullan
Affiliation:
Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
C. MacCann
Affiliation:
School of Psychology, The University of Sydney, Sydney, Australia
C. Hunt
Affiliation:
School of Psychology, The University of Sydney, Sydney, Australia
*
*Address for correspondence: A. C. Milton, School of Psychology, The University of Sydney, NSW 2006, Australia. (Email: alyssa.milton@sydney.edu.au)
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Abstract

Aims.

To examine health professionals’ views and practices relating to the specific barriers to communication that arise at the time of mental health diagnosis, and the strategies used to support individuals throughout this process.

Methods.

An online survey of the beliefs and practices of 131 mental health clinicians working in different clinical settings across Australia was conducted.

Results.

Exploratory factor analysis of the items relating to barriers to communication resulted in three latent factors (‘stigma, diagnosis and risk’; ‘service structure’; and ‘individual circumstances’ such as the person receiving the diagnosis being young, having a culturally and linguistically diverse background or being unwell at the time of conversation). Using linear regression it was found that variance in ‘stigma, diagnosis and risk’ was significantly explained by whether participating clinicians had medical training, their experience working with serious mental health problems, their confidence handling distress and attitude towards diagnosis. Variance in ‘individual circumstances’ was significantly explained by participating clinicians’ confidence handling distress. The most frequently used strategies to support diagnostic discussions centred on the health professionals’ communication skills, gauging the individual's perception of their circumstances, responding with empathy, following-up after discussion, addressing stigma concerns, using collaborative practice and setting up for the conversation.

Conclusions.

Three main areas for health professionals to reflect on, plan for and ultimately address when discussing news with the individual concerned emerged (‘stigma, diagnosis and risk’; ‘service structure’; and ‘individual circumstances’). Variations in practice indicate that practitioners should be cognisant of their own beliefs and background and how this impacts their communication practice.

Keywords

Communicationhealth service deliverypatient-provider relationshipsstigma
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 27 , Issue 4 , August 2018 , pp. 357 - 368
Copyright
Copyright © Cambridge University Press 2017 

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References

ABS (2008 a). 4102.0 – Australian Social Trends, 2008 Australian Bureau of Statistics.Google Scholar
ABS (2008 b). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Australian Bureau of Statistics.Google Scholar
Baile, W, Buckman, R, Lenzi, R, Glober, G, Beale, E, Kudelka, A (2000). SPIKES – A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 5, 302–311.Google Scholar
Bartlett, MS (1954). A note on the multiplying factors for various χ 2 approximations. Journal of the Royal Statistical Society Series B (Methodological) 16, 296–298.Google Scholar
Beyondblue (2016). Getting Support: Who Can Assist. Retrieved 15th September 2016 from http://resources.beyondblue.org.au/prism/file?token=BL/0114.Google Scholar
Biernacki, P, Waldorf, D (1981). Snowball sampling: problems and techniques of chain referral sampling. Sociological Methods and Research 10, 141–163.Google Scholar
Buston, K (2002). Adolescents with mental health problems: what do they say about health services ? Journal of Adolescence 25, 231–242.Google Scholar
Caldwell, TM, Jorm, AF (2001). Mental health nurses’ beliefs about likely outcomes for people with schizophrenia or depression: a comparison with the public and other healthcare professionals. Australian and New Zealand Journal of Mental Health Nursing 10, 42–54.Google Scholar
Clafferty, R, Mccabe, E, Brown, K (2001). Conspiracy of silence? Telling patients with schizophrenia their diagnosis. Psychiatric Bulletin 25, 336–339.Google Scholar
Cleary, M, Hunt, G, Horsfall, J (2009). Delivering difficult news in psychiatric settings. Harvard Review of Psychiatry 17, 315–321.Google Scholar
Cleary, M, Hunt, G, Escott, P, Walter, G (2010 a). Receiving difficult news: views of patients in an inpatient setting. Journal of Psychosocial Nursing and Mental Health Services 48, 40–48.Google Scholar
Cleary, M, Hunt, G, Walter, G (2010 b). Delivering difficult news. Views of mental health staff in inpatient settings. Journal of Psychosocial Nursing and Mental Health Services 48, 32–39.CrossRefGoogle ScholarPubMed
Corrigan, PW (2007). How clinical diagnosis might exacerbate the stigma of mental illness. Social Work 52, 31–39.Google Scholar
Crisp, AH, Gelder, MG, Rix, S, Meltzer, HI, Rowlands, OJ (2000). Stigmatisation of people with mental illnesses. British Journal of Psychiatry 177, 4–7.Google Scholar
Farooq, S, Naeem, F, Singh, SP (2016). Telling the patients about diagnosis and outcome of schizophrenia: what, when and how? Early Intervention in Psychiatry 10, 101–102.Google Scholar
Faul, F, Erdfelder, E, Buchner, A, Lang, AG (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods 41, 1149–1160.Google Scholar
Finch, JF, West, SG (1997). The investigation of personality structure: statistical models. Journal of Research in Personality 31, 439–485.Google Scholar
Friedrich, B, Evans-Lacko, S, London, J, Rhydderch, D, Henderson, C, Thornicroft, G (2013). Anti-stigma training for medical students: the Education Not Discrimination project. British Journal of Psychiatry 202, s89–s94.Google Scholar
Gaetano, J (2013). Holm-Bonferroni sequential correction: an EXCEL calculator – ver. 1.2. Retrieved 10th April 2016 from http://www.researchgate.net/profile/Justin_Gaetano2/.Google Scholar
Gallagher, A, Arber, A, Chaplin, R, Quirk, A (2010). Service users’ experience of receiving bad news about their mental health. Journal of Mental Health 19, 34–42.CrossRefGoogle ScholarPubMed
Gantt, A, Green, R (1985). Telling the diagnosis: implications for social work practice. Social Work and Health Care 11, 1985–1986.Google Scholar
Green, R, Gantt, A (1987). Telling patients and families the psychiatric diagnosis: a survey of psychiatrists. Hospital and Community Psychiatry 38, 666–668.Google Scholar
Hair, JF, Black, WC, Babin, BJ, Anderson, RE, Tatham, RL (2006). Multivariate Data Analysis. Pearson Prentice Hall: Upper Saddle River, NJ.Google Scholar
Heeren, T, Edwards, EM, Dennis, JM, Rodkin, S, Hingson, RW, Rosenbloom, DL (2008). A comparison of results from an alcohol survey of a prerecruited Internet panel and the National Epidemiologic Survey on Alcohol and Related Conditions. Alcoholism: Clinical and Experimental Research 32, 222–229.Google Scholar
Holm, S (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics 6, 65–70.Google Scholar
Hwang, W (2008). Diagnostic nondisclosure of schizophrenia to Chinese American patients. Asian Journal of Counselling 15, 1–31.Google Scholar
IBM Corp. (2012). IBM SPSS statistics for windows version 21. Armonk, NY: International Business Machines Corp.Google Scholar
Kaiser, HF (1974). An index of factorial simplicity. Psychometrika 39, 31–36.Google Scholar
Lauber, C, Nordt, C, Braunschweig, C, Rössler, W (2006). Do mental health professionals stigmatize their patients? Acta Psychiatrica Scandinavica 113, 51–59.Google Scholar
Levin, T, Kelly, B, Cohen, M, Vamos, M, Landa, Y, Bylund, C (2011). Using a psychiatry e-list to develop a model for discussing a schizophrenia diagnosis. Psychiatric Services 62, 244–246.Google Scholar
Lewis, S (1995). A search for meaning: making sense of depression. Journal of Mental Health 4, 369–382.CrossRefGoogle Scholar
Link, BG, Struening, EL, Rahav, M, Phelan, JC, Nuttbrock, L (1997). On stigma and its consequences: evidence from a longitudinal study of men with dual diagnoses of mental illness and substance abuse. Journal of Health and Social Behavior 38, 177–190.Google Scholar
Loughland, C, Kelly, B, Ditton-Phare, P, Sandhu, H, Vamos, M, Outram, S, Levin, T, Investigators, C (2015). Improving clinician competency in communication about schizophrenia: a pilot educational program for psychiatry trainees. Academic Psychiatry 39, 160–164.Google Scholar
Markowitz, FE (1998). The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. Journal of Health and Social Behavior 39, 335–347.Google Scholar
Mcdonald-Scott, P, Machizawa, S, Satoh, H (1992). Diagnostic disclosure: a tale in two cultures. Psychological Medicine 22, 147–157.Google Scholar
Mcneilly, D, Wengel, S (2001). The ‘ER’ seminar: teaching psychotherapeutic techniques to medical students. Academic Psychiatry 25, 193–200.CrossRefGoogle ScholarPubMed
Milton, A, Mullan, B (2014 a). Communication of a mental health diagnosis: a systematic synthesis and narrative review. Journal of Mental Health 23, 261–270.Google Scholar
Milton, A, Mullan, B (2014 b). Diagnosis telling in people with psychosis. Current Opinion in Psychiatry 27, 302–307.CrossRefGoogle ScholarPubMed
Milton, A, Mullan, B (2015). A qualitative exploration of service users’ information needs and preferences when receiving a serious mental health diagnosis. Community Mental Health Journal 51, 459–466.Google Scholar
Milton, AC, Mullan, B (2016). Views and experience of communication when receiving serious mental health diagnosis: satisfaction levels, communication preferences and acceptability of the SPIKES protocol. Journal of Mental Health. Advance online publication, 1–10, doi: 10.1080/09638237.2016.1207225.Google Scholar
Milton, AC, Mullan, B, Hunt, C (2016). Information giving challenges and support strategies at the time of a mental health diagnosis: qualitative views from Australian health professionals. Social Psychiatry and Psychiatric Epidemiology 51, 735–746.CrossRefGoogle ScholarPubMed
Modgill, G, Patten, SB, Knaak, S, Kassam, A, Szeto, AC (2014). Opening minds stigma scale for health care providers (OMS-HC): examination of psychometric properties and responsiveness. BMC Psychiatry 14, 120.Google Scholar
Mooney, CZ, Duval, RD (1993). Bootstrapping: a Nonparametric Approach to Statistical Inference. Sage: Newbury Park, CA.CrossRefGoogle Scholar
Nordt, C, Rössler, W, Lauber, C (2006). Attitudes of mental health professionals toward people with schizophrenia and major depression. Schizophrenia Bulletin 32, 709–714.CrossRefGoogle ScholarPubMed
Olson, R, Bialocerkowski, A (2014). Interprofessional education in allied health: a systematic review. Medical Education 48, 236–246.Google Scholar
RANZCP (2016). Mental health advice Psychiatrists and psychologists. Retrieved 15th Sept 2016 from https://www.ranzcp.org/Mental-health-advice/Psychiatrists-and-psychologists.aspx.Google Scholar
Riecher-Rössler, A, Mcgorry, PD (2016). Early Detection and Intervention in Psychosis: State of the Art and Future Perspectives. Karger: Basel.Google Scholar
Rosenfield, S (1997). Labeling mental illness: the effects of received services and perceived stigma on life satisfaction. American Sociological Review 62, 660–672.Google Scholar
Rüsch, N, Abbruzzese, E, Hagedorn, E, Hartenhauer, D, Kaufmann, I, Curschellas, J, Ventling, S, Zuaboni, G, Bridler, R, Olschewski, M (2014). Efficacy of coming out proud to reduce stigma's impact among people with mental illness: pilot randomised controlled trial. British Journal of Psychiatry 204, 391–397.Google Scholar
Schulze, B (2007). Stigma and mental health professionals: a review of the evidence on an intricate relationship. International Review of Psychiatry 19, 137–155.Google Scholar
Seeman, M (2010). Breaking bad news: schizophrenia. Journal of Psychiatric Practice 16, 269–276.Google Scholar
Shergill, S, Barker, D, Greenberg, M (1998). Communication of psychiatric diagnosis. Social Psychiatry and Psychiatric Epidemiology 33, 32–38.Google Scholar
Sibitz, I, Provaznikova, K, Lipp, M, Lakeman, R, Amering, M (2013). The impact of recovery-oriented day clinic treatment on internalized stigma: preliminary report. Psychiatry Research 209, 326–332.Google Scholar
Świtaj, P, Wciórka, J, Smolarska-Świtaj, J, Grygiel, P (2009). Extent and predictors of stigma experienced by patients with schizophrenia. European Psychiatry 24, 513–520.Google Scholar
Trump, L, Hugo, C (2006). The barriers preventing effective treatment of South African patients with mental health problems. South African Psychiatry Review 9, 249–260.Google Scholar
Villani, M, Kovess-Masféty, V (2016). Qu'en est-il de l'annonce du diagnostic de schizophrénie aujourd'hui en France? L'Encéphale. Advanced online publication, 1–10, doi: 10.1016/j.encep.2016.01.011.Google Scholar
Watkins, M (2016). Monte Carlo PCA for Parallel Analysis. Retrieved 20th April 2016 from http://edpsychassociates.com/Watkins3.htmlGoogle Scholar
Wisdom, J, Green, C (2004). “Being in a funk”: teens’ efforts to understand their depressive experiences. Qualitative Health Research 14, 1227–1238.Google Scholar
Wittchen, H-U, Jacobi, F, Rehm, J, Gustavsson, A, Svensson, M, Jönsson, B, Olesen, J, Allgulander, C, Alonso, J, Faravelli, C (2011). The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology 21, 655–679.Google Scholar
Yamaguchi, S, Niekawa, N, Maida, K, Chiba, R, Umeda, M, Uddin, S, Taneda, A, Ito, J (2015). Association between stigmatisation and experiences of evidence-based practice by psychiatric rehabilitation staff in Japan: a cross-sectional survey. Journal of Mental Health 24, 78–82.Google Scholar
Yanos, PT, Roe, D, West, ML, Smith, SM, Lysaker, PH (2012). Group-based treatment for internalized stigma among persons with severe mental illness: findings from a randomized controlled trial. Psychological Services 9, 248.Google Scholar
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