The participants shared their experiences about interaction with other professionals within mental health care. From the analysis three thematic clusters emerged. One cluster of experiences dealt with situations in which participants commented upon interpersonal knowledge and communication. Another cluster of experiences covered mutual accessibility, including ambulatory care. A last cluster of experiences covers unfamiliarity with existing system and resources.
Interpersonal knowledge and communication
Our findings revealed that participants had occasionally experienced common consultations were they met the patient and a collaborative partner face to face. More interesting the participants reported positive experiences with these consultations. In situations where the participants knew the collaboration partners either by meeting them briefly or even only being familiar with their names, the communication tended to be easier, faster and more effective than in situations in which they had no knowledge of each other. One GP said:
I think it's much easier to have a dialogue when I know who I'm talking to.
The participants expressed benefits of meeting each other face to face and hearing about each other's possibilities, treatment plans and organisation. Recognising and sharing situations in which colleagues have experienced mutual knowledge as beneficial for communication and collaboration was an eye opener for GPs and mental health professionals. Despite this none of the participants mentioned any regularity in meetings or common consultations that included meetings with GPs. A participant from the outpatient clinic said:
We have invited other professionals to information meetings, but again it's the old saying that GPs are so busy, so they are not invited.
The participants from the outpatient clinic and primary mental health services had recently started a joint meeting series, which they found promising.
Mutual accessibility (including ambulatory care)
Both GPs and psychiatric nurses at outpatient clinics experienced problems when they needed to contact physicians and specialists in the acute wards. The focus groups with GPs were dominated by outspoken frustration over unavailable mental health professionals, especially competent consultants. The GPs spoke about a general need for contact before referring a patient to clarify where to refer a patient or preparing the acute ward for an incoming patient. The GPs had also experienced situations where entering specialised service could be avoided through contact between GPs and mental health specialists, by providing GPs with advice for further treatment. Direct cell phone numbers for reaching mental health specialists were proposed to ease the situation. A GP said:
Professionals in specialist mental health care should be trained to address themselves as consultants.
GPs said that telephone calls were transferred from one person to another, and they often ended up with a secretary saying that the message would be delivered to the right person. Meanwhile, the patient had to wait for an answer while the GP handled other patients, and the GP could be occupied when the specialist phoned back. Neither GPs nor mental health professionals considered this procedure to be optimal. One GP said:
I can't sit and wait for 15 minutes for a phone call about an acute situation. It's frustrating both for me and the patient. The patient is pending, in and out of the office, sometimes kept an eye on by the police. It's a messy situation.
There were also problems the other way around as physicians on call in the acute ward expressed problems getting in contact with GPs. To establish contact was especially important in the process of discharging a patient, but due to problems getting in touch with GPs this was not prioritised. One physician on call said:
It is not so easy to get in touch with GPs. You end up in line with everyone else.
Both GPs and mental health professionals expressed the need for more ambulatory services, bringing specialised mental health services closer to the patients, GPs and other municipal services. A specific problem with long distances is that some patients find it difficult to travel to premises where specialised mental health treatment is offered. Distances and opportunities to travel were mentioned as factors that increased this problem. This problem was not mentioned by GPs working in the municipality where specialised mental health care was localised, however, reinforcing the impression that localisation and distance do matter. One GP said:
It would be easier if you knew that, for example, every 14
day a specialist in mental health care would come here to meet patients and talk to us.
According to the participants, regular ambulatory services could also give service partners the opportunity to meet each other both in formal situations as an appointment and in informal settings as lunch breaks, and thereby increase mutual knowledge.
Unfamiliarity with existing system and resources
Mental health professionals working in the acute ward expressed concerns with the system for in-house training. The head nurses in the departments had all experienced problems due to lack of training of physicians on call in the acute ward. One head nurse said:
I have experienced standing outside the building, pointing at another building they are supposed to be at.
Physician on call said that an updated telephone list with all available "secret" numbers to GPs existed, but several of them did not know of that list. This reinforces the impression that there are shortcomings in the system for in-house training of physicians on call in the acute psychiatric ward.
Participants revealed their lack of knowledge about possible co-operative partners and other mental health services in their region. Some of the GPs even lacked information about the location of the acute psychiatric ward, and were unfamiliar with the educational level of nurses working in specialised and municipal mental health care. Primary care nurses in the municipalities presumed that a large service system could cause some problems. One primary care nurse said:
There is no lack of professionals to handle the patient, but the clue is to put things in a system where no one falls away.
The participants from primary mental health services expressed a need for meeting places with GPs, and hypothesised that this also could give GPs information on services offered in their municipality. GPs on the other hand expressed a need for consultative services, especially from psychiatrists, because as one GP said:
Almost every time medication is a topic.
Participants in the focus groups also suggested routines and methods like direct cell-phone numbers, updated phone lists and allocated times for telephone consultation in order to reduce the time spent talking to what they regarded as irrelevant people, or waiting for someone to call back.