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A Delphi Study of Problems in Providing Community Care to Patients With Nonpsychotic Chronic Mental Illness

Mr. Koekkoek is affiliated with Brinkveld Outpatient Community Care, Altrecht Mental Health Care, Oude Arnhemseweg 260, 3705 BK Zeist, Netherlands (e-mail: b.koekkoek{at}altrecht.nl). Dr. van Meijel is with the Research Group on Mental Health Nursing, INHOLLAND University for Applied Sciences, Amsterdam. Dr. Schene is with the Department of Psychiatry, Academic Medical Center, University of Amsterdam. Dr. Hutschemaekers is with the Institute for Professionalization, Gelderse Roos Mental Health Care, Wolfheze, and with the Academic Center of Social Sciences, Radboud University, Nijmegen, Netherlands.

OBJECTIVE: The study identified problems that professionals perceive in community care of patients with nonpsychotic chronic mental illness. METHODS: Eight national experts from the Netherlands participated in a four-phase modified Delphi procedure to identify and rate the urgency of problems in patient care and the extent to which problems were amenable to change. RESULTS: A total of 39 problems were identified in five categories: patients, professionals, their interactions, the family and social system, and the mental health system. Participants noted the many social problems of these patients and their unusual help-seeking behavior. They often perceived these patients as able but unwilling to get better. They also noted that their diagnoses tend to be unclear and shifting and that more precise classifications would help in development of treatments. CONCLUSIONS: Elucidating the distinction between the psychiatric symptoms of these patients and their unusual help-seeking behavior may improve diagnosis and patient care.

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